bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2505Cardiorespiratory fitness in childhood is an independent predictor of subclinical cardiovascular disease in adulthood: The Childhood Determinants of Adult Health Study
Authors: Huynh Q , Venn A J , Magnussen C , Marwick T H 
Published: October 2019

Abstract

Background
Asymptomatic myocardial disease is the precursor to heart failure – to which cardiorespiratory fitness (CRF) is an important contributor. It is however unclear if CRF in childhood can predict cardiovascular disease in adulthood and whether it can do so independently of adult risk factors.

Methods
This study followed 562 participants from childhood (aged 7–15 years in 1985) to adulthood (aged 36–49 years in 2017–19). Time to finish a 1.6km run was standardised by age and sex to estimate CRF in childhood. CRF in adulthood was estimated using physical working capacity at a heart rate of 170bpm. Echocardiogram was used to identify abnormal myocardial function and structure in adulthood, including reduced global longitudinal strain (abnormal GLS greater than −18% in 102/562 participants), left ventricular hypertrophy (LVH in 55/562), dilated left atrial (LA volume index>34 in 268/562) and increased LV filling pressure (E/e'>8 in 32/562).

Results
CRF tracks weakly through the life-course (r=0.14, p<0.001). Childhood CRF was negatively associated with abnormal GLS (OR=0.76 [95% CI: 0.62, 0.92]), and was positively associated with dilated LA (OR=1.33 [95% CI: 1.12, 1.59]) and LV hypertrophy (OR=1.39 [95% CI: 1.01, 1.92]) in adulthood. There was no association with increased LV filling pressure. While the associations with abnormal GLS and dilated LA were independent of adult CRF, the association of LV hypertrophy was attenuated and rendered insignificant after adjusting for adult CRF. A simple predictive model including age, sex and childhood CRF could predict abnormal GLS in adulthood with good discrimination (C-statistic=0.71 [95% CI: 0.66, 0.77]) – which was not significantly different from a predictive model using adult risk factors (p=0.53).

Conclusions
CRF in childhood is an important and independent predictor of subclinical cardiovascular disease in adulthood.
P2517Feasibility and safety of cardiac rehabilitation program during Ramadan fasting among patients having coronary artery disease and moderate left ventricular dysfunction
Authors: A Rifaie O , Shabana A M , Alaa Y A , Khorshed H M 
Published: October 2019

Abstract

Background
Ramadan fasting (RF) is an important worship activity for Muslims. It entails complete abstinence of food and fluids from dawn to sunset (14–16 hours) for 30 days. The safety and feasibility cardiac rehabilitation program during (RF) is largely unknown.

Aim
To assess safety and feasibility of cardiac rehabilitation program (CRP) during (RF) in patients with coronary artery disease (CAD) with moderate left ventricular dysfunction (LVD). Moreover, to study the effect of (RF) on some blood parameters

Patients and methods
Fifty three patients joining (CRP) at our university hospital were included in the study. All had (CAD) with moderate (LVD). Patients were divided into two groups according to their Ramadan fasting status. Group I (fasting) were 32, while group II (non fasting) were 21. All patients underwent exercise training during cardiac rehabilitation in Ramadan. Serum lipid profile, plasma osmolality, renal functions, echocardiography and exercise parameters were assessed before and after (CRP).Clinical follow up was available for one month post Ramadan.

Results
The two groups were similar in baseline characteristics including: risk factors, serum osmolality, urea, creatinine, lipid profile, hemoglobin values, ejection fraction and exercise parameters.All patients successfully completed the (CRP). No patient in group I had any ischemic episode or exacerbation of (LVD) during or one month after the end of Ramadan.After the program, both groups showed significant improvement in ejection fraction (group I: 43±2% to 52±2%, p<0.001, group II: 41.1±4 to 47.2±3%. p<0.002), total cholesterol (group I: 174.8±40.8 to 169.4±37.1 mg%, p=0.034, group II: 172.9±43.3 to 163.0±40.7 mg%, p=0.01), LDL: Group I: 100.7±33.4 to 94.5±261 mg%, p=0.023, group II: 104.5±42.1 to 93.8±33.8 mg%, p=0.005), and HDL: Group I: 42.7±10.6 to 44.5±10.9 mg%, p=0.029, group II: 40.6±8 to 45±8.9 mg%, p<0.001). However, triglyceride levels improved significantly only in group I (162.3±65.4 to 152.8±52.3 mg%, p=0.042, group II: 144±60 to 133.9±48.8 mg%, p=0.149) l. There was also similar improvement in exercise duration after (CRP) in both groups. It is worthy to note that fasting did not increase the serum osmolality in group I (277.91±15.14 before, and 281.01±11.61 mmol/L after (RF), p value= 0.34)

Conclusion
Cardiac rehabilitation is feasible and safe among patients with (CAD) and (LVD) during (RF). Moreover, (RF) resulted in significant improvement in serum triglycerides without change in plasma osmolality denoting absence of hemoconcentration despite fasting.
P2521Exercise-Based Cardiac Rehabilitation in post myocardial infarction patients with mid-range ejection fraction
Authors: Burazor I , Seferovic P , Ostojic M , Ivanovic B , Andjic M , Otasevic P , Constantinos D , Adler Y 
Published: October 2019

Abstract

Heart failure is a major cause of morbidity, mortality and re-hospitalizations and is highly prevalent in myocardial infarction survivors. Cardiac rehabilitation based on exercise training and heart failure self-care counseling have each been shown to improve clinical status and clinical outcomes. We designed our study with aim to evaluate the usefulness of exercise based in house cardiac rehabilitation/ secondary prevention program in patients with heart failure with mid-range ejection fraction (HFmrEF) after myocardial infarction.

Patients and methods
Out of 2753 patients who were admitted to our three weeks in- hospital secondary prevention program – exercised based cardiac rehabilitation, we analyze a total of 219 patients who were admitted early after coronary revascularization (percutaneus coronary interventions or coronary bypass surgery) with HFmrEF. The majority of patients were males (68%). Risk factors and co morbidities were noted. Patients were selected for exercise training after six minute walking test or exercise stress test (cardiopulmonary dominantly to evaluate unexpected exertional dyspnea). After 3 weeks in house cardiac rehabilitation the patients were re-tested.

Results
The major comorbidities in our patient population were as follows: hypertension, diabetes and dyslipidemia. Six minutes walking test was performed and the total distance walked ranged from 120 to 480 meters and the beginning of the program. Patient had 7 -days a week training program. After the 3 weeks in hospital exercise rehabilitation the improvement in the test was ∼32%. Cardiopulmonary test showed also improvement of functional capacity.We noted several rhythm disturbance complications by telemetry (VES, SVES). None had acutisation of heart failure (with peripheral edema and congestion). All patients fulfilled cardiac rehabilitation program.

Conclusions
Supervised multidisciplinary cardiac rehabilitation program, including an individualized exercise component is effective and can improve functional status and exercise tolerance in patient with HFmrEF after myocardial infarction.
P2535Pregnant patients with pulmonary hypertension-the case of a medical centre
Authors: Irtyuga O , Sefieva J , Karelkina E , Gabrelyan A , Bautin A , Yakubov A , Li O , Pervunina T , Zazerskaya I , Moiseeva O 
Published: October 2019

Abstract

Background
Nowadays, Pulmonary Hypertension (PH) is one of the most pressing issues in cardiovascular disease. Subsequently, pregnant women have a high degree of risk of morbidity and mortality and this poses a big challenge. Studies show that very often PH occurs due to congenital heart disease and for this reason, it is recommended to avoid pregnancy or to terminate the pregnancy at an early stage. Women who choose to remain pregnant should be treated at specialized PH centers with the experience of managing PH during and after pregnancy.

Purpose
The main purpose of this study was to estimate the survival of pregnant pts with PH depending on the severity of PH and etiology.

Methods
8336 women during delivery on admission were screened from the period spanning January 2014 to December 2016. Of this number, 4268 (51%) the medical records of pregnant women with cardiovascular disease were retrospectively reviewed to identify patients with coexisting PH and pregnancies. Data on 98 (1.18%) pts with PH were identified and included in the study. All patients' PH severity was measured by Doppler echocardiography. Pulmonary artery systolic pressure value of 35 to 50 mm Hg, 51 to 70 mm Hg, or greater than 71 mm Hg measured by echocardiography corresponded to the mild, moderate, or severe PH, respectively. Demographics, characteristics of PH and pregnancy, management and outcomes were as well analyzed.

Results
54 cases (55%) were classified into WHO group 1, 40 cases (41%) in group 2 (reason –left heart disease), 4 cases (4%) in group 4 (reason - pulmonary thromboembolism), and none in group 3 or 5. The systolic pulmonary artery pressure was <50 mmHg in 70,4% of patients, 51–70 mmHg in 18,4% and ≥70 mmHg in 11,2% The median age was 28 years. All deaths occurred in women with PH in WHO group 1, with moderate or severe PH severity, and with NYHA grade of III to IV. Pulmonary vascular-targeted medications were used in all pts with severe PH and in some cases with moderate PH 14 pts (14%), but none was administered to pts with mild PH. During pregnancy, 9 pts took monotherapy of the sildenafil but 1 pregnant patient took a combination of therapy with iloprost. After delivery, 14 pts took monotherapy and 9 took combination therapy. This notwithstanding, 3 pts who took the combination therapy (3%), died within 15 days after delivery (9,14,15 days, respectively). All of them died from uncontrolled PH and heart failure after delivery.

Conclusion
Our study shows that maternal mortality is associated with the severity of PH. Mortality in pregnant patients with pulmonary hypertension is still the most discussed problem in cardiology and obstetrics. It is necessary to diagnose this disease at an early stage, prevent pregnancy in pts with severe to moderate PH as much as possible, continue observation, adequately apply therapy in order to help curtail this problem.
P2540Sex-specific differences in the clinical presentation, surgical complications, and course of chronic thromboembolic pulmonary hypertension
Authors: Barco S , Klok F A , Konstantinides S V , Dartevelle P , Fadel E , Jenkins D , Kim N H , Madani M , Matsubara M , Mayer E , Pepke-Zaba J , Simonneau G , Delcroix M , Lang I M 
Published: October 2019

Abstract

Background
Women are more susceptible to develop several forms of pulmonary hypertension, but they may have better survival rates than men. Sparse data are available concerning sex-specific differences in chronic thromboembolic pulmonary hypertension (CTEPH).

Purpose and methods
We investigated sex-specific differences in the clinical presentation of CTEPH, functional parameters, exposure to pulmonary endarterectomy (PEA), and survival.

Results
Women constituted half of the study population (N=679 treatment-naïve patients from the European CTEPH registry) and were characterized by a lower prevalence of some cardiovascular risk factors (e.g. prior acute coronary syndrome, smoking habit, chronic obstructive pulmonary disease), but more prevalent obesity, cancer, and thyroid diseases. Median age was 62 (IQR 50–73) years in women and 63 (IQR 53–70) in men. Women underwent PEA less often than men (54% vs 65%; Figure 1, Panel A) and were exposed to fewer additional cardiac procedures, notably coronary artery bypass graft surgery (0.5% vs. 9.5%). The prevalence of specific reasons for not being operated, including the patient's refusal and the proportion of proximal vs. distal lesions, did not differ between sexes. A total of 57 (17.0%) deaths in women and 70 (20.7%) in men were recorded over long-term follow-up. Female sex was positively associated with long-term survival (adjusted Hazard Ratio 0.66; 95% Confidence Interval 0.46–0.94). Short-term mortality was identical in the two groups (Figure 1, Panel B).

Conclusions
Women with CTEPH had a lower prevalence of cardiovascular risk factors and underwent PEA less frequently than men, who, in turn, were more often exposed to additional major cardiac surgery procedures. Women had more favorable long-term survival.

Acknowledgement/Funding
The CTEPH registry is supported by a research grant from Actelion Pharmaceuticals Ltd.
P2547Statin and glucose-lowering treatment in individuals with and without schizophrenia
Authors: Eriksson S V E N , Eberhard J , Osby U , Westman J , Forslund L , Wallen J 
Published: October 2019

Abstract

Background
We have recently shown that Cardiovascular (CV) mortality is surprisingly high in patients with schizophrenia in Sweden. Diabetes is 2–3 times more common in patients with schizophrenia. Treatment with Metformin have consistently shown effective to lower CV mortality in patients with diabetes. In addition, recent studies have shown that treatment with Metformin reduces weight and improves lipids even in patients with schizophrenia without diabetes. One reason for the high CV mortality in Swedish patients with schizophrenia may be lack of risk factor treatment, such as glucose-lowering treatment and/or lipid lowering treatment with statins.

Objective
To determine the prevalence of treatment with glucose-lowering treatment and statins in patients with and without schizophrenia in Stockholm, Sweden.

Material and methods
Cross-sectional study based on individual-level patient data from the Stockholm regional health-care data warehouse. 6 347 patients with a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision code F 20.X) were compared with 2 062 112 without schizophrenia from Stockholm County. The prescription of Metformin and insulin were compared in 5-year age groups from 30 to 85 years of age. In addition, the prescription of statins (any statin) were also compared in the same population.

Results
The prescription of metformin in age groups under 60 years were approximately 2 to 8 times more common in patients with schizophrenia, in patients over 60 the corresponding figures were 0.7 to 3 times. The prescription of statin in age groups under 60 were approximately 0.8–3 times more common in patients with schizophrenia. In contrast, in patients over 60 years statins were less often prescribed in patients with schizophrenia compared to controls.
Figure 1

Conclusions
Our results indicate that lack of treatment with metformin may not be a reason for the increase cardiovascular mortality in patients with schizophrenia. However, the surprisingly low prescription of statins in older (>60 years) patients with schizophrenia might explain the high CV mortality in this patient group.
P2548Lithium use and risk of out-of-hospital cardiac arrest in patients with bipolar disorder: A nationwide nested case-control study
Authors: Christensen D M , Barcella C A , Gerds T A , Gislason G H , Torp-Pedersen C , Kessing L V , Mohr G H 
Published: October 2019

Abstract

Background
Lithium is a mood stabilizer widely used in the treatment of bipolar disorder. Lithium has been linked to malignant proarrhythmic electrocardiographic changes such as QT-prolongation, atrioventricular and sinoatrial block. However, evidence regarding the risk of cardiac arrest with lithium use is lacking.

Purpose
We investigated the risk of out-of-hospital cardiac arrest associated with lithium use among patients with bipolar disorder.

Methods
All out-of-hospital cardiac arrest cases from 2001 through 2014 of presumed cardiac cause with a history of bipolar disorder were identified from the nationwide Danish Cardiac Arrest Registry. We conducted a nested case-control study by matching all cardiac arrest cases with bipolar disorder on age, sex and time since first diagnosis of bipolar disorder with four controls from the general population who also had a history of bipolar disorder. Conditional logistic regression adjusted for comorbidities and concomitant pharmacotherapy was used to determine the association between lithium monotherapy and risk of out-of-hospital cardiac arrest compared to mood stabilizing monotherapy with valproate, lamotrigine and quetiapine, respectively. Exposure was defined as redeemed prescriptions for only one of either lithium, valproate, lamotrigine or quetiapine up to two months before index.

Results
The study population consisted of 1,410 patients with bipolar disorder, comprising 282 out-of-hospital cardiac arrest cases each matched with 4 controls. The median age was 69 years, 47.2% were male and the median time from first diagnosis of bipolar disorder was 7.25 years. Among cases, 59 (20.9%) were in lithium monotherapy and among controls the number was 299 (26.5%). For monotherapy with other mood stabilizers we observed the following distributions: quetiapine 18 (6.4%) cases and 51 (4.5%) controls, valproate 12 (4.3%) cases and 51 (4.5%) controls, and lamotrigine 15 (5.3%) cases and 64 (5.7%) controls. Lithium was not associated with an increased risk of OHCA compared to other mood stabilizing drugs: Hazard ratio (HR) 0.64 [95% confidence interval (CI) 0.31–1.33] (reference quetiapine), HR 0.56 [95% CI 0.25–1.24] (reference valproate) and HR 0.53 [95% CI 0.25–1.10] (reference lamotrigine).
Figure 1

Conclusion
Among patients with bipolar disorder, lithium was not associated with an increased risk of cardiac arrest compared to other mood stabilizing drugs. Further studies focusing on the cardiovascular safety of mood stabilizing drugs are warranted.
P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology
Authors: Bielecka-Dabrowa A , Gasiorek P , Sakowicz A , Banach M 
Published: October 2019

Abstract

Purpose
The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65.

Methods
Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months.

Results
At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01).
Kaplan-Meier Analysis - survival and AF

Conclusions
The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF.

Acknowledgement/Funding
The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz
P2550The influence of tonic-clonic seizures on heart rate variability in patients with refractory epilepsy
Authors: Faria M T , Rodrigues S , Dias D , Rego R , Rocha H , Sa F , Oliveira A , Campelo M , Pereira J , Rocha-Goncalves F , Cunha J P S , Martins E 
Published: October 2019

Abstract

Background
Heart Rate Variability (HRV) is an increasing area of interest in patients with epilepsy. The effects of epilepsy on the autonomic control of the heart are not completely understood and that autonomic dysfunction has been implicated in some cases of Sudden Unexpected Death in Epilepsy (SUDEP).

Objective
To study the influence of generalized tonic-clonic seizures (GTCS) on HRV of patients with focal refractory epilepsy.

Method
We prospectively evaluated (January 2015 to July 2018) 121 patients admitted to our institution's Epilepsy Monitoring Unit. All patients performed a 48-hour Holter recording. Patients who had GTCS during the recording were included and we selected the first GTCS as the index seizure. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs during inter-ictal and post-ictal periods: baseline, pre-ictal (5 min before the GTCS seizure), post-ictal (5 min after the seizure), and late post-ictal (>5 hours after the seizure). We compared HRV data from these patients with normative values for a healthy population (controlling age and gender). The study was approved by our Institution Ethics Committee and all patients gave informed consent.

Results
Twenty three patients were included (mean age: 38.61±11.58; 70% Female). Thirty percent presented cardiovascular risk factors without known cardiac disease. We found significant differences between the analyzed periods for all but one (LF/HF) HRV metrics (using Friedman test, p<0.05, two-tailed). Specifically during the post-ictal period, we found a significant reduction for AVNN, SDNN, RMSSD and pNN50 (Wilcoxon test, p<0.05; two-tailed). LF/HF was increased during this period, but changes were not statistically significant. There was also a tendency for a reduction of AVNN, SDNN, RMSSD and pNN50 and an increase of LF/HF in our patients during all the analyzed periods when compared to normative healthy population values.

Conclusion
Our work shows reduced HRV after a GTCS in patients with focal resistant epilepsy, both in inter-ictal and post-ictal periods, when compared to normative healthy population values. These results might reflect long term structural changes in autonomic centers. The HRV changes were significant particularly during the post-ictal period, and should prompt further investigation, giving this period is critical for SUDEP.