bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of glucagon like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on vascular function and myocardial work index in patient with type-2 diabetes
Authors: Ikonomidis I , Pavlidis G , Thymis J , Birba D , Kalogeris A , Kousathana F , Kountouri A , Balampanis K , Parissis J , Andreadou I , Katogiannis K , Dimitriadis G , Bamias A , Iliodromitis E , Lambadiari V 
Published: November 2020

Abstract

Background/Introduction
Type-2 diabetes mellitus (T2DM) is associated with endothelial and myocardial dysfunction.

Purpose
We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on vascular and cardiac function of T2DM patients.

Methods
A hundred-sixty T2DM patients were randomized to insulin (n=40), liraglutide (n=40), empagliflozin (n=40) or their combination (GLP-1RA+SGLT-2i) (n=40) as add-on to metformin. We measured at baseline, 4 and 12 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (marker of glycocalyx thickness), b) pulse wave velocity (PWV), central systolic blood pressure (cSBP), c) global LV longitudinal (GLS), circumferential (GCS) and radial (GRS) strain, d) the ratio PWV/GLS, as an index of ventricular-arterial interaction, e) myocardial work index (GWI) using speckle tracking imaging.

Results
Twelve months post-treatment, all patients improved PBR, PWV, GLS, GCS and GRS (p&lt;0.05). GLP-1RA, SGLT-2i and their combination showed a greater reduction of PBR, PWV and cSBP than insulin, despite a similar HbA1c reduction (p&lt;0.05). GLP-1RA or GLP-1RA+SGLT-2i provided a greater decrease of PWV/GLS (28.1% and 31% vs. 11.1% and 14.5%) and a greater increase of GWI (12.7% and 17.4% vs. 3.1% and 2%) compared with insulin or SGLT-2i. SGLT-2i or GLP-1RA+SGLT-2i showed a greater decrease of PWV (10.1% and 13%), cSBP than insulin or GLP-1RA (PWV: 3.6% and 8.6%) (p&lt;0.05 for all comparisons) (Table 1). The dual therapy showed the greatest effect on measured markers in patients with LVEF &lt;55% (p&lt;0.05).

Conclusions
Twelve-month treatment with GLP-1RA, SGLT-2i and their combination showed a greater improvement of vascular markers and effective cardiac work than insulin in T2DM. The combined therapy was superior to either insulin, or GLP-1RA and SGLT-2i separately.

Funding Acknowledgement
Type of funding source: None
Impact of timing of randomization after an acute coronary syndrome and subsequent events in patients with type 2 diabetes mellitus: an analysis of the EXAMINE trial
Authors: Elharram M , Sharma A , White W , Bakris G , Rossignol P , Mehta C , Ferreira J , Zannad F 
Published: November 2020

Abstract

Background
The timing of enrolment following an acute coronary syndrome (ACS) may influence cardiovascular (CV) outcomes and potentially treatment effect in clinical trials. Using a large contemporary trial in patients with type 2 diabetes mellitus (T2DM) post-ACS, we examined the impact of timing of enrolment on subsequent CV outcomes.

Methods
EXAMINE was a randomized trial of alogliptin versus placebo in 5380 patients with T2DM and a recent ACS. The primary outcome was a composite of CV death, non-fatal myocardial infarction [MI], or non-fatal stroke. The median follow-up was 18 months. In this post hoc analysis, we examined the occurrence of subsequent CV events by timing of enrollment divided by tertiles of time from ACS to randomization: 8–34, 35–56, and 57–141 days.

Results
Patients randomized early (compared to the latest times) had less comorbidities at baseline including a history of heart failure (HF; 24.7% vs. 33.0%), prior coronary artery bypass graft (9.6% vs. 15.9%), or atrial fibrillation (5.9% vs. 9.4%). Despite the reduced comorbidity burden, the risk of the primary outcome was highest in patients randomized early compared to the latest time (adjusted hazard ratio [aHR] 1.47; 95% CI 1.21–1.74) (Figure 1). Similarly, patients randomized early had an increased risk of recurrent MI (aHR 1.51; 95% CI 1.17–1.96) and HF hospitalization (1.49; 95% CI 1.05–2.10).

Conclusion
In a contemporary cohort of T2DM with a recent ACS, early randomization following the ACS increases the risk of CV events including recurrent MI and HF hospitalization. This should be taken into account when designing future clinical trials.
Figure 1

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Takeda Pharmaceutical
Association of baseline hemoglobin A1c levels with bleeding in patients with non-ST-segment elevation acute coronary syndrome underwent percutaneous coronary intervention
Authors: Fan H.L , Liu Y.H , Chen P.Y , Jiang L , Wei X.B , Guo W , Zeng L.H , Tan N , Chen J.Y , He P.C 
Published: November 2020

Abstract

Background
The association between baseline hemoglobin A1c (HbA1c) levels before the percutaneous coronary intervention and bleeding is unclear in patients with non-ST-segment elevation acute coronary syndrome.

Purpose
To investigate the association between baseline HbA1c levels before the percutaneous coronary intervention and bleeding in patients with non-ST-segment elevation acute coronary syndrome.

Methods
This observational cohort study enrolled 6,283 consecutive patients with non-ST-segment elevation acute coronary syndrome, from 1 January 2010 to 31 December 2014. Based on baseline HbA1c levels, the patients were divided into the HbA1c &lt;7% group (n=4,740) and the HbA1c ≥7% group (n=1,543). The primary outcomes are major bleeding events (BARC grades 3–5) and all-cause death during follow-up.

Results
Of the patients who were enrolled, 4,705 (74.9%) were male and 2,143 (34.1%) had a history of diabetes mellitus, with a mean (SD) age of 64.13 (10.32) years. Median follow-up duration was 3.21 years. Compared with HbA1c &lt;7% patients, the risk of major bleeding events and all-cause was both higher in HbA1c ≥7% patients (major bleeding: adjusted hazard ratio, 1.62; 95% confidence interval, 1.04–2.53; P=0.032; all-cause death: adjusted hazard ratio, 1.26; 95% confidence interval, 1.03–1.55; P=0.027). The result of the subgroups analyses was consistent with the primary analyses.

Conclusions
Higher baseline HbA1c levels before percutaneous coronary intervention was associated with an increase in bleeding risk in non-ST-elevation acute coronary syndrome patients. This study suggests that the HbA1c levels should be taken into account for the prolonged antithrombotic strategies of non-ST-elevation acute coronary syndrome patients.
Figure 1. Kaplan-Meier Analysis for Outcomes

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Science and Technology Planning Project of Guangzhou City (201707010002)
Increased exposure to air pollutants leads to greater atherosclerotic burden mediated by systemic inflammation
Authors: Theofilis P , Oikonomou E , Vogiatzi G , Lazaros G , Mystakidi V.C , Barbaresos N , Tasios P , Tsalamandris S , Fountoulakis P , Miliou A , Papaioannou N , Asimakopoulos M.N , Tousoulis D 
Published: November 2020

Abstract

Introduction
Air pollution has been a well-described environmental factor contributing significantly to the global disease burden.

Purpose
To examine the association of gaseous air pollutants with atherosclerosis, especially in subjects with coronary artery disease (CAD).

Methods
2053 individuals enrolled in the Corinthia study underwent clinical and biochemical assessment followed by carotid ultrasonography to evaluate carotid intima-media thickness (cIMT) and plaque burden. Inflammation was estimated via measurement of C-Reactive protein (CRP). Air pollutants concentration analysis was performed in prespecified regions with respect to their proximity to heavy industries, highways and shipyards.

Results
A higher concentration of gaseous air pollutants was observed in Region 4 when compared to other regions (Table). Mean cIMT, maximum cIMT and carotid plaque burden were significantly increased in individuals of Region 4 (Table, Figure A and B), a result which remained unaffected after adjustment for cardiovascular confounders (Figure C). In parallel, inhabitants of Region 4 had higher levels of CRP (Region 1: 4.60±5.01mg/l; Region 2: 3.08±3.26mg/l; Region 3: 4.37±4.70mg/l, Region 4: 6.78±9.77mg/l, p&lt;0.001). To examine the effect of air pollution on atherosclerosis in CAD, propensity scores were applied to match healthy controls with CAD subjects in terms of atherosclerosis risk factors resulting in two matched groups; one in regions 1, 2 and 3 -low air pollution areas (LAPA)- and another in region 4 -high air pollution area (HAPA). Interestingly, we noted substantially higher inter-area differences in mean cIMT of CAD individuals (Figure D).

Conclusion
Air pollution may significantly contribute to atherosclerosis progression, potentially via the induction of inflammation. A more pronounced effect was noted in CAD individuals exposed to high air pollution.

Funding Acknowledgement
Type of funding source: None
Professional drivers and cardiovascular risk: APPTIV cohort
Authors: Esquirol Y , Buscail-Tan B , Duchalet-Serrano G , Colonna C , Mazziotta C , Meresse C , Smallwood C , Monier S , Ferrieres J 
Published: November 2020

Abstract

Background
Professional drivers have a high risk of morbidity, including myocardial infarction. Bus, taxi and truck drivers have most often constituted the studied populations. However, if the transport sector faces road risk, 70% of employees in all activity sectors are exposed to this risk in France. Most often studied by the analysis of global working time, the real driving time and the distance travelled are rarely taken into account, whereas they are potentially modifiable factors.

Purpose
To assess the associations between exposure to road risk by taking into account driving time and the number of kilometers travelled professionally and certain cardiovascular risk factors, in different sectors of professional activity.

Method
Based on the APPTIV cohort, data from 984 men and women employees from 94 companies in France was collected from 2018 to 2019, during occupational health medical visits focused on road risk. The number of Kms / month (&lt;400 (ref); &lt;1600; ≥1600) and the duration of driving (hours / d &lt;1 (ref); &lt;4; ≥4) were studied according to the respective tertiles. A variable with 9 classes was created. Logistic regressions adjusted for age, gender and activity sectors were carried out to explain the associations with certain cardiovascular factors (Hypertension, overweight (≥25 kg/m2), obesity (30 kg/m2) Hypertriglyceridemia (≥1.7 mmol/l), Hypercholesterolemia, HypoHDLemia).

Results
The population studied came from 23.30% of the transport sector, 23.30% of the construction sector, 26.75 of the public administration and 4.78% of the trade sector. After adjustments, the estimated risks of hypertension according to the driving time or the number of km travelled are not significant. Driving between 1 and 4 hours and more than 4 hours per day increases the risk of obesity, by: OR: 1.85 (1.22–2.80); 1.85 (1.19–2.86), the risk of hypertriglyceridemia of 1.39 (1.0–1.95); 1.54 (1.09–2.18). Traveling more than 1600 km / m increases the risk of hypertriglyceridemia by 1.5. People driving between 400 and 1600 km / m with a driving time between 1 and 4 h / d or those covering more than 1600 km with long driving times (&gt;4 h / d) have an estimated risk of obesity at 1.82 (1.05–3.14) and 1.87 (1.13–3.11) respectively. Those traveling over 1600 km / m with long driving times (&gt;4 hrs / day) have a 1.5 times risk of hypertriglyceridemia.

Conclusion
Taking into account the number of hours of driving and the kilometers travelled professionally, this study highlighted some employee profiles with high cardiovascular risk, accessible to medical and professional prevention measures.

Funding Acknowledgement
Type of funding source: None
Gender differences in exercise stress testing protocol selection, exercise capacity, and prognostic value of METs
Authors: Harb S , Wang T.W , Wu Y.W , Menon M.V , Cho L.C , Cremer P.C , Jaber W.A.J 
Published: November 2020

Abstract

Background
Exercise capacity, as measured by metabolic equivalents of task [METs], varies with gender and is an independent predictor of mortality. We sought to investigate gender differences in the protocol selected, the estimated exercise capacity, and the prognostic value of METs.

Purpose
Investigate the gender differences in the protocol chosen (adjusting for age and comorbidities), the METs achieved (also adjusting for the protocol selected), and the predictive value of exercise capacity adjusted to METs achieved.

Methods
In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent exercise stress testing. Protocols were split into Bruce vs. non-Bruce. METs were estimated based on established gender-specific formulas (the St James Take Heart Project formula for women, and the Veterans Affairs cohort formula for men).The primary outcome was all-cause mortality.

Results
The mean age was 53.3±12.5 years, and 59% were male. Table 1 presents the baseline characteristics and exercise parameters. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Females were more commonly referred for non-Bruce protocols [adjusted OR 2.6; 95% CI (2.5–2.7)] even after adjusting for age and comorbidities. Within the same protocol chosen, females achieved lower estimated METs [Beta −1.4; 95% CI (−1.43 to −1.37)]. Exercise capacity was inversely related to mortality in both genders and across protocols (figure 1), however, after adjusting for age, comorbidities, protocol chosen, and the number of METs achieved, the HR for death was significantly lower for women [adjusted HR=0.44; 95% CI (0.41–0.46)].

Conclusion
After adjusting for age and comorbidities, women tend to be more commonly referred for non-Bruce protocols, achieve less estimated METs (after adjusting for the protocol chosen), and have half the mortality for the same METs achieved.
Death vs. Exercise capacity by gender

Funding Acknowledgement
Type of funding source: None
Assessment of myocardial remodeling in the perioperative period of coronary artery bypass grafting: effects of prehabilitation
Authors: Argunova Y , Korotkevich A , Moskin E , Pomeshkina S , Barbarash O 
Published: November 2020

Abstract

Purpose
To assess serial changes in the morphological and functional parameters, and indicators of myocardial perfusion in the perioperative period of coronary artery bypass grafting (CABG), depending on the preoperative management strategy.

Methods
60 male patients with stable coronary artery disease (CAD) were randomized into two groups before on-pump CABG. Group 1 patients (n=30, aged of 61.5 [56; 63] years) underwent treadmill training at 80% of VO2max for a 7-day period. Group 2 patients (n=30, aged of 62.0 [56; 64] years) underwent routine management without prehabilitation. Cardiac morphological and functional parameters were evaluated using echocardiography in the preoperative period and 5–7 days after CABG. Adenosine loading single-photon emission computed tomography (SPECT) was used to measure the parameters of myocardial perfusion before and after the indexed CABG. Data were processed using the QPS program (Cedars Sinai Medical Center (USA)) and the 17-segment polar mapping. Statistical analysis was performed using commercially available Statistica 10.0 software package (Statsoft, USA).

Results
Both groups demonstrated a decrease in LVEF in the postoperative period. However, an LVEF decline in Group 1 patients was less significant (p=0.00015) than in the control group (p=0.000003). LV end-systolic dimension increased by 8.5% and LV end-systolic volume by 18% in patients who underwent prehabilitation as compared to the baseline, whereas these changes were more pronounced in the control group (17% (p=0.00029) and 41% (p=0.00028), respectively).
Group 1 patients demonstrated better myocardial perfusion parameters in the postoperative period. Patients in the prehabilitation group reported higher accumulation levels of radiopharmaceuticals in the basal (75.0 [72.5; 80] and 72.0 [70; 75]%, p=0.036), middle (87.0 [83; 91] and 81.0 [77; 84]%, p=0.012) and apical (86.0 [82; 89] and 82.0 [78; 86]%, p=0.037) myocardium as compared with those in the control group. The stress-induced ischemia (SDS) was less pronounced in Group 1 compared to Group 2 (p=0.025).

Conclusion
Optimized myocardial remodeling parameters and improved myocardial perfusion in the postoperative period have proved the effectiveness of high intensity physical trainings introduced in the prehabilitation program for CABG.

Funding Acknowledgement
Type of funding source: None
The impact of interval vs. continuous training on exercise capacity and endothelial function in post-myocardial patients: a randomised control trial
Authors: Novakovic M , Kosuta D , Trsan J , Krevel B , Tasic J , Vizintin Cuderman T , Rajkovic U , Bozic Mijovski M , Fras Z , Jug B 
Published: November 2020

Abstract

Introduction
High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) are two most common and well established exercise modalities for cardiac rehabilitation in patients after myocardial infarction. Yet, data on their effects on cardiovascular parameters beyond exercise capacity (e.g. endothelial function) are scarce.

Methods
Patients referred to cardiac rehabilitation (CR) after myocardial infarction were randomised to HIIT or MICT. HIIT consisted of 7 cycles of 1.5 min of 80–90% VO2peak and 3 min of 65–70% VO2peak intensity; MICT consisted of 32 min of 75% VO2peak intensity. We ultrasonographically appraised flow-mediated dilation (FMD) – a marker of endothelial function – before (resting), immediately after and one hour after (a) the first and (b) the last exercise training session, in order to appraise the specific effects of HIIT vs. MICT on acute and long-term vascular response to training. Cardiopulmonary exercise testing was performed in all patients. We compared the effects of training modalities with ANCOVA using baseline values as covariates, and examined the improvement after CR in each intervention group with paired-samples t-test.

Results
Eighty-six patients were included (55±10 years of age, 19% females), 43 in each group. There were no differences between HIIT and MICT groups in baseline characteristics. VO2peak improved in both groups (HIIT: 22.8 to 24.9 ml/kg/min, p=0.016 and MICT: 21.9 to 24.5 ml/kg/min, p&lt;0.001), with no significant between-group differences (p=0.571). Also, resting FMD improved after both HIIT and MICT (4.6 to 6.7%, p=0.016, and 4.7 to 8.0%, p=0.001, respectively), with no significant between-group differences (p=0.177). Acute vascular response to training, however, improved with HIIT (FMD one hour after the last training session: 4.1 to 7.1%, p=0.022), but not MICT (5.9 to 6.4%, p=0.584).

Conclusion
Both HIIT and MICT significantly and comparably improve exercise capacity and resting FMD in patients after myocardial infarction. In addition, however, HIIT is associated with improved vascular response during recovery period after exercise.

Funding Acknowledgement
Type of funding source: None
Effect of mobile guided cardiac rehabilitation on quality of life – the EU-CaRE randomised clinical trial
Authors: Houben V , Snoek J.A , Prescott E , Mikkelsen N , Van Der Velde A.E , Eijsvogels T.H.M , Prins L.F , Kolkman E , Meindersma E , Gonzales-Juanatey J.R , Pena-Gil C , Ilou M.C , Eser P , Wilhelm M , Van 't Hof A.W.J 
Published: November 2020

Abstract

Background and purpose
Although participation in cardiac rehabilitation (CR) improves quality of life (QoL), participation in CR, especially among elderly, is limited.
We conducted this study to assess whether mobile home-based CR (mCR) increases QoL in elderly (≥65 years old) patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional CR.

Methods
It is designed as a randomised multi-centre study with two parallel arms. Randomisation assigned patients either to mCR or a control group. mCR Consisted of six months of home-based CR with telemonitoring and coaching. Control-group patients did not receive any form of CR throughout the study period. Quality of life was measured with the SF-36v2 questionnaire at 0, 6 and 12 months.

Results
A total of 179 patients were included in this study (90 control, 89 mCR). A flowchart of the trial is presented in Figure 1. Patients were predominantly male (81.1%). Baseline characteristics can be found in Table 1.
Patients using mCR improved on physical QoL after 6 (p=0.026) and 12 (p=0.008) months. There was no difference on mental QoL for both groups (mCR 6 months p=0.563, 12 months p=0.945; control 6 months p=0.589, 12 months p=0.542). No difference existed in QoL between the mCR and control group (physical: 6 months p=0.070, 12 months p=0.150; mental: 6 months p=0.355, 12 months p=0.625).

Conclusion
Although there is no significant difference in QoL between the control and mCR group, mCR increases physical QoL after 6 and 12 months in elderly patients who decline participation in conventional CR. Therefore E-Health tools should be considered as an alternative for conventional CR when (elderly) patients decline to participate in conventional CR.
Figure 1. Flow chart of all eligible patients

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme
Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study
Authors: Redfern J , Hyun K , Brieger D , Chew D , French J , Astley C , Gallagher R , Ellis C , Carr B , Lefkovits J , Nallaiah K , Lintern K , Neubeck L , Briffa T 
Published: November 2020

Abstract

Background
Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.

Purpose
To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.

Methods
SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.

Results
In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&lt;0.001), CABG (11% v 2%, p&lt;0.001) and a diagnosis of STEMI (21% v 5%, p&lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&lt;0.001), statins (91% 73%, p&lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&lt;0.001) than non-attendees.

Conclusions
Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation