bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipid-lowering therapy and LDL-cholesterol in patients after acute coronary syndromes
Authors: Haider P , Galli L , Schrutka L , Distelmaier K , Wojta J , Hengstenberg C , Krychtiuk K A , Speidl W S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Medical University of Vienna.

Background

Intensive lipid lowering after acute coronary syndromes (ACS) reduces recurrent cardiovascular events, however recent studies have shown that LDL-cholesterol goal achievement is low in patients after myocardial infarction. We compared LDL-C goal achievement in patients after ACS that were discharged with statin monotherapy or with a combination lipid lowering therapy (LLT).

Methods and Results

We included 227 consecutive patients with a median age of 62 (IQR 52-72) years of which 67.8% of patients were male. 59.5% of patients underwent PCI because of ST-elevation myocardial infarction (STEMI) and 40.5% because of NSTEMI. 30.4% were on LLT at time of the ACS. Median LDL-C decreased from 104.8 (IQR 75.3-139.2) mg/dL before the acute event to 52.2 (IQR 37.8-74.6) mg/dL three to six months after the myocardial infarction, resulting in 55.1% of patients on LDL-C goal of 55 mg/dL. Only 5 (2.2 %) patients were discharged without LLT and 5 (2.2 %) patients were treated with PCSK9-inhibitors. 89.4% of patients were treated with high dose and 7.5% of patients with moderate or low dose statins. Patients that were discharged on statin monotherapy (n=160, 70.5%) reached a median LDL-C of 55.0 (IQR 41.0 to 78.8) mg/dL that was significantly higher as compared to patients on combination therapy with ezetimibe (n=62, 27.3%) that was 43.0 (IQR 32.3 to 62.5) mg/dL (p<0.002). The proportion of patients with statin monotherapy that reached the LDL-C goal was only 50.6% as compared to 71.0% of patients with combination therapy (p<0.001). Logistic regression analysis revealed that out of age, gender, type of myocardial infarction and statin-pretreatment only baseline LDL-C (p<0.005) and combination therapy (HR 4.6; p<0.001) were predictors for LDL-C goal achievement.

Conclusions

After acute myocardial infarction, only 50.6% of patients on statin monotherapy reach the recommended LDL-C goal of 55mg/dL. LLT combination therapy with ezetimibe significantly increased the proportion of patients reaching the treatment target and should be mandatory in most of the patients after acute myocardial infarction.
Suboptimal treatment of dyslipidemia in clinical practice
Authors: Gjana A , Pavli E , Kristo A , Metani D , Teferici D , Bileri A , Dibra L , Hoti K , Kastrati A , Dibra A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Recent European Society of Cardiology (ESC) guidelines on the treatment of dyslipidemia recommend a target threshold <55 mg/dL of low density lipoprotein (LDL) cholesterol in patients with coronary artery disease. Some studies have suggested that most patients do not reach their LDL target. There is little evidence about the extend of this problem among patients treated in a University Hospital.

Purpose

Patterns of statin treatment and efficasy based on the achivement of LDL target level according to current and previous ESC guidelines.

Methods

We obtained clinical and laboratory data from 100 consecutive patients, whom were previously diagnosed and treated for coronary artery disease, and were readmitted at our hospital either for planned intervention or for signs or symptoms of ischemic heart disease. During the period between the 2 hospitalizations, all patients were under the supervision of their family physician or local cardiologyst. We analyzed patterns of statin treatment and their effect on cholesterol level regarding achivement of target threshold based on current and previous ESC guidelines.

Results

At first hospitalization, mean age was 65 +/- 9. 80% of the patinets were male. Mean total cholesterol levels were 190+/-52 mg/dl and mean LDL cholesterol levels were 133 +/-45 mg/dl on admission. On discharge a high intensity statin was prescribed in 75% of the patients, and a combination of Ezetimibe with statin was prescribed in 5% of them. On readmission mean total cholesterol levels were 163+/-46 mg/dl and mean LDL cholesterol levels were 109 +/-42 mg/dl. 79% of the patients were on a high intensity statin regime, and none of them were taking Ezetimibe. A target LDL chol <70 mg/dl recommended by 2016 ESC guidelines was reached in 21% of the patients, while a target LDL chol < 55 mg/dl recommended by 2019 ESC guidelines was reached in only 8% of the patients. Between the two hospitalizations, 39 (39%) of the patients had their lipid lowering therapy modified. 26 (26%) of them had an increase in statin dosage, all of them following their cardiologyst reccomendation. 13 patinets (13%) had a reduction in statin dosage and interruption of Ezetimibe treatment, despite the lack of any side effect. 4 of them following their cardiologyst reccomendation, 6 following their family physician, lab physician or pharmacist reccomendation and the last 3 patient decided on their own.

Conclusions

Implementation of guidelines in dyslipidemia treatment for secondary prevention in clinical practice is far from optimal even for patients discharged from an University Hospital. Additional efforts should be done to raise the awareness of all health care actors about the necessity of treatment with high dose statins and achivements of recommendet LDL target threshold for patienst with coronary artery disease.
Can previous therapy with statin be considered a protective factor in acute coronary syndrome?
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Statin therapy is nowadays a cornerstone in primary and secondary prevention of cardiovascular events.

Purpose

This retrospective observational study intends to characterise the influence of previous therapy with statins on clinical and electrocardiographic presentation of acute coronary syndrome (ACS) and on in-hospital morbidity and mortality.

Methods

We evaluated a population of 746 patients admitted in a Cardiac Care Intensive Unit diagnosed with ACS (D). We then considered two groups: patients with previous therapy with statins (D1) and patients without it (D2). We documented demographic factors, personal history, clinical and electrocardiographic presentation of ACS, coronary angiography and angioplasty. The following in-hospital complications were defined: heart failure (HF), cardiogenic shock, reinfarction, stroke, major bleeding and need for blood transfusion. In-hospital mortality was compared between both groups.

Results

D1 consisted of 37.5% of the population (N=280). These patients had a higher prevalence of hypertension (90.7% vs 65.4%, p <0.001), diabetes (45.0% vs 27.8%, p <0.001), dyslipidaemia (81.8% vs. 36.6%, p = 0.001), chronic renal failure (18.6% vs 7.6%, p = 0.001), stroke (10.7% vs. 4.5%, p = 0.003), previous myocardial infraction (MI) (45,0% vs 12,6%, p = 0.001) and previous coronary artery bypass graft (13.2% vs. 2.0%, p = 0.001). They also had more frequently smoking habits (37.4% vs 13.9%, p = 0.001). They were less frequently admitted with ST-elevation MI (24.6% vs 49.2%, p = 0.001) and more frequently with non-ST elevation MI (56.1% vs 40, 9%, p = 0.001) and unstable angina (10.7% vs 5.6%, p = 0.02). The rate of coronary angiography was similar, however patients receiving previous statin therapy underwent less angioplasty. During hospitalization, there were no differences in any of the complications considered, nor in in-hospital mortality between the 2 groups.

Conclusions

In patients with ACS, previous therapy with statins seems to influence the presentation of ACS but it does not affect in-hospital morbidity and mortality. An important percentage of patients with diabetes and of those with previous MI or stroke were not on statins therapy as recommended in the European guidelines.
Prevention of metabolic syndrome implies prevention of severe and multivessel coronary artery disease
Authors: Papadopoulos A , Sdogkos E , Spahiu A , Konstantinou T , Georgakopoulos A , Theodosiou P , Pittas S , Vogiatzis I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

Metabolic Syndrome (MS) is the result of metabolic, clinical, and hemodynamic disturbances caused by a group of cardiometabolic risk factors. The particular components of the syndrome are each individually also a predisposing factor for Coronary Artery Disease (CAD). The purpose of our study is to demonstrate the direct correlation of MS with the angiographic severity of CAD so that by affecting by prevention of one axis of this equation, a favorable effect is automatically achieved on its outcome as well.

Methods

We have studied 151 patients, 124 males - 27 females of mean age 63.56 ± 11.28 years, who were hospitalized for Acute Coronary Syndrome (ACS) and underwent coronary angiography. MS definition is according to the criteria set by the respective scientific companies. Thus, patients were classified into Group A with MS (46 patients - 35 males, 11 females - mean age 62.07 ± 11.35 years) and Group B without MS (105 patients - 89 males, 16 females – a mean age 65.06 ± 12.54 years). The correlation between MS, and the severity of CAD, has been estimated using the SYNTAX Score.

Results

Group A patients had a higher incidence of ST-elevation myocardial infarction (STEMI) than Group B patients, namely 32 patients (69.56%) versus 28 patients (26.67%), (p = 0.002), a higher incidence of multivessel disease, 20 patients (43.48%) versus 16 patients (16.8%), (p = 0.02), reduced Ejection Fraction (42.4% ± 9.6% vs. 53.5% ± 6.54% - p = 0.01) and higher SYNTAX Score (19.52 ± 7, 68 vs. 9.64 ± 5.32 - p = 0.01). In Group A with MS, lipid levels disorders were also observed (Total cholesterol, triglycerides, LDL, HDL - p = 0.01), higher values of fasting plasma glucose and HbA1c but also of mean platelet volume (MPV), which is considered a significant prognostic factor in patients with CAD (11.91 ± 1.93 femtolitres vs. 9.84 ± 1.06 femtolitres).

Conclusions

MS is associated with more severe clinically and angiographically CAD. Prevention and regulation of MS factors are significant for the avoidance of the occurrence of severe coronary syndrome.
The relationship between frailty and HRQoL in elderly cardiovascular patients in Phase II Cardiac Rehabilitation
Authors: Xu J , Yokoyama M , Shimada K , Fujiwara K , Abidan A , Kunimoto M , Nozawa Y , Kasuya H , Tabata M , Daida H , Minamino T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

With an aging cardiovascular disease population, frailty is become an important prognostic factor in patients, which is associated with poor quality of life outcomes, such as fatigue, and decreased physical activity. However, the relationship between frailty and health-related quality of life (HRQOL) in elderly patients undergoing cardiac rehabilitation (CR) remains unclear.

Methods

In this study, 217 patients (mean age: 74.6 ± 5.8 years; male: 67%) were recruited who participated in early phase II CR at a university hospital between November 2015 and December 2016. As part of the CR processed, patients were asked to complete the Kihon Checklist (KCL) and 36-Item Short Form Survey (SF-36). We divided patients into three groups according to their KCL results: the frailty group (n = 81; 37%), the pre-frailty group (n = 71; 32%), and the non-frailty group (n = 65; 29%). The three groups were compared based on their basic characteristics and SF-36 scores.

Results

Among the three groups, sex, body mass index, 6-minute walking distance (6MWD), hemoglobin level, and low-density lipoprotein cholesterol level varied significantly (p<0.05). The frailty group scored significantly lower than the other two groups on all items of the SF-36, the Physical Component Summary (PCS), and the Mental Health Component Summary (MCS) (p< 0.05). In all groups, the PCS scores were below the standardized mean scores. Interestingly, MCS score in the frailty group was below the standardized mean scores. Additionally, the significant correlations were found between the PCS and 6MWD in the non-frailty group (p=0.006, r=0.38) and pre-frailty group (p=0.002, r=0.52), but no correlation was found in the frailty group (p=0.14, r=0.22). On the other hand, there was no significant correlation between MCS score and 6MWD in all groups.

Conclusions

HRQOL as well as physical and mental domains declined in frail elderly patients undergoing CR, which suggests that an intervention program considering social life and daily roles is necessary.
Impact of COVID-19 situation on non COVID myocardial infarction admissions
Authors: Del Castillo-Carnevali H , Alvarez J , Torres J , Magnani S , Morante M E , Sahuquillo A , Ripoll T , Peral V , Gamez J M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

COVID-19 outbreak nudged worldwide health systems to reallocate resources from from other areas to help fighting against this novel infectious disease. Consequently, accuracy and quality care of cardiovascular patients was partially compromised. Moreover, fear to get to hospital made patients to stay home despite the presence of symptoms that would have led them to search medical aid in other scenarios.

Aim

We aimed to demonstrate that non COVID myocardial infarction admissions after the outbreak were more complex in term of coding and length of stay (LOS) compared to those previous to pandemic situation.

Methods

We analyzed complexity coding weight (CW) parameters (according to current Spanish Coding manual CIE-10)obtained from local healthcare authorities of 903 admissions from Balearic Islands Region from January 2019 to December 2021. Admissions with higher coding value were considered more complex. We performed an interrupted time series using pre pandemic admissions as a control group.

Results

2020 showed a lower number of admissions (268/mean CW: 0,651), specially form March to June compared to 2019 (347/mean CW: 0,631) and 2021 (288/ mean CW: 0,627). CW values and LOS, trend and comparison are showed in figures.

Conclusions

Number of myocardial infarction admissions were reduced in 2020. Complexity trend to mildly increase in 2020. No significant variations in LOS where found. Further analysis with data from other regions would be useful to confirm this trend in the whole country.
Non-alcoholic steatohepatitis and hepatic fibrosis are strongly associated with estimated 10-years cardiovascular risk in people living with severe obesity
Authors: Lajeunesse-Trempe F , Dugas S , Maltais-Payette I , Piche M E , Dimitriadis G K , Biertho L , Tchernof A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Cardiometabolic health, diabetes and obesity research network IUCPQ Foundation.

Background

Obesity (Body Mass Index [BMI] over 30 kg/m2) is associated with metabolic disturbances that promote the development and progression of cardiovascular diseases (CVD). However, the association between anthropometric indices of obesity (BMI, Waist Circumference [WC], Waist-to-Hip ratio [WHR] or Neck Circumference [NC]) and CVD risk factors has not always been observed in people living with severe obesity (BMI >35 kg/m2). Among obesity-related metabolic disorders, non-alcoholic ateatohepatitis (NASH) is associated with an increased risk of CVD and cardiac events. NASH has been shown to correlate with a degree of obesity, as defined by BMI or WC. The association between anthropometric parameters, NASH and CVD risk factors has not been explored yet in people living with severe obesity.

Purpose

The aim of this study was to explore the relationships between CVD risk score, anthropometric parameters and the presence of NASH (hepatic steatosis and fibrosis) in a population with severe obesity.

Method

A total of 2257 patients with severe obesity, who underwent bariatric surgery with concomitant liver biopsy were included. All biopsy specimens were classified according to the Brunt grading system. Pre-operative demographic and anthropometric data (age, sex, weight, height, BMI, WC, WHR, NC) were recorded. Comorbidities were assessed (type 2 diabetes, hypertension, dyslipidemia). The 10-year cardiovascular risk was calculated preoperatively in each patient using the Framingham risk score (FRS). Dependent variable FRS was compared using Kruskal Wallis H test and Chi2 exact test. Associations were tested using multivariate logistic regression analysis.

Results

In this specific population (mean age of 46.2 years old, mean BMI of 47.8 kg/m2, 69.1% female), FRS did not significantly increase with weight, BMI and WC, but was positively correlated with WHR and NC (p<0.05). A total of 47.3 % of patients with a histopathological diagnosis of NASH had a moderate-to-high FRS. Among NASH patients with histopathological evidence of grade-4 fibrosis, 69.3% had a moderate-to-high FRS. Presence of NASH and fibrosis were more strongly correlated with a moderate-to-high FRS (OR of 1.61 and 1.37, respectively), compared to all other anthropometric parameters (p<0.05), except WHR (OR of 1.99).

Conclusion

In people living with severe obesity, the presence of NASH and hepatic fibrosis is strongly associated with a high FRS but not more than WHR. Further research is needed to identify the best predictors of CVD and cardiac events in people living with NASH and severe obesity.
Factors influencing systemic coronary risk estimation 2 (SCORE 2)
Authors: Bielecka-Dabrowa A , Banach M , Sakowicz A , Sosnowska B , Adach W , Gryglewska K
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): statutory measures.

Purpose

The aim of the study was to identify factors correlating with estimated an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in apparently healthy people aged 40-69 years with risk factors that are untreated or have been stable for several years and independent predictors of high and very high CVD risk.

Methods

148 patients from high-risk country without established ASCVD, diabetes mellitus, CKD, Familial Hypercholesterolemia were included in the study. The clinical examination, laboratory results, chest x-ray, echocardiography using Vivid E95 - GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), spiroergometry using The MetaSoft® Studio application were performed. The subjects were divided into a low-risk group with low-to-moderate CVD risk in SCORE2 (70 pts) and a high risk group with high and very high CVD risk (78pts).

Results

Pts from high risk group had significantly more frequently s arrythmia (23 vs 2%; p<0,001) and obesity (45 vs 10%; p<0.001), they more often use too much amounts of alcohol (8 versus 0%; p=0.02) compared to low risk group. High risk pts had also significantly higher BMI (29 vs 24 kg; p<o.001), fat (27 vs 19 kg; p<0,001) and TBW (41 vs 38kg; p=0.03); higher LAVI (35 vs 27 ml/m2; p<0.001), left ventricular mass index (86 vs 73 g/m2; p<0,001); E/E’ (7,5 vs 6 cm/s; p=0,0002) but lower V02AT (13 vs 15 ml/min/kg; p=0,01), V02/kg (20 vs 22 ml/min/kg; p=0.008) compared to counterparts. High risk pts presented also higher values of hs of TnT (6,8 vs 3,2 pg/ml; p<0,001 ) and NTproBNP (100 vs 5 pg/ml; p<0,001) and lower level of eGFR (82 vs 98 ml/min/1,73m2). In a multiple logistic regression model the following variables were independently associated with high and very high CVD risk: : E/E’>6,75 cm/s (OR 3.9 95% CI: 1.5-10.3; p=0.004) and hs TnT >4.8 pg/ml (OR6.02, 95% CI: 2.3-15.8; p=0.0002) SCORE 2 (%) correlated positively with metabolic age (R Spearman= 0,79; p<0.0001), hs TnT (R=0.6;p<0.001), NT-proBNP (R=0,5;p<0.001) and negatively with eGFR (R=-0,5; p<0/001), VO2max (ml/min/kg) (R=-0,3; p=0.0008) -Figure 1.

Conclusions

Higher left ventricular filling pressure assessed by E/E’ and higher hsTnT level are independent predictors of high and very high risk in SCORE 2. The increasing 10-year cardiovascular disease risk correlates with higher metabolic age, higher level of NT-proBNP and hsTnT and lower level of eGFR.
Prevalence and significance of T-wave inversion on the electrocardiogram of patients with marfan syndrome
Authors: Ibrahim B , Poveda P , Kasiakogias A , Tojalsi L , De Frutos F , Potterton A , Sharma S , Papadakis M , Tome M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Cardiac risk in the young charity, and Robert Luff Foundation.

Background

The 12-lead ECG is used as a screening tool in healthy individuals and patient populations, and pathological T-wave inversion (TWI) warrant further investigation for heart disease. Marfan syndrome (MFS) can be associated with valvular disease and a cardiomyopathy-like phenotype but there are limited data on the ECG of this cohort.

Purpose

We aimed to characterize the ECG of MFS patients, with particular emphasis on the prevalence and significance of TWI.

Methods

The study population included consecutive MFS patients, aged ≥18 years old, free of cardiothoracic surgery, seen in our Aortopathy clinic between 2015 and 2019. We collected information on demographics, MFS systemic score, body habitus (height, weight and body mass index-BMI), medical treatment and echocardiographic data. Chest deformities were defined as presence of pectus excavatum (PE), pectus carinatum (PC) or chest wall asymmetry (CA). The ECG was systematically analysed based on established criteria. The presence of TWI and its localisation were recorded.

Results

116 MFS patients were included (mean age 39±15 years, females 60%, Caucasian 89%, BMI 25±6 Kg/m2). 44% of patients were on beta-blocker. Chest deformities were present in 42% of the patients (PE 18%, PC 22%, CW 2%) and scoliosis in 59% of them. Echocardiography revealed a mean aortic root was 38.1±4.8mm but no evidence of significant cardiomyopathy in any of the patients. Four individuals exhibited moderate mitral regurgitation. ECG abnormalities are summarised in Figure 1. Anterior TWI was present in 10.3%, inferior TWI in 4.3% and lateral in 3.4%. Age, ethnicity, BMI, scoliosis, or valvular pathology were not associated with TWI. However, anterior TWI was more common in females compared to males (14.5% versus 4.3%) and in patients with PE compared to those without (31.3% vs 8%, p=0.003).

Conclusion

Pathological TWI were present in almost a fifth of MFS patients. Anterior TWI were more frequently present in females and in patients with pectus excavatum and are likely to represent a benign trait. The exact significance of other TWI remains to be elucidated
Markers of imminent myocardial infarction
Authors: Sundstrom J , Lampa E , Jensevik Eriksson K , Ganna A , Svennblad B , Gustafsson S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): AFA Insurance and the European Commission Seventh Framework Programme.

Background and Purpose

Myocardial infarction is a leading cause of death globally, but is notoriously difficult to predict. While most studies to date have considered long timeframes for etiological and prediction models, we aimed to identify biomarkers of an imminent first myocardial infarction and design relevant prediction models.

Methods

We used a novel case–cohort consortium of 2018 persons without prior cardiovascular disease (420 cases, 1598 subcohort representatives) from six European cohorts. We investigated associations of 817 proteins, 1025 metabolites, and 16 clinical variables at baseline with subsequent risk of a first myocardial infarction within 6 months after baseline. Associations in weighted, stratified Cox proportional hazards models that passed multiple testing bounds in the discovery sample were verified in an independent validation sample. We also developed a prediction model for clinical use.

Results

Forty-eight proteins, 43 metabolites, age, sex, and systolic blood pressure were associated with risk of an imminent first myocardial infarction in models adjusted for technical covariates only (Figure 1). Brain natriuretic peptide (BNP) was most consistently associated with imminent myocardial infarction risk, in models adjusting for additional covariates including age and sex. Using clinically readily available variables, we devised a prediction model (Figure 2) with good ability to discriminate between subsequent cases and non-cases (cross-validated C-index 0.78) to which the addition of BNP did not improve performance.

Conclusion

We found 94 biomarkers associated with risk of a first myocardial infarction within 6 months in persons without prior cardiovascular disease, and devised a prediction model with good discriminative ability for an imminent first myocardial infarction in the general population, with potential for motivating primary prevention efforts.
The association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques assessed by near-infrared spectroscopy
Authors: Saether J , Vesterbekkmo E K , Gigante B , Giskeodegard G F , Bathen T F , Follestad T , Wiseth R , Madssen E , Bye A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association The Liaison Committee for education, research and innovation in Central Norway.

Background

Lipid content in coronary atheromatous plaques, measured by near-infrared spectroscopy (NIRS), can predict the risk of future coronary events. Biomarkers that reflect lipid content in coronary plaques may therefore improve coronary artery disease (CAD) risk assessment, and lipoprotein subfractions could potentially add value beyond traditional lipid measurements.

Purpose

We aimed to investigate the association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques in statin-treated patients with stable CAD undergoing percutaneous coronary intervention.

Methods

56 patients with stable CAD underwent three vessel imaging with NIRS when feasible. The coronary artery segment with the highest lipid content, defined as the maximum lipid core burden index within any 4mm length across the entire lesion (maxLCBI4mm), was selected as target segment. Lipoprotein subfractions were analyzed in fasting serum samples by nuclear magnetic resonance spectroscopy. Penalized linear regression analyses (lasso) were used to identify the best predictors of maxLCBI4mm. The uncertainty of the lasso estimates was assessed as the percentage of the resampled datasets by bootstrapping.

Results

Only modest evidence was found for an association with lipoprotein subfractions and maxLCBI4mm. The lipoprotein subfractions with strongest potential as predictors according to the percentage presence in resampled datasets were lipoprotein a (Lp(a)) (reg.coeff = 57.0; 78.1 % presence) and free cholesterol in the smallest high-density lipoprotein (HDL) subfractions (reg.coeff = 36.5; 74.3 % presence). When including established cardiovascular risk factors in the regression model, none of the lipoprotein subfractions was considered potential predictors of maxLCBI4mm.

Conclusion

In this study, Lp(a) and free cholesterol in the smallest HDL subfractions in serum showed the strongest potential as predictors for lipid content in coronary atheromatous plaques. Although the evidence is modest, our study suggests that measurements lipoprotein subfractions may provide additional information with respect to coronary plaque composition compared to traditional lipid measurements, but not in addition to established risk factors. Future studies are needed to verify our findings, and to investigate the clinical implication of lipoprotein subfractions as meaningful biomarkers for lipid-rich plaques and enhanced risk prediction in CAD.
Community echocardiographic left ventricular hypertrophy and mortality in South Asians in the UK: E-ECHOES study
Authors: Shantsila E , Shantsila A , Williams N , Lip G Y H , Gill P S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England.

Background

People of South-Asian origin have high cardiovascular morbidity, contributed by health inequalities. Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, but its scale in South Asian communities is unknown. Left ventricular hypertrophy (LVH) on echocardiography is a measure of target organ damage related to uncontrolled hypertension. The study aims to assess prevalence of LVH in South Asian community and its impact on mortality. This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years).

Methods

Left ventricular mass index (LVMI) was calculated using echocardiography. LVH was established as increased LVMI. Predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression.

Results

The study included 3200 South Asians (age 59±10, 52% women, 45% had a history of hypertension). There were 182 deaths, including 64 cardiovascular deaths during a 5.8±1.0-year follow-up. LVH was found in 1568 (49%). In those with LVH, 705 (45%) did not have a diagnosis of hypertension. On Cox regression LVH was independently associated with all-cause mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.01-1.88), cardiovascular mortality (HR 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%.

Conclusion

South Asians in the UK have a very high prevalence of hypertension which is often underdiagnosed and poorly controlled, leading to LVH and excess in overall and cardiovascular mortality. The findings call for more effective screening and management of hypertension with lower BP targets.
Does right ventricular remodeling in elite athletes persist years after training cessation?
Authors: Prosperi S , Monosilio S , Ferrara R , Lemme E , Di Gioia G , Mango R , Gualdi G , Squeo M R , Maestrini V , Pelliccia A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Intense and prolonged exercise training induces morpho-functional cardiac changes, known as "athlete’s heart". The physiologic nature of this cardiac remodeling has been questioned and data on reversibility of cardiac remodeling, especially of the right ventricle (RV), after the suspension of high intensity training are scarce.

Purpose

To describe cardiac morpho-functional changes by echocardiography in a group of Olympic athletes prior the Olympic games (T1) and years after cessation of their competitive athletic career (T2).

Methods

Endurance athletes evaluated prior their participation to the Olympic games (edition 2004-2008-2012) and after cessation of their athletic career (> 3 years of cessation of intensive exercise training) were invited to be evaluated at our Institute. 12-lead ECG, exercise ECG test and echocardiogram were performed. Echocardiogram parameters at T1 and T2 were compared including left ventricle (LV) and RV dimension, systolic and diastolic function.

Results

25 athletes were enrolled (mean age 47±2 years). The mean time from the end of their agonistic activity was 12 ± 7 years. No differences in terms of LV dimensions and function were observed (Table). Veterans showed a significant decrease in RV dimensions and improvement in function at T2 compared to T1.

Conclusion

After suspension of competitive training, Veteran athletes showed reverse remodeling of the right ventricle compared with the evaluation during the peak training by echocardiography.
The role of peak VO2 in prognosis in patients undergoing a Cardiac Rehabilitation program
Authors: Alves Da Silva P , Aguiar-Ricardo I , Martins A M , Cunha N , Abrantes A , Rodrigues M C , Fiuza S , Caldeira E , Roxo D , Ramalhinho M , Santos L , Miguel S , Pinto F J , Abreu A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Peak oxygen uptake (peak VO2) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation.

Although guidelines suggest a peak VO2<14mL/(kg.min) as a cut-off for transplant and a peak VO2<12mL/(kg.min) in patients under beta-blockade (BB), recent data emerged, questioning the suitability of such cut-offs.

Purpose

To correlate CPET and echo data with outcomes after CR programs and to determine the best cut off for peak VO2 in a population with a high percentage of BB therapeutics.

Methods

Single center prospective study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psychologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program. Multivariate analysis with Cox regression was used to correlate with events and survival was analyzed with Kaplan Meier curves.

Results

We analyzed 349 patients who underwent CR (82% male, mean age 60 ±11,4 years). The majority was referred for ischemic heart disease (83%) followed by valvular heart disease (7%). Mean follow-up was 36,7± 19,2 months. During FUP, 7,2% pts had CV related admissions (n=25), 4 of which were myocardial infarction. Sixteen pts died (4,6%) of which 2,3% were from cardiovascular causes. On multivariate analysis peak VO2 (HR 0.827 CI 95% 0.72-0.949, p=0.07), ejection fraction (HR 0.962 CI 95% 0.933-0.991, p=0.01) and test duration (HR 0.756 CI 95% 0.712-0.778, p=0.01) correlated with hospital admissions. Regarding mortality only peak VO2 showed statistical significance (HR 0.8 CI 95% 0.69-0.93, p=0.04). On this matter we further analyzed the best cut-off in predicting events: a peak VO2 > 14 mL/(kg.min) was a better predictor of event free-survival in these patients when comparing with a peak VO2 of 12 mL/(kg.min).

Conclusions

Cardiac rehabilitation has an established impact in prognosis. Echo and CPET data obtained at the beginning of the CR program can be used to identify patients who might benefit from a more closed surveillance in order to reduce risks of hospitalization.

Moreover, in our population, a peak VO2 cut-off of 14mL/(kg.min) seemed to better correlate with event-free survival.
Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study
Authors: Goevaerts W F , Tenbult - Van Limpt N C C W , Brouwers R W M , Kemps H M C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation.

Purpose

The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement.

Methods

In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals.

Results

All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (>68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2).

Conclusions

The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.
Cardiac rehabilitation designed for obese patients with atrial fibrillation: OPTICARE XL results on burden, frequency and severity of Atrial Fibrillation
Authors: Tenbult - Van Limpt N , Brouwers R , Ter Hoeve N , Den Uijl I , Spee R , Van Den Berg - Emons R , Boersma H , Lu Y , Kemps H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial Fibrillation (AF) is associated with substantial morbidity, mortality and low quality of life. Obesity is an important risk factor for AF and weight reduction is associated with a decrease in AF burden. Previous studies showed that conventional CR programs lead to insufficient weight reduction in obese patients. The OPTImal CArdiac REhabilitation XL (OPTICARE XL) study was an open label randomized controlled trial (RCT), evaluating effects of a CR program specifically designed for weight reduction in patients with obesity and non-valvular AF.

Objective

We hypothesize that this novel tailor-made CR program (OPTICARE XL) will lead to reduced AF burden, as compared to conventional CR.

Design and setting: Multi-center RCT, conducted between February 2017 and January 2019 in 2 large Dutch CR centers. Patients were randomized to the OPTICARE XL CR intervention-program or a conventional CR-program.

Methods

The primary endpoint was AF symptom burden, assessed by the Atrial Fibrillation Severity Scale (AFSS). Secondary endpoints were AF symptom number, AF symptom frequency and AF symptom severity. Data were collected at baseline (prior to CR, T0), at the end of the intervention and conventional program (T1) and 1.5 year after inclusion (T2).

Results

Of 68 included patients, 28 were randomized to conventional CR and 40 to OPTICARE XL CR. Patients were predominantly male (60%), had a mean age of 62.4 ± 10.4 years and a mean BMI of 36.1 ± 4.4 kg/m2.

With regards to AF burden, no significant within and between-group differences were observed between T0 and T1, T1 and T2, and T0 and T2 (OPTICARE XL: T0 14.6 ± 4.4, T1 14.1 ± 5.9, T2 14.3 ± 6.9; conventional CR: T0 16.4 ± 6.5, T1 15.3 ± 6.3, T2 15.9 ± 7.6; Figure 1).

There was a significant difference (p=0.02) in the AF symptom number at T2 in favor of the intervention group (Figure 2). AF symptom frequency decreased in the intervention group from T0 to T2 (31.5 to 25.8; p=0.027) and in conventional CR from T0 to T1 (32.2 to 28.2; p=0.010). However, for both AF symptom frequency and symptom severity, no significant between-group differences were observed.

Conclusion

Compared to conventional CR, OPTICARE XL CR did not result in a reduced AF burden. However, it did reduce the AF symptom number at long-term follow-up. Novel CR programs such as OPTICARE XL may have added value in the treatment of obese patients with AF.
What makes athletes with extra training volume at a sports cardiology center different
Authors: Jiravsky O , Pesova P , Pleva M , Krausova D , Sknouril L , Sterbova T , Kantor M , Spacek R , Raskova I , Jiravska Godula B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Athletes have always recognized the importance of training, but in modern times there has been a dramatic increase in the volume and intensity of training that athletes undergo. This has led to concerns about the potential risks associated with such high levels of training. However, there is also evidence to suggest that athletes who train the hardest may actually be at lower risk of developing cardiovascular problems.

Objective

To determine the proportion of athletes with arrhythmias screened at a sports cardiology center. To define the differences in care between an athlete with and without an arrhythmia.

Methodology

Retrospective analysis of the registry of all athletes of the one Sports Cardiology Centre. Statistical comparison of the cohort of athletes with weekly training volume above the 95th percentile versus the rest of the cohort.

File: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 males and 15 females (13%), aged 26 (+/-11 years) were examined and definitively closed at CSK. Median 95th percentile group training volume was 18 hours, mean 22 (+/3) hours vs 9 (+/- 3) hours (p<0.001), detailed in Table 1.

Results

The cohort of athletes in the greater than 95th percentile of weekly training volume sides differed statistically significantly from the rest of the cohort only in the type of sport according to ESC (typically endurance athletes, p=0.021) and the percentage of medication used regularly (50% vs 16.9%, p=0.039). Data summarized in Table 2.

Conclusion

Apart from the statistically significant greater use of regular medication, there was no difference from the rest of the cohort in workflow and sports cardiology centre outcomes in the cohort of those athletes with the highest training volume. The difference in heart dimensions and volumes on echocardiographic and MRI scans will be the subject of further investigation.
Benefits of patient-managed ECGs to verify the time of recurrent atrial fibrillation after electrical cardioversion in the PRE-ELECTRIC study
Authors: Andersen E , Solberg M G , Enger S , Onarheim S , Olufsen M , Christophersen I E , Ulimoen S R , Walle-Hansen M M , Berge T , Tveit A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Vestre Viken Hospital Trust.

Background

Electrical cardioversion (ECV) is a common procedure to terminate persistent atrial fibrillation (AF). The recurrence rate after ECV is high, and recurrence is often unrecognized by the patients.

Purpose

To investigate the benefits of patient-managed out-of-hospital electrocardiography (ECG) to diagnose recurrence of AF after ECV.

Methods

PRE-ELECTRIC (predictors for recurrence of atrial fibrillation after electrical cardioversion) is a prospective, observational study. We included 200 adult patients with persistent AF referred for ECV at Bærum Hospital between 2018 and 2022. Time to recurrence of AF was verified by digital thumb ECG, recorded twice daily and whenever experiencing symptoms. The observation period was 28 days. We defined patient motivation as expected number of days with ECG recordings minus missed days with ECG recordings divided by expected number of days with ECG recordings. Shortly after recurrence of AF, we called the patients and investigated their awareness of recurrence.

Results

Mean age was 66.2 (± 9.3) years, and 42 (21.0%) were women. The most frequent comorbidities were hypertension (n=94, 47.0%) and heart failure (n=51, 25.5%). A total of 164 patients underwent ECV of AF, and the procedure was initially successful for 90.6%. Recurrence of AF had occurred in 50.3% of the successfully cardioverted patients after 4 weeks, and median time to recurrence was 5 days. Of all the cardioverted patients, 123 patients (75%) had 100% motivation with no missed days of measured thumb ECGs during the observation period. Nearly 97% of the patients had above 89% motivation with three or less missed days. More than 37% of the patients with recurrence of AF were not aware of the recurrence at the time of contact.

Conclusions

Recurrence of AF after ECV was frequent. Patients showed high motivation to self-managed out-of-hospital ECG-recordings, and this was useful for diagnosing recurrence of AF.
The LIPL Study Postprandial lipid profile, inflammation and platelet activity in patients with chronic coronary syndrome
Authors: Pogran E , Haller P H , Wegberger C W , Tscharre M T , Vujasin I V , Kaufmann C K , Dick P D , Jaeger B J , Wojta J W , Huber K H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

In general, most people spend their day in a non-fasting state. Hence, it is suggested that the changes in atherosclerosis happen mainly under the influence of non-fasting lipids. Up to date, the studies in the postprandial state were primarily performed on healthy subjects.

Aim

This exploratory, cross-sectional study investigates the change in lipid profile, in biomarkers of inflammation, as well as markers of platelet activation in patients with different cardiovascular risk profiles in the postprandial state.

Methods

The studied population consists of 66 patients with different cardiovascular risk: patients with a history of chronic coronary syndrome (CCS) and diabetes mellitus type 2 (DM2) (n=20), CCS without DM2 (n=25), and a healthy control group (n=21). Lipid variables and markers of platelet function were assessed during the fasting state (baseline) and three and five hours after a standardized fat meal using a standardized oral fat tolerance test (OFTT), a milkshake with 90g of fat. Platelet activity was measured with the Multiplate Assay using adenosine diphosphate (ADP), arachidonic acid (ASPI) and thrombin-receptor activating peptide (TRAP) as stimulants.

Results

Patients with CCS and DM2 were significantly older and had the highest BMI. All patients with CCS were on acetylsalicylic acid, and 95% of CCS patients were on high-dose statins. HDL-c decreased significantly during the OFTT, with a peak after five hours (3.46±0.4 mg/dL, p<0.001). Triglycerides (TG) increased significantly during the OFTT, with a peak after five hours (130.2 ± 14.5 mg/dL, p<0.001) irrespective of the group. All other variables of the lipid profile remained stable during the OFTT. The absolute leucocyte and neutrophile count and the neutrophile to lymphocyte ratio (NLR) increased significantly during the OFTT in the whole study population, whereas the absolute lymphocyte count increased significantly only in the control group. A significant increase in platelet activity during OFTT was shown in the control group by the increased absolute platelet count, increased reticulated thrombocytes, and increased platelet reactivity measured by the ASPI and TRAP tests, respectively. There was no significant change in the markers of platelet activity during the OFTT in patients with CCS with/without DM2.

Conclusion

This study showed that a standardized fatty meal changes HDL-c and TG concentrations and leads to an increased postprandial inflammation response irrespective of the cardiovascular risk and to increased platelet activity in healthy subjects, while there was no increase in platelet activity in higher-risk CCS patients.