bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care results of TELEREH-HF randomized clinical trial
Authors: Piotrowicz E , Mierzynska A , Pencina M , Opolski G , Zareba W , Banach M , Kowalik I , Orzechowski P , Szalewska D , Pluta S , Irzmanski R , Glowczynska R , Kalarus Z , Jaworska I , Piotrowicz R 
Published: November 2020

Abstract

Background
Heart failure (HF) is a clinical syndrome associated with physical capacity impairment and poor quality of life (QoL). The hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation and homemonitoring of implantable devices might be an option to improve QoL. Purpose to investigate the influence of HCTR on various facets of QoL in HF pts in comparison to usual care (UC).

Methods
The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF pts (NYHA I-III, LVEF≤40%). Patients were randomized 1:1 to HCTR plus UC or UC. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home) or UC with observation. The psychology telecare had a form of supportive psychotherapy via phone. The Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after intervention/observation.

Results
HCTR group showed significant improvement in overall QoL, physical domain, and 4 areas of QoL (physical functioning [PF], role functioning related to physical state, general health, vitality). A significant positive change in QoL in UC group was observed in vitality and social functioning. There were significant differences in QoL after intervention/observation between groups. Results showed higher improvement in HCTR for overall QoL, physical domain and 3 areas of QoL (PF, role functioning related to physical state and bodily pain [BP]), Table 1.

Conclusion
In comparison to UC, HCTR resulted in significant improvement in overall QoL, physical domain and 3 specific areas of QoL: PF, role functioning related to physical state and BP.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development, Warsaw, Poland
Effects of cardiac rehabilitation on quality of life and exercise capacity in patients with coronary artery disease: do women benefit equally?
Authors: Deljanin Ilic M , Stojanovic M , Igrutinovic Novakovic J , Vukovic A , Igic I , Ilic S 
Published: November 2020

Abstract

Background
Quality of life is an important factor in the etiology and prognosis of coronary artery disease (CAD) as well as to evaluate effects of different interventions in cardiovascular diseases. Improvement in quality of life (QOL) is an important goal for patients (pts) participating in cardiac rehabilitation (CR).

Purpose
To examine whether women and men benefit equally from comprehensive CR in terms of QOL and exercise tolerance in pts with CAD.

Methods
We enrolled 1362 CAD patients (mean age 60.4±9.5 years). All patients participated in a comprehensive three weeks CR program at residential center and in all pts before and after CR exercise test was performed. Psychological dimensions were assessed at baseline and post-CR by validated questionnaire Short-Form 36 Health Status Survey (SF-36). All data were analyzed based on gender.

Results
Women participate in CR in lower percentage than man: 336 (24.7%) women vs 1026 (75.3%) men. Out of 1362 CAD pts, SF-36 was performed in 119 pts (75.6% men and 23.5% women). Before CR, physical function (PF), fatigue (F) and social functioning (SF) were significantly higher in men than in women (P&lt;0.001; &lt;0.05 and &lt;0.01). After CR, scores of all domains of the SF-36 were significantly improved in all 119 pts (P&lt;0.001). However, compared to the baseline, and based on gender, women had greater improvement than men in PF: 36.6%vs 11.4%, physical limitation (PL): 119.6 vs 52.2%, emotional well-being (EWB): 12.9% vs 7.5%, SF: 23% vs 4.9%, body pain (BP): 16.4%vs 4.9%, F: 14.3%vs 10.9% and health change (HC): 34%vs 17.9%. At the end of stationary CR there was no significant difference in domains of the SF-36 between men and women. At baseline men had significantly higher level and duration of exercise test than women (both P&lt;0.001). After CR, level and duration of exercise test increased significantly in 1026 men ( by 12% and by 16.5%; both P&lt;0,001), and 336 women (by 18% and by 21%; both P&lt;0.001), and it was still higher in men than women after CR (both P&lt;0.001).

Conclusions
Study demonstrated that women are generally less participate in CR than men. Results indicated that CR improve QOL in CAD pts, especially in women, which was expressed through higher improvement in PF, PL, EWB, SF,BP, F and HC than in men. Those positive changes in QOL were associated with significant improvement in exercise capacity in men as well as in women. CR needs to improve in referral and participation of women.

Funding Acknowledgement
Type of funding source: None
Quality indicators of a cardiac rehabilitation program in women with coronary heart disease
Authors: Juanes Dominguez I , Tojal Sierra L , Fernandez De Leceta Z , Saez De Buruaga E , Garcia S , Torres M , Etxebarria S , Pasalodos L.M , Alonso A.M , Bello M.C 
Published: November 2020

Abstract

Introduction
Cardiac rehabilitation programs (CRP) are well known to improve functional status and prognosis after a cardiovascular event. This programs are class IA recommendation. However, many studies have demonstrated that women are less likely to stick to a CRP.

Purpose
To compare baseline characteristics between men and women participating in a cardiac rehabilitation program and to determine whether there are gender differences in the benefits obtained after the program.

Methods
Using data from our Department of CRP, we analysed a total of 1091 patients referred between 2015 and 2018 to our center CRP after a cardiovascular diagnosis. Clinical, analytical and echocardiographic outcomes were collected. We defined benefit as the achievement of the target levels established for each cardiovascular risk factor (CVRF) as well as improvement in the exercise capacity. This capacity was evaluated with exercise tests and maximum O2 uptake at the beginning and at the end of the CPR.

Results
Between 2015 and 2018, 189 (17.3%) of them women with a mean age of 62 years were enrolled in the CRP. There were no significant gender differences in mean age or incidence of CVRF. Likewise, there weren't differences in cardiovascular diagnosis, risk stratification, left ventricular ejection fraction or exercise test performed before the program.
In the results after CRP there were no important gender differences in the percentage of patients who achieved the quality indicators described as HbA1c &lt;7.0%, systolic arterial pressure &lt;140 mmHg, diastolic arterial pressure &lt;90 mmHg. Percentage of LDL cholesterol &lt;70 mg/dl was significantly higher in male patients. Both in men and women an improvement of the second exercise test result was observed.

Conclusions
1. Men and women who suffer from a coronary heart disease have similar clinical characteristics.
2. Among patients with coronary heart disease who attended a cardiac rehabilitation program there were no significant gender differences in the benefits obtained after the program.

Funding Acknowledgement
Type of funding source: None
Implementation study of CT calcium score in patients with atypical angina pectoris and non-specific thoracic complaints in primary care: rationale, objectives, and design of the CONCRETE study
Authors: Koopman M.Y , Martens S.M.P , Willemsen R.T.A , Van Bruggen R , Dinant G.J , Van Der Harst P , Doggen C , Oudkerk M , Van Ooijen P , Gratama J.W , Braam R , Vliegenthart R 
Published: November 2020

Abstract

Background
Identifying and excluding coronary artery diseases (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). It is unclear what the best diagnostic and prognostic strategy is for these patients in primary care. Computed Tomography coronary calcium scoring (CT CCS) has a high sensitivity for early diagnosis and exclusion of CAD. However, CT CCS has not been tested in a primary care setting. In the CONCRETE study, the impact of direct access of GPs to CT CCS on management and diagnosis will be investigated. CONCRETE is the abbreviation for “COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain.” Currently, we present the rationale, objectives and design of this study.

Purpose
The purpose of CONCRETE is to study the implementation of CT CCS in primary care, and determine the effects on GP office level. The primary objective is to determine the increase in detection/treatment rate of CAD in GP offices with CT CCS, compared to GP offices with standard of care.

Methods
CONCRETE is an implementation study with a cluster randomized design, in which direct access to CT CCS in a group of 40 GP offices is compared to the standard of care in a control group of 40 GP offices. In both arms, inclusion of 800 patients with atypical angina pectoris and non-specific thoracic complaints is intended.

Results
Recruitment of GP offices and participants started in January 2019. First results will be presented.

Conclusion
CONCRETE will determine whether access to CT CCS will lead to earlier and more effective detection or exclusion of CAD in GP patients with atypical angina pectoris and non-specific thoracic complaints, in comparison to the standard of care. Implementation of the study findings could initiate a change in the (Dutch) GP healthcare policy, for these patients in primary care.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation
Traditional cardiovascular risk factors and glomerular filtration rate in patients with rheumatoid arthritis
Authors: Madrakhimov S.B , Shukurov U.M , Ubaydullaev S.A 
Published: November 2020

Abstract

The leading cause of premature death in rheumatoid arthritis (RA) is cardiovascular complications associated with vascular atherosclerosis. Even a slight decrease in glomerular filtration rate (GFR) is an important independent risk factor for cardiovascular complications.
The purpose of the study: to determine GFR in patients with RA, to identify the relationship between GFR and traditional risk factors for the development of cardiovascular complications.

Methods
The study included 58 patients with RA aged 21 to 60 years, who do not have concomitant kidney diseases, arterial hypertension (AH) of stage III, and diseases accompanied by the development of secondary nephropathy. GFR was calculated using the CKD-EPI formula. All patients were evaluated for traditional cardiovascular risk factors: hypertension, dyslipidemia, a complicated hereditary history of early development of cardiovascular diseases, overweight, and smoking. The European SCORE scale and the Reynolds Risk Score (RRS) predictive scale in the EULAR modification were used to assess the total risk of cardiovascular complications.

Results
Women predominated among the patients – 61 (86.6%). The mean age of patients is 45 years. Seropositive patients with rheumatoid factor prevailed, with moderate and high activity of the process, III x-ray stage according to Steinbroker. In 36 (62%) patients, GFR was in the range from 60 to 89 ml/min/1.73m2, in 38% of patients-more than 90 ml/min/1,73m2. The average GFR in patients with RA was 88.43±16.13 ml/min/1.73m2, in the comparison group-83.54±15.22 ml/min/1.73m2 (p=0.063). Arterial hypertension was diagnosed in 40 (68.9%) patients with RA: 70.2% of women and 55.3% of men. The level of total cholesterol in patients with RA is significantly higher than in the comparison group (p&lt;0.001), even in patients younger than 40 years, the level of total cholesterol is higher than in those without arthritis (5±1.15 and 4.14±0.21 mmol/l, p=0.027). The average value of the SCORE scale in RA patients and in the comparison group is generally comparable, and when compared by age periods. In patients younger than 40 years who suffer from hypertension, GFR is lower than in patients of the same age, but without hypertension: 86 [79; 101.5] and 104.5 [101; 112] ml/min/1.73m2, respectively, p=0.043. Relationships between GFR and traditional cardiovascular risk factors were identified: body mass index (r=−0.414; p&lt;0.001), total cholesterol levels (r=−0.402; p&lt;0.001), low-density lipoproteins (r=−0.331; p=0.013), triglycerides (r=−0.283, p=0.028), systolic BP (r=−0.257; p=0.027), diastolic BP (r=−0.255; p=0.029) at the time of the study, the value of the Score scale (r=−0.529; p&lt;0.001) and RRS (r=−0.341; p=0.031).

Conclusion
Most patients with rheumatoid arthritis showed a decrease in glomerular filtration rate, and GFR is associated with traditional risk factors for cardiovascular events.

Funding Acknowledgement
Type of funding source: None
Cardio-pulmonary-exercise testing, stress-induced right ventricular diastolic dysfunction and exercise capacity in non-severe chronic obstructive pulmonary disease
Authors: Cherneva Z , Denchev S.D , Cherneva R.C.H 
Published: November 2020

Abstract

Background
Data regarding echocardiographic structural and functional abnormalities in right ventricular diastolic dysfunction (RVDD), cardio-pulmonary exercise testing (CPET) abnormalities and their association with exercise capacity among non-severe chronic obstructive pulmonary disease (COPD) patients without pulmonary arterial hypertension (PAH) at rest is limited.

Purpose
The aim of the study was to find echocardiographic parameters of the right ventricle that may be predictors for stress RVDD in non-severe COPD patients without PAH and to determine their correlation with the 6-minute walking test (6-MWT).

Methods
We applied a ramp protocol of CPET in 104 patients. Dynamic hyperinflation (ICdyn) was measured. Emphysema was evaluated by Goddard score. Echocardiography was performed before and 1–2 minutes after peak CPET. Stress RVDD was assumed if peak E/e'&gt;6.0. Exercise capacity was evaluated by the 6-MWT. ROC analysis detected the best cut-off values of the RV echocardiographic predictors for stress RVDD. Multivariate analysis with covariates left ventricle (LV) (LV E/A at rest; LV E/e' at rest; stress LV E/A; stress LV E/e'), lung function (FEV1), ICdyn, Goddard score, age, sex, and BMI was performed. A p-value &lt;0.05 was accepted of statistical significance.

Results
78% of the patients had stress RVDD. RV wall thickness (RVWT), right atrial volume index (RAVI) and exercise systolic PAH were significantly higher in COPD patients with stress RVDD. After multivariable regression analysis RAVI and rest RV E/e' ratio &gt;5.1 remained independent predictors for stress RVDD; RAVI and RVWT were independent predictors for diminished exercise capacity (6-MWT).

Conclusion
There is a high prevalence of stress induced RVDD in non-severe COPD patients without PAH at rest. RAVI and rest RV E/e'&gt;5.1 are the best predictors for stress E/e' &gt;6; RAVI and RVWT are associated with decrements in exercise capacity.

Funding Acknowledgement
Type of funding source: None
Inhibition of interleukin-6 by tocilizumab improves endothelial glycocalyx and myocardial work index in patients with rheumatoid arthritis
Authors: Ikonomidis I , Pavlidis G , Katsimbri P , Thymis J , Birba D , Kostelli G , Katogiannis K , Makavos G , Andreadou I , Frogoudaki A , Vrettou A.R , Boumpas D , Iliodromitis E 
Published: November 2020

Abstract

Background/Introduction
Tocilizumab, an interleukin-6 receptor blocker is used for the treatment of rheumatoid arthritis (RA).

Purpose
We investigated the effects of tocilizumab on endothelial glycocalyx and myocardial function in patients with RA.

Methods
Eighty patients with RA (age: 64±9 years) were randomized to tocilizumab (n=40) or prednisolone (n=40)for 3 months. We measured at baseline and 3 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI), c) global LV longitudinal strain (GLS), longitudinal systolic (LongSr) and diastolic (LongSrE) strain rate, d) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) using speckle tracking imaging.

Results
At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared with baseline, patients under tocilizumab had reduced PBR (2.14±0.2 vs. 1.97±0.2μm), PWV (11±3 vs. 10.3±2m/s), cSBP (134±18 vs. 129±16mmHg) and LongSrE (0.91±0.3 vs. 1±0.3 1/s) at 3 months (p&lt;0.05). There were no statistically significant differences in the above measured markers in patients under prednisolone (p&gt;0.05) (Table). Compared with prednisolone, tocilizumab treatment achieved a greater increase of GLS (8.5% vs. 2.4%), GWI (12.2% vs. 2.7%), GCW (10.3% vs. 5.9%) and a greater reduction of GWW (−30% vs. −13%) (p&lt;0.05 for all comparisons), despite a similar reduction in C-reactive protein post-treatment. The percent decrease of PBR was associated with the percent decrease of cSBP (r=0.46), PWV (r=0.37) and reversely related with the percent improvement of GLS (r=−0.43) and GWI (r=−0.39) (p&lt;0.05).

Conclusions
IL-6 inhibition by tocilizumab improves endothelial and vascular function leading to a greater increase of effective myocardial work compared to prednisolone in patients with RA.

Funding Acknowledgement
Type of funding source: None
Coronary vasomotor dysfunction is associated with worse outcomes in patients with inflammatory disease
Authors: Weber B , Brown J.M , Divakaran S , Stevens E , Hainer J , Bibbo C , Taqueti V , Blankstein R , Dorbala S , Massarotti E , Costenbader K , Liao K , Dicarli M 
Published: November 2020

Abstract

Background
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. This excess CV risk is associated with traditional risk factors, glucocorticoid treatment, and systemic inflammation. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. It is not clear if coronary vasomotor dysfunction would be associated with worse clinical outcomes in systemic autoimmune inflammatory conditions.

Purpose
We tested the hypothesis that impaired coronary flow reserve (CFR), which in the absence of flow-limiting obstructive coronary artery disease (CAD) reflects vasomotor dysfunction, among patients with SLE, RA, and PsO is associated with worse clinical outcomes.

Methods
We included patients with RA, SLE, and PsO who underwent clinically indicated rest/stress myocardial perfusion positron emission tomography (PET) at a large academic medical center from 2006 to 2019. Patients with an abnormal myocardial perfusion study (summed stress score &gt;3) or left ventricular ejection fraction &lt;40% were excluded. CFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to the MBF at rest and adjusted for baseline heart rate and blood pressure.

Results
Among the 175 patients (median age 65.1 years, 80% female) in the cohort, 24% had SLE, 35% PsO, and 41% RA. There was no difference in mean CFR between patients with RA, SLE, or PsO. Over a median follow-up of 8.5 years after PET, there were 47 deaths. Patients in the lowest and middle tertile (CFR &lt;2.18) had a higher all-cause mortality when compared with the highest (Figure 1), and this association remained significant after adjusting for age and a composite clinical score incorporating sex, symptoms, and CV risk factors (lowest vs. highest tertile: HR 2.8; 95% confidence interval 1.2–6.5; p=0.01). CV risk factors such as diabetes, hypertension, obesity, tobacco use, and a family history of CAD were not significantly different across CFR tertiles, suggesting that inflammatory-disease specific risk factors may contribute to coronary vasomotor dysfunction.

Conclusions
In patients with systemic inflammatory disease, coronary vasomotor dysfunction was associated with worse outcomes independent of traditional CV risk factors and may have utility as a marker of CV risk among patients with inflammatory disease.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32HL094301-02 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”
Sex difference in left ventricular global longitudinal strain in patients with systemic sclerosis: association with outcomes
Authors: Gegenava T , Leeuwen N , Wijngaarden S , Vries-Bouwstra J , Cassani D , Tanner F , Jordan S , Distler O , Bax J.J , Delgado V , Ajmone-Marsan N 
Published: November 2020

Abstract

Background
Cardiac involvement is an important cause of hospitalization and mortality in patients with systemic sclerosis (SSc). Advanced echocardiographic measures such as global longitudinal strain (GLS) have already demonstrated to help identifying cardiac involvement and improve risk-stratification in these patients. However, possible sex differences in echocardiographic parameters including GLS have not been explored so far.

Purpose
To compare standard and advanced (GLS) echocardiographic parameters between male and female patients with SSc and evaluate their association with cardiovascular outcomes.

Methods
A total of 408 patients (345 females, 54±14 years old and 63 males 51±13 years old) were included in the study. The study endpoint was all-cause mortality combined with hospitalisations for heart failure, myocardial infarction, coronary interventions, device implantations, arrhythmias, cerebral infarction and peripheral ischemic disease.

Results
Males and females were comparable in terms of cardiovascular risk-factors and comorbidities but showed differences in terms of disease characteristics: greater modified rodnan skin score and higher creatine phosphokinase was observed in males as compared to females, although high NT-proBNP and deteriorated glomerular filtration rate was more prevalent in females. By standard echocardiography, male SSc patients were characterised by greater left ventricular (LV) volumes, but no difference was observed in LV ejection fraction. By advanced echocardiographic analysis, LV GLS was more preserved in female patients (−21% (IQR: −22% to −20%) as compared to males (−20% (IQR −21% to −19%), p&lt;0.001. After median follow-up of 39 months (IQR: 22–66), the combined endpoint occurred in 84 patients, males were affected significantly more frequently as compared to females (20 (32%) vs. 64 (19%), p=0.017). Kaplan-Meier survival analysis showed that impaired LV GLS (based on median value −20%) was associated with higher cumulative rates of all-cause mortality both in males and females with SSc (females: Chi-Square = 80.307 Log Rank &lt;0.001; males: Chi-Square = 4.493 Log Rank = 0.034) (Fig. 1). In univariate cox regression analyses, LV GLS was also significantly associated with the endpoint both in males and females (in males HR: 1.291, 95% CI: 1.033–1.612, p=0.025, in females HR: 1.386, 95% CI: 1.290–1.491, p&lt;0.001).

Conclusions
Our study shows that among patients with SSc, LV GLS is more impaired in males as compared to females but in both groups is associated with higher prevalence of death and cardiovascular hospitalization.

Funding Acknowledgement
Type of funding source: None