bluuebunny/crossref_metadata_2025 huggingface dataset:
Untargeted metabolites and vascular health in cardiovascular risk patients
Authors: Streese L , Springer AM , Deiseroth A , Carrard J , Infanger D , Schmaderer C , Schmidt-Trucksaess A , Madl T , Hanssen H
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Background

The mechanistic pathways how classical cardiovascular (CV) risk factors affect macro- and microvascular health are not fully understood. The metabolome reflects a chemical fingerprint of the upstream epigenetic processes and seems to have the potential to provide insights into multiple molecular mechanisms underlying vascular health or vascular abnormalities that contribute to the pathogenesis of CV disease.

Purpose

We aimed to investigate the associations of CV risk factors with the metabolic fingerprint and macro- as well as microvascular health in an untargeted metabolic approach in predefined CV risk groups of aged individuals.

Methods

This cross-sectional study investigated the metabolic fingerprint, as well as the macro- and microvascular health from a well-characterized aged (50-80 years) cohort, based on the EXAMIN AGE study. One hundred and fifty-five participants with no to ≥three previously defined CV risk factors were analysed. Nuclear magnetic resonance spectroscopy was used to analyse the metabolic fingerprint. Carotid-femoral pulse wave velocity as well as retinal vessel diameters were analysed to quantify macro- and microvascular health.

Results

The metabolic fingerprint gradually changed with increasing number of risk factors. Whereas the metabolic profile of individuals with a small number of risk factors were more homogenous, the profile became more heterogeneous with increasing numbers of risk factors. There was strong evidence for a negative association of glutamine [estimate (95% CI): -14.54 (-17.81 to -11.27), p < 0.001], glycine [-5.84 (-7.88 to -3.79), p < 0.001], histidine [-0.73 (-0.96 to -0.50), p < 0.001], and acetate [-1.68 (-2.91 to -0.46), p = 0.007] with a higher CV risk profile. Tryptophan was positively associated with higher CV risk [0.31 (0.06 to 0.56), p = 0.015]. The combination of a priori defined CV risk factors explained up to 45.4% of the metabolic variation. The metabolic fingerprint explained 20% of macro- and 23% of microvascular variation.

Conclusion

Metabolic profiling has the potential to improve and individualise CV risk stratification. It may help better understand some of the underlying metabolic mechanisms of atherosclerotic disease development. Our findings support future preventive strategies to target specific metabolites and thereby reduce CV risk and associated vascular disease. Metabolic profiling may have added value to predict CV disease development and potentially guide future treatment strategies.
Changes in physical activity behavior and development of cardiovascular risk in children
Authors: Lona G , Hauser C , Koechli S , Infanger D , Endes K , Faude O , Hanssen H
Published: May 2021

Funding Acknowledgements

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

Background

Prevention of cardiovascular (CV) disease should start early in life. The study aimed to investigate the association of changes in physical activity, sedentary behavior and cardiorespiratory fitness (CRF) with development of body mass index (BMI), blood pressure (BP) and retinal microvascular health in children over four years.

Methods

In 2014, 391 children aged 6-8 years were screened, and thereof 262 children were reexamined after four years following standardized protocols. Retinal arteriolar (CRAE) and venular diameters were measured by a retinal vessel analyzer. CRF was objectively assessed by a 20m shuttle run, physical activity and sedentary behavior by use of a questionnaire.

Results

Children who achieved higher CRF levels reduced their BMI (β [95% CI] -0.35 [-0.46 to -0.25] kg/m2 per stage, P ≤ 0.001) and thereby developed wider CRAE (β [95% CI] 0.25 [0.24 to 0.48] µm per stage, P = 0.03) at follow-up. Moreover, children with elevated or high systolic BP at baseline, but lower levels of sedentary behavior during the observation period, had wider CRAE at follow-up (β [95% CI] -0.37 [-0.66 to -0.08] µm per 10 min/d, P = 0.013).

Conclusion

An increase of CRF over four years was associated with a reduced BMI and consequently wider retinal arterioles at follow-up. In children with elevated or high systolic BP, a reduction of sedentary behavior by merely 10 min per day significantly improved retinal microvascular health as a primary prevention strategy to promote childhood health and combat development of manifest CV disease later in life.
Patient education interventions for health behaviour change in adults diagnosed with coronary heart disease: a systematic review and meta-analysis
Authors: Shi W , Ghisi GLM , Zhang L , Hyun K , Pakosh M , Gallagher R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patient education is recommended to increase disease-related knowledge and modify coronary heart disease (CHD) risk factors. Although the importance has been established, there is a lack of knowledge of its efficacy and relative impact of duration on disease-related knowledge and health behaviour outcomes.

Purpose

It aimed to assess the efficacy of structured patient education on those outcomes in adults with CHD for short-term (less than six months) and long-term (six to 12 months) effect.

Methods

Eligible randomised controlled trials published in English, Simplified Chinese, Spanish, and Portuguese were searched in seven electronic databases from database inception through 2020. Reference lists, relevant conference lists, and keywords from the Internet were also searched. Outcomes included disease-related knowledge, smoking cessation, medication adherence, physical activity, and healthy dietary behaviour.

Results

Overall, 73 studies reporting 71 unique trials were included. Participants (n = 24,985) were aged mean 60.5 ± 5.7 years, mostly male (72.5%). About 74% of studies used more than one mode for education delivery, with phone calls and booklets being used the most frequent. Patient education was associated with significant improvement in all outcomes measured in meta-analyses (P < 0.05). In addition, regression analyses showed that a prolonged intervention duration does not significantly improve the outcomes, except for the disease knowledge (p = 0.009) and physical activity (p = 0.026).

Conclusions

Structured patient education, in a variety of modes and intensities, improves disease-related knowledge and health behaviours in adults with CHD. The findings can be used to guide design of cardiac programs, particularly related to intervention duration in clinical practice.

Abstract Figure 1. PRISMA flow diagram
Does lipoprotein(a) predict cardiovascular events in a long-term follow-up?
Authors: Borges-Rosa J , Campos GM , Martinho S , Almeida JPL , Goncalves V , Ferreira C , Freitas AA , Ferreira JA , Milner J , Oliveira-Santos M , Baptista R , Goncalves L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Elevated plasma lipoprotein(a) [Lp(a)] concentrations are associated with an increased risk of atherosclerotic cardiovascular disease and its role in risk categorizing was recognized in the new ESC guidelines for the management of dyslipidaemias. We investigated 1) the association between baseline Lp(a) levels and incident long-term cardiovascular (CV) events and 2) its relationship with type 2 diabetes mellitus (T2DM) in a Southern European population.

Methods

We retrospectively assessed baseline Lp(a) concentrations in a total of 499 patients of a primary prevention cohort followed at the Lipidology Clinic of our hospital, with a median follow-up time of 15 (IQR 12-17) years. Lp(a) was analysed as a continuous variable, as a categorical variable with a 180mg/dL cut-off and by quartiles. We collected data on major CV events (CV death, myocardial infarction, stroke) as a composite outcome. Cox proportional hazard regression analyses were used to estimate hazard ratios (HR) and 95% confidence interval (CI).

Results

Mean age was 48.30 ± 14.41 years and 61.70% were male (n = 499). Median Lp(a) was 36.60 (IQR 0-396) mg/dL and 12.4% of patients had very high Lp(a) (≥180mg/dL); T2DM prevalence was 13.60%. The composite outcome incidence was 10%. At the baseline, individuals with T2DM had lower Lp(a) levels (11.85 IQR 3-330 mg/dL vs. 46.40 IQR 0-396, p < 0.01 mg/dL). There was a moderate inverse correlation between Lp(a) and HbA1c (r = -0.67, p < 0.01) but no significant correlations with lipid profile (total, LDL or HDL), risk scores (SCORE or the ACC pooled cohort equation), age nor gender. We found no relationship between baseline Lp(a) quartiles and composite outcome’s incidence (age-, sex-, and diabetes-adjusted HR: 1.15, 95%CI: 0.71-1.87, p = 0.57) (Figure 1), neither with the individual CV endpoints. Exploratory analysis showed that patients on aspirin had lower Lp(a) levels (29.55 IQR 0-264 mg/dL vs. 63.60 IQR 1-396 mg/dL, p < 0.01).

Conclusion

In a single centre cohort of a primary prevention southern European population, we did not find an association between Lp(a) levels and incident CV events in a 15-year median follow-up time.
The values of low-density lipoprotein cholesterol and acute coronary syndrome
Authors: Ferraz LM , Faustino A , Neves A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

All individuals with a history of acute coronary syndrome (ACS) should receive intensive statin therapy in order to achieve the desirable low-density lipoprotein cholesterol (LDL-C) values recently modified in the guidelines of the European Society of Cardiology.

Purpose

To evaluate the lipid profile control of ACS patients with 6 year follow-up.

Methods

Retrospective study of 138 consecutive patients (P) admitted in our hospital for ACS during one year: 63 ± 13 years, 76.8% male, 26.9% with history of coronary artery disease and 56.5% of dyslipidemia. A 6 year follow-up was performed and a therapeutic goal was defined as LDL-C values below 55mg/dL and an LDL-C reduction of ≥50% from baseline, according to the guidelines of the European Society of Cardiology. High/moderate/low intensity statins were defined according to the therapeutic recommendations of the American College of Cardiology. Univariate analysis was performed.

Results

The mean LDL-C value at ACS admission was 112.5 ± 36.9mg/dL. 96.4% of patients were discharged on statins: 41.3% with rosuvastatin 10mg, 15.2% with simvastatin 20mg, 15.2% with atorvastatin 10mg, 10.9% with pitavastatin 2mg and 6.5% with atorvastatin 20mg.

Antidislipidemic therapy was changed in 7.9% of patients in the scheduled evaluation 1 month after discharge.

The mean LDL-C value after a 6 year follow-up was 83.6 ± 27.2mg/dL, with 85.8% P not meeting the defined therapeutic goal. Most of them (97.5%) continued medicated with statin, however, only 28.3% of P were on high-intensity statins and 3.8% were on low-intensity statins, despite the verified statistically significant association between LDL-C values and statin type used (high/medium/low intensity, p < 0.05).

Conclusion

Despite the proven benefit of statins, especially in high-risk patients, there are still aspects to improve, notably in the establishment of more effective therapies in order to achieve the desired new goals.
Nichtrauchen ist clever: a smoking prevention program for schoolchildren and what we learn from the kids
Authors: Meienberg A , Mayr M , Vischer A , Zellweger M , Burkard T
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): PFIZER: unrestricted medical grant

Background

Tobacco consumption is an important preventable cause of premature death worldwide. Nevertheless, smoking is still common, globally. Smoking in adulthood is closely associated with smoking during adolescence. Therefore, as a global epidemic, tobacco consumption must not only be tackled in adults, but it is particularly important to focus on smoking prevention among young people.

Purpose

In 2014, a hospital-based smoking prevention program "Nichtrauchen ist clever!" (NIC!) for adolescents was initiated, consisting of three parts: namely a workshop, a film, and a patient interview. The aim of the study was to evaluate the acceptance of the program, and to explore participants’ awareness on smoking related diseases and factors that promote smoking initiation.

Methods

We performed an observational study to evaluate students’ acceptance of the program and their smoking habits, and a qualitative approach, to assess their view on reasons for smoking initiation and their knowledge about smoking-related diseases.

Results

Between January 2016 and December 2019, 1658 students participated our observational study with a mean age of 13.3 years (SD ±0.9). Twenty-six percent (429/1658) have already tried tobacco products (so called triers), specifically cigarettes, electronic (e)-cigarettes, and shisha. Use of e-cigarettes was most popular among triers 58% (252/429). All parts of the program were widely rated as good and excellent, and 88% (1408/1604) of participants reported they had acquired good or excellent knowledge about smoking.

Particularly lung cancer, cancer in general and heart diseases were frequently mentioned to be smoking related; peer pressure, stress and coolness were identified as reasons for smoking initiation. The influence of marketing and multimedia on smoking behaviour in the young was barely noticed.

Conclusion

NIC!" had a high acceptance among the participants and a large number of students reported relevant knowledge gain. We identified important knowledge-gaps relating smoking initiation and smoking related diseases, helping to improve further smoking prevention approaches.
Features of emotional status of smoking patients with ischemic heart disease
Authors: Ibatov A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose. To study emotional status of smoking  patients with ischemic heart disease (IHD). 

Methods.  277 patients with IHD  (angina pectoris II - IV function class) were examined. Patients were divided in two group according to their smoking status. The first group included 139 smoking  patients (average age 53.9 ± 0.7 years). The second group included 138 nonsmoking  patients with IHD  (average age 59.9 ± 0.7 years).  A level of anxiety and the depression were examined by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the Mini-Mult questionnaire - short form MMPI questionnaire. 

Results. The groups did not differ in class of angina pectoris and treatment. The patients of 1st  group had level of anxiety and depression 6.9 ± 0.3 score and 5.4 ± 0.4 score accordingly. The patients of  2nd group had level of anxiety and depression 8.7 ± 0.4 score (p < 0.01)  and 6.8 ± 0.3 score accordingly (p < 0.05). The patients of 1st group had such personality characteristics accordingly: on scale of Hypochondriasis – 54.9 ± 0.7 T-score; on scale of Depression – 50.3 ± 1.1 T-score; on scale of Hysteria – 52.1 ± 0.6 T-score; on scale of Psychopathic Deviate – 45.1 ± 0.8  T-score; on scale of Paranoia – 51.3 ± 0.9 T-score; on scale of Psychasthenia – 47.6 ± 0.9 T-score; on scale of Schizophrenia – 47.6 ± 0.9 T-score; on scale of Hypomania – 49.9 ± 1.0 T-score. The patients of 2nd group had the such personality characteristics accordingly: on scale of Hypochondriasis - 58,1 ± 0,7 T-score (p < 0.01); on scale of Depression – 53.4 ± 1.1 T-score (p < 0.05); on scale of Hysterias – 55.4 ± 0.6 T-score (p < 0.01); on scale of Psychopathia Deviate – 46.9 ± 0.9 T-score (p >0.05); on scale of Paranoia – 55.0 ± 1.1 T-score (p < 0.05); on scale of Psychasthenia – 51.5 ± 1,0 T-score (p < 0.05); on scale of Schizophrenia – 51.3 ± 1.0 T-score (p < 0.05); on scale of Hypomania – 49.6 ± 0.9 T-score (p > 0.05).  Conclusion. The smoking  patients  with ischemic heart disease had less expressed accentuated personality characteristics and  lower  level of anxiety and depression, in comparison with nonsmoking  patients, that should be considered in treatment and rehabilitation.
Smoking and associated unhealthy lifestyle behaviours in patients with chronic cardiac diseases during COVID-19 related lockdown
Authors: Chague F , Boulin M , Eicher JC , Bichat F , Saint-Jalmes M , Cransac-Miet A , Trojak B , Soudry A , Danchin N , Laurent G , Cottin Y , Zeller M
Published: May 2021

Funding Acknowledgements

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

OnBehalf

CLEO-CD

Background

  Lockdown can affect tobacco smoking (TS) behaviours. 

Purpose

To evaluate the impact of lockdown on (TS) and associated lifestyle behaviours in patients with Chronic coronary syndrome (CCS) and congestive heart failure (CHF)

Methods

CCS and CHF patients were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown start 

Results

(Table) 343 questionnaires were fit for analysis, 43 (12.5%) were current smokers (CS). CS were younger (p < 0.001), none stopped and 13 increased their consumption (main reasons were stress and boredom). CS felt more often cramped (p = 0.023). CS who increased their TS consumption showed a trend toward a higher rate of unhealthy lifestyle behaviours

Conclusions

During the lockdown, more than ¼ of CS with CCS or CHF increased their TS consumption and none quitted. Moreover, TS was often associated with other deleterious behaviours increasing their risk for short and long term

Main results Total Non-Smokers Smokers p* N(%) 344 301 43 Age, years 67.7 ± 12.8 69.2 ± 12.2 57.2 ± 12.1 <0.001 Men/Women 229/115 197/104 32/11 0.300 CCS/CHF 220/124 185/116 36/7 0.004 Urban/Rural 163/181 137/164 26/17 0.073 Living alone at home 83(24.3) 68(22.7) 15(34.9) 0.089 COVID screening (PCR) 11(3.2) 7(2.3) 4(9.3) 0.037 Feeling cramped 19(5.5) 13(4.4) 6(14.0) 0.023 Feeling less well 75(21.9) 65(21.7) 10(23.8) 0.842 K6 ≥ 5 81(23.7) 70(23.5) 11(25.6) 0.845 Physical activity decrease 146(42.6) 125(42.1) 21(48.8) 0.323 Screen time increase 154(45.0) 130(43.5) 24(55.8) 0.100 Alcohol consumption increase 14(5.5) 11(4.9) 3(7.5) 0.419 Sleep change 83(24.6) 68(22.5) 15(39.5) 0.083 Weight increase 77(22.4) 64(21.3) 13(30.2) 0.242 Smokers (n = 43) Smoking increase No smoking increase p** Feeling less well 5(38.5) 5(17.2) 0.238 Screen time increase 10(76.9) 14(46.7) 0.104 Weight increase 6(46.2) 7(23.3) 0.173 n(%) or mean ± SD. *p value: Smokers vs non smokers. **p value: Smoking increase vs no smoking increase
Metabolic determinants of proximal aortic stiffness among healthy people with abdominal obesity
Authors: Tsaban G , Yaskolka-Meir A , Rinott E , Zelicha H , Kaplan A , Shalev A , Katz A , Shai I
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): (1) the Deutsche Forschungsgemeinschaft; (2) Israel Ministry of Health

Background

Increased proximal aortic stiffness (PAS) is directly associated with cardiovascular risk. Likewise, metabolic syndrome (MS) and abdominal obesity are associated with cardiovascular risk. The direct association between MS determinants and PAS among a healthy population with abdominal obesity remains to be examined.

Purpose

To examine the association between MS determinants and PAS among healthy participants with abdominal obesity.

Methods

We utilized the cross-sectional baseline data of the DIRECT-PLUS study (clinicaltrials.gov NCT03020186), where we recruited healthy participants with abdominal obesity/dyslipidemia. Along with anthropometric measurements and blood tests, all participants underwent magnetic-resonance-imaging from which PAS we assessed by calculating the aortic arch pulse-wave-velocity (from the ascending to the descending aorta). We defined MS according to the NCEP-ATP-III criteria.

Results

Of 282 participants who had a valid PAS estimation [mean-age: 51.0, 88.3% male, mean-body-mass-index: 31.2kg/m2, mean-waist circumference (WC): 109.5cm] 171 (60.9%) had MS. PAS was mainly associated with age (r = 0.735, p < 0.001). PAS was associated with an increased 10-year Framingham Risk Score (β=0.165,p = 0.008 after adjustment for age and gender). Participants with MS had higher PAS than non-MS participants (6.6m/sec vs. 5.4m/sec, p = 0.002 after adjusting for age and gender). PAS increased along with cumulative number of MS criteria (p-of-trend < 0.001). In multivariate models, adjusted for gender, age, and dichotomous-components of the MS, worse PAS remained significantly associated with high-density lipoprotein cholesterol (HDL-c; β=0.-116,p = 0.007) and increased blood-pressure (β=0.165,p < 0.001), but not with fasting-glucose, waist-circumference or plasma-triglycerides (p > 0.05 for all). In models adjusted for age, gender, and continuous determinants of MS, worse PAS remained associated with mean-arterial pressure (β=0.218,p < 0.001) and HDL-c (β=0.-126,p = 0.004).

Conclusions

Among a healthy population with abdominal obesity, reduced HDL-c levels and increased blood pressure might be the more dominant predictors of poor PAS state, out of the MS components.
High prevalence of unkown dysglycemia and chronotropic response to exercise in patients admitted in cardiac rehabilitation program
Authors: Abdennbi K , Mouine N , Vallee A , Duval M , Amah G , Gagey S , Guiti C , Blacher J , Valensi P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction : Some studies suggest a high rate of unknown glycemic abnormalities in coronary patients. The aim of the study was to determine the prevalence of dysglycemia detected by oral glucose load (OGL)  in patients ongoing Cardiac Rehab , and to analyse chronotropic response to exercise before and after Cardiac rehab in dysglycemic patients.

Patients and methods : We included 838 patients, mostly coronary patients after acute coronary syndrome, including 79% men and 375 were diabetics. OGL has been performed in non-diabetics and ergospirometry test performed in all patients before and after rehabilitation.

Results : At OGL, 189 of 463 non-diabetics (41%) had dysglycemia: Diabetes (n = 42 including 17 according to fasting glycemia), Glucose intolerance (GI) (n = 102 including 32 with fasting hyperglycemia (FH),  FH isolated (n = 45). We compared 417 patients with known or discovered diabetes, GI and 319 normoglycemic or FH. Diabetics were older and had a higher BMI than GI and normoglycemic-FH (p <0.001). Resting heart rate (HR) was higher and maximal HR on exercise is lower in diabetics than other 2 groups (p <0.001) without significantly differing between GI and normoglycaemia-FH. VO2max was lower in diabetics and GI than normoglycemic-FH s (p <0.001 and 0.01). After cardiac rehabilitation, resting HR is changed little, HR max and VO2max increased in 3 groups but kept the same inter-group differences

Conclusion :This data confirms the high prevalence of unknown dysglycemia and the importance of OGL  for their screening, especially in coronary patients. In diabetics, the higher resting HR and the lack of chronotropic reserve probably indicate autonomic dysregulation which partially improves after cardiac rehabilitation.
Predictive factors of erectile dysfunction in a cardiac rehabilitation programme. What can we improve?
Authors: Adeba Garcia A , Alvarez Velasco R , Vigil-Escalera Diaz M , Martin Fernandez M , Barriales Alvarez V , Persia Paulino YR , Flores Fuentes AY , Alvarez Asensio R , Cuevas Perez J , Aparicio Gavilanes A , Ledesma Odoriz D , Martinez Diaz J , Soroa Ortuno M , Hevia Nava JS
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Erectile dysfunction (ED) is a frequent comorbidity in patients with chronic coronary syndrome; it is related to both cardiovascular risk factors (CVRF), the treatments administered and the vascular disease itself. We analyse the predictors of ED in the cardiac rehabilitation unit of a third level hospital.

Material and methods

Observational and prospective cohort of male patients participating in the cardiac rehabilitation programme (CRP) between 2015 and 2019. This CRP lasts 1 month, with 3 weekly sessions of monitored and supervised exercise, in addition to talks related on the cardiovascular area, diet, etc. One of these sessions is on ED, in which the patient is asked about the entity, possible interactions with drugs, etc. In addition, the degree of ED is evaluated anonymously using the IIEF5 scale, in which 5 questions are used to evaluate different conditions of the disease by scoring from 1 to 5, with values of less than 21 being considered as ED. For the statistical analysis we carried out a multiple regression model adjusted by the clinical variables collected at the beginning of the programme.

Results

Out of a total of 343 patients 90% were male and 265 completed the questionnaire. 63% presented ED. The mean age is 56 ± 9 years. The distribution of CVRF: 43% hypertense, 23% diabetics, 72% dyslipemia, 22% ex and 48% smokers. As for the diagnoses prior to the start of CRP, 59% suffered from STEMI, 22% from NSTEMI, 9% from unstable angina and 9% were post-operative from cardiac surgery. In the global multiple regression model the factors predisposing to ED and presenting statistically significant coefficients were age (-0.2 CI: -0.27- -0.12, p < 0.001), hypertension (-1.6; CI -2.9- -0.3, p = 0.014) and diabetes (-2.0 CI: -3.1- -0.6, p = 0.007). We performed a predictive model for the different age ranges according to the presence/absence of hypertension and diabetes (Figure 1).

Conclusions

ED is a prevalent entity in our series, with age-adjusted multivariate analysis predicting its development and hypertension and diabetes as potentially modifiable factors related to it.

Abstract Figure. Graph 1: Predictive regression model
The talk test"s responsiveness to an 8-week exercise-training program in cardiovascular disease patients
Authors: Martins EM , Silveira LS , Ribeiro GS , Vieira AM , Roque ABAO , Mortimer FM , Benetti M , Karsten M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Talk test (TT) is an alternative and accessible tool for prescribing and monitoring aerobic training intensity. Although the TT is reliable and valid for cardiorespiratory assessment, its responsiveness to exercise training remains unexplored.

Purpose

To evaluate the responsiveness of TT in cardiovascular disease (CVD) patients who underwent an exercise training program.

Methods

Twenty-one CVD patients (61.7 ± 8.4 years) performed an exercise-training program on phase II of cardiac rehabilitation (45-min 3-times a week). The six-minute walk test (6MWT) and TT were done to assess functional capacity at baseline and after 8 weeks. In the individualized TT the treadmill’s speed and/or grade were increased every 2-min, with speed changes based on a reference equation for the 6MWT distance (6MWD). The subjects were asked to read a 38 words standard paragraph at the last 30s of each stage and to answer if they could talk comfortably. Answer options were i) YES (TT+), ii) UNCERTAIN (TT±), or iii) NO (TT-). The first ventilatory threshold (VT1) was identified by two reviewers using the heart rate variability analysis. A paired t-test was applied to analyze the TT duration and 6MWD. The VT1 and TT workload were analyzed by the Wilcoxon test. Spearman correlation was adopted to compare the TT± and VT1 stages.

Results

Improvement in the VT1 (2.9 ± 1.2 vs 4.4 ± 1.4 min; p < 0.001), duration (12.1 ± 4.4 vs 14.9 ± 5.2 min; p < 0.001), workload at TT- (67.8 ± 48.4 vs 104.5 ± 65.9 w; p < 0.001), and in the 6MWD (471.5 ± 100.3 vs 533.7 ± 92.9 m; p < 0.001) were observed. There was strong correlation between TT± and VT1 in pre (r = 0.613; p < 0.05) and post-rehabilitation (r = 0.678; p < 0.05).

Conclusion

Talk test performed on a treadmill showed responsiveness after eight weeks of exercise training, being sensitive to the physiological changes provided by the rehabilitation program in CVD patients.
Cardiac rehabilitation and secondary prevention in COVID-19 times: Single center experience
Authors: Burazor I , Spiroski DS , Terzic J , Otasevic P , Babic R , Nikolic A , Ilic I , Loncar G , Cosic Z , Colic M , Rihor B , Andjic M , Bojic M , Davos D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR) is a class I treatment for cardiovascular disease, still, underutilization of these services remains. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has been present.

Purpose and methods

We aimed to present the cardiac rehabilitation during COVID 19 times in Belgrade. At the beginning of epidemic in Serbia the number of patients in in-house city program was 70 out of 70 beds, with 200 patients who were scheduled (on the waiting list). Similarly to the other countries, we continued to admit only urgent patients with acute coronary settings.

Results

Only one PPCI center in Belgrade (2 million inhabitants plus surrounding area; out of five centers) continue to admit COVID-negative patients with STEMI from 13of March to 11 of May, during the first pick of COVID-19 epidemic in Serbia. Out -patients cardiac rehabilitation programs were stopped. The totals of 80 patients (PCR negative) were transferred to exercised based cardiac rehabilitation secondary prevention program during the first pick of epidemic directly from acute hospital. The majority of patients were males in their 50s. All risk factors were noted and patients were with much less risk factors compared to non- epidemic era. Lipid profile was measured. Six minutes walking test was performed at the beginning and exercise plan was made. Unfortunately, exercise based three weeks in- house cardiac rehabilitation was completed in only 1% of patients while others quite the program.

Conclusion

The COVID-19 pandemic presents a time to highlight the value of home-based models as we search for ways to continue to provide care. Standardization of home based CR models is essential to provide care for a wider range of patients and circumstances in the near future.
Fit, Female or Fifty - is cardiac rehabilitation fit for purpose? A systematic review and meta-analysis with meta-regression
Authors: Smith M , Orchard JJ , La Gerche A , Gallagher R , Fitzpatrick J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention, aimed to address modifiable risk factors for coronary artery disease. It is recommended worldwide for patients following myocardial infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery. A growing body of evidence points towards a lack of uptake in CR in females and younger people.

Purpose

To examine the effectiveness of contemporary CR programs and assess whether they cater for all patients regardless of age, gender and prior level of fitness, via systematic review, meta-analysis and meta-regression.

Methods

MEDLINE was examined for studies involving exercise prescription or CR following MI, PCI and cardiac surgery from January 2010 to May 2020. RCTs and cohort studies of ≥10 patients were included for programs delivering phase II or III CR. Primary outcome measures were peakVO2max, 6-minute walk test (6MWT) and Metabolic Equivalent of Task (METs). Data were extracted using random effects meta-analysis. Epidemiological data were analysed for age, proportion of males to females and prior level of fitness. Baseline level of fitness was assessed by peakVO2max, 6MWT and METs values on entry into CR programs. Meta-regression was then used to determine change in fitness and the influence of age or gender.

Results

Thirty-three of the 713 studies (13 RCT, 20 cohort) were eligible and included in the review. Participants had a mean age of 60.0 years and 6/49 (12%) of study groups had a mean age <55 years. Male participants comprised 81.9% of those who completed CR and 41/58 (71%) participants were below average for cardiorespiratory fitness (CRF) when compared to normative values for those aged 60-69 years on entering CR.

CRF improved in all study groups by the end of CR programs (mean improvement in peakVO2 3.3mL/kg/min, 6MWT 90.8m and METs 1.7). Meta-regression analysis showed that males were more likely to have an increase in 6MWT distance compared to females (mean difference 3.16m (95% CI 0.44-5.89). However, gender and age did not independently affect peakVO2max or METs.

Conclusion

CR following MI, PCI or cardiac surgery improved mean CRF in all study groups. While males were more likely to show an improvement in 6MWT there was no appreciable difference in effect in other outcomes after controlling for age or gender differences.

Females, younger people and those of average or above CRF appear to be under-represented in data and attendance at cardiac rehabilitation. Given that CR outcomes are equal across gender and age, more effort should be made to encourage female and younger patients to attend. A ‘Precision Medicine’ model of exercise prescription may assist in this aim.
Preventive counseling with subsequent remote support does not further improve the quality of life after catheter ablation of atrial fibrillation
Authors: Pogosova N , Ovchinnikova AI , Yufereva YM , Sokolova OY , Davtyan KV , Arutyunov AA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is associated with substantially reduced quality of life (QoL). Both catheter ablation (CA) and education have a potential to improve QoL in AF patients (pts). 

Purpose

To assess the impact of preventive counseling with long-term support on QoL in pts after CA performed for paroxysmal AF.

Methods

A prospective randomized controlled study with 2 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1) into 2 groups. Before discharge, both groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge pts from intervention group received biweekly preventive counseling via email for 3 months (6 sessions). Control group received usual care. QoL was assessed at baseline and at 12 months using SF-36 questionnaire.

Results

A total of 90 pts aged 35 to 80 years were enrolled (mean age, 57.4 ± 9.9 years, men, 52.2%). Both groups had a poor QoL at baseline, and both groups experienced improvement in the physical health component at 1 year, but the degree of this improvement in the intervention group was similar to the control (table).

Conclusions

Preventive counseling with remote support via email does not further improve QoL in AF pts after CA.

Intervention group Control group P Integral component of physical health Baseline (points) mean ± SD 44.1 ± 7.9 40.2 ± 8.7 0.028 Mе (25%; 75%) 44.5 (38.7; 50.1) 38.6 (34.4; 47.1) At 12 months (points) mean ± SD 49.4 ± 6.0* 45.7 ± 7.7* 0.010 Ме (25%; 75%) 51.0 (45.2; 53.9) 46.3 (42.4; 50.6) Δ% after 12 months, Ме (25%; 75%) 11.8 (1.4; 32.7) 18.7 (-0.3; 30.4) n/s Integral component of mental health Baseline (points) mean ± SD 46.1 ± 9.0 45.0 ± 8.4 n/s Mе (25%; 75%) 47.8 (39.1; 53.9) 48.0 (37.2; 52.0) At 12 months (points) mean ± SD 48.2 ± 8.1 46.8 ± 8.7 n/s Ме (25%; 75%) 50.1 (46.1; 53.6) 48.0 (41.0; 54.3) Δ% after 12 months, Ме (25%; 75%) 3.6 (-10.8; 32.6) 8.9 (-15.6; 30.8) n/s * p <0.001 vs baseline
The effects of different preventive counseling programs on physical activity in patients with paroxysmal atrial fibrillation after catheter ablation
Authors: Pogosova N , Ovchinnikova AI , Ovchinnikova AI , Yufereva YM , Yufereva YM , Sokolova OY , Sokolova OY , Davtyan KV , Davtyan KV , Arutyunov AA , Arutyunov AA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Physical activity (PA) is associated with lower risk of all-cause death in atrial fibrillation (AF), so interventions to increase PA in AF patients (pts) has a potential to improve their outcomes.

Purpose

To assess the impact of different preventive counseling programs on PA in pts after catheter ablation (CA) of paroxysmal AF.

Methods

A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. PA was assessed using the International Questionnaire on Physical Activity (IPAQ) at baseline and after 12 months.

Results

A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features and PA level. The baseline proportion of pts with sufficient (moderate or high) PA was high in all 3 groups (86.6%, 88.9% and 91.1%, respectively). At 1 year of follow-up both intervention groups had a significantly higher proportion of pts maintaining high PA levels vs control (table). 

Conclusions

Preventive counseling programs combining in-hospital and remote counseling via phone or e-mailsupport higher physical activity levels in AF pts after CA.

Different counseling programs and PA Levels of physical activity 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 Months P for Group 2 vs. control at 12 Months Baseline After 12 months Baseline After 12 months Baseline After 12 months Low,% 13.3 2.2 11.1 0 8.9 2.2 n/s n/s Moderate,% 62.2 71.1 71.1 82.2 60 93.3 <0.01 n/s High,% 24.4 26.7 17.8 17.8 31.1 4.4 <0.005 <0.05
Left ventricular remodeling: is there a real impact of cardiac rehabilitation?
Authors: Cunha NPD , Aguiar-Ricardo I , Rodrigues T , Silverio Antonio P , Couto Pereira S , Alves Da Silva P , Valente Silva B , Brito J , Pinto R , Lemos Pires M , Borges M , Jordao A , Rodrigues C , Pinto FJ , Abreu A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive. 

Purpose

Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram. 

Methods

Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP.

Results

205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) <40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%). 

After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF < 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device. 

Conclusions

A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.
The prevalence of short PR interval in adolescent athletes and non-athletes
Authors: Abela M , Grech N , Degiorgio S , Xuereb R , Xuereb S , Yamagata K , Bonello J , Fleri Soler J , Buttigieg L , Camilleri W , Burg M , Sammut MA , Felice T , Grech V , Papadakis M
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Malta Heart Foundation and Beating Hearts

Background

Little is known about the prevalence and clinical relevance of an isolated short PR interval in young individuals.

Objectives

To explore the PR interval in adolescent athletes and non-athletes and determine possible association with sex, age, ethnicity, athletic ability and sporting discipline.

Methods

Between 2017-2018, school children aged 14-17 years were invited to participate in a National cardiac screening programme comprised of a health questionnaire and a resting 12-lead ECG. An athlete was defined as an individual participating in >4 hours/week of organised sports. Sport disciplines were categorised as skill, power, mixed and endurance. A short PR interval was defined as <120ms.

Results

A total of 1619 (61.0%) non-athletes and 1036 (39.0%) athletes  (median age 15 years, 50.5% females, 93.0% Caucasian) participated in the screening program. Most athletes participated in mixed sports (62.2%).

The mean PR interval was shorter in non-athletes compared to athletes (136.65 ± 19.00ms vs 139.93 ± 19.86ms p < 0.001) and in females compared to males (135.98 ± 18.39ms vs 139.93 ± 20.20ms, p < 0.001). An isolated short PR interval was present in 405 (15.3%) individuals. Associated pre-excitation was present in an additional 5 cases (0.2%). A short PR interval was commoner in females (18.7% vs 11.7%, p < 0.001) and in non-athletes (16.6% vs 13.2%, p = 0.020). Age (p = 0.657) and ethnicity (p = 0.115) did not influence the presence of a short PR interval.

The presence of a short PR interval in adolescent athletes was independent of the sporting discipline category (p = 0.071), in both males (p = 0.400) and females (p = 0.233).  The absolute PR interval did not differ significantly between sporting categories (p = 0.065),  in both genders (males, p = 0.202, females, p = 0.279).

Symptoms that were suggestive of arrhythmias were present in similar proportions of individuals with short and normal PR intervals (18.8% vs 17.1%, p = 0.393). 

Conclusion

An isolated short PR interval was a frequent finding in this cohort, with a predilection for females and non-athletes. The high frequency of short PR in young individuals suggests that in the absence of pre-excitation or symptoms, further evaluation is not warranted. Long-term follow-up studies may further elucidate the clinical relevance of this phenomenon.
Causes of sudden cardiac death in young athletes and nonathletes: systematic review and meta-analysis
Authors: D"ascenzi F , Valentini F , Pistoresi S , Frascaro F , Pietro P , Cavigli L , Focardi M , Cameli M , Bonifazi M , Metra M , Mondillo S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. The etiology of sudden cardiac death (SCD) in young people is still debated. The aim of this meta-analysis was to identify the most frequent causes of SCD in individuals aged ≤35 years, the differences between athletes and nonathletes and among geographic areas.

Methods.  Studies published between 01/01/1990 and 01/31/2020 and evaluating post-mortem the etiology of SCD in young individuals (≤35 years) were included. Individuals were divided in athletes and nonathletes. Studies that did not report separately data between athletes and nonathletes were excluded.

Results. Thirty-four studies met the inclusion criteria and a total population of 5,060 victims of SCD were analysed (2,890 athletes, 2,170 nonathletes). Structurally normal heart, hypertrophic cardiomyopathy (HCM), idiopathic left ventricular hypertrophy, and anomalous origin of coronary arteries (AOCA) were the most frequent causes of SCD in athletes while coronary artery disease (CAD), arrhythmogenic cardiomyopathy (ACM), and channelopathies were frequent causes of SCD in nonathletes. The number of SCDs due to ischemic heart disease (19.6% vs. 9.1%, p = 0.009), ACM (11.5% vs. 4.7%, p = 0.03) and channelopathies (8.4% vs. 1.9%, p = 0.02) was higher in nonathletes comparing with athletes. SCD due to non-ischemic left ventricular scar (5.1% vs. 1.1%, p = 0.01) was more frequent in athletes. HCM (p = 0.01) and AOCA (p = 0.004) were more frequently cause of SCD in US while ACM (p = 0.001), structurally normal heart (p = 0.02), and channelopathies (p = 0.02) in Europe.

Conclusions. Structurally normal heart, HCM, AOCA were frequent causes of SCD in athletes while CAD, ACM and channelopathies in nonathletes. The causes of SCD differ between US and Europe.
The impact of image and performance enhancing drugs on bi-ventricular structure and function in strength-trained athletes and the association to fat-free mass
Authors: Morrison B , Chester N , Mcgregor-Cheers R , Kleinnibbelink G , Johnson C , Harrison J , Stansfield B , Henney A , George K , Warburton D , Mckinney J , Sculthorpe N , Cooper R , Fairbairn T , Oxborough D
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Canadian Institute of Health Research Michael Smith Foreign Study Supplement

Background

Image and performance enhancing drugs (IPED) cause cardiac enlargement and dysfunction. Previous work has not assessed impact of user status (current [CU] vs. past [PU]) or allometric scaling cardiac dimensions for individual differences in fat-free mass (FFM).

Purpose

To investigate CU and PU of IPED and allometric scaling on LV and RV remodeling in strength-trained athletes.

Methods

Thirty-four (29 ± 6 years; 82% male) strength-trained athletes were recruited. Fourteen were CU, 9 PU and 11 non-users (NU) of IPEDs.  Participants underwent bioelectric impedance body composition analysis, IPED and training questionnaire and 2D echocardiography with strain imaging. All structural data was allometrically scaled to FFM according to the laws of geometric similarity.

Results

CU and PU had significantly higher FFM compared to NU (82.4 ± 10.1 kg vs. 72.0 ± 6.3 kg vs. 58.2 ± 14.0 kg). Absolute values of all RV and LV size were larger between CU and NU. LV mean wall thickness (MWT) was larger in CU compared to PU but there were no differences between PU and NU. Allometric scaling eliminated all differences with exception of LV mass and LVMWT. LVEF was significantly lower in CU and PU compared to NU (55 ± 3 vs. 57 ± 4 vs. 61 ± 4) whilst LV GLS was lower in CU compared to PU and NU and LV GCS was lower in CU compared to NU but not PU. There was no significant difference between groups for RV functional indices.

Conclusion

 Strength-trained athletes currently using IPEDs have bi-ventricular enlargement as well as reduced LV function. Allometric scaling highlights that increased size is partially associated with a larger FFM, with exception of LVMWT which is independently increased through IPED use. PUs demonstrate reverse structural remodeling whilst functional differences partially remain.

CU PU NU RVD1 (mm) 45 ± 5* 43 ± 6 37 ± 6 Scaled RVD1 (mm/kg^0.33) 10.5 ± 0.9 10.4 ± 1.5 9.7 ± 1.0 LVd (mm) 58 ± 7* 55 ± 4 50 ± 4 Scaled LVd (mm/kg^0.33) 13.4 ± 1.2 13.3 ± 0.7 13.1 ± 0.6 MWT (mm) 10 ± 1*” 8 ± 1 8 ± 1 Scaled MWT (mm/kg^0.33) 2.3 ± 0.2*” 2.0 ± 0.1 2.0 ± 0.2 LVEDV (ml) 169 ± 42* 135 ± 28 116 ± 28 Scaled LVEDV (ml/kg) 2.0 ± 0.4 1.9 ± 0.3 2.0 ± 0.2 LV Mass (g) 255 ± 85*” 179 ± 30 137 ± 40 LV mass index (g/kg) 3.1 ± 0.8* 2.5 ± 0.3 2.4 ± 0.4 * CU and NU “ CU and PU ^ PU and NU

Abstract Figure. Myocardial strain imaging