bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2502Intensity and duration of lifestyle interventions for long term weight loss and association with mortality: a meta-analysis of randomised trials
Authors: Benatar J R , Singh N , Stewart R A H 
Published: October 2019

Abstract

Background
Lifestyle interventions are widely recommended for weight management, particularly in patients with diabetes and cardiovascular disease. The intensity and duration of interventions needed to achieve sustained weight reduction are uncertain.

Objectives
To investigate the importance of the frequency and duration of lifestyle interventions for achieving weight loss over ≥ one year, and to evaluate associations between weight loss and all-cause mortality.

Method
Meta-analysis of randomised trials published in English-language journals from 1980 to June 2018 that assessed lifestyle compared to control interventions on weight loss in ≥100 subjects, and which reported weight change and mortality for ≥ one year.

Results
31 randomised trials with a total of 20 816 overweight or obese participants, 70% of whom had cardiometabolic risk factors, were included. The weighted mean difference in body weight between diet and lifestyle intervention and control arms at 1 year was −3.65, 95% confidence interval (CI) −4.66, −2.65 kg, and at 3 years was −2.45, 95% CI: −3.73, −1.17kg. Weight loss at one year was greater in studies with more compared to fewer interventions (>vs ≤28/year (−4.53 [IQR −5.93, −3.12] kg vs −2.38 [−3.98, −0.78] kg, p=0.001). There were 593 deaths (rate ∼0.3%/year), and the odds ratio for mortality for weight loss interventions compared to the controls was 0.86 (95% CI 0.74, 1.01), p=0.09.
Table 1. Association with intervention intensity with weight loss achieved and mortality Number of interventions in first year N studies# Number of patients Mean difference p Total deaths Odds ratio p Random effect model (kg) (95% CI) Fixed effect model (95% CI) ≤6 3 510 −0.84 [−1.40, −0.28] <0.0001 5 1.45 [0.22, 9.40] 0.7 7–12 6 2022 −2.04 [−3.24, −0.84] <0.0001 10 1.34 [0.35, 5.16] 0.67 13–24 6* 3490 −2.46 [−5.59, 0.67] <0.0001 23 1.20 [0.49, 2.96] 0.69 ≥25 18 13717 −3.53 [−4.13, −2.92] <0.0001 555 0.84 [0.71, 1.00] 0.05 Total 31 100 −2.98 Total 31 *2 studies reported mortality but not weight loss.

Conclusion
Lifestyle programs with frequent patient interactions sustained over a year or more achieve modest weight loss. The level of intervention needed for clinically meaningful weight reduction may be unrealistic for most medical practices. There is a modest non-significant reduction in mortality with lifestyle programs, but limited data on whether lifestyle interventions for obesity decrease mortality in persons at higher risk because of cancer, heart failure or ischaemic heart disease.

Acknowledgement/Funding
None
P2503Clinical outcomes of discordant exercise electrocardiographic and echocardiographic findings in patients with chest pain and no history of coronary artery disease
Authors: Im E.-S , Sohn I.-S 
Published: October 2019

Abstract

Purposes
The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared to concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD).

Methods
A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into four groups: ECG−/Echo− (negative ECG and Echo), ECG+/Echo− (positive ECG and negative Echo), ECG−/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death.

Results
MACEs were similar between ECG−/Echo− and ECG+/Echo− groups. Compared to ECG+/Echo− group, ECG−/Echo+ group had more MACEs [adjusted hazard ratio (HR) adjusted by clinical risk factors (95% confidence interval), 3.57 (1.75–7.29), p<0.001]. Compared with ECG+/Echo+ group, ECG−/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs [HR, 0.49 (0.29–0.81), p=0.006].

Conclusions
Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared to exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes
P2509Less effect of cardiac rehabilitation for elderly cardiac patients with lower educational attainment
Authors: Kjesbu I , Mikkelsen N , Sibilitz K , Wilhelm M , Gil C P , Iliou M C , Zeymer U , Meindersma E P , Ardissino D , Van Der Velde A E , Van't Hof A W J , De Kluiver E P , Prescott E 
Published: October 2019

Abstract

Background
Previous analyses from EU-CaRE study have shown that elderly cardiac patients with basic education have a greater burden of cardiovascular risk factors and a lower exercise capacity at baseline of cardiac rehabilitation (CR). We hypothesize that participation in CR will diminish this socioeconomic gap.

Purpose
To describe if educational level predicts the benefits of CR in an elderly population in Europe.

Methods
The observational EU-CaRE study is a prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Consecutive patients age 65 or older with coronary heart disease or valve surgery participating in CR were included. Data were obtained at baseline (T0) and at the end of CR (T1) and include risk factors for cardiovascular disease, clinical and psychological assessment, medical treatment and exercise capacity. Patients were divided into basic, intermediate and higher educational levels. We compared changes from T0-T1 by multiple regression models.

Results
A total of 1621 (99% of included) patients were eligible for follow-up analyses. At baseline patients with basic education had more diabetes, higher BMI, lower exercise capacity (VO2 peak) and higher scores for depression (GAD) and anxiety (PHQ-9). At T1 they had improved significantly less on these parameters. The results were not affected by adjustment for gender, age, country and baseline value of the variable. Use of evidence-based medication did not differ by level of education.
Difference between T0 and T1 Factor High Intermediate Basic p-value* N total 1621 N=386 N=775 N=460 BMI, mean (SD) −0.16 (0.71) −0.08 (0.82) −0.26 (0.95) 0.794 LDL (mmol/L), mean (SD) −0.07 (0.63) −0.11 (0.62) −0.04 (0.58) 0.978 HbA1c (mmol/mol), mean (SD) 0.23 (3.70) 0.52 (4.39) 0.04 (5.79) 0.021 GAD score, mean (SD) −0.92 (2.72) −0.76 (3.07) −0.13 (3.47) 0.003 PHQ-9 score, mean (SD) −1.45 (3.21) −1.16 (3.36) −0.93 (4.49) <0.001 Diet score, mean (SD) 0.57 (1.72) 0.63 (1.90) 0.23 (1.81) 0.003 VO2 peak (ml/kg/min), mean (SD) 2.47 (2.90) 1.95 (2.78) 1.75 (2.56) 0.016 *Adjusted for gender, age, country and baseline value.
Difference in VO2peak, GAD and PHQ score

Conclusions
In this large European study with high-quality data from 7 CR centers we found an increased gap disfavoring the lower educated elderly patients participating in CR. These results indicate that “one-size cardiac rehabilitation” does not fit all and indicate that a more personalized CR with attention to the different needs of some patient groups is appropriate.

Acknowledgement/Funding
Horizon2020
P2511Effects of two different preventive counselling programs with remote support on salt and sodium-reach foods intake patterns in coronary patients with abdominal obesity
Authors: Pogosova N , Salbieva A O , Sokolova O Y , Yufereva Y M , Ausheva A K , Karpova A V , Yusubova A I 
Published: October 2019

Abstract

Background
Salt restriction is essential for a healthy diet, especially for patients (pts) with cardiovascular diseases. Pts education has a potential to promote healthier dietary patterns.

Purpose
To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with coronary artery disease (CHD).

Methods
A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported salt intake was assessed by consumption of sodium-reach foods such as sausages, pickles and by adding salt to cooked foods.

Results
A total of 120 pts (mean age±SD, 57,75±6,25 years, men, 83.4%) were enrolled. The Table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.
Group 1 Group 2 Group 3 (Control) Group 1 vs 3, Group 2 vs 3, (n=40) (n=40) (n=40) P for change from baseline P for change from baseline Pts adding salt to cooked foods at least sometimes   Baseline 87.5% 90.0% 85.0%   At 12 months 25.0%** 10.0%** 89.5% <0.01 <0.01 Pts avoiding pickled vegetables   Baseline 17.5% 20.0% 15.4%   At 12 months 62.5%* 77.5%** 7.9% <0.05 <0.01 Pts avoiding wurst, sausages, smoked meats   Baseline 0.0% 10.0% 7.5%   At 12 months 77.5%** 87.5%** 2.6% <0.01 <0.01 *p<0.05, **p<0.01 vs baseline within group.

Conclusion
Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of salt and high-sodium foods intake.
P2523Hand grip strength as a predictor of exercise capacity in coronary heart disease
Authors: Choi C U , Choi J I , Kim W , Jang W Y , Kang D O , Park Y , Na J O , Kim E J , Rha S W , Park C G , Seo H S , Kim J W 
Published: October 2019

Abstract
A recent study has shown that quadriceps strength can be used to predict the level of exercise capacity in patients with coronary heart disease (CHD). We investigated whether the relationship between muscular strength and exercise capacity is also observed with hand grip strength (HGS). We studied 443 participants (age, 61.8±11.2 y; 77.7% male) who underwent coronary intervention and participated in cardiac rehabilitation between 2015 and 2018. Participants were assessed for grip strength, measured using a Jamar dynamometer. Logistic regression was used to assess the relationship between various clinical measures (HGS, age, sex, etc) with the distance walked on a 6-minute walk test (6MWT) and maximal oxygen uptake (VO2max). HGS was significantly related to distance walked on the 6MWT (r=0.435, p<0.001). It was the only predictor of all exercise capacity categories, and one of the strongest predictors of each exercise capacity category. A HGS of 25.5% of body weight predicted an achievement of a 200 m walk on the 6MWT (positive predictive value = 0.95). However, HGS less than 35.5% of body weight predicted that 500m could not be done in 6 minutes (negative predictive value = 0.97). This trend was also observed in the subgroups in which VO2max was measured. This study demonstrates that HGS is associated with exercise capacity in CHD and can be used to predict the level of exercise capacity. These findings may contribute to setting the recommended level of daily activity as well as the level of cardiac rehabilitation in CHD.
Logistic regression models for different levels of exercise capacity Level of exercise capacity B±S.E p-value Odd ratio 95% CI Distance of 6MWT   200 m Grip strength 0.054±0.014 <0.001 1.056 1.027–1.086   300 m Grip strength 0.042±0.009 <0.001 1.042 1.024–1.062   400 m Grip strength 0.047±0.011 <0.001 1.048 1.026–1.070   500 m Grip strength 0.051±0.016 0.001 1.053 1.021–1.086 VO2max level   4 METs Grip strength 0.054±0.010 <0.001 1.056 1.036–1.076   6 METs Grip strength 0.059±0.011 <0.001 1.061 1.039–1.083   8 METs Grip strength 0.081±0.015 <0.001 1.085 1.053–1.117   10 METs Grip strength 0.113±0.049 0.019 1.12 1.019–3.232 Data are presented as mean ± standard deviation (SD). 6MWT, 6-minute walk test; STEMI, ST-Elevation Myocardial Infarction; SE, standard error; CI, confidence interval; VO2max, Maximal Oxygen uptake; METs, Metabolic equivalents.
P2526Association between preoperative nutritional status and clinical outcomes of patient with coronary artery disease undergoing percutaneous coronary intervention
Authors: Chen S , Leu H B 
Published: October 2019

Abstract

Background
Malnutrition is associated with poor outcomes in patients with cancer, heart failure and chronic kidney disease. Different nutritional assessment tools have been developed to provide a better screening tool for malnutrition status evaluation. The prognostic significance of the Controlling Nutritional Status (CONUT) score has been widely used but has limited information for the predictive value in coronary artery disease (CAD) patients.

Methods
We conducted a cohort which enrolled 3118 patients with CAD undergoing percutaneous coronary intervention (PCI) from 2005 to 2015. Nutritional status was evaluated using the CONUT score which comprises of serum albumin and total cholesterol levels, and total lymphocyte count. Higher scores reflect worse nutritional status. The patients were classified as normal (0–1), mildly (2–4), moderately (5–8), or severely malnourished (9–12) based on the CONUT score. The association between nutritional status and future events including acute myocardial infarction (AMI), ischemic stroke, revascularization, congestive heart failure, major adverse cardiovascular events (CV death, stroke and AMI) and total cardiovascular events were evaluated.

Results
81.5% of our patients were male, and the mean age was 71.5±12.1 years. The mean CONUT score was 2.6. Patients with higher COUNT score were older, have lower body weight, BMI, lower LDL-C values and worse renal function. The Kaplan-Meier analysis revealed patients with high CONUT score was significantly associated with higher rates of the major event including MACE (log-rank P<0.001), acute myocardial infarction (P<0.001), cardiovascular death (P<0.001), congestive heart failure (P<0.001) and total CV events (log-rank P<0.001). After adjusting for comorbidities and medication, increasing CONUT score was independently associated with higher risk of developing AMI (HR: 1.13; 95% CI 1.03–1.24, P=0.008); CV death (HR: 1.18, 95% CI: 1.07–1.30, P=0.001); CHF (HR: 1.11, 95% CI: 1.04–1.18, P=0.002); MACE: (HR: 1.14, 95% CI: 1.07–1.22, P<0.001) and total CV events (HR: 1.11, 95% CI: 1.07–1.15, P<0.001). The subgroup analyses demonstrated that the association of CONUT score existed independently with other established cardiovascular risk factors.
Nutritional status and MACE

Conclusion
CONUT score is a promising marker for long-term outcome prediction and risk stratifications in patients with CAD undergoing PCI.

Acknowledgement/Funding
None
P2527Accumulative impact of poor nutrition and frailty on 1-year mortality among acute decompensated heart failure patients
Authors: Sumi T , Oguri M , Takahara K , Umemoto N , Shimizu K , Tanaka A , Ishii H , Murohara T 
Published: October 2019

Abstract

Background
Several studies have proved that both poor nutrition (PN) and Frail are associated with poor prognosis among heart failure patients. However, it has not been fully revealed whether PN and frail could have impact on prognosis accumulatively.

Purpose
The purpose of the present study was to evaluate the impact of nutritional and Frailty status on 1-year mortality among hospitalized patients with acute decompensated heart failure (ADHF).

Methods
Study subjects comprised of 315 hospitalized patients with ADHF. To evaluate the nutritional and Frailty status, we calculated the controlling nutritional status (CONUT) score and the Study of Osteoporotic Fractures (SOF) index at hospital admission. PN and Frailty were defined as the CONUT score ≥5 and SOF index ≥2, respectively.

Results
z Sixty-nine subjects (21.9%) were died within 1-year. PN and Frailty were observed in 33.3% and 55.6% of study subjects, respectively. Both PN and Frailty were similarly related to the 1-year mortality by univariate cox regression analysis (Hazard Ratio (HR) 2.43, 95% confidence interval (CI) 1.51–3.91, p=0.0003: HR 3.13, 95% CI 1.83–5.66, p<0.0001, respectively).
Study subjects were classified into 4 groups according to the nutritional and frailty status: control (normal nutrition without Frailty, n=110), PN alone (PN without Frailty, n=30), Frailty alone (Frailty without PN, n=100), and PN + Frailty (PN with Frailty, n=75). The Kaplan-Meier event curves for 1-year all-cause mortality illustrated that subjects with PN + Frailty had a significantly higher mortality than in subjects with control, PN alone and Frailty alone (log rank p=0.0001, 0.0180, 0.0070, respectively).
As well as, cox regression analysis revealed that PN + Frailty showed significantly higher mortality than control, PN alone and Frailty alone. (HR 5.33, 95% CI 2.75–11.1, p<0.0001: HR 2.99, 95% CI 1.26–8.78, p=0.011: HR 2.07, 95% CI 1.21–3.61, p=0.008, respectively). Moreover, multivariate cox regression analysis also revealed that PN with Frailty was independently associated with 1-year mortality even after adjustment for age, body mass index, systolic blood pressure, and chronic kidney disease. (HR 3.40, 95% CI 1.69–7.32, adjusted p<0.001)
Kaplan-Meier curve for 1year mortality

Conclusions
The combination assessment consisted with nutrition and frailty could identify poor prognosis patients with ADHF.
P2528Responsiveness to nutritional intervention would impact on future cardiovascular prognosis in poor fitness patients
Authors: Ehara M , Shibata K , Kameshima M , Fujiyama H , Terai M , Shimizu K , Matsui Y , Higashida Y , Watanabe M , Shimada A , Ohkawa Y , Yamada S 
Published: October 2019

Abstract

Purpose
Nutritional improvement has been proposed for long-term cardiovascular prognosis as well as fitness recovery. We aimed to examine whether “responsiveness” to nutritional and exercise interventions would impact patients' cardiovascular prognosis even patients in low baseline fitness level.

Methods
We included 254 consecutive patients who participated in the phase II comprehensive cardiovascular rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion phases of CCR. Nutritional guidance was periodically performed individually during CCR. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided into “low fitness” and “normal fitness” groups based on the median of baseline PVO2. Each group was further classified into four categories according to the changes in VO2 and GNRI during CCR: “Both NOT improved”, “Only GNRI improved”, “Only PVO2 improved”, and “Both improved”.

Results
Cox proportional regression analysis showed that the category of “both NOT improved” was an independent predictor for cardiovascular risk among the baseline low fitness group (Hazard ratio: 4.5, p=0.007); whereas no significant difference among the normal fitness group. Kaplan-Meier analysis revealed that the event-free survival rate was significantly lower in the “both NOT improved” category (log rank p=0.002) among the baseline low fitness group (figure); whereas no significant difference among the normal fitness group.
GNRI/PVO2 improvement vs. prognosis

Conclusion
Responsiveness to nutritional and exercise intervention could be a predictive factor of cardiovascular prognosis even in low fitness patients.
P2560Metalloprotease nardilysin controls heart rate through the transcriptional regulation of ion channels critical for sinus automaticity
Authors: Ohno M , Matsuura H , Makiyama T , Nishi K , Iwasaki H , Matsuda S , Kimura T , Nishi E 
Published: October 2019

Abstract

Nardilysin (NRDC; N-arginine dibasic convertase) is a metalloprotease of the M16 family. We have demonstrated that NRDC in the extracellular space enhances ectodomain cleavage of multiple membrane proteins. We also reported that nuclear NRDC regulates transcription of several target genes as a transcriptional coregulator. These results indicated that NRDC is a protease having localization-dependent multiple functions. NRDC-deficient mice (Nrdc−/−) showed wide range of phenotypes such as hypomyelination, hypothermia, and bradycardia. In this study, we have explored a role of NRDC in the regulation of heart rate. (1) Pharmacological blocking of autonomic nervous system revealed that an intrinsic heart rate of Nrdc−/− was significantly reduced compared with that of wild-type mice. (2) In Nrdc−/− hearts, mRNA levels of Cav3.1 and HCN1/4, ion channels responsible for sinus automaticity, were significantly reduced. (3) Funny (If) current and T-type Ca current measured in the sinus node cells were markedly reduced in Nrdc−/− cells, indicating that the functions of Cav3.1 and HCN4 are impaired. (4) Gene knockdown of NRDC in primary rat ventricular myocyte led to the reduction of mRNA level of HCN4. (5) Chromatin immunoprecipitation-PCR analysis showed that NRDC binds to the promoter region of Cav3.1 and HCN4, suggesting the direct involvement of NRDC in transcriptional regulation of these ion channels. (6) Atrium-specific Nrdc−/− (Sarcolipin-Cre) showed mild bradycardia and reduced Cav3.1 mRNA expression. Together, our results indicated that NRDC in cardiomyocyte controls heart rate through the transcriptional regulation of ion channels critical for sinus automaticity.

Acknowledgement/Funding
KAKENHI (17K09575)