bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to cardiac rehabilitation after acute coronary syndrome and its impact on patient outcome
Authors: Sulzgruber P , Sinkovec H , Kazem N , Hofer F , Hammer A , Koller L , Todorovic M , Katsch F , Gall W , Duftschmid G , Heinze G , Niessner A 
Published: November 2020

Abstract

Background
Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially cardiac rehabilitation proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and overall modification of cardiovascular risk factors. However, profound epidemiological measures on adherence to a recommended cardiac rehabilitation after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to cardiac rehabilitation after ACS and its impact on patient outcome from an Austrian nationwide perspective.

Methods
Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to recommended cardiac rehabilitation was investigated according to health insurance documentation. Patients were followed prospectively until the primary study endpoint (= mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to cardiac rehabilitation on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model.

Results
During the observation period a total of 16.518 patients (median age: 64 years [54–74]; male: 68.4% [n=11.306]) met the inclusion criteria. Of alarming importance 86.6% (n=14.305) of all patients presenting with ACS did not perform any cardiac rehabilitation as recommended by current guidelines. During patient follow-up until 01/2018 a total of 1774 (10.7%) individuals died. Adherence to recommended cardiac rehabilitation had a strong an independent inverse association with mortality with an adjusted hazard ratio of 0.73 (95% CI: 0.54–0.98; p=0.036) (see Figure 1).

Conclusion
The present nationwide investigation highlighted an overall low adherence to recommended cardiac rehabilitation after ACS. Since cardiac rehabilitation after ACS was associated with a 27% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of cardiac rehabilitation and associated intensified risk factor modification should be promoted, in order to prevent fatal atherothrombotic events.
Figure 1. Cumulative mortality

Funding Acknowledgement
Type of funding source: None
Relationship between papillary muscles abnormalities and apparently unexplained infero-lateral T-wave inversion in athletes
Authors: Bettella N , De Lazzari M , Zorzi A , Vessella T , Cipriani A , Motta R , Perazzolo Marra M , Corrado D 
Published: November 2020

Abstract

Aims
To evaluate by cardiac magnetic resonance (CMR) if left ventricle papillary muscle abnormalities, such as hypertrophy and abnormal location, may be the anatomo-functional substrates responsible for TWI inversion in lateral or infero-lateral leads in otherwise healthy athletes.

Methods
We included competitive athletes with TWI in lateral or infero-lateral leads in the absence of cardiac diseases detected by CMR. The control population included healthy athletes with normal ECG, matched for age and gender. We compared thickness, volume (both absolute and relative to the cardiac mass) and position of the papillary muscles between cases and controls.

Results
We included 53 athletes with apparently unexplained TWI in the lateral or infero-lateral leads (median age 20 years (17–42), 86.8% males) and 53 athletes with no TWI matched for age and gender. 4 patients (7.6%) had family history for cardiomyopathy or sudden cardiac death. Athletes with TWI showed more hypertrophic papillary muscles compared to controls, with statistically significant difference in diameter, area and volume (p&lt;0.01). The median ratio between the papillary muscles and the left ventricular mass was 4.4% among athletes with TWI versus 3% among those without TWI (p&lt;0.001). Papillary muscles showed apical displacement in 47% of cases, compared to 17% in the control group (p=0.001).

Conclusions
Idiopathic TWI in lateral or infero-lateral leads is associated with left ventricle papillary muscle hypertrophy and their apical displacement detected by CMR. The comprehension of clinical and prognostic significance of papillary muscle abnormalities responsible for these ventricular repolarization alterations requires further studies.
Example

Funding Acknowledgement
Type of funding source: None
The platelets behaviour in non-alcoholic fatty liver disease. A potential role for antiplatelets drugs?
Authors: Baratta F , Del Ben M , Pastori D , Bartimoccia S , Cammisotto V , Cocomello N , Colantoni A , Pani A , Nocella C , Carnevale R , Angelico F , Violi F 
Published: November 2020

Abstract

Background and purpose
Previous studies showed a favorable effect of aspirin, which irreversibly acetylates cyclooxygenase-1 (COX1) so preventing Thromboxane (Tx) A2 biosynthesis, in non-alcoholic steatohepatitis (NASH) and its sequelae. However, the behavior of COX1 in NASH patients is still unknown.

Methods
We conducted a cross-sectional study on 44 outpatients with NASH, 50 subjects with simple steatosis (NAFL) and 50 subjects without hepatic steatosis balanced for age, gender and BMI. Serum TxB2, a stable metabolite of TxA2, and urinary 11-dehydro-TxB2, as markers of COX1 activation, plasma soluble P-selectin (sP-selectin), a maker of in vivo platelet activation, serum bacterial lipopolysaccharide (LPS) and serum zonulin, a marker of gut permeability, were measured.

Results
Urinary 11-dehydro-TxB2 (p&lt;0.001) and serum TxB2 (p&lt;0.001) levels as well as sP-selectin (p&lt;0.001) were significantly higher in patients with NASH/NAFL compared to the controls (figure 1); the markers of COX1 activation significantly correlated with sP-selectin (p&lt;0.001). Serum LPS was higher in patients with NASH compared with NAFL and controls (p&lt;0.001) and serum zonulin was significantly higher in patients with NASH as compared to controls (p=0.031). A positive correlation (rS=0.37; p&lt;0.001) was observed between serum LPS and serum zonulin. Moreover, serum LPS correlated with serum and urinary 11-dehydro-TxB2 (rS=0.30; p&lt;0.001 and rS=0.61; p&lt;0.001, respectively) and with sP-Selectin (rS=0.32; p&lt;0.001) (figure). At multivariate analysis, LPS above median (OR=3.15, p=0.015) and liver diagnosis (NAFL vs. Controls: OR=6.54; p&lt;0.001 and NASH vs Controls: OR=4.54; p=0.007) were independently associated with sP-selectin above median (table).

Conclusions
Patients with NAFLD display enhanced platelet activation, which is associated to COX1 up-regulation. LPS increased by impaired gut permeability may favor platelet activation.
Figure 1

Funding Acknowledgement
Type of funding source: None
Incidence and predictors of arrhythmias in patients with systemic sclerosis and no overt cardiac disease
Authors: Stronati G , Manfredi L , Dichiara C , Dello Russo A , Gabrielli A , Guerra F 
Published: November 2020

Abstract

Background
Cardiac involvement in SSc is frequent, mostly subclinical and represents a negative prognostic factor. Speckle tracking derived measurement global longitudinal strain (GLS) has been able to identify primary heart involvement in patients with SSc and no overt cardiac disease. SSc-related cardiomyopathy, defined as a condition affecting the heart primarily and globally, has been proven to progress over time and seems to be correlated to cardiac arrhythmias. Nonetheless, cardiac arrhythmias represent 6% of the overall causes of death in SSc patients.

Purpose
The aim of our study was to assess the incidence of cardiac arrhythmias in SSc patients with no overt cardiac disease and to identify potential predictors.

Methods
Prospective longitudinal study enrolling all consecutive patients with a diagnosis of SSc and no overt cardiac disease or pulmonary hypertension. Echocardiographic parameters and GLS were obtained at baseline and at each follow up. Presence of atrial fibrillation (AF), atrial tachycardia (AT), ventricular ectopic beats &gt;1000/24 h (VEB), supraventricular ectopic beats (SVEB), bundle branch block (BBB) and atrioventricular block (AVB) was assessed through clinical history, ECG and 24-Holter monitoring over time.

Results
Among 67 consecutive patients with SSc, 11 (16.7%) had at least one episode of AF or AT. Moreover, respectively 12 (17.9%) and 16 (23.9%) had a significant amount of SVEB and VEB at Holter monitoring. Conduction defects were common, with 4 (4.6%) of all patients with grade I AVB, 1 (1.5%) with grade II AVB and 1 (1.5%) with complete heart block. Complete right BBB was seen in 6 (6.9%) of patients. Four patients (4.6%) experienced a sudden cardiac death during follow-up (median 20 months, 1st-3rd quartile 12–24 months).
Years from SSc diagnosis (RR 1.10; 95% CI 1.02–1.23; p=0.047) and indexed right atrial volume (iRAV; RR 1.22; 95% CI 1.07–1.39; p=0.004), but not indexed left atrial volume were independently correlated with the diagnosis of AF/AT. The same two variables were independently correlated with any degree of AV block (years from SSc diagnosis: RR 1.11; 95% CI 1.01–1.23; p=0.004; iRAV: RR 1.14; 95% CI 1.02–1.27; p=0.019). Due to the low sample size, we were unable to detect any clinical predictors of sudden cardiac death in our population, however those who died experienced a larger worsening in left ventricle GLS values (4.0±1.6 vs. 0.9±0.4, p=0.056).

Conclusions
Supraventricular arrhythmias and conduction defects are common in patients with SSc. Time from diagnosis and right atrial volumes are able to predict the incidence of such conditions, supporting the hypothesis that a long-lasting disease and the anatomical remodelling of the right atrium could contribute to the developing of tachy- and bradyarrhythmias in this population.

Funding Acknowledgement
Type of funding source: None
Primary signs of vasular inflammation in children with familial hypercholesterolemia
Authors: Slastnikova E , Sadykova D.I , Galimova L.F , Usova N.E 
Published: November 2020

Abstract

Familial hypercholesterolemia is one of the most common genetic diseases that leads to premature atherosclerosis. We investigated endothelial function in children with heterozygous familial hypercholesterolemia in order to detect the first signs of endothelial inflammation in non-invasive ways.
In 57 children with heterozygous familial hypercholesterolemia (Group 1), endothelial function was studied by measuring levels of nitric oxide (NO), endothelin and hypersensitive C-reactive protein (hsCRP). All secondary causes that could lead to a change in these indicators were excluded. Children from Group 1 had no Clinical or ultrasound signs of atherosclerosis. No children from Group 1 were ever treated by statins or other lipid-lowering therapy. Results were compared with a group of children comparable in age and sex (Group 2). Average age of Group 1 was 9 years old ±2 months, Group 2 is 9 years old ±3 months. Average lipid values in Group 1: total cholesterol (TH) – 7.2±0.9 mmol/L, low density lipoproteins (LDL) – 4.7±0.7 mmol/L, triglycerides and high density lipoproteins (HDL) corresponded to normal. Group 2 average lipids: TH – 4.2±0.7 mmol/L, LDL – 2.3±0.4 mmol/L, the level of triglycerides and (HDL) corresponded to normal.

Results
The results in Group 1 were: NO 66.15±1.19 μmol/L, endothelin 0.418±0.121 pmol/L, hsCRP 0.25±0.1 mg/dl. They showed in Group 2: NO 39.15±0.15 μmol/L, endothelin 0.231±0.05 pmol/L, hsCRP 0.11±0.2 mg/dl. The results in group 1 were significantly higher (endothelin and hypersensitive reactive protein) and lower (NO) in terms of indicators.

Conclusions
There is significant difference in the levels of vasodilators, vasoconstrictors and hsCRP between Group 1 and Group 2, that means there are the signs of inflammation in the Children with no clinics of peripheral or coronary atherosclerosis. It can be used as biomarkers of premature atherosclerosis and can help to avoid it.

Funding Acknowledgement
Type of funding source: None
Long-term follow-up of paediatric patients with a subcutaneous implantable cardioverter-defibrillator
Authors: Van Der Stuijt W , De Wilde K.C , Baalman S.W.E , Quast A.B.E , Blom N.A , Wilde A.A.M , Knops R.E 
Published: November 2020

Abstract

Background
Inherited channelopathies, cardiomyopathies and structural heart diseases are known to increase the risk of sudden cardiac death in children and are occasionally treated with an implantable cardioverter-defibrillator (ICD). Due to their physical growth and higher level of activity, children experience more adverse events than adults, such as lead fractures, vascular problems and infections. The subcutaneous ICD (S-ICD) was introduced to avoid these lead-related complications and is expected to be especially beneficial for children who require ICD therapy. However, long-term follow-up data of this population are lacking.

Purpose
To evaluate long-term clinical outcomes of the S-ICD in the paediatric population.

Methods
Follow-up data were prospectively collected of all paediatric patients (age &lt;18 years) who received their S-ICD in our tertiary centre between November 2009 and June 2019. Clinical outcomes that were assessed were appropriate or inappropriate shocks and complications that required surgical intervention.

Results
A total of 21 paediatric patients received an S-ICD, with a median age of 15 years (ranged 8–17) and a median body mass index of 18.8 kg/m2 (ranged 15.5–28.8, lowest weight 30kg). The indication for ICD implantation was mostly idiopathic ventricular fibrillation (38.1%) or genetic arrhythmic disease (28.6%). The subcutaneous lead was implanted in an S-shape to accommodate for growth in small patients, and straightening of the lead could be observed on successive chest X-rays (see figure). There was no need for lead or device revisions in this cohort. After a median follow-up of 4.3 years (IQR 2.7–6.5), five patients (23.8%) received an appropriate shock for ventricular arrhythmias and six patients (28.6%) received an inappropriate shock for supraventricular tachycardia (n=4) or double-counting (n=2). Complications that required device extraction occurred in three patients after 0.8±1.1 years and was the result of inappropriate shocks (n=1) and pocket infection (n=2). In two patients the S-ICD was extracted due to progression of their cardiac disease, of whom one needed biventricular pacing and one underwent heart transplantation.

Conclusions
The S-ICD appears efficacious in this heterogeneous paediatric population. Although higher than reported in adults, the long-term complication rate in paediatric S-ICD recipients is similar to the paediatric transvenous ICD population.

Funding Acknowledgement
Type of funding source: None
Alterations in mechanical properties of carotid artery in overweight and obese children
Authors: Kim S.A , Park P.K.H 
Published: November 2020

Abstract

Background
Atherosclerosis begins at a young age in a process that is clinically silent before events occur. Obesity in childhood has been associated with the alterations of vascular properties.

Purpose
The aim of this study was to investigate the subtle changes of mechanical properties of carotid artery (CA) in overweight and obese children.

Methods
We prospectively recruited a cohort of overweight (n=25) and obese (n=176) children aged 7–17 years and non-obese children with same age and gender (controls, n=31). Overweight is defined as a body mass index (BMI) at or above the 85th percentile and below the 95th percentile and obesity as a BMI at or above the 95th percentile for children of the same age and gender. The mechanical properties of carotid artery were directly measured in a cross-sectional image of common carotid artery using a velocity-vector imaging (VVI) analysis including instantaneous vessel area and deformation parameters as fractional area change (FAC), circumferential strain, and strain rate (SR).

Results
Compared to controls, obese children had higher blood pressures and serum glucose and worse lipid profiles than controls, whereas overweight children showed no any difference in blood pressure and laboratory findings. Among vascular properties, there were no differences in carotid intima-media thickness (cIMT) between the three groups. However, obese children showed larger vessel area and higher arterial stiffness presented as lower FAC, circumferential strain and SR than controls, whereas overweight children showed no difference in vascular properties with obese children and with controls except for circumferential SR. Circumferential SR in overweight children was significantly reduced than controls (0.47±0.19 cm/s, 0.75±0.22 cm/s, respectively, p&lt;0.001) and was the only vascular parameter distinguishing overweight children from controls. In multiple linear regression analysis, independent determining factors of the circumferential SR of carotid artery were age (β=−0.13, p=0.03), serum triglycerides (β=−0.14, p=0.01) and BMI (β=−0.37, p&lt;0.001) in this population.

Conclusions
In overweight and obese children, a decrease in circumferential SR of carotid artery precedes the changes of vessel wall thickness and vessel area. We demonstrated the subtle changes of mechanical properties of carotid artery precede the changes of structural properties in overweight and obese children.

Funding Acknowledgement
Type of funding source: None
Increasing age as a major determinant of major adverse outcomes in patients with atrial fibrillation: the EURObservational research programme in atrial fibrillation general long-term registry
Authors: Boriani G , Proietti M , Laroche C , Piot O , Lane D.A , Potpara T , Maggioni A.P , Lip G.Y.H 
Published: November 2020

Abstract

Introduction
Increasing age is a well-known determinant for incident atrial fibrillation (AF) as well as for adverse outcomes. With a progressively ageing population in Europe (and elsewhere), contemporary data are needed to investigate the impact of age in relation to major adverse events in AF patients.

Purpose
To evaluate the impact of increasing age on major adverse outcomes in a contemporary European AF cohort.

Methods
Patients enrolled in the EORP-AF Long Term General Registry were categorized by age: &lt;65, 65–74, 75–84, and ≥85 years. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death, all-cause mortality were considered as outcomes.

Results
Among the 9762 patients included in this analysis, 2946 (30.2%) were &lt;65 years, 3288 (33.7%) were 65–74 years, 2954 (30.3%) were 75–84 years and 574 (5.9%) were ≥85 years. With increasing age categories, there was a progressively higher prevalence of most risk factors and comorbidities. Accordingly, both mean CHA2DS2-VASc and HAS-BLED scores were progressively higher across the age categories (both p&lt;0.0001). At discharge, use of any oral anticoagulant (OAC) drug was lower in patients ≥85 years compared to those aged 65–74 or 75–84 years (83.6% vs. 89.4% and 88.8%, respectively) but significantly higher than in those &lt;65 years (80.2%) [p&lt;0.001]. Rate of all major adverse events progressively increased across the age categories, being higher in those aged ≥85 (all p&lt;0.001). Kaplan-Meier curves showed an increasing cumulative risk across the age groups for all the outcomes (p&lt;0.0001) (Figure 1). A fully adjusted Cox regression analysis demonstrated a progressively increasing association between age categories and the risk of all major adverse outcomes (Table 1).

Conclusions
In a large contemporary cohort of European AF patients, increasing age was a major determinant of major adverse outcomes.
Figure 1. Kaplan-Meier Curves for All-Cause Death

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies supported its activities with unrestricted grants.
Long-term echocardiographic assessment of descendants of gestational breast cancer patients exposed to anthracycline-based chemotherapy
Authors: Oneto Fernandez M , Gonzalez-Manzanares R , Garcia-Duran C , Mesa Rubio D , Ruiz Ortiz M , Delgado Ortega M , Rodriguez Almodovar A.M , Romo Penas E , De La Haba J , Castillo Dominguez J.C 
Published: November 2020

Abstract

Background
Breast cancer is the most common cancer in women and the leading cause of cancer death in women. Although gestational breast cancer (GBC) accounts only for a small amount of diagnosis, the incidence is increasing due to delayed childbearing.
Treating GBC is a significant challenge, having to maintain a balance between effective treatment for the patient and safety for the descendants.
Anthracycline-based chemotherapy (AC) remains to be the systemic treatment of choice in many GBC patients.
Although AC in GBC appears to be safe for the descendants, data on the long-term cardiotoxic effects of AC are scarce.

Purpose
To evaluate long-term cardiotoxicity on descendants of GBC patients exposed to AC during pregnancy or breastfeeding.

Methods
We retrospectively recruited descendants of GBC patients and classified them according to AC exposure (case group and non-exposed control group). We performed a thorough echocardiographic assessment.

Results
We identified 7 GBC patients that received AC during pregnancy (n=6) or breastfeeding (n=1). All of them were diagnosed during the second or third trimester. Median cumulative anthracycline dose was 508mg/m2.
A total of 8 cases and 5 controls were recruited. Median age at echocardiographic assessment was 10 years in cases and 8 years in controls. None of them had known prior cardiac disease. Echocardiographic parameters were within normal values in both groups (Table 1).

Conclusion
A long-term echocardiographic assessment showed no abnormalities in a series of descendants of GBC exposed to AC during pregnancy or breastfeeding. This study may contribute to a better understanding of the safety for the descendants of AC during pregnancy or breastfeeding.

Funding Acknowledgement
Type of funding source: None