bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of exercise based cardiac rehabilitation program in patients with transcatheter aortic valve replacement
Authors: Estrada Martinez LE , Lara Vargas JA , Pineda Juarez JA , Morales Portano JD , Gomez Alvarez JB , Merino Rajme JA , Campo Aguirre R , Leyva Valadez E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Due to the increase in global prevalence of degenerative valve disease, aortic stenosis (AS) has played a preponderant role in the cardiovascular scenario, especially in patients undergoing transcatheter aortic valve replacement (TAVR). An alternative management for this patients are the cardiac rehabilitation programs (CRP); however, their effect has not been completely understood, both in exercise capacity and quality of life, but neither in the improvement of cardiopulmonary performance and other cardiovascular outcomes. Purpose: To evaluate the effect of the CRP on exercise tolerance and cardiopulmonary performance in patients with AS undergoing TAVR. Methods: A cohort study was conducted including 26 patients with AS undergoing TAVR and divided into an intervention group who performed a 4-week supervised training program in the Cardiac Rehabilitation Service and a control group to whom instructions and recommendations to performed unsupervised exercise at home were given. Demographic and clinical data (VO2Max, METS12, oxygen pulse, heart rate, double product, left ventricular ejection fraction, body mass index) were collected at baseline and after a 4-week follow-up. Results: 15 patients were included in the intervention group and 11 patients in the control group. There were no baseline significant differences between groups. After the intervention, significant differences were observed in the METS 12 final gain variable between the control and intervention group (4.55 vs 3.1 p = 0.01). Intergroup analysis showed significant differences (percentage changes) in the intervention group with an increase of METS12 (67.4%, p = 0.001), oxygen pulse (18.21%, p = 0.01), final METS (39.47% p = 0.001) and a decrease in VO2 recovery time (-12.5%, p = 0.05), in the ergometric performance index by heart rate (-38.17%, p = 0.001) and by double product (-38.1%, p = 0.001).

Conclusions
A 4-week cardiac rehabilitation program is effective to improve exercise tolerance and cardiopulmonary response in patients with AS undergoing TAVR; improvement was statistically significant in METS12, oxygen pulse, VO2 recovery time, METS-load and ergometric performance index for heart rate and double product. METS12 final gain was statistically significant in intervention group in comparison with the control group.
Abstract Figure. Control vs Intervention Group (METS12)
Low skeletal muscle density combined with muscle dysfunction predicts adverse events after adult cardiovascular surgery
Authors: Yamashita M , Kamiya K , Matsunaga A , Kitamura T , Hamazaki N , Nozaki K , Ichikawa T , Maekawa E , Meguro K , Yamaoka-Tojo M , Miyaji K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): This study was supported by the Grant for Japan Society for the Promotion of Science (JSPS) KAKENHI.

Introduction
Although muscle dysfunction is widely known as a poor prognostic factor in patients with cardiovascular disease, no study has examined whether the addition of low skeletal muscle density (SMD) assessed by computed tomography (CT) to muscle dysfunction is useful.

Purpose
The present study aimed to examine whether SMDs can strengthen the predictive ability of muscle dysfunction for adverse events in patients who underwent cardiovascular surgery.

Methods
We retrospectively reviewed 853 patients (median age: 69 years, 65.1% male) aged ≥40 years who had preoperative CT for risk management purposes and muscle dysfunctions measured during postoperative cardiac rehabilitation. Muscle dysfunctions were determined from weakness (low grip strength) and slowness (slow gait speed) based on the Asia Working Group for Sarcopenia. Low SMD based on transverse abdominal CT images was defined as a mean Hounsfield unit of the psoas muscle &lt;45. To examine the complementary prognostic value for all-cause deaths, all-cause events, and cardiovascular-related events when low SMDs were added to four patterns of muscle dysfunction (weakness only, slowness only, weakness or slowness, and weakness and slowness), the continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) index were calculated.

Results
For all definitions of muscle dysfunction, the addition of SMDs was shown to significantly improve the cNRI (estimates: 0.377 to 0.468 for all-cause death, 0.220 to 0.248 for all-cause events, 0.308 to 0.322 for cardiovascular-related events) and IDI (estimates: 0.005 to 0.011 for all-cause death, 0.005 to 0.010 for all-cause events, 0.009 to 0.012 for cardiovascular-related events) in all analyses. Low SMDs combined with muscle dysfunctions were associated with the highest risk of all-cause death (Figure 1: A-D). Patients with neither low SMDs nor muscle dysfunction had the lowest risk of all-cause events and cardiovascular-related events (Figure1: E-L).

Conclusion
The predictive ability of muscle dysfunction for adverse events was consistently increased by addition of SMDs in patients who underwent cardiovascular surgery. Our results suggest that when CT is performed for any clinical investigation, the addition of the organic assessment of skeletal muscle can strengthen the diagnostic accuracy of muscle wasting.
Abstract Figure 1
The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review
Authors: Pallikadavath S , Patel R , Kemp CL , Hafejee M , Peckham N , Jain V , Mccann GP 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants.

Purpose
This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time.

Methods
The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated.

Results
Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%).

Conclusion
Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment.
Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.
Nursing management of anxiety and sleep disorders in patients hospitalized in a cardiac intensive care unit
Authors: Mzoughi K , Mansouri S , Aissa I , Ben Mrad I , Zairi I , Kraiem S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac intensive care unit is an environment that induces a high rate of stress, anxiety and sleep disorders in hospitalized patients. All these elements can create an obstacle in the continuity of care and increase cardiovascular risk.

Purpose
The purpose of our study was to evaluate the anxiety and sleep disorders in patients admitted to the ICUU and to evaluate nurses’ behavior to these disorders.

Materials and methods
We conducted a descriptive, transversal, observational, prospective study in the cardiology department of Habib Thameur Hospital, which included 37 patients admitted to the ICU and 11 nurses practicing in the department. A questionnaire including two validated scales (HADS-A for anxiety and RCSQ for sleep) was submitted to patients and a self-questionnaire was administered to nurses.

Results
Patients mean age was 61.24 ± 13.41 years with a sex ratio of 2.36. Eight patients (22%) admitted to the ICU had anxiety disorder. In univariate analysis, female gender and mean hospital stay were significantly associated with anxiety among patients admitted to the ICU. In multivariate analysis, female gender was the only independent factor associated with anxiety at ICU hospitalization (relative risk = 3, 95% confidence interval 2.25-3.37, p = 0.005). Seventeen patients (40%) were afraid of death. The majority of patients (92%, n = 34) felt safe with the health care team. Most patients (92%, n = 34) responded to their visitors (through the window), 97% of whom were family members.
Seven patients (19%) had poor sleep. The item with the lowest average was the quality of sleep (53.86 ± 15.65). In univariate analysis, urban living and the average number of sleep hours were significantly associated with poor sleep. Surveillance of vital signs, noise and monitor alarms were the main factors of sleep disturbance.
Eleven nurses were included in our study. Seven nurses considered the management of anxiety as not important, and six answered that the management of sleep disorders was not important. The most used medication by nurses to relieve both symptoms was Hydroxyzine tablets. The most common non-medical way to relieve anxiety was privacy. The most common non-medication way to improve sleep was brightness reduction.

Conclusion
Our study shows that despite the prevalence of anxiety and sleep disorders in patients admitted to the ICU, their care by nurses was not adequate.
Specific training on assessment and coping with these disorders could improve nursing care.
Sex-based differences in program completion and clinical outcomes in patients following outpatient cardiac rehabilitation
Authors: Chan E , Chirico D , Arena R , Feng Y , Liang Z , Ahmed SB , Colbert J , Aggarwal S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Females have greater reduction in mortality compared to males, following completion of a cardiac rehabilitation (CR) program, yet they continue to have lower referral rates and program completion. Since 1996, a local rehabilitation program has been the main provider of CR in our health zone. A standardized rapid referral program was implemented in 2008 to improve referral rates of hospitalized patients. Since then, the relationship between sex and CR completion is unknown.

Purpose
To evaluate the relationship between sex and CR completion and to evaluate the association between CR completion and clinical outcomes, stratified by sex.

Methods: We included consecutive patients who were referred to CR and who
1) were hospitalized for an acute coronary syndrome (ACS) or stable angina between 2008 and 2016; 2) had angiographic evidence of at least one-vessel coronary disease; and 3) had revascularization with percutaneous intervention, coronary artery bypass or medical management. The outcomes of interest were CR completion, anxiety and depression categories, exercise capacity, death, and need for revascularization. Logistics regression models were used to determine the association between sex and CR completion. The association between sex, CR completion, and the outcomes of interest were assessed using multivariable cox proportional hazards models.

Results
A total of 726 females and 2645 males were included in this study. The rate of CR completion was lower in females compared to males (64.6% vs 69.98%, p = 0.006). Following adjustment for baseline characteristics, female sex independently predicted lower rates of CR completion, OR 0.81 (95%CI 0.67-0.97).
Both sexes displayed improvements in peak metabolic equivalents (METs) achieved during exercise testing (W: initial 5.99 ± 1.93; 12-week 7.22 ± 1.92; M: initial 7.62 ± 2.04; 12-week 8.81 ± 1.93, p = 0.001). Amongst CR completers, one-year mortality was similar between sex (W: 1.84% vs M: 3.27%, p = 0.118), as was revascularization (W: 14.29% vs M: 11.97%, p = 0.193), however both sexes had higher one-year mortality in CR non-completers.

Conclusion
Despite a standardized CR referral protocol, a sex-difference in CR completion remains. In CR completers, one-year mortality and revascularization was similar in both sexes, however mortality was higher in CR non-completers. Our study suggests that addressing the causes of female CR non-completion following ACS or stable angina may improve outcomes.
Outcomes by CR Completion and Sex All NC (n = 1051) W-NC (n = 257) M-NC (n = 794) p-value All C (n = 2320) W-C (n = 469) M-C (n = 1851) p-value Revascularization-1 year (%) 146 (14.94) 28 (11.72) 118 (15.59) 0.107 267 (12.44) 62 (14.29) 205 (11.97) 0.193 Death-1 year (%) 67 (6.86) 19 (7.95) 48 (6.50) 0.442 64 (2.98) 8 (1.84) 56 (3.27) 0.118 W = Women;M = Men;NC = Non-Completers;C = Completers
Assessment of vascular function in formerly pre-eclamptic women as a novel marker of future cardiovascular risk
Authors: Faes E , Mannaerts D , Witvrouwen I , Van Berendoncks A , Jacquemyn Y , Van Craenenbroeck EM 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Women with a history of pre-eclampsia (PE) are at increased risk of cardiovascular disease (CVD). The association between PE and CVD in later life may be explained by vascular dysfunction, either pre-existing or elicited by PE. Several small studies have shown that vascular dysfunction may persist for years in some patients, indicator of future CVD risk, while other studies could not confirm these findings.

Purpose
In this longitudinal prospective cohort study, we aim to comprehensively assess vascular function in previously pre-eclamptic women (early (&lt;34 weeks) and late (&gt;34 weeks)) and healthy controls. We hypothesize that vascular dysfunction is both more persistent and pronounced in early PE compared to late PE since different pathophysiologic mechanisms underlie both subtypes of PE.

Methods
For this first analysis, 63 PE patients were compared to 16 non-pregnant healthy controls. Endothelial function was determined by flow-mediated dilatation (FMD), modified FMD (mFMD) and low-flow mediated constriction (L-FMC). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) and augmentation index using pulse wave analysis of the brachial artery, and corrected for heart-rate (Aix75).

Results
Average post-partum period was 11 months (1.4-111.5 months). Thirty-five presented with early PE, 28 with late PE.
In the total PE group, FMD was significantly decreased compared to healthy controls (7.1 ± 2.8 vs 8.9 ± 3.8; p = 0.037), but no difference between early and late PE was observed. Likewise, Aix75 remained elevated after PE (16.5 ± 11.5 vs 5.8 ± 10.1; p &lt; 0.001), again, without difference between early and late PE. cfPWV was not different after PE compared to healthy controls (p &gt; 0.05) but was significantly higher in the early PE group compared to the late PE group (6.9 ± 1.0 vs 6.4 ± 1.0; p = 0.045).

Conclusion
Even in the postpartum, PE is characterized by overt and persisting endothelial dysfunction and arterial stiffness. Arterial stiffness is more pronounced in early PE compared to late PE.
This reaffirms that PE has consequences beyond placental impairment and that the persisting vascular impairment in the postpartum could reflect the risk of CVD later in life.
The most common cardiovascular diseases in an outpatient cardiology office with online patient support
Authors: Podgorodetskaya N , Demkina AE 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Purpose. To study cardiovascular diseases diagnosed in the cardiology office with online patient support on the basis at Korolev Family Outpatient Clinic No. 4
Methods. The Clinic has created a cardiology room with online patient support. A special feature of the online office is that after a full-time appointment, patients are tracked through our Instagram account. Patient support is provided in the form of posts and video lectures lasting up to 60 minutes in the period from 01.01.2020 to 01.12.2020.
Results. 1,938 people (35% men; average age 55.7 years) were treated, including 980 patients with cardiovascular diseases (56% men; average age 56.7 years). The most common cardiovascular diseases were arterial hypertension (72%), cardiac arrhythmia (15.6%) and coronary heart disease (11.6%). The second stage of treatment was carried out online through the medical blog Instagram account (online). The average monthly reach of an online consultation room is 15,100 users; 11.8% of them are men; the main age group from 24 to 45 years is 37.4% of users. The highest participation over 11 months was achieved by posts about hypertension (27,058) and cardiac arrhythmia (100,681).
Conclusions. Cardiovascular diseases are the most common reason for visiting the therapeutic department. Analysis of the work shows that hypertension (72%), cardiac arrhythmia (15.6%) and coronary heart disease (11.6%) are the most common cardiovascular diseases. This corresponds to epidemiological data on the prevalence of cardiovascular diseases among the Russian population. Online support is a popular form of interaction between healthcare professionals and patients. The average annual and monthly coverage of the online consultation room is 165,000 and 15,000 people, respectively. The most popular topics in the online consultation are hypertension and cardiac arrhythmia. Further research is needed to combine face-to-face meetings and online patient support to ensure patient compliance, build trust in healthcare professionals, and improve patient quality of life.
COVID-19 pandemic stresses trigger ST-elevation and non-ST-elevation acute myocardial infarction in Middle Eastern individuals not infected with the virus
Authors: Hammoudeh A , Mdanat E , Tabbalat R , Jarrah M , Alhaddad IA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Abdul Hameed Showman Foundation

OnBehalf
The Jordan COVID-19 AtheRosclerotic Cardiovascular Events (JoCORE) Study Investigators
Background. The vicarious stresses associated with the covid-19 pandemic have been reported to cause psychosocial behavioral changes in individuals not infected with the virus. No reports have evaluated the effect of these stresses on triggering acute ST-segment elevation and non-ST-segment elevation myocardial infarction (STEMI and NSTEMI, respectively) in such individuals. Purpose. We sought to study the nature of MI triggers and clinical profiles in non covid-19 individuals during the pandemic. Methods: Patients not infected with the covid-19 virus admitted to 9 hospitals with STEMI and NSTEMI during the pandemic crisis in Jordan from February through December 2020 were evaluated for pre-MI exposure to psychosocial and economic triggers related to the pandemic, lockdown and shutdown. Results: Of 144 patients enrolled, 58 (40.3%) had STEMI and 86 (59.7%) had NSTEMI. Compared with the NSTEMI group, the STEMI group tended to be younger (59.0 + 13.8 vs. 62.3 + 12.7 years, p = 0.14), had significantly more men than women (94.9% vs. 75.6%, p = 0.005), were more likely to be smokers (75.9% vs. 55.8, p = 0.02) and had lower prevalence of prior coronary revascularization (17.2% vs. 45.3%, p = 0.001). In-hospital mortality among the 133 patients who were alive upon hospital arrival was 1.5%. All patients reported exposure to at least one psychosocial stressful trigger, including lockdown and loneliness stress (65.3%), fear of contacting covid-19 infection or of uncertainty (26.4%), anger (18.8%), and death of a significant person during the pandemic (4.2%) Financial hardship and volatile income were reported by 42.4% of patients. STEMI and NSTEMI patients did not have significant differences in the frequency of psychosocial (100% vs. 99.9%, respectively, p = NS) or economic triggers (34.5% vs. 47.7%, respectively, p = NS). Conclusions. Exposure to psychosocial and financial stresses related to the covid-19 pandemic and its related lockdown can trigger acute MI. An increase in the number of these events may become a potentially serious health issue with longer duration of the unremitting pandemic.