bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT)
Authors: Boriani G , Proietti M , Laroche C , Fauchier L , Marin F , Nabauer M , Potpara T , Dan G.A , Kalarus Z , Tavazzi L , Maggioni A.P , Lip G.Y.H 
Published: November 2020

Abstract

Introduction
The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated.

Aims
To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients.

Methods
We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death.

Results
A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p&lt;0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p&lt;0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p&lt;0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p&lt;0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1).

Conclusions
In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death.
Figure 1. Outcomes at 1-year Follow-up

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants
Pulmonary hemodaynamic in obesity
Authors: Zhou N , Klass M , Corentin S , Kevin F , Motoji Y , Beatrice P , Loi P , Closset J , Naeije R , Faoro V 
Published: November 2020

Abstract

Background
Higher prevalence of pulmonary hypertension exist in obesity subjects. Little known about pulmonary hemodynamics during exercise in obesity population.

Purpose
To assess and compare the response of pulmonary vascular resistance during exercise in obese subjects vs healthy controls.

Methods
Seventeen obesity subjects (gender: 25%men, age: 44±11 years, height: 1.7±0.1 m, weight: 111±17 kilogram, BMI: 38±4 kg/m2) were compared to twenty gender-, age-, height- and race-matched healthy control subjects (age: 46±12 years, height: 1.7±0.1 m, weight: 64±11 kilogram, BMI: 22±2 kg/m2). All subjects underwent an incremental exercise stress echocardiography with measurements of pulmonary artery pressure (PAP), cardiac output (CO), cardiac index (CI) and tricuspid annular plane systolic excursion (TAPSE) at rest and at increasing exercise intensities. Total pulmonary vascular resistance index (PVRi) was calculated as mean PAP/CI and right ventricular-arterial coupling as TAPSE/systolic PAP.

Results
The results are described in the table 1. Pulmonary hemodynamic was not different at rest between two groups, but lower at maximal exercise in obesity subjects. In obesity subjects, identical exercise level was associated with a higher mean PAP and PVRi, and a lower TAPSE/systolic PAP ratio.

Conclusion
While pulmonary hemodynamic seems preserved at rest in obesity patients, pulmonary vascular resistance is increased and right ventricular coupling is decreased, particularly at exercise.

Funding Acknowledgement
Type of funding source: None
Association between the phenotype of metabolically healthy obesity and the risk of myocardial infarction
Authors: Malyutina S , Mustafina S , Vinter D , Rymar O , Shcherbakova L , Verevkin E.U , Gafarov V , Bobak M 
Published: November 2020

Abstract

Aim
This study aimed to investigate the associations between the metabolically healthy obesity (MHO) and the risk of myocardial infarction (MI) in a Russian population sample.

Materials and methods
A random population sample of men and women aged 45–69 years old at baseline was examined in 2003–2005 in a Russian city; after that the cohort was followed-up for 12 years on the average (2003–2016). A sub-cohort of subjects with body mass index (BMI) ≥30 kg/m2 at baseline was selected for present study (3157 individuals, 73.2% women); of those, 3008 subjects free from baseline history of MI/acute CHD was included for analysis. The data on incident myocardial infarction (MI) were ascertained from register of MI, two repeated examinations and repeated postal interviews during 12-year follow-up of the cohort. We used two definitions of MHO: by NCEP ATPIII, 2001 (the presence of 2 or less components of the metabolic syndrome) and by IDF 2005 (waist circumference (WC) ≥94 cm in men and ≥80 cm in women regardless of risk factors). Multivariable Cox regression was conducted using the SPSS package (V. 13.0).

Results
The prevalence of MHO at baseline ranged from 20% (by IDF) to 45% (by NCEPATPIII) in obese sub-cohort. Among subjects with MHO at baseline, about one half of subjects developed metabolically unhealthy obesity phenotype (MUO) during 12-years. Women were more likely to retain MHO (32%) and more frequent transited from MUO to MHO (14%) compared to men (22% and 6% by IDF criteria, correspondently) during 12 years.
The relative risk of incident MI in subjects with MUO at baseline was 1.9 times higher than in those with MHO (HR 1.9, 95% CI 1.2–2.9) by NCEPATP III. Among men, the relative risk of MI in those with MUO (by NCEP ATP III) was 2 times higher than in a group with MHO (HR 2.1, 95% CI 1.1–4.0). Among women, the relative risk of MI in those with MUO (by NCEP ATP III) was 2.2 (95% CI 1.2- 4.2) compared to MHO group. Using the IDF criteria, the relative risk of MI in MUO vs. MHO was 2.2 (95% CI 0.9–5.7) in men and 2.2 (95% CI: 0.9–5.7) in women.

Conclusions
In this study population, men aged 45–69 have more frequent progression from metabolically healthy to metabolically unhealthy obesity during 12 years compared to women. The 12-year risk of incident MI in subjects with MUO was approximately twice higher compared to MHO and the excess risk was similar in men and women.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Wellcom Trust
Alcohol consumption behavior and new-onset atrial fibrillation in patients with newly-diagnosed type 2 diabetes mellitus: a nationwide population-based study
Authors: Choi Y.J , Choi C.E.K 
Published: November 2020

Abstract

Background
Type 2 Diabetes mellitus (T2DM) has a high risk of being associated with cardiovascular diseases including atrial fibrillation (AF). Although excessive alcohol consumption is an established modifiable risk factor for AF, alcohol behavior modification for preventing the risk of AF is not widely studied.

Objective
We explored the clinical effects of alcohol consumption behavior on the prevention from new-onset AF in patients with T2DM.

Methods
A total of 180,964 patients newly diagnosed with T2DM were identified between 2009 and 2014 from the Korean National Health Insurance Service database after excluding a previous history of AF. We followed up them until 2017, and compared the risk of AF according to alcohol consumption behavior.

Results
During follow-up of mean 4.3 years, new-onset AF occurred in 2,386 patients. Compared to non-drinkers, heavy drinker (≥30 g/day) at the baseline had a higher risk of AF (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.112–1.492), whereas mild-drinker had no statically significant difference. According to alcohol consumption behavior, subject who stopped drinking from the time of T2DM diagnosis had the lower risk of AF; abstinence group (HR 1.33, 95% CI 1.135–1.569), restart group (HR 1.38, 95% CI 1.131–1.688) and continuous group (HR 1.48, 95% CI 1.238–1.776). In subgroup analysis, the impact of alcohol consumption behavior was more pronounced in male, but not in female; abstinence group (HR 1.30, 95% CI 1.101–1.536), restart group (HR 1.40, 95% CI 1.141–1.711), and continuous group (HR 1.49, 95% CI 1.244–1.789).

Conclusions
Abstention from alcohol reduced the risk of AF development in patient newly diagnosed with T2DM. Especially, in men, alcohol consumption behaviour modification is an important strategy for preventing cardiovascular event in patient newly diagnosed with T2DM.

Funding Acknowledgement
Type of funding source: None
Association between maternal diabetes and cardiac left ventricular structure and function in the neonate: a study from the Copenhagen Baby Heart Study
Authors: Ghouse J , Voegg O , Sillesen A.S , Pihl C , Axelsson A.R , Vejlstrup N , Oyen N , Jensen M.T , Wohlfart J , Damm P , Olesen M.S , Mathiesen E.R , Iversen K , Bundgaard H , Boyd H 
Published: November 2020

Abstract

Background
Prenatal exposure to maternal diabetes has been associated with increased risk of congenital heart defects.

Purpose
To evaluate whether maternal diabetes is associated with more subtle morphological and functional cardiac changes in neonates without congenital heart defects.

Methods
We included 17,869 newborns sampled from the Copenhagen Baby Heart Study, all of whom underwent transthoracic echocardiography within 30 days of delivery. We investigated the association between exposure to maternal diabetes (pre-existing diabetes [type 1 or type 2 diabetes] or gestational diabetes [GDM]) and the neonates' echocardiographic indices of left ventricular structure (left posterior wall thickness in end-diastole [LVPWd], interventricular septum thickness in end-diastole [IVSd], left ventricular internal diameter in end-systole [LVIDs] and end-diastole [LVIDd]), systolic function (fractional shortening [FS], stroke volume [SV]) and diastolic function (mitral valve peak early and atrial filling velocities, deceleration time of early filling, and E/A-ratio), using linear and logistic regression. Models were adjusted for maternal age, infant sex, infant birth weight for gestational age and gestational age in days. In additional analyses, we evaluated the relationship between HbA1C levels in first and third trimester and left ventricular structure and function.

Results
We found that infants exposed to pre-existing maternal diabetes (n=x) had, on average, a thicker LVPWd (mean difference 0.12 mm [95% CI: 0.06–0.19]), a smaller LVIDs (−0.27 mm [95% CI: −0.46, −0.07]) and LVIDd (−0.43 mm [95% CI: −0.66, −0.19]), and decreased SV (−0.50 ml [95% CI: −0.77, −0.23]). We found no significant differences in IVSd, FS, and measures of diastolic function for infants exposed to pre-existing maternal diabetes compared with infants not exposed to diabetes. Infants exposed to GDM (n=) also had thicker LVPWd (0.06 mm [95% CI: −0.28, −0.01]) and smaller LVIDs (−0.15 mm [95% CI: −0.28, −0.01]); however, on average, IVSd, LVIDd, and measures of systolic and diastolic function did not differ for infants born to mothers with and without GDM. We observed no consistent association between HbA1C levels measured early and late in pregnancy in mothers with diabetes and indices of left ventricular structure and function.

Conclusion
In conclusion, we found that exposure to maternal pre-existing diabetes, and to a lesser degree GDM, was associated with changes in neonatal left ventricular structure and function, including a thicker left ventricular posterior wall, smaller left ventricular internal diameters, and lower stroke volumes.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Rigsbospitalet Research Foundation
Effects of tirzepatide, a novel dual GIP and GLP-1 receptor agonist, on lipid profiling in patients with type 2 diabetes
Authors: Ruotolo G , Roth K.D , Milligan P.L , Lin Y , Wilson J.M , Pirro V , Duffin K.L , Haupt A 
Published: November 2020

Abstract

Background/Introduction
In a Phase 2 trial, tirzepatide (TZP) dose-dependently reduced HbA1c, body weight and serum triglycerides in moderately obese type 2 diabetes (T2D) patients.

Purpose
To understand changes in fasting serum lipids with TZP, lipidomics profiling of multiple lipid classes was conducted.

Methods
Patients (n=314) were randomized to receive weekly subcutaneous TZP, dulaglutide, or placebo for 26 weeks. Shotgun lipidomic analysis was performed in positive electrospray using a Sciex Triple TOF 5600 mass spectrometer operating in MS/MSALL mode and sphingomyelin (SPM) data were acquired in positive electrospray TOF mode. Data were assessed using MMRM.

Results
At 26 weeks, total cholesterol esters (CE), phosphatidylcholines (PC) and phosphatidylinositols (PI) increased with placebo; dulaglutide treatment did not affect any lipid class (Table). With TZP 10 and 15 mg, total triacylglycerides (TAG), diacylglycerides (DAG), phosphatidylethanolamines (PE), PC and PI dose-dependently decreased at 4, 12 and 26 weeks, whereas total CE and phosphatidylserines (PS) levels did not change at any timepoint. At 26 weeks, individual, but not total, SPM and ceramide (Cer) changes were observed with TZP 15 mg. Most saturated, long chain SPM (14:0, 20:0, 21:0, 22:0, 23:0, 24:0) and Cer (22:0, 23:0, 24:0) were reduced by 8–16% and 14–20%, respectively. Conversely, unsaturated SPM (24:1,24:2) increased by 6.5% and 11.4%, and unsaturated glycosylated Cer 16:0 lactosyl and 24:1 hexosyl increased by 22.4% and 19.3%, respectively. TZP 10 and 15 mg decreased total SPM by 4–6% at 4 weeks, and total Cer between 8% and 13% at 4 and 12 weeks.

Conclusions
Tirzepatide dose-dependently reduced levels of total TAG, DAG, PE, PC, and PI at all timepoints, whereas levels of saturated long chain SPM and Cer were reduced and those of some unsaturated SPM and glycosylated Cer increased at 26 weeks. Net improvements in lipidomics profiling with tirzepatide warrant further evaluation of potential benefits on cardiovascular events and NASH.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Eli Lilly and Company
Living alone combined with physical frailty or cognitive frailty is independent risk factor of outcomes in the patients with acute heart failure after discharge
Authors: Takabayashi K , Kitaguchi S , Nohara R 
Published: November 2020

Abstract

Background
Living status is an important factor to manage the conditions of acute heart failure (AHF) patients after discharge. In patients with heart failure (HF), a frailty is a common and serious complication. However, the association between living alone and the outcome in HF patients have not been well described.

Purpose
The purpose of this study is to identify the association between living alone and following outcomes. Furthermore, we reveal the impact of living alone combined with physical or cognitive frailty in AHF patient after discharge.

Methods
We have enrolled 1117 discharged patients with AHF in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry; 13 hospitals in a city in Japan) from April 2015 to January 2017. The KICKOFF Registry is a prospective multicenter community-based cohort of AHF patients. We defined physical frailty as impossible outdoor walking and cognitive frailty as dementia. We divided into three groups, living without alone (non-alone, n=898), living alone without frailty (alone without frailty, n=148) and living alone with physical or cognitive frailty (alone with frailty, n=71). We compared the clinical characteristics and outcomes between three groups. We defined a primary outcome as a composite endpoint that included all-cause mortality and hospitalization for HF.

Results
During the follow-up period whose median was 573 days, a total of 548 patients (49.1%) had the composite endpoint, and the highest proportion of the composite endpoint was in alone with frailty, 63.4%. This was followed by 49.2% in non-alone, and 41.2% in alone without frailty. In the Kaplan-Meier analyses, the composite endpoint was a significantly higher in alone with frailty than the other groups (Figure A), but there was no significant difference between all patients with living alone and those without living alone (Figure B). After adjustment by gender, age, and the other co-morbidities (HF, coronary artery disease, valvular disease, hypertension, diabetes, atrial fibrillation and chronic kidney disease) in the Cox proportional hazard model, the composite endpoint hazard ratio (HR) increased significantly in the factor of alone with frailty when compared with the others (adjusted HR, 1.38; 95% confidence interval, 1.00–1.86; p=0.048).

Conclusion
In this study, the patients with only living alone have not independently prognostic impact, but those with living alone combined physical frailty or cognitive frailty have independently prognostic impact after discharged AHF.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This research was supported by research funding from Nakajima Steel Pipe Company Limited.
Effects of late aerobic exercise on cardiac remodeling of rats with small myocardial infarction
Authors: Souza L.M , Okoshi M.P , Gomes M.J , Rodrigues E.A , Pontes T.H.D , Damatto F.C , Oliveira L.R.S , Lima A.R.R , Gatto M , Borim P.A , Zornoff L.A.M , Okoshi K , Pagan L.U 
Published: November 2020

Abstract

Background
Physical exercise has been highlighted as an important non-pharmacological therapy for prevention and treatment of several cardiovascular diseases. However, its effects on hearts with minor cardiac remodeling are not clear.

Purpose
To evaluate the influence of aerobic physical exercise on functional capacity, cardiac structure, left ventricular (LV) function, and gene expression of NADPH oxidase subunits in rats with small-sized myocardial infarction (MI).

Methods
Three months after MI induction, Wistar rats were divided into three groups: Sham; sedentary MI (MI-SED); and aerobic exercised MI (MI-EA). Rats exercised three times a week for 12 weeks on a treadmill. Echocardiogram was performed before and after experimental period. Infarction size and cardiomyocyte diameters were evaluated by histology. Gene expression was assessed by RT-PCR.

Results
Only rats with MI size lower than 30% of LV total area were included in the study. Functional capacity was higher in MI-AE than the other groups. Infarction size did not differ between groups. Infarcted rats had increased LV diastolic and systolic diameter, left atrial diameter, and LV mass, with systolic dysfunction. LV diastolic posterior wall thickness was higher in MI-AE than Sham, and relative wall thickness was lower in MI-SED than MI-AE and Sham groups. Cardiomyocyte diameter was smaller in infarcted groups than Sham. Myocardial gene expression of the NADPH oxidase subunits NOX2, NOX4, p22phox, and p47phox did not differ between groups.

Conclusion
Small-sized myocardial infarction changes cardiac structures and left ventricular systolic function. Late aerobic physical exercise improves functional capacity and cardiac remodeling by preserving left ventricular geometry. NADPH oxidase subunits gene expression is not involved in cardiac remodeling or modulated by aerobic exercise in rats with small myocardial infarction.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): CNPq; CAPES
Trimetazidine combined with exercise improves anti-stress capacity through enhancing autophagy and apoptosis of myocardium in mice
Authors: Jiang L 
Published: November 2020

Abstract

Aims
To observe the effects of trimetazidine, aerobic exercise alone or combined on the anti-stress capacity of mice, and further explore its potential mechanism.

Methods
Forty-four C57/BL male mice aged 8 weeks were randomly divided into four groups: control group (group C, n=11), exercise group (group E, n=11), trimetazidine (TMZ)group (group T, n=11),exercise combined with TMZ group (group TE, n=11). Saline intragastric administration, medium intensity swimming training, TMZ (10mg/kg) intragastric administration, medium intensity swimming training combined with TMZ intragastric administration were given respectively. Swimming for 6 days a week, 1 hour a day lasting for 4 weeks. After the intervention, each group was randomly subdivided into the rest and the exhaustive exercise (EE) subgroups. The mice in the EE-subgroup (n=6) underwent exhaustive exercise. The myocardial ultrastructure was observed under electron microscope to measure the anti-stress ability of mice. The expression of key autophagy proteins LC3-II, P62 and BNIP3 were detected and the number of myocardial autophagosomes were observed under electron microscope. The protein of apoptosis related, Bcl-2 and the expression of heat shock protein 70 (HSP70) were also being detected.

Results
Exhaustive exercise induced the cardiac muscle damage successfully. TMZ and exercise alone or combined alleviated the cardiac damage significantly with improved autophagy (P&lt;0.05) at the basal state and after exhaustive exercise. The level of apoptosis (P&lt;0.05) and the expression of HSP70 was upregulated after the exhaustive exercise.

Conclusions
TMZ and exercise alone improved the anti-stress capacity of mice effectively and the combination has a synergistic effect. The mechanism may be related to the promotion of autophagy, apoptosis and HSP70 expression of myocardium.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): China natual science founding