bluuebunny/crossref_metadata_2025 huggingface dataset:
Indexed right and left atrial volumes together provide incremental value more than left atrium volume alone in af patients
Authors: Boyuk F , Wenli G , Zhu C , Zhang J , Yan C , Wu M , Yiu K H
Published: June 2024

Background

Atrial fibrillation is the most common rhythm disorder in the world. Determining the pathoanatomical effects of atrial fibrillation will enable us to better understand the disease process.

Purpose

According to our hypothesis, adding indexed right atrial volume parameters to the indexed left atrial volume measurement can provide incremental information.

Method

A total of 416 patients were included in the study. After the diagnosis of atrial fibrillation, in addition to routine echocardiographic parameters, Indexed Systolic Left Atrial Volume Area Length (LA Esv AL), Left Atrial Volume Simpson (LA Esv Mod), Indexed Systolic Right Atrial Volume Area Length (RA Esv AL), Right Atrial Volume Simpson (RA Esv Mod) measurements were also performed . Patients have been followed about 12 years from the index case. Cluster analysis was performed according to similarity of echocardiographic parameters and demographic parameters. As a result of the analysis, patients were divided into two clusters. The cut-off values of the variables (age and echo parameters) that were significant between clusters were analyzed with ROC curve. Youden J index was used to determine cut-off values. Hazard Ratio was calculated by performing Cox regression analysis for death, heart failure and stroke according to the determined cut-off values.

Results

A total of 413 patients were included in the study (mean age 69.93± 12.14 years). The average follow-up period was 10 years. 281 patient experienced adverse event (death, stroke, heart failure). After adjustment several parameters (age, LVEF and comorbidities ) enlargement of LA Esv Mod and RA Esv Mod together was associated with stroke than one atrial enlargement alone (Picture 1); adjusted HR, 4,31 [95% CI, 2,03-9,17; P < .001] , for death; LA Esv AL and RA Esv AL was associated with endpoint (Picture 2); HR, 6,41 [95% CI, 4,03-10,2; P < .001] , for heart failure LA Esv AL and RA Esv AL was associated with end point; HR, 7,26 [95% CI, 4,33-12,19; P < .001]. LA and RA volume enlargement was found better predictiv than LA atrial volume alone.

Conclusion

In patients with atrial fibrillation, left atrial enlargement accompanied by right atrial enlargement are associated with long-term poor outcomes. This study shows that indexed right atrial volume measurement has an incremental value when combined with the left atrial volume measurement in patients with atrial fibrillation.
Does endothelial function differ among sexes in patients with diabetes or kidney disease?
Authors: Renier M , Michielsen M , Vandecruys M , Decorte E , Van Craenenbroeck A H , Cornelissen V
Published: June 2024

Background/introduction

Endothelial dysfunction is a known driver of disease progression in both type 2 diabetes mellitus (T2DM) and kidney disease. Brachial artery flow-mediated dilation (FMD), representing endothelium-dependent nitric oxide-mediated dilation in response to increased shear stress, is considered gold standard to quantify macrovascular dysfunction non-invasively. As evidence is mounting that men are more likely to suffer from macrovascular dysfunction than women, we hypothesized that this would be reflected in patient populations with T2DM and/or kidney disease.

Purpose

To assess gender differences in macrovascular dysfunction, as measured by FMD, in patients with T2DM and/or kidney disease.

Methods

Preliminary baseline data was collected from two ongoing randomized controlled trials in patients with T2DM and in kidney transplant recipients (KTRs) 3 months post-transplantation. FMD was assessed with the semi-automated UNEX EF device under standardized conditions. Biochemical analyses were done using routine techniques. Images were manually analyzed by a single researcher (MR) using PCAnalysis software (version 1.0.14).

Results

Twenty-six subjects, 13 with T2DM and 12 KTRs were included. As expected, patients with T2DM had a higher BMI, higher HbA1c but higher eGFR compared to KTRs (Table 1). Compared to KTRs, patients with T2DM presented with a significantly worse FMD (FMD= 4.50% [IQR=5.77] vs 10.88% [6.48]). Overall, no significant difference in FMD between men and women was found (p=0.11), but higher values could be observed in females (FMD= 9.08% [IQR=6.97] vs 4.50% [7.88]). As depicted in Figure 2 this tendency was also observed in the two subgroups: KTR (M: FMD = 9.07% [IQR=9.62] | F: 11.92% [ 5.16]) and T2DM (M: FMD = 3.90% [IQR=5.00%] | F: 07.09% [6.83]).

Conclusion(s)

Although no significant differences in vascular function between sexes were detected, our preliminary data showed a tendency for higher FMD-values in women; both in T2DM and KTRs. This supports the statement that male subjects seem to suffer more from macrovascular dysfunction. Further research is needed to elucidate the underlying pathways via which sex impacts the disease process in T2DM and kidney disease and to evaluate how personalized preventive lifestyle measures might differentially impact on outcome.
Peak oxygen uptake impairment in childhood cancer survivors treated with anthracycline-based chemotherapy: a systematic-review and meta-analysis
Authors: Fyfe E , Weinkauf K , Hewitt D , Wang J , Kennedy M , Pituskin E , La Gerche A , Haykowsky M J , Foulkes S
Published: June 2024

Background

Exposure to cardiotoxic therapies such as anthracycline chemotherapy places childhood cancer survivors (CCS) at markedly increased risk of heart failure and cardiovascular mortality. Peak oxygen uptake (VO2peak) is an objective marker of cardiovascular function that is a strong predictor of incident heart failure and cardiovascular mortality. However, the degree of VO2peak impairment in CCS is yet to be definitively established.

Purpose

To perform a systematic review and meta-analysis comparing VO2peak and cardiac function in CCS treated with anthracycline chemotherapy versus age-matched non-cancer controls (CON).

Methods

A systematic search was performed using Embase, Scopus, MEDLINE, CINAHL and SPORTDiscus databases to identify cross-sectional studies comparing VO2peak (primary outcome) and resting cardiac function in CCS versus CON. Studies were included if i) participants were childhood cancer survivors (≤18 years old when cancer was diagnosed) exposed to anthracycline-based chemotherapy; ii) assessments were performed after completing adjuvant therapy; iii) reported VO2peak assessed from a maximal exercise test with expired gas analysis. Studies were excluded if they i) reported no original data; ii) did not include a healthy non-cancer control group; iii) reported duplicate data; iv) were not available in English. Values for CCS and CON were compared using a fixed-effects model, with results reported as weighted mean differences (WMD) with 95% confidence interval (95% CI) for the difference between CCS relative to CON. Heterogeneity was determined using the I2 statistic.

Results

2026 studies were identified, of which 18 unique case-control studies reporting peak VO2 in CCS (n=786, 44% female, mean age: 16 yrs, mean time post-therapy: 2.7 yrs) and CON (n=1379, 50% female, mean age: 16 yrs) were included in the meta-analysis. Childhood cancer survivors had markedly lower VO2peak (WMD: -7.08 mL/kg/min; 95% CI: -7.75 to -6.42, I2: 79%). Resting left-ventricular ejection fraction (LVEF) was the only measure of cardiac function with a sufficient number of studies for meta-analysis (n=5 studies). In contrast to VO2peak, there was only a small decrement in resting LVEF (WMD: -1.6%; 95% CI: -2.6 to -0.6; I2: 49%), and the mean resting LVEF for CCS was in the normal range in all studies (Range: 61.4% to 72.0%).

Conclusion

Despite negligible differences in resting cardiac function, CCS have a marked reduction in VO2peak that may explain their increased risk of heart failure and cardiovascular mortality. Incorporating measures of VO2peak into cardiac surveillance may improve the identification of CCS at risk of future cardiovascular events who may benefit from therapies (eg. exercise-based cardiac rehabilitation) to address impairment in VO2peak. Figure 1Pooled results for VO2peak  Figure 2Pooled results for resting LVEF
Cardiovascular risk factors among undocumented and documented Chinese immigrants living in Italy
Authors: Pellegrino A , Calabrese M , Vacirca I , Boddi M , Modesti P A
Published: June 2024

Background

Cardio-metabolic diseases are highly prevalent among ethnic minority groups in Europe. However, information on health needs of undocumented immigrants, especially regarding risk factors, are lacking.

Purpose

To investigate prevalence, awareness and treatment of hypertension, diabetes mellitus, and hypercholesterolemia in a large cohort of undocumented and documented (registered with National Health Service, NHS) Chinese immigrants living in Italy.

Methods

Present study was a population-based, cross-sectional study. Chinese first-generation immigrants of a community resident in Italy underwent blood pressure (BP) measurement, blood tests (fasting glucose, FG, and total cholesterol, TC), and anthropometric measurements. Hypertension was diagnosed for BP≥140/90 mmHg at two visits, and/or BP-lowering medication use; type 2 diabetes for FG≥126 mg/dL at two visits, and/or glucose lowering drugs use; hypercholesterolemia for TC≥240 mg/dL and/or statins use. Undocumented and documented immigrants were compared via logistic regression analysis adjusted for age, sex, central obesity, and education level.

Results

A large proportion of investigated Chinese immigrants (3435) were undocumented (1766, 51% with 1669, 49% registered with NHS). At logistic regression analysis, prevalence of hypertension was similar between the two groups, while prevalence of diabetes and hypercholesterolemia was higher among undocumented immigrants, despite having a younger age and a lower prevalence of central obesity. Registration to NHS was associated with a higher awareness and prevalence of treated subjects for hypertension and diabetes. More precisely, registered immigrants were 6 times more treated for type 2 diabetes than undocumented migrants. A small minority of subjects were treated with statins independently of NHS registration.

Conclusion

Undocumented immigrants seem to represent a large proportion of the Chinese immigrant population living in Italy. They had lower levels of awareness and rate of treatment for hypertension and type 2 diabetes than immigrants registered with the NHS. Acute treatment for stroke and myocardial infarction is guaranteed to all subjects regardless of NHS registration in Italy as in the majority of European countries. Health policies targeting this hard-to-reach population must be improved.
Effectiveness of chronic disease self-management program for older adults with cardiovascular disease
Authors: Olszewski R , Watros K , Brzezinski J , Manczak M , Owoc J , Dobrucka I , Borkowska A , Majka K , Jaciubek M , Jeziorski K
Published: June 2024

Background

As the population ages, the prevalence of chronic diseases such as cardiovascular disease (CVD) is expected to increase significantly. Non-pharmacological methods are increasingly being sought to manage cardiovascular disease in the presence of other chronic diseases. The Chronic Disease Self-Management Program (CDSMP) originating over at Stanford University is a group-based education and support program that teaches people with chronic diseases how to manage their conditions and improve their quality of life.

Purpose

Evaluation of the effectiveness of the 6-week CDSMP workshops among individuals with CVD and chronic illnesses as well as the identification of potential areas for improvement and dissemination of the program.

Methods

The effectiveness of the workshops was assessed by conducting surveys before the workshops and immediately after the end of the 6-week workshops. The following tools were used to assess the effectiveness: visual analogue scale VAS for the level of pain, fatigue and sleep problems, Mini-COPE questionnaire, The Patient Health Questionnaire (PHQ-9) and the Chronic Disease Self-Efficacy Scales developed by the authors of the program. The results are presented as median and interquartile range (IQR). The Wilcoxon signed-rank test was used to analyze the values before and after the workshops.

Results

A 64-pts with CVD (60% hypertension) a mean age of 70 years. The participants were predominantly female (90%) and male (10%).The study proved the effectiveness of the workshops. All three indicators measured on an analogue scale improved after 6 weeks of workshops. Pain level decreased from 5 (IQR: 2-6) to 3 (IQR:1-5), p=0.022; fatigue level decreased from 6 (IQR: 4-8) to 5 (IQR: 3-6), p=0.052 and sleep problems from 6 (IQR: 2-7) to 3 (IQR: 1-5), p <0.001. In the Mini-COPE questionnaire, the greatest change was noted in the ability of looking for advice and help from others (p=0.009). There was also a statistically significant decrease in the overall PHQ-9 value: before the workshops the median was 7 (IQR: 3-11), and after the workshops 6 (IQR: 3-9), p=0.034. As for the Chronic Disease Self-Efficacy questionnaire, participants achieved the greatest benefits in the domains of: disease management at a general level, coping with symptoms of the disease and coping with difficult emotions and depressive moods.

Conclusion

The CDSMP can be a valuable tool for managing these complex issues and improving the health and well-being of older adults with CVD and chronic illnesses.
Association of exercise blood pressure response with subclinical abnormalities of cardiac remodeling and function in middle-aged women
Authors: Piche M , Paquin A , Gigleux I , Premont C , Marin-Couture E , Mathieu M A , Neyron A S , Couture P , Despres J P , Lamarche B
Published: June 2024

Background/Introduction

Hypertension is the most common risk factor in women and confers the highest risk for developing heart failure among women. Hypertensive response to exercise (HRE) is observed in individuals with normal resting blood pressure (BP). An excessive elevation of systolic BP (SBP) during exercise has been independently associated with future hypertension and the development of heart failure. However, limited evidence exists on the associations of exercise SBP response and subclinical abnormalities of cardiac remodeling and function in women.

Purpose

We examined the association between the SBP response to exercise and parameters of subclinical cardiac remodeling and function in middle-aged women.

Methods

150 normotensive women with abdominal adiposity (waist circumference >80 cm) and without cardiac condition were recruited. None were treated for BP. Anthropometric, metabolic and echocardiographic data were collected. Exercise BP was assessed during a maximal exercise treadmill test. All exercising BP measurements were collected manually using standard auscultatory methods according to current guidelines. HRE was defined as ≥90th percentile from age- and sex-specific normative data. Standard echocardiography and speckle tracking echocardiography were obtained.

Results

A total of 126 women (66% menopausal) aged 54 ± 11 years and pre-test resting SBP of 114 ± 9 mmHg were included. Women with HRE (n=30, 24% of women) had similar age and BMI compared to women without HRE (p>0.05). Waist-to-hip ratio and resting SBP (118±8 vs 112±9 mmHg) were higher in the HRE group (p<0.05). Exercise duration and metabolic equivalents were comparable between women with or without HRE (p>0.05). Abnormalities of cardiac remodeling (increased left ventricular (LV) wall thickness and LV mass) were found in women with HRE (p<0.01). No difference was between groups observed for parameters of diastolic function (mitral velocities and the E/A ratio, left atrial dimension, and the E/E' ratio) and systolic function (LV global longitudinal strain) after adjustment for age (all p>0.05). In univariate analyses (all women), maximal SBP was significantly associated with pre-test resting SBP, LV wall thickness, and LV mass, all p<0.01). In multivariate analyses, maximum exercise SBP remained independently associated with cardiac remodeling indices (p<0.01).

Conclusion

Normotensive women with abdominal obesity and exaggerated exercise BP response are more likely to have adverse cardiac remodeling, which may predispose toward the development of heart failure. An excessive exercise BP in women may be an inexpensive screening tool to identify women at highest risk for developing future hypertension and heart failure.
Age-standardized comparison of cardiovascular events and all-cause mortality in people living with HIV and in general population
Authors: Camps-Vilaro A , Teira R , Subirana I , Domingo P , Curran A , Galindo M J , Montero M , Romero A , Guerri R , Degano I R , Marrugat J
Published: June 2024

Background

Antiretroviral therapy (ART) has improved the prognosis of HIV infection, but people living with HIV (PLWH) still experience disparities in life expectancy and comorbidities prevalence.

Purpose

This study aimed to compare the standardized incidence rates of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality between PLWH and the general population in Spain.

Methods

Two cohorts were included: the VACH cohort (PLWH) and the REGICOR cohort (general population). Participants aged 25-74 years without prior ASCVD were followed for a duration of 15 years. Baseline data on demographics, cardiovascular risk factors, and comorbidities were collected. Fifteen-year ASCVD incidence [coronary artery disease (CAD) and stroke] and all-cause mortality rates were standardized by age. Incidence of ASCVD and all-cause mortality were compared between the cohorts using the log-rank test and Cox proportional hazards models. All the analyses were stratified by sex and age groups (25-54, and 55-74 years).

Results

We included 10,218 general population participants and 6,829 PLWH. PLWH were 12 years younger, predominately male, and they had elevated triglyceride levels and a higher incidence of smoking compared to the general population. In contrast, they had lower levels of LDL cholesterol, total cholesterol, and BMI. Men with HIV aged 25-54 years had significantly higher ASCVD standardized incidence rates compared to men in the general population. No significant differences were observed in old men and young women in incidence rates. Both young men and women with HIV had significantly higher all-cause standardized mortality rates compared to the general population (Table 1). After adjusting for ASCVD risk factors, no significant difference remained in the risk of CAD and stroke among PLWH and the general population. However, the adjusted risk of all-cause mortality was 3-5 times higher in PLWH (Table 2).

Conclusion

The higher incidence of ASCVD among PLWH as compared to general population is explained by differences in the prevalence of risk factors. All-cause mortality risk in young PLWH, however, was almost three times higher that of general population.
Feasibility exergaming as a physical activity for older adults: a systematic literature review
Authors: Klompstra L , Stromberg A , Jaarsma T , Rytterstrom P
Published: June 2024

Background

Physical activity among older adults is important for both primary and secondary prevention of cardiovascular disease (CVD). Increases in physical activity by any level are associated with reduced cardiovascular risk, and physical activity contributes to overall well-being by managing risk factors, enhancing cardiovascular function, and supporting a healthy lifestyle for individuals already affected by CVD.

Exercising with virtual reality technology has the potential to improve physical activity. Exergaming (a combination of exertion and video games) has an effect equivalent to other types of exercising on improving walking distance in older adults. To implement exergaming in cardiovascular care of general prevention of CVD feasibility for older adults using exergaming should be considered.

Purpose

To assess the feasibility of exergaming in older adults based on the experiences of acceptability, demand, implementation, and practicality of exergames.

Methods

A systematic literature review based on qualitative research. We assessed 4 online electronic databases (PubMed, Scopus, CINAHL and Web of Science) in December 2023 for peer-reviewed literature. The following search string was utilized across the databases: ((exergames OR exergaming OR active AND video AND games) AND (experiences OR perceptions OR attitudes OR views) AND (qualitative AND research OR qualitative AND study OR qualitative AND methods OR interview) AND (elderly OR aged OR older OR elder OR geriatric)).

Results

In total 158 articles were identified by the databases, whereof 31 were included in the analysis (see figure).

Acceptability: Participants found exergaming enjoyable, especially with social interaction. Exergaming was seen a part of functioning in daily life.

Demand: Exergaming was seen as physical and cognitive demanding. There could be technical (e.g. visuals in fast space) and safety (e.g. difficulties maintaining balance) challenges with exergaming.

Practicality of exergaming: Introducing exergaming to older adults necessitates a thorough familiarization process. It is crucial for them to receive a comprehensive introduction, they should receive written and video instructions, along with follow-up calls to provide motivation for engaging in exergaming. Moreover, exergaming should be possible within the home environment.

Implementation: To be able to follow improvement and being challenged in the exergame was seen as important to implementation. Participants expressed how to implement exergaming into their daily life and the importance that exergaming was age appropriate.

Conclusion

Exergaming is feasible for older adults and could be considered for use in preventive cardiology to stimulate physically activity. The study also helps to identify specific adaptations that need to be made to accommodate older adults.
Treatment method and adherence in patients with hypertension and type 2 diabetes mellitus
Authors: Swiatoniowska-Lonc N
Published: June 2024

Introduction

Type 2 diabetes (DM) and hypertension (HA), are recognized as a leading health, social and economic problem. The prevalence of HA among Polish adults is 31%, of which 70% are patients with DM. The treatment regimen for type 2 DM is often complex and includes elements of behavioral therapy, pharmacotherapy and insulin therapy. However, in order for the patient to adhere to the therapeutic regimen, treatment must be tailored to the patient's capabilities. The more difficult the therapeutic regimen, the lower the adjustment to adherence.

The purpose of this study was to evaluate the relationship between the method of treatment and the level of adherence to therapeutic recommendations by patients suffering from HA and type 2 DM simultaneously.

Material and methods

The Adherence to Refills and Medications Scale (ARMS) and the Diabetes Treatment Satisfaction Scale (DTSQ) were used in the study. The study included 150 patients divided into 3 groups according to the method of treatment (group I (n=86)-treated with pills, group II (n=20)-treated with insulin, group III (n=44)-treated with botills and insulin.

Results

A comparative analysis of the level of adherence to pharmacological recommendations as perceived by patients showed significant differences between the groups, and the highest level was achieved by the group treated with insulin only 16.7±7.4, and the lowest level in the group treated with a combined regimen (tablet+insulin) 19.6±8.1; p=0.020). In the assessment of satisfaction with treatment, statistically significant differences in satisfaction were observed in the group of patients treated with the combination regimen, where more than half (55%) of the respondents showed complete lack of satisfaction with treatment. In univariate correlation analysis, the type of treatment regimen was not related to the level of adherence to pharmacological recommendations and adherence to health behaviors. However, a significant effect of comorbidities, acute complications of diabetes, early neurological incidents in the course of diabetes, and age and education of the respondents was observed. In multivariate analysis, a statistically significant independent determinant of adherence to pharmacological recommendations was the absence of comorbidities and the level of adherence to health recommendations was influenced by the age of the respondents.

Conclusions

The method of diabetes treatment has no effect on the level of health behavior in patients with NT and type 2 DM. The highest level of adherence to pharmacological recommendations of diabetes treatment is found in patients treated with insulin only and the lowest in patients treated with pills and insulin. Patients treated with the combination regimen have low levels of treatment satisfaction.
The impact of intensive glycemic control on prognosis in diabetes patients with severe coronary artery disease across different age groups
Authors: Li Q X , Yuan J Q
Published: June 2024

Background

Glycemic control is crucial for patients with diabetes mellitus (DM) and coronary artery disease (CAD). Some studies suggested that strict glycemic control does not significantly improve outcomes in patients with DM and CAD. Individualized glycemic control plans should be developed based on the patient's condition. However, there is limited research on the correlation between strict glycemic control and prognosis in patients with severe coronary artery disease, and the optimal level of glycemic control remains unclear.

Methods

This study ultimately included 2,051 consecutive patients with triple-vessel coronary disease enrolled from April 2004 to February 2011 at Fuwai Hospital in China, after excluding those with missing glycated hemoglobin (HbA1c) data and with hemoglobin <90 g/L. Patients were categorized into five groups based on their HbA1c levels: <6.0%, 6.0%-6.4%, 6.5%-6.9%, 7.0%-7.9%, and ≥8.0%. The primary endpoint was all-cause death, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, and non-fatal stroke.

Results

The median follow-up time was 5.88 years. During this period, a total of 323 (15.7%) all-cause deaths and 537 (26.2%) MACCEs were recorded. The relationship between HbA1c levels and the risk of endpoint events showed a non-linear U-shaped pattern. Patients with HbA1c levels between 6.0% and 6.9% had a lower risk of adverse outcomes, while those with HbA1c ≥8.0% had the highest risk of endpoint events. Further analysis revealed a significant interaction between HbA1c and age (p = 0.001). In the subgroup with age <70 years, as HbA1c increased, the risk of adverse events gradually rose, with patients having HbA1c <6.0% exhibiting the lowest risk of death and MACCE. In the subgroup with age ≥70 years, there was an L-shaped relationship between HbA1c levels and endpoint events. Patients with HbA1c <6.0% had a significantly higher risk of death and MACCE compared to other groups. The restricted cubic spline analysis also demonstrated similar results. In patients aged ≥70 years, the risk of death and MACCE gradually increased at HbA1c levels below 6.8% and 7.3%, respectively.

Conclusion

Our study revealed a U-shaped relationship between admission HbA1c levels and adverse outcomes in patients with triple-vessel coronary disease and concomitant diabetes. The descending arm of the U-shaped curves is primarily contributed by older patients, while the ascending arm is mainly contributed by younger patients. In younger patients with triple-vessel coronary disease, strict glycemic control may contribute to improving prognosis. However, in older patients with triple-vessel coronary disease, it is advisable to avoid excessively low HbA1c levels and adopt a more lenient glycemic control approach. Forest plots.  Restricted cubic spline plots.
Digital health readiness for Japanese patients with cardiovascular disease
Authors: Ozaki S , Kaihara T , Kuramoto T , Nishina H , Falter M , Scherrenberg M , Xu L , Dendale P , Akashi Y
Published: June 2024

Background

Digital health has been increasingly applied to the cardiovascular field, especially since the COVID era. Japan is a super-aged society with an average life expectancy of 81 years for men and 87 years for women in 2023. However, there are no existing tools to measure digital health readiness and learnability to implement "digital cardiology" in such a society.

Purpose

The purpose of this study is to validate the Japanese translation of the Digital Health Readiness Questionnaire (DHRQ) created in Belgium to assess the digital readiness of Japanese patients with cardiovascular disease.

Methods

A multicentre cross-sectional study of 210 patients with cardiovascular disease in Kawasaki, an urban, aging city, was conducted at a university hospital and a city hospital. Regarding the translation of the DHRQ, the back translation method was used and the differences between the translated version and the original version were discussed. The DHRQ consists of the DHRQ score and the learnability score. Multivariate analysis and confirmatory factor analysis were performed.

Results

A total of 208 complete questionnaires were included in the analysis. The average age was higher than in Belgium (68 ± 14 vs. 62 ± 15 years), of which 82 (39%) were female. The highest age was 96 and the lowest was 24. Smartphone ownership was higher than in Belgium (86% vs. 81%), but smartwatch and PC ownership was lower than in Belgium (18% vs. 28% and 54% vs. 87%). In multiple regression analysis, age, education level, and smartphone ownership were significant predictors of DHRQ and learnability scores (p ≤ 0.001), while gender and income were not significant predictors. Cronbach's alpha analysis was above 0.8 for all domains of the DHRQ, which implied acceptable internal consistency. The fit indices of the confirmatory factor analysis (Table) showed good fit. The goodness of fit improved when one topic of digital usage with low factor loading ("I use a wearable.") was removed.

Conclusion

In Japan, a super-aged society, the trend is almost the same as in Belgium, and DHRQ can be used. The introduction of digital cardiology needs to be individualized, paying attention to age, education level (the higher the better), and smartphone ownership (but not dependent on income).
Home-based cardiac rehabilitation with a smartwatch and a smartphone gamification application: a pilot Study
Authors: Arima Y , Kaihara T , Takizawa S , Doi S , Honda K , Kobayashi Y , Kasagawa A , Kawagoe Y , Suzuki T , Kai T , Koga M , Mitarai T , Higuma T , Tanabe Y , Akashi Y
Published: June 2024

Background

Home-based cardiac rehabilitation (HBCR) is emerging in the COVID era, but few studies have addressed "gamification", the use of game elements in non-game contexts.

Purpose

This pilot study investigates the applicability of gamification application to HBCR.

Methods

Patients who were hospitalized with acute coronary syndrome and agreed to undergo HBCR using a smartphone/smartwatch immediately after discharge were candidates for the study. The smartphone application included gamification, whereby the patients earned points for achieving exercise within an appropriate heart rate range and received feedback based on their points. The primary endpoint was the frequency of performing HBCR with the application from discharge to the date of the first outpatient visit. Secondary endpoints were the frequency of complications and correlations in several parameters of the application.

Results

The study included data from 16 patients. The mean duration of intervention was 29 ± 6 days. Total smartphone application use was 59.9% (282/471 days). Peak VO2 increased significantly after HBCR (18.4 ± 4.1 vs. 21.1 ± 5.4 mL/min/kg, p = 0.004) and the patients had no complications. Total application use was significantly positively correlated (r = 0.665, p = 0.007) with the application use persistence index (calculated by dividing the duration of application use in the second half of the intervention by the duration of use in the first half).

Conclusion

The smartphone application with gamification can be safely applied to HBCR. Continued use of the application creates a virtuous circle for patients, and gamification may be one of the keys to this.
Happiness and cardiovascular mortality: the HAPIEE study
Authors: Pikhart H , Lin F , Tamosiunas A , Kozela M , Capkova N , Pikhartova J , Bobak M
Published: June 2024

Background

There is mixed evidence on the relationship between happiness and cardiovascular mortality (CVD), and how it is affected by health and other variables, with almost no evidence in the region of Central and Eastern Europe (CEE) with high CVD mortality. This analysis aims to evaluate such association in longitudinal data from three countries of CEE, and investigate the role of other variables in this association.

Methods

This analysis is based on data from 18,362 men and women from the prospective longitudinal Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study conducted in the Czech Republic, Lithuania and Poland who were 45-70 years old at the baseline. Happiness was based on 4-points Likert scale answers to the question "Taking all things together, would you say you are …", with the answers "Very happy", "Quite happy", "Not very happy", and "Not at all happy". Cardiovascular mortality was obtained from local or national mortality registers. Cox proportional hazards regression was used to estimate the hazard ratios (HRs).

Results

1,051 cardiovascular deaths have been recorded over the 11 years of follow-up (among 2,718 all-cause deaths). After adjustment for country and age the HR comparing very happy and unhappy was 0.39 (95%CI: 0.26-0.58) in men and 0.70 (0.43-1.13) in women. This association was reduced after adjusting for socioeconomic characteristics, health behaviours and conventional risk factors (HR 0.65 in men and 0.95 in women); and disappeared in both sexes after controlling for self-rated health. No evidence for country interaction was identified.

Conclusions

Happiness has been shown to predict CVD mortality in this population sample from CEE although it may be explained by established risk factors and self-rated health.
Biological sex matters: cognitive performances and their predictors differ in female and male patients with heart failure
Authors: Gagnon C , Berube B , Besnier F , Vachon F , Sellier F , Iglesies-Grau J , Gayda M , Dionne V , Benhalima H , Nigam A , Juneau M , L L'allier P , Bouabdallaoui N , Rouleau J , Bherer L
Published: June 2024

Objectives

1) To compare cognitive performances in male and female individuals with HF; 2) to determine whether cardiorespiratory fitness, Myers score and functional capacity predict cognition differently according to biological sex.

Methods

68 patients, 25 female (68±9 yrs) and 48 male participants (67±8 yrs) with HF, completed a 6-minute walking test (6MWT), a cardiopulmonary exercise test (CPET) (VO2peak and MYERS score, both are prognostic parameters) and the following cognitive assessment: global cognition (Montreal Cognitive Assessment), memory (Rey Auditory Verbal Learning Test (RAVLT)), executive functions (Stroop, Verbal fluency, Trail Making Test B), processing speed (Coding, Trail Making Test Part A).

Results

Male and female patients were comparable for age, NYHA class and LVEF (all ps>.05). For cognition, after adjusting for age and education, male and female participants differed significantly on RAVLT immediate recall, M=6.48±3.51, F=8.21±3.30, p<.05, and phonological and switching verbal fluency, respectively, M=12.09±4.61, F=14.09±4.28 and M=10.93±2.95, F=12.45±3.23, (p<.05). Simple linear regressions showed that in female participants, RAVLT immediate recall (R= .466, p<.05) and switching verbal fluency (R=.450, p<.05) were predicted by the MYERS score: higher risk score was associated with poorer performances in both tests. Also, performances in phonological and switching fluency in female participants were predicted by the 6MWT, respectively, R=.458, p<.05, and R=.491, p<.05; walking a greater distance was associated with better performances. In male participants, RAVLT immediate recall (R=.462, p<.01) and switching verbal fluency (R=.372, p<.05) were only predicted by the 6MWT; walking a longer distance was associated with better performances.

Conclusion

Female patients with HF obtained better performances on memory and executive function tests vs men. Performances on these tests were predicted by different clinical fitness markers. In female participants, the MYERS score predicted their performances on memory and executive functions, and the 6MWT predicted executive function performances. In contrast, in male participants, only the 6MWT predicted performances on these tests. Albeit only a first step, these results suggest that cognition is influenced differently in male and female patients with HF. This could eventually open the door to personalized treatment approaches targeting the proper clinical fitness indicator to improve cognition.
Acute effect of aerobic exercise on brain-derived neurotrophic factor levels in patients with chronic heart failure
Authors: Fuertes-Kenneally L , Manresa-Rocamora A , Baladzhaeva S , Sempere-Ruiz N , Hernandez-Perez I , Blasco-Peris C , Sanz-Rocher A , Garcia-Alvarez M , Climent-Paya V , Sarabia J
Published: June 2024

Brain-derived neurotrophic factor (BDNF), known for its pivotal role in neuroplasticity, has emerged as a promising diagnostic and prognostic biomarker for chronic heart failure (CHF). BDNF, through its interaction with the tropomyosin-related kinase receptor B (TrkB), has been linked with the pathogenesis of various cardiovascular diseases, including coronary artery disease, cardiomyopathy, and hypertension. Patients with CHF exhibit diminished BDNF levels compared to their healthy counterparts. Notably, exercise has been shown to elevate BDNF levels in healthy individuals. However, no study has explored the potential effects of acute exercise on BDNF levels in patients with CHF. Therefore, the aim of the current study was to analyse the acute effect of aerobic exercise on BDNF levels in patients with CHF. Additionally, we investigated the influence of different patient characteristics (e.g., age, weight, and cardiorespiratory fitness) and exercise variables (e.g., duration) on BDNF concentrations. Eleven patients (53.2 ± 5.5 years; seven males) with CHF were finally included. BDNF levels were measured before and immediately after a cardiopulmonary exercise test on a cycle ergometer. Paired t-test, mean change with its 95% confidence interval (CI), and Pearson correlation were used to conduct statistical analyses. Moreover, Mann-Whitney U test was used to carry out between-group comparisons (e.g., sex) in changes in BDNF. Correlations were interpreted as weak (< 0.30), low (0.30 – 0.49), moderate (0.50 – 0.69), strong (0.70 – 0.89), or very strong (> 0.90). The findings showed a statistically significant increase (p = .005) in BDNF levels of 320.7 (CI = 136.4, 505.1) pg·ml-1. No differences were found between male and female patients (p = .269). Moreover, a moderate yet non-significant negative correlation was observed between the acute exercise-induced effect on BDNF levels and patients’ weight (r = –0.593; p = .054) and body mass index (BMI) (r = –0.530; p = .094). Aerobic exercise acutely increases BDNF levels in male and female patients with CHF. Further studies are required to determine the influence of patient characteristics (i.e., weight and BMI).
Heart failure with preserved ejection fraction incidence in hypertensive patients according to cardiorespiratory fitness
Authors: Kokkinos P , Samuel I B , Pittaras A , Panagiotakos D , Doumas M , Grassos H , Howard D H , Faselis A F , Myers J
Published: June 2024

Introduction

Heart failure (HF) with preserved ejection fraction (HFpEF) is closely associated with traditional cardiac risk factors including hypertension. Strategies to prevent the incidence of HFpEF include lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and HFpEF incidence in hypertensive patients has not been evaluated.

Purpose

Evaluated the association between CRF and HFpEF incidence in hypertensive patients.

Method

We assessed CRF in 390,880 hypertensive patients (mean age 62.7 ± 8.6 years by a standardized exercise treadmill test (ETT) performed across US Veterans Affairs Medical Centers. All had no evidence of HF or myocardial infarction prior to completion of the ETT. We established five age-and-gender-specific CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved during the ETT. Q1 (n=80,569; METs=4.6±1.2); Q2 (n=101,358; METs=7.0±1.1): Q3 (n=77,649; METs=8.4±1.2); Q4 (n=97,624; METs=10.3±0.9); Q5 (n=33,680; METs=13.2±1.5)

Results

During 5,471,090 person-years of follow-up (median 14.0 years), there were 16,493 HFpEF events with an average annual rate of 2.4 events per 1,000 person-years. The adjusted risk of HFpEF decreased progressively across CRF categories as CRF increased, independent of comorbidities. Compared to Q1 (Referent; 4.6±1.2 METs), the risk was 27% lower (hazard ratio [HR] 0.73, 95% CI 0.69-0.75) for individuals within Q2 (7.0 ±1.1 METs) and 61% lower (HR 0.39, 95% CI 0.36-0.43) for those in Q5. Being unfit carried the highest risk (HR, 2.22; 95% CI, 2.33-2.80) of any other comorbidity. Similar findings were observed for those <65.0 and ≥65 years.

Conclusions

Higher CRF levels were independently associated with lower HRpEF incidence in a dose-response manner in hypertensive patients. The lower risk was observed at relatively low CRF levels (7.0 METs) achievable by most middle-aged and older individuals by engaging in approximately 25-30 minutes of brisk walk daily.
Effect of SGLT2 inhibitors in the management of moroccan patients with heart failure with reduced ejection fraction
Authors: Mouine N , Loudiyi N , Zaimi A , Malki M , Bouzelmat H , Chaib A , Lakhal Z , Benyass A
Published: June 2024

Introduction

Chronic heart failure became more frequent in Moroccan patients. The aim of our study is to determinate the benefit of SGLT2 inhibitors in patients with heart failure with reduced ejection (HFrEF) fraction.

Materials and methods

It's a prospective study included 140 patients with heart failure with reduced ejection fraction (HFrEF), admitted in Cardiac Rehabilitation unit, Cardiology centre, Morocco. All of them had clinical evaluation, echocardiography and cardio respiratory evaluation.

Results

The average of patients was 67,13 ± 7,4 years with male predominance, they have more than three cardiovascular risk factors dominated by diabetes and hypertension, coronary artery disease is the most frequent etiology, they had reduced ejection fraction (EF : 32 ± 6,4%).

After 20 sessions of exercise training and therapeutic education specially optimisation of treatment by introducing precociously Quadruple theray ( Betablockers, MRA, ARNi, and SGLT2inhibitors), patients have a good quality of life, they become less symptomatic (dyspnea class III to II of NYHA); they significantly improve 6 min walk test and maximal work load (from 59, 6 ± 10,7 to 71, 2 ± 19,2 watt) and VO2max (from 14,2 ± 5,3 to 19,7 ± 6,9 ml/kg/min)

Conclusion

This study demonstrated that exercise training and optimisation of treatment specially SGLT2inhibitors is clearly benefit for patients with HFrEF to improve their exercise capacities and quality of life
The usefulness of the tidal Volume difference(Peak-rest) as a prognostic indicator in patients with heart failure with reduced ejection fraction
Authors: Moriya S , Iwata H , Nakade T , Sunayama T , Maeda D , Yatsu S , Ishiwata S , Nakamura Y , Suda S , Kato T , Hiki M , Matsue Y , Yokoyama M , Kasai T , Minamino T
Published: June 2024

Background

The diaphragm is not only a crucial respiratory muscle but also plays a vital role in the cardiovascular system. It supports venous return to the right atrium and regulates heart rate variability and sympathetic activity. The capacity to increase the tidal volume of the lungs varies depending on the diaphragm's function. We hypothesized that the more severe the heart failure, the lower the diaphragm's functionality and, consequently, the less increase in tidal volume (TV). Thus, we proposed that the TV difference between peak exercise and rest during cardiopulmonary exercise testing (CPET) could predict prognosis in heart failure patients with reduced ejection fraction (HFrEF).

Purpose

To investigate whether ΔTV (Peak-rest) in milliliters helps in predicting prognosis in HFrEF patients.

Methods

We enrolled 136 HFrEF patients who underwent CPET, with data available on TV increase from rest to peak exercise point (ΔTV (Peak-rest) in milliliters). The primary endpoint was a combined outcome of all-cause mortality and heart failure hospitalization.

Results

During a median follow-up of 4.0 years (interquartile range: 2.4-5.3 years), we observed 56 combined events. The cutoff value for ΔTV (Peak-rest) in milliliters, defined by the median, was 714ml. Patients with ΔTV (Peak-rest) below 714ml exhibited a significantly higher event rate compared to those with ΔTV (Peak-rest) of 714ml or higher (Log-rank: p<0.001). This association remained significant even after adjusting for age and sex (HR: 0.27, P<0.001).

Conclusions

ΔTV (Peak-rest) in milliliters is a promising prognostic indicator in patients with HFrEF and could serve as a new tool for prognosis assessment in these patients.
Safety and efficacy of home-based neuromuscular electrical stimulation on physical function in frail older patients with heart failure: a randomized crossover study
Authors: Kato M , Ono S , Seko H , Nakatani E , Seo Y , Omote T , Omote S
Published: June 2024

Introduction

Neuromuscular electrical muscle stimulation (NMES) therapy is a non-volitional method used to elicit muscle contractions without inducing dyspnea. By stimulating skeletal muscles, NMES therapy enhances exercise capacity, increases muscle mass, and improves muscle function in patients with heart failure (HF). Recently, supervised NMES has been reported to safely increase lower limb motor function in frail older patients hospitalized for acute HF. However, the safety and effectiveness of home-based NMES therapy remain uncertain, particularly in frail older patients with HF.

Purpose

This study aimed to examine the safety and efficacy of home-based NMES therapy on lower extremity function in frail older patients with HF.

Methods

Eight frail older patients (age ≥ 75 years) with HF undergoing home or ambulatory cardiac rehabilitation (CR) were enrolled in this randomized, open-label, crossover study. Participants underwent CR plus home-based NMES therapy and CR alone for 8 weeks each in random order, separated by a 4-week washout period. NMES with a 50-Hz frequency was administered for 50 minutes per day, five times per week with electrodes placed on the quadriceps, gastrocnemius, and soleus muscles. Patients participated in a supervised exercise program, a combination of endurance and resistance training with light to moderate intensity, once or twice times weekly at the hospital or at home. Adverse cardiac events and plasma brain natriuretic peptide (BNP) and creatine kinase (CK) levels were assessed as indicators of NMES safety. The Short Physical Performance Battery (SPPB) and the Barthel Index (BI) were measured as parameters of lower extremity function and activities of daily living.

Results

The average age of the patients was 85 years, and three were men. All patients completed the study without experiencing any adverse cardiac events. In comparison with CR alone, there were no significant effects of CR plus home-based NMES therapy on BNP (P = 0.51), CK (P = 0.34), or BI (P = 0.17). The 8-week treatment with CR plus home-based NMES therapy resulted in a significant increase in SPPB score compared to CR alone (P < 0.05).

Conclusions

Home-based NMES therapy was safe and improved lower extremity function in frail older patients with HF undergoing CR.