bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low testosterone is associated with increased risk of major adverse cardiovascular events in smokers with erectile dysfunction
Authors: Ioakeimidis N , Georgakopoulos C , Terentes-Printzios D , Dima I , Gardikioti V , Angelis A , Gourgouli I , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Purpose
Tobacco cigarette smoking and decreased concentrations of testosterone are major risk factors of erectile dysfunction (ED) and independent predictors of cardiovascular disease (CVD). We investigated, whether testosterone deficiency has a complementary predictive value for CVD events in smokers with ED.

Methods
A cohort of 398 men with ED and without known atherosclerotic CVD (mean age: 55±10 years) were followed for the occurrence of major adverse cardiovascular events (MACE), (CVD death, coronary artery disease, stroke). Total testosterone (TT) levels were measured in all patients.

Results
Among the study population, 205 (52%) were smokers. During a mean follow-up of 6 years (range: 1–11 years), 30 (7.5%) patients demonstrated a MACE. Baseline TT levels were significantly lower and prevalence of smoking was higher in the CV-event group than the event-free survival group (P&lt;0.01 and P&lt;0.05, respectively). Kaplan–Meier analysis showed that patients with low TT (≤4.0 ng/mL) had a worse prognosis than patients with TT &gt;4.0 ng/mL (log rank: 6.52, P=0.011), and that smokers had a greater risk of adverse events than never smokers (log rank: 4.42, P=0.04). We then stratified all patients into four groups, on the basis of smoking status (current/never smokers) and low or high TT (≤ or &gt;4.0 ng/mL) and cardiac event-free survival curves were constructed by Kaplan–Meier analysis (figure). The event-free rate in smokers with low TT is significantly lower than that of smokers with low TT or never smokers with normal TT (log rank: 11.3, P=0.02). Smokers with low TT had an almost 4-fold higher risk of MACEs compared to never smokers with normal TT (adjusted hazard ratio: 3.91; P=0.030).

Conclusion
Cigarette smoking combined with low TT concentration is associated with a shorter event-free period compared with either smoking or testosterone deficiency alone. The measurement of testosterone concentration may be useful to further stratify the risk of ED smokers without known CVD.

Funding Acknowledgement
Type of funding sources: None. Smoking testosterone deficiency and MACE
Iron deficiency and athletic performance
Authors: Csulak E , Sydo N S , Horvath L H , Sydo T S , Babis B B , Mocsari S Z M , Kaufmann M K , Lakatos B L , Kovacs A K , Dohy Z S D , Szabo L S Z , Toth A T , Vago H V , Merkely B M 
Published: October 2021

Abstract

Introduction
Iron metabolism determines the oxygen transport of the blood, thereby affecting the exercise capacity and performance. In patients with heart failure iron deficiency is a major risk factor that predicts and influences patient's quality of life. In athletes diagnosing iron deficiency is also extremely important as it determines sport performance.

Purpose
Our aim is to study the correlation of iron metabolism parameters with exercise capacity in athletes.

Methods
Cardiopulmonary exercise test (CPET) was performed as part of detailed sports cardiology screening. We studied in athletes the changes of iron metabolism parameters (serum iron, transferrin, total iron-binding capacity (TIBC), ferritin) and correlation with the exercise physiology parameters.

Results
Our measurements were performed on 105 top athletes: swimmers (n=58,55%; male = 29; junior = 30; 20,4±4,6 y), football players (n=47, 45%; junior = 6; 23,2±5,4 y). Laboratory test verified hemoglobin (male = 153,8±9,4; female = 141,2±7,7 g/L; p&lt;0,001) and hematocrit (male = 0,45±0,03; female = 0,42±0,02 L/L; p&lt;0,001) value in a normal range for all. In women, significantly lower ferritin (67,8±76,2 vs. 98,9±48 μg/L; p&lt;0,05) and higher TIBC (78,1±14,3 vs. 66,5±9,3 μmol/L; p&lt;0,001) were observed. Young male athletes had significantly lower serum iron (16,1±6 vs. 21,2±7,5 μmol/L; p&lt;0,05), ferritin (68±42,7 vs. 109,1±45,5 μg/L; p&lt;0,01) and higher TIBC (76,1±11,0 vs. 64,3±7,4 μmol/L; p&lt;0,001) compared to adults. During CPET male athletes had higher maximal aerobic capacity (52.2±4.4 vs. 55.9±5.5 mL/kg/min; p&lt;0.001) and ventilation (115.8±16.1 vs. 153.2±26 L/min; p&lt;0.001) compared to females. Maximal aerobic capacity and ventilation showed positive correlation with ferritin (p&lt;0,0001). The ferritin cut-off value of iron supplementation was &lt;100 μg/L. Iron supplementation was required in almost half of the athletes (n=49, 47%).

Conclusion
Diagnosing iron deficiency in athletes, complete iron panel containing ferritin is required. According to our results iron status determines performance, therefore iron deficiency screening and iron supplementation is essential.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Supported by the ÚNKP-20-3-I New National Excellence Program of the Ministry for Innovation and Technology from the Source of the National Research, Development and Innovation Fund - The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging programmes of the Semmelweis University.
Features of remote rehabilitation using the developed mobile app in patients after cardiac bypass surgery
Authors: Lyapina I N , Soloduhin A , Krupianko E , Shaleva V , Dren' E , Pomeshkina S 
Published: October 2021

Abstract

Aim of the study
The aim of the study is to evaluate the features and availability of the developed remote rehabilitation program with the use of a mobile application in patients who have undergone coronary artery bypass surgery (CABG) and surgical correction of valvular heart disease (VHD).

Material and methods of research
In the current epidemiological situation, to increase the availability of cardiorehabilitation for patients after open heart surgery, a mobile application with the program “Remote rehabilitation of patients who have undergone heart surgery” was developed.
The remote rehabilitation program included 46 patients (median age 60.0 [53.0; 64.0]) who underwent cardiac surgery. Of these, 22 patients after CABG (median age 61.0 [53.0; 63.5]) and 24 patients after surgical correction of VHD (median age 59.5 [54.0; 63.75]).
On the 5th day after the surgery, the developed application for remote rehabilitation was installed on the smartphone. It consisted of 5 sections: Dosed Walking, Therapeutic gymnastics, Diet, Psychology and Chat.
After application installing and until the moment of discharge from the hospital, 3 classes with a total duration of 6 academic hours were conducted with each patient. After being discharged from the hospital the patients were recommended to use the mobile app for rehabilitation at home for 4 months. 4 months after the surgery the app usage statistics were evaluated and a telephone survey of the reasons for non-complience was conducted.

Results
A total of 34 (74%) patients used the mobile app for remote rehabilitation. Of these, 24 (52.0%) used the app section “Dosed Walking” and “Therapeutic Gymnastics” at least 5 times a week for 4 months, 10 (22%) used the app no more than 10 times during the entire follow-up period, and 12 (26%) did not engage in remote rehabilitation using the app. 22% of patients received consultations with a cardiologist via chat in mobile app.
The telephone survey revealed the main reasons for the irregular participation of patients in the remote rehabilitation program using the mobile app: lack of interest/desire to engage in physical rehabilitation – 16 (35%), problems with the Internet – 6 (13%), lack of time – 4 (8.5%), incorrect function of the app – 4 (8.5%).

Conclusions
Insufficient adherence of patients after cardiac surgery to a remote rehabilitation program using a mobile application, associated with a lack of motivation in patients, was demonstrated. This implies the importance of developing and implementing further measures to increase the motivation and adherence of patients to participate in long-term remote cardiac rehabilitation programs.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Russian Federation President grant
A randomized clinical study evaluating effects of high-intensity interval training on myocardial microvascular dysfunction
Authors: Rafique M , Solberg O G , Gullestad L , Bendz B , Rolid K , Nytroen K , Lunde K 
Published: October 2021

Abstract

Background
Myocardial microvascular function assessed with the Index of Microcirculatory Resistance (IMR) after heart transplantation (HTx) predicts the development of cardiac allograft vasculopathy (CAV) and adverse long-term outcome. This study aimed to evaluate the otherwise beneficial effects of high-intensity interval training (HIT) on microvascular dysfunction development.

Methods
Eighty-one de novo HTx patients were randomized to nine consecutive months of HIT or standard care rehabilitation. Coronary physiology assessment with a pressure wire was performed in the left anterior descending coronary artery. IMR was calculated by multiplying the mean distal coronary pressure by the mean hyperemic transit time. Results obtained at three and twelve months after HTx were compared to assess the treatment effect of HIT.

Results
Results were available for 60 patients. 71% were men, and the mean age was 48±13. IMR in the HIT group (n=26) decreased from 14.8±9.5 to 13.8±8.0, change = 1.2, 95% CI [−2.6 to 4.9] and increased in the standard care group (n=34) from 13.8±5.8 to 16.8±12.0, change = −3.5, 95% CI [−7.1 to 0.1]. The mean difference between groups was 4.7, 95% CI [−9.7 to 0.4], p=0.07.

Conclusion
These results suggest that early initiation of HIT improves microvascular function.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Stiftelsen Dam
Masters Athlete Screening Study (MASS): incidence of cardiovascular disease and major adverse cardiac events over five years of screening
Authors: Morrison B N , Isserow S , MacDonald M , Cater C , Zwaiman I , Taunton J , Warburton D E R , McKinney J 
Published: October 2021

Abstract

Background
The long-term implications of cardiovascular disease (CVD) in masters athletes, and whether screening decreases their risk of major adverse cardiac events (MACE) is unknown.

Purpose
To evaluate the incidence of CVD and MACE over five years of a screening study.

Methods
Masters athletes (≥35 years) from a variety of sports without previous history of coronary artery disease (CAD) underwent yearly cardiovascular screening. The screen consisted of anthropometrics, blood pressure, resting electrocardiogram, modified American Heart Association 14-element recommendations, cardiovascular event questionnaire, physical examination (year 1) and Framingham Risk Score (years 1–3). Participants with an abnormal screen according to the European Association of Cardiovascular Prevention and Canadian Cardiology Society Guidelines underwent further evaluations (computed coronary tomography angiography was not included for all athletes but based on clinical assessment). Participants who withdrew during the study received a follow-up questionnaire to determine MACE and vital status.

Results
In the first year of the Masters Athlete Screening Study, 798 masters athletes (62.7% male, 54.6±9.5 years) were screened; 91 (11.4%) of the cohort were found to have CVD. CAD was the most common diagnosis (69.2%). During the following four years, there were an additional 89 CVD diagnoses with an incidence rate of 3.58/100, 4.14/100, 3.74/100, 1.19/100, for years two to five, respectively. Fifteen participants had more than one diagnosis. The most common diagnoses over the five years were arrhythmias (n=33; 37.1%), aortic dilatation (n=20; 22.5%), CAD (n=18; 20.2% (5 obstructive, 13 non-obstructive)) and other (n=7; 7.9%) (myocarditis (n=2), myocardial bridging (n=1), cerebrovascular disease (n=1), dilated cardiomyopathy (n=1), probable Long QT syndrome (n=1), papillary fibroelastoma (n=1)). A total of 10 MACE occurred (two cardiovascular deaths, five myocardial infarctions and three cerebrovascular accidents). All events occurred in male athletes (63.6±12.5 years). Out of the 136 participants that received the lost to follow-up questionnaire, 101 (74.3%) completed it. Of those, one male athlete underwent percutaneous coronary intervention. The incidence of MACE over the study period was 0.30/100 athletes per year.

Conclusion
Yearly cardiovascular screening of masters athletes identified ∼3 new diagnoses per 100 athletes per year. Ten MACE occurred despite yearly screening and high CV fitness of masters athletes.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): MITACs and CIHR
Previous psychiatric disorders and antipsychotic drugs in COVID-19 patients: early findings on possible worse outcome
Authors: Scarpone M , Bergami M , Cenko E , Bugiardini R , Poluzzi E , Manfrini O 
Published: October 2021

Abstract

Background
There are a range of traditional risk factors for COVID-19, but it is not well established if there are also psychiatric related risk factors. These factors could increase angiotensin-converting enzyme 2 expression and potentiate COVID-19 cell entry.

Purpose
We aimed to assess if psychiatric disorders and antipsychotic treatments represent risk factors for COVID-19 worst outcomes.

Methods
We describe the demographics, symptoms, therapeutic management, and survival outcomes of COVID-19 in the population who were admitted in a single academic hospital in Northern Italy between March 1 and June 30, 2020. Patients were determined to have COVID-19 if they had a positive SARS-CoV-19 swab. We used logistic regression analyses to control for confounding by concomitant risk factors for COVID-19 and for therapeutic management of comorbidities including psychiatric disorders and antipsychotic related drugs.

Results
Among 609 patients, in-hospital death occurred in 120 (19.7%). A psychiatric disorder in the previous years was overrepresented (p&lt;0.0001) in non-survivors (35.5%) in comparison with survivors (22.1%). Age and a history of hypertension were as well, established (p&lt;0.005) risk factors for COVID-19 adverse outcomes: 80.6±11.4 vs 68±17.4 years and 70% vs 52% of people with hypertension in non-survivors vs survivors. Various pre-existing conditions were also associated (p&lt;0.001) with increased risk of death, such as stroke or transient ischemic attacks, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) (20% vs 8%, 35% vs 17%, and 24% vs 10%, respectively). We did not observe that prior use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers were more prevalent in non-survivors compared with survivors. On the opposite, prior use of aspirin, P2Y receptor antagonists, and antipsychotic drugs was more common (p&lt;0.001) in non-survivors compared with their counterparts (36% vs 21%, 12% vs 5%, and 28% vs 10%, respectively). After multivariable adjustment, use of antipsychotic drugs was associated with higher risks of in-hospital death (OR: 2.27; 95% CI, 1.17–4.4). Other independent predictors of death were older age (OR: 2.8; 95% CI, 1.69–4.63), CKD (OR: 2.2; 95% CI, 1.21–4.03) and COPD (OR: 2.04; 95% CI, 1.22–3.42).

Conclusions
Antipsychotic drugs might be an independent risk factor for COVID-19 adverse outcomes. Although preliminary, our findings have implications for clinical services as they provide crucial information for understanding who is at greatest risk for COVID-19.

Funding Acknowledgement
Type of funding sources: None.
Predicting atrial fibrillation after acute abdominal surgery
Authors: Madsen C V , Leerhoey B , Joergensen L , Meyhoff C S , Sajadieh A , Dominguez H 
Published: October 2021

Abstract

Introduction
Post-operative atrial fibrillation (POAF) is currently considered a phenomenon rather than a definite diagnosis. Nevertheless, POAF is associated with an increased rate of complications, including stroke and mortality. The incidence of POAF in acute abdominal surgery has not been reported and prediction of patients at risk has not previously been attempted.

Purpose
We aim to report the incidence of POAF after acute abdominal surgery and provide a POAF prediction model based on pre-surgery risk-factors.

Methods
Designed as a prospective, single-centre, cohort study of unselected adult patients referred for acute, general, abdominal surgery. Consecutive patients (&gt;16 years) were included during a three month period. No exclusion criteria were applied. Follow-up was based on chart reviews, including medical history, vital signs, blood samples and electrocardiograms. Chart reviews were performed prior to surgery, at discharge, and three months after surgery. Atrial fibrillation was diagnosed either by specialists in Cardiology or Anaesthesiology on ECG or cardiac rhythm monitoring (≥30 seconds duration). Multiple logistic regression with backward stepwise selection was used for model development. Receiver operating characteristic curves (ROC) including area under the curve (AUC) was produced. The study was approved by the Regional Ethics committee (H-19033464) and comply with the principles of the Declaration of Helsinki of the World Medical Association.

Results
In total, 466 patients were included. Mean (±SD) age was 51.2 (20.5), 194 (41.6%) were female, and cardiovascular comorbidity was present in ≈10% of patients. Overall incidence of POAF was 5.8% (27/466) and no cases were observed in patients &lt;60 years. Incidence was 15.7% (27/172) for patients ≥60 years. Prolonged hospitalization and death were observed in 40.7% of patients with POAF vs 8.4% patients without POAF (p&lt;0.001). Significant age-adjusted risk-factors were previous atrial fibrillation odds ratio (OR) 6.84 [2.73; 17.18] (p&lt;0.001), known diabetes mellitus OR 3.49 [1.40; 8.69] (p=0.007), and chronic kidney disease OR 3.03 [1.20; 7.65] (p=0.019). A prediction model, based on age, previous atrial fibrillation, diabetes mellitus and chronic kidney disease was produced (Figure 1), and ROC analysis displayed AUC 88.26% (Figure 2).

Conclusions
A simple risk-stratification model as the one provided, can aid clinicians in identifying those patients at risk of developing POAF in relation to acute abdominal surgery. This is important, as patients developing POAF are more likely to experience complications, such as prolonged hospitalization and death. Closer monitoring of heart rhythm and vital signs should be considered in at-risk patients older than 60 years. Model validation is warranted.

Funding Acknowledgement
Type of funding sources: None.
Comorbidities vs age for the prediction of excess of length of in-hospital stay in patients undergoing new pacemaker implantation
Authors: Del Castillo-Carnevali H , Marschall A , Fraile C , Torres Lopez M O N , Goncalves Sanchez M D F , Gomez Sanchez M I , Basabe Velasco M E , Marti Sanchez D , Rueda Linares A , Coto Morales B , Rodriguez Torres D J , Dejuan Bitria C , Biscotti Rodil B , Rubio Alonso M A , Alvarez Anton S A 
Published: October 2021

Abstract

Background
Traditionally, advanced age has been considered a major factor for increased length of in-Hospital stay (LOS) and health-care costs. However, recent studies suggest that comorbidity burden may have an equal, if not greater, effect on LOS as age in a variety of clinical scenarios.

Purpose
We aimed to determine the impact of comorbidity on LOS, as compared to age, in patients undergoing new pacemaker (PM) implantation.

Methods
In this retrospective study, patients that underwent new PM implantation (both elective and non-elective) in our centre between January 2015 and June 2018 were admitted for chart-review. We excluded patients that underwent PM replacement and lead removal procedures. Furthermore, patients that underwent other invasive procedures, such as percutaneous coronary intervention, coronary bypass or heart valve surgery, were excluded in order to minimize confounding factors. Excess in LOS was defined as an in-hospital stay &gt;3 days. Multivariate logistic regression models were generated in order to evaluate the impact of comorbidity burden (as assessed by the Charlson Comorbidity Index (CCI)) and age on LOS. Furthermore, we compared the excess of LOS in elderly patients (i.e. ≥75 years) and low comorbidity burden (i.e. CCI ≤1) with younger patients.

Results
423 elective and non-elective patients with a mean age of 82 were included in the study. The median follow-up time was 34 (15–46) months. Baseline clinical characteristics are detailed in the table. A CCI &gt;1 resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 11.7 (7.3–18.9), p&lt;0.001); HR: 1.04 (0.98–1.04), p=0.43, respectively). When analyzed separately, according to elective (n=150) vs non-elective (n=270) indication, CCI remained a significant predictor (HR: 7.1 (2.1–24.2), p=0.002; HR: 13.8 (7.6–25.1), p&lt;0.001, respectively). Age remained not significant. Elderly patients (age ≥75 years) with low comorbidity burden (CCI≤1) had a significantly shorter LOS compared to a younger overall population (2 (1–3) vs 2 (2–4) days, p=0.016) (Figure).

Conclusion
Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Androgen deprivation therapy with agonists of GnRH: cardiovascular adverse events and comorbidity considerations in patients with prostate cancer
Authors: Gritskevich E Y U , Demidova T Y U 
Published: October 2021

Abstract

Study objective
To assess cardiovascular adverse events and comorbidity considerations in patients with local prostate cancer (pT3N0M0) who were treated with agonists of gonadotropin-releasing hormone (aGnRH).

Study design
Follow-up study.

Materials and methods
102 patients were enrolled to the study, 99 subjects were followed up till the study completion. The mean age was 69±8,64 years old. The study of body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), was performed at baseline, after 3, 6 and 12 months ADT.
Achievement of low threshold values of testosterone was accompanied by an increase in the levels of BMI, WC, FPG, HbA1c, LDL-C, TG over 12 months of ADT regardless of baseline age, with a maximum increase during the first 3 months of treatment, and progressively after 6 months and 12 months. FPG (mmol/l) basic, 3, 6 and 12 months, respectively 5,18±0,91; 5,67±0,93; 5,77±0,96; 5,90±1,12 (for all differences p≤0.001); HbA1c (%) 5,36±0,66; 5,66±0,83; 5,77±0,82; 5,89±0,83 (for all differences p≤0.001). WC (cm): 91.5, 95.4 (+4.2%), 96.1 (+5.0%), 96.4 (+5.4%) (for all differences p≤0.017); BMI (kg/m2): 27.4, 28.2 (+2.9%), 28.4 (+3.6%), 28.4 (+3.6%) (p≤0.004 for all differences, save for differences between values in 6 and 12 months – p=0.995); LDL-C (mmol/l): 3.04 – 3.29 (+8.2%) – 3.47 (+14.1%) – 3.61 (+18.7%) (for all differences p≤0.001), TG (mmol/l): 1.7 – 1.9 (+11.8%) – 2.0 (+17.6%) – 2.1 (+23.5%) (p≤0.004). The proportion of patients with prediabetes, type 2 diabetes, according to ADA criteria, is increasing from 15% to 66% and from 4% to 13% respectively, with arterial hypertension – from 57% to 65%, with coronary artery disease – from 22% to 31% patients in the study 12 months after the start of therapy.

Conclusion
Long-term androgen deprivation therapy with GnRH agonists leads to an early, progressive, clinically significant deterioration of metabolism. According to the results of monitoring comorbid conditions in dynamics, a rise in the incidence of concomitant diseases was revealed during the year of therapy.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Pirogov Russian National Research Medical University