bluuebunny/crossref_metadata_2025 huggingface dataset:
Veterans Health Administration: Implementation of pharmacogenomic clinical decision support with statin medications and the SLCO1B1 gene as an exemplar
Authors: Tomcsanyi Kelly M , Tran Kelvin A , Bates Jill , Cunningham Francesca E , Silverman Robert , Norris Amy K , Moore Von R , Voora Deepak
Published: May 2023

Purpose

To describe the implementation of clinical decision support tools for alerting prescribers of actionable drug-gene interactions in the Veterans Health Administration (VHA).

Drug-gene interactions have been the focus of clinicians for years. Interactions between SCLO1B1 genotype and statin medications are of particular interest as these can inform risk for statin-associated muscle symptoms (SAMS). VHA identified approximately 500,000 new users of statin medications prescribed in VHA in fiscal year 2021, some of whom could benefit from pharmacogenomic testing for the SCLO1B1 gene. In 2019, VHA implemented the Pharmacogenomic Testing for Veterans (PHASER) program to offer panel-based, preemptive pharmacogenomic testing and interpretation. The PHASER panel includes SLCO1B1, and VHA utilized Clinical Pharmacogenomics Implementation Consortium statin guidelines to build its clinical decision support tools. The program’s overarching goal is to reduce the risk of adverse drug reactions such as SAMS and improve medication efficacy by alerting practitioners of actionable drug-gene interactions. We describe the development and implementation of decision support for the SLCO1B1 gene as an example of the approach being used for the nearly 40 drug-gene interactions screened for by the panel.

Conclusion

The VHA PHASER program identifies and addresses drug-gene interactions as an application of precision medicine to reduce veterans’ risks for adverse events. The PHASER program’s implementation of statin pharmacogenomics utilizes a patient’s SCLO1B1 phenotype to alert providers of the risk for SAMS with the statin being prescribed and how to lower that risk through a lower dose or alternative statin selection. The PHASER program may help reduce the number of veterans who experience SAMS and may improve their adherence to statin medications.
Common Factor Structure of the Ten Subtest Wechsler Adult Intelligence Scale–Fourth Edition in a Clinical Sample and 15 Subtest Version in the Standardization Sample
Authors: Sudarshan Navaneetham J , Bowden Stephen C
Published: May 2023

Objective

The 10 core subtests of the Wechsler Adult Intelligence Scale-IV (WAIS-IV) suffice to produce the 4 index scores for clinical assessments. Factor analytic studies with the full complement of 15 subtests reveal a 5-factor structure that aligns with Cattell–Horn–Carroll taxonomy of cognitive abilities. The current study investigates the validity of 5-factor structure in a clinical setting with reduced number of 10 subtests.

Method

Confirmatory factor analytic models were fitted to a clinical neurosciences archival data set (n_Male = 166, n_Female = 155) and to 9 age-group samples of the WAIS-IV standardization data (n = 200 for each group). The clinical and the standardization samples differed as (a) the former comprised scores from patients, aged 16 to 91, with disparate neurological diagnosis whereas the latter was demographically stratified, (b) only the 10 core subtests in the former but all 15 subtests in the latter were administered, and (c) the former had missing data, but the latter was complete.

Result

Despite empirical constraints to eliciting 5 factors with only 10 indicators, the well-fitting, 5-factor (acquired knowledge, fluid intelligence, short-term memory, visual processing, and processing speed) measurement model evinced metric invariance between the clinical and standardization samples.

Conclusion

The same cognitive constructs are measured on the same metrics in every sample examined and provide no reason to reject the assumption that the 5 underlying latent abilities of the 15 subtest version in the standardization samples can also be inferred from the 10 subtest version in clinical populations.
Effect of Vinegar on the Oxidative Stability of Mayonnaise During its Storage
Authors: Alnokkari Afraa
Published: May 2023

Mayonnaise is an emulsion of oil that is susceptible to lipid oxidation, which can cause spoilage and the formation of harmful compounds. This study aims to evaluate the impact of Syrian apple and grape vinegar on the oxidative stability of mayonnaise and compare the use of natural antioxidants to synthetic ones such as butylated hydroxyanisole and butylated hydroxytoluene. The study measured total phenol content, radical scavenging activity, and identified some phenolic compounds by High Performance Liquid Chromatography (HPLC). The rancidity of mayonnaise was examined using peroxide value and thiobarbituric acid number. The fatty acids content in the mayonnaise samples was examined using gas chromatography. Vinegar samples containing high concentrations of phenolic antioxidants showed high ability to scavenge free radicals. The antioxidants in vinegar protected the mayonnaise samples from primary and secondary oxidation, and there was no statistically significant difference between the ratio of unsaturated fatty acids in the samples containing vinegar at the beginning and at the end of the storage period. The study shows the significance of using vinegar to protect mayonnaise from deterioration and increase its shelf life, in addition to its role as a dressing.
Joan Robinson and the reconstruction of economic theory
Authors: Martins Nuno Ornelas
Published: May 2023

Joan Robinson provided numerous contributions to economic theory, ranging from her earlier approach to imperfect competition to her participation in the Keynesian revolution, which had a significant influence in the Cambridge heterodox wing, and Post-Keynesianism. But towards the end of her life, her rejection of received theories was great enough to be often interpreted as a form of theoretical nihilism. However, at this stage she also outlined a radical project for a reconstruction of economic theory, drawing on her notion of historical time, while placing distribution at the centre of economic theory. This later project of a reconstruction of economic theory is revisited here, focussing on the various difficulties it faced, and its overall significance and impact.
Non-monetary incentives to increase enrollment in payments for environmental services
Authors: Chabé-Ferret Sylvain , Le Coent Philippe , David-Legleye Valentin , Delannoy Véronique
Published: May 2023

Payments for Environmental Services (PESs) are increasingly used to foster farmers’ adoption of greener practices, but their effectiveness is often undermined by low enrollment. In a large randomized field experiment (N = 20,000), we test several non-monetary incentives to increase enrollment into the French implementation of the Agri-Environmental Schemes program of the European Union. We find that sending 10,000 information letters triggers the enrollment of 75 ± 52 farmers at a cost of 102 $\pm\ $71 Euros/new enrollee. Pre-stamped reply forms increase contacts with caseworkers but fail to raise enrollment. Testimonies by other farmers seem to decrease the effectiveness of the letters. Diffusion effects could increase the impact of our non-monetary incentives by 40% to 50% and decrease the cost of an additional enrollee by around 30%.
Pre-hospital delay, clinical characteristics, angiographic findings, and in-hospital mortality in young and middle-aged adults with acute coronary syndrome: a single-centre registry analysis
Authors: Bauer Dávid , Neuberg Marek , Nováčková Markéta , Kočka Viktor , Toušek Petr
Published: May 2023

There are several differences between younger and older adults with acute coronary syndrome (ACS). However, few studies have evaluated these differences. We analysed the pre-hospital time interval [symptom onset to first medical contact (FMC)], clinical characteristics, angiographic findings, and in-hospital mortality in patients aged ≤50 (group A) and 51–65 (group B) years hospitalised for ACS. We retrospectively collected data from 2010 consecutive patients hospitalised with ACS between 1 October 2018 and 31 October 2021 from a single-centre ACS registry. Groups A and B included 182 and 498 patients, respectively. ST-segment elevation myocardial infarction (STEMI) was more common in group A than group B (62.6 and 45.6%, respectively; P < 0.001). The median time from symptom onset to FMC in STEMI patients did not significantly differ between groups A and B [74 (40–198) and 96 (40–249) min, respectively; P = 0.369]. There was no difference in the rate of sub-acute STEMI (symptom onset to FMC > 24 h) between groups A and B (10.4% and 9.0%, respectively; P = 0.579). Among patients with non-ST elevation acute coronary syndrome (NSTE-ACS), 41.8 and 50.2% of those in groups A and B, respectively, presented to the hospital within 24 h of symptom onset (P = 0.219). The prevalence of previous myocardial infarction was 19.2% in group A and 19.5% in group B (P = 1.00). Hypertension, diabetes, and peripheral arterial disease were more common in group B than group A. Active smoking was more common in group A than group B (67 and 54.2%, respectively; P = 0.021). Single-vessel disease was present in 52.2 and 37.1% of participants in groups A and B, respectively (P = 0.002). Proximal left anterior descending artery was more commonly the culprit lesion in group A compared with group B, irrespective of the ACS type (STEMI, 37.7 and 24.2%, respectively; P = 0.009; NSTE-ACS, 29.4 and 21%, respectively; P = 0.140). The hospital mortality rate for STEMI patients was 1.8 and 4.4% in groups A and B, respectively (P = 0.210), while for NSTE-ACS patients it was 2.9 and 2.6% in groups A and B, respectively (P = 0.873). No significant differences in pre-hospital delay were found between young (≤50 years) and middle-aged (51–65 years) patients with ACS. Although clinical characteristics and angiographic findings differ between young and middle-aged patients with ACS, the in-hospital mortality rate did not differ between the groups and was low for both of them.
Effectiveness of a Sedentary Behaviour Intervention as a Personalised Secondary Prevention Strategy (SIT LESS) for patients with coronary artery disease: primary outcomes of the SIT LESS trial
Authors: Van Bakel B M A , Kroesen S H , Bakker E A , Van Miltenburg R V , Gunal A , Scheepmaker A , Aengevaeren W R M , Willems F F , Wondergem R , Pisters M F , De Bruin M , Hopman M T E , Thijssen D H J , Eijsvogels T M H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation.

Background

High levels of time spent sedentary are associated with increased risk of cardiovascular disease morbidity and mortality, even after accounting for traditional risk factors. A sedentary lifestyle is highly prevalent among patients with coronary artery disease (CAD).

Purpose

This clinical trial aimed to determine whether a multicomponent, hybrid (center- and home-based), sedentary behaviour change intervention as a personalized secondary prevention strategy (SIT LESS) reduces daily sedentary time among patients with CAD participating in cardiac rehabilitation.

Methods

Patients were randomised to usual care (n=104) or SIT LESS (n=108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with an activity tracker connected to a smartphone application. Primary outcome was the change in objectively measured sedentary time between pre- to post-rehabilitation.

Results

Patients (77% male) were 63±10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (−1.6 [−2.1 to −1.1] hours/day) and controls (−1.2 [ ─1.7 to −0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day, Central Figure). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥9.5 hours/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2-0.8)). No differences were observed in the other predefined secondary outcomes.

Conclusions

Among patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥9.5 hours/day was observed.
Rapid improvements in physical (in)activity patterns in patients with myocardial infarction immediately following hospital discharge
Authors: Van Bakel B M A , De Koning I A , Bakker E A , Pop G A M , Cramer G E , Van Geuns R J M , Thijssen D H J , Eijsvogels T M H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation.

Background

Physical activity counselling plays a pivotal role in recovery after myocardial infarction (MI), but little is known about changes in physical activity (PA) and sedentary behaviour (SB) patterns in the acute phase post MI.

Purpose

This study aimed to objectively assess PA and SB during hospitalisation and during the first week post-discharge and to identify whether potential changes in PA patterns differed based on sex, age, need for coronary artery bypass grafting (CABG), presence of ST-elevated myocardial infarction (STEMI), and level of cardiac anxiety.

Methods

Consecutively admitted patients hospitalised with an MI were approached to participate in this prospective cohort study. SB, light-intensity PA (LIPA) and moderate-vigorous PA (MVPA) were objectively assessed for 24 h/day during hospitalisation and up to 7 days post-discharge in 165 patients. Changes in PA and SB upon the transition from the hospital to home were evaluated using mixed model analyses and outcomes were stratified for predefined subgroups based on patient characteristics.

Results

Patients (78% male) were 65±10 years and diagnosed with STEMI (50%) or NSTEMI (50%). Sedentary time was high during hospitalisation (12.6 [11.8-13.7] h/day), but substantially decreased following transition to the home environment (−1.8 (−2.4 to −1.3) h/day) (Central Figure). The number of prolonged sedentary bouts (≥60 min) decreased between hospital and home (−1.6 (95%CI −2.0; −1.2) bouts/day). LIPA (1.1 [0.8-1.6] h/day) and MVPA (0.2 [0.1-0.3] h/day) were low during hospitalisation, but significantly increased following transition to the home environment (LIPA: +1.8 (1.4 to 2.3) h/day; MVPA: +0.4 (0.3 to 0.5) h/day, both p<0.001). Improvements in PA and SB were similar across groups, except for CABG patients who did not alter their PA patterns post-discharge.

Conclusions

Patients with MI demonstrate high levels of sedentary behaviour and low physical activity volumes during hospitalisation, which immediately improved following discharge at the patient’s home environment.
Family screening in inherited cardiac conditions: predicting likelihood of a diagnosis
Authors: Abela M , Felice T , Sammut M A , Debattista J , Scerri J , Scerri C , Grech V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiovascular Research Scholarship awarded by 'Research, Innovation and Development Trust (University of Malta)', kindly donated by Beating Hearts Malta.

Scholarship awarded by Tertiary Education Scholarship Scheme.

Introduction

Family screening is an important pillar in inherited cardiac conditions (ICC), yet the likelihood of disease in screened relatives is difficult to predict. The objective of this study was to create a clinical score to help predict the likelihood of a diagnosis in relatives undergoing screening.

Methodology

The BEAT-IT national cardiac screening program enrolled 2708 adolescents (14-16 years). Families of probands with a preclinical or clinical diagnosis were offered cardiac screening. Those with an abnormal preliminary screen were further evaluated. Data was analyzed with SPSS v23 using chi squared. P<0.05 was considered statistically significant.

Results

A total of 19 families were evaluated, 81 family members (60.5% female, mean age 41.1±16.7 at evaluation) underwent cardiac screening because of a preclinical (n=17, 89.4%) or clinical (n=1 HCM, n=1 LQTS) phenotype in the index case. Some (n=8, 9.9%) were labelled with a clinical phenotype (n=5 LQTS, n=2 HCM, n=1 DCM). The highest diagnostic yield was in long QT (55.6%) and HCM (50.0%) probands. All relatives were asymptomatic.

Several factors increased the likelihood of a relative being given a diagnosis at screening. The i) presence of a proband phenotype (p<0.001), ii) abnormal screening ECG (p<0.001), iii) abnormal echocardiography suggestive of an ICC (p<0.001), iv) low ejection fraction (p=0.043), v) fibrosis on MRI (p=0.035), vi) likely or definite pathogenic mutation in the proband (p<0.001) and vii) a gene positive relative (p<0.001) were all significantly predictive. Age at evaluation, gender, family history of sudden cardiac death and arrhythmias at screening were not predictive. A relative with ≥3 variables had a higher probability of a clinical diagnosis (72.7% vs 0%, p<0.001).

Conclusion

A combined clinical and genetic evaluation was able to identify an ICC in 9.9% of screened family members. The presence of ≥3 clinical variables at screening was linked to a higher probability of a diagnosis in relatives. A comprehensive evaluation in relatives with a suspicion of an ICC is necessary useful for diagnostic purposes.
DNA methylation as a biomarker for cardiometabolic disease risk
Authors: Janovska J , Nixdorff U N , Voicehovska J V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Cardiovascular disease (CVD) is the leading cause of death in most countries [1]. Risk factors known to predispose to the development of CVD include increasing age, male gender, diabetes mellitus, high blood cholesterol, tobacco smoking, high blood pressure (hypertension), obesity, physical inactivity, and family history [2]. Elevated plasma homocysteine is also an independent risk factor for CVD [2,3]. The mechanism by which elevated homocysteine contributes to CVD risk is not well understood, but it is well-established that dietary folate and vitamin B supplementation can reduce serum homocysteine levels by facilitating remethylation of homocysteine to methionine [4]. DNA methylation can modulate gene expression in response to exposure to various substances, such as nutrients, smoking, and environmental chemicals.Variation in healthy aging and lifespan is ascribed more to various non-genetic factors than to inherited genetic determinants, and a major goal in aging research is to reveal the epigenetic basis of aging. The remethylation cycle is essential for the systemic methyl donor supply, which is used for important biological processes, such as cytosine-5 methylation of genomic DNA, an epigenetic modification that plays an important role in maintaining genomic stability, chromatin structure, and in controlling transcriptional capacity [2,4].

Methodology/Principal Findings

In this prospective study, we examined both gender patients, aged 40-50 years. Relationship between prevalence of Cardiometabolic risk factors (metabolic syndrome, oxidative stress and arterial hypertension) or its predisposing conditions (hypertrigliceridemia, dislipedimia, inusline resistance, D vitamin hipovitaminosis)) and DNA hydroximethylation was investigated. Hydroxymethylation measurement was done using a gold standard technique (liquid chromatography + mass spectrometry), the biological age equivalent was calculated by LC-MS in laboratories Reunis, to verify the potential value of DNA methylation as a CVD biomarker.

Results

Generally, 296 both gender patients were analyzed regarding metabolic syndrome and oxidative stress, age group 40-50 years (Me=47,1). MethylAge (DNA-hydroxymethylation) in analyzed group has average age 40,1 years old. DNA Hydroxymethylation is higher in those individuals, who has increased waist circumference, as well as, statistically significant correlation was observed between MethylAge waist circumference, metabolic syndrome and hypertriglyceridemia (p<0,05).

Conclusion

The evidence that the age-related changes in DNA methylation play a role in aging comes from studies of anti-aging interventions (e.g., caloric restriction, iron deficiency, dyslipidemia). Our data showed a link between premature biological ageing and waist circumference, hypertrigliceridimia. Hydroxymethylation of DNA is a good epigenetic marker for aging and risk assessment, especially in alliance with AGEs and oxidative stress research.
The impact of excessive epicardial adipose tissue accumulation on cardiorespiratory fitness in adults without cardiac disease: a cross-sectional magnetic resonance imaging study
Authors: Piche M , Chartrand D , Almeras N , Pibarot P , Larose E , Lamarche B , Poirier P , Despres J P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research.

Background/Introduction

Excessive epicardial adipose tissue (EAT) is associated with worse exercise capacity and is thought to play a role in the pathophysiology of heart failure with preserved ejection fraction. Few studies have explored the relationship between EAT, cardiorespiratory fitness in men and women without cardiovascular disease.

Purpose

To investigate the association between EAT, cardiorespiratory fitness, and physical activity levels in asymptomatic men and women of variable degree of adiposity.

Methods

A total of 239 participants (43% women) free from cardiovascular disease who underwent concurrent quantification of EAT volume assessed by cardiac magnetic resonance and a cardiopulmonary exercise testing (CPET) (VO2peak [ml/kg/min]) were studied. Physical activity levels/intensity were measured by questionnaire and using pedometer. Participants were categorized into low-EAT, moderate-EAT, and high-EAT groups on the basis of EAT volume.

Results

Mean age of participants was 49.8 ± 8.3 years, BMI 26.0 ± 3.7 kg/m2 (15% with obesity), waist circumference 89 ± 11 cm, visceral adipose tissue volume 91.3 ± 51.3 cm3, and EAT volume 9.8 ± 3.1 cm3. EAT volume decreased with increment in cardiorespiratory fitness in men and women of variable adiposity (p<0.05). Men and women with high-EAT had worse cardiometabolic profile (visceral adiposity, insulin resistance, high blood pressure, dysglycemia, atherogenic dyslipidemia), and lower cardiorespiratory fitness (VO2peak) than those with low-EAT (all p<0.05). Physical activity levels were comparable across EAT tertiles (p=NS). The association between EAT and cardiorespiratory fitness was no longer significant after controlling for visceral adiposity.

Conclusions

In men and women of variable degree of adiposity, excessive EAT accumulation is associated with visceral adiposity and worse cardiorespiratory fitness. Further longitudinal studies are needed to understand the interplay between EAT and cardiorespiratory fitness, and the development of obesity-related heart failure features.
Tumour necrosis factor receptor 1 inhibition and cardiovascular disease: a cis-Mendelian randomization study
Authors: Rajasundaram S , Gill D
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health and Care research (NIHR).

Background

Tumour necrosis factor receptor 1 (TNFR1) is a newly proposed drug target that has emerged from a growing understanding of the inflammatory basis of cardiovascular disease[1]. A range of pre-clinical models and observational data in humans support the potential efficacy of TNFR1 inhibition. However, pre-clinical models are poor predictors of therapeutic efficacy in humans and observational data is inherently vulnerable to confounding and reverse causation[2,3]. Mendelian randomization (MR) is a genetic epidemiological approach that overcome these limitations and are capable of robust causal inference[3], rendering them better able to investigate the potential efficacy of novel drug targets[2].

Purpose

To leverage MR to investigate the causal effect of TNFR1 inhibition on the risk of developing coronary artery disease (CAD), ischaemic stroke (IS), atrial fibrillation (AF), and heart failure (HF) (see Figure 1).

Methods

cis-Mendelian randomization was performed to estimate the causal effect of TNFR1 inhibition (weighted by serum C-reactive protein (CRP) levels) on liability to coronary artery disease (CAD), ischaemic stroke (IS), atrial fibrillation (AF), and heart failure (HF). Anti-TNF therapies are a cornerstone treatment modality for Crohn’s disease and so Crohn’s was included as a positive control to validate the genetic instrument for TNFR1 inhibition. Furthermore, Bayesian colocalization (coloc) was performed to assess the likelihood that a shared causal variant underlies both TNFR1 signalling and each of these four cardiovascular diseases, thus allowing for interrogation of the risk of confounding by linkage disequilibrium in MR estimates[4]. Genetic association estimates were leveraged from the largest genome-wide association studies (GWAS) for which full publicly available summary data were available.

Results

As expected, a significant cis-MR effect for genetically proxied TNFR1 inhibition was observed for Crohn’s disease (odds ratio (OR) per 1 standard deviation (SD) reduction in CRP = 0.05, 95% CI = 0.01 to 0.28, P = 5.32 x 10-4). However, no evidence of a causal association was observed between genetically proxied TNFR1 inhibition and the odds of developing CAD (OR per SD reduction in CRP = 0.99, 95% CI = 0.55 to 1.76), IS (OR per SD reduction in CRP = 1.55, 95% CI = 0.30 to 8.03), AF (OR per SD reduction in CRP = 1.11, 95% CI = 0.54 to 2.29), or HF (OR per SD reduction in CRP = 1.02, 95% CI = 0.46 to 2.29) (see Figure 2). No evidence of colocalization was observed between TNFR1 signalling and any of these four cardiovascular diseases.

Conclusions

These findings do not support TNFR1 signalling inhibition as likely to be an efficacious therapeutic target for coronary artery disease, ischaemic stroke, atrial fibrillation, or heart failure.
Lower exercise capacity correlates with slower heart rate recovery in post-coronary artery bypass surgery patients
Authors: Satoto H , Lampus N , Febrianora M , Desandri D R , Dwiputra B , Ambari A M , Radi B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Heart rate recovery (HRR) describes the ability of the autonomic nervous system changes from the sympathetic to the parasympathetic nervous system. The slower heart rate recovery means there is an autonomic dysfunction of the nervous system. Heart rate recovery has been known to be a predictor of mortality in patients undergoing exercise stress test. Patients with slow heart rate recovery have a higher risk of cardiovascular death. Decreased exercise capacity is also known to increase the risk of cardiovascular death.

Purpose

This study aims to determine the relationship between low exercise capacity and slow heart rate recovery.

Methods

Patients who underwent post-coronary artery bypass (CABG) surgery cardiovascular rehabilitation program at our national cardiovascular center in 2022 were enrolled in this study. We assessed heart rate recovery during the maximal exercise stress test, by subtracting from maximal heart rate during the exercise stress test with heart rate at the first and second minute after exercise stress test. We used predicted METs from Bruce protocols treadmill test time to determine each patient’s exercise capacity.

Results

There were 238 patients (age 58±7 years old, 89.9% male). The mean exercise capacity was 6.42±2.21 METs and the mean first and second-minute heart rate recovery was 14±11 and 26±15 beats per minute. Predicted exercise capacity had a significant positive weak correlation with first-minute heart rate recovery/HRR1 (r=0.279; p=0.000) and a significant positive moderate correlation with second-minute heart rate recovery/HRR2 (r=0.409; p=0.000) in post-CABG patients. We performed receiver operating characteristic analysis that showed the area under the curve for exercise capacity was 0.69 for HRR1 and 0.71 for HRR2, and found the exercise capacity cut-off was 5.5 METs . Patients with exercise capacity less than 5.5 METs were likely to have slower HRR1 (OR=4.4 (95% CI, 2.7 – 7.2) p=0.000) and slower HRR2 (OR=3.8 (95% CI, 2.4 – 6.0) p=0.000).

Conclusions

There is a correlation between low exercise capacity and slow heart rate recovery. Patients with lower exercise capacity were likely to have slower heart rate recovery in post-CABG patients.
Cardio-protective effect of trimetazidine in patients with disseminated breast cancer
Authors: Sadigova T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Relevance of the problem. Anthracycline cardiotoxicity is the most unfavorable form due to irreversible complications of cardiovascular system caused by anthracyclines during the chemotherapy (CT) of the breast cancer (BC). Despite the fact that this type of cardiotoxicity has been studied better than others, the problem of preventing such complications remains relevant to this day. In our study, we suggest Trimetadizine (TMZ) as a cardioprotective agent in patients with disseminated breast cancer receiving Doxorubicin chemotherapy.

Material and methods

The study included 93 patients (aged 41.2±8.3 years) who underwent surgery for breast cancer and several courses of chemotherapy with Doxorubicin (according to the stage of breast cancer). Patients were randomized into 2 groups: the first group (n=47; G1) received TMZ at a dose of 70 mg daily, in the control group (n=46; G2) patients didn't receive TMZ. All patients before the start of the study underwent a complete echocardiographic examination and checked cardiac biomarkers such as troponin and brain natriuretic peptide (BNP). The exclusion criterion was patients with any kind of cardiovascular pathology. The primary endpoint of the study was a reduction in left ventricular ejection fraction (LVEF) deterioration as assessed by series of echocardiographic studies conducted after each course of chemotherapy, and then every 3 months after completion of chemotherapy for 1 year. Secondary outcome measures included echocardiographic (EchoCG) measurements of LV diastolic dysfunction, structural myocardial changes assessed by echocardiography, and control cardiac biomarkers.

Results

Both groups achieved the same cumulative dose of Doxorubicin. No patient died or discontinued chemotherapy during the study. There were no significant differences between the two groups in terms of baseline clinical findings, echocardiographic parameters, and changes in biomarkers. 3-5 months after the start of CT, standard echocardiography showed unreliable changes in LVEF, shortening fraction, and LV measurements. However, tissue Doppler showed a decrease in myocardial velocity (P = 0.001) in G2, indicating LV diastolic dysfunction. While no such changes were observed in G1.

Conclusion

Tissue Doppler proved to be more sensitive than standard echocardiography for early diagnosis of cardiac dysfunction, and TMZ appears to have a cardioprotective effect in case of anthracycline cardiotoxicity.
A randomized controlled study investigating the impact of dietary education and counselling with a smartphone application on secondary prevention of coronary artery disease (TeleDiet Study)
Authors: Kaihara T , Falter M , Scherrenberg M , Xu L , Maes J , Meesen E , Dendale P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Daiichi-Sankyo, Inc.

Background

In secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimization. While face-to-face nutritional follow-up is part of standard of care in many centres, few studies have investigated the potential of remote follow-up using digital solutions.

Purpose

We investigated the effectiveness of a smartphone application for nutrition education and feedback with pictures of meals by a dietitian for CAD patients.

Methods

Sixty patients with CAD were randomized 1:1 to either a TeleDiet group or a Control group. Patients in the TeleDiet group participated in dietary education using a messaging application. The primary outcome was the change of the Mediterranean diet score (MedDietScore). Blood tests (blood lipids, blood glucose and kidney function), body mass index, self-efficacy, medication adherence, and health-related quality of life (HRQoL) and the Nutrition-Score during the observation period were analysed as secondary outcomes. The Nutrition-Score is a modification of the MedDietScore in which parameters about salt and sugar intake are added to the score, and an intake of zero alcohol is considered positive (in contrast to the MedDietScore).

Results

Sixty patients participated in the study. The difference in the MedDietScore in the TeleDiet group was greater than in the control group, but not significant (2.0 [-1.0, 4.0] vs. 0.0 [-3.0, 1.5], p = 0.066). The difference in the Nutrition-Score in the TeleDiet group from baseline to week 12 was significantly greater than in the control group (3.0 [1.0, 3.5] vs. 0.0 [-3.0, 2.0], p = 0.029). There was a significant difference in the within-group analysis only in the TeleDiet group (32 [30, 38] at baseline vs. 36 [33, 41] at week 12, p = 0.045). Nutrition knowledge of the TeleDiet group improved significantly compared to the control group (1.9 ± 1.7 vs. 0.8 ± 2.1, p = 0.048). The change in HRQoL in the TeleDiet group was greater than in the control group, but not significant (7.4 ± 8.9 vs. 3.2 ± 7.0, p = 0.063).

Conclusion

A feedback system using a simple messaging application that allows CAD patients to simply send a picture of their food has a positive effect on nutrition knowledge and the implementation of the Mediterranean diet.
Discordance between LDL cholesterol and apolypoprotein B. Which to prefer to guide treatment?
Authors: Cobarro L , Martinez R , Ugueto C , Contreras C , Saldana J , Torremocha A , Rivero B , Juarez V M , Severo A , Canales L , Lara A , Vila J , Castro A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Current cardiovascular risk guidelines recommend target values of low-density lipoprotein cholesterol (LDLc) < 55 mg/dL and apolipoprotein B (apoB) < 65 mg/dL. However, they don’t clarify what the attitude should be when one of the two targets is not achieved.

Our objective was to establish the prevalence of LDLc and ApoB discordance in a secondary prevention population in our cardiac rehabilitation unit and describe the size of LDLc particles in this cohort of patients.

We conducted a retrospective observational study including patients with previous ischemic heart disease with lipid-lowering treatment in secondary prevention followed up in our cardiac rehabilitation unit between February 2022 and September 2022.

We present a series of 100 patients with a mean age of 60.5 years (S.D. 9.7), 79% male, with high prevalence of cardiovascular risk factors (59% hypertension, 26% diabetes mellitus, 52% smokers). All patients received lipid-lowering therapies, with statins alone or in combination with Ezetimibe. 30 patients (30%) had LDLc > 55 mg/dL and ApoB < 65 mg/dL, 37 (37%) reached target LDL and ApoB levels (LDLc < 55 mg/dL and ApoB < 65 mg/dL), and 33 (33%) did not reach any of the target levels (LDLc > 55mg/dL and ApoB > 65 mg/dL). No patient had LDLc < 55mg/dL and ApoB > 65mg/dL. Among patients with ApoB target level achieved and LDLc > 55mg/dL, the mean LDLc/ApoB ratio was 1.1 (S.D. 0.1). The mean ratios stratified by LDLc level are represented in Figure 1 and specified in Table 1.

The conclusion of our study is that in clinical practice we find a group of patients with discrepancy between LDLc and ApoB levels that is not represented in the main studies of cardiovascular outcomes. Therefore, we do not know what therapeutic approach we should take. It is known that these relatively high LDLc values when apoB is in range correspond to larger and less dense particles, and therefore less atherogenic, and it has been suggested that ApoB levels better reflect residual risk than LDLc in statin-treated patients.

At this point, the question that arises is: should we take these patients to an LDL < 55mg/dL or is their lipid risk controlled?
Prevalence of atrial fibrillation and its associated factors among type 2 diabetics attending a tertiary hospital
Authors: Kalokola F , Salla A , Kalluvya S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Self funding.

Introduction

Type 2 Diabetes Mellitus (T2DM) is an increasing public health burden associated with increase morbidity and mortality among adults and is a risk factor for the development of atrial fibrillation (AF). When these two conditions coexist, they confer an increased risk of symptom burden and mortality. In Africa, few studies have reported the prevalence, and associated factors of atrial fibrillation among adults with T2DM.

Purpose

This study was aimed to determine the prevalence and associated factors of (AF) among adults with T2DM attending outpatient clinic at Bugando Medical Centre (BMC).

Methods

Hospital based cross-sectional study was conducted between April 2022 to June 2022 at the medical clinic. A total of 215 patients were enrolled after meeting the inclusion criteria. Structured questionnaires were used to capture social demographic and clinical information including glycated hemoglobin (HbA1c) levels, duration of diabetes, type of hypoglycemics, body mass index (BMI), waist to hip ratio, estimated glomerular filtration rate (eGFR) and history of hypertension. All participants underwent a resting 12-lead electrocardiogram (ECG) for assessment of AF. Data was analyzed by the use of STATA software version 15.

Results

215 patients with T2DM and a median age of 62 (IQR):(53-69) years, 60.5% were females and 42.3% had hypertension. The median duration since diagnosis of DM was made was 8 years with more than a third (67.9%) of participants having a HbA1c ≥7% while 80.7% were either overweight or obese. Thirteen (6.1%) of 215 patients (10 women, 3 men) had AF. Only eGFR < 60ml/min/1.73m² (OR 5.49; 95% CI 1.1-27.3, p=0.037) was associated with AF.

Conclusion

Prevalence of atrial fibrillation was high in this population of type 2 diabetes mellitus and it was significantly associated with low eGFR.
Effects of first presentations of 12 cardiovascular disease phenotypes on cardiovascular, non-cardiovascular and all-cause mortality in the general population
Authors: Prugger C , Perier M C , Gonzalez-Izquierdo A , Hemingway H , Denaxas S , Empana J P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular diseases (CVD) present as diverse phenotypes, which have considerably different effects on subsequent prognosis. However, studies quantifying these differences in prognosis after various first presentations of CVD are so far lacking.

Purpose

Our main study objective was to investigate the effects of first presentations of 12 distinct CVD phenotypes on the risk of cardiovascular mortality (primary outcome) and non-cardiovascular as well as all-cause-mortality (secondary outcomes) in the general population. Further objectives were to assess whether the effects differ by sex, age and ethnicity and to what extent referral to cardiac rehabilitation within 6 months can mitigate the effects.

Methods

Based on England-wide linked electronic health records, we set up a cohort study of 1,310,518 people aged 30 years and older who were initially free of CVD. We followed them up from 2010 to 2016 for 12 validated CVD phenotypes (exposures) and cardiovascular as well as non-cardiovascular mortality (outcomes). We estimated hazard rate ratios (HRRs) and 95% confidence intervals (CIs) using Cox’s proportional hazards models with CVD presentations as time-dependent variables.

Results

During a median follow-up of 4.2 years, 10,906 cardiovascular deaths and 81,516 first presentations of CVD phenotypes occurred. Presentations of all 12 phenotypes increased cardiovascular mortality, with HRRs (95% CIs) ranging from 1.67 (1.47-1.89) for stable angina and 1.68 (1.44-1.95) for transient ischaemic attack to 7.85 (6.62-9.31) for haemorrhagic stroke. Non-cardiovascular and all-cause mortality also increased with all phenotypes, but to a lesser extent. Subgroup analyses indicate CVD phenotypes with markedly heterogeneous impact on prognosis in women and men, middle and older age groups and ethnic groups. Referral to cardiac rehabilitation recorded in 3,018 (3.70%) first CVD presentations attenuated the effects of haemorrhagic stroke, heart failure and myocardial infarction (HRRs (95% CIs): 2.46 (1.55-3.90), 2.22 (1.37-3.60) and 0.89 (0.57 -1.40), respectively) on cardiovascular mortality when compared to no referral (HRRs (95% CIs): 8.18 (6.80-9.83), 6.50 (6.10-6.92) and 4.32 (3.90-4.80), respectively).

Conclusions

First presentations of 12 CVD phenotypes are associated with heterogeneous but significantly increased risks of cardiovascular mortality. Referral to cardiac rehabilitation is a missed opportunity in high-risk CVD phenotype presentations.
Effects of concurrent exercise training on blood pressure variability and values are blunted in subjects with non-dipping blood pressure nocturnal pattern
Authors: Caminiti G , Sposato B , Iellamo F , Perrone M A , Di Carlo R , Cascelli G , Franchini A , Volterrani M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

The purpose of this study was to investigate the effects of 12-weeks concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks patients underwent six minute walk test, ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). After CT exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the nondipping group (between groups changes: -1.0 mmHg and -1.3 mmHg; p 0.02 and p 0.006 respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while were unchanged in the non-dipping group (between groups changes: -7.1 mmHg and -7.8 mmHg; p 0.004 and p 0.0002 respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small not significant changes in both groups. In conclusion: the effects of CT on BPV and BP were blunted in hypertensive subjects with non.dipping BP pattern
Insomnia due to hypertriglyceridemia can be treated by rosuvastatin/ezetimibe
Authors: Fazio G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Metabolic syndrome associated with elevated fasting triglyceridemia (TG) is often associated with insomnia. The new guidelines of ESC for dyslipidemia advice the statin and/or ezetimibe treatment like fist line therapy in patients with hypertriglyceridemia, also before then fibrates or omega 3.

We examined the impact of rosuvastatin/ezetimibe treatment in reduction of insomnia in patents with hypertriglyceridemia.

Methods

In this study was enrolled a group of 148 patients with hypertriglyceridemia and insomnia. Patients were screened for severe insomnia, defined by a score of four or more on the three Hamilton Depression Rating Scale (HDRS) sleep items, and for HTG characterized by TG≥200mg/dL. The duration of sleep was evaluated with smartwatch every 7 days.

Mean age was 61,12 years. All patient was admitted in ambulatory of cardiology and were in wash out treatment for dyslipidaemic syndrome. In all we added 20 mg of rosuvastatin plus 10 mg of ezetimibe daily to therapy and reassessed patients after 30 days.

Results

Rosuvastatin/ezetimibe treatment was effective as add-on therapy in reduction of insomnia . All treated patients reported an improvement in symptoms. After 30 days, insomnia disappeared in 69% of patients and was reduced in 21% of patients.

The number of the sleeping hours improved from 5:35 min to 7:25 minutes.

Therapy was well tolerated in 99% of patents, and stopped only in 2 cases.

Conclusions

Our initial experience with rosuvastatin/ezetimibe in hypertriglyceridemia treatment suggests that this therapy may play a role in the treatment of insomnia
Are you short of breath? comparing functional capacity using new york heart association class and cardiopulmonary exercise testing
Authors: Hammett R , Fleri Soler J , Gauci M , Desira J , Abela M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

New York Heart Association (NYHA) scale is used to assess symptom severity in heart failure patients. Despite it being used routinely in clinical practice, it is heavily dependent on patient and physician subjectivity. Cardiopulmonary exercise testing (CPET) provides a potentially more objective and reproducible measure of functional capacity.

Purpose

To assess functional capacity in NYHA 1 versus NYHA 2-4 patients. Investigators also wanted to explore any relationship between NYHA class and CPET variables in heart failure patients.

Method

A retrospective analysis of patients who underwent CPET between 2021 & 2022 was performed. The patients were grouped according to NYHA score and ejection fraction (EF). A separate subgroup analysis was carried out in NYHA 1, comparing patients with an EF < 35% and EF > 35%.

Results

A total of 160 patients were included, a dominant male (81.3%) Caucasian (95%) population with an average age of 53.9 years. 13.8% had an EF <35%. 51.9% had ischaemic cardiomyopathy. 103 (64.4%) patients had a NYHA score of 1, the rest had a NYHA score of 2-3. There was no significant difference between demographic parameters and co-morbidities between the groups.

Figure 1 depicts CPET parameters comparing NYHA 1 vs NYHA 2-4 groups. VO2 MAX and % VO2 Max Predicted were significantly higher in NYHA 1 vs NYHA 2-4 (Figure 1). NT-proBNP levels were lower in the NYHA 1 group (378 pg/mL vs 850 pg/mL, p=0.023). Further analysis of the NYHA Class 1 group, comparing EF< 35% and >35% was carried out. It was discovered that despite being assigned the same NYHA Class, the EF <35% group had significantly lower VO2 max, % predicted VO2 max and VE/VCO2.

EF was an important predictor of CPET performance in NYHA 1 patients. Those with an EF <35% had a lower VO2 max (p=0.001), low % VO2 Max predicted (p=0.005) and higher VE/VCO2 (p=0.002). NT-proBNP was also higher in this subgroup (p=0.047).

Conclusion

NYHA is an effective tool at assessing symptom severity in heart failure patients, albeit subjectively. CPET is particularly useful in NYHA 1 patients as it can give an objective assessment of functional capacity in these asymptomatic individuals. Future studies should explore the possible role of CPET in determining suitability for advanced heart failure therapies in NYHA 1 heart failure patients.