bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefit of cardiac rehabilitation for elderly patients
Authors: Scherrenberg H , Scherrenberg M , Falter M , Intan-Goey V , Kaihara T , Dendale P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Benefit of cardiac rehabilitation for elderly patients

Background

Comprehensive cardiac rehabilitation (CR) is a class IA recommendation by European guidelines for all patients with ischemic heart disease (IHD). The risk profile of older IHD patients is often different from younger patients and there is less evidence available about the effects of CR. Therefore, it is still unclear if a one-size-fits-all centre-based CR focusing on the core components such as education, diet, risk reduction and optimal medication is as effective for elderly patients as for younger adults.

Methods

Patients with a revascularization for IHD who participated in at least 8  phase II center-based CR sessions between 2011–2014 were identified. A total of 294 patients were included in this study. The patients were divided in two groups: 0-64 years old and ≥ 65 years. The primary outcome was the incidence of major adverse cardiovascular events (MACE) during the 5-year follow-up. MACE is the composite of all-cause mortality, stroke and coronary artery revascularization.

Results

The medical records of 294 patients were retrospectively reviewed. Statistically significant baseline risk profile differences between the two groups were observed for the prevalence of current smokers (P <0.001) and diabetes mellitus (P= 0.002). Furthermore, significant differences in blood pressure and lipid levels were present. No statistically significant differences between the two age groups were observed for 5-year coronary revascularizations (P = 0.794) and 5-year MACE (P = 0.221). Only significant differences between the age groups could be found in cardiovascular mortality (P = 0.023) and in all-cause mortality (P < 0.001). However, the total years of life lost were lower in the group with patients older than 64 year (14 vs 32 years).

Conclusion

There is clear difference in cardiovascular risk profile between younger and older IHD patients that participate in CR. There was no significant difference in 5-year MACE between the two groups. These results underline the importance to not forget recommending CR to elderly patients.

Outcomes All (n = 294) <65 y (n = 153) +65 y (n = 141) P-value 1-year coronary revascularization 11 (3.7%) 5 (3.3%) 6 (4.3%) 0.656 2-year coronary revascularization 23 (7.8%) 12 (7.8%) 11 (7.8%) 0.989 5-year coronary revascularization 36 (12.2%) 18 (11.8%) 18 (12.8%) 0.794 Cardiovascular mortality 8 (2.7%) 1 (6.5%) 7 (5%) 0.023 All-cause mortality 14 (4.8%) 2 (1.4%) 12 (8.5%) <0.001 5-year MACE 49 (16.7%) 20 (13.1%) 29 (20.1%) 0.221
Outcomes of ST elevation myocardial infarction (STEMI) hospitalizations during corona virus disease 19 (COVID 19) era
Authors: Simoni L , Alimehmeti I , Gina M , Tafaj E , Ceka A , Dibra A , Goda A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Multiple studies reports a reduction of STEMI hospitalizations rates during COVID 19 pandemic outbreak. Contradictory STEMI complications rates are reported during COVID 19 pandemic regarding case fatalities rates, cardiogenic shock, life threatening arrhythmias and others.

Purpose. To evaluate the impact of the COVID 19 outbreak on STEMI patient outcomes and complication rates in country with low COVID 19 incidence and mortality and without changes in Cardiology hospital services.

Methods. Was conducted a retrograde study collecting data for STEMI hospitalizations, revascularization procedures and case fatalities and other complications from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center. Incidence rate ratio (IRR) was used to compare STEMI admissions and revascularization procedures and risk ratio (RR) to compare case fatality rate and other complications rate.

Results

Hospital admissions for STEMI declined during 2020 (COVID 19 period) from a total of 217 patients in 2019 to 155 patients hospitalization in 2020 representing IRR 0.72 (p = 0.009). Reduction were observed in the number of primary PCI from 168 procedures in 2019 to 113 in 2020 (IRR 0.67 p = 0.001). Symptom onset to our ICU (including regional transportation) was significantly higher in 2020 than in 2019 (939.97 ± 1122 versus 436.15 ± 383 minutes p <0.0001) The STEMI case fatality was importantly increased during pandemic outbreak (13.55%) compared to 2019 (8.3%) (RR= 1.63 p = 0.001), but a similar a primary PCI-STEMI case fatality 6.2% versus 5.95%. Also an increase was observed for cardiogenic shock (IRR =1.75 p = 0.003).

Results; Hospitalizations and related invazive revascularization procedures for STEMI significantly reduced during COVID 19 pandemic. We identified a substantial increase of STEMI case fatalities and cardiogenic shock during pandemic outbreak. Delayed timely reperfusion by primary PCI has an important impact on infarct related mortality.
Relationship between CHA2DS2-VASC score on admission to emergency department and in-hospital major adverse cardiovascular events in patients diagnosed with ST-elevation myocardial infarction
Authors: Inan DUYGU , Genc DUYGU , Simsek BARIS , Tanik OZAN , Akdeniz EVLIYA , Korkmaz BETUL , Aydogdu UFUK , Vatanoglu ELIF G , Zeren GONUL , Ceylan BUSRA , Yumurtas CAGDAS , Yuksel GIZEM , Pay LEVENT , Tanboga HALIL , Karabay CAN Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Inotroduction

. CHA₂DS₂-VASc scoring system, which includes traditional risk factors of coronary artery disease, is actually created to determine the risk of thromboembolism in patients with atrial fibrillation. In this study; the value of CHA₂DS₂-VASc score, which can be calculated easily on admission, was evaluated for predicting in-hospital adverse outcomes in ST elevation miyocardial infarction (STEMI) patients without atrial fibrillation.

Method

This was a single center cross-sectional study. 1933 STEMI patients enrolled to the study. Primary end points include in-hospital death, cardiopulmonary arrest and cerebrovascular accident and were identified as MACE

Results

MACE rate was 10% (193 patients), in-hospital mortality rate was 9% (169 patients).In proportional logistic regression analysis, CHA₂DS₂-VASc score was an independent predictor for MACE (OR and CI 95%, 2.31[1.37-3.90]; p value:0.0016). In the regression analysis, the CHA₂DS₂-VASc score was taken as an uncatagorized continuous variable, and the relationship between the CHA₂DS₂-VASc score and MACE was observed to be linear. Additionally heart rate (OR and 95% CI, 1.56 [0.97- 2.50]; p value: 0.0242), killip class on admission (OR and 95% CI, 24.19[10.74-54.46]; p value <0.0001), creatinine level on admission (OR and 95% CI, 1.54 [1.10-2.16]; p value: 0.0024), peak CK-MB level (OR and 95% GA, 1.63 [0.98-2.70]; p value: 0.0001) and presence of no-reflow (OR and 95% CI, 2.45 [1.25-4.80]; p value: 0.0085) were indendified as other independent predictors of MACE.

Conclusion

CHA₂DS₂-VASc score was observed as an indepented predictor for MACE in STEMI patients. To evaluate the relationship between CHA₂DS₂-VASc score and outcomes, the linear analysis of the CHA₂DS₂-VASc score without categorization in prediction model is used and this is the main difference of our study from others.

Table-1 Variables Odss Ratio (OR) and 95% CI p value CHA₂DS₂-VASc ( 0 to 3) 2.31 (1.37-3.90) p = 0,0016 Heart Rate (Beats per minute) ( 68 to 94) 1.56 (0.97-2.50) p =0.0242 Systolic Blood Pressure (mmHg) ( 115 to 156) 0.83 (0.51-1.34) p = 0.3523 Killip Class ( I to IV) 24.19 (10.74-54.46) p < 0.0001 Hemoglobin (g/dL) ( 12 to 15) 0.96 (0.54-1.70) p = 0.4066 Creatinine ( mg/dL) (0.74 to 1.0) 1.54 (1.10-2.16) p = 0.0024 Peak CK-MB (IU/L) (40.8 to 165.1) 1.63 (0.98-2.70) p = 0.0001 No-reflow (yes) 2.45 (1.25-4.80) p = 0.0085 Independent predictors of MACE in STEMI patients according to penalized proportional odds logistic regression analysis

Abstract Figure. Partial impact plots of predictors
Non-ST elevation myocardial infarction; admission to angiogram time at a busy district general hospital
Authors: Harris A , Prabhakar M , Mattar W
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Timely management of acute coronary syndromes, including patients presenting with non-ST elevation myocardial infarction (NSTEMI), is crucial in improving outcomes and reducing mortality. Clinical Guideline 94 (CG94) by National Institute of Health and Care Excellence (NICE) states that patients presenting with a NSTEMI with an intermediate or higher risk score should be offered coronary angiography within 96 hours of admission to hospital.

Purpose

The purpose of this audit is to assess how well our General Hospital adhered to the recommended NSTEMI intervention set by the NICE guidelines.

Methods

Data was collected between September and December 2019 for patients admitted with an NSTEMI to the cardiology department at our General Hospital. Data was analysed using in-patient paper notes and Microsoft Excel.

Results

Of the 54 patients admitted with NSTEMI, 67% met the NICE guideline for angiogram within 96 hours of admission. The most common reason for delay was infection or raised inflammatory markers (28%). Other medical reasons include pulmonary oedema (11.1%), acute kidney injury (11.1%) and stroke (11.1%). Another notable reason for delay to angiogram was weekend admissions and wait for cardiology bed (22.2%). Six-month mortality rates showed that, 75% of deceased patients did not undergo an angiogram within 96 hours of admission.

Conclusion

We have an elderly population with multiple co-morbidities. Therefore, whilst patients are being managed for other acute medical problems they are deemed unfit for an immediate angiogram ultimately causing a delay. Furthermore, some patients were not referred to cardiology immediately after the NSTEMI event which causes delay in organising the angiogram. Finally, some patients were awaiting a cardiology bed in the Acute Admissions Unit. This causes delay as patients cannot undergo angiogram without a cardiology bed available for recovery. These delays are causing significant differences in the mortality rates of NSTEMI patients.

In order to address these issues, a hospital guideline for junior doctors regarding the management of NSTEMIs has been designed and distributed. The guideline emphasises the importance of early cardiology referral, the management of acute medical problems in NSTEMIs such pre-hydration to prevent acute kidney injury, and the medical management of NSTEMIs in line with the 2020 ESC guidelines. Finally, it would be useful to re-audit these findings to assess if mortality rates and adherence to the NICE and ESC guidelines improve following these interventions.
Symptoms, ecg-changes and family history of cardiac disease precedes sudden cardiac death in hypertrophic cardiomyopathy - A nationwide study among the young in Sweden 2000-2010
Authors: Borjesson E , Wisten A , Borjesson M , Stattin E-L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND - Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease associated with increased morbidity and mortality, and may be the most common cause of sudden cardiac death (SCD) in the young.

PURPOSE - To characterize detailed family history, symptoms, hospital utilization and ECG-changes before SCD due to HCM.

METHODS - Cases were identified using the SUDDY.se cohort database, a nationwide comprehensive cohort consisting of 903 individuals aged 0-35, who suffered from SCD, in Sweden 2000-2010. The database also includes five population-based controls from Statistics Sweden, per case, together with parents of cases and controls (n = 15 633). Our database encompasses data from mandatory national registries together with the autopsy reports, medical records, ECGs (also military conscript), and detailed family history from an interview-based questionnaire (relatives, post-mortem). All individuals with autopsy findings or clinical diagnosis pre-mortem consistent with HCM were included in the study.

RESULTS- HCM was the cause of death in 38 cases, (38/903, 4,2%); 31 male and 7 female, mean age 22 years. The majority of cases (27/38= 71%) presented with possible cardiac symptoms (Including chest pain (10/27 = 26,3%), syncope 22%, palpitations 37%), prior to death. A majority,69%, were attending hospital or outpatient care (vs 21% in controls) within 180 days prior to death. The majority of cases (68%) died during recreational activity (n = 14; 37%) or exercise/competitive sports (n = 12; 31%). In seven of the 12 sports-related cases, death occurred during competitive sports, with basketball being the most common sport (43%). Almost half of the cases had a known cardiac disorder prior to death (15/38, 39%), where HCM was diagnosed premortem in nine cases (9/38, 24%). In addition, we found that over half of the SCD-cases with HCM, presented with an abnormal ECG (n = 22; 58%) prior to death, 12 (55%) in the absence of symptoms. Half of the cases (n = 19) had a positive family history (1st-3rd generation) for heart disease.

CONCLUSION(S) - In this nation-wide study of SCD due to HCM, more than 2/3 of cases, had experienced cardiac symptoms prior death, and a high percentage was seeking hospital or outpatient care, in the last 6 months prior to death. A positive family history for cardiac disease, as well as ECG-abnormalities, was seen in half of the cases, respectively. These findings demonstrate that clinical screening including ECG and family history is of great importance in identifying individuals at risk of SCD due to HCM. Such screening, as well as increased attention to possible cardiac symptoms in the young, should possibly be expanded beyond professional athletes to aid prevention of SCD in the young population with HCM.
The quality of life in patients with takotsubo syndrome in the remote period of disease
Authors: Leonova I , Evdokimov D , Boldueva S , Feoktistova V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

The quality of life in patients with takotsubo syndrome in the remote period of disease

Purpose of the study. To assess the quality of life and the severity of symptoms of heart failure (HF) in patients with takotsubo syndrome (TTS) in the long-term period of the disease.

Material and methods. 25 patients (women, mean age 57.5 ± 28.5 years) with TTS diagnosed based on InterTAK criteria were included in the study. The quality of life was assessed at the prehospital stage and one year after the acute episode using the following questionnaires: Minnesota CHF Quality of Life Questionnaire (MLHFQ), a scale for assessing the clinical state of a patient with heart failure, Health-related quality of life questionnaire (HeartQoL).

Results. When comparing the data of the MLHFQ questionnaire on the quality of life at the prehospital stage and one year after discharge, a significant decrease in the quality of life was revealed (before hospitalization - 19.6 ± 2.7 points, one year after - to 24.2 ± 2.8 (p < 0.01). According to the HeartQoL questionnaire, a significant decrease in the quality of life was also revealed: a year after the disease in comparison with the initial data (from 31.2 ± 1.4 points decreased to 29.4 ± 1.2) (p <0, 01). When comparing the results of assessing the clinical state before hospitalization, at the time of hospitalization and a year after discharge, an increase in the severity of CHF manifestations was noted (before hospitalization 1.2 ± 0.2; in the acute period - 6.5 ± 0.3; after year after discharge from the hospital - 3.8 ± 0.2) (p <0.01).

Conclusions. After a year of follow-up, patients with CT showed a decrease in the quality of life and an increase in the severity of symptoms of heart failure compared to the period before the acute episode.
Cardiopulmonary exercise testing in repaired tetralogy of Fallot: a valuable tool for pulmonary regurgitation severity assessment
Authors: Garcia Bras P , Sousa L , Mano T , Monteiro A , Rito T , Ilhao Moreira R , Rio P , Silva S , Martins C , Coito S , Capile E , Agapito A , Ferreira R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction and purpose

The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients.

Methods

A retrospective chart review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected.

Results

Cardiopulmonary exercise testing was performed in 54 adult repaired TOF patients (59% male), with a mean follow-up of 60 ± 33 months. The mean age was 34 ± 9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28 ± 7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%). 12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death.

Peak VO2 consumption (pVO2) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, 95% CI 0.879-1.036, p= 0.262) or PVR (HR 0.92, 95% CI 0.829-1.028, p = 0.914), while percent of predicted pVO2 significantly correlated with severity of pulmonary regurgitation (HR 0.95, 95% CI 0.918-0.993, p = 0.020) and PVR (HR 0.94, 95% CI 0.886-0.992, p = 0.025).

VE/VCO2 slope was not a significant predictor of severity of pulmonary regurgitation (HR 1.03, 95% CI 0.929-1.130, p = 0.622) or PVR (HR 1.04, 95% CI 0.952-1.128, p = 0.414) or) and neither cardiorespiratory optimal point (HR 0.94, 95% CI 0.786-1.120, p = 0.480) nor maximum end-tidal carbon dioxide pressure (PETCO2) (HR 0.93, 95% CI 0.846-1.037, p = 0.213) correlated with severity of pulmonary regurgitation or PVR.

Conclusion

Percent of predicted peak VO2 had the highest predictive power of all CPET parameters analysed in adult repaired TOF patients. Preoperative CPET could be an accessible way to identify high-risk patients earlier for PVR and should therefore be included in the routine assessment of these patients.
Association between red blood cell transfusions and adverse effects after transcatheter aortic valve replacement- a meta analysis
Authors: Abdul Razzack A , Pothuru S , Mandava S , Adeel Hassan S , Theja Reddy K , Missael Rocha Castellanos D , Arshad J , Sattar Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging.

Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI).

Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p < 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p < 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p < 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0)

Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution

Abstract Figure.
A systematic review and meta-analysis of the role of statins and their intensity in peripheral artery disease
Authors: Sagris M , Katsaros J , Giannopoulos S , Kokkinidis DG
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Peripheral artery disease (PAD) affects more than eight million Americans. However, several studies have shown that those patients are often undertreated, and that statin utilization is suboptimal.  American Heart Association guidelines highlight statins as the first-line lipid-lowering therapy to treat patients with PAD. Our objective with this meta-analysis was to further explore the impact of statins on PAD outcomes and examine whether the actual statin (high vs low intensity) dose impacts outcomes.

Methods

We performed a systematic review and meta-analysis according to the PRISMA guidelines. Any study that presented a comparison of statins vs no statins for PAD patients or compared high vs low intensity statins and provided outcomes with hazard ratio was considered as potentially eligible. The Medline (PubMed) database was searched up to August 30, 2020. A random effects meta-analysis was performed.

Results

In total, 38 studies and 275,670 patients were included in this meta-analysis. In total, 136,025 (49.34%) were on statins vs 139,645 (50.66%) who were not on statins. Statins had an association with a reduction in all cause-mortality by 42% (HR:0.58, 95% CI: 0.49-0.67, I2= 96.26%) and cardiovascular death by 43% (HR:0.57, 95% CI: 0.40-0.74, I2= 80.39%). Statins use was associated with an increase in amputation-free survival by 56% (HR:0.44, 95% CI: 0.30-0.58, I2 = 15%). The risk of amputation and loss of patency was reduced by 35% (HR:0.65, 95% CI:0.41-0.89, I2 = 86.91%), 46% (HR:0.54, 95% CI: 0.34-0.74, Ι2 = 0%), respectively. Statins use was also associated with a reduction in the risk of major adverse cardiovascular events (MACE) by 35% (HR:0.65, 95% CI: 0.51-0.80, I2= 93.22%) and the incidence of myocardial infarction (MI) by 41% (HR:0.59, 95% CI: 0.33-0.86, I2 = 76.78%). Among patients treated with statins, high-intensity treatment group was associated with a reduction in all cause-mortality by 36% (HR:0.64, 95% CI: 0.54-0.74, I2 = 96.49%) compared to patients treated with low intensity statins.

Conclusion

Statin treatment among patients with PAD was associated with a statistically significant reduction in all-cause mortality, cardiovascular mortality, MI, MACE, risk for amputation or loss of patency. Statins were also associated with a higher amputation free survival.
24-hour blood pressure monitoring in hypertensive patients with abdominal obesity in the dynamics of antihypertensive treatment
Authors: Penkova MARINA , Koval SERGEY , Mysnychenko OLGA , Starchenko T , Rieznik L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

24-hour blood pressure monitoring (ABPM) is an additional method for examining patients with arterial hypertension (AH). The list of indications for its implementation is constantly expanding. One of the most important indications is the evaluation of the effectiveness of treatment against the background of physical and emotional stress.

Aim

study of the parameters of 24-hour blood pressure monitoring in patients with AH and AO in the dynamics of antihypertensive therapy.

Methods

120 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: ACE inhibitors perindopril, thiazide diuretic indapamide and calcium antagonist amlodipine once in the morning at doses: 4 mg / 1.25 / 5 mg; 4 mg / 1.25 / 10 mg; 8 mg / 2.5 / 5 mg; 8 mg / 2.5 / 10 mg. ABPM was performed according to the standard method before and after 6 months of treatment.

Results

24-hour systolic blood pressure (SBP) and 24-diastolic blood pressure (DBP) in patients were 148 (141-158) / 97 (81-101) mm Hg. 24-hour pulse blood pressure - 59 (51-63) mm Hg. The SBP time index was 86 (67-96)%, the DBP time index was 84%. Daytime SBP variability in patients was 17 (11-20) mm Hg, daytime DBP variability was 13 (8-14) mm Hg. SBP variability at night was 14 (9-13) mm Hg, DBP variability at night was 10 (8-12) mm Hg. As a result of treatment, the target blood pressure level was achieved in 69% of the examined according to the data of the office measurement of blood pressure and in 50% of the patients according to the results of ABPM. The number of patients with pathological variability of blood pressure decreased from 47% to 25% (p <0.05). An excessive morning rise in SBP at the beginning of the study was noted in 30% of patients, and at the end of the observation - in 15% (p <0.05). Morning BP dynamics was in 43%, and after therapy in 23% (p <0.01). The number of patients with nocturnal hypertension decreased from 75% to 35% after 6 months of treatment (p <0.0001). The distribution of patients by blood pressure profiles revealed that at the beginning of the study, the "diper" type was in 44% of the patients, the "over-diper" type in 22% of the patients, the "non-diper" type was in 28%, and the "night-picker" type was observed at 6%. After 6 months of treatment, the number of patients with the "diper" profile increased to 73%, and the number of patients with the "over-diper" profile decreased to 7%, the number of patients with unfavorable non-diper and night-picker profiles changed to 5% and 1% of patients, respectively.

Conclusion

The fixed combination of perindopril, indopamide and amlodipine led to the normalization of all parameters of the 24-hour BP profile in hypertensive patients with AO. Treatment was not accompanied by metabolic disturbances in these patients.
Impact of air pollution on mortality due to cerebrovascular diseases
Authors: Kuzma L , Dabrowski EJ , Kurasz A , Swieczkowski M , Bachorzewska-Gajewska H , Dobrzycki S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The short-term effect of air pollution on cardiovascular mortality is well-documented but a scarce number of studies focus on cause-specific mortality in low-polluted areas.

Purpose

We decided to distinguish deaths due to cerebrovascular disease (CbVD) from a region widely known as the Green Lungs of Poland to assess the short-term effect of air pollution on CbVD mortality.

Methods

The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR) of air pollution.

Results

In the overall analysis of the studied region PM2.5 had an impact on increased CbVD mortality at LAG 0 (OR 1.046, 95% CI 1.013 – 1.080, P = 0.006), LAG 0-1 (1.048, 1.002-1.082, P = 0.040), and LAG 0-3 (1.052, 1.015-1.090, P = 0.006). The influence of PM10 was noted at LAG 0 (1.041, 1.002-1.082, P = 0.040). CbVD mortality in Bialystok was increased by exposure to PM10 at LAG 0 (1.05, 1.00-1.09, P = 0.048) and CO at LAG 1 (1.07, 1.00-1.14, P = 0.04). Additionally, an effect of CO was observed in cold season at LAG 1 (1.09, 1.02-1.17, P = 0.02), LAG 0-1 (1.08, 1.00-1.016, P = 0.04), and LAG 0-3 (1.09, 1.01-1.18, P = 0.04). In Suwalki, an impact of PM2.5 was also observed.

Conclusions

A short-term increase in air pollutants concentrations, especially in PM2.5 and CO, had an influence on CbVD mortality. Mortality rates were significantly increased in cold season. We also found heterogeneity in the influence of major contributors on mortality between analyzed cities.
Body composition, lipid profile and mediterranean diet adherence in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 pandemic
Authors: Linan Pinto M , Pinto R , Charneca S , Vasques J , Lemos Pires M , Borges M , Rodrigues C , Alves Da Silva P , Ricardo I , Santa-Clara H , Abreu A , Pinto FJ , Sousa Guerreiro C
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Cardiovascular disease (CVD) is recognized as a major public health issue and remains the leading cause of mortality worldwide. There is a clear association between adiposity, blood lipid profile, and adherence to the Mediterranean diet (MD) with the risk of CVD. However, the assessment of body composition parameters, dietary patterns and nutritional intervention in CVD patients undergoing a cardiovascular rehabilitation (CR) program remains insufficient. 

Purpose

 to characterize body composition, lipid profile and MD adherence in patients with CVD who were attending an exercise-based CR program during COVID-19 era. 

Methods

 The study was developed between October 2020 and January 2021 in a phase III centre-based CR program. Body composition was assessed by dual energy x-ray absorptiometry Hologic Explorer-W. Adherence to the MD was assessed by the 14-item MD questionnaire. Fasting blood sample was taken for measurement of lipid profile. 

Results

 A sample of 41 patients (mean age 64.4 ± 7.9 years, 87.8% male) was evaluated. The most prevalent CVD were coronary artery disease (89.5%) and heart failure (21.1%). The main CVD risk factors at admission in the CR program were dyslipidaemia (71.1%), hypertension (68.4%), physical inactivity (26.3%) and diabetes mellitus (21.0%). In our sample the mean body mass index was 28 ± 3.8 kg/m2, being most patients overweight (75.6%), and having a substantially increased risk of metabolic complications (85.3%) accordingly to waist-hip ratio. Body composition assessment showed that 14.6% of the patients had a body fat mass index above 90th percentile. Although only 9.8% of the patients had reduced fat free mass, 17.1% showed appendicular lean mass below the reference value. In addition, less than one third of the patients (31.7%) revealed a high adherence to the MD pattern. A sub-analysis on blood lipids (n = 26) showed that most patients had levels of LDL cholesterol (76.9%) and non-HDL cholesterol (65.4%) above the therapeutic target and 15.4% had triglycerides higher than 150 mg/dl. 

Conclusion

 Body composition, lipid profile and dietary patterns, play a major role in CVD secondary prevention. Our findings showed that a substantial number of CVD patients, in COVID-19 era, did not have optimal body composition, were above lipid profile targets, and had a low/medium adherence to the MD. Thus, this study highlights the relevance of nutrition on cardiometabolic status and demonstrates the crucial role of nutritional intervention as an integrated part of a long-term phase III CR program. Moreover, further research about nutritional intervention in patients undergoing CR is warranted.
High-intensity interval vs moderate-intensity continuous exercise in heated water-based on acute hemodynamic, vascular, and cardiac autonomic responses in older individuals with hypertension
Authors: Roque Marcal I , Amaral VT , Fernandes B , Abreu RM , Guimaraes GV , Ciolac EG
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP #2017/25648-4 #2018/09695-5) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES – Finance Code 001).

OnBehalf

Exercise and Chronic Disease Research Laboratory (ECDR)

Introduction

Post-exercise hypotension is an important tool in the treatment and control of hypertension. In recent years, high-intensity interval exercise (HIIE) has gained significant popularity in exercise-based prevention and rehabilitation of clinical populations. However, to date, it is not clarifying the acute responses of exercise performed in heated water-based in older individuals with hypertension.

Purpose

To assess hemodynamic, vascular, and cardiac autonomic responses to heated water-based HIIE versus moderate-intensity continuous exercise (MICE) in older individuals with hypertension.

Methods

Twenty older individuals (67 ± 7 y) under treatment for hypertension were randomly assigned to perform HIIE (25 min), MICE (30 min) and control (CON; 30 min) sessions in a heated swimming pool (30-32ºC). Blood pressure (BP), arterial stiffness, endothelial reactivity, and heart rate variability (HRV) were measured before (PRE), immediately after (POST), and after 45 min (REC). 24-h ambulatory BP monitoring and ambulatory HRV were also performed after each intervention. HRV were analyzed in ms² (ms²) or normalized units (nu) and then converted into natural logarithms (ln). Time domain markers as mean of intervals R-R (µi-RR), and frequency domain such as high frequency band (HF) and low frequency band (LF).

Results

Systolic BP increased at POST (p < 0.05) in all interventions, with higher increases in CON (29 ± 3 mmHg) and MICE (19 ± 3 mmHg) than HIIE (9 ± 4 mmHg). Although systolic BP reduced at REC in all interventions, it returned to levels similar to PRE in HIIE, and continue at higher levels than PRE in MICE and CON. HIIE promoted a higher response on markers of parasympathetic modulation at REC compared to MICE (HFln,nu 0.14 ± 0.06, p = 0.02) and CON (µi-RR: 0.02 ± 0.01, p = 0.05). By contrast, during night-time, HIIE demonstrated a lower parasympathetic modulation than CON (HFln,nu: -0.06 ± 0.03, p = 0.05). In addition, CON showed a higher HRV during 24-h compared to HIIE and MICE.

Conclusion

Despite differences between interventions in BP and cardiac autonomic responses, heated water-based HIIE or MICE were not effective to improve hemodynamic and vascular responses. These results may have important implications in the management of older individuals with hypertension in heated water-based.
Arterial stiffness and age moderate the association between physical activity and global cognition in the older adults
Authors: Noriega De La Colina A , Badji A , Lamarre-Cliche M , Bherer L , Girouard H , Kaushal N
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Merck Sharp & Dohme Corp Program of the Faculty of Medicine of the Université de Montréal The Canadian Institutes of Health Research (CIHR)

Background

The growing concern on the impact of higher arterial stiffness on cognitive decline in older adults, leads to the question of whether non-pharmacological interventions like physical activity should be introduced to correct or diminish the progression of arterial stiffness.

Purpose

The goal of this study is to elaborate a model for arterial stiffness as a moderator for the physical activity and global cognition relationship in function of age. 

Methods

One hundred ten healthy older adults aged 60 to 75 years old (46 men and 64 women) were examined for arterial stiffness (carotid-femoral Pulse Wave Velocity (cf-PWV)), global cognition (Montreal Cognitive Assessment and Mini Mental State Examination) and self-reported physical activity (PACED diary). The double moderation analysis used PROCESS macro for SPSS, where physical activity was included as the independent variable (X), global cognition as the dependent variable (Y), arterial stiffness as moderator 1 (W), and age moderator 2 (Z). This study used a cf-PWV cutoff of 8.5 m/s to identify micro-structural damage in the brain related to arterial stiffness.

Results

Results found that the arterial stiffness x age interaction moderated the effect of physical activity on global cognition (β = -.89, SE = .42, p = .037) (Model: R2 = .15, p = .018). Physical activity had a positive effect on cognition in younger-older adults (aged 60 to 68.5 years) with high arterial stiffness i.e. cf-PWV > 8.5 m/s (β = .57, SE = .222, p = .011, 95% CI .133 to 1.014), and in older-older adults (aged 68.6 to 75 years) with low arterial stiffness i.e. cf-PWV < 8.5 m/s (β = .49, SE = .190, p = .010, 95% CI = .116 to .869). 

Conclusions

These results support targeted physical activity interventions based on age and degree of arterial stiffness, furthering the notion that even daily life physical activity could play an important role in older adults’ cognitive performances.

Physical activity on global cognition Conditional effects of physical activity on global cognition Moderators cf-PWV Age Effect SE p CI < 8.5 m/s < 68.5 years .171 .245 .487 -.315 to .657 < 8.5 m/s > = 68.5 years .574 .222 .011* .133 to 1.014 > = 8.5 m/s < 68.5 years .492 .190 .010* .116 to .868 > = 8.5 m/s > = 68.5 years .002 .180 .990 -.355 to .359 Physical activity conditional effects on global cognition at determined values of arterial stiffness and age. SE: Standard Error, CI: Confidence Interval, cf-PWV: carotid-femoral Pulse Wave Velocity, *p-value<.05.
Assessment of the quality of life in the treatment approaches of patients with the comorbid course of arterial hypertension and metabolic disorders aimed at reducing cardiovascular risk
Authors: Zlatkina V , Shkapo V , Nesen A , Starchenko T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Cardiovascular diseases (CVD) remain the leading cause of premature death worldwide. According to epidemiological studies CVD prevention is highly effective. A 50% reduction in mortality from coronary artery disease (CAD) is associated with exposure to risk factors and only 40% with improved treatment.

Purpose.  To assess the quality of life (QOL) in patients with arterial hypertension (AH) and metabolic disorders, to establish its impact on therapy effectiveness. We examined 280 patients with AH and comorbidity - 171 women and 109 men aged 45-75 years. Along with AH, all patients had comorbidities: 72.6 % suffered from coronary artery disease (CAD), 10.5% after myocardial infarction (MI), 35 % had clinical signs of heart failure (HF), 22, 1% - type 2 diabetes mellitus (t2DM), 27.4% - chronic kidney disease (CKD).

Methods. Anthropometry, blood pressure (BP) measurement, immunoassay (C-reactive protein), biochemical blood analysis (lipid, carbohydrate metabolism parameters, QOL determination (questionnaire Sf-36).

Results. In patients with comorbidity of pathologies (presence of AH, t2DM, CKD, CAD, obesity), there was a decrease in assessments in almost all indicators of QOL, and especially significant limitations in the performance of daily activities due to both physical and mental state.

Conclusion. The degree of AH in patients with t2DM decreased QOL of physical activity, role-physical functioning, pain and general health, reflecting physical health, as well as mental health, including vitality, social activity, role emotional functioning. T2DM in patients with AH significantly worsens QOL of this category of patients as in physical component summary and mental component summary. The indicators of QOL are significantly affected by the duration of t2DM, as well as the degree of compensation. Achievement of the target BP levels in patients with AH with t2DM shows an improvement in a number of QOL parameters and makes it possible to recommend the Sf-36 questionnaire as a criterion for the effectiveness of the therapy.
Hypertensive response in exercise - a tool to predict stroke risk?
Authors: Graca Rodrigues TE , Cunha N , Silverio-Antonio P , Couto Pereira P , Valente Silva B , Alves Da Silva P , Brito J , David C , Pinto FJ , Almeida AG
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

There is some evidence suggesting that exaggerated hypertensive response to exercise (HRE) may be associated with higher risk of future cardiovascular events, however the relationship between systolic blood pressure (SPB) during exercise test and stroke is not fully understood.

Purpose

To evaluate the ability to predict the risk of stroke in patients with HRE in exercise test.

Methods

Single-center retrospective study of consecutive patients submitted to exercise test from 2012 to 2015 with HRE to stress test. HRE was defined as a peak systolic blood pressure (PSBP) > 210 mmHg in men and > 190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure > 90 mmHg or a rise of 10 mmHg. Patient’s demographics, baseline clinical characteristics, vital signs during the stress test and the occurrence of stroke during follow-up were analysed

Results

We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%), dyslipidaemia (61%), previously known coronary disease (32%), diabetes (28%) and smoking (38%). Atrial fibrillation was present in 5.9% of patients.

During a mean follow-up of 60 ± 2 months, the incidence of stroke was 2.1% (n = 8), all with ischemic origin. Considering the parameters analysed on exercise test, only PSBP demonstrated to be an independent predictor of stroke (HR 1.042, CI95% 1.002-1.084, p = 0.039,) with moderate ability to predict stroke (AUC 0.735, p = 0.0016) with a most discriminatory value of 203 mmHg (sensibility 56%, specify 67%). Regarding baseline characteristics, after age, sex and comorbidities adjustment, previously controlled hypertension was found to be an independent protective factor of stroke (OR 4.247, CI 95% 0.05-0.9, p = 0.036) and atrial fibrillation was an independent predictor of stroke occurrence (HR 8.1, CI95% 1.4-46.9, p = 0.018). Atrial fibrillation was also associated with hospitalization of cardiovascular cause and major cardiovascular events occurrence (mortality, coronary syndrome and stroke). Baseline SBP was associated with atrial fibrillation development (p = 0.008).

Conclusion

According to our results, PSBP during exercise test is an independent predictor of stroke occurrence and should be considered as a potencial additional tool to predict stroke occurrence, particularly in high risk patients. The identification of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs.
Improvement of cardiovascular risk prediction by longitudinal risk factor and competing risk data
Authors: Roman Degano I , Marrugat J , Elosua R , Subirana I
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Spanish Society of Cardiology

OnBehalf

REGICOR Study

Background

Cardiovascular risk assessment is the cornerstone of cardiovascular primary prevention. However, most of the recommended or regionally validated risk assessment tools are not updated.

Purpose

To analyze the effect of including longitudinal information of risk factors as well as competing risks for cardiovascular risk prediction.

Methods

Data from 10,152 general population individuals from North-Eastern Spain was included. Individuals were recruited in 1995-2000-2005 in three different cohorts of the REGICOR Study. Risk factor data was obtained at baseline and in 2 follow-up visits. Risk factor data included age, sex, education, lipid profile, blood pressure, glucose, smoking, body mass index, and treatment for hypercholesterolemia, hypertension and diabetes. Event data was obtained by cross linkage with healthcare and mortality databases. Cardiovascular events included myocardial infarction, angina and stroke. Cancer mortality and other mortality were included as competing risks. Four cox proportional hazards models developed to model time to coronary/cerebrovascular events with longitudinal or competing risk data. Interactions between age and risk factors were included. Discrimination was assessed with the area under the ROC curve (AUC) and Sommer’s D statistic, and compared with discrimination of Framingham-REGICOR function.

Results

The variable with the largest effect on coronary/cerebrovascular event incidence was diabetes treatment in the longitudinal models [Hazard ratio -HR- (95% confidence interval -CI-): 3.02 (2.00, 4.58)/2.58 (1.33, 5.00)] as well as in the competing risk models [HR (95% CI): 3.08 (2.09, 4.55)/2.77 (1.48, 5.18)]. In addition to currently used variables, medication for hypertension and diabetes, and interaction between age and diabetes medication were included in all models. Compared to the Framingham-REGICOR function, discrimination improved with the inclusion of longitudinal or competing risk data as shown in the Table.

Conclusion

Including longitudinal information of cardiovascular risk factors or competing risks improved discrimination of a regionally validated cardiovascular risk function. The availability of these data in healthcare databases would allow its use in primary care cardiovascular risk assessment.

Discrimination analysis Models AUC (95% CI) developed models AUC (95% CI) Framingham-REGICORfunction p-value Competing risks - coronary events 0.80 (0.77-0.82) 0.74 (0.71-0.77) < 0.001 Competing risks - cerebrovascular events 0.78 (0.74-0.82) 0.68 (0.63-0.72) < 0.001 Longitudinal data - coronary events 0.79 (0.78-0.81) 0.76 (0.74-0.78) < 0.001 Longitudinal data - cerebrovascular events 0.80 (0.78-0.83) 0.71 (0.69-0.74) < 0.001