bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender-specific relationship between abdominal obesity and prevalence of new-onset atrial fibrillation in the general Japanese population
Authors: Ninomiya Y , Kawasoe S , Ichiki H , Kubozono T , Miyahara H , Tokushige K , Ohishi M 
Published: November 2020

Abstract

Background
The number of incidences of atrial fibrillation (AF) is expected to rise rapidly in the near future because of the increased number of geriatric patients in Japanese society. In addition, obesity is increasing in the general Japanese population. Although a higher body mass index is associated with a higher risk of AF, the relationship between abdominal obesity (large waist circumference) and new-onset AF is unclear.

Methods and results
We performed a longitudinal retrospective observational study from January 2007 to October 2018 using the annual health checkup data. Data from 58,844 adults (29,572 males, age 54±13 years) without baseline AF, who underwent routine health checkups, were analyzed. We performed logistic regression analyses to determine the strength of the association between abdominal obesity and new-onset AF. We also examined the effect of abdominal obesity on the incidences of AF stratified by gender. During a median follow-up of 4 years, we recorded new cases of AF in 322 (0.5%) individuals. In univariate analysis, a large waist circumference was significantly associated with new-onset AF, both in males [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02 to 1.05, p&lt;0.001] and in females (HR 1.04, 95% CI 1.01 to 1.06, p=0.002), respectively. In multivariate analysis adjusted for clinical variables (age, hypertension, dyslipidemia, estimated glomerular filtration rate, habitual drinking and diabetes), a large waist circumference was significantly and independently associated with new-onset AF in males (HR 1.04, 95% CI 1.03 to 1.06, p&lt;0.001), but not in females (HR 1.01, 95% CI 0.99 to 1.04, p=0.269).

Conclusion
Abdominal obesity is independently associated with an increased risk of new-onset AF in males. This association in males might imply some sex-specific mechanisms. There might be a gender difference in the effectiveness of interventions to decrease abdominal obesity to prevent AF.

Funding Acknowledgement
Type of funding source: None
Night heart rate variability identifies cardiovascular risk in community dwelling people with uncomplicated type 2 diabetes mellitus
Authors: Hadad R , Larsen B.S , Fenger A.S , Stavnem D , Mattsson N , Kristiansen O.P , Nielsen O.W , Sajadieh A 
Published: November 2020

Abstract

Introduction
Low Heart rate variability (HRV) reflects cardiac autonomic neuropathy, associated with increased cardiovascular mortality in type 2 diabetes (T2DM) patients. Measuring HRV is challenged by environmental noise, mental stress and physical activity during the day-time. Thus, measuring night-time HRV during sleep may be a better tool to predict cardiovascular (CV) events in low risk T2DM patients without previous cardiovascular disease.

Methods
Copenhagen Holter Study included 678 community dwelling subjects aged 55–75 years free of previous cardiovascular disease. Day- and night-time HRV were available for 653. The population included 133 well-controlled T2DM patients (mean HbA1c 7.2%). Median follow- up was 14.4 years. HRV is defined as standard deviation for the mean value of normal-to-normal complexes (SDNN). Night-time HRV measurements were pre-defined from 2:00 to 2:15 AM. CV events were defined as CV death, myocardial infarction, stroke, or coronary revascularization.

Results
The rate of CV events was 17 and 31 per 1000 patient-year in patients without and with T2DM, respectively (p=0.015). Night-time SDNN was inversely associated with CV events in T2DM patients with a HR of 0.74 (0.61–0.89), P=0.001, for each 10 ms increment in SDNN, after adjustment for sex, age, LDL, smoking, systolic BP, glucose, CRP and NT pro-BNP (table 1). Twenty-four-hours HRV was not associated with cardiovascular events (table 1). Conventional risk factors had an AUC of 0.704 (95% CI 0.602–0.806) to predict CV events in T2DM. Prediction was improved by the addition of night-time SDNN; AUC 0.765 (95% CI 0.669–0.862), P=0.037, but not by CRP or NT-proBNP (Figure 1). In subjects with well-controlled T2DM and night-time SDNN ≤30 ms, the 10-year risk of CV death and CV even-rate were 12% and 45%, respectively. This allocates these T2DM patients in a “very high-risk” group, and more aggressive targets for blood-pressure and lipids according to the current guidelines.

Conclusion
Reduced night-time HRV associates with increased risk of CV events in persons with well-controlled T2DM. We observed improved risk prediction of cardiovascular events in T2DM by night-time HRV, which may have therapeutic consequences.
Figure 1. ROC Curve

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Heart Foundation
The association between SGLT2 inhibitors and new-onset arrhythmias: a nationwide population-based longitudinal cohort study
Authors: Siao W.-Z , Jong G.P 
Published: November 2020

Abstract

Background/Introduction
Clinical trials have shown the cardiovascular protective effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors and reduced hospitalization for heart failure. However, no study has investigated the association between SGLT2 inhibitors and the risk of arrhythmias.

Purpose
To evaluate the risk of new-onset arrhythmias (NOA) and all-cause mortality with the use of SGLT2 inhibitors.

Methods
This was a population-based cohort study utilizing Taiwan's National Health Insurance Research Database. Each patient aged 20 years and older who took SGLT2 inhibitors was assigned to the SGLT2 inhibitor group, whereas sex-, age-, diabetes mellitus duration-, drug index date-, and propensity score-matched randomly selected patients without SGLT2 inhibitors were assigned to the non-SGLT2 inhibitor group. The study outcome was all-cause mortality and NOA.

Results
A total of 399,810 patients newly diagnosed with type 2 diabetes mellitus (T2DM) were enrolled. A 1:1 matching propensity method was used to match 79,150 patients to 79,150 controls in the non-SGLT2 inhibitors group for analysis. The SGLT2 inhibitor group was associated with a lower risk of all-cause mortality (adjusted hazard ratio [aHR] 0.547; 95% confidence interval [CI] 0.482–0.621; P=0.0001) and NOA (aHR 0.830; 95% CI 0.751–0.916; P=0.0002). Subgroup analysis revealed that the SGLT2 inhibitor group was associated with a lower risk of all-cause mortality in all age and severity of the adapted Diabetes Complication Severity Index (aDCSI) subgroups. Furthermore, NOA and atrial fibrillation were associated with a lower risk in subgroups with an aDCSI score of between 1 and 2.

Conclusions
Patients with T2DM prescribed with SGLT2 inhibitors were associated with a lower risk of all-cause mortality and NOA compared with those not taking SGLT2 inhibitors in real-world practice. The potential protective effect of NOA and atrial fibrillation is observed, especially in individuals with T2DM and an aDCSI score of between 1 and 2.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): This study was supported in parts by grants from Chung Shan Medical University Hospital.
Effect of air pollution on acute heart failure hospitalization differ across specific heart failure populations
Authors: Takei M , Harada K , Miyazaki T , Kohsaka S , Matsushita K , Shiraishi Y , Shinme T , Shindo A , Miyamoto T , Kitano D , Kodera S , Nakano H , Yamamoto T , Takayama M 
Published: November 2020

Abstract

Introduction
Several report showed the association between ambient air pollution including particular matter under 2.5um (PM2.5) and increasing rate of hospitalization for heart failure. However, these report analyzed mainly cross-sectional, epidemiological data, thus the reports regarding association between vulnerability to PM2.5 and specific populations in acute heart failure (AHF) were scarce.

Purpose
1. To analyze the association between air pollution and rate of hospitalization for AHF
2. To analyze whether the vulnerability to air pollution differ between specific populations in AHF. Methods
A case-cross over analysis was conducted to 4980 consecutive patients registered for multicenter acute heart failure registry in 2017 in our city Japan. This registry enrolled patients transferred to cardiovascular care unit (80 institutions) via emergency medical services across our city area. Logistic regression analysis were conducted to estimate percentage changes in the rate of acute heart failure hospitalization associated with per 1μg/m3 PM2.5 concentration increase. We also conducted subgroup analysis for patients stratified by age, gender, comorbidities, left ventricular ejection fraction, and clinical scenario.

Results
An increase in 1 μg/m3 PM2.5 concentration corresponded to 2.9% (95% CI 1.2–4.6%) increase in AHF hospitalization. Patients with age younger than 75, without prior heart failure hospitalization, without history of hypertension, without anemia, and with reduced ejection fraction were more susceptible to increase in PM2.5 concentration (Figure).

Conclusions
Increase in PM2.5 concentration was associated with increased rate of AHF hospitalization. Effect of PM2.5 may differ across specific AHF subpopulations.
Figure 1

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Tokyo Metropolitan Government
Subacute post-operative atrial fibrillation after valvular surgery in patients undergoing cardiac rehabilitation: predictive factors
Authors: Maranta F , Bonaccorso A , Rizza V , Pellegrino S , Meloni C , Avitabile M , De Bonis M , Alfieri O , Cianflone D 
Published: November 2020

Abstract

Background
Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery (occurring in up to one third of patients). It may develop between the second and fourth postoperative days (acute POAF) as well as later, within 30 days after surgery (subacute). Episodes of atrial fibrillation in the subacute phase (sPOAF) are associated with an increase in morbidity, length of hospital stay and several complications both in the mid- and long- term. Therefore, POAF is not just an acute event but it may impact on long term clinical outcomes.

Aim of the study
The aim of this study was to identify the clinical predictors of postoperative atrial fibrillation in the subacute phase (sPOAF) in patients performing Cardiovascular Rehabilitation (CR) after cardiac surgery.

Materials and methods
A retrospective study was conducted on 737 post-surgical valvular patients (median age 62 years; 55,4% male) hospitalised in our Unit for in-patient CR program. During all the hospital stay patients received continuous monitoring with 12-lead ECG telemetry. We evaluated the predictive value of anamnestic data, the type of cardiac surgery intervention, the clinical course in the Cardiac Surgery Unit and in the CR Unit, the 6 minutes-walking tests (6MWT) parameters and main blood tests on sPOAF onset.

Results
SPOAF was documented in 170 patients (23,1%). Those who developed sPOAF were older [median 66 (56–74) years vs median 61 (50–70) years; p&lt;0,001), had a history of atrial fibrillation prior to surgery (29,4% vs 16,2%; p&lt;0,001), had a worse functional result at the 6MWT at the admission in CR Unit [median 250 (180–320) vs median 275 (210–370); p=0,015], had higher values of neutrophil-lymphocite ratio at baseline [median 2,33 (1,84–3,27) vs median 2,17 (1,64 - 2,87); p=0,027] when compared to those who did not develop POAF. At the multivariable logistic regression analysis, the occurrence of POAF in the acute phase (OR 2,916; 95% CI 2,011–4,228; p&lt;0,001), advanced age (OR 1,027; 95% CI 1,01–1,044; p=0,002), previous history of atrial fibrillation (OR 1,652; 95% CI 1,068–2,555; p=0,024), higher values of NLR at baseline (OR 1,144; 95% CI 1,028–1,272; p=0,013) and mitral valve surgery (OR 1,632, 95% CI 1,075–2,480; p=0,022) were found to be independent predictors of sPOAF after cardiac surgery.

Conclusions
Atrial fibrillation is a common complication after cardiac surgery with great clinical relevance. Advanced age, previous history of AF, higher values of NLR at baseline, mitral valve surgery and the occurrence of POAF in the acute phase were shown to be predictors of sPOAF in a cardiac surgery population during the rehabilitation period.

Funding Acknowledgement
Type of funding source: None
High-intensity interval training improves interventricular synchrony and strain under hypoxic stress in sedentary males
Authors: Huang Y.C , Wang J.S 
Published: November 2020

Abstract

Background
Interventricular interactions in increased RV afterload such as hypoxia stress, which affects both synchrony and function in an in-series effect as well as a parallel effect arising from leftward septal shift. Improved myocardial contractility is a critical circulatory adaptation to exercise training, however, the types of exercise that can improve interventricular synchrony under hypoxic environment have not yet been established.

Purpose
This study investigates how high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) influence on the interventricular synchrony in response to normobaric hypoxia in sedentary men.

Methods
Fifty-four sedentary males were randomized to perform HIIT (3-minute intervals at 40% and 80% VO2peak, n=18), MICT (sustained 60% VO2peak, n=18) for 30 minutes/day, 5 days/week for 6 weeks and the control group (CTL, n=18). Synchrony measurements at apical 4-chamber view including (1) intra-delay, the difference in time to peak strain (TS) between segmental septal-to-lateral ventricular or atrial walls, and (2) inter-delay, the difference in TS between RV or RA free wall and LV or LA lateral wall. The data were acquired by 2-dimensional speckle tracking echocardiography at rest under hypoxic condition (12% FIO2, simulated an altitude of 4,500 m) before and after the interventions.

Results
HIIT had significantly elevated radial and longitudinal strains in both LA and LV (p&lt;0.05). As the results showed, HIIT was superior than MICT in improvement of longitudinal intra-delay of LV; furthermore, only HIIT simultaneously ameliorated both radial and longitudinal synchrony at apex. Although the HIIT enhanced intraventricular synchrony in both motions, whereas the interventricular synchrony deteriorated at radial motion. In atrium synchrony, although both groups augmented the intra-LA synchrony, however, only HIIT reduced the inter-delay between LA and RA at the roof motion. LV end-systolic volume (ESV) significantly correlated with the longitudinal inter-delay of ventricle (r=−0.53, p&lt;0.05), whereas the LV end-diastolic volume (EDV) correlated with the inter-delay of atrium in roof motion (r=0.40, p&lt;0.05).

Conclusion
We found differences between HIIT and MICT in segmental intra- and inter- synchrony. HIIT enhanced both ventricular or atrial synchrony, and further increased the EDV coupled with decreased ESV. These findings give new insight into cardiac adaptation to difference endurance training and the long-term impact of such changes warrants future study in cardiac diseases.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Council of Taiwan
Better outcome of exercise-related out-of-hospital cardiac arrest in men and in the young
Authors: Frisk Torell M , Stromsoe A , Herlitz J , Claesson A , Rawshani A , Borjesson M 
Published: November 2020

Abstract

Background
Survival from out-of-hospital cardiac arrest (OHCA) is higher if the arrest occurs in relation to physical activity,however there is contradicting data on prognosis with regards to gender and age. The purpose of the study was to compare prognosis and circumstances of exercise-related OHCA in different age-groups as well as between genders in a large unselected population.

Methods
Observational data from exercise-related OHCA occurring outside of home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 and from 2016 to 2018 was analyzed. Comparing analyses were made for three different age-groups (0–35, 36–65 and &gt;65 years) and for males versus females.

Results
A total number of 9607 cases of OHCA outside of home where resuscitation was attempted occurred during the study period, 635 (6.6%) were exercise-related. Mean age was similar between males and females (59.1 years in both groups). The 30-day survival rate was significantly higher among exercise-related OHCAs compared to non-exercise-related OHCAs (44.5% vs 18.8%, p&lt;0.0001). The highest survival rate was observed in the age-group 0–35 years, compared to 36–65 years and &gt;65 years respectively (59.6% vs 46.0% and 40.4% respectively, p=0.01). A sub-group analysis of victims aged 0–25 years (n=32) showed a survival rate of 68.8%. Exercise-related OHCA in women (9.1% of total) were bystander witnessed to a lower extent than in men (66.7% vs 79.6%, p=0.03). Both men and women received bystander CPR at the same extent but median time to CPR was 1min longer for women (2.0 vs 1.0 min, p=0.001). Women had lower rates of ventricular fibrillation as initial rhythm (43.4% vs 64.7%, p=0.003) and 30-day survival was lower among women (29.3% vs 46.0%, p=0.02).

Conclusion
Women seem to be protected from exercise-related OHCA but in case of occurrence the prognosis is actually worse compared to men. This may partly be explained by lower grade of bystander witnesses and longer time to CPR, but the results indicate the need for further studies on additional factors, such as variances in underlying disease pattern and exercise habits of women. In addition, this study presents an exceptionally high survival rate for exercise-related OHCA in the youngest age-groups, especially in victims 0–25 years of age which is a novel finding.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Swedish Heart-Lung Foundation, Laerdal Foundation
Characteristics and health status of patients with and without confirmed HFpEF
Authors: Deaton C , Forsyth F , Mant J , Edwards D , Hobbs R , Taylor C , Aziz A , Schiff R , Odone J , Zaman J 
Published: November 2020

Abstract

Aims
Patients with heart failure with preserved ejection fraction (HFpEF) are usually older and multi-morbid and diagnosis can be challenging. The aims of this cohort study were to confirm diagnosis of HFpEF in patients with possible HFpEF recruited from primary care, to compare characteristics and health status between those with and without HFpEF, and to determine factors associated with health status in patients with HFpEF.

Methods
Patients with presumed HFpEF were recruited from primary care practices and underwent clinical assessment and diagnostic evaluation as part of a longitudinal cohort study. Health status was measured by Montreal Cognitive Assessment (MOCA), 6-minute walk test, symptoms, and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and quality of life (QoL) by EQ-5D-5L visual analogue scale (VAS).

Results
151 patients (mean age 78.5±8.6 years, 40% women, mean EF 56% + 9.4) were recruited and 93 (61.6%) were confirmed HFpEF (those without HFpEF had other HF and cardiac diagnoses). Patients with and without HFpEF did not differ by age, MOCA, blood pressure, heart rate, NYHA class, proportion with atrial fibrillation, Charlson Comorbidity Index, or NT-ProBNP levels. Patients with HFpEF were more likely to be women, overweight or obese, frail, and to be more functionally impaired by 6 minute walk distance and gait speed than those without. Although not statistically significant, patients with HFpEF had clinically significant differences (&gt;5 points) on the physical limitations, symptom burden and clinical summary subscales of the KCCQ, but did not differ by other subscales or by EQ-5D-5L VAS (70±17 vs 73±19, p=0.385). More patients with HFpEF reported daytime dyspnoea (63% vs 46%, p=0.035) and fatigue (81% vs 61%, p=0.008), but not other symptoms compared to those without HFpEF. For both groups BMI was moderately negatively correlated with KCCQ subscale scores, and 6 minute walk distance was positively correlated with KCCQ subscales.

Conclusions
Nearly 40% were not confirmed as HFpEF indicating the challenges of diagnosis. Patients with confirmed HFpEF differed by sex, overweight/obesity, frailty, functional impairment, and symptoms but not by age or comorbidities from those without HFpEF. These differences were reflected in some subscale scores of the KCCQ, but not how patients reported their quality of life on the KCCQ QoL subscale and EQ-5D-5L VAS. Older patients with HFpEF reported relatively high QoL despite poor health status by functional impairment, frailty and symptoms.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research School of Primary Care Research
Ictal ECG changes and antiepileptic drug therapy
Authors: Teryan R.A , Drapkina O.M 
Published: November 2020

Abstract

Purpose
Epileptic seizures may cause severe cardiac arrhythmias. Most people with epilepsy die suddenly and whose death is recognized to a sudden unexpected death in epilepsy (SUDEP). There are controversial reports on the association between polytherapy using antiepileptic drugs and SUDEP. First-line drugs include, in particular, carbamazepine, oxcarbazepine, and lamotrigine, which are sodium channel blockers that may impair heart function. Often a patient requires a combination of antiepileptic drugs

Methods
204 patients with epilepsy and were on antiepileptic drugs therapy. The ECG cardiac monitor was implanted in all patients (n=204) and was analyzed together with the preclinical data including age, sex, family history, cardiac risk factors (hypertension, dyslipidemia, diabetes mellitus), heart disease, antiepileptic drug type.

Results
After a follow-up of 12-month ictal ECG changes (rhythm and conduction disturbances, ST segment abnormalities) were observed in 134 (66%) patients, and only in 70 (34%) – without ictal ECG changes, the average age in these groups was 34,4±9,9 and 36,7±11,8 years (p&gt;0,05). In the group with ictal ECG changes among patients receiving as monotherapy antiepileptic drugs, ictal ECG changes were found in 53.7% of cases, with polytherapy antiepileptic drugs significantly more often – in 71.5% of cases (p&lt;0.05). a reliable association between carbamazepine and changes in sinoatrial and atrioventricular conduction (p=0.01) was significant. In the analyzed group of patients, carbamazepine therapy was also associated with the presence of ictal ST-segment abnormalities (depression/elevation) (p=0.013). A positive association was observed between the administration of oxcarbazepine and development of ictal tachycardia (p=0.04) and ictal right and left bundle branch block, which was observed in 71.4% of cases against the background of oxcarbazepine, significantly more often than with other drugs (p=0.005).

Conclusion
In agreement with previous publications available in the literature, our results confirm the risk of high-frequency rhythm and conduction disturbances, ST segment abnormalities related to antiepileptic drugs, in particular, carbamazepine and oxcarbazepine and indicates the need of not only cardiological examination before prescribing an antiepileptic drugs, but also a thorough follow-up during the therapy. Patients with ictal ECG changes, primarily rhythm and conduction disturbances, should be under the dynamic control of not only neurologists but also cardiologists and require regular cardiological check-up (ECG, Holter monitoring of the electrocardiogram, echocardiography).

Funding Acknowledgement
Type of funding source: None