bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there a different impact of traditional risk factors on calcium score, in an asymptomatic population?
Authors: Temtem M , Serrao M , Mendonca M I , Santos M , Sousa J A , Mendonca F , Sousa A C , Freitas S , Henriques E , Rodrigues M , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Abstract

Background
The coronary calcium score has been increasingly used to stratify and predict cardiovascular risk, particularly in low and intermediate-risk persons. Understanding which determinants have more impact on coronary calcium score level, could lead to the development of new stricter preventive measures for reducing coronary artery calcification (CAC) and, consequently, cardiovascular risk.

Purpose
Our study aimed to investigate the impact of the traditional risk factors (TRFs) on the CAC score level and if there is a different association between this TRFs and CAC score degrees, in an asymptomatic population.

Methods
The study cohort comprised 1,122 consecutive asymptomatic individuals without known coronary artery disease (CAD) belonging to the healthy controls of GENEMACOR study and referred for computed tomography for CAC scoring assessment. The traditional risk factors considered were (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary artery disease. According to the Hoff's nomogram, 3 categories were created: low CAC (0≤CAC&lt;100 and P&lt;50); moderate CAC (100≤CAC&lt;400 or P50–75) and high or severe CAC (CAC≥400 or P&gt;75). We evaluated the association of the different TRFs with these levels of CAC score (Chi-square test). Finally, we performed a logistic regression model adjusted for all significant TRFs selected in the bivariate analyses.

Results
Smoking was significantly associated with high levels of CAC score, 28.4% vs 21.7%; p=0.038 as well as hypertension, 58.8% vs 45.6%; p=0.001, type 2 diabetes 21.1% vs 9.6%; p&lt;0.0001, dyslipidemia, 73.0% vs 66.1%; p=0.057. Family history did not show a significant association with CAC (p=0.717). Then, we constructed a logistic regression model adjusted the significant risk factors in previous analysis. The final multivariate analysis, selected as independent predictors of high CAC: Type 2 diabetes; OR=2.309; 95% CI 1.533–3.479; p&lt;0.0001, hypertension; OR=1.627; 95% CI 1.185–2.233; p=0.003, and smoking, OR=1.565; 95% CI 1.102–2.222; p=0.012.

Conclusions
In this study, well-known and modifiable cardiovascular risk factors are associated with high calcium score levels. However, hypertension and diabetes seem to be preferentially associated with higher CAC scores, while tobacco, although it has a significant association, seems to be not so strong as diabetes and hypertension. This concept may mean that smoking has its primary role in plaque instability and not so much in the growing and calcification of plaques.

Funding Acknowledgement
Type of funding sources: None.
High plasma D-dimer and von Willebrand factor levels are associated with risk of upper gastrointestinal bleeding in patients with chronic coronary syndromes receiving long-term antiplatelet therapy
Authors: Korobkova V , Komarov A L , Shakhmatova O O , Dobrovolsky A B , Novikova E S , Guskova E V , Titaeva E V , Yarovaya E B , Shuleshova A G , Panchenko E P 
Published: October 2021

Abstract

Purpose
Plasma von Willebrand factor (VWF) and D-dimer levels have been proposed as markers of endothelial damage, coagulation activation and subsequent cardiovascular events. Thrombotic and hemorrhagic burdens are closely related. However, the association of coagulation markers with bleeding complications in pts with atherosclerosis remains unclear.
We aimed to assess the predictive value of D-dimer and VWF levels for upper gastrointestinal bleeding (UGIB) in patients with chronic coronary syndromes (CCS) receiving long-term antithrombotic therapy.

Patients and methods
Single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200) included 934 pts with CCS (78.6% males, age 61±10.7 yrs, 76% after elective PCI). The UGIB annual incidence was 1.9 events per 100 patient-years.
VWF was determined in 28 pts with UGIB and 141 controls, matched for age, sex and main clinical risk factors. D-dimer was determined from 28 and 380 pts respectively

Results
The median for VWF was 139 [interquartile range 107–168]%. The median for D-dimer was 443,8 [interquartile range 272.5–702.4] ng/ml. ROC analysis revealed acceptable discriminatory ability for VWF (cut off &gt;105%; AUC=0.67, 95% CI: 0.59–0.74, p=0.001) and for D-dimer (cut off &gt;928 ng/ml; AUC=0.63, 95% CI: 0.59–0.68, p=0.002). High levels of coagulation markers remained significant in regression model adjuster for ESC panel of UGIB risk factors. OR for D-dimer = 3.4, 95% CI: 1.09–10.66; p=0.03). OR for VWF = 11.74, 95% CI: 1.19–116.18; p=0.03).

Conclusion
VWF and D-dimer should be considered as valuable prognostic biomarkers to improve the prediction of UGIB in addition to well-known scoring systems in CCS patients receiving long-term antithrombotic therapy.

Funding Acknowledgement
Type of funding sources: None.
A novel NKX2–5 double variant corresponds with familial atrial septal defect with arrhythmia in Indonesia
Authors: Rozqie R , Satwiko M G , Anggrahini D W , Hartopo A B , Sadewa A H , Mumpuni H , Dinarti L K 
Published: October 2021

Abstract

Background
The transcription factor NKX2–5 is essential for heart development during embryonic stages. The genetic variant of NKX2–5 is founded in many congenital heart diseases, especially atrial septal defect (ASD). Most of NKX2–5 variants in Asia based on Chinese population are single nucleotide polymorphisms. Whether the same variant of NKX2–5 is also involved in Southeast Asia population is still unknown. Therefore, we investigate the NKX2–5 variant in atrial septal defect population in Indonesia.

Purpose
To investigate the genetic variation of NKX2–5 in ASD in Indonesian population.

Methods
We screened 97 patients with ASD (including 23 familial patients) for sequence variant in NKX2–5. DNA samples were extracted from venous blood samples. The whole two coding exons of the NKX2–5 gene from DNA samples were amplified by multiplex PCR and directly sequenced. Variations were detected by comparison with the standard reference genome. The distribution of genotype frequency in atrial septal disease familial and non-familial were analyzed.

Results
We identified a novel heterozygous DNA sequence double variant (c413 G&gt;A, rs1366528649 and c561 G&gt;C, rs767559311) in exon 2 of NKX2–5 gene was identified only in 3 familial ASD patients. These patients are related to first-degree relatives. Patients with these double variants have septal defects and arrhythmias in young-to middle-aged adults (sinus node dysfunction dan atrial tachycardia). Moreover, one reported single nucleotide polymorphisms (SNPs) (c63 A&gt;G, rs2277923) was detected in 83 patients (85.6%), as 20 patients (87%) were present among the familial group, and 63 patients (85.1%) were found from the non-familial group. The distribution of rs2277923 variation among the familial and non-familial groups was not different. Variation of rs2277923 has 2 genotypes: homozygous AG presented in 42 patients (43.3%) and heterozygous AG shown in 41 patients (42.3%). The distribution of both genotypes is also similar between familial and non-familial groups.

Conclusions
We discovered that the novel NKX2–5 double variants (rs1366528649 and rs767559311) might contribute to familial ASD risk, although the rs2277923 is the most commonly found variant in ASD patients in Indonesia.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dana Masyarakat Faculty of Medicine, Public Health and Nursing UGM fiscal years 2020
How common is undiagnosed prediabetes or type 2 diabetes mellitus in the cardiology ward?
Authors: Stratinaki M , Milaki K , Stavrakis S , Pitarokoilis M , Korela D , Detoraki M , Stavratis S , Katsiavos A , Kafarakis P , Garidas G , Lamprogiannakis E , Foukarakis E 
Published: October 2021

Abstract

Background
Type 2 diabetes mellitus (T2DM) is one of the most important risk as well as prognostic factors in patients with cardiovascular disease. Thus, it is of crucial importance to identify the patients with T2DM or prediabetes and provide them the necessary treatment and follow up.

Purpose
To identify the prevalence of undiagnosed prediabetes or T2DM in the patients admitted to cardiology department of our hospital during one year.

Methods
We retrospectively analyzed the data from the patients admitted to the cardiology department of our hospital (general secondary hospital) for a period of 12 months. We recorded the reason of admission, whether they had been previously diagnosed with T2DM or prediabetes.For those without a known history of T2DM glycosylated hemoglobin (HbA1C) was measured during their hospital stay. If HbA1c was higher than 6.5% the patient was classified as diabetic and if HbA1c was 5.7–6.4% the patient was classified as pre-diabetic.

Results
1524 patients were admitted in the cardiology department during 1 year (612 female, 912 male, mean age 76±12.4 years).Of them, 932 (61.15%) had no history of T2DM or prediabetes. 524 (34.38) were admitted due to acute decompensation of heart failure (ADHF), 206 (13.51%) due to acute coronary syndrome (ACS), 103 (6.75%) due to atrial fibrillation (AF), 87 (5.7%) due to other arrhythmias and 12 (0.78%) for other reasons (including pericarditis, endocarditis etc).229 patients (24.5%) were identified as prediabetics and 329 (35.3%) as diabetics. In terms of the reason of admission, as prediabetics were classified the following number of patients: 124 (23.66%) with ADHF, 42 (20.38%) with ACS, 26 (25.24%) with AF, 35 (40.22%) with other arrhythmias and 2 (16.66%) of those admitted for other reasons. Respetctively, as diabetics were classified 230 (44.8%) patients with ADHF, 74 (32.6% with ACS, 15 (12.7%) with AF, 7 (12.4%) with other arrhythmias) and 3 (9.2%) of those admitted for other reasons.

Conclusions
59.8% of all patients admitted in the cardiology department with no previous history of T2DM was found to have either prediabetes or T2DM. Given the fact that T2DM plays pivotal role in the prognosis of cardiovascular disease as well as the well established benefits of the new antidiabetic drugs especially in patients with heart failure and coronary artery disease, screening of all patients for T2DM could be very helpful in order to identify these patients and offer them suitable and timely treatment.

Funding Acknowledgement
Type of funding sources: None.
Adverse coronary plaque characteristics are more common in patients with diabetes
Authors: Simon J , Hahn V , Jermendy G Y , Kolossvary M , Kardos A , Szilveszter B , Boussoussou M , Vattay B , Merkely B , Maurovich-Horvat P 
Published: October 2021

Abstract

Introduction
Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. However, there is a lack of data about the prevalence of adverse coronary artery plaques characteristics in patients with DM.

Purpose
In our study we aimed to compare the prevalence of adverse atherosclerotic coronary artery plaque characteristics between patients with and without DM.

Methods
We have analyzed the data of patients who underwent coronary computed tomography angiography (CCTA) between October 2012 and December 2020. Our exclusion criteria were coronary anomaly, congenital or other structural heart disease, previous revascularization or heart transplantation, non-diagnostic image quality and no available data on the presence of DM. Patients were divided into two groups based on the presence of DM.

Results
In total, 11,357 patients were included in our study. Prevalence of DM was 14.5%. There were significant differences in age (63.2±9.5 vs 58.1±12.2 years, p&lt;0.001) and major cardiovascular risk factors such as hypertension, dyslipidemia and smoking between the two groups (all p&lt;0.05). We have measured higher coronary artery calcium score in patients with DM vs. without DM (424.3±744.0 vs 174.2±794.6, p&lt;0.001). Obstructive coronary artery disease (stenosis &gt;70%) was more frequent in the DM group (24.6% vs 10.5%, p&lt;0.001). While 29.6% of patients without DM had at least one plaque with adverse characteristics, this rate was 38.9% in those with DM (positive remodeling: 19.6% vs 26.1%, low attenuation: 7.6% vs 10.2%, spotty calcium: 16.9% vs 21.6%, napkin-ring sign: 1.7% vs 2.6%, all p&lt;0.05).

Conclusions
The prevalence of severe coronary artery stenosis and coronary plaques with adverse characteristics was higher in patients with DM. Multivariate analysis is needed to further explore this association.

Funding Acknowledgement
Type of funding sources: None.
Education and lifestyle measures for awareness of syncope prodroms to prevent syncope recurrence in schoolchildren
Authors: Mair V , Santos F R A , Pereira H G , Pastore C A , Samesima N , Diniz L J , Takada J Y , Mansur A P , Nakagawa N K 
Published: October 2021

Abstract

Background
Syncope is a transient loss of consciousness secondary to cerebral hypoperfusion and is characterized by a sudden onset, short duration and spontaneous recovery. The prevalence of syncope is between 30 to 50% in children and adolescents, 75% of them could corresponding to neuromediated reflex syncope (NRS) and to postural orthostatic tachycardic syndrome (POTS). The efficacy of education and lifestyle measures to prevent syncope prodromes in schoolchildren is still little known.

Objective
The aim of this study was to assess the education and lifestyle measures (syncope prodromes recognition, frequent water intake, counter-pressure maneuvers and physical activity) for preventing syncope prodromes in schoolchildren over 12 months.

Methods
We included 123 children and, at baseline, we assessed clinical parameters such as heart rate (HR), and systolic and diastolic blood pressure (SBP and DBP, respectively), and oriented how to recognize syncope prodromes and triggers as well as to take lifestyle and other measures (frequent water intake, counter-pressure maneuvers and physical activity). We performed statistical analysis using ANOVA for continuous variables and Qui-Square Test or Fisher Exact Test for categorical variables, when appropriate.

Results
Children were divided in three groups: no NRS-POTS (noNRS-POTS; n=103, mean age: 10.0 years, 49 male, height: ∼1.42 m, weight: ∼60.9 kg, HR: ∼63 bpm, SBP: ∼100,1 mmHg and DBP: ∼65.8 mmHg), NRS (n=5, mean age: 10.4 years, 2 male, height: ∼1.39 m, weight: ∼63.9 kg, HR: ∼68 bpm, SBP: ∼107,2 mmHg and DBP: ∼69.8 mmHg), and POTS (n=15, mean age: 10.47 years, 6 male, height: ∼1.39 m, weight: ∼69.0 kg, HR: ∼53 bpm, SBP: ∼100,7 mmHg and DBP: ∼63.6 mmHg). From 123 children, 95% (n=117) had history of syncope prodromes and 13.8% (n=17) had syncope history. Over the 12-month, only 10.6% of them (n=13) continued to have syncope prodromes and, most interesting, none of them had a new syncope event.

Conclusion
Education and lifestyle measures were effective to significantly reduce syncope prodromes and to prevent any new syncope event.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Sao Paulo
COVID-19 infection impact on cardiovascular and thrombotic events during acute phase and medium-term of the disease
Authors: Varela Lopez A , Diaz Argueso L , Broco Fernandez C , Cacho Antonio C E , Antunez Muinos P J , Otero Garcia O , Jimenez Ramons V , Gonzalez Ferreiro T , Perez-Poza M , Bastos Fernandez M , Garcia Campos A , Varela Roman A , Lopez Pais J , Lopez Otero D , Gonzalez Juanatey J R ,   CARDIOVID
Published: October 2021

Abstract

Background
Coronavirus disease (COVID-19) was labelled a global pandemic in April 2020 by the World Health Organisation. By December of the same year the disease caused by SARS-COV-2, known as COVID-19 (Coronavirus disease 2019), had spread over 200 countries, infecting more than 70 million people, causing more that 1.5 million of deaths.
Recent studies suggest SARS-CoV-2 infection may be related to cardiovascular and thrombotic events although the strength of association remains unclear.

Aims
Evaluate the emergence of cardiovascular and thrombotic events (such as major acute cardiovascular events, ictus and other thrombosis) in the acute moment and in medium-term follow-up in COVID-19 patients.

Methods
Single-Center, retrospective, observational study of cohorts based on all the inhabitants of the health area. Survival analysis of main outcomes (mortality, heart failure [HF], and major acute cardiovascular events – MACE - [a composite of cardiovascular mortality, myocardial infarction and stroke]) were adjusted by multivariate logistic regression.

Results
Of the total population studied, 447,979 inhabitants, 1,030 (0.23%) were diagnosed with COVID-19 infection, of which 14,8% were smokers, 31,2% had high blood pressure (HTA), 12,8% had diabetes, 29,2% had dyslipidaemia, 2,7% had peripheral artery disease, 4,7% had ischemic heart disease, 3,3% had had a previous transient ischemic attack, 10% were in anti-aggregation treatment and 5,8% were in anticoagulation treatment at the time of diagnosis. Concerning the analytics middle values, the group treated with ACEI/ARAB had higher troponins and ferritin than the group without ACEI/ARAB treatment, whereas higher reactive C protein and D-dimer were found in this last group. The main results showed that COVID-19 infection had no effect regarding to cardiovascular and thrombotic disease on mortality (OR: 1.64, 95% CI 0.98 2.76, p=0.062), heart failure (OR: 0.98, 95% CI 0.53 1.79, p=0.942), thrombotic events (OR: 1.02, 95% CI 0.22 4.83, p=0.98) and major acute cardiovascular events (OR: 0.88, 95% CI 0.48 1.60, p=0.665).

Conclusions
In conclusion, COVID-19 infection had no effect on the emergence of cardiovascular or thrombotic events taking into account the 6-month prognosis, defined as mortality, heart failure, or major acute cardiovascular events.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 pandemic triggers acute myocardial infarction, stroke, and out-of-hospital cardiac arrest in non-infected individuals: the final results of the JoCORE study
Authors: Alhaddad I , Hammoudeh A , Mdanat E , Makhamreh H , Ibdah R , Fakhri M , Tabbalat R ,   JoCORE Study Investigators
Published: October 2021

Abstract

Introduction
The relentless COVID-19 pandemic caused a devastating sickness and loss of life at a global level. The stress related to the pandemic lockdown and near total paralysis of most human activities was associated with behavioral changes. It is largely unknown if these stresses could trigger acute cardiovascular events among non-infected individuals.

Purpose
To explore the relation between COVID-19 associated stresses and acute cardiovascular events among non-infected individuals.

Methods
Adult patients presented with acute myocardial infarction (AMI), stroke or out-of-hospital cardiac arrest (OHCA) at 11 hospitals in Jordan from March 2020 through February 2021 were assessed for potential exposure to stressful life events related to the COVID-19 pandemic. None of the patients was COVID-19 infected or a health care worker.

Results
Of 297 patients enrolled (mean age 58.4±13.1 years, 18.5% females), 267 patients (89.8%) had AMI, 15 patients (5.1%) had stroke, and 15 patients (5.1%) had OHCA. Cigarette smoking was present in 59.6%, hypertension in 50.5%, dyslipidemia in 42.8%, diabetes in 37.4%, and 35% had prior diagnosis of cardiovascular disease. Coronary revascularization was performed in 228 (85.4%) of AMI patients. In-hospital mortality among the AMI and stroke patients was 4.3% and none of the OHCA patients survived. The most common stresses preceded these events included financial hardships (50.8%), lockdown stress (25.9%), fears from the pandemic (24.9%), anger (22.6%), loneliness (19.2%), smoking binges (19.9%), death of a significant person (6.4%), and food binges (3.4%).

Conclusions
The COVID-19 pandemic and lockdown caused immense psychosocial and financial stresses that triggered life threatening acute cardiovascular events in non-infected individuals. Early recognition of stress-related symptoms during this unremitting pandemic warrants proper referral and evaluation.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): ABDEL HAMEED SHOMAN FOUNDATION (AHSF) RESEARCH FUND
Resilience of the hellenic navy SEALs assessed by heart rate variability during cognitve tasks
Authors: Mourtakos S , Vasiliou G , Papageorgiou C , Konotangelos K , Philippou A , Bersimis F , Geladas N , Koutsilieris M , Sidossis L , Tsirmpas C , Papageorgiou C 
Published: October 2021

Abstract

Background
The interaction between high physical performance under extreme conditions and simultaneous control of the cognitive executive functioning has been a subject of research in literature for the past few decades. Stroop test and Heart-rate variability (HRV), have been verified clinical tools for the assessment of cerebral and autonomic/ cardiovascular stress responses respectively.

Purpose
The investigation of HRV adaptive response to stress and cognitive stress resilience under extremely strenuous conditions.

Methods
34 consecutive subjects were enrolled. Of them, 18 were candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (HNS) and 16 were healthy controls (HC). All subjects underwent stroop tasks, along with mental state and personality examination. HRV variables in time and frequency domains recordings were acquired, during each aforementioned cognitive testing procedure.

Results
HNS's performance on both cognitive and emotion stroop tasks were equivalent to controls. During the size comparison of the number stroop and emotion stroop, HC had statistically significantly higher power content at different HRV frequency bands compared to HNS participants (p=0.036 and p=0.06 respectively). Finally, in a between group comparison of the psychometric tools, HNS had significantly higher somatization (p&lt;0.01), anxiety (p=0.037) and neuroticism (p=0.047) than HC. Correlation was conducted for each group separately, between the psychometric tools and the measurements of HRV for both number and emotion stroop. Moderate negative correlations were found between SDNN (Standard deviation of normal-to-normal RR-intervals) during the size comparison of number stroop and three out of nine categories of psychometric questionnaire; somatization (r(23)=−0.452, p&lt;0.05), anxiety (r(23)=−0.457, p&lt;0.05) and hostility (r(23)=−0.445, p&lt;0.05)

Conclusion
The above findings suggest that HNS display flexibility in their autonomic regulation during cognitive and emotional tasks. This characteristic is closely related to problem solving or adaptability skills. Additionally, HRV can be a promising clinical index regarding the assessment of psychophysiological resilience especially in the neurovisceral integration (NVI) model.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica