bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased exposure to air pollutants leads to greater atherosclerotic burden mediated by systemic inflammation
Authors: Theofilis P , Oikonomou E , Vogiatzi G , Lazaros G , Mystakidi V.C , Barbaresos N , Tasios P , Tsalamandris S , Fountoulakis P , Miliou A , Papaioannou N , Asimakopoulos M.N , Tousoulis D
Published: November 2020

Introduction

Air pollution has been a well-described environmental factor contributing significantly to the global disease burden.

Purpose

To examine the association of gaseous air pollutants with atherosclerosis, especially in subjects with coronary artery disease (CAD).

Methods

2053 individuals enrolled in the Corinthia study underwent clinical and biochemical assessment followed by carotid ultrasonography to evaluate carotid intima-media thickness (cIMT) and plaque burden. Inflammation was estimated via measurement of C-Reactive protein (CRP). Air pollutants concentration analysis was performed in prespecified regions with respect to their proximity to heavy industries, highways and shipyards.

Results

A higher concentration of gaseous air pollutants was observed in Region 4 when compared to other regions (Table). Mean cIMT, maximum cIMT and carotid plaque burden were significantly increased in individuals of Region 4 (Table, Figure A and B), a result which remained unaffected after adjustment for cardiovascular confounders (Figure C). In parallel, inhabitants of Region 4 had higher levels of CRP (Region 1: 4.60±5.01mg/l; Region 2: 3.08±3.26mg/l; Region 3: 4.37±4.70mg/l, Region 4: 6.78±9.77mg/l, p<0.001). To examine the effect of air pollution on atherosclerosis in CAD, propensity scores were applied to match healthy controls with CAD subjects in terms of atherosclerosis risk factors resulting in two matched groups; one in regions 1, 2 and 3 -low air pollution areas (LAPA)- and another in region 4 -high air pollution area (HAPA). Interestingly, we noted substantially higher inter-area differences in mean cIMT of CAD individuals (Figure D).

Conclusion

Air pollution may significantly contribute to atherosclerosis progression, potentially via the induction of inflammation. A more pronounced effect was noted in CAD individuals exposed to high air pollution.

Funding Acknowledgement

Type of funding source: None
Professional drivers and cardiovascular risk: APPTIV cohort
Authors: Esquirol Y , Buscail-Tan B , Duchalet-Serrano G , Colonna C , Mazziotta C , Meresse C , Smallwood C , Monier S , Ferrieres J
Published: November 2020

Background

Professional drivers have a high risk of morbidity, including myocardial infarction. Bus, taxi and truck drivers have most often constituted the studied populations. However, if the transport sector faces road risk, 70% of employees in all activity sectors are exposed to this risk in France. Most often studied by the analysis of global working time, the real driving time and the distance travelled are rarely taken into account, whereas they are potentially modifiable factors.

Purpose

To assess the associations between exposure to road risk by taking into account driving time and the number of kilometers travelled professionally and certain cardiovascular risk factors, in different sectors of professional activity.

Method

Based on the APPTIV cohort, data from 984 men and women employees from 94 companies in France was collected from 2018 to 2019, during occupational health medical visits focused on road risk. The number of Kms / month (<400 (ref); <1600; ≥1600) and the duration of driving (hours / d <1 (ref); <4; ≥4) were studied according to the respective tertiles. A variable with 9 classes was created. Logistic regressions adjusted for age, gender and activity sectors were carried out to explain the associations with certain cardiovascular factors (Hypertension, overweight (≥25 kg/m2), obesity (30 kg/m2) Hypertriglyceridemia (≥1.7 mmol/l), Hypercholesterolemia, HypoHDLemia).

Results

The population studied came from 23.30% of the transport sector, 23.30% of the construction sector, 26.75 of the public administration and 4.78% of the trade sector. After adjustments, the estimated risks of hypertension according to the driving time or the number of km travelled are not significant. Driving between 1 and 4 hours and more than 4 hours per day increases the risk of obesity, by: OR: 1.85 (1.22–2.80); 1.85 (1.19–2.86), the risk of hypertriglyceridemia of 1.39 (1.0–1.95); 1.54 (1.09–2.18). Traveling more than 1600 km / m increases the risk of hypertriglyceridemia by 1.5. People driving between 400 and 1600 km / m with a driving time between 1 and 4 h / d or those covering more than 1600 km with long driving times (>4 h / d) have an estimated risk of obesity at 1.82 (1.05–3.14) and 1.87 (1.13–3.11) respectively. Those traveling over 1600 km / m with long driving times (>4 hrs / day) have a 1.5 times risk of hypertriglyceridemia.

Conclusion

Taking into account the number of hours of driving and the kilometers travelled professionally, this study highlighted some employee profiles with high cardiovascular risk, accessible to medical and professional prevention measures.

Funding Acknowledgement

Type of funding source: None
Gender differences in exercise stress testing protocol selection, exercise capacity, and prognostic value of METs
Authors: Harb S , Wang T.W , Wu Y.W , Menon M.V , Cho L.C , Cremer P.C , Jaber W.A.J
Published: November 2020

Background

Exercise capacity, as measured by metabolic equivalents of task [METs], varies with gender and is an independent predictor of mortality. We sought to investigate gender differences in the protocol selected, the estimated exercise capacity, and the prognostic value of METs.

Purpose

Investigate the gender differences in the protocol chosen (adjusting for age and comorbidities), the METs achieved (also adjusting for the protocol selected), and the predictive value of exercise capacity adjusted to METs achieved.

Methods

In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent exercise stress testing. Protocols were split into Bruce vs. non-Bruce. METs were estimated based on established gender-specific formulas (the St James Take Heart Project formula for women, and the Veterans Affairs cohort formula for men).The primary outcome was all-cause mortality.

Results

The mean age was 53.3±12.5 years, and 59% were male. Table 1 presents the baseline characteristics and exercise parameters. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Females were more commonly referred for non-Bruce protocols [adjusted OR 2.6; 95% CI (2.5–2.7)] even after adjusting for age and comorbidities. Within the same protocol chosen, females achieved lower estimated METs [Beta −1.4; 95% CI (−1.43 to −1.37)]. Exercise capacity was inversely related to mortality in both genders and across protocols (figure 1), however, after adjusting for age, comorbidities, protocol chosen, and the number of METs achieved, the HR for death was significantly lower for women [adjusted HR=0.44; 95% CI (0.41–0.46)].

Conclusion

After adjusting for age and comorbidities, women tend to be more commonly referred for non-Bruce protocols, achieve less estimated METs (after adjusting for the protocol chosen), and have half the mortality for the same METs achieved.

Death vs. Exercise capacity by gender

Funding Acknowledgement

Type of funding source: None
Assessment of myocardial remodeling in the perioperative period of coronary artery bypass grafting: effects of prehabilitation
Authors: Argunova Y , Korotkevich A , Moskin E , Pomeshkina S , Barbarash O
Published: November 2020

Purpose

To assess serial changes in the morphological and functional parameters, and indicators of myocardial perfusion in the perioperative period of coronary artery bypass grafting (CABG), depending on the preoperative management strategy.

Methods

60 male patients with stable coronary artery disease (CAD) were randomized into two groups before on-pump CABG. Group 1 patients (n=30, aged of 61.5 [56; 63] years) underwent treadmill training at 80% of VO2max for a 7-day period. Group 2 patients (n=30, aged of 62.0 [56; 64] years) underwent routine management without prehabilitation. Cardiac morphological and functional parameters were evaluated using echocardiography in the preoperative period and 5–7 days after CABG. Adenosine loading single-photon emission computed tomography (SPECT) was used to measure the parameters of myocardial perfusion before and after the indexed CABG. Data were processed using the QPS program (Cedars Sinai Medical Center (USA)) and the 17-segment polar mapping. Statistical analysis was performed using commercially available Statistica 10.0 software package (Statsoft, USA).

Results

Both groups demonstrated a decrease in LVEF in the postoperative period. However, an LVEF decline in Group 1 patients was less significant (p=0.00015) than in the control group (p=0.000003). LV end-systolic dimension increased by 8.5% and LV end-systolic volume by 18% in patients who underwent prehabilitation as compared to the baseline, whereas these changes were more pronounced in the control group (17% (p=0.00029) and 41% (p=0.00028), respectively).

Group 1 patients demonstrated better myocardial perfusion parameters in the postoperative period. Patients in the prehabilitation group reported higher accumulation levels of radiopharmaceuticals in the basal (75.0 [72.5; 80] and 72.0 [70; 75]%, p=0.036), middle (87.0 [83; 91] and 81.0 [77; 84]%, p=0.012) and apical (86.0 [82; 89] and 82.0 [78; 86]%, p=0.037) myocardium as compared with those in the control group. The stress-induced ischemia (SDS) was less pronounced in Group 1 compared to Group 2 (p=0.025).

Conclusion

Optimized myocardial remodeling parameters and improved myocardial perfusion in the postoperative period have proved the effectiveness of high intensity physical trainings introduced in the prehabilitation program for CABG.

Funding Acknowledgement

Type of funding source: None
The impact of interval vs. continuous training on exercise capacity and endothelial function in post-myocardial patients: a randomised control trial
Authors: Novakovic M , Kosuta D , Trsan J , Krevel B , Tasic J , Vizintin Cuderman T , Rajkovic U , Bozic Mijovski M , Fras Z , Jug B
Published: November 2020

Introduction

High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) are two most common and well established exercise modalities for cardiac rehabilitation in patients after myocardial infarction. Yet, data on their effects on cardiovascular parameters beyond exercise capacity (e.g. endothelial function) are scarce.

Methods

Patients referred to cardiac rehabilitation (CR) after myocardial infarction were randomised to HIIT or MICT. HIIT consisted of 7 cycles of 1.5 min of 80–90% VO2peak and 3 min of 65–70% VO2peak intensity; MICT consisted of 32 min of 75% VO2peak intensity. We ultrasonographically appraised flow-mediated dilation (FMD) – a marker of endothelial function – before (resting), immediately after and one hour after (a) the first and (b) the last exercise training session, in order to appraise the specific effects of HIIT vs. MICT on acute and long-term vascular response to training. Cardiopulmonary exercise testing was performed in all patients. We compared the effects of training modalities with ANCOVA using baseline values as covariates, and examined the improvement after CR in each intervention group with paired-samples t-test.

Results

Eighty-six patients were included (55±10 years of age, 19% females), 43 in each group. There were no differences between HIIT and MICT groups in baseline characteristics. VO2peak improved in both groups (HIIT: 22.8 to 24.9 ml/kg/min, p=0.016 and MICT: 21.9 to 24.5 ml/kg/min, p<0.001), with no significant between-group differences (p=0.571). Also, resting FMD improved after both HIIT and MICT (4.6 to 6.7%, p=0.016, and 4.7 to 8.0%, p=0.001, respectively), with no significant between-group differences (p=0.177). Acute vascular response to training, however, improved with HIIT (FMD one hour after the last training session: 4.1 to 7.1%, p=0.022), but not MICT (5.9 to 6.4%, p=0.584).

Conclusion

Both HIIT and MICT significantly and comparably improve exercise capacity and resting FMD in patients after myocardial infarction. In addition, however, HIIT is associated with improved vascular response during recovery period after exercise.

Funding Acknowledgement

Type of funding source: None
Effect of mobile guided cardiac rehabilitation on quality of life – the EU-CaRE randomised clinical trial
Authors: Houben V , Snoek J.A , Prescott E , Mikkelsen N , Van Der Velde A.E , Eijsvogels T.H.M , Prins L.F , Kolkman E , Meindersma E , Gonzales-Juanatey J.R , Pena-Gil C , Ilou M.C , Eser P , Wilhelm M , Van 't Hof A.W.J
Published: November 2020

Background and purpose

Although participation in cardiac rehabilitation (CR) improves quality of life (QoL), participation in CR, especially among elderly, is limited.

We conducted this study to assess whether mobile home-based CR (mCR) increases QoL in elderly (≥65 years old) patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional CR.

Methods

It is designed as a randomised multi-centre study with two parallel arms. Randomisation assigned patients either to mCR or a control group. mCR Consisted of six months of home-based CR with telemonitoring and coaching. Control-group patients did not receive any form of CR throughout the study period. Quality of life was measured with the SF-36v2 questionnaire at 0, 6 and 12 months.

Results

A total of 179 patients were included in this study (90 control, 89 mCR). A flowchart of the trial is presented in Figure 1. Patients were predominantly male (81.1%). Baseline characteristics can be found in Table 1.

Patients using mCR improved on physical QoL after 6 (p=0.026) and 12 (p=0.008) months. There was no difference on mental QoL for both groups (mCR 6 months p=0.563, 12 months p=0.945; control 6 months p=0.589, 12 months p=0.542). No difference existed in QoL between the mCR and control group (physical: 6 months p=0.070, 12 months p=0.150; mental: 6 months p=0.355, 12 months p=0.625).

Conclusion

Although there is no significant difference in QoL between the control and mCR group, mCR increases physical QoL after 6 and 12 months in elderly patients who decline participation in conventional CR. Therefore E-Health tools should be considered as an alternative for conventional CR when (elderly) patients decline to participate in conventional CR.

Figure 1. Flow chart of all eligible patients

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme
Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study
Authors: Redfern J , Hyun K , Brieger D , Chew D , French J , Astley C , Gallagher R , Ellis C , Carr B , Lefkovits J , Nallaiah K , Lintern K , Neubeck L , Briffa T
Published: November 2020

Background

Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.

Purpose

To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.

Methods

SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.

Results

In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees.

Conclusions

Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation
The beneficial effects of physical preoperative and postoperative training for the cognitive function in cardiosurgical patients
Authors: Trubnikova O , Tarasova I , Moskin E , Argunova Y , Kupriyanova D , Barbarash O
Published: November 2020

Background and aim

The cardiac surgery patients have an increased risk of postoperative cognitive dysfunction (POCD). The positive healing effects of physical exercise was demonstrated early in patients with cognitive impairment. The aim of the study was to evaluate the effect of physical preoperative and postoperative training for the cognitive function in patients undergoing on-pump coronary artery bypass grafting (CABG).

Methods

We analyzed the neurophysiological data from 125 male coronary artery disease (CAD) patients who participated in two sub-studies: the patients with a short preoperative course of treadmill training (n=33) and with postoperative aerobic exercise training (n=92). The study of preoperative physical training included CABG-candidates, which were divided into 2 groups: with (n=17) and without training (n=16). The preoperative physical training consisted of a 5–7 day course of intensive training on a treadmill. The study with postoperative aerobic exercise training enrolled CAD patients, undergoing on-pump CABG, which were divided into 2 groups: with supervised cycling training (n=39) and without training (n=53). Three-week trainings course began on the 14-th day after CABG. The patients with and without preoperative and postoperative physical training were comparable in terms of preoperative characteristics and intraoperative parameters. The patients were underwent the neuropsychological and EEG examination to assess postoperative changes in neurophysiological performance.

Results

The patients with preoperative treadmill training had the POCD incidence at 7–10 days after GABG in 44% cases vs. 74% - in the group without training. The relative risk of POCD developing in the patients with preoperative training was: OR=0.24, 95% CI: 0.07–0.81, Z=2.297, p=0.02. Additionally, the patients with preoperative training demonstrated a lower power in the theta (4–6 Hz) and beta1 (13–20 Hz) frequency ranges 7–10 days after CABG. The patients with postoperative cycling training also demonstrated better cognitive function at 1 month after CABG compared to the patients without training. The incidence of POCD was 21% in the cycling training group vs. 44% – in the group without training. The relative risk of POCD developing was: OR=0.23, 95% CI: 0.09–0.60, Z=3.041, p=0.0024. Also, it was found that the postoperative cycling training group showed a lower percentage theta power increase at 1 month after CABG.

Conclusion

Both the short preoperative and three-week postoperative physical training course can produce beneficial effects on the postoperative neurophysiological status in CABG patients. The engagement of physical training in the rehabilitation program of CABG patients can improve cognitive functioning after cardiac surgery.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): RFBR and Kemerovskaya region
Sport specific incidence and progression of coronary artery calcification among amateur athletes: a follow-up of the Measuring Athletes Risk of Cardiovascular events (MARC) study
Authors: Aengevaeren V , Mosterd A , Braber T.L , Nathoe H.M , Eijsvogels T.M.H , Velthuis B.K
Published: November 2020

Background

Emerging evidence indicates increased coronary atherosclerosis in amateur athletes. However, previous studies were limited by its cross-sectional design and limited sample size, preventing the exploration of sport specific associations with coronary atherosclerosis.

Purpose

We aimed to compare the incidence and progression of coronary artery calcification (CAC) between runners, cyclists and other types of athletes using a prospective cohort study with repetitive measurements.

Methods

Asymptomatic middle-aged men, who previously underwent a sports medical evaluation without abnormalities, were recruited in the Measuring Athlete's Risk of Cardiovascular events (MARC) study (n=318) and were asked to participate in this follow-up study. CT imaging was performed to assess CAC scores. Data was collected between 2012–2014 (i.e. baseline) and 2019–2020 (i.e. follow-up). We categorized participants as runners, cyclists or “other” sports (e.g. water polo, tennis, hockey, etc.) based on their dominant sport performance at baseline.

Results

We included 260 men in this interim analysis, with an average follow-up time of 6.3±0.5 years. Age (61.4±6.4 years), systolic blood pressure (143±20 mmHg), BMI (25.2±2.8 kg/m2), LDL-cholesterol (3.2±0.9 mmol/L), smoking (0.3 [0–8] pack years) and family history of coronary heart disease (28%) did not differ between runners (n=64), cyclists (n=75) and other athletes (n=121, all p>0.05). CAC was present in 137 (53%) men at baseline, which increased to 181 (70%) at follow-up. CAC scores increased from 1 [0–33] to 33 [0–129]. Cyclists had a lower CAC prevalence and CAC scores compared to individuals performing other sports at follow-up (Figure 1). Of those without CAC at baseline (n=123, 47%), cyclists less often developed CAC during follow-up compared with runners (adjusted OR=0.36 [0.17–0.79], p=0.01). In the entire cohort, CAC progression (ln delta CAC+1) was less prominent in cyclists than runners (adjusted B=−0.75 [−1.39 to −0.11], p=0.02), whereas progression of CAC in participants performing other sports did not differ from the runners. In participants with CAC at baseline, cyclists also had less CAC progression than runners (B=−0.49 [−0.95 to −0.02], p=0.04).

Conclusion

Cyclists have a lower incidence and less progression of CAC during 6 years of follow-up compared with runners and individuals performing other sports.

Figure 1. Sport specific CAC prevalence and scores

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Hartstichting
Differentiation between physiological sport adaptation and hypertrophic cardiomyopathy in highly trained athletes using cardiac magnetic resonance
Authors: Czimbalmos C , Nardocci C , Deetjen E , Szabo L , Dohy Z , Toth A , Suhai F.I , Csecs I , Horvath V , Kiss O , Sydo N , Merkely B , Vago H
Published: November 2020

Differentiation between hypertrophic cardiomyopathy (HCM) patients and healthy athletes (HA) is a common clinical conundrum. We aimed to analyze cardiac magnetic resonance (CMR) characteristics of HA, sedentary HCM and athletic HCM patients and to determine CMR parameters which can help to diagnose HCM in athletes.

Male sedentary HCM patients with slightly elevated maximal end-diastolic wall thickness (EDWT 13–18 mm, n=40, 47.6±14.7y) and HA (n=30, 27.5±5.6y) were consecutively enrolled. Additionally, athletes with HCM were enrolled (n=16, 29.6±13.4 y), where a comprehensive investigation confirmed the diagnosis of HCM. We determined conventional CMR parameters (left ventricular (LV) ejection fraction (EF), end-diastolic (EDVi) and end-systolic volume index, mass index (Mi)), derived parameters such as EDWT/LVEDVi, LVM/LVEDV ratio and strain parameters such as global longitudinal (GLS), radial (GRS) and circumferential strain (GCS), SD of peak LS and CS using feature tracking. Presence of late gadolinium enhancement (LGE) was also determined. CMR parameters representing LV hypertrophy pattern or LV function were analyzed using a logistic regression to detect the best CMR parameters to predict HCM in athletes. To differentiate between HA and athletes with HCM optimal cut-off values for CMR parameters were calculated using receiver operating curve analysis.

Comparing the three groups significant differences were found regarding conventional and derived CMR parameters and strain values. None of the HA showed LGE, 75% of athletic HCM and 82% of sedentary HCM patients showed LGE. The univariate regression model showed that LVEF, EDWT, EDWT/LVMi, LVM/LVEDV, GCS, GRS, SD of peak LS and CS are determinants of the diagnosis of HCM among athletes. Multivariate regression revealed that EDWT/LVMi and GCS are independent disease predictors in athletes (p<0.05).

Cut-off value for GCS ≤−32.5 and for EDWT/LVEDVi >0.126 discriminate athletic HCM from HA with a sensitivity of 81.3 and 87.5% (AUC 0.93), and a specificity of 96.7 and 83.3% (AUC 0.95), respectively (Figure 1).

CMR characteristics of sedentary and athletic HCM may differ, therefore establishing diagnostic parameters based on comparison between athletic HCM and HA is essential. CMR based strain and derived parameters may help to differentiate between physiological and pathological left ventricular hypertrophy in athletes.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary (NKFIA) and National Research, Development and Innovation Office (NFKIH) of Hungary.
Aortic stiffness and distensibility in elite athletes: impact of discipline and gender
Authors: Abuli M , Sanz-De La Garza M , Vidal B , Doltra A , Sarquella Brugada G , Carvalho S , Santiago J , Rodas G , Guasch E , Sitges M
Published: November 2020

Background

Aortic remodeling in athletes is variable among sports disciplines with more ascending aorta (Asc Ao) dilatation in endurance (EAs) as compared to power athletes (PAs). Nevertheless, the impact of this differential remodeling on the Asc Ao functional properties is not well established. The aim of this study was to assess the distensibility and stiffness of the ascending aorta in endurance and power elite athletes in order to evaluate if this aortic remodeling implies functional changes.

Methods

119 elite athletes (61 EA and 58 PA, 49% female sex, mean age: 18.7±7.1 years) underwent standardized pre-participation screening with 12 lead ECG, transthoracic echocardiography and maximum stress test. Asc Ao diameter was measured from parasternal long axis views in 2D echocardiography. The aortic distensibility index (ADi) was calculated as 2 × (systolic Asc Ao diameter − diastolic Asc Ao diameter) / (diastolic Asc Ao diameter) × (pulse pressure) (cm–2 dyn–1 10–6). Aortic stiffness (AS) index was defined as Ln (systolic blood pressure/diastolic blood pressure) / (systolic Asc Ao diameter − diastolic Asc Ao diameter)/diastolic proximal Asc Ao diameter.

Results

Globally, EA presented larger AscAO, both in absolute and indexed values, than PA (28±3.0 vs 26±3.0cm, p<0.001 and 16.4±1.5 vs 15.7±1.9cm, p<0.05, while were no differences in AS or ADi) (Figure 1A). Nevertheless, ADi in male EAs was higher than in male PAs (ADi: 4.3±1.7 vs 3.2±1.3 cm2/dyn/10–6, p<0.05) and AS was lower (AS: 4.7±1.7 vs 6.3±3.8, P<0.005) (Figure 1B and 1C). Female athletes presented higher ADi (ADi: 4.7±1.9 vs 4.0±1.6 cm, p<0.05) and a trend towards lower AS (4.8±2.9 vs 5.1±2.6, p: 0.4) than male athletes. There were no differences in AS or ADi between female EAs and PAs.

Conclusion

Male EAs showed an increased aortic distensibility with lower stiffness as compared to that observed in male PAs. This difference was not observed in female EAs and PAs, potentially due to better baseline distensibility with less room for improvement with endurance training.

Funding Acknowledgement

Type of funding source: None
Evaluation of cardiac titin expression after long-term exercise in a rat model
Authors: Kellermayer D , Olah A , Ruppert M , Barta B.A , Sayour A.A , Virag-Tulassay E , Kellermayer M , Merkely B , Radovits T
Published: November 2020

Introduction

The main role of the giant elastic protein titin is to provide passive stiffness to striated (i.e. cardiac and skeletal) muscles. The adult cardiac muscle contains two titin isoforms: the more compliant N2BA and the stiffer N2B isoforms. Titin reduces passive stiffness in cardiac muscle by increased expression of the more compliant N2BA isoform (elevated N2BA:N2B ratio). Moreover, decreased passive stiffness is associated with increased exercise tolerance. Long-term exercise induces physiological adaptation of the heart, termed athlete's heart. Currently, there is limited data of titin's role in the athlete's heart.

Aims

Our aim is to evaluate exercise-induced morphological and functional changes of the heart. Furthermore, to determine the N2BA:N2B ratio in the rat model of athlete's heart.

Methods

Rats were divided into exercised (n=12) and control (n=12) groups. Athlete's heart was induced by a 12-week-long swim training (200min/day). The control group swam 5 min/day. Following the training period cardiac changes were assessed by echocardiography. In vivo cardiac function was examined by left ventricular (LV) pressure-volume (P-V) analysis. Titin isoform expressions were detected by sodium-dodecyl-sulfate (SDS)-agarose gel electrophoresis.

Results

Echocardiography and post-mortem measured cardiomyocyte diameters confirmed athlete's heart and LV hypertrophy in exercised rats. P-V analysis showed improved contractility, active relaxation and mechanoenergetics in the exercised group. The N2BA:N2B titin ratio was significantly increased in exercised rats compared to controls (0.28 vs. 0.21, p<0.05).

Conclusions

Our results confirm the morphological and functional changes of the athlete's heart. The increased ratio of N2BA:N2B titin corresponds to a more compliant heart in the exercised rats.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): National Research, Development and Innovation Office of Hungary (K 120277) and the ÚNKP-19-3-I New National Excellence Program of The Ministry For Innovation and Technology.
Impact of a 246 km ultra-marathon race on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber relationships
Authors: Pagourelias E , Christou G , Anifanti M , Sotiriou P , Christou K , Koutlianos N , Deligiannis A , Vassilikos V , Kouidi E
Published: November 2020

Background

It is well documented that prolonged intense exercise such as a marathon, transitorily alters cardiac function. However, the impact of ultra-endurance (UE) exercise on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber functional relationships has not yet been thoroughly investigated.

Purpose

The aim of the study was the evaluation of the acute effects of UE exercise on longitudinal deformation of all cardiac chambers and on intra-, inter- and atrioventricular functional relationships.

Methods

Echocardiographic assessment was performed the day before and at the finish line of “Spartathlon”: a 246 Km ultra-marathon. 2D speckle-tracking echocardiography was performed in all 4 chambers during the same cardiac cycle, allowing a simultaneous strain-time data display of all cardiac chambers (Figure 1). Peak global deformation values and temporal parameters adjusted for the heart rate were extracted from the derived curves, while a segmental analysis for left (LV) and right ventricle (RV) was also performed.

Results

Out of 60 participants initially screened, 27 athletes (17 male, age 45±7 years) finished the race in 33:34±1:59 hours. Both LV (−20.9±2.3 pre- to −18.8±2% post-, p=0.009) and RV global strains (−22.9±3.6 pre- to −21.2±3% post-, p=0.04) decreased post-race, even though remained within normal range for the 85% of the participants. Peak atrial strains [right (RA) and left (LA)] did not change (p=0.12 and 0.95). Basal and mid segmental strain values significantly decreased post-race, while both LV and RV apical strain values remained unaffected (p=0.899 and p=0.46, accordingly) (Figure). Concerning interchamber relationships, RV and RA strain curves were constantly larger in magnitude than those of the LV and LA, with RV/LV, LV/LA, RV/RA and RA/LA peak values' ratios remaining unchanged from pre- to post-race. Finally, although right chambers' time-to-peak values were shorter compared to the left ones, all chambers' strain curves peaked later post-race (p<0.001 for all).

Conclusions

Despite subtle changes in LV and RV strain, 4-chamber deformation values remained within normal range even after running a 246 km ultra-marathon. Following a segmental analysis, this finding could be explained for both ventricles by a preservation of apical deformation. Additionally, inter- and atrioventricular concordance was also maintained.

Figure 1

Funding Acknowledgement

Type of funding source: None
Can quantitative 18F-FDG PET/CT and serum cytokine analysis differentiate ARVC from cardiac sarcoidosis?
Authors: Abbas H , McKiddie F , Kouri M , Duncan L , Fong M , Wilson E , Norris K , Matheson J , Scally C , Dempsey O , Denison A , Wilson H.M , Dawson D.K , Broadhurst P
Published: November 2020

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) and Cardiac Sarcoidosis (CS) may both cause malignant arrhythmia and sudden death, but differentiating the two can be difficult.

Purpose

To investigate the role of quantitative FDG PET/CT at distinguishing ARVC from CS, and explore whether addition of an inflammatory panel correlates with PET uptake, aiding diagnosis.

Methods

10 patients with CS, 10 with ARVC were enrolled. Participants were prospectively studied with PET/CT. LV uptake was quantified using software and a 17-segment model, measuring maximum standardised uptake (SUVmax) and mean myocardial uptake, comparing these to a local normal reference range (21 volunteers) using a z-score. Blood levels of IL-1b, IL-6, IL-8, IL10, IL-12p40, MCP-1, TGFb, GRO, TNFa, IFNy, FGF2, PDGF were measured using ELISA, compared with 10 healthy controls.

Results

There were no significant differences in cytokine levels between CS and ARVC; most cytokine levels were higher in CS, except IL-6, IL-8 and MCP-1 in ARVC (Table 1). Increased PET uptake was noted in 1 segment of 1 ARVC patient, and in 1–2 segments of 5 CS patients (z-scores 2.25 SD; 2.15–2.38 SD). No pattern of uptake distinguished ARVC from CS, qualitatively assessing LV polar maps (Figure 1A, B). SUVmax and mean uptake were higher in CS vs. ARVC (p<0.05; p=0.13). No significant correlation between cytokine levels and PET uptake was detected (Figure 1C, D).

Conclusion

Quantitative PET/CT uptake and a blood inflammatory panel did not have utility in differentiating the two conditions in our population. There was generally more PET and serum inflammatory activity in CS.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): NHS Endowments
Increased mortality in women with severe aortic stenosis and low ejection fraction
Authors: Paquin A , Annabi M.-S , Bienjonetti-Boudreau D , Pibarot P , Clavel M.-A
Published: November 2020

Background

Women with severe aortic stenosis (AS) tend to be operated with more advanced valvular heart disease. They also have worse survival after aortic valve replacement (AVR). This difference between sexes in surgical referral and its relationship to mortality have not been previously studied in patients with severe AS and low left ventricular ejection fraction (LVEF).

Purpose

To assess sex differences in patients with severe AS and low LVEF, and to evaluate their potential association with mortality.

Methods

This is a retrospective study of consecutive patients presenting with a diagnosis of severe AS and low LVEF (≤50%) on echocardiogram, at the Quebec Heart and Lung Institute between 2004–2015. Patients were excluded if they had congenial or rheumatic heart disease, and/or more than moderate aortic regurgitation. Patients were compared according to sex for incidence of AVR and long-term all-cause mortality with univariate (Kaplan-Meyer with log-rank test), and multivariate analysis (Cox regression model) adjusting for baseline comorbidities, LVEF and severity of valvular disease.

Results

Our database had a total of 1129 patients, of which 578 were included in the analysis. There were 149 women (26%). Mean follow-up time was 3.10±3.04 years (1795 patient-years). There were 279 AVR and 284 deaths. Women were older (77±11 vs 74±10 years, p=0.004), and had less coronary artery disease (60% vs 79%, p<0.001) and dyslipidemia (55% vs 72%, p<0.001). Women had comparable severity of AS at baseline, with better LVEF (37% vs 35%, p=0.02). In univariate analysis, there was a strong tendency for increased mortality in women compared to men (p=0.06). After comprehensive baseline adjustement, female sex was predictive of mortality (HR 1.33 [1.00–1.75], p=0.04). Women were also less likely to be operated than men (HR 0.70 [0.51–0.94], p=0.02). After further adjustment for AVR as a time-dependent variable, there was only a trend toward the significance of sex as a predictor of mortality (p=0.12). In a sex-specific analysis of predictors of mortality, LVEF was predictive of mortality in women (HR 0.97 [0.94–0.99], p=0.007), while not in men (0.99 [0.98–1.01], p=0.51).

Conclusions

Despite adjustment for comorbidities and AS severity, women were less likely to be referred to AVR and had a higher overall mortality. After adjustment for AVR, female sex was no longer a predictor of mortality, underlying the negative impact of the lack of treatment in women with decreased LVEF. Thus underrecognition and suboptimal management of severe AS in female patients with low LVEF should be further investigated to identify contributing factors and possible solutions.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Dr Clavel has received a grant from the Heart and Stroke Foundation of Canada
Sex differences in door-to-balloon time and long-term adverse events after percutaneous coronary intervention for acute coronary syndrome: a sub-study from the Prospective JAMIR study
Authors: Kimura T , Ito T.I , Honda S , Nishihira K , Kojima S , Takegami M , Asaumi Y , Suzuki M , Kosuge M , Takahashi J , Sakata Y , Takayama M , Sumiyoshi T , Kimura K , Yasuda S
Published: November 2020

Background

Shortening of onset to admission time (OAT) and door-to-balloon time (DBT) is associated with lower adverse cardiac event after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Bleeding event also results in poor outcome in patients with AMI after primary PCI. Little is known about sex differences in DBT and ischemic, bleeding events after AMI.

Purpose

This study aimed to assess the sex differences of OAT, DTB and adverse cardiac event, incident of bleeding event after primary PCI in patients with AMI.

Methods

The Japan AMI Registry (JAMIR) is a multicenter, nationwide, prospective registry enrolling patients with AMI from 50 institutes between December 2015 and May 2017. Primary endpoints of this study were ischemic event (composite of cardiovascular death, myocardial infarction and ischemic stroke) and bleeding event (BARC type 3 or 5,).Median follow-up period was 12 months.

Results

A total of 3,411 patients were enrolled at first. Among them, 329 patients without treated with PCI and 199 patients missing OAT time were excluded from this study. A total 2883 patients of men (n=2240, 77.7%) and women (n=643, 22.3%) were enrolled. OAT and DBT of women were significantly longer than that of men (OAT: 130min, interquartile range 62–300 min vs. 155 min, interquartile range 69–350 min, p=0.040, DBT: 67 min, interquartile range 50–95 min vs. 75 min, interquartile range 53–120 min, p<0.001). There was no significant difference in ischemic events between men and women (7.1% vs. 7.5%, log-rank p=0.741, Figure 1). Multivariate Cox regression analysis showed female sex was significantly associated with lower ischemic event (hazard ratio 0.57; 95% confidence interval 0.38–0.85; p=0.007). Bleeding event of women was significantly higher than that of men (BARC type 3 or 5: 3.8% vs. 7.8%, p<0.001, Figure 2).

Conclusion

The real-world database of the JAMIR showed that the female sex was significant factor for the delay in primary percutaneous coronary intervention and high incident of bleeding, however, ischemic event was lower than that of male sex. Sex difference appears to be associated with ischemic and bleeding event after acute myocardial infarction.

Funding Acknowledgement

Type of funding source: None
Sex-related trends of cardiovascular risk perception and prevention behaviors: results from the italian society of cardiovascular survey
Authors: Polimeni A , Sorrentino S , Crea P , Spaccarotella C , Mongiardo A , De Rosa S , Zangara S , Bruschi G , Lopera Quijada M.J , Cenci C , Mercuro G , Indolfi C
Published: November 2020

Background

Recent reports evidenced gender differences in the knowledge, perception and awareness of cardiovascular risk factors and cardiovascular diseases.

Purposes

To evaluate trends in awareness of cardiovascular risk, as well as knowledge of symptoms and preventive behaviors related to cardiovascular disease (CVD).

Methods

As part of Vivi con il Cuore (campaign with the goal of raising awareness about women's heart disease) a nationwide survey was conducted. Standardized questions on awareness of CVD risk, as well as prevention behaviors and barriers, were provided through a computer-assisted web interviewing platform to a large sample of Italians citizens ranging from 40 to 70 years old. The sample was representative of the population by age, sex, and area of geographical residence.

Results

A total of 1,000 subjects were included in this survey, of which 511 (51%) female. About 60% of women indicated cancer as the leading cause of death among female sex, while only 22% indicated cardiovascular disease. Similarly, when the same question was asked to men, 44% indicated cancer and 21% cardiovascular disease, observations that were consistent across age categories. Although a well sizable part of the population (90% of the interviewees) have consulted the general practitioner in the last year, only 45% of women and 56% of men declared to receive information about CVD risk. Almost 84% among men and women, recognized the importance of knowing how to understand the symptoms of a heart attack due to the possibility of survival. An additional survey was conducted among young cardiologists under 40 years old, including a total of 200 young cardiologists, similarly distributed among men and women (47% and 53% respectively). About 24% of young cardiologists indicated breast cancer as the leading cause of death in women, while only 70% reported cardiovascular diseases. Furthermore, 35% of participants reported that they did not have adequate training on the risks of heart disease in women.

Conclusions

In this survey, only 22% of women were aware that cardiovascular disease is the number one killer of women. Likewise, a well sizable part of young cardiologists (30%) does not recognize cardiovascular disease as the leading cause of death in women. These data should inform public health campaigns to focus on evidence-based strategies to prevent CVD and to help target messages that resonate and motivate women to take action.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Abbott
Oestradiol and the risk of myocardial infarction in women: a cohort study of UK Biobank participants
Authors: Peters S , Woodward M
Published: November 2020

Background

It is commonly assumed that high oestradiol levels in women are cardioprotective. We assessed the association between oestradiol and the risk of incident myocardial infarction in women.

Methods

We used data from 263,295 female UK Biobank participants (mean age 56.2; SD 8.0 years) without prior cardiovascular disease. Associations of oestradiol with age and other cardiovascular risk factors were assessed. Cox proportional hazards models estimated crude, age, and multiple-adjusted hazard ratios (HR) for MI associated with oestradiol levels.

Results

After a mean follow-up of 9 years, 2,206 incident cases of MI had been recorded, including 230 events among the 57,204 women (mean age 48) with detectable oestradiol levels. In the unadjusted analyses, a unit higher in log-transformed oestradiol was associated with a HR (95% CI) for MI of 0.73 (0.58; 0.92). After adjusting for age this HR became 0.94 (0.75; 1.17), and after further adjusting for classical CVD risk factors, 1.05 (0.83; 1.31. Results were similar in subgroup analyses defined by age, menopausal status, socioeconomic status, pill use, and the use of hormone replacement therapy. The multivariable adjusted HR for the 171,431 women (mean age 59) with undetectable levels of oestradiol, compared to those with detectable levels, was 0.97 (0.92; 1.02).

Conclusion

Higher levels of oestradiol were not associated with a decreased risk of MI. The presumed cardioprotective effects of oestradiol seem to be largely confounded by age, and further confounded by other cardiovascular risk factors.

Figure 1

Funding Acknowledgement

Type of funding source: None
Does arterial stiffness increase in patients with early surgical menopause?
Authors: Akcay M , Coksevim M , Gedikli O , Ulubasoglu H , Yilmaz O
Published: November 2020

Introduction

Surgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients.

Method

We included 40 patient early surgical menopause and 40 control group patients with clinically and demographically similar characteristics. Oscillometric measurement method with Mobil-O-Graph 24h-ABPM NG® arteriography was used to measure the arterial stiffness and cardiovascular hemodynamic parameters.

Results

Of the 40 patients who underwent surgical early menopause, 27 (67.5%) had malignancy, 11 (27.5%) with myoma and 2 (5%) with bleeding. There were no differences in baseline demographic, laboratory, echocardiographic parameters and coronary artery disease risk factors.In terms of arterial stiffness parameters, PWV were significantly higher in the early surgical menopause group than in the control group (6.5±0.8; 5.6±1.2 p<0.001), but there was no statistically significant difference in Alx (28.3±10.9; 27.4±9.0 p=0.69).Also, there was no statistically significant difference in terms of cardiac hemodynamic parameters and central aortic pressures.

Conclusion

When arterial stiffness is noninvasively evaluated by oscillometric method, it is significantly increased in surgical early menopause patients independent of other risk factors.

Funding Acknowledgement

Type of funding source: None