bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial stiffness in adolescence predicts elevated blood pressure in young adulthood: the ALSPAC study
Authors: Agbaje A O , Barker A R , Tuomainen T P
Published: October 2021

Background

The American Heart Association's scientific statement on the importance of arterial stiffness recommended that future studies investigate whether increasing arterial stiffness with advancing age results from the age-associated increase in systolic blood pressure (BP). The statement also recommended investigating the natural history of arterial stiffness and BP vis-à-vis the rate at which arterial stiffness and BP increase with age. These questions remain largely unanswered in a population sample of apparently healthy adolescence and young adults.

Purpose

To investigate whether carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, during adolescence predicts increased systolic and diastolic blood pressure in young adulthood.

Methods

We studied 3862 British (56% females) participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, Bristol, UK. cfPWV was measured by Vicorder device ultrasound scan, total fat mass and lean mass were measured by dual-energy Xray absorptiometry, and systolic and diastolic BP by Omron BP/pulse monitor. We conducted multivariable linear regression analyses and adjusted for baseline covariates such as age, sex, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, high sensitivity C-reactive protein, fasting blood glucose, fasting insulin concentration, heart rate, moderate to vigorous physical activity, smoking status, family history of cardiometabolic diseases, total fat mass, lean mass and systolic or diastolic BP depending on the outcome. All variables were measured both at age 17.7 and 24.5 years.

Results

Participants mean (SD) age in years at different time points were [17.72 (0.33) and 24.54 (0.73)]. Over a 7-year follow-up period, cfPWV was directly and independently associated with systolic BP [β = 10.762 (CI: 3.107 to 18.417); p=0.006] and diastolic BP [19.535 (12.879 to 26.191); p<0.0001].

Conclusion

Our findings showed that increasing arterial stiffness independently predicts higher systolic and diastolic BP with advancing age. Besides, a 0.1 m/s increase in arterial stiffness at age 17.7 years may result in a 1 mmHg increase in systolic BP and a 2 mmHg increase in diastolic BP seven years later. Therefore, public health effort should be targeted at preventing or reducing arterial stiffness during adolescence in order to decrease the risk of elevated BP in later life.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Jenny and Antti Wihuri Foundation and the Finnish Cultural Foundation
Features of gene polymorphism in comorbid patients with arterial hypertension and coronary heart disease
Authors: Drobotya N V , Shlyk S V , Khaisheva L A , Aruyunyan L V , Pirozhenko A A
Published: October 2021

The problem of cardiovascular comorbidity becomes particularly relevant in the context of a pandemic, since it is known that cardiovascular diseases (especially arterial hypertension – AH and coronary heart disease – CHD) significantly increase the frequency of hospitalizations and fatal outcomes in patients with COVID-19. From these positions, it is fundamentally important to identify a group of individuals with a high prognostic probability of developing combined cardiovascular pathology in the cohort of patients with hypertension.

There is a hypothesis about the genetic relationship between different diseases, which helps to identify their common genetic variants, which in turn makes it possible to determine new loci of susceptibility for each of the comorbid conditions. Recent data indicate the feasibility of developing this problem from the standpoint of genetic polymorphism.

Material and methods

The work is based on the results of a comprehensive examination of 100 patients with AH. A molecular genetic study to determine the main variants of gene polymorphism was performed on a DT 96 amplifier manufactured by DNA Technology (Russia). The method for determining the variants of gene polymorphism was a polymerase chain reaction with real-time detection of the results.

Results

All patients included in the study were divided into 2 groups: patients with AH without CHD – 62% (62 people) and patients with AH with CHD – 38% (38 people). The relationships of polymorphism of 9 main variants of genes involved in the pathogenesis of isolated AH and in combination with CHD were studied. When analyzing the frequency of the studied genes in patients with hypertension with and without CHD, statistically significant differences were obtained for the NOS3 T-786C polymorphic gene, which was significantly more common in comorbid patients. Patients with a combination of AH and CHD are characterized by the presence of the CC genotype and the C allele of the VOS3 gene (p=0.040 and p=0.035), while the TT genotype of the T-786C polymorphic marker of the NOS3 gene is characteristic of patients with isolated AH. It should be noted that the carrier of the “mutant” allele C of the T-786C polymorphism of the NO3S gene, according to our calculated statistical data, increases the risk of CHD in patients with hypertension by 5 times (OR=5.242, p=0.035).

Conclusion

The study of the genetic aspects of comorbidity is theoretically important for understanding the mechanisms of its formation. From a practical point of view, it is valuable to use modern genetic approaches for early detection of a prognostically unfavorable category of AH patients with a high risk of comorbid pathology developing.

Funding Acknowledgement

Type of funding sources: None.
Predictors of antihypertensive efficiency of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus
Authors: Manukyan M , Falkovskaya A , Mordovin V , Zyubanova I , Tsoi E , Ryabova T , Pekarskiy S
Published: October 2021

Background

Currently, one of the actively studied interventional methods for the treatment of resistant hypertension (RHTN) is renal denervation (RDN). Despite the safety of the procedure and the long-lasting antihypertensive effect, a significant decrease in systolic blood pressure (SBP) ≥10 mmHg is observed only in 60–80% of patients. According to the Global SYMPLICITY Registry (GSR) study, patients with diabetes mellitus could benefit from lower blood pressure after renal denervation due to initially higher sympathetic activity. The indicators associated with the processes of sympathetic hyperactivation include impaired diastolic function and total peripheral resistance (TPR), reflecting the resistance of arterioles (resistive vessels) to blood flow.

Purpose

To identify predictors of the antihypertensive efficacy of renal denervation in patients with RHTN and type 2 diabetes mellitus (DM) based on the results of a six-month follow-up.

Methods

The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4±6,4 years, 14 men, mean 24-hour (24-hr) blood pressure (BP) (systolic/diastolic) 158,6±15,2/79,8±12,7 mmHg, mean HbA1c 7,2±1,2%). The prospective interventional study with renal denervation (NCT02667912 and NCT01499810 at ClinicalTrial.gov) enrolled 30 patients. Office BP and ABPM, diastolic function and TPR assessment were performed in all patients at baseline and 6 months after RDN. 29 patients completed 6-month follow-up.

Results

RDN led to a significant reduction in systolic and diastolic 24-hr BP (−10.9/−5.7 mmHg, p=0.002/0.003). Depending on the degree of decrease in 24-hr systolic BP, the patients were retrospectively divided into 2 groups: “responders” (persons with a decrease in 24-hr SBP by 10 or more mmHg) and “non-responders” (with a lesser degree of decrease in 24-hr SBP). The proportion of respondents to the intervention was 48.3%. Initially, the group of “responders” differed from the group of “non-responders” by higher average E/e' values (15.1 and 11.9, respectively, p=0.049) and TPR indicators (2.39±0.45 and 1.93±0.35 dyn s cm–5, respectively, p=0.003). These indicators were included in a logistic model to predict the antihypertensive efficacy of renal denervation. The sensitivity was 78.6% (11 correct predictions out of 14 cases), specificity – 80% (12 correct predictions out of 15 cases), (p=0.020).

Conclusion

Estimation of the total peripheral resistance and the average ratio E/e' allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research
Premature atherosclerotic cardiovascular disease: association of clinical factors with form of atherosclerosis onset
Authors: Rogozhina A A , Averkova A O , Zubova E A , Minushkina L O , Chichkova M A , Khasanov N R , Kosmacheva E D , Boeva O I , Zateyshchikov D A
Published: October 2021

Background

The cardiovascular death rate significantly declined last decades. But premature atherosclerosis burden remains an unresolved problem.

Purpose

The study aimed to assess the association of clinical factors with types of premature atherosclerosis onset.

Methods

Date of 702 patients (pts) (523 men and 179 women) with premature atherosclerosis (men ≤55 (48.6±6.2), women ≤60 (52.7±7.0) years of age) were analyzed with decision tree method using SPSS 23.0 program with the Python GUI module. Clinical and instrumental variables (n=109) were used. The test sample was formed by the cross-validation method.

Results

Myocardial infarction at the onset of atherosclerosis (n=542, 77.2%) was associated with the presence of peripheral atherosclerosis (1st order node, p<0.0001, F=93.174). The 2nd order node was a uric acid level (p<0.0001, F=26.493) in pts without peripheral atherosclerosis. In pts with uric acid level, less than 225 mmol/L-the left ventricle posterior wall thickness more than 10 mm was a 3d order node (p<0.0001, F=30.143). Area under the ROC-curve 0.916, p=0.011. Multivessel lesion according to coronary angiography data (102 patients) was associated with family history of cardiovascular disease (p=0.001, F=13.238), the area under the ROC-curve was 0.667, p=0.041. For pts. with peripheral atherosclerosis (n=66, 9,4%) the aortic root diameter obtained by an echo was the 1st order node (p<0.0001, F=36.057). In pts with aortic root diameter over 27 mm, a 2nd order node was creatinine level above 90 mmol/L (p=0.036, F=9.945) and in pts with a smaller diameter of aortic root was the history of hypertension emergency (p=0.001, F=13.897). Area under the ROC-curve 0.676, p=0.02. For pts. with ischemic stroke (n=26, 3,7%) as atherosclerosis onset 1st order node was brachiocephalic atherosclerosis lesion (p<0.0001, F=30.259). Among them, untarget BP level was 2nd order node (p=0.033, F=4.958). For pts without atherosclerosis age over 46.7 yrs was a 2nd order node (p<0.0001, F=24.515), and for pts younger than 46.7 yrs admission glucose higher than 11.06 mmol/L was a 3rd order node (p=0.026, F=12.382). This model had high predictive accuracy (area under the ROC-curve 0.963, p<0.0001).

Conclusion

Thus multiple clinical variants of premature atherosclerotic cardiovascular disease onset appeal to develop an individualized approach to early diagnosis and management of this kind of patient.

Funding Acknowledgement

Type of funding sources: None.
Effect of revascularization on exercise-induced changes in cardiac and pro-thrombotic biomarkers in patients with coronary artery disease
Authors: Hansen C H , Cwikiel J , Bratseth V , Arnesen H , Flaa A , Seljeflot I
Published: October 2021

Introduction

Exercise-induced increase in cardiac and pro-thrombotic biomarkers have previously been shown in patients with coronary artery disease (CAD) before revascularization, which may be due to myocardial ischemia.

Purpose

We aimed to examine whether resting levels and exercise-induced changes of high sensitive cardiac Troponin T (cTnT), NT-proBNP, pro-thrombin fragment (F) 1+2, D-dimer, tissue factor pathway inhibitor (TFPI) and endogenous thrombin potential (ETP) were affected by revascularization in patients with CAD. We hypothesized that resting and exercise-induced levels of the biomarkers would be reduced after revascularization.

Methods

Patients presenting with symptoms of CAD were included. A maximal exercise ECG stress test (EST) (EST1) was performed, and venous blood samples were drawn at rest and within five min after termination. All patients underwent coronary angiography. Patients (n=20) with confirmed CAD, fully revascularized with percutaneous coronary intervention (PCI) and without symptoms of angina, were invited to perform a second EST (EST2), at the same workload (median 145W), at a median of 66 days after revascularization. Mean exercise duration at both time points were 11:30 min:sec. Of the total population 15 patients were treated with PCI on stenosis located on LAD and 5 patients with stenosis on RCA.

Results

Significant increase in cTnT and NT-proBNP from resting to post exercise levels at EST1 was found as expected (p<0.001, both). Also at EST2, increased levels were observed (p<0.01, both), however, not significantly different from the changes at EST1. Resting levels of cTnT at EST2 compared to EST1 were significantly higher (median 8.1 vs 7.1 ng/L, p=0.02). At both visits significant increase in D-dimer (p=0.008 and <0.001), F1+2 (p=0.009 and 0.001) and TFPI (p<0.001 and 0.001) during exercise were demonstrated, with no difference in these changes. There were no significant changes in ETP during exercise at any visit, but resting levels were reduced at EST2 vs EST1 (p<0.01). Also resting levels of TFPI were reduced at EST2 (p<0.01).

Conclusion

After revascularization there was still significant increase in exercise-induced release of cardiac and pro-thrombotic biomarkers, thus revascularization does not affect the ability to release these biomarkers. Also, the higher resting levels of cTnT after revascularization indicate that revascularization per se does not affect secretion of cardiac biomarkers, probably due to the disease state. The lower resting levels of ETP and TFPI after revascularization may, however, be indicative of reduced thrombin generation potential and endothelial activation.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Stein Erik Hagens Foundation for Clinical Heart Research, Oslo, Norway
“Actua” project: secondary prevention in patients at high-cardiovascular risk
Authors: Prieto Lobato A , Corbi Pascual M J , Redondo Prieto M , Cubells Pastor M , Muros Ortega A , Carrasco Carrasco E , Cordoba Soriano J G , Martinez Pastor A , Division Garrote J A
Published: October 2021

Introduction

It is acknowledged that secondary prevention for patients at high cardiovascular risk is suboptimal. Data from EUROASPIRE V registry showed that less than 50% of cardiovascular risks factors were controlled in this population.

Purpose

“Actua” study was designed to identify potential gaps regarding secondary prevention for patients at very-high cardiovascular risk. The main objective was to assess differences between scientific evidence and clinical practice through an agreement/disagreement analysis of a questionnaire with statements based on clinical guidelines and expert recommendations.

Methods

A qualitative analysis based on Delphi methodology was conducted. The study was divided into 2 phases. In phase 1, doctors were asked to show agreement or disagreement with the statements presented by the scientific committee through a Likert 5-points-scale. Consensus was stablished according to consensus method of Tastle. Results were expressed as a percentage (%CNS) which shows power of agreement or disagreement consensus. CNS>70% were considered as consensus. In phase 2, same doctors were asked again about the statements with no consensus or high dispersion in previous phase, after disclosing results in phase 1. In addition, a third questionnaire was conducted to asses socio-demographic data of the sample.

Results

246 and 265 questionnaires were conducted in phase 1 and 2 respectively. 90% of respondents in phase 1 and 94,3% in phase 2 answered all the questions. Statements which showed consensus among participants are represented in table 1. As reported, there was consensus in goals for blood pressure (<130/80mmHg), cLDL (<70mg/dl), chronic use of acetylsalicylic acid in secondary prevention for coronary artery disease, stroke and peripheral artery disease. Doctors also agreed with the fact that 40mg atorvastatin can achieve 50% cLDL reduction levels from baseline. Scarce resources in secondary prevention were reported as main reason for medical attendants not following the best standards of care. Besides, most respondents agreed with the statement that a simpler treatment regime could improve therapeutical adherence in most patients. In phase 2, consensus was achieved in the statements showed in table 2.

Conclusion

Doctors admitted that complex recommendations and lack of following-up were the main causes of low adherence to treatment among patients at high cardiovascular risk.

Limitations

The study was conducted following recommendations from 2016 ESC/EAS guidelines for the management of dyslipaemias.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Grupo Ferrer Internacional, S.A. Table 1. Questions phase 1Table 2. Questions phase 2
Lipoprotein (a) and cardiovascular risk in familial combined hyperlipidaemia: does it exist?
Authors: Dima I , Skoumas I , Vavouranaki G , Ioakeimidis N , Tsioufis K , Vlachopoulos C
Published: October 2021

Background

Previous studies suggest there is an association between levels of lipoprotein a [Lp (a)] and increased cardiovascular risk in general population and familial hypercholesterolaemia patients. The purpose of this study was to define the exact relationship between the levels of Lp (a) and cardiovascular risk in a Familial Combined Hyperlipidaemia (FCH) population.

Methods

We enrolled 1094 (615 males, mean age 49 years old) patients who fulfilled the FCH criteria, from the outpatient lipid clinic of our hospital. Lp (a) levels were measured and information were obtained regarding demographic characteristics, the presence of coronary artery disease (CAD) and CAD risk factors. Patients were categorized initially according to baseline Lp (a) levels to quintile 1 (≤30mg/dl) (N=769), quintile 2 (>30 mg/dl, ≤50mg/dl) (N=149), quintile 3 (>50mg/dl, ≤100mg/dl) (N=124), quintile 4 (>100mg/dl, ≤150mg/dl) (N=31), and quintile 5 (>150mg/dl) (N=21). We calculated the percentage of patients with CAD in each quintile. Additionally, we performed logistic regression analysis to predict the presence of CAD based on the levels of Lp (a) and other CAD risk factors, age, sex, the presence of diabetes mellitus, hypertension and smoking.

Results

Mean value for Lp (a) in the whole population was 29.67mg/dl. The percentages of CAD were 13.1%, 16.8%, 15.3%, 22.6%, and 23.8% respectively for quintiles 1–5 (Figure 1). The number of CAD patients increases as baseline Lp (a) levels increase. To further support the finding, regression analysis revealed that age, gender and Lp (a) added significantly to the model. Lp (a) could predict CAD, independently of other factors.

Conclusions

The correlation between Lp (a) and Familial Combined Hyperlipidaemia is unclear. There is an increasing trend for the presence of CAD in higher Lp (a) levels and a positive relationship, indicating a straightforward correlation between these two parameters.

Funding Acknowledgement

Type of funding sources: None.
Cardiovascular benefit of lowering LDL-C below 1 mmol/L (40 mg/dl)
Authors: Marston N A , Giugliano R P , Park J G , Ruzza A , Sever P S , Keech A C , Sabatine M S
Published: October 2021

Background

The 2019 ESC/EAS Dyslipidemia Guidelines recommend an LDL-C goal of <1.4 mmol/L (∼55 mg/dl) for patients with very high-risk ASCVD, and <1 mmol/L (∼40 mg/dl) for those with recurrent events within 2 years despite taking maximally tolerated statin therapy. The addition of PCSK9 inhibitors to statin therapy can achieve LDL-C levels well below 1 mmol/L in many patients, yet the clinical benefit of LDL-C lowering beyond this level has recently been questioned.

Methods

FOURIER was a cardiovascular outcomes trial comparing evolocumab vs. placebo in patients with stable ASCVD on optimized statin therapy with a median follow-up of 2.2 years. We performed an exploratory analysis to determine the consistency of CV risk reduction with LDL-C lowering below ∼1 mmol/L (40 mg/dl) with evolocumab. We modeled the achieved LDL-C at 48 weeks in the two treatment arms as well as the percentage of LDL-C difference between the two arms that was due to LDL-C below ∼1 mmol/L (40 mg/dl) as a function of baseline LDL-C. We then modeled the hazard ratio (HR) for the composite of CV death, MI or stroke (per 1 mmol/L reduction in LDL-C) with evolocumab vs. placebo as a function of baseline LDL-C.

Results

All 27,564 patients from FOURIER were included in this analysis. Patients with lower baseline LDL-C achieved lower LDL-C levels following evolocumab therapy, with achieved LDL-C typically being below 1 mmol/L (40 mg/dl) once the baseline LDL-C was below 2.4 mmol/L (94 mg/dl) and reaching levels approaching 0.5 mmol/L (∼20 mg/dl). Accordingly, the further baseline LDL-C levels were below 2.4 mmol/L (94 mg/dl), the greater the proportion of the difference in achieved LDL-C between the evolocumab and placebo arms was due to LDL-C levels below ∼1 mmol/L (40 mg/dl), reaching nearly 40% of the difference in LDL-C between treatment arms (Upper Panel). Despite this, the clinical benefit of LDL-C lowering was not attenuated (p=0.78) (and even appeared greater), with robust reductions in risk of CV death, MI or stroke even when LDL-C was lowered to nearly 0.5 mmol/L (∼20 mg/dl) and having close to 40% of the LDL-C difference between treatment arms due to LDL-C lowering below ∼1 mmol/L (40 mg/dl) (Lower Panel).

Conclusion

PCSK9 inhibitors added to statin therapy can achieve LDL-C well below 1 mmol/L (40 mg/dl). There is no evidence for attenuation of the clinical benefit of lowering LDL-C below this threshold. These data support lowering LDL-C to below 1 mmol/L (40 mg/dl) in patients with ASCVD.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health
Low testosterone is associated with increased risk of major adverse cardiovascular events in smokers with erectile dysfunction
Authors: Ioakeimidis N , Georgakopoulos C , Terentes-Printzios D , Dima I , Gardikioti V , Angelis A , Gourgouli I , Tsioufis K , Vlachopoulos C
Published: October 2021

Purpose

Tobacco cigarette smoking and decreased concentrations of testosterone are major risk factors of erectile dysfunction (ED) and independent predictors of cardiovascular disease (CVD). We investigated, whether testosterone deficiency has a complementary predictive value for CVD events in smokers with ED.

Methods

A cohort of 398 men with ED and without known atherosclerotic CVD (mean age: 55±10 years) were followed for the occurrence of major adverse cardiovascular events (MACE), (CVD death, coronary artery disease, stroke). Total testosterone (TT) levels were measured in all patients.

Results

Among the study population, 205 (52%) were smokers. During a mean follow-up of 6 years (range: 1–11 years), 30 (7.5%) patients demonstrated a MACE. Baseline TT levels were significantly lower and prevalence of smoking was higher in the CV-event group than the event-free survival group (P<0.01 and P<0.05, respectively). Kaplan–Meier analysis showed that patients with low TT (≤4.0 ng/mL) had a worse prognosis than patients with TT >4.0 ng/mL (log rank: 6.52, P=0.011), and that smokers had a greater risk of adverse events than never smokers (log rank: 4.42, P=0.04). We then stratified all patients into four groups, on the basis of smoking status (current/never smokers) and low or high TT (≤ or >4.0 ng/mL) and cardiac event-free survival curves were constructed by Kaplan–Meier analysis (figure). The event-free rate in smokers with low TT is significantly lower than that of smokers with low TT or never smokers with normal TT (log rank: 11.3, P=0.02). Smokers with low TT had an almost 4-fold higher risk of MACEs compared to never smokers with normal TT (adjusted hazard ratio: 3.91; P=0.030).

Conclusion

Cigarette smoking combined with low TT concentration is associated with a shorter event-free period compared with either smoking or testosterone deficiency alone. The measurement of testosterone concentration may be useful to further stratify the risk of ED smokers without known CVD.

Funding Acknowledgement

Type of funding sources: None. Smoking testosterone deficiency and MACE
Iron deficiency and athletic performance
Authors: Csulak E , Sydo N S , Horvath L H , Sydo T S , Babis B B , Mocsari S Z M , Kaufmann M K , Lakatos B L , Kovacs A K , Dohy Z S D , Szabo L S Z , Toth A T , Vago H V , Merkely B M
Published: October 2021

Introduction

Iron metabolism determines the oxygen transport of the blood, thereby affecting the exercise capacity and performance. In patients with heart failure iron deficiency is a major risk factor that predicts and influences patient's quality of life. In athletes diagnosing iron deficiency is also extremely important as it determines sport performance.

Purpose

Our aim is to study the correlation of iron metabolism parameters with exercise capacity in athletes.

Methods

Cardiopulmonary exercise test (CPET) was performed as part of detailed sports cardiology screening. We studied in athletes the changes of iron metabolism parameters (serum iron, transferrin, total iron-binding capacity (TIBC), ferritin) and correlation with the exercise physiology parameters.

Results

Our measurements were performed on 105 top athletes: swimmers (n=58,55%; male = 29; junior = 30; 20,4±4,6 y), football players (n=47, 45%; junior = 6; 23,2±5,4 y). Laboratory test verified hemoglobin (male = 153,8±9,4; female = 141,2±7,7 g/L; p<0,001) and hematocrit (male = 0,45±0,03; female = 0,42±0,02 L/L; p<0,001) value in a normal range for all. In women, significantly lower ferritin (67,8±76,2 vs. 98,9±48 μg/L; p<0,05) and higher TIBC (78,1±14,3 vs. 66,5±9,3 μmol/L; p<0,001) were observed. Young male athletes had significantly lower serum iron (16,1±6 vs. 21,2±7,5 μmol/L; p<0,05), ferritin (68±42,7 vs. 109,1±45,5 μg/L; p<0,01) and higher TIBC (76,1±11,0 vs. 64,3±7,4 μmol/L; p<0,001) compared to adults. During CPET male athletes had higher maximal aerobic capacity (52.2±4.4 vs. 55.9±5.5 mL/kg/min; p<0.001) and ventilation (115.8±16.1 vs. 153.2±26 L/min; p<0.001) compared to females. Maximal aerobic capacity and ventilation showed positive correlation with ferritin (p<0,0001). The ferritin cut-off value of iron supplementation was <100 μg/L. Iron supplementation was required in almost half of the athletes (n=49, 47%).

Conclusion

Diagnosing iron deficiency in athletes, complete iron panel containing ferritin is required. According to our results iron status determines performance, therefore iron deficiency screening and iron supplementation is essential.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Supported by the ÚNKP-20-3-I New National Excellence Program of the Ministry for Innovation and Technology from the Source of the National Research, Development and Innovation Fund - The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging programmes of the Semmelweis University.
Features of remote rehabilitation using the developed mobile app in patients after cardiac bypass surgery
Authors: Lyapina I N , Soloduhin A , Krupianko E , Shaleva V , Dren' E , Pomeshkina S
Published: October 2021

Aim of the study

The aim of the study is to evaluate the features and availability of the developed remote rehabilitation program with the use of a mobile application in patients who have undergone coronary artery bypass surgery (CABG) and surgical correction of valvular heart disease (VHD).

Material and methods of research

In the current epidemiological situation, to increase the availability of cardiorehabilitation for patients after open heart surgery, a mobile application with the program “Remote rehabilitation of patients who have undergone heart surgery” was developed.

The remote rehabilitation program included 46 patients (median age 60.0 [53.0; 64.0]) who underwent cardiac surgery. Of these, 22 patients after CABG (median age 61.0 [53.0; 63.5]) and 24 patients after surgical correction of VHD (median age 59.5 [54.0; 63.75]).

On the 5th day after the surgery, the developed application for remote rehabilitation was installed on the smartphone. It consisted of 5 sections: Dosed Walking, Therapeutic gymnastics, Diet, Psychology and Chat.

After application installing and until the moment of discharge from the hospital, 3 classes with a total duration of 6 academic hours were conducted with each patient. After being discharged from the hospital the patients were recommended to use the mobile app for rehabilitation at home for 4 months. 4 months after the surgery the app usage statistics were evaluated and a telephone survey of the reasons for non-complience was conducted.

Results

A total of 34 (74%) patients used the mobile app for remote rehabilitation. Of these, 24 (52.0%) used the app section “Dosed Walking” and “Therapeutic Gymnastics” at least 5 times a week for 4 months, 10 (22%) used the app no more than 10 times during the entire follow-up period, and 12 (26%) did not engage in remote rehabilitation using the app. 22% of patients received consultations with a cardiologist via chat in mobile app.

The telephone survey revealed the main reasons for the irregular participation of patients in the remote rehabilitation program using the mobile app: lack of interest/desire to engage in physical rehabilitation – 16 (35%), problems with the Internet – 6 (13%), lack of time – 4 (8.5%), incorrect function of the app – 4 (8.5%).

Conclusions

Insufficient adherence of patients after cardiac surgery to a remote rehabilitation program using a mobile application, associated with a lack of motivation in patients, was demonstrated. This implies the importance of developing and implementing further measures to increase the motivation and adherence of patients to participate in long-term remote cardiac rehabilitation programs.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Russian Federation President grant
A randomized clinical study evaluating effects of high-intensity interval training on myocardial microvascular dysfunction
Authors: Rafique M , Solberg O G , Gullestad L , Bendz B , Rolid K , Nytroen K , Lunde K
Published: October 2021

Background

Myocardial microvascular function assessed with the Index of Microcirculatory Resistance (IMR) after heart transplantation (HTx) predicts the development of cardiac allograft vasculopathy (CAV) and adverse long-term outcome. This study aimed to evaluate the otherwise beneficial effects of high-intensity interval training (HIT) on microvascular dysfunction development.

Methods

Eighty-one de novo HTx patients were randomized to nine consecutive months of HIT or standard care rehabilitation. Coronary physiology assessment with a pressure wire was performed in the left anterior descending coronary artery. IMR was calculated by multiplying the mean distal coronary pressure by the mean hyperemic transit time. Results obtained at three and twelve months after HTx were compared to assess the treatment effect of HIT.

Results

Results were available for 60 patients. 71% were men, and the mean age was 48±13. IMR in the HIT group (n=26) decreased from 14.8±9.5 to 13.8±8.0, change = 1.2, 95% CI [−2.6 to 4.9] and increased in the standard care group (n=34) from 13.8±5.8 to 16.8±12.0, change = −3.5, 95% CI [−7.1 to 0.1]. The mean difference between groups was 4.7, 95% CI [−9.7 to 0.4], p=0.07.

Conclusion

These results suggest that early initiation of HIT improves microvascular function.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Stiftelsen Dam
Masters Athlete Screening Study (MASS): incidence of cardiovascular disease and major adverse cardiac events over five years of screening
Authors: Morrison B N , Isserow S , MacDonald M , Cater C , Zwaiman I , Taunton J , Warburton D E R , McKinney J
Published: October 2021

Background

The long-term implications of cardiovascular disease (CVD) in masters athletes, and whether screening decreases their risk of major adverse cardiac events (MACE) is unknown.

Purpose

To evaluate the incidence of CVD and MACE over five years of a screening study.

Methods

Masters athletes (≥35 years) from a variety of sports without previous history of coronary artery disease (CAD) underwent yearly cardiovascular screening. The screen consisted of anthropometrics, blood pressure, resting electrocardiogram, modified American Heart Association 14-element recommendations, cardiovascular event questionnaire, physical examination (year 1) and Framingham Risk Score (years 1–3). Participants with an abnormal screen according to the European Association of Cardiovascular Prevention and Canadian Cardiology Society Guidelines underwent further evaluations (computed coronary tomography angiography was not included for all athletes but based on clinical assessment). Participants who withdrew during the study received a follow-up questionnaire to determine MACE and vital status.

Results

In the first year of the Masters Athlete Screening Study, 798 masters athletes (62.7% male, 54.6±9.5 years) were screened; 91 (11.4%) of the cohort were found to have CVD. CAD was the most common diagnosis (69.2%). During the following four years, there were an additional 89 CVD diagnoses with an incidence rate of 3.58/100, 4.14/100, 3.74/100, 1.19/100, for years two to five, respectively. Fifteen participants had more than one diagnosis. The most common diagnoses over the five years were arrhythmias (n=33; 37.1%), aortic dilatation (n=20; 22.5%), CAD (n=18; 20.2% (5 obstructive, 13 non-obstructive)) and other (n=7; 7.9%) (myocarditis (n=2), myocardial bridging (n=1), cerebrovascular disease (n=1), dilated cardiomyopathy (n=1), probable Long QT syndrome (n=1), papillary fibroelastoma (n=1)). A total of 10 MACE occurred (two cardiovascular deaths, five myocardial infarctions and three cerebrovascular accidents). All events occurred in male athletes (63.6±12.5 years). Out of the 136 participants that received the lost to follow-up questionnaire, 101 (74.3%) completed it. Of those, one male athlete underwent percutaneous coronary intervention. The incidence of MACE over the study period was 0.30/100 athletes per year.

Conclusion

Yearly cardiovascular screening of masters athletes identified ∼3 new diagnoses per 100 athletes per year. Ten MACE occurred despite yearly screening and high CV fitness of masters athletes.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): MITACs and CIHR
Previous psychiatric disorders and antipsychotic drugs in COVID-19 patients: early findings on possible worse outcome
Authors: Scarpone M , Bergami M , Cenko E , Bugiardini R , Poluzzi E , Manfrini O
Published: October 2021

Background

There are a range of traditional risk factors for COVID-19, but it is not well established if there are also psychiatric related risk factors. These factors could increase angiotensin-converting enzyme 2 expression and potentiate COVID-19 cell entry.

Purpose

We aimed to assess if psychiatric disorders and antipsychotic treatments represent risk factors for COVID-19 worst outcomes.

Methods

We describe the demographics, symptoms, therapeutic management, and survival outcomes of COVID-19 in the population who were admitted in a single academic hospital in Northern Italy between March 1 and June 30, 2020. Patients were determined to have COVID-19 if they had a positive SARS-CoV-19 swab. We used logistic regression analyses to control for confounding by concomitant risk factors for COVID-19 and for therapeutic management of comorbidities including psychiatric disorders and antipsychotic related drugs.

Results

Among 609 patients, in-hospital death occurred in 120 (19.7%). A psychiatric disorder in the previous years was overrepresented (p<0.0001) in non-survivors (35.5%) in comparison with survivors (22.1%). Age and a history of hypertension were as well, established (p<0.005) risk factors for COVID-19 adverse outcomes: 80.6±11.4 vs 68±17.4 years and 70% vs 52% of people with hypertension in non-survivors vs survivors. Various pre-existing conditions were also associated (p<0.001) with increased risk of death, such as stroke or transient ischemic attacks, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) (20% vs 8%, 35% vs 17%, and 24% vs 10%, respectively). We did not observe that prior use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers were more prevalent in non-survivors compared with survivors. On the opposite, prior use of aspirin, P2Y receptor antagonists, and antipsychotic drugs was more common (p<0.001) in non-survivors compared with their counterparts (36% vs 21%, 12% vs 5%, and 28% vs 10%, respectively). After multivariable adjustment, use of antipsychotic drugs was associated with higher risks of in-hospital death (OR: 2.27; 95% CI, 1.17–4.4). Other independent predictors of death were older age (OR: 2.8; 95% CI, 1.69–4.63), CKD (OR: 2.2; 95% CI, 1.21–4.03) and COPD (OR: 2.04; 95% CI, 1.22–3.42).

Conclusions

Antipsychotic drugs might be an independent risk factor for COVID-19 adverse outcomes. Although preliminary, our findings have implications for clinical services as they provide crucial information for understanding who is at greatest risk for COVID-19.

Funding Acknowledgement

Type of funding sources: None.
Predicting atrial fibrillation after acute abdominal surgery
Authors: Madsen C V , Leerhoey B , Joergensen L , Meyhoff C S , Sajadieh A , Dominguez H
Published: October 2021

Introduction

Post-operative atrial fibrillation (POAF) is currently considered a phenomenon rather than a definite diagnosis. Nevertheless, POAF is associated with an increased rate of complications, including stroke and mortality. The incidence of POAF in acute abdominal surgery has not been reported and prediction of patients at risk has not previously been attempted.

Purpose

We aim to report the incidence of POAF after acute abdominal surgery and provide a POAF prediction model based on pre-surgery risk-factors.

Methods

Designed as a prospective, single-centre, cohort study of unselected adult patients referred for acute, general, abdominal surgery. Consecutive patients (>16 years) were included during a three month period. No exclusion criteria were applied. Follow-up was based on chart reviews, including medical history, vital signs, blood samples and electrocardiograms. Chart reviews were performed prior to surgery, at discharge, and three months after surgery. Atrial fibrillation was diagnosed either by specialists in Cardiology or Anaesthesiology on ECG or cardiac rhythm monitoring (≥30 seconds duration). Multiple logistic regression with backward stepwise selection was used for model development. Receiver operating characteristic curves (ROC) including area under the curve (AUC) was produced. The study was approved by the Regional Ethics committee (H-19033464) and comply with the principles of the Declaration of Helsinki of the World Medical Association.

Results

In total, 466 patients were included. Mean (±SD) age was 51.2 (20.5), 194 (41.6%) were female, and cardiovascular comorbidity was present in ≈10% of patients. Overall incidence of POAF was 5.8% (27/466) and no cases were observed in patients <60 years. Incidence was 15.7% (27/172) for patients ≥60 years. Prolonged hospitalization and death were observed in 40.7% of patients with POAF vs 8.4% patients without POAF (p<0.001). Significant age-adjusted risk-factors were previous atrial fibrillation odds ratio (OR) 6.84 [2.73; 17.18] (p<0.001), known diabetes mellitus OR 3.49 [1.40; 8.69] (p=0.007), and chronic kidney disease OR 3.03 [1.20; 7.65] (p=0.019). A prediction model, based on age, previous atrial fibrillation, diabetes mellitus and chronic kidney disease was produced (Figure 1), and ROC analysis displayed AUC 88.26% (Figure 2).

Conclusions

A simple risk-stratification model as the one provided, can aid clinicians in identifying those patients at risk of developing POAF in relation to acute abdominal surgery. This is important, as patients developing POAF are more likely to experience complications, such as prolonged hospitalization and death. Closer monitoring of heart rhythm and vital signs should be considered in at-risk patients older than 60 years. Model validation is warranted.

Funding Acknowledgement

Type of funding sources: None.
Comorbidities vs age for the prediction of excess of length of in-hospital stay in patients undergoing new pacemaker implantation
Authors: Del Castillo-Carnevali H , Marschall A , Fraile C , Torres Lopez M O N , Goncalves Sanchez M D F , Gomez Sanchez M I , Basabe Velasco M E , Marti Sanchez D , Rueda Linares A , Coto Morales B , Rodriguez Torres D J , Dejuan Bitria C , Biscotti Rodil B , Rubio Alonso M A , Alvarez Anton S A
Published: October 2021

Background

Traditionally, advanced age has been considered a major factor for increased length of in-Hospital stay (LOS) and health-care costs. However, recent studies suggest that comorbidity burden may have an equal, if not greater, effect on LOS as age in a variety of clinical scenarios.

Purpose

We aimed to determine the impact of comorbidity on LOS, as compared to age, in patients undergoing new pacemaker (PM) implantation.

Methods

In this retrospective study, patients that underwent new PM implantation (both elective and non-elective) in our centre between January 2015 and June 2018 were admitted for chart-review. We excluded patients that underwent PM replacement and lead removal procedures. Furthermore, patients that underwent other invasive procedures, such as percutaneous coronary intervention, coronary bypass or heart valve surgery, were excluded in order to minimize confounding factors. Excess in LOS was defined as an in-hospital stay >3 days. Multivariate logistic regression models were generated in order to evaluate the impact of comorbidity burden (as assessed by the Charlson Comorbidity Index (CCI)) and age on LOS. Furthermore, we compared the excess of LOS in elderly patients (i.e. ≥75 years) and low comorbidity burden (i.e. CCI ≤1) with younger patients.

Results

423 elective and non-elective patients with a mean age of 82 were included in the study. The median follow-up time was 34 (15–46) months. Baseline clinical characteristics are detailed in the table. A CCI >1 resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 11.7 (7.3–18.9), p<0.001); HR: 1.04 (0.98–1.04), p=0.43, respectively). When analyzed separately, according to elective (n=150) vs non-elective (n=270) indication, CCI remained a significant predictor (HR: 7.1 (2.1–24.2), p=0.002; HR: 13.8 (7.6–25.1), p<0.001, respectively). Age remained not significant. Elderly patients (age ≥75 years) with low comorbidity burden (CCI≤1) had a significantly shorter LOS compared to a younger overall population (2 (1–3) vs 2 (2–4) days, p=0.016) (Figure).

Conclusion

Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Androgen deprivation therapy with agonists of GnRH: cardiovascular adverse events and comorbidity considerations in patients with prostate cancer
Authors: Gritskevich E Y U , Demidova T Y U
Published: October 2021

Study objective

To assess cardiovascular adverse events and comorbidity considerations in patients with local prostate cancer (pT3N0M0) who were treated with agonists of gonadotropin-releasing hormone (aGnRH).

Study design

Follow-up study.

Materials and methods

102 patients were enrolled to the study, 99 subjects were followed up till the study completion. The mean age was 69±8,64 years old. The study of body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), was performed at baseline, after 3, 6 and 12 months ADT.

Achievement of low threshold values of testosterone was accompanied by an increase in the levels of BMI, WC, FPG, HbA1c, LDL-C, TG over 12 months of ADT regardless of baseline age, with a maximum increase during the first 3 months of treatment, and progressively after 6 months and 12 months. FPG (mmol/l) basic, 3, 6 and 12 months, respectively 5,18±0,91; 5,67±0,93; 5,77±0,96; 5,90±1,12 (for all differences p≤0.001); HbA1c (%) 5,36±0,66; 5,66±0,83; 5,77±0,82; 5,89±0,83 (for all differences p≤0.001). WC (cm): 91.5, 95.4 (+4.2%), 96.1 (+5.0%), 96.4 (+5.4%) (for all differences p≤0.017); BMI (kg/m2): 27.4, 28.2 (+2.9%), 28.4 (+3.6%), 28.4 (+3.6%) (p≤0.004 for all differences, save for differences between values in 6 and 12 months – p=0.995); LDL-C (mmol/l): 3.04 – 3.29 (+8.2%) – 3.47 (+14.1%) – 3.61 (+18.7%) (for all differences p≤0.001), TG (mmol/l): 1.7 – 1.9 (+11.8%) – 2.0 (+17.6%) – 2.1 (+23.5%) (p≤0.004). The proportion of patients with prediabetes, type 2 diabetes, according to ADA criteria, is increasing from 15% to 66% and from 4% to 13% respectively, with arterial hypertension – from 57% to 65%, with coronary artery disease – from 22% to 31% patients in the study 12 months after the start of therapy.

Conclusion

Long-term androgen deprivation therapy with GnRH agonists leads to an early, progressive, clinically significant deterioration of metabolism. According to the results of monitoring comorbid conditions in dynamics, a rise in the incidence of concomitant diseases was revealed during the year of therapy.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Pirogov Russian National Research Medical University