bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative course of coronary artery bypass grafting in patients with physical exercise prehabilitation
Authors: Argunova Y , Moskin E , Pomeshkina S , Barbarash O 
Published: November 2020

Abstract

Purpose
To evaluate the clinical effects of high-intensity physical exercise prehabilitation for elective coronary artery bypass grafting on the optimization of the postoperative course in patients with stable coronary artery disease.

Methods
60 male patients with stable coronary artery disease (CAD) were randomized into two groups before elective on-pump CABG. Group 1 patients (n=30, aged of 61.5 [56; 63] years) underwent a 7-day course of treadmill training at 80% of VO2 max. Group 2 patients (n=30, aged of 62.0 [56; 64] years) underwent routine preoperative management. The length of stay in the ICU and the length of stay in the hospital were assessed in all patients. In addition, the postoperative rate of myocardial infarction, stroke, heart rhythm disturbances (including atrial fibrillation), heart failure requiring inotropic support, hydrothorax and hydropericardium requiring puncture, wound infections, sternum diastasis, MODS, and the composite endpoint (total number of complications) were assessed. Statistical analysis was performed using the commercially available software package Statistica 10.0 (Statsoft, USA).

Results
Both groups were comparable in the main clinical and demographic data, and the intraoperative parameters. There were no cases of complications, heart and coronary insufficiency, episodes of heart rhythm disturbance and conduction disorders in patients undergoing preoperative physical training. All patients had good exercise tolerance. The trend towards reduced length of stay in the ICU and the length of stay in the hospital had been found in patients who underwent exercise prehabilitation compared with patients without training (20.0 [19.0; 22.0] vs. 21.0 [20.0; 23, 0] hours, respectively, p&gt;0.05 and 11.0 [9.5; 12.0] vs. 12.0 [10.0; 12.0] days, respectively; p&gt;0.05). There were no cases of intraoperative MI and postoperative stroke in Group 1 patients, whereas one case of MI and one case of stroke were registered in Group 2. The rate of the composite endpoint was lower in Group 1 patients than in Group 2 patients (p=0.02). In addition, the incidence of AF (6.6 and 10%, respectively), heart failure (6.6 and 20%, respectively), hydrothorax (0 and 6.6%, respectively) and pneumonia (0 and 6, 6%, respectively) was lower in Group 1 patients than in Group 2 patients.

Conclusion
The positive effects of high-intensity physical exercise prehabilitation for CABG on the optimization of postoperative course has been confirmed.

Funding Acknowledgement
Type of funding source: None
Do socioeconomic status and ethnicity predict CR outcomes in coronary heart disease patients in Denmark?
Authors: Kjesbu I , Sibilitz K.L , Prescott E 
Published: November 2020

Abstract

Background
Cardiac patients with low socioeconomic status and other ethnic background have worse prognosis and outcomes. Cardiac rehabilitation (CR) has the potential to diminish this socioeconomic and ethnical disparity, but evidence is lacking.

Purpose
To describe if socioeconomic status and ethnicity predicts CR outcomes in coronary heart disease (CHD) patients in Denmark.

Methods
The study is based “The Danish Cardiac rehabilitation database” (DHRD) which monitors quality of CR in Denmark. The study population are all patients with CHD (myocardial infarction or stable coronary artery disease with revascularization or medical treatment) participating in CR reported to the database from Aug 2015 to Mar 2018. The quality indicators (QI) were &gt;80% participation in exercise sessions, &gt;10% increase in VO2peak, smoking cessation, LDL &lt;1.8mmol/L (or 50% reduction of baseline LDL), blood pressure &lt;140/90, dietary consulting, screening for diabetes, screening for depression and medical treatment with acetylsalicylic acid, statins and beta-blockers at completion of CR. Educational level as a marker for socioeconomic status was divided into no-, basic-, medium- and high education, and ethnicity into Danish, Western and non-western origin. We compared QI across educational level and ethnicity using descriptive statistics.

Results
Analyses are based on 9000 patients. Age and gender differed significantly in the groups (all p&lt;0.001). Medical treatment and achievement of LDL- and blood pressure control was overall good with no difference across socioeconomic strata or ethnicity. Despite similar participation rate, higher education was associated with greater improvements in VO2peak. Patients of non-western ethnicity were less often screened for depression and less often received dietary consulting.

Conclusion
In this nationwide quality database for CR, medical treatment and achievement of traditional risk factor goals was good across socioeconomic and ethnic strata. However, outcome in VO2peak and implementation of screening for depression and diabetes showed disparity across socioeconomic and ethnic groups. The effect on long-term outcomes remains to be addressed.

Funding Acknowledgement
Type of funding source: None
Is there an exercise duration threshold for exercise-induced troponin elevation in healthy recreational athletes? The NEEDED 2014 advanced heart rate monitor substudy
Authors: Bjorkavoll-Bergseth M , Auestad B , Kleiven O , Skadberg O , Eftestol T , Melberg T , Moberg Aakre K , Orn S 
Published: November 2020

Abstract

Background/Introduction
Following prolonged strenuous exercise there is an exercise-induced troponin (cTn) elevation in healthy individuals. The precise mechanisms and clinical consequence of this cTn elevation remain to be determined. It has recently been demonstrated that exercise intensity, exceeding a heart rate (HR) of 150 bpm, is correlated with exercise-induced cTn elevation.

Purpose
The present work aims to determine if there is a threshold for exercise duration with a HR exceeding 150 bpm associated with an excessive exercise-induced cTn elevation.

Methods
A total of 177 healthy subjects were included in the present analysis of HR data obtained from sport watches used during a 91-km recreational mountain bike cycle race. Clinical status, cTnI, ECGs, blood pressure and demographics were obtained 24 h prior to- and at 3 h and 24 h after the race. Results are reported as median and 25th and 75th percentile. We used Tree regression to determine the association between elevated cTnI and exercise duration exceeding a HR of 150 bpm.

Results
Subjects were 82% (n=146) males, 44 (39–51) years, with a race time of 3.5 (3.1–3.9) h. Baseline cTnI was 1.9 (1.6–3.3) ng/L. There was a cTnI elevation in all study participants at 3 h, cTnI: 60.0 (36.0–99.3) ng/L, with a significant (p&lt;0.001) reduction at 24 hours following exercise, cTnI: 10.9 (6.1–22.4) ng/L. Tree regression identified 168 min of exercise, with a HR exceeding 150 bpm, to be associated with an excessive increase in cTnI both at 3 h, and at 24 h following the race (figure). The median cTn values above and below the threshold are presented in the Table.

Conclusion
The present analysis suggests that exceeding a specific duration of high intensity exercise may be associated with excessive cTn elevation in susceptible individuals.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Health authoritites.
The influence of vigorous training on the structure and cardiorespiratory fitness in adolescent athletes
Authors: Szabo L , Sydo N , Kiss O , Csulak E , Dohy Z , Czimbalmos C , Juhasz V , Horvath V , Suhai F.I , Merkely B , Vago H 
Published: November 2020

Abstract

Introduction
The functional and morphological adaptation of the cardiovascular system to vigorous exercise in adolescents is less understood compared to adult athletes. Therefore, the differential diagnosis of normal cardiovascular adaptation from the possible pathological alterations is challenging. Cardiovascular magnetic resonance is an important method for assessing ventricular function and morphology. Maximal oxygen uptake (VO2 max) has been established as a reliable measure of the maximal ability to produce metabolic power aerobically.

Aims
The aim of this study was to examine left (LV) and right (RV) ventricular morphologic and functional remodeling in elite adolescent athletes using cardiac magnetic resonance imaging (CMR) and cardiopulmonary exercise test (CPET).

Methods
Between 2017 and 2019 116 asymptomatic adolescent (14–20 years) athletes (&gt;6 training hour/week) underwent CMR and CPET as part of a detailed sports cardiology screening. Cine movie images were performed for the quantification of the LV and RV volumes, masses and ejection fraction, and advanced post processing included feature-tracking strain analysis. CPET was performed on a dedicated athlete protocol.

Results
All athletes participated in sports with a high dynamic component. Male athletes (n=74, 16±1 years) demonstrated higher LV and RV end –diastolic volume index (EDVi), stroke volume index (SVi) and mass index (Mi) compared with female athletes (p&lt;0.001). We found significant difference regarding the global circumferential strain (GCS) and mechanical dispersion (MD) of male and female athletes (GCS −34±4 vs. −31±5%; MD 4±2 vs. 7±4% p&lt;0.05). VO2 showed positive correlation with the LV and RV volumetric parameters (EDVi, SVi) and Mi (p&lt;0.001) and the absolute value of GCS (p&lt;0.05), and negative correlation with the MD (p&lt;0.001). In 36 athletes the VO2 max exceeded the age-adjusted expected VO2 max by 130%, which was categorized as excellent. Besides gender, age, and body surface area CMR based LVEDVi and LVMi were independent predictors of VO2 max.

Conclusion
The functional and morphological adaptation of the adolescent cardiovascular system shows noteworthy differences between male and female athletes. VO2 max correlates with several CMR based values including LV and RV volumetric parameters, masses and strain parameters such as GCS and MD.
Strain analysis of an adolescent athlete

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. ÚNKP-19-3-I New National Excellence Program of the Ministry for Innovation and Technology.
Electrocardiographic (ECG) predictors of major adverse cardiac events in women with ischemia and no obstructive coronary artery disease (INOCA)
Authors: Taha Y.K , Xu K , Mahmoud A.A , Smith S.M , Handberg E.M , Bairey Merz C.N , Pepine C.J 
Published: November 2020

Abstract

Introduction
The Women's Ischemia Syndrome Evaluation (WISE) studies observed that majority of women undergoing coronary angiography for symptoms/signs of ischemia have no obstructive coronary artery disease (INOCA) but have an increased risk of major adverse cardiac events (MACE) exceeding 2.5% yearly by 5 years. Identifying modifiable and non-modifiable factors that help predict or contribute to adverse outcomes in this population is important.

Purpose
Identifying electrocardiographic predictors of MACE in women with INOCA.

Methods
In a cohort of women referred for coronary angiography between 1996–2001 for symptoms and/or signs of ischemia, 944 underwent a resting 12-lead ECG at baseline read at core lab. No obstructive CAD was found in 567/944 (60%), (mean age 55.6±11 years). Complete follow up information for MACE as (first occurrence of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, or hospitalization for heart failure) or angina was available in 425 women.

Results
At follow up (median 5.9 years) MACE had occurred in 17.6% with angina hospitalization in 22.8% of these women. Women who experienced MACE were older (mean age 59±11 vs 55±10 years, P=0.02) and had longer corrected QT interval (mean QTc 437±29.7 vs 425±26.7 ms, P=0.001) vs. women without MACE. Diabetes, hypertension and history of smoking did not differ between MACE groups. Predictors of MACE by univariate analysis were: age at presentation (P=0.013), baseline heart rate (P=0.03), and QTc (P=0.0005). Baseline ST-T wave changes, QTc and waist circumference predicted angina hospitalization (P=0.003, 0.003 and 0.013 respectively). After adjusting for other risk factors in the multivariate analysis (see Figure) QTc, peripheral arterial disease (PAD) and current smoking were found to be independent predictors for MACE. ST-T wave changes and QTc independently predicted angina hospitalizations.

Conclusion
Among ECG findings in women with INOCA, QTc was a significant predictor of MACE and this was driven by hospitalization with angina. Ongoing ischemia likely contributes to these baseline ECG signals which could prove useful to better select subgroups for more intense anti-ischemic management.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute (NHLBI)
Prevalence of mitral valve diseases in the newborn – a large population-based study of newborns
Authors: Bjerrekaer J , Voegg R.O.B , Farooqui A , Boerresen M , Raja A.A , Pihl C , Norsk J , Bundgaard H , Iversen K 
Published: November 2020

Abstract

Background
Mitral valve abnormalities (MVA) include mitral valve regurgitation (MR), mitral valve prolapse (MVP), Barlow's mitral valve disease, and parachute MV. The prevalence of MVA has yet to be determined in an unselected population of newborns.

Objective
To determine the prevalence of MVA in unselected newborns and to assess the left ventricular (LV) structure and function in the neonatal heart with MR.

Methods
Transthoracic echocardiography (TTE) was performed within 28 days after birth in unselected neonates consecutively included in a prospective, multicenter, population-based study (2016–2018 (n=25,751)). TTE's were systematically reviewed for MR, MVP, Barlow's MV disease, and parachute MV. In a subgroup of 400 newborns with MR, the regurgitation was further classified as either traceable MR, mild MR, or moderate/severe MR based on the ratio of the trans-mitral jet in systole over the diastolic filling duration using M-mode in the 4-chamber view of the LV.

Results
Of 25,751 included newborns, we found a prevalence of MVA of 26.7%. (6,883/ 25,751). The prevalence of MR was 26.2%, MVP was 0.35%, Barlow's disease was 0.13%, and parachute mitral valve was 0.027%. MR was more frequent in females compared to males (50.4 vs 48.2%, p&lt;0.01). Newborns with MR had enlarged left atrial diameter (11.91±2.03 mm vs 11.53±2.02 mm, p&lt;0.01) and LV end-diastolic and end-systolic diameter (LVIDd 19.98±1.88 mm vs 19.87±1.83 mm, p&lt;0.01, LVIDs 13.48±1.47 mm vs 13.31±1.41 mm, p&lt;0.01), thicker LV posterior wall (2.19±0.60 mm vs 2.05±0.52 mm, p&lt;0.01), increased early and atrial mitral inflow velocities (MV E velocity (0.65±0.14 m/sec vs 0.61±0.13 m/sec, p&lt;0.01), MV A velocity (0.60±0.13 m/sec vs 0.57±0.13 m/sec, p&lt;0.01)), but lower fractional shortening (32.54±4.22% vs. 32.96±4.17%, p&lt;0.01) as compared to newborns without MVA.
In subgroup analysis MR severity was classified as traceable in 44% (175/400) of cases, mild MR in 52% (209/400) of cases and moderate/severe MR in 4% (16/400) of cases. Comparing traceable MR with moderate/severe MR (19.48±1.88 mm vs 20.96±2.64 mm, p=0.01) and comparing mild MR with moderate/severe MR (19.85±1.92 mm vs 20.96±2.64 mm, p=0.04) showed significant increases in LV end-diastolic diameter.

Conclusion
Over one fourth of all newborns had a MV abnormality of which mitral regurgitation accounted for the vast majority. The presence of MR was associated with asymmetric LV remodeling and discrete changes in LV function. Subgroup analysis revealed that increment in MR severity was primarily associated with an increase in LV end-diastolic diameter.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Herlev-Gentofte Hospital
Acute coronary syndromes in nonagenarians: do we have reliable risk scores?
Authors: Vidal P , Cepas Guillen P.L , Caldentey G , Martinez Gomez E , Borrego-Rodriguez J , Echarte Morales J , Minguito Carazo C , Alonso Orcajo N , Llagostera M , Castillo M , Viana Tejedor A , Quiroga X , Freixa X , Fernandez-Vazquez F , Sabate M 
Published: November 2020

Abstract

Introduction
GRACE score is strongly validated to determine the probability of death in acute coronary syndrome (ACS), nevertheless its usefulness in nonagenarians, a population with frequently associated comorbidities, is less stablished. BARTHEL and CHARLSON scores might be useful tools to predict outcomes in this population.

Objective
The aim of this study was to evaluate the potential applicability of GRACE score and two comorbidity scores (CHARLSON and BARTHEL) to estimate prognosis in nonagenarians with ACS.

Material and methods
We retrospectively included all consecutive patients equal to or older than 90 years old admitted with non-ST (NSTEMI) or ST segment elevation myocardial infarction (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristics and procedural data. In-hospital and at 1-year follow-up all-cause and cardiovascular mortality were assessed. Risk score accuracy was evaluated by area under the curve ROC (AUC).

Results
A total of 444 patients (mean age 92.6±2.4 years, 60% females) were analyzed.
Approximately half of them (n=241, 54%) with STEMI and the remainder (n=203, 46%) with NSTEMI. Global GRACE-AUC for in-hospital and 1-year all-cause mortality were moderate (0.64; 95% CI: 0.59–0.69 and 0.62; 95% CI: 0.57–0.67, respectively). Only in the NSTEMI group, the GRACE-AUC was better to predict in-hospital mortality, 0.70 (95% CI: 0.63–0.77). Neither CHARLSON nor BARTHEL showed better predictive results than GRACE score (AUC ≤0.60).

Conclusion
GRACE score has moderate accuracy to estimate mortality in nonagenarian patients with ACS. BARTHEL and CHARLSON scores do not improve the predictive value of GRACE score. An individualized approach is required to make therapeutic decisions in this special population.
Figure 1. ROC-GRACE curves

Funding Acknowledgement
Type of funding source: None
Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance
Authors: Caro Codon J , Lopez-Fernandez T , Alvarez-Ortega C , Zamora Aunon P , Rodriguez Rodriguez I , Gomez Prieto P , Buno Soto A , Canales Albendea M , Feliu Batlle J , Rodriguez Fraga O , Martinez Monzonis A , Gonzalez-Costello J , Serrano Antolin J.M , Gonzalez-Juanatey J.R , Lopez-Sendon J.L 
Published: November 2020

Abstract

Background
The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown.

Design
Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk.

Methods
A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy.

Results
At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)].

Conclusions
This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)
Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: a systematic review and meta-analysis
Authors: Bendary A , Ramzy A.R , Bendary M.B , Salem M.S 
Published: November 2020

Abstract

Background
Patients with severe aortic stenosis (AS) and concomitant active cancer (AC) are considered high-risk patients and usually are not allowed to undergo surgical valve replacement. Transcatheter aortic valve replacement (TAVR) may be an attractive option for them; however, little is known about the outcomes of TAVR in this subset of complex patients.

Methods and results
In this meta-analysis, Medline, Cochrane Library and Scopus databases were searched (anytime up to April 2019) for studies evaluating the outcomes of TAVR in patients with or without AC. We assessed pooled estimates (with their 95% confidence intervals [CIs]) of the risk ratio (RR) for the all-cause mortality at the 30-day and 1-year follow-ups, a 4-point safety outcome (any bleeding, stroke, need for a pacemaker and acute kidney injury) and a 2-point efficacy outcome (device success and residual mean gradient [mean difference]). Three studies (5162 patients) were included. Of those patients, a total of 368 patients (7.1%) had AC. Apart from a significantly higher need for a postprocedural pacemaker (RR 1.29, 95% CI: 1.06–1.58, P=0.01), TAVR in AC patients resulted in similar outcomes for safety and efficacy at the 30-day follow-up compared to those without AC. Patients with AC experienced similar rates of the all-cause mortality at the 30-day follow-up compared to those without (RR 0.92, 95% CI: 0.53 to 1.59, P=0.76); however, the all-cause mortality was significantly higher in patients with AC at the 1-year follow-up (RR 1.71, 95% CI: 1.26 to 2.33, P=0.0006). This mortality difference was independent of cancer stage (advanced or limited) at the 30-day follow-up but not at the 1-year follow-up; only patients with limited cancer stages showed similar all-cause mortality rates compared to those without cancer at the 1-year follow-up (RR 1.22, 95% CI: 0.79 to 1.91, P=0.37).

Conclusion
TAVR in patients with AC is associated with similar 30-day and potentially worse 1-year outcomes compared to those in patients without AC. The 1-year all-cause mortality appears to be dependent on the cancer stage. Involving a specialized oncologist who usually considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices might refine the risk assessment process among these patients.
All-cause mortality (cancer vs no)

Funding Acknowledgement
Type of funding source: None