bluuebunny/crossref_metadata_2025 huggingface dataset:
Adding parenteral anticoagulation in STEMI undergoing PCI: safety and efficacy?
Authors: Carias M , Almeida A , Paralta M , Claudio F , Rocha R , Bento A , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Antithrombotic therapy is the cornerstone treatment for acute coronary syndromes. Often, parenteral anticoagulation (AC) is added to the dual antiplatelet treatment, till primary percutaneous coronary intervention (PCI). This strategy is recommended by latest guidelines, due to large experience, however, there has been no placebo-controlled trial evaluating the efficacy or safety of AC in primary PCI.

Purpose

This study aims to evaluate the efficacy and safety of treatment with parenteral AC, either with UFH or with low molecular weight heparin (LMWH), in ST segment elevation myocardial infarction (STEMI), undergoing PCI.

Methods

Retrospective, multicenter, cohort of 1052 STEMI patients, admitted to primary PCI was divided in two groups: one undergoing parenteral AC and one with no AC. We did a sub analyze comparing the group treated with UFH and LMWH, against placebo. The primary efficacy endpoints were in-hospital and one year follow-up mortality, major adverse cardiovascular events (MACE) during hospitalization (re-infarction, mechanical complication, sudden cardiac death averted, ventricular arrhythmia, heart failure, stroke, and cardiogenic shock) and glycoprotein IIaIIIb inhibitor bailout strategy (GPIIaIIIb). The safety endpoints were TIMI major bleeding and decrease of hemoglobin (Hb) value greater than 3g/dL.

Results

Of the total of 1052 patients: 564 (54%) were treated with parenteral anticoagulation and 488 were not. In the anticoagulation sample, 207 patients were treated with UFH (37%), and 357 patients were treated with LMWH (63%). There were no statistically significant differences in both groups, in terms of age and sex distribution, with a 18-26% of women and mean age of 62,8-66,2±0,9 years old.

AC, and LMWH, had a statistically significant association with lower in-hospital mortality (p<0,01), with odds ratio (OR) 0,3 and 0,28 respectively. UFH did not have a statistically significant association with lower mortality (p=0,8). In terms of follow-up mortality, there was no statistically significant association in either group. In terms of MACE and GPIIaIIIb, AC, LMWH and UFH had a statistically significant association with lower MACE and GPIIaIIIB (p<0,01), with a OR 0,9, OR 0,56 and OR 0,77 respectively, on MACE, and with OR 0,1, OR 0,3 and OR 0,2, on GPIIaIIIB.

Regarding safety, neither AC, nor LMWH or UFH, had a statistically significant association with TIMI major bleeding (p=0,24, p=0,2, and p=0,8). LMWH had a statistically significant association with Hb value decrease greater than 3g/dL (p=0,03 RR 6%), that was not verified in AC or UFH samples (p=0,1), against placebo.

Conclusion

Adding AC, in STEMI patients admitted to primary PCI, to the antithrombotic therapy strategy is associated with lower in-hospital mortality, MACE and GPIIaIIIB bailout strategy, without increasing rates of TIMI major bleeding or Hb value decrease greater than 3g/dL.
Impact of telemedicine on treatment of diabetes mellites in patients with cardiovascular Disease during SARS-Cov-2 pandemic
Authors: Nakauchi R , Nishio N , Nishio N , Fujii Y , Fujii Y , Takahashi A , Takahashi A , Yamada T , Taniguchi N , Hata T , Nakajima S , Takahashi Y
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In 2020, the Japanese government issued a new policy to facilitate telemedicine to prevent spread of SARS-Cov-2 infection in outpatient of medical facilities. This policy included consultation via telephone or web and issuing prescriptions directly to pharmacies. However, the patients with diabetes mellites usually have few symptoms. Accordingly, evaluation of control status and medical feedback is difficult on telemedicine basis. We sought to evaluate the impact of telemedicine on the treatment of DM in patients with cardiovascular disease during SARS-Cov-2 Pandemic period.

Method

Between April and Oct 2020, 165 patients with cardiovascular disease having diabetes mellites utilized telemedicine. We retrospectively analyzed indices of patients’ condition and compared them before and after telemedicine. These indices included serum blood sugar, hemoglobin A1c, HDL, LDL cholesterol and triglyceride.

Result

Mean age of the patients was 74.0 ± 9.6 years. Average interval of telemedicine was 6.6 ± 3.4 months. The value of HbA1c before and after telemedicine period was 6.7 ± 0.9 and 7.0 ± 1.2 % respectively (p=0.006). No statistical difference was observed in systolic/diastolic blood pressure, HDL LDL cholesterol and triglyceride during same period.

Conclusion

In telemedicine for the patients with cardiovascular disease, additional caution is needed when patients had concomitant diabetes mellites.
Large health disparities in the performance of the SCORE2 cardiovascular risk prediction model in an ethnic and socioeconomic diverse population
Authors: Kist J , Vos R C , Mairuhu A T A , Struijs J , Peet Van P G , Vos H M M , Os Van H J A , Beishuizen E D , Sijpkens Y W J , Faiq A , Numans M E , Groenwold R H H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Leiden University Medical Centre University Leiden.

Background/introduction

There is much evidence on cardiovascular health disparities in different ethnic and socioeconomic subgroups in (European) populations. Whether ethnicity and socioeconomic status should explicitly be taken into account as predictors in European risk prediction models, on top of traditional risk factors (blood pressure, cholesterol, age and gender), is still considered as a gap in evidence by the 2021 ESC Guideline on cardiovascular disease prevention.

Purpose

To assess the performance of the cardiovascular SCORE2 risk prediction model in ethnic and socioeconomic subgroups.

Methods

External validation of the SCORE2 risk model in a population-based study stratified by ethnicity (country of origin), and socioeconomic status (disposable household income).

Results

In total 6966 cardiovascular disease (CVD) events were observed versus 5495 events predicted by the SCORE2 model. Relative underprediction was the same in men and women (observed/mean predicted (OE-ratio) 1.3 and 1.2 in men and women, respectively). Underprediction was largest in the Surinamese subgroup (OE-ratio 1.9, in both men and women), particularly in the low socioeconomic Surinamese subgroups (OE-ratio 2,5 and 2.1 in men and women, respectively). In Dutch and the combined "other ethnicities", underprediction was observed in low socioeconomic subgroups too: OE-ratio 1.5 and 1.7 in men and women, respectively. Discrimination showed moderate performance in all subgroups, with C-statistics between 0.65 and 0.72, which is similar to discrimination of the SCORE2 model in the development study.

Conclusions

The SCORE 2 CVD risk model for low-risk countries (as the Netherlands are) was found to under predict CVD risk, particularly in low socioeconomic and Surinamese ethnic subgroups. Taking both socioeconomic status and ethnicity into account as predictors in CVD risk models is desirable for adequate CVD risk prediction and counselling.
Gender differences in cardiovascular health over adolescence using the novel Life's Essential 8 score
Authors: Martinez-Gomez J , Fernandez-Alvira J M , De Cos-Gandoy A , Bodega P , De Miguel M , Santos-Beneit G , Beneito-Dura M , Tresserra-Rimbau A , Laveriano-Santos E P , Casas R , Sacanella E , Estruch R , Lamuela-Raventos R M , Fernandez-Jimenez R
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III 2. SHE Foundation and “la Caixa” Foundation.

Background/Introduction

The evidence for gender differences in overall cardiovascular health (CVH) score and individual health metrics over adolescence is conflicting.

Purpose

To study gender differences in overall CVH status and its individual metrics in a large cohort of adolescents aged 12 to 16 years in Spain.

Methods

This study collected longitudinal data from 1324 adolescents at baseline (48.4% girls; 12.5 (0.4) years), 1211 (47.9% girls; 13.9 (0.4) years) at first follow-up and 1095 at second follow-up (48.2% girls; 15.8 (0.4) years) attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain. Eight individual metrics (nicotine exposure, diet, physical activity (PA), sleep health, body mass index (BMI), blood glucose, non-high-density lipoprotein cholesterol, and blood pressure (BP)) were measured and scored from 0 to 100 points according to the Life’s Essential 8 (LE8) criteria established by the American Heart Association. An overall CVH score was constructed summing the metrics described above, ranging from 0 to 100 points. Low, moderate, or high overall CVH score was defined as 0-49, 50-79, or 80-100 points, respectively. Differences in CVH over time were analyzed in individuals with CVH score available at three time-points (n=1077) using generalized linear mixed adjusted models.

Results

At approximately 12 years of age, most individuals had a moderate or high LE8 CVH score and CVH was slightly higher (healthier) in girls than boys (77.2 vs. 76.0 points) (Figure 1). LE8 CVH score increased significantly in boys and girls between 12 and 14 years of age (1.78 and 1.95 points, respectively), without gender differences (Figure 2). LE8 CVH score decreased significantly in boys and girls between 14 and 16 years of age; however, this decline was higher in boys than in girls (-3.17 versus -1.62 points, p value=0.007). Regarding individual metrics, mean scores were lowest for the diet, and sleep health and highest for BP. The highest declines over time were observed in PA, especially in boys, and nicotine exposure, especially in girls.

Conclusions

Most adolescents had a moderate or high overall CVH status, although boys showed slightly unhealthier scores and greater decline over time. Gender differences in individual CVH metrics were also found. This information is helpful for tailoring health promotion programs in adolescence.
Left ventricular Myocardial Work assessment in patients after coronary artery bypass graft during cardiac rehabilitation
Authors: Perone F , Di Stasio F , Caterino L , La Gambina V , Del Villano V , Comenale Pinto S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Myocardial work (MW) is a new tool in the echocardiographic assessment of the left ventricle (LV) performance. Specifically, this method evaluates LV function by incorporating myocardial strain and non-invasive blood pressure. Despite its added value in clinical application, it has not been studied in cardiac rehabilitation setting.

Purpose

The aim of this study is to investigate the change in left ventricle function, through MW, in patients undergoing coronary artery bypass grafting (CABG) before and after cardiac rehabilitation (CR).

Methods

Observational and prospective study that included patients undergoing CABG with indication for a CR program. All patients underwent a baseline evaluation and a transthoracic echocardiography before and after CR. In addition, a six-minute walking test and a Borg scale were also performed.

Results

Forty-one patients were included in the study. Baseline characteristics are shown in Table 1. At baseline, the left ventricle ejection fraction was 55,45%, the global work index was 1502,35 mmHg%, and the six-minute walking test was 57,07 meters. All parameters improved after a CR program at least two weeks. Indeed, the left ventricle ejection fraction was 59,41% (p = 0,025), the global work index was 1855,74 mmHg% (p = 0,0005), and the six-minute walking test was 447,92 meters (p = < 0,0001).

Conclusion

In patients undergoing coronary artery bypass grafting, the CR improves the left ventricle performance and global work index, associated with increased functional capacity.
Left atrium volume is the predominant cardiac dimension related to new-onset atrial fibrillation in the general population
Authors: Lu Z , Tilly M , Van Oortmerssen J , Leening M , Van Walsum T , De Groot N , Bos D , Kavousi M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, with significant sex differences in its epidemiology and etiology. Yet, sex-specific evidence comprehensively assessing the impact of cardiac volumes on AF development is sparse.

Purpose

To examine the association between cardiac volumes with new-onset AF among men and women.

Methods

From the population-based Rotterdam Study, 1021 men and 1179 women (mean age 69 years), free of AF, underwent non-contrast cardiac CT (2003 to 2006) to quantitatively assess cardiac structures in volumes (ml), except for aortic root diameter (expressed in mm). Sex-specific Cox proportional hazards regression models were used to assess the association between CT-assessed cardiac measures and risk of new-onset AF. Cardiac volumes were indexed to body surface area (BSA) and standardized to enable direct comparisons.

Results

After a median follow-up time of 9.1 years, 116 (11.0%) men and 81 (6.9%) women experienced new-onset AF. After adjustments for traditional cardiovascular risk factors, all assessed BSA-indexed cardiac volumes significantly associated with larger risk of AF among both men and women. Adjusted hazard ratios (HRs) per 1-standard deviation (SD) larger BSA-indexed volumes ranged from 1.20 [95% confidence interval (CI): 1.00-1.44] for right atrium to 1.66 (95% CI: 1.40-1.98) for left atrium in men; and ranged from 1.27 (95% CI: 1.01-1.61) for aortic root to 1.88 (95% CI: 1.56-2.27) for left atrium in women. A stronger association was found between right atrium and AF among women (HR; 95% CI: 1.59; 1.29-1.96), compared to men (p<0.01 for interaction). After further adjustment for left atrium, the association of all other cardiac volumes with AF, among both men and women, were no longer significant.

Conclusions

We observed significant associations between various cardiac volumes and increased AF risk, most evidently among women. Findings underscored the predominant role of left atrium size on AF development.
Cardiac Rehabilitation - tackling ventricular remodeling and improving functional capacity
Authors: Martins A , Aguiar-Ricardo I , Alves Da Silva P , Cunha N , Abrantes A , Jordao A , Santos L , Rodrigues M C , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Exercise-based cardiac rehabilitation (CR) is part of the management of patients with established cardiovascular disease. Echocardiography and CPET are used to evaluate cardiac function and cardiorespiratory fitness improvement after such interventions.

Purpose

To analyze the cardiovascular impact of an exercise based CR program on ventricular remodeling and functional capacity.

Methods

Prospective cohort study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psycologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program.

Results

We analysed 349 patients (82% male, mean age 60 ±11,4 years) most of which referred by ischemic heart disease (83%) followed by valvular heart disease (7%). After program completion there was a significant improvement in echo ejection fraction (48,4 ± 12,8% vs 52,07 ± 12,8% Z=-5,036 p<0.001), although other parameters didn’t show the same trend namely left atrial volume and TAPSE. Regarding CPET data, there was a significant improvement in test duration (496,6 ± 158 seconds vs 542,9 ± 147 seconds, p<0.001), in workload (66,2 ± 41,6W vs 123,6 ± 48W, p<0.001), peak VO2 (15,8 ± 4,72mL/(kg.min) vs 16,75 ± 5,17mL/(kg.min) p=0.004) and O2 pulse (11,1 ± 2,8 vs 11,8 ± 2,9; p<0.001). Similar improvements were also seen when analysing pts with reduced ejection fraction regarding ejection fraction, duration of test and workload (p<0.005) but not on peak VO2 (14,4 +- 4,3mL/(kg.min) vs 15,2 +- 4,7mL/(kg.min), p=0.11) or pulse O2.

Conclusions

Exercise based cardiac rehabilitation has a very favorable impact in terms of cardiorespiratory fitness evaluated by several CPET parameters and such impact is also present in high risk individuals with reduced ejection fraction. Advocating for increasing referral of these patients is key to better improve cardiorespiratory capacity.
Respiratory exchange ratio overshoot during exercise recovery: a novel prognostic marker in heart failure
Authors: Vecchiato M , Zanardo E , Borasio N , Quinto G , Battista F , Ermolao A , Neunhaeuserer D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In recent years considerable new evidence has been added on the analysis of the recovery phase in patients with heart failure. Transient increases (overshoot) in respiratory gas variables have been observed during exercise recovery, but their clinical significance is not clearly understood. Respiratory Exchange Ratio (RER) at peak exercise (RER peak) is an objective index of exercise intensity. The overshoot phenomenon of the RER is commonly observed during recovery from maximal cardiopulmonary exercise testing (CPET) but initial studies have found a decreased RER-magnitude in patients with heart failure with reduced ejection fraction (HFrEF).

Purpose

To characterize the functional and prognostic significance of RER recovery kinetics in individuals with HFrEF.

Methods

This cross-sectional study included all patients with HFrEF who underwent functional evaluation with maximal CPET for the heart transplant checklist at the Sports and Exercise Medicine Division of the Padova University Hospital between January 2018 and December 2021. The presence of overshoot phenomena of different respiratory gas indices was evaluated during the recovery phase, focusing on the RER. The RER behaviour has been evaluated assessing the maximal value during recovery phase (RER max) and the magnitude of the RER overshoot (RER mag).

Results

164 patients with HFrEF and 128 controls were included in the study. RER recovery parameters were significantly lower in patients with HFrEF compared to healthy subjects. The RER overshoot showed significant correlations with prognostically relevant CPET parameters and these RER metrics were significantly higher in patients presenting better ventilatory and Weber classes. 24 patients with HFrEF did not present a RER overshoot showing worse cardiorespiratory fitness and efficiency compared to patients with overshoot. Mean follow-up period was 2.57 years during which there were 55 first major cardiovascular events, 22 deaths, 21 heart transplants, and 9 ventricular assist device implantations. The absence of RER overshoot predicted major adverse cardiac events- and transplant-free survival in univariate and multivariate Cox regression analysis.

Conclusions

RER overshoot represents a new index to monitor respiratory gas kinetics during the recovery phase, since it is a feasible and reproducible parameter for clinical practice. A reduced overshoot or its absence are significantly associated with functional impairment, cardiorespiratory inefficiency and worse prognosis. Thus, the evaluation of the respiratory gas indices during recovery from maximal CPET should be included in routine test interpretation, particularly for patients with HFrEF.
Incentives for physical activity in cardiac patients in Germany: pre-trial health economic modelling
Authors: Mohebbi D , Ogurtsova K , Dyczmons J , Dintsios C M , Kairies Schwarz N , Icks A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Düsseldorf

Cardiovascular disease (CVD) is the most prevalent non-communicable disease and the leading cause of death globally. Evidence suggests that exercise-based interventions in secondary prevention can mitigate adverse health events. Implementing incentive schemes for patients to engage in physical activity (PA) might be a promising approach to improve adherence. The INPHY trial, a complex intervention that is currently being developed at the University Hospital Düsseldorf, aims at improving PA in people with coronary heart disease (CHD) using monetary and social incentives. The UK Medical Research Council (MRC) framework for the development and evaluation of complex interventions recommends pre-trial health economic modelling to inform the design of the trial.

A decision-analytic Markov model was developed to evaluate the costs and benefits of exercise-based, incentivized secondary prevention interventions from a health services provider. A cohort of individuals with a history of myocardial infarction was followed in the model from age 65 years through a total of 25 1-year Markov cycles. Primary outcomes included costs, quality-adjusted life-years (QALY) gained and incremental cost-effectiveness ratios (ICERs). Sensitivity and scenario analyses were performed to reflect parameter and model uncertainty.

In the base-case, the incremental QALYs gained from the monetary and social incentives, relative to control, were respectively estimated at 0.01 [95% CI 0.00-0.01] and 0.03 [95% CI 0.02-0.05]. In comparison to control, the implementation of the monetary and social incentive interventions increased the costs by 795€ [95% CI 697-884] and 831€ [95% CI 593-1,191], respectively. ICERs were 24,473€ [95% CI 15,871-38,868] and 112,015€ [95% CI 81,140-169,888] per QALY gained for the social and monetary incentive interventions, respectively. At a per-capita gross domestic product threshold (GDP) of 43,000€/QALY for Germany, the probability that the social and monetary incentive intervention would be seen as cost effective was 100% and 0%, respectively.

Exercise-based secondary prevention using incentivized reinforcement schemes might offer a cost-effective strategy to reduce the burden of CHD, offering good value for money in preventing a significant non-communicable disease. Translation of these findings into policy and practice alongside rigorous monitoring and evaluation is important. More epidemiological research from Germany is recommended to reduce the remaining model uncertainty surrounding this decision.
Coronary calcium score (CAC) appears to be independent of lipid profile in treated patients with Heterozygous Familial Hypercholesterolaemia
Authors: Haggag A , Jumdally R U M I , Moustafa I B R A H I , Madani D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery calcium (CAC) score has been shown to improve the risk stratification and prediction of Atherosclerotic Cardiovascular Disease (ASCVD) in cohorts of patients with Heterozygous Familial Hypercholesterolaemia (FH) [i].

Objectives

We sought to examine the CAC score in patients with FH who are on treatment and correlate to the therapy, Total Cholesterol (TC), Low Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) levels.

Method

Retrospective Analysis of patients with established diagnosis of FH from a specialist lipid clinic who underwent CAC for risk stratification.

Results

The study included 64 patients, of which 33 patients (52%) were males with an average age of 57.4 years. At diagnosis, the mean elevated TC level was 7.40 ±1.60 mmol/l.

37 patients (58%) were on statin, (7 patients were on Rosuvastatin 20 mg, 20 patients were on Atorvastatin 40 mg, 8 patients were on Atorvastatin 20 mg, 2 patients were on Atorvastatin 80 mg), 8 patients (12%) were on a combination of PCSK9 and statins, 3 patients (5%) were on fibrates (fenofibrates) 160 mg, 3 patients (5%) were on Ezetimibe 10 mg, 4 patients (6%) were on Bempedoic Acid 180 mg, 9 patients (15%) were on lifestyle modifications and did not prefer to start on any lipid lowering agents.

71% of patients with TC level of 7.29 ±1.87 mmol/l had a calcium score of less than 100. CAC of >100 was observed in 29% of patients with a TC level of 7.44 ±1.50 mmol/l. (p value of 0.741)

CAC score >100 appeared independent of (A) LDL level (27% with a mean LDL level of 4.81±1.81 mmol/l versus 73% with a CAC <100 and a mean LDL level of 4.40 ±1.38mmol/l) (p value of 0.424) and of HDL level (29% of patients with a mean HDL level of 1.45 ±0.64mmol/l versus 71% with a CAC score< 100 with a mean HDL level of 1.44 ±0.61mmol/l) (p value of 0.768).

Despite therapy, 45 patients (27 %) had high LDL level with a mean LDL level of 4.5 ±1.50mmol/l though we found no difference in CAC score between the two groups (p value of 0.424).

Conclusion

In a single centre retrospective analysis of patients with Heterozygous Familial Hypercholesterolaemia on therapy, there appears to be no correlation between the CAC score of more than 100 and baseline therapy, Total Cholesterol, LDL or HDL levels achieved. We postulate that more stringent LDL reduction to ~1.4mmol/l should be adopted with further analysis of Coronary calcium score in the long term.
Some results are striking - what about lung function in adults with congenital heart disease?
Authors: Hock J , Bessar M , Dalla Pozza R , Ewert P , Hager A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Stiftung KinderHerz Weserstr. 101 45136 Essen.

Background

During the last years, lung function tests became of high interest in patients with a congenital heart defect (CHD). However, data are still rare and mostly concentrate on spirometry, investigating forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and its ratio (FEV1/FVC).

Purpose

This study prospectively examined patients with CHD regarding their lung function. Data reported were FVC, FEV1, and FEV1/FVC (spirometry) as well as total lung capacity (TLC) and residual volume, presented as its ratio to TLC (RV/TLC) and compared to the latest Global Lung Initiative reference values (2021).

Methods

From April 2018 to October 2022, one hundred eighty-six adults with CHD (32 ± 10 years, 83 female) participated in the study. Their results (z-scores) were compared with the student’s T-test against zero.

Results

Patients mostly reached normal values but differed significantly in FVC-z (-1.1 ± 1.2, p<0.001), FEV1-z (-1.2 ± 1.2, p<0.001), its ratio (FEV1/FVC-z: -0.3 ± 1.0, p<0.001), TLC-z (-0.6 ± 1.2, p<0.001) and RV/TLC-z (1.1 ± 0.9, p<0.001). However, with the border of z>-1.645 as normal results, 33% had striking results: 43 showed a reduced FVC (FVC-z<-1.645), and 10 an obstructive pattern (FEV1/FVC<-1.645). Out of the patients with reduced FVC, 17 patients (40%) had a normal TLC (TLC-z>-1,645), which stands for a non-specific pattern, and 26 patients (60%) had a real restriction, which was only detected via body plethysmography.

Conclusions

Patients with CHD and a reduced FVC in spirometry need to undergo body plethysmography. Most of them have unrevealed ventilatory restrictions that should be further analyzed and treated if needed.
Pilot study: The LIPL-PLATELET study postprandial LIPid paneLs and PLATELET activity in coronary heart disease after treatment with PCSK9-inhibitors
Authors: Pogran E , Ahmed A A , Burger A B , Kaufmann C K , Rega-Kaun G R , Fasching P F , Huebl W H , Huber K H
Published: May 2023

Funding Acknowledgements

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

Reports about a pleiotropic potential of pro-protein convertase subtilisin/kexin type 9 inhibitor are scarce. This hypothesis-generating study investigates the platelet reactivity after standardized oral fat tolerance testing (OFTT) under an optimized lipid-lowering therapy (statin plus ezetimibe) alone and during the add-on treatment with the alirocumab.

We investigated ten patients with the chronic coronary syndrome (CCS). Lipid variables and markers of platelet function were assessed during the fasting state and 3 and 5 hours after OFTT using a milkshake with 90g of fat. Measurements were performed in the same CCS patients under dual lipid-lowering therapy (DLLT) alone and after three months of add-on therapy with alirocumab.

Postprandial inflammatory reaction did not change, irrespective of alirocumab. Neutrophile to lymphocyte ratio increased during the OFTT more significantly when on dual lipid-lowering therapy (p=0.021). The multiplate electrode aggregometry test with ASPI reagents (p=0.037) showed a paradoxically higher platelet reactivity five hours after OFTT with the addition of alirocumab compared to the DLLT only. Platelet reactivity remained unchanged during OFTT in CCS patients before or after alirocumab therapy.

Altogether, alirocumab showed a trend of decreased postprandial inflammation and an increase in platelet reactivity.
Cardiac rehabilitation using a virtual trainer in patients with heart failure
Authors: Lacraru A , Busnatu S , Pana M A , Andrei C L , Sinescu C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): European Union’s Horizon 2020.

Background/Introduction

According to WHO cardiovascular diseases (CVDs) are the leading cause of mortality. Heart attacks and strokes account for more than four out of every five CVD fatalities. Early identification of patients at risk to developing cardiovascular diseases and prompt initiation of appropiate treatment can prevent premature deaths. After a patient overcomes an acute cardiovascular event, he is referred for rehabilitation to help him restore most of his normal cardiac functions.

Purpose

This study is part of a European project called vCare (Virtual Coaching Activities for Rehabilitation in Elderly), which aimed to test a rehabilitation program carried out by patients at home with the help of a virtual coach. In Romania, we evaluated the effectiveness of the cardiac rehabilitation program using the vCare system in reducing cardiovascular risk and improving quality of life in patients with heart failure (HF).

Methods

We conducted a prospective interventional pilot study in which we enrolled a total of 30 patients with HF who were divided into 3 groups: 10 patients in the experimental group (EG), 10 patients in ambulatory group (AG) and another 10 in the control group (CG). The follow-up period lasted 3 months.

The patients in the EG performed cardiac rehabilitation (CR) at home using vCare app, patients in the AG underwent conventional CR at Bagdasar Arseni Hospital and those in the CG only received advice at discharge to perform regular physical activity at home and reduced cardiovascular risk factors.

At the time of inclusion (time 0) all patients were clinically examined, blood tests and echocardiography were performed and also ECG exercices test for the assessment of exercices capacity and personalization of the CR program in the case of those from EG and AG. Furthermore they filled out several questionnaires (Minnesota, HADS scale, Fagerstrom). At the end of the rehabilitation program (time 1) all patients were reassessed in the same way as at enrollment.

Results

Patients with HF in EG had an increase in quality of life by up to 30% from time 0 to time 1, in exercices capacity by 4% and a significant decrease in cardiovascular risk factors was identified. Similar data were observed in patients from the AG, while in patients from the CG, a decrease in exercices capacity and a worsening of anxiety and depression were found.

Conclusions

Patients with HF who perform cardiac rehabilitation using vCare system had similar results compared to the AG and better results compared to CG, especially in terms of quality of life and their activities of daily life.

This kind of cardiac rehabilitation can represent a safe and efficient solution for ensuring continuity of medical care and access to personalized motor treatments for patients with cardiological disease.
SPREAD multicentre study: sports practice and its effect on bicuspid aortic valve disease
Authors: D'ascenzi F , Cavigli L , Claessen G , Van Craenenbroeck E , Cavarretta E , D'andrea A , Sanz De La Garza M , Eijsvogels T , Halle M , Andreini D , Moreo A , Schreurs B , Sitges M , Stefani L , Pelliccia A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Bicuspid aortic valve (BAV) is the most common congenital cardiac condition among the general population and competitive athletes. BAV could be associated with progressive aortic dilatation, stenosis and/or regurgitation. There are concerns about the possible detrimental effects of exercise training on aortic size and valve function due to the hemodynamic stress on the aorta during exercise. However, data in the literature are scarce and sometimes discordant.

Objectives

This multicenter study aimed to analyze the influence of sport on aortic size and valve function in BAV patients.

Methods

Three groups were analyzed: competitive athletes with BAV, athletes with tricuspid aortic valve (TAV) and sedentary controls with BAV, age- and sex-matched. We assessed the morphology and degree of aortic valve stenosis, regurgitation, aortic dimension, and left ventricular (LV) characteristics by 2D echocardiography. Individuals with moderate-severe stenosis and regurgitation or relevant aortic dilation (> 45 mm (men) or >41 mm (women) were excluded from the study.

Results

The study population was composed of 500 subjects:184 BAV athletes (84% males; mean age 30±11 years), 191 TAV athletes (82% males; mean age 30±11 years), 125 BAV sedentary controls (82% males; mean age 34±10 years). The aortic annulus was greater in BAV athletes (25.0±3.6 mm) than in TAV athletes (21.7±2.9 mm) and BAV controls (23.9±3.6 mm), p<0.005. Sinuses of Valsalva, sinotubular junction and ascending aorta diameters were smaller in TAV athletes than in BAV subjects (<0.005), but there were no significant differences between BAV athletes and BAV controls. LV index volumes and mass were greater in BAV athletes than in the other two groups (p<0.005). Moreover, BAV athletes showed higher gradients than sedentary controls (p<0.005).

Conclusions

This multicenter study demonstrated that athletes with BAV have larger aortic diameters than athletes with TAV. However, no differences between BAV athletes and sedentary controls were observed, suggesting that exercise training does not significantly affect aortic dilation, with the exception of aortic annulus. Conversely, sports practice negatively influenced valve function in BAV athletes. Valvular dysfunction seems to affect the LV geometry, with a trend for being more dilated and hypertrophic in BAV athletes than in the other groups.
Performance of the Systematic COronary Risk Evaluation 2 (SCORE2) in the EPIC-Norfolk prospective population study
Authors: Van Trier T , Snaterse M , Boekholdt M , Scholte Op Reimer W J M , Visseren F L J , Hageman S H J , Dorresteijn J A N , Wareham N J , Peters R J G , Jorstad H T
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): EPIC-Norfolk is supported by programme grants from the Medical Research Council UK (MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (CRUK 8257).

Introduction

The latest European guidelines recommend the use of the Systematic COronary Risk Evaluation 2 (SCORE2) to assess 10-year risk of fatal and non-fatal cardiovascular disease (CVD) in individuals aged 40-70 years. Therefore, validation of the SCORE2 algorithm in a large population is needed.

Purpose

To assess the predictive performance of SCORE2 in individuals without prior myocardial infarction, stroke or diabetes mellitus.

Methods

Individuals aged 40-70 without prior myocardial infarction, stroke or diabetes mellitus were included from the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. We assessed discriminative power using the C-statistic; calibration was assessed by plotting calculated SCORE2 (low-risk algorithm) 10-year risks against observed CVD event rates. We defined the composite cardiovascular outcome as death due to ischemic heart disease, cardiac failure, cerebrovascular disease or peripheral-artery disease, or non-fatal myocardial infarction or non-fatal stroke. Observed probabilities were adjusted for competing mortality events.

Results

We included 20,318 individuals (56% women) with a median (IQR) age of 56 (50-63) years, with baseline measures between 1993-1997. Mean predicted 10-year risk was 3.7% (95% confidence interval (CI) 3.7-3.8) versus adjusted observed 4.2% (95% CI 3.9-4.5) 10-year CVD incidence, yielding a ratio of 1.1 (95% CI 1.1-1.2).(Figure) Observed events consisted of 1.5% (95% CI 1.3-1.7) fatal CVD events, 1.8% (95% CI 1.6-2.0) non-fatal myocardial infarctions, 1.5% (95% CI 1.3-1.6) non-fatal strokes and 23.4% (95% CI 22.1-23.2) competing mortality events. Overall C-statistic was 0.75 (95% CI 0.73-0.77).

Conclusion

SCORE2 demonstrates reasonable discriminative ability and accurate risk estimations in low-risk individuals in a large, prospective population cohort. However, as actual CVD incidence is expected to be lower given the baseline between 1993-1997, these findings do not indicate that SCORE2 is suitable for current use for risk assessment in individuals from the United Kingdom.
The role of tele-rehabilitation in post-myocardial infarction populations during the covid-19 pandemic in a tertiary care centre
Authors: Kyaw K K K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The role of teleconsultation has been highly valued for health care professionals in cardiovascular field in recent years as the ongoing Covid-19 pandemic has affected the face-to-face patient visits to specialist heart centres. Moreover, the cardiac rehabilitation is the key element of post-coronary care, and the role of remote real-time tele-rehabilitation would play a promising future for post-myocardial ischaemia patient populations during the covid-19 crisis. (1)

Purpose

Our primary aim was to study the role of tele-rehabilitation on long-term patient safety and positive compliance rates. Further objectives were to understand the reasons for patient satisfaction following remote consultation.

Methods

A total of 50 patients were enrolled into cardiac rehabilitation clinics from 1st April 2022 to 31st October 2022. Out of them,40 attended virtual tele-rehabilitation service due to ongoing covid-19 pandemic. The study questionnaire was created upon the level of perception of patient satisfaction in three domains, including easy access to remote consultations, positive compliance and quality of overall teleconsultation especially the voice quality, and delivery of exercise regimes with remote control. A final survey of patient satisfaction was recorded from the day patients receiving the first virtual appointment up to next 6 weeks remote consultations.

Results

It was found that 32 out of 40 patients (80%) received a positive response upon overall virtual consultations and tele-rehabilitation services. In 8 (20%) of the 40 patients who did not meet the level of satisfaction, the main reasons were lack of clear instructions among exercise regimes and poor explanation of patient concerns during the remote tele-rehabilitation sessions. However, we identified the main reasons for which positive satisfaction in virtual rehabilitation sessions, and these revealed reduced patient waiting times, avoidance of infection risks in vulnerable post-coronary intervention patient groups and flexible accessibility for varieties of cardiac tele-rehabilitation sessions during the ongoing covid-19 crisis. (3)

Conclusion

The implementation of remote real-time consultations in cardiac rehabilitation services has led to significant improvement in patient quality of care especially reduced patient waiting times, and cost-effectiveness due to flexible opportunities for tele-exercise sessions. Moreover, it can provide speedy, focused interaction on specific issues of care during the post-coronary rehabilitation periods, often circumventing the need for patient travel. (2)
Technology assisted physical activity among hospitalised medical patients a cluster randomised clinical trial
Authors: Dall C , Gunnarsson D , Andersen H , Pedersen L , Suetta C , Prescott E , Henriksen M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Bispebjeg University Hospital (public hospital) Danish Physiotherapy Foundation.

Background

To investigate whether patients, with independent basic mobility, admitted to medical wards, by simple feedback on physical activity (the integration of accelerometer measurements and tablet feedback) can be nudged to increase the level of activity during hospitalization.

The aim is to investigate if medical patients with intact basic mobility, can increase the level of physical activity by simple feedback from a new technology solution.

Methods

Design: A cluster randomised clinical trial. Primary outcome: time spend out of bed (min/day). Power calculation: 320 patients.

All included patients had their physical activity level measured. The intervention group received feedback by an app on a tablet. The patients participated for a minimum of 24 hours and up to 7 days. Inclusion of patients from the Department of Carardiology, Geriatric Department and Department of Pulmonary and Infectious disease. Primary efficacy measure: Time out of bed (min).

Results

354 patients were included. Difference between those who received feedback (intervention) and those without feedback (control) was 23.6 min/day more out of bed (95%CI 13.75 – 33.50); P = <.0001.

Conclusion

Patients admitted to medical wards, with independent basic mobility, were on average 23.6 minutes more physically active per day (21%) when they received feedback about their physical activity.

Implication

This technological solution with feedback can be a tool to nudge the patients with independent basic mobility to stay physically active during hospitalization. The solution may also allocate resources for those patients who have a greater need for help and support for mobilization.
Apnea-Hypopnea Index an indicator of increased right cardiac preassures
Authors: Fringu F , Sturz C , Tomoaia R , Zdrenghea D , Horvat D , Caloian B , Comsa H , Rosu R , Cismaru G , Gusetu G , Gurzau D , Ursu M , Simu G , Ivan S , Pop D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obstructive sleep apnea (OSA) is a disorder frequently associated with clinical conditions and complications such as refractory hypertension, atrial fibrillation, nocturnal angina, dysrhythmias, congestive heart failure and stroke.

Polysomnography is the gold standard test required to diagnose OSA, along with a targeted history and comprehensive examination of the patient. It involves the recording of various physiologic variables during sleep. Sleep related obstructive events may be measured using two indices: the apnea-hypopnea index (AHI) and the respiratory disturbance index, an AHI≥15 being diagnostic for OSA.

The aim of this study was to determine the interaction between sleep apnea and demographic or echocardiographic markers.

Material and methods

This was a prospective study that included 33 patients with sleep apnea. Polysomnography was performed using a VitalNight cardiorespiratory polygraph to determine the apnea hypopnea index (AHI) and echocardiography was performed using a Vivid E95 scanner to determine the left ventricular ejection fraction (LVEF), the peak systolic right ventricular to right atrial pressure gradient (Gmax) and the right ventricular diameter and function (TAPSE and s’).

Results

The mean age of the patients was of 63±8 years and 14 patients (42%) had a Gmax>25mmHg. Regarding cardiovascular risk factors, 31 patients (94%) had arterial hypertension and 26 (79%) were smokers. Out of all patients, 25 (76%) had an appropriate echocardiographic acoustic window. The patients had mean values of AHI of 45±19. Mean values for the LVEF, Gmax, TAPSE and s’ were 53 ± 11%, 25± 14 m/s, 22 ± 4 mm, and 14 ± 3 cm/s, respectively. AHI showed moderate correlations to age (r=0.27), cervical perimeter (r=0.38) and BMI (r=0.30), but also to echocardiographic parameters as LVEF (r=0.29), Gmax (r=0.42), RV diameter (r=0.39), TAPSE (r=0.38) and s’ (r=0.34). ROC curves were determined to calculate the value of AHI to predict a Gmax >25 mmHg. A significant Gmax, as an indicator for increased right cardiac pressures, was predicted with a high sensitivity (86%) and specificity (84%) by a value of AHI > 45 (AUC=0.81, 95%CI = 0.64-0.927, p<0.001).

Conclusion

In conclusion the study demonstrated that smoking and hypertension are important risk factors in patients with sleep apnea syndrome. There was a significant correlation between AHI and echocardiographic parameters of the right heart. AHI can be used as a predictor of increased right cardiac preassure when the value is above 45.
Obesity in heart failure with preserved ejection fraction with and without diabetes: risk factor or innocent bystander?
Authors: Prausmüller Suriya , Weidenhammer Annika , Heitzinger Gregor , Spinka Georg , Goliasch Georg , Arfsten Henrike , Abdel Mawgoud Ramy , Gabler Cornelia , Strunk Guido , Hengstenberg Christian , Hülsmann Martin , Bartko Philipp E , Pavo Noemi
Published: May 2023

Aims

Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM.

Methods and results

This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM, and survival was assessed. A total of 6744 individuals with HFpEF were included, of which 1702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4 kg/m2 vs. 27.1 kg/m2, P < 0.001), higher N-terminal pro-brain natriuretic peptide values (864 mg/dL vs. 724 mg/dL, P < 0.001), and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1–Q3: 20–80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared with those without T2DM, with a mortality rate of 39.2% and 26.7%, respectively (P < 0.001). In the overall cohort, using the BMI category 22.5–24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5 kg/m2 [HR: 1.27 (confidence interval 1.09–1.48), P = 0.003] and decreased in BMI categories ≥25 kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM.

Conclusion

Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with a greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI–based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.