bluuebunny/crossref_metadata_2025_split huggingface dataset:
The beneficial effects of physical preoperative and postoperative training for the cognitive function in cardiosurgical patients
Authors: Trubnikova O , Tarasova I , Moskin E , Argunova Y , Kupriyanova D , Barbarash O 
Published: November 2020

Abstract

Background and aim
The cardiac surgery patients have an increased risk of postoperative cognitive dysfunction (POCD). The positive healing effects of physical exercise was demonstrated early in patients with cognitive impairment. The aim of the study was to evaluate the effect of physical preoperative and postoperative training for the cognitive function in patients undergoing on-pump coronary artery bypass grafting (CABG).

Methods
We analyzed the neurophysiological data from 125 male coronary artery disease (CAD) patients who participated in two sub-studies: the patients with a short preoperative course of treadmill training (n=33) and with postoperative aerobic exercise training (n=92). The study of preoperative physical training included CABG-candidates, which were divided into 2 groups: with (n=17) and without training (n=16). The preoperative physical training consisted of a 5–7 day course of intensive training on a treadmill. The study with postoperative aerobic exercise training enrolled CAD patients, undergoing on-pump CABG, which were divided into 2 groups: with supervised cycling training (n=39) and without training (n=53). Three-week trainings course began on the 14-th day after CABG. The patients with and without preoperative and postoperative physical training were comparable in terms of preoperative characteristics and intraoperative parameters. The patients were underwent the neuropsychological and EEG examination to assess postoperative changes in neurophysiological performance.

Results
The patients with preoperative treadmill training had the POCD incidence at 7–10 days after GABG in 44% cases vs. 74% - in the group without training. The relative risk of POCD developing in the patients with preoperative training was: OR=0.24, 95% CI: 0.07–0.81, Z=2.297, p=0.02. Additionally, the patients with preoperative training demonstrated a lower power in the theta (4–6 Hz) and beta1 (13–20 Hz) frequency ranges 7–10 days after CABG. The patients with postoperative cycling training also demonstrated better cognitive function at 1 month after CABG compared to the patients without training. The incidence of POCD was 21% in the cycling training group vs. 44% – in the group without training. The relative risk of POCD developing was: OR=0.23, 95% CI: 0.09–0.60, Z=3.041, p=0.0024. Also, it was found that the postoperative cycling training group showed a lower percentage theta power increase at 1 month after CABG.

Conclusion
Both the short preoperative and three-week postoperative physical training course can produce beneficial effects on the postoperative neurophysiological status in CABG patients. The engagement of physical training in the rehabilitation program of CABG patients can improve cognitive functioning after cardiac surgery.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): RFBR and Kemerovskaya region
Sport specific incidence and progression of coronary artery calcification among amateur athletes: a follow-up of the Measuring Athletes Risk of Cardiovascular events (MARC) study
Authors: Aengevaeren V , Mosterd A , Braber T.L , Nathoe H.M , Eijsvogels T.M.H , Velthuis B.K 
Published: November 2020

Abstract

Background
Emerging evidence indicates increased coronary atherosclerosis in amateur athletes. However, previous studies were limited by its cross-sectional design and limited sample size, preventing the exploration of sport specific associations with coronary atherosclerosis.

Purpose
We aimed to compare the incidence and progression of coronary artery calcification (CAC) between runners, cyclists and other types of athletes using a prospective cohort study with repetitive measurements.

Methods
Asymptomatic middle-aged men, who previously underwent a sports medical evaluation without abnormalities, were recruited in the Measuring Athlete's Risk of Cardiovascular events (MARC) study (n=318) and were asked to participate in this follow-up study. CT imaging was performed to assess CAC scores. Data was collected between 2012–2014 (i.e. baseline) and 2019–2020 (i.e. follow-up). We categorized participants as runners, cyclists or “other” sports (e.g. water polo, tennis, hockey, etc.) based on their dominant sport performance at baseline.

Results
We included 260 men in this interim analysis, with an average follow-up time of 6.3±0.5 years. Age (61.4±6.4 years), systolic blood pressure (143±20 mmHg), BMI (25.2±2.8 kg/m2), LDL-cholesterol (3.2±0.9 mmol/L), smoking (0.3 [0–8] pack years) and family history of coronary heart disease (28%) did not differ between runners (n=64), cyclists (n=75) and other athletes (n=121, all p&gt;0.05). CAC was present in 137 (53%) men at baseline, which increased to 181 (70%) at follow-up. CAC scores increased from 1 [0–33] to 33 [0–129]. Cyclists had a lower CAC prevalence and CAC scores compared to individuals performing other sports at follow-up (Figure 1). Of those without CAC at baseline (n=123, 47%), cyclists less often developed CAC during follow-up compared with runners (adjusted OR=0.36 [0.17–0.79], p=0.01). In the entire cohort, CAC progression (ln delta CAC+1) was less prominent in cyclists than runners (adjusted B=−0.75 [−1.39 to −0.11], p=0.02), whereas progression of CAC in participants performing other sports did not differ from the runners. In participants with CAC at baseline, cyclists also had less CAC progression than runners (B=−0.49 [−0.95 to −0.02], p=0.04).

Conclusion
Cyclists have a lower incidence and less progression of CAC during 6 years of follow-up compared with runners and individuals performing other sports.
Figure 1. Sport specific CAC prevalence and scores

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Hartstichting
Differentiation between physiological sport adaptation and hypertrophic cardiomyopathy in highly trained athletes using cardiac magnetic resonance
Authors: Czimbalmos C , Nardocci C , Deetjen E , Szabo L , Dohy Z , Toth A , Suhai F.I , Csecs I , Horvath V , Kiss O , Sydo N , Merkely B , Vago H 
Published: November 2020

Abstract

Differentiation between hypertrophic cardiomyopathy (HCM) patients and healthy athletes (HA) is a common clinical conundrum. We aimed to analyze cardiac magnetic resonance (CMR) characteristics of HA, sedentary HCM and athletic HCM patients and to determine CMR parameters which can help to diagnose HCM in athletes.
Male sedentary HCM patients with slightly elevated maximal end-diastolic wall thickness (EDWT 13–18 mm, n=40, 47.6±14.7y) and HA (n=30, 27.5±5.6y) were consecutively enrolled. Additionally, athletes with HCM were enrolled (n=16, 29.6±13.4 y), where a comprehensive investigation confirmed the diagnosis of HCM. We determined conventional CMR parameters (left ventricular (LV) ejection fraction (EF), end-diastolic (EDVi) and end-systolic volume index, mass index (Mi)), derived parameters such as EDWT/LVEDVi, LVM/LVEDV ratio and strain parameters such as global longitudinal (GLS), radial (GRS) and circumferential strain (GCS), SD of peak LS and CS using feature tracking. Presence of late gadolinium enhancement (LGE) was also determined. CMR parameters representing LV hypertrophy pattern or LV function were analyzed using a logistic regression to detect the best CMR parameters to predict HCM in athletes. To differentiate between HA and athletes with HCM optimal cut-off values for CMR parameters were calculated using receiver operating curve analysis.
Comparing the three groups significant differences were found regarding conventional and derived CMR parameters and strain values. None of the HA showed LGE, 75% of athletic HCM and 82% of sedentary HCM patients showed LGE. The univariate regression model showed that LVEF, EDWT, EDWT/LVMi, LVM/LVEDV, GCS, GRS, SD of peak LS and CS are determinants of the diagnosis of HCM among athletes. Multivariate regression revealed that EDWT/LVMi and GCS are independent disease predictors in athletes (p&lt;0.05).
Cut-off value for GCS ≤−32.5 and for EDWT/LVEDVi &gt;0.126 discriminate athletic HCM from HA with a sensitivity of 81.3 and 87.5% (AUC 0.93), and a specificity of 96.7 and 83.3% (AUC 0.95), respectively (Figure 1).
CMR characteristics of sedentary and athletic HCM may differ, therefore establishing diagnostic parameters based on comparison between athletic HCM and HA is essential. CMR based strain and derived parameters may help to differentiate between physiological and pathological left ventricular hypertrophy in athletes.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary (NKFIA) and National Research, Development and Innovation Office (NFKIH) of Hungary.
Aortic stiffness and distensibility in elite athletes: impact of discipline and gender
Authors: Abuli M , Sanz-De La Garza M , Vidal B , Doltra A , Sarquella Brugada G , Carvalho S , Santiago J , Rodas G , Guasch E , Sitges M 
Published: November 2020

Abstract

Background
Aortic remodeling in athletes is variable among sports disciplines with more ascending aorta (Asc Ao) dilatation in endurance (EAs) as compared to power athletes (PAs). Nevertheless, the impact of this differential remodeling on the Asc Ao functional properties is not well established. The aim of this study was to assess the distensibility and stiffness of the ascending aorta in endurance and power elite athletes in order to evaluate if this aortic remodeling implies functional changes.

Methods
119 elite athletes (61 EA and 58 PA, 49% female sex, mean age: 18.7±7.1 years) underwent standardized pre-participation screening with 12 lead ECG, transthoracic echocardiography and maximum stress test. Asc Ao diameter was measured from parasternal long axis views in 2D echocardiography. The aortic distensibility index (ADi) was calculated as 2 × (systolic Asc Ao diameter − diastolic Asc Ao diameter) / (diastolic Asc Ao diameter) × (pulse pressure) (cm–2 dyn–1 10–6). Aortic stiffness (AS) index was defined as Ln (systolic blood pressure/diastolic blood pressure) / (systolic Asc Ao diameter − diastolic Asc Ao diameter)/diastolic proximal Asc Ao diameter.

Results
Globally, EA presented larger AscAO, both in absolute and indexed values, than PA (28±3.0 vs 26±3.0cm, p&lt;0.001 and 16.4±1.5 vs 15.7±1.9cm, p&lt;0.05, while were no differences in AS or ADi) (Figure 1A). Nevertheless, ADi in male EAs was higher than in male PAs (ADi: 4.3±1.7 vs 3.2±1.3 cm2/dyn/10–6, p&lt;0.05) and AS was lower (AS: 4.7±1.7 vs 6.3±3.8, P&lt;0.005) (Figure 1B and 1C). Female athletes presented higher ADi (ADi: 4.7±1.9 vs 4.0±1.6 cm, p&lt;0.05) and a trend towards lower AS (4.8±2.9 vs 5.1±2.6, p: 0.4) than male athletes. There were no differences in AS or ADi between female EAs and PAs.

Conclusion
Male EAs showed an increased aortic distensibility with lower stiffness as compared to that observed in male PAs. This difference was not observed in female EAs and PAs, potentially due to better baseline distensibility with less room for improvement with endurance training.

Funding Acknowledgement
Type of funding source: None
Evaluation of cardiac titin expression after long-term exercise in a rat model
Authors: Kellermayer D , Olah A , Ruppert M , Barta B.A , Sayour A.A , Virag-Tulassay E , Kellermayer M , Merkely B , Radovits T 
Published: November 2020

Abstract

Introduction
The main role of the giant elastic protein titin is to provide passive stiffness to striated (i.e. cardiac and skeletal) muscles. The adult cardiac muscle contains two titin isoforms: the more compliant N2BA and the stiffer N2B isoforms. Titin reduces passive stiffness in cardiac muscle by increased expression of the more compliant N2BA isoform (elevated N2BA:N2B ratio). Moreover, decreased passive stiffness is associated with increased exercise tolerance. Long-term exercise induces physiological adaptation of the heart, termed athlete's heart. Currently, there is limited data of titin's role in the athlete's heart.

Aims
Our aim is to evaluate exercise-induced morphological and functional changes of the heart. Furthermore, to determine the N2BA:N2B ratio in the rat model of athlete's heart.

Methods
Rats were divided into exercised (n=12) and control (n=12) groups. Athlete's heart was induced by a 12-week-long swim training (200min/day). The control group swam 5 min/day. Following the training period cardiac changes were assessed by echocardiography. In vivo cardiac function was examined by left ventricular (LV) pressure-volume (P-V) analysis. Titin isoform expressions were detected by sodium-dodecyl-sulfate (SDS)-agarose gel electrophoresis.

Results
Echocardiography and post-mortem measured cardiomyocyte diameters confirmed athlete's heart and LV hypertrophy in exercised rats. P-V analysis showed improved contractility, active relaxation and mechanoenergetics in the exercised group. The N2BA:N2B titin ratio was significantly increased in exercised rats compared to controls (0.28 vs. 0.21, p&lt;0.05).

Conclusions
Our results confirm the morphological and functional changes of the athlete's heart. The increased ratio of N2BA:N2B titin corresponds to a more compliant heart in the exercised rats.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Research, Development and Innovation Office of Hungary (K 120277) and the ÚNKP-19-3-I New National Excellence Program of The Ministry For Innovation and Technology.
Impact of a 246 km ultra-marathon race on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber relationships
Authors: Pagourelias E , Christou G , Anifanti M , Sotiriou P , Christou K , Koutlianos N , Deligiannis A , Vassilikos V , Kouidi E 
Published: November 2020

Abstract

Background
It is well documented that prolonged intense exercise such as a marathon, transitorily alters cardiac function. However, the impact of ultra-endurance (UE) exercise on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber functional relationships has not yet been thoroughly investigated.

Purpose
The aim of the study was the evaluation of the acute effects of UE exercise on longitudinal deformation of all cardiac chambers and on intra-, inter- and atrioventricular functional relationships.

Methods
Echocardiographic assessment was performed the day before and at the finish line of “Spartathlon”: a 246 Km ultra-marathon. 2D speckle-tracking echocardiography was performed in all 4 chambers during the same cardiac cycle, allowing a simultaneous strain-time data display of all cardiac chambers (Figure 1). Peak global deformation values and temporal parameters adjusted for the heart rate were extracted from the derived curves, while a segmental analysis for left (LV) and right ventricle (RV) was also performed.

Results
Out of 60 participants initially screened, 27 athletes (17 male, age 45±7 years) finished the race in 33:34±1:59 hours. Both LV (−20.9±2.3 pre- to −18.8±2% post-, p=0.009) and RV global strains (−22.9±3.6 pre- to −21.2±3% post-, p=0.04) decreased post-race, even though remained within normal range for the 85% of the participants. Peak atrial strains [right (RA) and left (LA)] did not change (p=0.12 and 0.95). Basal and mid segmental strain values significantly decreased post-race, while both LV and RV apical strain values remained unaffected (p=0.899 and p=0.46, accordingly) (Figure). Concerning interchamber relationships, RV and RA strain curves were constantly larger in magnitude than those of the LV and LA, with RV/LV, LV/LA, RV/RA and RA/LA peak values' ratios remaining unchanged from pre- to post-race. Finally, although right chambers' time-to-peak values were shorter compared to the left ones, all chambers' strain curves peaked later post-race (p&lt;0.001 for all).

Conclusions
Despite subtle changes in LV and RV strain, 4-chamber deformation values remained within normal range even after running a 246 km ultra-marathon. Following a segmental analysis, this finding could be explained for both ventricles by a preservation of apical deformation. Additionally, inter- and atrioventricular concordance was also maintained.
Figure 1

Funding Acknowledgement
Type of funding source: None
Can quantitative 18F-FDG PET/CT and serum cytokine analysis differentiate ARVC from cardiac sarcoidosis?
Authors: Abbas H , McKiddie F , Kouri M , Duncan L , Fong M , Wilson E , Norris K , Matheson J , Scally C , Dempsey O , Denison A , Wilson H.M , Dawson D.K , Broadhurst P 
Published: November 2020

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) and Cardiac Sarcoidosis (CS) may both cause malignant arrhythmia and sudden death, but differentiating the two can be difficult.

Purpose
To investigate the role of quantitative FDG PET/CT at distinguishing ARVC from CS, and explore whether addition of an inflammatory panel correlates with PET uptake, aiding diagnosis.

Methods
10 patients with CS, 10 with ARVC were enrolled. Participants were prospectively studied with PET/CT. LV uptake was quantified using software and a 17-segment model, measuring maximum standardised uptake (SUVmax) and mean myocardial uptake, comparing these to a local normal reference range (21 volunteers) using a z-score. Blood levels of IL-1b, IL-6, IL-8, IL10, IL-12p40, MCP-1, TGFb, GRO, TNFa, IFNy, FGF2, PDGF were measured using ELISA, compared with 10 healthy controls.

Results
There were no significant differences in cytokine levels between CS and ARVC; most cytokine levels were higher in CS, except IL-6, IL-8 and MCP-1 in ARVC (Table 1). Increased PET uptake was noted in 1 segment of 1 ARVC patient, and in 1–2 segments of 5 CS patients (z-scores 2.25 SD; 2.15–2.38 SD). No pattern of uptake distinguished ARVC from CS, qualitatively assessing LV polar maps (Figure 1A, B). SUVmax and mean uptake were higher in CS vs. ARVC (p&lt;0.05; p=0.13). No significant correlation between cytokine levels and PET uptake was detected (Figure 1C, D).

Conclusion
Quantitative PET/CT uptake and a blood inflammatory panel did not have utility in differentiating the two conditions in our population. There was generally more PET and serum inflammatory activity in CS.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): NHS Endowments
Increased mortality in women with severe aortic stenosis and low ejection fraction
Authors: Paquin A , Annabi M.-S , Bienjonetti-Boudreau D , Pibarot P , Clavel M.-A 
Published: November 2020

Abstract

Background
Women with severe aortic stenosis (AS) tend to be operated with more advanced valvular heart disease. They also have worse survival after aortic valve replacement (AVR). This difference between sexes in surgical referral and its relationship to mortality have not been previously studied in patients with severe AS and low left ventricular ejection fraction (LVEF).

Purpose
To assess sex differences in patients with severe AS and low LVEF, and to evaluate their potential association with mortality.

Methods
This is a retrospective study of consecutive patients presenting with a diagnosis of severe AS and low LVEF (≤50%) on echocardiogram, at the Quebec Heart and Lung Institute between 2004–2015. Patients were excluded if they had congenial or rheumatic heart disease, and/or more than moderate aortic regurgitation. Patients were compared according to sex for incidence of AVR and long-term all-cause mortality with univariate (Kaplan-Meyer with log-rank test), and multivariate analysis (Cox regression model) adjusting for baseline comorbidities, LVEF and severity of valvular disease.

Results
Our database had a total of 1129 patients, of which 578 were included in the analysis. There were 149 women (26%). Mean follow-up time was 3.10±3.04 years (1795 patient-years). There were 279 AVR and 284 deaths. Women were older (77±11 vs 74±10 years, p=0.004), and had less coronary artery disease (60% vs 79%, p&lt;0.001) and dyslipidemia (55% vs 72%, p&lt;0.001). Women had comparable severity of AS at baseline, with better LVEF (37% vs 35%, p=0.02). In univariate analysis, there was a strong tendency for increased mortality in women compared to men (p=0.06). After comprehensive baseline adjustement, female sex was predictive of mortality (HR 1.33 [1.00–1.75], p=0.04). Women were also less likely to be operated than men (HR 0.70 [0.51–0.94], p=0.02). After further adjustment for AVR as a time-dependent variable, there was only a trend toward the significance of sex as a predictor of mortality (p=0.12). In a sex-specific analysis of predictors of mortality, LVEF was predictive of mortality in women (HR 0.97 [0.94–0.99], p=0.007), while not in men (0.99 [0.98–1.01], p=0.51).

Conclusions
Despite adjustment for comorbidities and AS severity, women were less likely to be referred to AVR and had a higher overall mortality. After adjustment for AVR, female sex was no longer a predictor of mortality, underlying the negative impact of the lack of treatment in women with decreased LVEF. Thus underrecognition and suboptimal management of severe AS in female patients with low LVEF should be further investigated to identify contributing factors and possible solutions.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Dr Clavel has received a grant from the Heart and Stroke Foundation of Canada
Sex differences in door-to-balloon time and long-term adverse events after percutaneous coronary intervention for acute coronary syndrome: a sub-study from the Prospective JAMIR study
Authors: Kimura T , Ito T.I , Honda S , Nishihira K , Kojima S , Takegami M , Asaumi Y , Suzuki M , Kosuge M , Takahashi J , Sakata Y , Takayama M , Sumiyoshi T , Kimura K , Yasuda S 
Published: November 2020

Abstract

Background
Shortening of onset to admission time (OAT) and door-to-balloon time (DBT) is associated with lower adverse cardiac event after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Bleeding event also results in poor outcome in patients with AMI after primary PCI. Little is known about sex differences in DBT and ischemic, bleeding events after AMI.

Purpose
This study aimed to assess the sex differences of OAT, DTB and adverse cardiac event, incident of bleeding event after primary PCI in patients with AMI.

Methods
The Japan AMI Registry (JAMIR) is a multicenter, nationwide, prospective registry enrolling patients with AMI from 50 institutes between December 2015 and May 2017. Primary endpoints of this study were ischemic event (composite of cardiovascular death, myocardial infarction and ischemic stroke) and bleeding event (BARC type 3 or 5,).Median follow-up period was 12 months.

Results
A total of 3,411 patients were enrolled at first. Among them, 329 patients without treated with PCI and 199 patients missing OAT time were excluded from this study. A total 2883 patients of men (n=2240, 77.7%) and women (n=643, 22.3%) were enrolled. OAT and DBT of women were significantly longer than that of men (OAT: 130min, interquartile range 62–300 min vs. 155 min, interquartile range 69–350 min, p=0.040, DBT: 67 min, interquartile range 50–95 min vs. 75 min, interquartile range 53–120 min, p&lt;0.001). There was no significant difference in ischemic events between men and women (7.1% vs. 7.5%, log-rank p=0.741, Figure 1). Multivariate Cox regression analysis showed female sex was significantly associated with lower ischemic event (hazard ratio 0.57; 95% confidence interval 0.38–0.85; p=0.007). Bleeding event of women was significantly higher than that of men (BARC type 3 or 5: 3.8% vs. 7.8%, p&lt;0.001, Figure 2).

Conclusion
The real-world database of the JAMIR showed that the female sex was significant factor for the delay in primary percutaneous coronary intervention and high incident of bleeding, however, ischemic event was lower than that of male sex. Sex difference appears to be associated with ischemic and bleeding event after acute myocardial infarction.

Funding Acknowledgement
Type of funding source: None