bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term outcomes in patients with non-ST-segment elevation myocardial infarction
Authors: Paula S , Santos M , Santos H , Almeida I , Figueiredo M , Almeida S , Almeida L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The proportion of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing among the acute coronary syndromes (ACS). Reinfarction (RI) is a potential complication in high-risk patients with NSTEMI and it will cause an impact on these patients’ prognosis.

Purpose

Identify high-risk patients with RI and their prognosis in the setting of NSTEMI.

Methods

Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients without RI; G2 - patients with RI during hospitalization. Logistic regression and survival analysis were performed.

Results

7180 patients were admitted with NSTEMI, RI occurred in 71 pts (0.99%). Regarding epidemiological and past history G2 was older (71±12 vs 66±12, p=0.001), had higher rates of previous stroke (15.9% vs 7.0%, p 0.003) and peripheric arterial disease (6.3% vs 6.1%, p=0.004). The groups were similar regarding arterial hypertension (p=0.74), diabetes type 2 (p=0.11) and dyslipidaemia (p=0.48).

G2 had higher levels of brain natriuretic peptide (45.5% vs 24.5%, p<0.001) and lower levels of haemoglobin (20.3% vs 7.9%, p<0.001). Patients taking prasugrel (2% vs 0.3%, p=0.002) or ticagrelor (6.1% vs 2.2%, p<0.001) previously to the admission were more susceptible to have RI. Patients with severe left ventricular systolic dysfunction (3.4% vs 2.6%, p<0.001), need of invasive (2.8% vs 0.8%, p<0.001) or non-invasive (4.2% vs 1.3%, p<0.001) ventilation and percutaneous coronary intervention (PCI) (80.3% vs 64.7%, p0.006) had higher rates of RI.

Logist regression confirmed that PCI (p=0.03, OR 2.22, CI 1.08-4.53), previous stroke (p=0.02, OR 0.58, CI 0.37-0.92) and pts previously taking prasugrel (p=0.02, OR 1.85, CI 1.11-3.10) were predictors of RI in the setting of NSTEMI.

Conclusion

RI in the setting of NSTEMI was associated with PCI, previous stroke and pts previously taking prasugrel. One year prognosis was poorer for patients who suffered RI.
Cardiac rehabilitation in MINOCA patients
Authors: Houben V , Pustjens TFS , Meerman A , Rasoul S , Van 'T Hof AWJ
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background and purpose

Although cardiac rehabilitation (CR) after myocardial infarction (MI) has been proven to be beneficial, only a minority of patients participate. This study was performed to gain more knowledge about referral and participation rates for CR in patients with myocardial infarction with Nonobstructive Coronary Arteries(MINOCA).

Methods

All patients meeting the diagnostic MINOCA criteria and admitted between January 2017 and April 2019 were retrospectively analysed. They were divided into the 1) ‘Conclusive MINOCA’ (confirmed MI, (peri)myocarditis, cardiomyopathy, or miscellaneous) and 2) ‘Indeterminate MINOCA’ group. Patients who died in hospital were excluded. Referral and participation in CR was verified.

Results

Of the 196 included MINOCA patients, 110 (56%) were female and the mean age was 60±13.7 years. 62 Patients(31.6%) had conclusive MINOCA and 134 patients (68.4%) had indeterminate MINOCA. In Figure 1 the distribution of CR referral and participation is shown. Figure 2 shows the referral and participation rates for conclusive and indeterminate MINOCA patients. Conclusive MINOCA patients were more likely to be referred(79.0% vs. 61.9%, p=0.018) and participated more often in CR (45.2% vs. 26.1%, p=0.008). This relation was even stronger when confirmed MI was the final diagnosis as compared to the other MINOCA patients (referral91.3% vs. 64.2%, p=0.009; participation 69.6% vs. 27.2%, p<0.001).

Conclusion

Only one-third of MINOCA patients participate in CR. Referral and participation rates were significantly higher in MINOCA with confirmed underlying diagnosis (especially confirmed MI) as compared to MINOCA with indeterminate diagnosis. MINOCA patients should be more often referred to CR with a focus on MINOCA with indeterminate underlying diagnosis.
Asymptomatic severe aortic stenosis, conservative treatment or early valve replacement? a systematic review and meta-analysis
Authors: K Awad A , Elseidy S , Elgenidy A , Elbadawy M A , Sayed A , Mohamad T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Asymptomatic aortic stenosis’ management is not only a daily practice challenge but also an area of clinical research controversy. As evidence on conservative versus early aortic valve replacement (AVR) is debatable, we conducted a systematic review and meta-analysis to compare the efficacy of conservative management versus AVR in asymptomatic aortic stenosis (AS).

Methods

Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of conservative management versus AVR on all causes, cardiovascular, non-cardiovascular mortality. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated using random-effects models.

Results

A total of 6216 patients were included from 12 studies (observational=9, and randomized clinical trial=3) with a mean follow-up duration of 50 months. When compared to early AVR, conservative management has statistically significant higher risk of all causes mortality (RR: 0.36, 95%CI [0.31 to 0.42], p<0.00001, figure 1), cardiovascular mortality (RR: 0.32, 95%CI [0.24 to 0.41], p<0.00001, figure 2), and non-cardiovascular mortality (RR: 0.42, 95%CI [0.24 to 0.56], p=0.0005). Regarding other complications, conservative treatment showed significant higher risk of sudden cardiac death (RR: 0.46, 95%CI [0.15 to 0.90], p=0.005), yet with no difference over AVR in stroke and myocardial infarction (RR: 0.79, 95% CI [0.17 to 3.64], p=0.61) and (RR: 0.67, 95% CI [0.39 to 1.16], p=0.15), respectively. A subgroup sensitivity analysis based on surgical AVR vs. transcatheter AVR and severe vs. very severe AS reflected the findings of the overall results.

Conclusions

Patients with asymptomatic aortic valve stenosis, managed with early AVR, have a lower risk of all-cause, cardiovascular, and non-cardiovascular mortality when compared to conservative management.
Cardiac practice during the second year of COVID-19 pandemic: are we going back to normal?
Authors: Dakhil Z A , Cader F A , Oz TUG˘BA , Borreli NUNZIA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Little data is known regarding the impact of the COVID-19 pandemic on cardiac services during the second year. This globally distributed survey aimed to study the impact of the pandemic on cardiovascular services, type of PPE currently used by participants and their academic achievements during pandemic.

Methods

A 23-item online survey was distributed via social media among HCPs involved in cardiac services. Survey items assessed the proportion of change in various cardiac services in 2021, as compared with 2020.

Results

Among 111 respondents, 54.95% were resident in Asia, while 27.02% were resident in Europe, see Figure (1). Among total respondents; 57.7 % were females. 58.6% of respondents were from COVID-19 designated hospitals. Interventional cardiologists constitute 46.8% of respondents, clinical cardiologists were 22.5%, 12.6% were specialising in cardiac imaging, while 9% were electrophysiologists. 55% were consultants/attendings while 34.2% were fellows/ trainees. Proportions of return of cardiac services to pre-pandemic states are depicted in Figure (2). The highest return to pre-pandemic services were in emergency coronary catheterisation (25.2%), 21.6% of respondents noted return to pre-pandemic states in elective coronary catheterizations, and trans-thoracic echocardiograms [TTE]. Telemedicine was used by 64.9% of outpatient consultations. 94.6% of respondents were vaccinated. Respondents reported that most used PPE during their daily practice was surgical mask (69.36 %) followed by N95/FFP mask (53.15%). 30.6% reported decline in conference participation as faculty/speaker, while 21.6% reported decline in publications during the pandemic.

Conclusion

In an increasingly vaccinated global cardiology workforce, cardiac services are gradually picking up to pre-pandemic rates, with the highest being noted for coronary catheterisations and trans-thoracic echocardiograms.
Successful perindopril/amlodipine+indapamide treatment as second line in uncontrolled hypertensive patients in line with european guidelines
Authors: De Champvallins M , Brzozowska-Villatte R , Mancia G
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): The study was sponsored by Servier.

Background

ESC/ESH guidelines recommend use of a RAAS inhibitor + CCB + Thiazide as second step treatment for hypertensive patients with uncontrolled blood pressure (BP), preferably as single-pill combination.

Purpose

We investigated the results of adding indapamide SR 1.5 mg to the single-pill combination of perindopril/amlodipine (Per/Aml) in a context of a randomized double-blind controlled trial.

Method

The study compared 2 treatment strategies over 6 months: initiation with Per/Aml with further conditional uptitration up to Per/Amlo 14/10 mg, followed after 3 months of bi-therapy by addition of indapamide SR 1.5 mg for 3 additional months, versus initiation with Valsartan (Val) and further addition of amlodipine, then uptitration up to Val/Amlo 160/10 mg. The study was completed by an additional 8-month extension period (M14) at the same dose for the patients controlled at M6, for safety purposes.

Results

Compared with initiation of Val alone, initiation of treatment with Per/Amlo led to lower number of patients needing further uptitration at M3 (23% vs 31%). In 202 patients uncontrolled with Per/Amlo 14/10, the addition of indapamide SR 1.5 mg led to a large additional decrease in systolic BP (-14.8±13.3 mmHg) and diastolic BP (-7.2±9.7 mmHg) with BP control achieved in 82.5% of the patients (<140/90 mmHg) and BP response in 94%. During the whole period (11 months), 5.9% of the patients (n=10) discontinued the triple therapy due to 11 adverse reactions, versus 3.9% of those receiving Per/Amlo 14/10 over the same period.

Conclusion

These findings confirm the BP-lowering efficacy and safety of adding the thiazide-like indapamide to a previous ACE inhibitor+CCB (Per/Amlo) combination providing clinical evidence for this triple therapy, preferably to be given as single-pill combination.
Alternations in markers of insulin resistance: HOMA-IR, HOMA-B, QUICKI, after dual therapy combination with valsartan/amlodipine in prediabetic hypertensive patients
Authors: Liontos A , Papathanasiou A , Biros D , Papagiannopoulos C , Athanasiou L , Tsourlos S , Veliani C , Kolios NG , Pappa C , Zarachi A , Christaki E , Liberopoulos E , Elisaf M , Milionis H , Liamis G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction-Purpose

The combination of valsartan with amlodipine is more effective than monotherapy for managing HT. The purpose of this study was to investigate the effect of the fixed combination of valsartan/amlodipine 160/5 mg per day on HOMA-IR (homeostatic model assessment for insulin resistance), HOMA-B (HOMA for β cell function) and QUICKI (quantitative insulin-sensitivity check index) values in patients with stage 2 hypertension (systolic arterial pressure 160-179 mmHg and/or diastolic pressure 100-109 mmHg) and prediabetes (IFG/IGT) before and after 3 months of treatment with the dual therapy.

Methods

Data from 54 patients who visited our outpatient clinic for lipid metabolism during the period 2014-2018. 54 persons were randomized in the valsartan/amlodipine group 160/5 mg per day (33 males/21 females from whom 14 were smokers and 8 were alcohol consumers) with BMI: 28.09[26.81-29.89], all of whom successfully completed the study. The median values of systolic and diastolic arterial pressure for the study population: 162 [159.25-165] and 100 [92-103.75] mmHg, respectively.

Results

The resulting variations of systolic and diastolic arterial pressure as well as the variations of HOMA-IR, HOMA-B and QUICKI are presented on Table 1.

Conclusions

From the studied group it is concluded that the 3-month treatment with valsartan/amlodipine improved with statistical significance the values of both systolic and diastolic arterial pressure (reduction by -13.58% and -13% for systolic and diastolic arterial pressure, respectively, p<0.001, for both values). Regarding glucose levels, there has also been a reduction by -0.04%, without statistical significance, while the increase of insulin levels (+16.13%) by the end of the 3-month period was also deemed statistically insignificant. Additionally, there have been noted statistically insignificant increases in HOMA-IR (+12.65%) and HOMA-B (+17%). Finally, no change has been observed in QUICKI values.
Changes in TRG/ApoA-1 ratio, TRG/HDL-C ratio and lipid serum profile after combination therapy with manidipine/delapril in prediabetic hypertensive patients
Authors: Liontos A , Papathanasiou A , Biros D , Papagiannopoulos C , Tsourlos S , Athanasiou L , Zarachi A , Pappa C , Pargana E , Nasiou M , Christaki E , Liberopoulos E , Elisaf M , Milionis H , Liamis G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction-Purpose

Both manidipine and delapril have been proven to have a neutral effect on lipids. Patients with idiopathic hypertension are being administered with the 30mg hydrochloric delapril and 10mg hydrochloric manidipine formulation. The purpose of this study was to investigate the effect of the fixed combination of delapril/manidipine 30/10mg on lipid and apolipoprotein levels as well as on TRG/ApoA-1 and TRG/HDL-C ratios as indicative markers of insulin resistance, in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-179 mmHg and/or diastolic blood pressure (DBP) 100-109 mmHg) and with prediabetes (IFG/IGT), before and after the 3-month treatment.

Methods

53 patients referred to our outpatient clinic for lipid metabolism disorders and met the study’s criteria were included, during the period 2014-2018. In the group of delapril/minidipine there were randomized 30 males and 23 females from whom 12 were smokers and 7 alcohol users). The patients’ BMI was 28.73 [27.73-30.3] and the values of SBP and DBP were: 156 [151-161] και 100 [88-101] mmHg, respectively. The serum lipid and apolipoprotein levels were measured before and after the 3-month treatment.

Results

The resulting variations of SBP and DBP levels, as well as the changes in lipid levels, apolipoprotein levels and TRG/ApoA-1 and TRG/HDL-C ratios are presented on Table 1.

Conclusion

From the sample group it can be observed that the 3-month combination therapy with manidipine/delapril improved statistically significantly both SBP and DBP levels (reduction by -13.58% and -13%, respectively). Concerning serum lipid levels, the combination therapy statistically significantly improved TCHOL, LDL-CHOL, and non-HDL-CHOL levels (decrease by 4.01%, 6.7% and 5.4%, p= 0.009, 0.006 and 0,08 respectively). The changes in apolipoprotein values were small and only ApoB values showed a statistically significant variation. Finally, there wasn’t a statistically significant improvement on neither TRG/ApoA-1 nor TRG/HDL-C ratios.
Blood pressure target attainment according to the recent ESC cardiovascular prevention guidelines
Authors: Barkas F , Koutsogianni AD , Adamidis P , Anastasiou G , Liberopoulos E , Liamis G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

New cardiovascular prevention guidelines have recently been issued by the European Society of Cardiology (ESC).

Purpose

To record blood pressure (BP) target attainment according to the recent ESC cardiovascular prevention guidelines.

Methods

A retrospective observational study involving 1334 dyslipidemic patients followed-up for ≥3 years at the Outpatient Lipid Clinic in University General Hospital of Ioannina, Greece. BP target attainment was recorded. ESC 2021 guidelines recommend a general target of BP <140/80 mmHg and individual targets of: i) diastolic BP <80 mmHg in all patients and ii) systolic BP 120-130 mmHg in patients 18-69 years of age without chronic kidney disease, or systolic BP 130-140 mmHg in patients 18-69 years of age with chronic kidney disease, or in those ≥70 years of age.

Results

Among the 1334 subjects, 935 (45% men, 68 [60-75 years old]) were diagnosed with hypertension and received antihypertensive treatment. Of those, 19% were diagnosed with chronic kidney disease, 24% with atherosclerotic cardiovascular disease and 23% with type 2 diabetes. Of those, 75% were receiving an angiotensin receptor blocker, 52% a thiazide diuretic, 52% a calcium channel blocker, 37% a β-blocker, 13% an angiotensin converting enzyme inhibitor, 6% an aldosterone receptor blocker and 2% a centrally acting antihypertensive drug. Half of subjects had BP <140/80 mmHg, but only 21% achieved the individualized BP targets.

Conclusions

A considerable proportion of hypertensive patients do not achieve target BP values.
Heart rate variability and atrial fibrillation in the general population: a longitudinal and mendelian randomization study
Authors: Geurts S , Tilly MJ , Arshi B , Stricker BHC , Kors JA , Deckers JW , De Groot NMS , Ikram MA , Kavousi M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This study is further supported by the Gender and prevention grant (555003017) from ZonMw.

Background

Sex-differences and the causality of the association between heart rate variability (HRV) and atrial fibrillation (AF) remain unclear.

Purpose

To investigate the sex-differences and the causality of the association between heart rate variability and atrial fibrillation.

Methods

12,334 participants free of AF from a large population-based cohort study were included. Measures of HRV including the standard deviation of normal RR-intervals (SDNN), SDNN corrected for heart rate (SDNNc), RR-interval differences (RMSSD), RMSSD corrected for heart rate (RMSSDc), and heart rate were assessed at baseline and follow-up examinations. Joint models, adjusted for cardiovascular risk factors, were used to determine the association between longitudinal measures of HRV with new-onset AF. Additionally, we evaluated sex-differences. Genetic variants for HRV were used as instrumental variables in a Mendelian randomization (MR) analysis using GWAS summary-level data.

Results

During a median follow-up of 9.4 years, 1,302 incident AF cases occurred. In joint models, higher SDNN (hazard ratio (HR), 95% confidence interval (CI), 1.24, 1.04-1.47, p=0.0213), and higher RMSSD (HR, 95% CI, 1.33, 1.13-1.54, p=0.0010) were significantly associated with new-onset AF. Sex-stratified analyses showed that the associations were mostly prominent among women. In MR analyses, genetically determined decreases in SDNN (odds ratio (OR), 95% CI, 1.60, 1.27-2.02, p=8.36x10-05), and RMSSD (OR, 95% CI, 1.56, 1.31-1.86, p= 6.32x10-07) were significantly associated with increased AF risk.

Conclusions

Longitudinal measures of uncorrected HRV were significantly associated with new-onset AF, in particular among women. MR analyses supported the causal relationship between uncorrected measures of HRV with AF. Our findings indicate that measures to modulate HRV might prevent AF in the general population, especially among women.
Dietary total antioxidant capacity is associated in Polish men and women with the prevalence of cardiovascular diseases and their risk factors
Authors: Witkowska AM , Waskiewicz A , Zujko ME , Mironczuk-Chodakowska I , Drygas W
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular diseases (CVD) are the main cause of mortality in the Polish population. Improper diet and lifestyle are among the risk factors for CVD. Previous studies have suggested that dietary total antioxidant capacity (DTAC) is a measure of diet quality.

Purpose

The aim of the study was to investigate the relationship between diet quality measured by DTAC and the prevalence of CVD and CVD risk factors in the representative sample of men and women in Poland.

Methods

The study evaluated participants (2594 men, 3136 women) of the population-based cross-sectional Polish National Multicenter Health Examination Survey (WOBASZ II), which was conducted in 2013-2014. Dietary data were collected using a single 24-hour dietary recall method. The database on dietary antioxidants was compiled from published and own experimental data. DTAC was calculated taking into account the antioxidant capacity of individual foods and the amount of food intake. Men and women were divided into quartiles of CVD prevalence and its risk factors (diabetes; hypertension; BMI≥25; central obesity, CO; low level of leisure-time physical activity, LTPA) according to DTAC. Statistical calculations were performed using the Statistical Analysis System (SAS), version 9.4 (SAS Institute Inc., Cary, NC, USA).

Results

DTAC in men ranged from 0.47 to 95.69 mmol/day, while in women it was 0.32-191.82 mmol/day. In men, the prevalence of CVD was 23.7% in the lowest DTAC quartile (Q1) versus 14.9% in the highest quartile (Q4) (p<0.0001), while in women it was 23.4% (Q1) and 17.4% (Q4), respectively (p<0.0002). In women, but not in men, DTAC was inversely associated with diabetes (p<0.0002), hypertension (p<0.0001), CO (p<0.02) and low LTPA (p<0.0006).

Conclusions

DTAC is inversely related to the prevalence of CVD in both genders. In women, but not in men, there is a significant inverse association of DTAC with CVD risk factors such as metabolic diseases, central obesity and lower physical activity. In order to reduce the risk of CVD, Polish men and women should be advised to improve the quality of their diet by increasing the dietary intake of antioxidants.
Manipulating rest interval length in sprint interval training alters post-exercise hypotension and within-session oxygen consumption
Authors: Ketelhut S , Moehle M , Guerlich T , Hottenrott L , Hottenrott K
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

It is well documented that sprint interval training (SIT) elicits similar or even superior health and performance benefits compared to continuous aerobic training, albeit a significantly reduced time commitment. A distinctive feature of intermittent exercise training is the possibility to modulate the different training variables resulting in numerous different protocols. This makes this training approach infinitely variable and individually adjustable. The purpose of this study was to examine the effects of manipulating the rest interval length during SIT on post-exercise hypotension and within-session oxygen consumption.

Methods

Thirty healthy adults (aged 30.9 ± 8.7 years; BMI 22.1 ± 2.3 kg/m2; 14 males, 16 females) participated in this study. All participants completed two SIT protocols consisting of 4x 30-seconds all-out cycling sprints interspersed by either 1 (R1) or 3 (R3) minutes of active recovery. Both before and throughout the 45 minutes after the training, peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), and heart rate (HR) were assessed. Throughout the SIT protocols, oxygen consumption (VO2) was continuously monitored.

Results

Only after R3 a significant reduction in pSBP, pDBP, cSBP, cDBP, and PWV could be detected. Significant interaction effects could be detected in pSBD, pDBP, cSBP, cDBP, and PWV. HR significantly increased after both conditions (Table 1.). No significant (p>0.05) differences in time spent at 75%, 85%, 95%, and 100% of maximal VO2 between R1 and R3 could be detected.

Conclusion

Rest interval manipulation seems to affect hemodynamic responses to SIT with longer resting intervals resulting in more substantial post-exercise hypotension effects. Time spent at a high percentage of maximal VO2 was not attenuated by rest interval manipulation. These results add crucial information for the prescription of SIT.
Heart rate recovery and risk of cardiovascular disease and all-cause mortality: a systematic review of prospective cohort studies
Authors: Michailidou S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

An attenuated decrease of heart rate recovery (HRR) immediately after exercise is an indicator of autonomic dysfunction and has been linked with a higher risk of cardiovascular disease and all-cause mortality in both healthy and clinical population. However, the evidence regarding its potential prognostic value varies across studies making its implementation in clinical practice for risk assessment difficult. The purpose of the present systematic review is therefore, to investigate the predictive value of heart rate recovery in CVD disease and all-cause mortality, in an evidenced-based manner to encourage its incorporation in clinical practice

Methods and Results

A systematic review was performed through a comprehensive search on PubMed that focused only on prospective cohort studies. Of the studies retrieved, a total of 13 eligible articles were included in this systematic review with nine of them enrolling 37 457 participants and 709 CVD cases for cardiovascular events, and 12 comprising 45 905 participants and 4 301 deaths for all-cause mortality.The study quality of the included studies was rated moderate to high (4-8) with high heterogeneity (I² = 0.0001). Results revealed no statistically significant difference in HRR for patients with and without cardiovascular events M=-2672.16, at 95% CI [-7341.6,1997.32] ; P-value = .234 as well as for people who died and those who did not M= -3141.667, at 95% CI [-7627.448,1344.144], P-value = .151. Also, the association between CVD and mortality was presented statistically significant, Chi-Square = p<0.0001 while a further analyses of heart rate recovery revealed that when distinguished between low and high, it was found to have a strong positive association with all-cause mortality, Chi-Square = p<0.0001.

Conclusion

The current systematic review findings indicated that a low HRR is directly linked with greater all-cause mortality risk. Also, given the strong association found between CVD and mortality, the study further supported that even though indirectly, a low HRR is also associated with an increased risk of cardiovascular events, supporting the notion that HRR has a prognostic value and could be used in clinical practice.
Women-specific risk factors and risk of incident atrial fibrillation in UK Biobank
Authors: Lu Z , Geurts S , Aribas E , De Groot NMS , Kavousi M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and carries a large morbidity and mortality risk. Recent evidence suggests differences in epidemiology and pathophysiology of AF between women and men and underscores a poorer prognosis of AF among women. This calls for further investigation regarding the impact of women-specific risk factors on AF development.

Purpose

To investigate the association between women-specific risk factors and new-onset AF.

Methods

235,191 women (mean [standard deviation] age: 55.7 [8.1] years) free of AF and without a history of hysterectomy and/or bilateral oophorectomy from the UK Biobank were included. Various women-specific risk factors were assessed from 2006 to 2010. Follow-up of new-onset AF occurred through October 2020. Cox proportional hazards analyses were performed to investigate prospective associations between each risk factor and incident AF. Additionally, natural splines were used to identify any potential nonlinear associations.

Results

After a median follow-up of 11.6 (interquartile range: 10.9–12.3) years, 4,629 (2%) women experienced new-onset AF. In fully adjusted models, having experienced irregular menstrual cycle was significantly associated with increased new-onset AF risk [hazard ratio (HR); 95% confidence interval (CI): 1.34; 1.01-1.79]. In addition, nonlinear associations were found between menopausal age, menarcheal age, number of live births, and number of total reproductive years with incident AF. Compared to the reference, early menopause (menopause <45 years of age) or delayed menopause (>60 years) significantly increased risks of incident AF (HR; 95CI: 1.24; 1.10-1.39 and 1.34; 1.01-1.78, respectively). Compared to the reference, both early menarche (menarche ≤11 years) and late menarche (menarche ≥13 years) were associated with AF incidence (HR; 95CI: 1.10; 1.00-1.21 and 1.08; 1.00-1.17, respectively). Compared to women with one or two children, having no children (HR; 95CI: 1.13; 1.04-1.24), or more than six children (HR; 95%CI: 1.67; 1.03-2.70) were associated with higher AF risks. Having reproductive years ≤20 years was significantly associated with incident AF (HR; 95CI: 1.74; 1.07-2.86).

Conclusions

Having experienced early or delayed menopause, early or late menarche, or irregular menstrual cycles conferred higher risks of incident AF among women in the UK Biobank. Interestingly, both nulliparity and multiparity, compared to having one or two children, were associated with an increased AF risk. Our results highlight the importance of knowledge regarding the reproductive history of women in devising screening strategies for AF prevention.
Baseline carotid intima-media complex echogenicity associates with the 3-year progression of intima-media thickness
Authors: Nyman E , Liv P , Wester P , Naslund U , Gronlund C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region Vasterbotten Central ALF and the Swedish Research Council

Background

Echogenicity of the intima-media (IM) complex and progression of carotid intima media thickness (cIMT) have both separately been demonstrated to predict cardiovascular disease (CVD). However, it is unknown if the IM echogenicity reflects arterial wall remodelling associated with increased progression of cIMT.

Purpose

The aim of this study was to evaluate if the baseline echogenicity of the IM-complex measured by ultrasound is associated with cIMT progression over a 3-year follow-up period.

Methods

Ultrasound images from baseline and 3-year follow-up performed for the randomised controlled trial ‘Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention’ (VIPVIZA) were included in this study (n: 3154). Participants were 40, 50 or 60 years old at baseline and had at minimum one traditional risk factor for CVD to be included in the VIPVIZA study. Measurements of mean cIMT were made at baseline and in the 3-year follow-up in the distal 1 cm of the common carotid artery at standardised angles bilaterally. Echogenicity of the IM-complex was determined by greyscale median (IM-GSM), automatically calculated from the B-mode ultrasound images. Associations between IM-GSM at baseline and the 3-year progression of cIMT were investigated using linear regression models, and stratified by sex, age and VIPVIZA study group (intervention versus control). In addition, adjusted analysis for traditional risk factors was also performed. All analysis was carried out on left and right sides separately.

Results

The unadjusted analysis showed associations between baseline IM-GSM with the 3-year progression of cIMT (p<0.001 for both left and right sides, Figure 1). The association between IM-GSM and cIMT was statistically significant bilaterally in both male and female participants and on comparison of VIPVIZA study subgroups. When stratifying by age group, the association between baseline IM-GSM and cIMT progression was present among 40 (p<0.001) and 60 year olds (p<0.001), but not among 50 years old (p=0.906) in the left side. In the right CCA the association was significant among 40 years old (p=0.047), but not for 50 and 60 years (p=0.106 and 0.067, respectively). Adjustments for traditional risk factors did not alter the estimated relationship between baseline IM-GSM and 3-year cIMT progression.

Conclusion

Baseline ultrasound echogenicity of the IM-complex is associated with the 3-year progression of cIMT among a middle-aged population with subclinical atherosclerosis. Echogenicity of the IM-complex may serve to identify arterial wall remodelling reflecting progressive atherosclerotic disease and could be a valuable tool in future CVD prevention.
Flow mediated dilatation: searching high and low for a technique
Authors: Koca C , Kozluca V , Esenboga K , Tan Kurklu TS , Kurklu HA , Kilickap M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Endothelial dysfunction has a central role in atherosclerosis physiology. Flow mediated dilatation (FMD) is a non-invasive method for determining endothelial function. Cuff occlusion of forearm for 5 minutes followed by sudden release cause hyperaemia response with increased flow rate and shear stress in brachial artery. FMD measures the ratio of arterial diameter change mediated by nitric oxide (NO) in response to this increase in shear stress. FMD was first defined in 1992 but has not gained wide clinical utility due to contradictory study results. The main reason for inconsistencies is the lack of standardized definition of FMD technique. We need more studies on different steps of FMD procedure.

Purpose

The optimal cuff position for FMD measurements is not precisely defined. When brachial arterial flow is disturbed by occlusion, different mediators play role in hyperaemia induced dilatation. Occlusion distal to brachial artery causes mainly NO and endothelium mediated dilatation upstream. Therefore, a forearm occlusion cuff position is proposed. Currently, there is no precise definition of the cuff position in forearm. We compared proximal and distal forearm cuff occlusion positions for FMD measurements.

Methods

We analysed FMD in fifty healthy volunteers (mean age 31,9 ± 9,5 years; 54 % female). The subjects underwent measurements with two different occlusion positions on the same day. The sequence of occlusion cuff position was determined with randomization. We have waited for an appropriate interval between measurements. We made sure that brachial artery has returned to its basal diameter and flow conditions before second measurement. Flow and diameter measurements were made with strict adherence to predefined timelines after cuff release. Same operator performed and recorded all FMD measurements.

Results

Measurements of basal diameter (p=0,97) and basal flow (p=0,53) were not different. We used random intercept mixed effects model for comparison of proximal and distal occlusion positions. This enabled interpretation of FMD results with refinement of sequence and basal diameter’s possible effects. The FMD values of proximal forearm occlusion cuff position were 2,2 % higher compared to distal position. (p=0,027) The sequence of occlusion cuff position did not have significant effect on consecutive FMD measurements. (p=0,405).

Conclusions

We have shown that the forearm occlusion cuff position affects FMD measurements. This effect can be responsible for inter-study differences of FMD. Further research is required for interpretation of this difference in terms of molecular mechanisms and its applicability in clinical practice.
Heart rate recovery is improved after locomotor training in persons with incomplete spinal cord injury: implications for health and prevention
Authors: Cahalin L , Cohen M , Nash M , Field-Fote E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Heart rate recovery after exercise provides meaningful information about physical fitness and prognosis in both health and disease. A more rapid decrease in heart rate after exercise has been associated with higher levels of fitness as well as better health and survival. In fact, heart rate recovery (HRR) ≤ 12 beats at one minute after maximal and sub-maximal exercise is a significant prognostic index of poorer health and survival. However, little research has examined HRR in persons with spinal cord injury (SCI) despite the need for a responsive measure of fitness and health in this population.

Purpose

The purpose of this study was to examine HRR before and after locomotor training (LT) in persons with SCI.

Methods

Twenty-nine subjects with incomplete SCI performed LT 5 days per week for 12 weeks using one of four training approaches: treadmill-based training with manual assistance (TMM), treadmill-based training with stimulation (TMS), over-ground training with stimulation (OGS), and treadmill-based training with robotic assistance (TMR). Before and after 12 weeks of LT the HRR was measured one minute after 2-3 minutes of walking at each subject’s maximal capacity. Heart rate data was captured via a recording band placed on each subjects’ chest that transmitted wireless signals to a data collection system which recorded heart rate data continuously.

Results

The peak HR during maximal walking of the cohort before and after LT was 75 ±15% and 71 ±14% of the age-predicted maximal HR, respectively. Fifteen of the 29 subjects (52%) had an abnormal HRR (≤ 12 beats) at baseline; following LT, HRR was improved in 11/15 (73%) of these subjects. In addition, 50% of subjects with a normal baseline HRR improved HRR after LT. There was no significant difference in HRR among training approaches at baseline or after LT.

Conclusions

Twelve weeks of LT was associated with an improvement in HRR in almost three-quarters of the subjects with an abnormal HRR at baseline, and HRR improved in one-half of the subjects with a normal HRR at baseline. These findings suggest that HRR may be of value for tracking fitness and prognosis in persons with SCI. Further investigation of HRR in subjects with SCI is warranted.
Piloting opportunistic cardiovascular risk assessment at a faith community event
Authors: Faizur Rahman ME , Ajumal HA , Latif A , Waqar S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Ethnic minority populations in the United Kingdom (UK) are known to have higher rates of undiagnosed and poorly controlled hypertension and metabolic disease (1). Muslims in the UK make up a significant proportion of these populations, and have lower reported rates of well-being and satisfaction with health services (2). Tailoring interventions to target under-served populations and activate positive health behaviours has been shown to improve uptake and outcomes (3).

Purpose

We undertook an opportunistic pilot intervention to explore the potential of using faith-placed community assets to identify undiagnosed and poorly managed cases of hypertension, diabetes, and explore cardiovascular disease (CVD) risk.

Methods

A community event was organised for Indian-origin Tamil speaking Muslims who gathered from across the UK in November 2021. We piloted a short CVD risk assessment intervention to take place during this event, delivered by doctors from the same community. Participants consented for assessment of body mass index (BMI), blood pressure (BP), random capillary blood glucose (CBG), and manual pulse rhythm check (with a commercially available smartphone based single-lead electrocardiogram device where needed). We also calculated the 10-year CVD risk using a nationally validated 10-year CVD risk calculator. The intervention was culturally tailored, specifically with men and women examined by the same sex and participants being given an Islamic reminder on good health to encourage their involvement.

Results

35 attendees were assessed in total. 33/35 (94%) attendees were 60-years-old or less. 18/35 (51%) had an elevated blood pressure reading (systolic BP ≥ 140mmHg or diastolic BP ≥ 90mmHg on both arms), with only 3/18 (17%) having a prior diagnosis of hypertension. Only 17/35 consented to CBG measurement, of which 4/17 (23%) had random CBG levels of >11.1 mmol/L with 3/17 having CBG levels of >25 mmol/L - none of them were known to have diabetes. 9/35 (26%) had 10-year CVD risk of >10%. 6/9 (67%) of these were not on statin therapy. 24/35 (69%) had elevated BMI, with 9/24 (37%) having a BMI of ≥ 30 kg/m2. None of the attendees had an irregular pulse to suggest arrhythmia. Full characteristics are shown in Figure 1 and results are further detailed in Figure 2. In Summary, 29/35 (83%) had at least one abnormal finding on assessment. All participants with abnormal findings were signposted to seek formal diagnosis and management through their general practitioner, and were offered lifestyle advice.

Conclusions

This brief and targeted intervention was successful at detecting undiagnosed cases of probable hypertension and hyperglycaemia, as well as identifying cases who would benefit from primary CVD risk prevention. Further research is needed to understand the scalability and feasibility of this approach to wider populations.
Implementing hybrid telerehabilitation following major cardiac surgery during COVID-19 pandemic in Hong Kong
Authors: Wong K F , Fu N , Fan KYY , Cheng K Y , Wong K L , Yung C Y , Ho C K L , Au TWK
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Department budget

Background

Aerobic exercise is a critical component of cardiac rehabilitation (CR) for patients (pts) who have undergone cardiac surgery. Exercise-based CR is ideally home-based and directly supervised by a trained physiotherapist. During COVID-19 pandemic in Hong Kong, there was increasing emphasis on social distancing and caregiving strategies to better reach pts outside hospital. As most cardiac surgeries were performed on urgent clinical needs including heart transplantation and aortic dissection, we implemented hybrid telerehabilitation (HTR) with transition to the use of remote care in order to continue comprehensive CR. We report the functional outcome of HTR group compared with usual care (UC) group.

Methods

From 7/2020 to10/2021, 36 pts ( 67% men, mean age 57±9.2 years) were enrolled into HTR (n=18) and UC (n=18) groups respectively for 12 weeks’ duration. Demographics in both groups were similar. Types of cardiac surgeries were heart transplant (n=5; 14%), CABG (n=6;17%), valvular surgery (n=17; 47%) and aorta operation (n=8; 22%). An individualized exercise prescription for HTR at home was determined based on initial standardized assessments in hospital and tailored to fit lifestyle and home environment. For HTR group, the goal is set at 150 minutes of low to moderate-intensity aerobic exercise per week at home. Exercise is progressed weekly based on daily metrics recorded by wearable device (exercise log and % target heart rate reserve (THRR) attained) and rate of perceived exertion (RPE). These were reported by pts through an online survey after each exercise session which were reviewed daily, with progress follow-up by phone calls or text messages on a weekly basis.

Functional capacity parameters were evaluated using symptom limited exercise treadmill test (ETT) and 6 minute walk test (6MWT). The advised level is based on the current activity level of the patient using a MET score list at intake by the physiotherapist. Handgrip and quadriceps strength were measured.

Results

All pts participated the programs. Both groups demonstrated significant improvement in MET scores and 6MWT after completion of CR programs.(Table ) Average exercise time at home was reported to be 379 ±98 minutes/ week (72% achieved >150 minutes/ week). Compared with UC, HTR showed significantly increased % change in MET score at baseline and upon completion of CR (22.1% vs 7%; p=0.02) and 6MWT (11.1% vs 5.3%; p=0.01). The effect muscle strength were similar in both groups with improving trend but no significant % change at baseline and end of CR.

Conclusion

Significant improvement in functional status can be demonstrated in comprehensive individualized HTR program in pts after major cardiac surgery. Adoption of digital technology with full integration into standard cardiac rehabilitation program should be recommended.
Exergaming in cardiac rehabilitation: a systematic review and meta-analysis
Authors: Blasco-Peris C , Fuertes-Kenneally L , Vetrovsky T , Sarabia-Marin JM , Climent-Paya V , Manresa-Rocamora A
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Valencia Region Innovation Agency (INNOAVI)

Background/Introduction

Cardiovascular disease (CVD) is the leading cause of death in Europe. The lack of physical activity is related to the onset of CVD. Despite the evidence of the effects of exercise-based cardiac rehabilitation (CR) on mortality risk in patients with CVD, the benefit of adding exergaming is unclear.

Purpose

The aim of this systematic review and meta-analysis was to (a) summarize the characteristics of previous studies regarding exercise-based CR programmes based on exergaming and (b) determine the effects of exergaming on functional capacity (i.e., distance covered in the 6-min walk test [6MWT]) and other outcomes (i.e., quality of life and motivation).

Methods

We carried out a systematic search in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (without language restrictions) up to June 2021. Our search strategy included terms related to patients (e.g., chronic heart failure, cardiovascular disease, and coronary artery disease) and the interventions (e.g., exergaming and cardiac rehabilitation). We included controlled and uncontrolled studies and extracted data regarding the characteristics of the study, patients, and intervention. In regards to the quantitative analysis, we used the standardised mean difference (SMD) or mean difference (MD) to measure the effect size and random-effects models to perform a pooled analysis of outcomes reported in at least three studies.

Results

Eight studies fulfilled our inclusion criteria, of which seven were randomised controlled trials and all of them had an active control group. The studies included were published from 2006 to 2021. Three studies recruited patients with diverse diagnoses, four articles included patients diagnosed with coronary artery disease, and one study with heart failure. Five studies performed supervised training sessions. The type of VR varied between studies: four of them used Oculus glasses or 3D constructed reality in screens, three used a game console, and one combined several devices. The mean intervention length was 17 weeks and six studies performed less than four training sessions a week. There was a non-significant increase in the distance covered in the 6MWT in favour of the experimental groups compared to the control groups (MD = 13,89 m [95% confidence interval -18,01 to 45,79]). Moreover, there was no intervention effect on symptoms of depression (SMD = -0,21 [95% confidence interval = -0,56 – 0,13]).

Conclusion(s)

Exergaming is feasible in patients with cardiovascular disease. However, the effects of adding VR to improve functional capacity and symptoms of depression are questionable. Future research is needed to clarify the role of exergaming in CR.