bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic stiffness and incident diabetes: the hard, bittersweet truth
Authors: Terentes-Printzios D , Ioakeimidis N , Aznaouridis K , Georgakopoulos C , Christopoulou G , Korogiannis L , Gardikioti V , Solomou E , Sigala E , Tousoulis D , Vlachopoulos C 
Published: November 2020

Abstract

Background/Introduction
Aortic stiffness increases with advancing age and is a major risk factor for age-related morbidity and mortality. Aortic stiffness and glycaemic dysregulation are related; however, temporal relationships between aortic stiffness and incidence of diabetes have not been fully delineated.

Purpose
We sought to investigate the role of arterial stiffness in the prediction of incident diabetes.

Methods
376 untreated hypertensive patients (mean age 52.6±12.5 years, 201 males) without known cardiovascular disease and without known history of diabetes, were included in the study. Markers of subclinical organ damage [carotid-femoral pulse wave velocity (PWV) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. eGFR was estimated using the Cockcroft-Gault formula. Hemoglobin A1c (HbA1c) and blood glucose were measured in venous blood samples. Patients were prospectively followed-up, for incidence of diabetes as defined by the American Diabetes Association criteria.

Results
During a median 13.5 years follow-up, forty-six patients (12.2%) patients were diagnosed with diabetes. In multivariable logistic regression analysis, only higher PWV (Odds Ratio [OR] = 1.271, 95% Confidence intervals [CI]: 1.002–1.612, P=0.048) was associated with higher risk of incident diabetes, which was independent of age, sex, pulse pressure, HbA1c, fasting blood glucose and eGFR. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of PWV to discriminate subjects with diabetes. The area under the curve (AUC) and 95% CIs of the ROC curve was AUC=0.66 (95% CI: 0.58–0.74, P=0.001) for PWV (Figure 1).

Conclusions
In our cohort, higher aortic stiffness was associated with higher risk of incident diabetes.
Figure 1. ROC curve for the prediction of diabetes

Funding Acknowledgement
Type of funding source: None
The lower the renal function in patients with chronic renal disease, the greater the improvement in the renal function cardiac rehabilitation provides
Authors: Hama T , Ushijima A , Ikari Y , Kobayashi Y 
Published: November 2020

Abstract

Background
Our previous study suggested that cardiac rehabilitation (CR) resulted in a significant improvement in the renal function in cardiac vascular disease (CVD) patients with chronic renal disease (CKD), using cystatin C. However, whether the difference in the severity of the renal impairment at the beginning of the CR affects the degree of the improvement in the renal function after CR is unknown.

Methods
We studied 203 CVD patients (155 males; 73 y/o) with CKD (15≤estimated glomerular filtration rate based on the serum cystatin C concentration [eGFRcys]&lt;60 ml/min/1.73m2) who participated in our 3-month CR program. The eGFRcys was examined at the beginning and end of the CR. In addition, the patients were divided into 3 groups according to the severity of the renal impairment at the beginning of the CR: CKD G3a group (45≤eGFRcys&lt;60 ml/min/1.73m2, n=122), CKD G3b group (30≤eGFRcys&lt;45 ml/min/1.73m2, n=60), and CKD G4 group (15≤eGFRcys&lt;30 ml/min/1.73m2, n=21). We compared the renal function at the beginning and end of the CR in each of the 3 groups. Moreover, we evaluated the correlation between the eGFRcys at the beginning of the CR and the change in the eGFRcys (%ΔeGFRcys).

Results
In all the study patients, the eGFRcys improved after the CR (45.5 to 47.7 ml/min/1.73m2, p&lt;0.001). In the CKD G3b and G4 groups, the eGFRcys also improved (38.4 to 41.5 ml/min/1.73m2, p=0.001; 23.2 to 28.0 ml/min/1.73m2, p=0.016). However, in the CKD G3a group, the eGFRcys did not improve after the CR (52.9 to 54.2 ml/min/1.73m2, p=0.074) (Figure 1). The univariate analysis results showed that the %ΔeGFRcys was significantly negatively correlated with the eGFRcys at the beginning of the CR (p=0.016, r=−0.26, Figure 2).

Conclusion
The greater the renal dysfunction in the CVD patients with CKD was, the greater the improvement in the renal function after participating in the CR program.

Funding Acknowledgement
Type of funding source: None
Predictors of emergency medical services utilization after different preventive counseling programs in paroxysmal atrial fibrillation patients after catheter ablation
Authors: Pogosova N , Yufereva Y.M , Ovchinnikova A.I , Sokolova O.Y , Davtyan K.V 
Published: November 2020

Abstract

Background
Catheter ablation (CA) is known to reduce atrial fibrillation (AF) burden, but even after CA patients (pts) may remain symptomatic and seek for emergency care.

Purpose
To identify predictors of emergency medical services (EMS) utilization after different preventive counseling programs in paroxysmal AF pts after CA.

Methods
This is a secondary analysis of a randomized controlled trial in AF pts after CA (radiofrequency or cryoballoon) assessing the effects of a long-term preventive counseling program encompassing remote support. Pts were randomized into 3 groups in 1:1:1 ratio. During hospitalization for CA pts from all groups received single-session preventive counseling with focus on their individual cardiovascular risk factors profile. After discharge, pts from Group 1 received remote preventive counseling by phone and pts from Group 2 by email every two weeks for the first 3 months after enrollment (a total of 6 sessions). Group 3 received usual care. At baseline and at 12 months of follow-up, pts underwent assessments of their demographic parameters (age, sex, education level, marital status, and socioeconomic status) and psychological status (stress level using a 10-point visual analogue scale [VAS] and anxiety and depression by the Hospital Anxiety and Depression Scale [HADS]; transthoracic echocardiography, ECG and 24-hour ECG monitoring. A multivariate regression analysis of seeking for EMS was performed with patients' baseline parameters as independent variables.

Results
A total of 135 pts aged 35 to 80 years were enrolled (mean age 57.3±9.1 years, 51.8% men). Over 1 year of follow-up, 53 study participants called the ambulance (which made up for 90 calls) with no significant differences between the study groups. Age (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–2.9; P=0.010), stress level ≥7 points (OR 3.2, 95% CI 1.4–7.5; P=0.007), left ventricular (LV) ejection fraction ≤62% (OR 2.6, 95% CI 1.1–6.1; P=0.024); and left atrial (LA) diameter ≥42 mm (OR 3.6, 95% CI 1.5–8.5; P=0.003) were independent predictors of an EMS call.

Conclusions
Age, perceived stress level, reduced LV function and LA size were independent predictors of EMS utilization after CA regardless of preventive counseling interventions.

Funding Acknowledgement
Type of funding source: None
Predictors of left ventricular scar at cardiac magnetic resonance in athletes with apparently idiopathic ventricular arrhythmias
Authors: Zorzi A , Crescenzi C , Vessella T , Cipriani A , Panattoni G , De Lazzari M , Perazzolo-Marra M , Sarto P , Corrado D , Calo' L 
Published: November 2020

Abstract

Introduction
In athletes with ventricular arrhythmias (VA) and otherwise unremarkable clinical findings, cardiac magnetic resonance (CMR) may reveal concealed pathological substrates. The aim of this multicentre study was to evaluate which VA characteristics were associated with CMR abnormalities.

Methods
We enrolled a consecutive series of 251 competitive athletes (74% males, mean age 28.5±14.5 years) who underwent CMR for evaluation of VA. We included athletes with &gt;100 premature ventricular beats (PVBs)/24-hour or ≥1 repetitive VA (couplets, triplets or non-sustained ventricular tachycardia) on 12-lead 24-hour ambulatory ECG monitoring and negative family history, electrocardiogram and echocardiogram. Features of VA that were evaluated included number, morphology, repetitivity and response to exercise testing.

Results
Left-ventricular late gadolinium-enhancement (LGE) was documented in 28 (11%) athletes, mostly (N=25) with a subepicardial/midmyocardial (non-ischemic) distribution. On 24-hour ECG monitoring, PVBs with a right-bundle-branch-block and intermediate/superior axis configuration or multiple morphologies were documented in 24/28 (86%) athletes with versus 55/223 (25%) without LGE (p&lt;0.001). More than 2000 PVBs were recorded in 6 (21%) athletes with versus 127 (57%) without positive CMR (p&lt;0.001). At exercise testing, repetitive VA occurred at high work-load in 12 (43%) athletes with versus 26 (12%) without LGE (p&lt;0.001). At multivariable analysis, all three VA features independently correlated with CMR abnormalities.

Conclusions
In athletes with apparently idiopathic VA, simple characteristics such as number and morphology of PVBs on 12-lead 24-hour ambulatory ECG monitoring and response to exercise testing predicted the presence of concealed myocardial abnormalities on CMR. These findings may help cost-effective CMR prescription.
Flow chart

Funding Acknowledgement
Type of funding source: None
Mechanical diversity in the adaptation of left and right ventricular function to long-term exercise: 3D echocardiographic study in a large cohort of competitive athletes
Authors: Fabian A , Lakatos B.K , Tokodi M , Kiss O , Babity M , Bognar C , Sydo N , Csulak E , Vago H , Merkely B , Kovacs A 
Published: November 2020

Abstract

Regular physical exercise results in complex remodelling of the left- (LV) and right ventricle (RV), commonly referred as the athlete's heart. Despite the well-known changes in ventricular volumes and mass, data are scarce regarding ventricular mechanics and its connection to exercise performance.
Accordingly, our aim was to characterize biventricular morphological and functional changes and their association with peak exercise capacity in a large cohort of athletes using three-dimensional (3D) echocardiography.
Competitive athletes of various training regimes (n=525, age: 20±6 years, training: 15±7 hours/week, 30% female) were enrolled, while 73 age- and gender-matched sedentary volunteers served as the control group. Full volume 3D echocardiographic datasets focused on the LV or the RV were acquired for further analysis: LV and RV end-diastolic volume (EDVi), LV mass (Mi) indices and ejection fraction (EF) were quantified. To characterize biventricular mechanics, LV and RV global longitudinal strain (GLS) and global circumferential strain (GCS) were also measured using dedicated software. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg).
Athletes had significantly higher LV and RV EDVi (81±13 vs. 64±11 mL/m2; 83±14 vs. 63±11 mL/m2; both p&lt;0.001) and also LVMi (87±15 vs. 65±12 g/m2; p&lt;0.001) compared to controls. LV and RV EF were significantly lower in athletes (57±5 vs. 60±6%; 55±5 vs. 58±5%; both p&lt;0.001). LV GLS (−19.5±2.1 vs. −20.6±2.6%; p&lt;0.001) and also LV GCS (−27.9±3.2 vs. −29.8±4.4%; p&lt;0.001) was lower in athletes compared to controls. In opposed to the LV, RV GLS did not differ between the two groups (−29.3±5.8 vs. −29.5±5.3%; p=NS), however, RVGCS was decreased in athletes compared to controls (−24.4±6.1 vs. −28.6±7.3%; p&lt;0.001). In athletes, ventricular morphology measured by LV and RV EDVi correlated with VO2/kg (both r=0.37; p&lt;0.001), while functional measures, such as lower resting LV GLS (r=0.22; p&lt;0.001) and RV GCS (r=0.14; p&lt;0.01) also showed relationship with better exercise performance.
According to our results, regular physical exercise is associated with significant changes of LV and RV geometry and mechanics. Resting biventricular systolic function of the athlete's heart is characterized by a mild reduction, which is attributable to a lower longitudinal and circumferential shortening on the left side of the heart, while on the right side lower circumferential shortening can be seen along with a maintained longitudinal shortening. Moreover, this mechanical pattern also correlates with exercise performance.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): “National Heart Program” NVKP_16-1-2016-0017; NKFIH K_16 K120277 to BM
Master athletes'ECG and the diagnostic accuracy of contemporary ECG interpretation criteria
Authors: Halasz G , Cattaneo M , Romano S , Biasini V , Villa M , Cassina T , Capelli B 
Published: November 2020

Abstract

Background
Over the last years, several efforts have been made to refine the ECG criteria for interpretation of young (16–35 years) competitive athlete's ECG in order to improve specificity maintaining good sensitivity. However, few data exist about the efficacy of such interpretation criteria in master athletes (over 35 years). We aimed to assess the diagnostic performance of screening based on 2017 International ECG recommendation (2017-International), 2010 European Society of Cardiology recommendation (2010-ESC) and Seattle criteria in a cohort of master athletes competing at regional and national level.

Methods
506 Caucasian master athletes (mean ages 47.9±8.7, 85,6% male, 65% endurance athletes) underwent standardized medical history, physical examination, resting and exercise ECG during their pre-participation screening. ECGs were retrospectively interpreted based on 2010-ESC, Seattle-criteria and 2017-International. For the purpose of the study we included also a transthoracic echocardiography as reference, to calculate the sensibility and specificity, area under the ROC curve (AUC) was estimated as measure of discriminative ability of each ECG criteria. Athletes with abnormalities underwent further examinations according to the European Guidelines.

Results
Twelve athletes (2,3%) were diagnosed with a condition potentially related to SCD (1 hypertrophic cardiomyopathy, 1 Type1 Brugada Syndrome, 4 Chronic Coronary Syndromes, 2 Dilated Cardiomyopathy, 3 Aortic Dilation, 1 Moderate aortic stenosis) during the pre-participation screening. International criteria failed to identify two athletes with DCM and left axis deviation on ECG while no athletes with complete right bundle branch block showed serious structural abnormalities. The most common ECG abnormalities were left axis deviation (7,1%), left atrial enlargement (4,2%) and T wave inversion (3%). 29 athletes (5,7%) exhibited a long QT interval according to 2010-ESC and 1 athlete according to International and Seattle criteria. The false positive ECG rate was 15% for 2017-International based screening, 21,9% for Seattle based screening and 30,40% for 2010-ESC based screening while the diagnostic accuracy for pathologies at risk of SCD was 0,73 (95% CI 0,69–0,77) for 2017 International based screening; 0,81 (95% CI 0,77–0,84) for Seattle Criteria based screening and 0,77 (95% CI 0,73–0,80) for 2010-ESC based screening.

Conclusion
In master athletes the 2017-International ECG criteria showed inferior accuracy compared to the Seattle criteria and 2010-ESC, the least showing a higher false positive rate mostly due to lower cut-off for long QT. Furthermore complete right bundle branch block may be considered a normal finding also in master asymptomatic athletes.
Accuracy of ECG criteria

Funding Acknowledgement
Type of funding source: None
Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes
Authors: Mohamed M , Rashid M , Farooq S , Siddiqui N , Parwani P , Shiers D , Thamman R , Gulati M , Shoaib A , Chew-Graham C , Mamas M.A 
Published: November 2020

Abstract

Background
Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness.

Purpose
To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI.

Methods
All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results
Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17).

Conclusion
Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.
Odds of management and clinical outcomes

Funding Acknowledgement
Type of funding source: None
Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across 5 world regions: results from the SURF-RA
Authors: Semb A.N.N.E , Ikdahl E , Sexton J , Kitas G , Van Riel P , Crowson C , Graham I , Rollefstad S 
Published: November 2020

Abstract

Background
Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD).

Purpose
The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA.

Methods
The audit is termed SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) and was performed in 53 centres/19 countries/5 world regions in 2014–2019. SURF-RA have been performed in patients with coronary heart disease, in primary care, and now in patients with stroke, SLE and antiphophlipid syndrome. The survey was approved by the Data Protection Officer (2017/7243) and a GDPR evaluation has been performed (10/10–2018).

Results
Among 14 503 patients with RA in West (n=8 493) and East (n=923) Europe, Latin (n=407) and North (n=4 030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol &gt;2.5 mmol/L: 63.3%. Overall, 29% used antihypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index &gt;30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2%, lowest in Asia (7.8%) and highest in East Europe (28.5%).

Conclusion
The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Lilly
Impaired longitudinal myocardial deformation, coronary microcirculatory dysfunction and increased intima-media thickness predict adverse cardiovascular events in psoriatic patients:a 4 year follow-up
Authors: Ikonomidis I , Makavos G , Rafouli-Stergiou P , Thymis J , Katsanos S , Katogiannis K , Varoudi M , Kapniari E , Theodoropoulos K , Iliodromitis E.K , Efthimiou O , Kazatzoglou A , Kostelli G , Papadavid E 
Published: November 2020

Abstract

Introduction
Psoriasis has been associated with vascular and myocardial dysfunction, atherosclerosis and increased cardiovascular risk in the setting of inflammation and oxidative stress. We aimed to evaluate the prognostic value of markers of myocardial deformation, coronary microcirculatory function and systemic inflammation and oxidative stress for future cardiovascular events.

Methods
In 260 psoriasis patients We measured a)left ventricular global longitudinal strain (GLS) by speckle tracking, b) coronary flow reserve (CFR), of the left anterior descending artery by pulse wave echocardiography, c) carotid-femoral pulse wave velocity (PWV), d) carotid intima media thickness (IMT) and e) inflammatory and markers of oxidative stress, namely interleukin-6,-12,-17,TNF-α,fetuin-α and protein carbonyl. Bivariate correlations of these measures with incidence of major cardiovascular events (MACE) defined as acute coronary syndrome, stroke and hospitalization for heart failure were performed.

Results
During a mean 4 year follow-up period (48±11monts) 21 MACEs occurred. By Cox regression analysis Incidence of MACEs were associated with impaired GLS (b=1.05 p=0,01, mean GLS −17.3±4), impaired CFR (b=−0.75, p=0.04, mean CFR 2.68±0.9) fetuin levels (b=0.70. r=0.046, mean fetuin value 45±24ng/ml) and IMT (b=0.79, P=0.015, mean IMT=1.3±0.6cm) after adjusting for age, sex and atheroclerotic risk factors. Among the aforementioned markers, GLS had the strongest value for prediction of MACEs (area under the curve 0.82 p=0.017). A cut-off value of GLS &gt;−16.5% predicted MACEs with a sensitivity 80% and specificity of 82.6%.

Conclusion
Impaired myocardial and vascular function is associated with adverse cardiovascular events in psoriasis. GLS as a marker of subclinical myocardial dysfunction has the strongest predictive value for MACEs incidence during a 4-year follow-up study.

Funding Acknowledgement
Type of funding source: None