bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of sodium-glucose contrasporter-2 inhibitors and glucagon-like peptide-1 receptor agonists on arterial stiffness, coronary flow reserve and liver steatosis in diabetes
Authors: Ikonomidis I , Michalopoulou E , Pavlidis G , Prentza V , Katogiannis K , Kostelli G , Katsanaki E , Vlachomitros D , Kountouri A , Korakas E , Pliouta L , Thymis J , Lambadiari V
Published: October 2024

Background

Patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) present an increased risk of cardiovascular disease. Sodium-glucose contrasporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have been shown to significantly decrease the risk of cardiovascular complications.

Purpose

The aim of the study was to investigate the effect of treatment with SGLT-2i or GLP-1RA on cardiovascular function and liver steatosis and fibrosis in patients with T2DM and NAFLD.

Methods

Forty patients with T2DM and NAFLD (mean age: 58 ± 11 years) were randomized to receive SGLT-2i (dapagliflozin; n = 20) or GLP-1RA (dulaglutide; n = 20). At baseline and after 6 and 12 months of treatment, we measured: (1) perfused boundary region (PBR) of the sublingual microvessels with a diameter 5-25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates reduced glycocalyx thickness. (2) Pulse wave velocity (PWV) using Complior (ALAM Medical), (3) coronary flow reserve (CFR) using Doppler echocardiography, (4) LV global longitudinal strain (GLS) using speckle-tracking echocardiography, (5) controlled attenuation parameter (CAP) score to assess steatosis grade and liver stiffness (E) to evaluate fibrosis score using liver elastography (FibroScan, Echosens), and (6) NAFLD fibrosis score (NFS).

Results

At baseline, patients between the two groups had similar age, sex, HbA1c, steatosis grade, fibrosis score and markers of cardiovascular function (p > 0.05). Compared with baseline, all patients had reduced PBR, PWV, CAP, E and NFS and increased CFR and GLS (p < 0.01) after 12-month treatment. In the whole study population, the percentage reduction of CAP and NFS was correlated with the corresponding decrease of PBR (r = 0.248 and r = 0.387), PWV (r = 0.290 and r = 0.281) and with the increase of GLS (r = -0.320 and r = -0.295) after 12-month treatment (p < 0.05 for all correlations). Both treatments with SGLT-2i and GLP-1RA reduced markers of liver steatosis and fibrosis (Table).

Conclusion

Both treatments with SGLT-2i and GLP-1RA improve cardiovascular function and reduce liver steatosis in patients with T2DM and NAFLD after 12 months.
Age and sex differences in the effects of short- and long-term exposure to air pollution on endothelial dysfunction
Authors: Zhang H , Li J
Published: October 2024

Background

Endothelial dysfunction is an integrated index of risk factor burden and a marker of atherosclerotic cardiovascular disease. Air pollution is widely acknowledged as a significant non-traditional risk factor for cardiovascular disease. However, the impact of air pollutants at varying concentrations and exposure durations on endothelial function in different populations remains unclear.

Purpose

We aimed to use brachial artery flow-mediated dilatation (FMD) to identify demographic differences in the effects of short- and long-term exposure to air pollution on endothelial dysfunction.

Methods

We measured FMD in 850 participants from October 2016 to January 2020. Location-specific concentrations of fine particulate matter <2.5 μm aerodynamic diameter (PM2.5), inhalable particulate matter <10 μm aerodynamic diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) measured by fixed ambient air monitoring stations were collected for short- and long-term exposure assessment. We used the moving average 7- and 14-day exposures before the date of FMD measurements to estimate the short-term exposure effects and the moving average 12-month exposures before the date of FMD measurements to estimate the long-term exposure effects. Multiple linear regression models and restricted cubic splines were used to assess the associations before and after stratified by age and sex.

Results

This study eventually included 828 participants [551 (66.5%) younger than 65 years and 553 (66.8%) men]. Each 10 μg/m³ increase in 12-month exposure to PM10 and NO2 was significantly and linearly associated with -0.20% (95% CI: -0.37 to -0.03) and -0.58% (95% CI: -0.99 to -0.18) changes in FMD in all participants. 12-month exposure to gaseous pollutants was also significantly but nonlinearly associated with lower FMD. 7-day exposure to Quartile 4 of SO2 was significantly associated with a 0.70% decrease in FMD compared to Quartile 1 (β = -0.70, 95% CI: -1.40 to -0.008). No relationships were observed between 7- and 14-day exposure to PM2.5, PM10, NO2, CO, and endothelial dysfunction. Although interaction effects were limited to SO2 and sex, significant associations with different air pollutants were only found in men and those younger than 65 years after stratified.

Conclusions

Long-term exposure to air pollution is strongly associated with decreased endothelial function, and susceptibility to air pollution varies significantly with age and sex. Further identification of different susceptible populations and proactive measures to mitigate air pollution may be beneficial in reducing the burden of cardiovascular disease.
Evidence that mitral and/or tricuspid regurgitation diminishes stroke volume increase during exercise
Authors: Kubota M , Adachi H , Hoshino K , Naito S
Published: October 2024

Background and Purpose

The severity of heart failure can be evaluated by peak oxygen consumption (VO2). Cardiac output is one of the major essential factors to determine the VO2. Therefore, cardiac output increases linearly as the exercise intensity increases. However, in mitral regurgitation, effective stroke volume decreases due to some blood flowing back into the left atrium from the left ventricle. This reduction may compromise oxygen delivery to working muscles and diminish oxygen uptake.

Peak VO2/HR is known to indicate the stroke volume at the peak exercise, but since c(A-V)O2 difference shows almost a similar change pattern during a ramp protocol, VO2/HR during the load is also reported to be an indicator of stroke volume (SV) at that work rate. However, there are no investigations that have examined the extent to which the increase in cardiac output during stress is affected by the severity of mitral regurgitation. Therefore, we investigated the influence of the degree of regurgitant volume in mitral regurgitation (MR) and tricuspid regurgitation (TR) affects the SV increasing response to exercise load. Additionally, we examined whether blunted SV increase influences on the peak VO2.

Methods

Among 525 patients who underwent cardiopulmonary exercise test (CPX) at our institution from January 2023 to October 2023, 518 patients (143 females, 375 males, mean age 65.2±15.0 years old) where precise analyses of CPX was possible. CPX was performed using breath-by-breath gas analysis, and an incremental load test (10watts/min) was administered until exhaustion. The rate of increase in VO2/HR per watt during an incremental loading (Δ(VO2/HR)/ΔWR) was used as an indicator of the degree of increase in SV. Typically, SV increases up to 60% of maximum load, around AT, after which it stops increasing and plateaus. Therefore, the slope of Δ(VO2/HR)/ΔWR was examined from the initiation of ramp loading to AT. The degree of reflux was evaluated by echocardiography and classified as none/trivial, mild and moderate/severe. The number of people in each group of None/trivial, mild, moderate/severe was, 392, 83, 30 for MR, and 416, 64, 24 for TR. Δ(VO2/HR)/ΔWR was evaluated for each degree of reflux, using ANOVA to determine whether there was a difference between groups.

Results

As shown in the Figure1, Δ(VO2/HR)/ΔWR decreased as the reflux flow rate increased for both MR and TR. Concurrently, peak VO2 also decreased in the moderate/severe group compared to the non/trivial-reflux group for both MR and TR (MR: 17.5±5.4 mL/min/kg vs. 14.9±3.5 mL/min/kg, TR: 17.2±5.3 mL/min/kg vs. 13.6±3.8 mL/min/kg).

Conclusion

The Δ(VO2/HR)/ΔWR obtained through CPX has been shown to be an index that can evaluate the severity of reflux. Additionally, it was also demonstrated that as regurgitation flow increased, true stroke volume decreases, which is correlated with a reduction in peak VO2.
The utility of cardiac rehabilitation in improving endothelium-dependent vascular function in very elderly patients
Authors: Matsuzawa Y , Someya R , Nakahashi H , Konishi M , Akiyama E , Tsujita K , Hibi K
Published: October 2024

Background

Endothelial function is crucial for cardiovascular health and diseases. Cardiac rehabilitation has been reported to be useful in enhancing physical performance, quality of life, and endothelial function. The aging of patients with cardiovascular diseases is further progressing, and it is unclear whether cardiac rehabilitation improves physical function and endothelial function in very elderly patients with cardiovascular diseases.

Purpose

The purpose of this study is to investigate whether outpatient cardiac rehabilitation for individuals aged 80 and above improves physical function, quality of life (QOL), and vascular endothelial function.

Methods

Forty nine patients aged over 80 years with cardiovascular diseases participated in an outpatient cardiac rehabilitation program. Cardiac rehabilitation was conducted for 1 hour per session, 1-2 times per week for 3-4 months. Cardiopulmonary exercise testing (CPX) was conducted for the evaluation of physical function. QOL was assessed with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. The reactive hyperemia index (RHI) was measured using EndoPAT2000 in each patient to assess endothelial function. An RHI ≤ 1.67 was defined as endothelial dysfunction.

Results

The mean ± standard deviation of age was 84 ± 4 years, with 16 (33%) being male. Peak oxygen uptake improved significantly (from 14.1 ± 4.0 to 15.4 ± 3.9 mL/kg/min, P=0.002), as did short physical performance battery scores (from 10.1 ± 2.7 to 10.7 ± 2.0, P=0.004), mini-mental state examination scores (from 27.7 ± 2.2 to 28.2 ± 2.0, P=0.004), Japanese version of the Cardiovascular Health Study criteria (from 2.3 ± 1.3 to 1.5 ± 1.2, P<0.0001), and KCCQ scores (from 76.8 ± 18.4 to 81.4 ± 20.4, P=0.02) after the cardiac rehabilitation program. Endothelial function also improved (LogRHI 0.48 ± 0.39 to 0.57 ± 0.30, P=0.027), and the prevalence of endothelial dysfunction decreased from 54% to 36% after the cardiac rehabilitation program.

Conclusion

Even in the very elderly patients, outpatient cardiac rehabilitation is beneficial for improving physical function, quality of life, and endothelial function.
A regional multicentre prospective survey addressing sport-related myocardial infarction: clinical characteristics of 155 patients and one year follow-up
Authors: Kouame I M , Chague F , Maza M , Bichat F , Braghini N , Saint-Jalmes M , Vincent Martin M , Lhuillier I , Porot G , Molins G , Mock L , Ravisy J , Cottin Y , Zeller M
Published: October 2024

Background

Exercise is a keystone of cardiovascular prevention; however, it is also a powerful trigger of acute cardiovascular events including sudden cardiac arrest and acute myocardial infarction. Contemporary studies addressing these sport-related myocardial infarction (SR-MI) are scarce.

Aim

To describe clinical characteristics and follow-up of SR-MI.

Methods

We conducted a regional multicentric prospective survey addressing patients admitted for a SR-MI in 2 intensive coronary units. SR-MI was defined as MI onset occurring during sport or within the 1st hour of recovery. A one-year follow-up was performed by phone call.

Results

From April 1st 2018 to February 23th 2023, 155 SRMI were included, of whom 13 (8.4%) were female, median age was 61-y. (IQR 54-66). Cycling was the most frequent sport (32.5%) followed by fitness and hiking (12.6% each) then jogging (11.3%) (Figure). Most were ST elevation MI (68.8%). The main risk factors were dyslipidaemia (33.8%), hypertension (27.3%) and tobacco smoking (24.5%). No cardiovascular risk factor other than age was identified in 38 patients (25.7%). Prodromal symptoms were reported by 66 subjects (42.6%). SR-MI occurred mostly during exercise (60.6%). Out of hospital cardiac arrest (OHCA) occurred in 20 (12.6%) patients, more commonly among patients with prior coronary artery disease (CAD) (p = 0.02) and tobacco smoking (p=0.047). A significant single vessel disease was observed in 67 patients (43.2%); revascularization was performed by stenting in 134 patients (86.5%) and surgery in 11 (7.1%). In-hospital death occurred in 4 patients and was associated to OHCA (p=0.007). Among the survivors at time of discharge (151 patients), 141 were eligible to follow-up, none one lost: one patient died suddenly at home, one suffered from a recurrent MI, one experienced a cardioversion from his implantable cardioverter defibrillator (ICD) and an ICD was implanted in 4 others. A cardiovascular rehabilitation was performed in 101 patients (65.2%); from the 30 smokers at the time of SRMI, 26 declared smoking cessation.

Conclusions

Among patients admitted for a SR-MI, most were male. Prodromal symptoms were common but neglected. OHCA occurred in 1 patient out of 8 and was associated with history of CAD, tobacco smoking and in-hospital death. Such findings highlight the need for mass education to prevention including recognition of prodromal symptoms and management of cardiac arrest. In this exercising population, rehabilitation rate was high and quitting tobacco was commonly achieved.Table
Structural echocardiographic parameters in male and female Asian athletes: a systematic review and meta-analysis
Authors: Hon J J , Paik B , Welsh J , Ling R R , Ng J J , Choong A M T L , Yeo T J
Published: October 2024

Introduction

Following repetitive structured and intense physical training, elite athletes’ hearts undergo physiological cardiac remodelling, including increased left ventricular (LV) size and LV wall thickness. These changes may mimic those seen in pathological cardiac conditions such as dilated and hypertrophic cardiomyopathy, posing a challenge for accurate diagnosis. Reference ranges for common echocardiographic parameters in elite Caucasian and Black athletes have been reported, facilitating differentiation between physiological and pathological changes in these demographics. However, there remains a paucity of data for Asian athletes despite their increasing representation in global sport.

Methods

We searched MEDLINE via PubMed, Embase, and the Cochrane Database for relevant studies from inception till 20th November 2023. We included observational studies that reported relevant echocardiographic parameters in elite Asian athletes. Studies that did not report gender-specific cardiac imaging parameters were excluded. After study selection and data extraction, random-effects meta-analysis of means was performed to obtain the weighted mean and 95% confidence intervals (CI) of common echocardiographic parameters stratified by gender.

Results

Our final search yielded 10 studies comprising a total of 1,111 elite athletes (996 male, 115 female; 53% Japanese, 21% uncategorised, 14% South-East Asian). Athletes participating in skill and power disciplines were excluded from analysis post-hoc due to a paucity of data and extreme data ranges.

In male athletes, mean LV wall thickness was 9.4 mm (95% CI 8.5-10.3, I2 = 98.9%), mean LV end diastolic diameter was 54.7 mm (95% CI 52.5-57.0, I2 = 98.6%), mean LV mass indexed to body surface area was 97.5 g/m2 (95% CI 90.5-104.5, I2 = 97.5%) and mean aortic root diameter was 31.9 mm (95% CI 29.2-34.7, I2 = 99.5%).

In female athletes, mean LV wall thickness was 7.9 mm (95% CI 7.5-8.4, I2 = 85.4%), mean LV end diastolic diameter was 47.1 mm (95% CI 45.8-48.3, I2 = 77.3%), mean LV mass indexed to body surface area was 79.5 g/m2 (95% CI 69.2-89.7, I2 = 92.8%) and mean aortic root diameter was 27.5 mm (95% CI 26.9-28.1).

Conclusion

This meta-analysis describes commonly reported echocardiographic parameters in elite Asian athletes from endurance and mixed sport disciplines. The absolute values of all reported parameters appear to fall far below reported limits for non-Asian athletes, highlighting substantial ethnic and regional variation in cardiac remodelling in elite athletes. While our results facilitate preliminary referencing of expected normal ranges in this demographic group, further studies are necessary to fully define the cardiac characteristics of Asian athletes.
Cardiac troponin fragmentation in marathon runners. The MaraCat2 study
Authors: Paana T , Hellman T , Vasankari T , Salonen S , Tuominen T , Teppo K , Jaakkola S , Heinonen O J , Wittfooth S , Airaksinen K E J
Published: October 2024

Background

Cardiac troponins(cTn) are in a key role in the diagnosis of acute myocardial infarction (MI). Minor cardiac troponin elevations are also common after strenuous exercise, while limited evidence suggests this elevation consists mostly of smaller cTn fragments.

Purpose

We aimed to determine if our novel cardiac troponin assay, measuring long molecular forms of cardiac troponin (long cTnT) can differentiate cardiac troponin elevation associated with strenuous exercise from that seen in MI.

Methods

In a Proof-of-Principle study, we developed a simple time-resolved immunofluorometric assay based on europium chelate labels for the measurement of long cardiac troponin T molecules, which showed high accuracy in discriminating between cTn elevations in MI and end-stage renal failure. In the present study, we compared the characteristics of cTn release after a marathon race and Type 1 MI using an improved version of the long troponin test and a commercially available cTnT test.

Troponin composition was analyzed in heparin plasma samples taken from 45 runners <1h after marathon race and from 45 patients with Type 1 MI. The concentration of long cTnT was measured with a novel immunofluorometric assay, total cTnT was measured with a commercial high-sensitivity cTnT assay, and the ratio of long to total cTnT (troponin ratio) was determined.

Results

Conventional cTnT exceeded the upper reference limit in 37 (82%) runners with a median concentration of 25.0 (IQR 16-36)ng/l. Median long cTnT concentration was 4.1 (IQR 2.4-5.8)ng/l. The median total and long cTnT concentration and the troponin ratio were higher in patients with MI than in marathon runners (p<0.001). Troponin ratio decreased (r=-0.497, p<0.001) in marathon runners and increased (r=0.466, p=0.001) in patients with MI with increasing troponin release (Figure 1). In the receiver operating characteristics curve analyses of all patients with cTnT release >14ng/l, long cTnT showed good predictive power with area under curve 0.969 (CI95% 0.939-1.000) in discriminating marathon runners from MI patients.

Conclusions

Our novel highly sensitive long cTnT immunoassay shows that the troponin release after strenuous exercise is composed mainly of smaller troponin fragments. Our test could be useful in separating benign cTnT elevations caused by exercise from those of acute MI.
Exploring the diagnostic yield of family screening and genetic testing in adolescent individuals with pre-clinical phenotypes
Authors: Abela M , Scerri J , Debattista J , Felice T , Grech V , Scerri C
Published: October 2024

Introduction

Family screening and genetic testing are key components in the management strategy of individuals diagnosed with an inherited cardiac condition (ICC). Disease penetrance for most ICCs, notably cardiomyopathies is age dependent, which is why a more permissive approach towards family screening is adopted in young individuals with a pre-clinical phenotype.

Study Objectives

The main objective of this study was to explore the role of family screening and genetic testing in adolescent subjects with a pre-clinical phenotype has not been formally explored.

Methodology

Adolescent probands with a pre-clinical phenotype following a national cardiac screening program (BEAT-IT) were offered genetic testing and family screening. Probands with anterior TWI were rescreened at 16 years. Only those with persistent changes were enrolled in the study. Genetic counselling was also offered to probands and relatives. Testing was initially offered to first degree relatives. Cascade testing (clinical and genetic) was also offered to other generations if a screened relative satisfied one or more of these conditions i) phenotype positive, ii) pre-clinical phenotype, iii) clinically relevant genotype.

Results

16 probands (mean age 15 years) were identified with a pre-clinical phenotype. All had an abnormal ECG (9=inferior/lateral TWI, 6=anterior TWI, 1=ST depression). A comprehensive evaluation was otherwise normal. Half were gene positive (G+), 4 had clinically relevant genotypes (n=4 inferior/lateral TWI). These were classified as likely pathogenic according to ACMG criteria (n=2 MYH7, n=1 ACTC1, n=1 MYBPC3).

71 family members were subsequently screened (59.2% female, median 43Y [IQR 27] at evaluation, 11.3% <18Y at evaluation, 67.6% first degree relatives).

A substantial proportion (n=13, 18.3%) were referred for further evaluation. Two (2/8, 25.0%) were <18Y. An abnormal ECG was the commonest reason for referral (n=9, 12.7%). Three (4.2%) were given a diagnosis (n=2 HCM [both MYH7}, n=1 DCM [ACTC1]). Seven (9.9%) were referred because of an abnormal ECG (n=3 inferolateral TWI, n=2 ventricular ectopics, n=1 anterolateral TWI, n=1 ST depression). Four were G+ and were offered surveillance.

Fourteen (19.7%) were offered family screening because of incorporating genetic testing into the study protocol. Genetics altered the evaluation strategy in 16.9% of screened relatives. More in-depth cascade testing identified 6 (8.5%) individuals who needed follow-up (n=1 diagnosis [DCM], n=1 abnormal ECG, n=4 G+). Gene negative individuals (6, 8.5%) were safely reassured and discharged.

Conclusion

Family screening in adolescent probands with pre-clinical phenotypes offers a reasonable diagnostic yield (4.2% diagnosis, 14.1% surveillance). Incorporating genetic testing into the evaluation protocol offers a more personalized strategy, altering management in a significant proportion of screened relatives (16.9%).
Holter monitoring in neuromuscular disorders: frequency and importance in clinical management
Authors: Fernandes S , Dias M , Conde I , Silva R , Ferreira C , Vilela F , Mane F , Mare R , Marques J , Rocha S
Published: October 2024

Introduction

Cardiac involvement is a common manifestation in a variety of neuromuscular disorders (NMD) and initial cardiac manifestations in these patients are often asymptomatic. Hence, regular 24h-Holter monitoring is recommended to identify conduction disturbances and rhythm disturbances.

Purpose

In this study, we aimed to assess abnormal findings in 24h-Holter monitoring to screen for conduction disturbances and arrhythmias in patients with NMD and evaluate its impact in patients’ treatment.

Methods

A retrospective single-centre study was conducted including all adult patients with NMD who received a 24h-Holter from January 2013 to September 2023.

Results

A total of 76 patients with NMD were included, 39 (51.3%) were male, and mean age was 46,3 ± 11,5 years. Most patients were asymptomatic. A total of 220 Holter recording was analysed. An average of 2,9 ± 1,6 Holter recordings per patient was performed. Abnormal Holter results were found in 47 (61,8%) patients, and mainly consisted of conduction disorders such as atrioventricular block in 31 (65,9%) patients. Other abnormalities included atrial fibrillation/flutter in 6 (12,8%) patients, supraventricular tachycardia in 4 (8,5%) patients, and non-sustained ventricular tachycardia in 6 (12,8) patients. Out of the group of the patients with abnormal Holter findings, ten patients had direct clinical treatment consequences, namely implantation of cardiac electronic devices or initiation of anticoagulation therapy.

Conclusion

In this study, holter findings resulted in relevant clinical treatment consequences in 10 out of 76 patients (13,2%). These results suggest that 24h-Holter monitoring may improve routine cardiac screening in patients with NMD.
Real-world effectiveness of primary care psychological therapy for depression and anxiety in patients with coronary heart disease
Authors: Suh J , El Baou C , John A , Stott J , Saunders R
Published: October 2024

Background

Depression and anxiety are often inadequately treated in patients with coronary heart disease (CHD), despite mental health issues being associated with poorer quality of life, higher cardiovascular morbidity, and higher mortality. Talking therapies, such as cognitive behavioural therapy, are the recommended first-line treatment for depression and anxiety symptoms in CHD patients. However, the evidence for their effectiveness was considered low in a recent Cochrane review, and trial participants may not represent patients treated in routine clinical settings.

Purpose

To assess the effectiveness of routinely-delivered talking therapies in patients with CHD from nationwide primary care talking therapy services in England, and to compare their treatment outcomes to patients without a CHD diagnosis.

Methods

Healthcare records from 1.9 million patients who completed a course of treatment (≥2 treatment sessions) via NHS Talking Therapies for anxiety and depression (NHS TTad) between 2012-2019 were linked to Hospital Episode Statistics, the Mental Health Services Data Set, and death records. Standard NHS TTad outcome indicators (recovery, reliable improvement, and reliable deterioration) were examined in three groups, with (1) any CHD (n=41,317; ICD-10=I20-I25), (2) acute coronary syndromes (ACS, n=29,991; I21, I22, I20.0), and (3) chronic CHD (n=40,524; I20.1-I20.9, I23-I25) at baseline. Effect sizes for pre-post treatment changes in depression and anxiety symptom measures (PHQ-9 and GAD-7) were calculated using the adapted Cohen’s d for within-subjects design (dav). Outcomes were also compared to those of propensity-score matched control groups without the relevant diagnoses, using logistic regression.

Results

After completing a course of talking therapy, 49.8% (95%CI=49.3;50.3) of patients with CHD recovered from depression or anxiety, 69.4% (95%CI=69.0;69.9) saw reliable improvement in symptoms, and 7.3% (95%CI=7.0;7.5) experienced reliable deterioration in symptoms. There were large reductions in both depression (dav=-1.02) and anxiety symptoms (dav=-1.03) on average. Compared to a control sample of patients with no diagnosis of CHD, those with a CHD diagnosis were less likely to recover (OR=0.87[95%CI=0.84;0.89]) or reliably improve (OR=0.84[95%CI=0.81;0.87]) and more likely to reliably deteriorate (OR=1.28[95%CI=1.21;1.36]), when matched on age, sex, ethnicity, deprivation, baseline depression and anxiety symptom scores, self-reported long-term health condition, and waiting times between referral, assessment, and treatment. The findings were consistent for patients with ACS and those with chronic CHD.

Conclusions

Nearly half of CHD patients who received primary care talking therapy recovered, in line with the UK Government target of 50% recovery for the services. Nevertheless, compared to otherwise similar patients without CHD, those with CHD at baseline had worse psychological treatment outcomes.
Clinical picture, outcomes and predictors of relapse in eosinophilia-associated coronary vasospasm: data from a European multicentric study
Authors: Huang F , Khellaf L R , Lefevre G , Berti A , D'humieres T , Sionis A , Ariza Sole A , Delvino P , Emmi G , Gilles F , Varenne O , Haziza F , Benamer H , Kahn J E , Groh M
Published: October 2024

Background and aims

Eosinophilia-associated coronary vasospasm is an under-recognized and scarcely reported life-threatening condition for whose management is undefined. Preliminary data suggest that eosinophil-targeted therapies could be beneficial. Our aim is to provide an in-depth report of the clinical picture, outcomes and predictors of relapse in patients with eosinophilia-associated coronary vasospasm.

Methods

European multicentric retrospective study, gathering twenty centers across France, Italy and Spain. Patients of 15 years or more with definite or suspected coronary vasospasm according to the 2017 International standardization of diagnostic criteria for vasospastic and concomitant (± 48 hours) eosinophilia (threshold: 0.5 x 109/L) were included in this study. Outcomes included vasospasm relapse and other major cardiovascular events (MACE) during follow-up. Predictors of relapse were assessed using bidirectional stepwise regression analysis.

Results

Thirty-seven patients (median age: 52 [42-64] years, 43% women) were included, among which 16 (43%) had aspirin-exacerbated respiratory disease, 16 (43%) and 13 (35%) fulfilled classification criteria for Eosinophilic Granulomatosis with Polyangiitis (all with negative antineutrophil cytoplasmic antibodies) and Hypereosinophilic syndrome, respectively. There was no predominant coronary territory involved. A iatrogenic trigger was evidenced in 7 (19%) patients, consisting in all cases but one of non-steroidal anti-inflammatory drugs. After a median follow-up of 32 [12-63] months, 20 (54%) patients relapsed (median time to first relapse: 10 [5−29] months), despite vasodilators regimen in 95% of cases. Besides coronary vasospasm(s), 13 (35%) patients experienced an additional MACE. In multivariate analysis, persistent eosinophilia (i.e. absolute eosinophil count > 0.5 x 109/L at the time of coronary vasospasm relapse or at last follow-up for relapsing and non-relapsing patients respectively) was the sole indepedendent predictor of relapse (Odds Ratio 8.87 [3.28-24.82]; p<0.001). All six patients treated with interleukin-5 biologics remained relapse-free under treatment.

Conclusions

Eosinophilia-associated coronary vasospasm can occur in patients with type 2 inflammation. Long-term normalization of absolute eosinophil counts appears crucial in preventing the recurrence of eosinophilia-associated coronary vasospasm, while conventional use of vasodilators seems ineficient.
Clinical, echocardiographic, and pathologic characteristics of patients with pathology-proven nonbacterial thrombotic endocarditis
Authors: El-Am E , Ahmad A , Abbasi M , Akiki E , Bois M , Maleszewski J , Kurmann R , Klarich K
Published: October 2024

Background

Non-bacterial thrombotic endocarditis (NBTE) is a non-infectious condition characterized by thrombotic and/or inflammatory depositions involving the cardiac valves. It is a challenging diagnosis of exclusion.

Purpose

This study aimed to better characterize patients with pathologically proven NBTE and assess its clinical, echocardiographic characteristics and prognostic implications.

Methods

We retrospectively identified patients with pathology-proven NBTE at a single center. Patients with positive preoperative blood cultures, a history of active or treated infective endocarditis, or identification of valvular organisms by special stains were excluded from the study. Patients with pathology reports of valve perforation or chordal rupture were also excluded because of the high likelihood of an infectious etiology for these lesions.

Results

A total of 53 patients with NBTE (median age 57 years; 61% females) were identified. In this cohort, 22% had a history of malignancy, 30% had connective tissue disease, 32% had coronary artery disease, and 11% prior history of NBTE. Neurological events accounted for 18 (34%) of the presenting symptoms (TIA n=17, CVA n=9), while new valvular dysfunction in 7 (13%) and fever in 8 (15%) of patients. Five patients (9%) had NBTE involving more than one valve. NBTE involved the mitral valve in 64%, aortic valve in 38% prosthetic/mechanical valve in 11%, and tricuspid valve in 5%. NBTE was identified at the time of autopsy in 34% of patients. NBTE recurred in 3 patients during follow-up. Excluding patients diagnosed at the time of autopsy, 9% of patients died within 1 year of NBTE diagnosis.

Conclusion

NBTE was diagnosed pathologically in the presence of hyper-inflammatory states due to critical illness or immunological diseases. It was predominantly on the left side of the heart and was associated with embolic phenomena, either clinically or on imaging. Patients diagnosed with antemortem with NBTE have a high mortality in the first year (9%).
Early left atrial changes in patients with systemic sclerosis by two-dimensional speckle tracking echocardiography
Authors: Hassan A , Dawood M , Ammar W
Published: October 2024

Background

Systemic Sclerosis (SSc) is an autoimmune disease that affects multiple organs 1. Primary myocardial involvement is not uncommon in SSc, with poor prognosis when symptomatic2-4. Pulmonary hypertension and right-sided affection of the heart are well-studied in SSC. Changes in the function of the left atrium (LA) in patients with SSc are early signs of left-sided affection of the heart, which has not yet been well investigated. Two-dimensional (2D) speckle tracking echocardiography (STE) is useful for detecting these early changes.

Aim

To assess the LA strain parameters in patients with SSC by 2D STE compared to age and sex-matched healthy subjects.

Methods

This study analyzed prospectively collected data from 30 consecutive SSc patients, excluding those with systemic hypertension and diabetes mellitus and a control group including 30 healthy female volunteers with a mean age of 35.6±7.7. Most SSC patients were females (28/30), with a mean age of 39±10.8. After obtaining informed consent, all participants underwent clinical evaluation and transthoracic echocardiography, including strain analysis.

Results

Left atrial reservoir (38.1±3.8 % vs. 45.33.7 %; p<0.001), conduit (21.82.7 % vs. 25.73.2 %; p<0.001), and contractile (16.23 % vs. 19.6±2 %; p<0.001) strain parameters were significantly reduced in the SSc population than the healthy controls. The LA stiffness index was also significantly higher in SSc patients (0.186±0.042 vs 0.138±0.018; p<0.001). The total emptying fraction (59.9±7 % vs. 64.73 %; p=0.003), expansion index (160.945.8 % vs. 185.224.1%; p=0.007), and passive emptying fraction (37.37.4 % vs. 40.7±8.5%; p=0.012) were significantly lower in SSc patients compared to the controls. However, the active emptying fraction showed no significant difference between the 2 groups. LA maximal volume was similar between the 2 groups.

Conclusion

Patients with systemic sclerosis demonstrate reduced LA phasic function even without LA enlargement, as compared to healthy individuals, based on 2D speckle-tracking echocardiography (STE).
Cardiac structure and function in patients with chronic obstructive pulmonary disease
Authors: Vesterlev D , Reimer Jensen A M , Duus L S , Janner E H , Karsum E , Christensen J , Yafasov M K , Johansen N D , Sivapalan P , Ulrik C S , Lapperre T , Browatzki A , Jensen J U S , Biering-Soerensen T
Published: October 2024

Background

Chronic obstructive pulmonary disease (COPD) is common and strongly associated with cardiovascular disease, but the pathophysiology has not been fully elucidated.

Purpose

We aimed to investigate cardiac structure and function in patients with COPD compared to a matched general population.

Methods

In a prospective cohort study, 796 patients with COPD were included and matched 1:2 on age and sex with controls from a general population study. All participants underwent an examination program including echocardiography.

Standardized linear regression coefficients were used to compare cardiac structure and function in patients with COPD vs. controls.

Impaired left ventricular (LV) function was defined as a left ventricular ejection fraction (LVEF) <50%, or global longitudinal strain (GLS) <16% (numerical). Impaired right ventricular (RV) function was defined as tricuspid annular plane systolic excursion (TAPSE) <1.7 cm. Diastolic dysfunction was defined as having at least two of the following parameters: E/e’ >14, septal e’ velocity <7cm/s, or lateral e’ velocity <10 cm/s, left atrial volume index (LAVi) >34 mL/m2, or tricuspid regurgitation velocity (TRV) >2.8 m/s. Logistic regression was used to assess associations between having COPD and systolic and diastolic dysfunction.

Results

Mean age was 70.2 ± 8.3 years and 52% were females. COPD patients had a mean forced expiratory volume in 1 second (FEV1) of 49.4 ± 18.8% predicted. At baseline, 43% of the patients with COPD had hypertension and 10% had diabetes (DM). Additionally, 57% with COPD had cardiovascular disease at baseline, including 12% with ischemic heart disease (IHD), 15% with atrial fibrillation (AF), 6% with heart failure, and 5% with a previous ischemic stroke.

Patients with COPD had impaired measures of cardiac structure and function including a lower GLS (COPD vs. controls: 16.3 vs. 19.2%), lower TAPSE (2.3 vs. 2.6 cm), larger LAVi (29.0 vs. 24.7 mL/m2), and higher TRV (2.7 vs. 2.3 m/s), p for all associations <0.001. (See figure).

Patients with COPD had a significantly higher prevalence of impaired LV systolic function (OR for GLS <16%: 8.18, 95% CI(6.04; 11.1), p <0.001), impaired RV systolic function (OR for TAPSE <1.7 cm: 2.77, 95% CI(1.63; 4.69), p <0.001), and LV diastolic dysfunction (OR for diastolic dysfunction grade I or higher: 4.00, 95% CI(3.12; 5.13), p <0.001) after adjustment for age, sex, hypertension, smoking, DM, IHD, AF, and lower density lipoprotein. (See figure).

Conclusion

Patients with COPD had significantly impaired LV and RV systolic function as well as impaired diastolic function compared with individuals from the general population. These findings underscore the importance of recognizing and addressing cardiovascular comorbidities in COPD.
Evaluating corticosteroid treatment strategies for cardiac sarcoidosis: analysis of the nationwide claims-based JROAD-DPC dataset
Authors: Kitai T , Sakamoto T , Yoshii T , Kurashima S , Irie Y , Moriuchi K , Amano M , Amaki M , Kanzaki H , Izumi C
Published: October 2024

Background

Corticosteroid-based immunosuppressive therapy is the cornerstone of treatment for cardiac sarcoidosis (CS), aimed at preventing severe adverse events including death, heart failure and lethal arrhythmic events. Nevertheless, data on the optimal initial dosing, appropriate tapering schedules, suitable maintenance dosages, and the recurrence rates among patients are insufficient.

Purpose

This study sought to scrutinize real-world data on corticosteroid therapy regimen for CS and to reassess optimal treatment protocols.

Methods

From the Japanese Diagnosis Procedure Combination database, 6,282 patients with hospitalized CS were identified between 2012 and 2022. Among them, 3,067 CS patients who were initiated on corticosteroid therapy during hospitalization were analyzed. We examined the baseline patient characteristics and treatment strategies for corticosteroid therapy, including starting dose, tapering period, maintenance dose, and their correlation with the onset of adverse events.

Results

The cohort had a mean age was 63±11 years, and 1,256 patients (41.0 %) were female. The starting dose of corticosteroids was 30.3±6.9 mg, with 88.6% of patients receiving a dose of ≧30 mg/day. The doses of corticosteroids at 30, 60, 90, 120, 150 and 180 days post-discharge were 21.4±9.8, 15.7±6.9, 12.2±5.7, 10.4±5.0, 9.3±4.5 and 9.0±4.6 mg, respectively. By day 180, 83.7% of the patients were maintained on ≦10 mg/day. However, 17.1 % of patients required an increase in corticosteroid dosage during the tapering course, primarily due to exacerbation of sarcoidosis. When analyzing only the group without corticosteroid escalation up to 180 days post-discharge, the average corticosteroid dose was 8.7±3.8 mg, with 95.3% of patients on ≦10 mg/day. We observed 965 re-hospitalization (31.5 %) during follow-up, with 58.8% of these patients having corticosteroid escalation to ≧30 mg, and 12.8% of patients received second-line immunosuppressive therapy, such as methotrexate.

Conclusion

The majority of CS patients were initiated on a corticosteroid regimen of 30 mg/day, which was subsequently tapered to below 10 mg/day by day 180. However, non-negligible number of patients experienced clinical events or relapse, underscoring the necessity for vigilant follow-up during corticosteroid therapy.Figure
High-sensitive cardiac troponin T in patients with idiopathic inflammatory myopathies
Authors: Barros E Silva P G , Machado L S G , Oliveira A C D , Mancuso F J N , Sato E I , Dias K T , Correia L A V , Ximenes M C , Lacerda M D V
Published: October 2024

Introduction

Patients with idiopathic inflammatory myopathies (IIM) may have positive blood tests of cardiac troponin in absence of clinically detected cardiac disease. This situation is more common using high-sensitive cardiac troponin T (hs-cTnT) but there is limited information of the expected results according to type of IIM and prognostic value of this test in this group of patients.

Methods

Prospective study with 32 healthy controls and 61 patients with IIM without known cardiac condition. These patients with IIM were followed for 25 months. High-sensitive cardiac troponin T (Roche Elecsys hs-cTnT) was measured at baseline in both groups and a value of 14 pg/ml was the percentile 99th and considered the upper limit of normality (ULN).

Results

The median value of hs-cTnT was higher in patients with myopathies [12.0 (5.0; 35.0) vs. 5.0 (4.0; 6.2) P< 0.001] and the frequency of abnormal values were also more common in patients with IIM compared to controls (45.9% vs 6.2%, p<0.001). The frequency varied according to the type of myositis: Inclusion Body Myosytis (75%), Polymyositis (66.7%) , Dermatomyositis (42.1%) and Antisynthetase syndrome (38.5%). In terms of magnitude, 57% had mild elevations (1 to 3 x ULN) while 11% had levels 3 to 5 times ULN and 32% had troponin values > 5x ULN (Figure 1). Among patients with IIM, elevated levels of hs-cTnT were not associated with left ventricle global longitudinal strain < 18% or lower ejection fraction and was not associated with cardiovascular events during 25 months of follow-up (Figure 2).

Conclusion

Abnormal values of high-sensitive cardiac troponin T are common in patients with idiopathic inflammatory myopathies including levels similar to myocardial infaction. This elevation was not associated with echocardiographic abnormalities or cardiovascular events in patients with IIM.Figure 1Figure 2
Is the female sex a risk factor for heart failure after myocardial infarction?
Authors: Kanic V , Naji F H
Published: October 2024

Background

In previous observations, female sex was associated with heart failure after myocardial infarction (MI). However, women were older and had more risk factors and were not treated the same as men.

Purpose

Our aim was to investigate the differential impact of sex on heart failure (including cardiogenic shock) and outcome in a propensity score matched population with MI who had undergone percutaneous coronary intervention (PCI) and the association between sex, heart failure and long-term mortality.

Methods

Data from 3624 (30.6% women) MI patients who underwent PCI at our institution were analyzed. Propensity-score matching analysis was performed to adjust for differences in baseline characteristics between men and women. After propensity matching, the sample comprised 2170 patients (1085 women and 1085 men). Heart failure was defined by clinical criteria (bilateral pulmonary rales, S3 gallop, edema or cardiogenic shock) and/or pulmonary edema on chest X-ray and/or ejection fraction <30%. The data were analyzed using descriptive statistics. The median follow-up time was 27 months (25th, 75th percentile: 9,48).

Results

In hospital, 329 (16.4%) patients developed heart failure, with a similar incidence in men and women (156(15.5%) vs. 173(17.2%);p=0.33) (Figure 1). Furthermore, female sex was not associated with heart failure either univariately (OR 1.13;95%CI 0.89-1.43;p=0.31) or after adjustment for confounding factors (aOR 1.27;95% CI 0.96-1.66;p=0.093). Age, hypertension, hyperlipidemia, ST- elevation MI, and P2Y12 receptor inhibitors were associated with heart failure.

We followed the patients for up to six years. At the end of the observation period, 330(16.4%) patients had died. The mortality rate was similar in both sexes (159(15.8%) men died compared to 171(17.0%) women; p=0.51) (Figure 2). In addition, sex was not associated with long-term mortality (aHR 1.11;95%CI 0.88-1.40;p=0.38) after adjusting for confounders. In-hospital heart failure was independently associated with long-term mortality (aHR 2.64;95%CI 2.04-3.41;p<0.0001). Hyperlipidemia, age, ST- elevation MI, radial access, P2Y12 receptor inhibitor and GFR were also associated with long-term mortality.

Conclusions

Our results suggest that sex itself is not associated with heart failure after MI when women are treated similarly to men, have similar risk factors, and are of similar age. It is more likely that women are more frequently affected by heart failure because they are older, have more risk factors, are less likely to be revascularized, and are less likely than men to be treated with guideline-recommended therapy,Heart failure in men and womenLong-term all-cause mortality
Cardiovascular profile of women in cardiac rehabilitation programs and its impact on their functional capacity
Authors: Gomez Sanchez M I , Delgado Calva F A , Marschall A F , Basabe Velasco M E , Dejuan Bitria C , Duarte Torres J , Biscotti Rodil B , Tapia Martinez M , Ramos Alejos-Pita C , Peruyero Gil V , D'amato M , Rey Hernandez M , Martinez C , Marti Sanchez D , Coto Morales B
Published: October 2024

Background

The value of cardiac rehabilitation (CR) for patients with a wide spectrum of cardiovascular diseases is supported by a solid body of scientific evidence. It has demonstrated improvement in cardiopulmonary capacity and physical endurance, as well as a reduction in morbidity, mortality and rehospitalization. Despite these benefits, it is an underutilized resource among women.

Purpose

Our objective was to study the clinical characteristics of women included in our CR program, as well as the evolution of their functional capacity, in comparison to men.

Methods

A retrospective observational study was conducted and consecutive patients who had participated in the CR program at our center, between the years 2019 and 2022, were included. Clinical characteristics and the evolution of functional capacity throughout the program were assessed, stratified by gender.

Results

175 patients were included and subdivided by gender into two groups: 144 males and 31 females. The mean age was slightly higher among the female patients, without reaching statistical significance, and the body mass index was similar in both groups. Ischemic heart disease was the primary reason for inclusion in 80% of cases. Within the female patients, 52% had hypertension (p=0.04) and 20% had diabetes (p=0.09), percentages slightly lower than those in males; a similar percentage of patients had dyslipidemia in both groups (see table).

The initial METs in ergometry [7.6 (6.3-10.2) among male patients and 4.6 (4.4-6.9) among female patients], and the final METs [10 (8.1-11.3) and 6.8 (5.6-7.6), respectively], were higher in the male group, with a significant increase in METs at the end of the CR program in both groups. Nonetheless, the absolute increase in METs was similar in both males and females.

Conclusions

Cardiovascular risk factors are more prevalent among males. CR programs demonstrate an improvement in functional capacity (defined as an increase in METs) in both males and females, with a similar absolute increase in METs for both genders. Therefore, we must increase our efforts to include more women in CR programs.