bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between air pollution and case-specific mortality in north-eastern part of Poland. Case crossover study with 4,500,000 person-years of follow-up
Authors: Kuzma L , Kurasz A , Dabrowski E J , Swieczkowski M , Dobrzycki S , Bachorzewska-Gajewska H 
Published: October 2021

Abstract

Background
Recent studies have reported associations between air pollution and daily mortality. The majority of them are conducted in highly polluted areas. Taking into consideration the scarce number of surveys from cities with moderate air quality we decided to conduct a study in this type of region.

Purpose
To assess the short-term impact of air pollution on cardiovascular (CVD), coronary artery-related (CAD), and cerebrovascular-related (CbVD) mortality.

Methods
The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR).

Results
The analysed region was inhabited by almost 500,000 residents. From 2008 to 2017 in Bialystok, Lomza, and Suwalki we recorded 49,573 deaths – 34,005, 8,082, 7,486, respectively. The median daily concentrations of PM10 (23.8 μg/m3, IQR=16.9) was the highest in Lomza, Median daily concentration of PM2.5 was the highest in Bialystok (16.2 μg/m3, IQR=15.9). In the case of Suwalki, daily median PM2.5 concentration was 9.8 μg/m3 (IQR=8.7), and PM10 – 18.0 μg/m3 (IQR=14.3). The IQR increase in PM2.5 (OR 1.036, 95% CI 1.016–1.056, P&lt;0.001) and PM10 concentration (OR 1.034, 95% CI 1.015–1.053, P&lt;0.001) was associated with increased CVD mortality on lag 0 and this effect persisted on following days. The effects of PMs were more expressed in association with CAD-related mortality (OR for PM2.5 = 1.045, 95% CI 1.012–1.080, P=0.008), (OR for PM10 = 1.044, 95% CI 1.010–1.078, P=0.011) and CbVD mortality (OR for PM2.5 = 1.046, 95% CI 1.013–1.080, P=0.006), (OR=1.041 for PM10, 95% CI 1.002–1.082, P=0.038). Additionally, IQR increase in NO2 concentration was associated with increased CAD-related mortality at lag 0–1 (OR=1.055, 95% CI 1.004–1.108, P=0.032). The highest OR for PMs was noted in Suwalki compared to Bialystok and Lomza. The trend was noted regardless of the cause of death from lag 0 to lag 0–3. In a comparison of seasons, we noted higher CVD mortality OR in the cold season for PM10 in Suwalki (P=0.047) and Bialystok (p=0.001). However, the impact of NO2 (P=0.02) and PM10 (P=0.03) on CAD related mortality was higher in the warm season.

Conclusions
The impact of air pollution on CVD mortality is also observed in moderately polluted areas. PMs and NO2 had the greatest impact on CAD-related mortality. Differences in effect size and seasonality may depend on the source of air pollution.

Funding Acknowledgement
Type of funding sources: None.
Impact of cardiovascular disease and diabetes on cerebral cognition in older adults: the role of routine echocardiography in a primary care setting of Northern Sweden
Authors: Saha S K , Kiotsekoglou A 
Published: October 2021

Abstract

Background
Older adulthood is often associated with type 2 diabetes (DM), and cardiovascular comorbidities (CVD), such as hypertension, atrial fibrillation (AF) with or without heart failure (HF). A combination of the illnesses may contribute to the decline in cerebral cognition. It is, however, not known whether there exists an association between cognitive function and cardiovascular diseases and co-existing DM in a community setting equipped with outpatient echocardiography services.

Subjects and methods
One hundred and thirty peri-octogenarians (79±11 years,), divided into four groups (Controls, CVD-DM, CVD+DM, and DM-CVD), matched for age, and gender, participated in the study to undergo a routine standard Doppler echocardiography, measures of which included left ventricular (LV) ejection fraction, left atrial (LA) size, pulmonary artery systolic pressure (PASP), and LV diastolic indices such as E/A-wave velocity ratio. Routine biochemistry included glomerular filtration rate and NT-proBNP, in addition to plasma glucose and HbA1c. Cognition was measured using a Mini-Mental State Examination (MMSE) score. In the CVD-DM group 14 out of 47 had AF+HF, In the CVD+DM 7 out of 24 had AF+HF (Chi sq p for trend = 0.9): i.e., a total of 30% had a combined co morbidity of DM+AF+HF. All of them had SGLT2 inhibitors alone or in combination of GLP1-RA. In the CVD group 27 out of 47 had AFIB, while in the DM+CVD group 11 of 24 had AFIB (Ci Sq p for trend=0.8)

Results
Mean ± SD of MMSE scores, LVEF%, PASP (mmHg), E/A ratio, and LA size (mm) in the Controls were respectively 27±3, 58±10, 22±5, and 34±9. MMSE scores did not differ. LVEF was significantly lower, and PASP higher in CVD with or without DM (all p&lt;0.05). LA was not only larger in these groups, LA size and PASP could predict MMSE at an adjusted R2 value of 0.6 (p&lt;0.05). E/A ratio and NT-proBNP contributed, albeit non significantly (p=0.06, Figure 1). When controlled for background AF and HF, DM and CVD equipoised MMSE score (p=NS).

Conclusion
In this community-based cross-sectional study, cerebral cognition, as assessed by MMSE scoring, was found to be preserved in DM with or without co-existing CVD, compared with age-matched Controls. DM and CVD equally contributed to the level of cognition. Whether the newest anti hyperglycemic agents preserve cognition beyond impacting a favorable cardiac outcome is a matter to be resolved by larger, multinational trails. Routine echocardiography in primary care plays a vital role to monitor cardiac function in an increasingly older adults faced with a significant disease burden (DM+AF+HF+CAD) with risk for impaired cognition.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novo Nordisk Figure 1
Distribution and prevalence of cardiovascular risk factors in a aging population of thalassemia patients: looking at the heart of the problem
Authors: Ajassa M , Barbero U , Longo F , Piga A , Gaglioti C M , De Benedictis M , Ferrero G B 
Published: October 2021

Abstract

Background
β-thalassemia major is a hereditary genetic disease hindered by many comorbidities due to transfusion-related iron. Since the introduction of chelation therapy life expectancy of these patients has increased from the 16 years of 1964 to 50 years today, with a marked improvement in the quality of life. Iron-related heart disease is still a leading complication but diabetes mellitus and hypogonadism may impact the cardiovascular risk in these patients, with an expected change in heart involvement with this unprecedentedly seen aging of these patients.

Target
This study aims to evaluate the distribution and prevalence of cardiovascular risk factors in a population of thalassemia major patients, and their relationship with observed cardiovascular events and potential modifying factors.

Methods and results
One-hundred fifty-nine patients older than 18 years of age with clinical and molecular diagnosis of β-thalassemia major and at least 15 years of follow-up were included in this study. Mean age was 40.9±8.4 years. Low serum lipid levels with low HDL levels were noted, with 17.6% having diabetes mellitus and 62% with hypogonadism; Splenectomy was reported in 70%. During the observed period 3.8% of patients had at least one episode of heart failure, 35.9% showed early signs of heart failure, 22% received diagnosis of diastolic dysfunction, 38% had a left ventricular ejection fraction &lt;55% and 21.4% showed supraventricular arrhythmias. Cardiovascular risk was then assessed using two algorithms (CUORE and Pooled Cohort Risk Equation - PCRE) and was generally low but despite that patients with hypogonadism (who showed lower cardiac T2* value than those without; p&lt;0.001) showed a statistically significant correlation with the occurrence of cardiovascular events.

Discussion
The β-thalassemia population has a relatively low mean age, but shows a particular metabolic profile in association with numerous comorbidities: an increased prevalence of diabetes mellitus, low HDL values and frequent hypogonadism which tends to be associated with increased iron deposition in myocardium. The cardiovascular risk estimated by specific algorithms (CUORE and PCRE) was generally low, mainly due to the young age of the cohort, but the prevalence of cardiac events was not negligible.

Conclusions
The chronic accumulation of iron in the heart and the specific metabolic profile, particularly observed in patients with hypogonadism, allows us to define Major Thalassemia patients as a population at high cardiovascular risk from many points of view (iron-related myopathy, atherosclerosis and arrhythmias), which requires a specific follow-up program, to prevent and to identify early signs of these serious complications.

Funding Acknowledgement
Type of funding sources: None.
Serial measurement of global longitudinal strain among women with breast cancer treated with proton radiation therapy
Authors: Hassan M , Awadalla M , Tan T C , Scherrer-Crosbie M , Zhang L , Zlotoff D A , Bany Bakar R , Hickey S B , Patel S A , Januzzi J L , Passeri J J , Keane F , Jimenez R , MacDonald S M , Neilan T G 
Published: October 2021

Abstract

Background
Conventional photon radiotherapy (RT) for breast cancer is associated with reduction in global longitudinal strain (GLS), an increase in both troponin and N-terminal pro-B type natriuretic peptide (NT-proBNP), and incident heart failure. The cardiac radiation exposure with proton-RT is reduced and, thus may be associated with less cardiotoxicity.

Objectives
To test the effect of proton-RT on GLS, troponin and NT-proBNP.

Methods
A prospective observational single center study of 69 women being treated with proton-RT for breast cancer. Serial measurements of GLS, high-sensitivity cardiac troponin-I (hs-cTnI), and NT-proBNP were performed at pre-specified intervals (pre proton-RT, 4 weeks after completion of proton-RT and again at 2 months post proton-RT).

Results
The mean age was 46±11 years, BMI was 25.6±5.2 kg/m2, 32% had hypertension and mean radiation dose to the heart and left ventricle (LV) were 0.44 Gy and 0.12 Gy respectively. There was no change in LV ejection fraction (pre proton-RT vs. 4-weeks post proton-RT vs. 2 months post proton-RT, 65±5 vs. 66±5 vs. 64±4%, p=0.15), global GLS (−21.7±2.7 vs. −22.7±2.3 vs. −22.8±2.1%, p=0.24) or segmental GLS from pre-to post proton-RT. Similarly, there was no change in hs-cTnI or NT-proBNP with proton-RT. However, post proton-RT, we found that patients with a history of hypertension had lower GLS when compared to women without hypertension (−21.3±3.5 vs. −24.0±2.4%, p=0.006).

Conclusion
Proton-RT did not impact LV function, or associate with an increase in biomarkers. These data support the potential cardiac benefits of proton-RT compared to conventional RT.

Funding Acknowledgement
Type of funding sources: None.
The prevalence of statin intolerance worldwide: a systematic review and meta-analysis with 4,143,517 patients
Authors: Bytyci I , Bajraktari G , Sahebkar A , Penson P E , Rysz R , Banach M Y 
Published: October 2021

Abstract

Background
The efficacy of statins in the prevention and treatment of cardiovascular disease is well established. Despite their large benefit, statin intolerance (SI) is still an important clinical challenge. In this meta-analysis, we aimed to estimate the overall prevalence of SI, the prevalence based on different diagnostic criteria and different disease settings.

Methods
We searched all electronic databases until the end of March 2021 for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence based on different diagnostic criteria (National Lipid Association/NLA, International Lipid Expert Panel/ILEP and European Atherosclerosis Society/EAS). The secondary endpoint was the SI prevalence in the groups of patients with different diseases' settings. A random-effects model was applied to estimate the overall pooled prevalence.

Results
One hundred and seventy-six studies (112 RCTs; 64 cohort studies) with 4,143,517 patients were included in the analysis. The overall SI prevalence was 9.1% (8.1 to 10%). The prevalence based on NLA criteria was similar compared to ILEP and EAS (7.0, 6.7, 5.9%, respectively; p&gt;0.05). The prevalence of SI in RCTs studies was significantly lower in comparison to the cohort studies (4.9 vs. 17%; p&lt;0.001). The SI prevalence in patients both in primary and secondary prevention was much higher (18%; mainly due to dominant cohort studies) than in the separate analysis of those in primary and secondary prevention (8.2, 9.1%, respectively; p&lt;0.05). In the subgroup analysis based on different disease in the primary prevention: familial hypercholesterolemia, hypercholesterolemia, dyslipidemia and diabetes mellites, the prevalence was 9, 12, 13 and 6%, respectively) and in the secondary prevention: stable coronary artery disease, acute coronary syndrome and myocardial infarction – 8, 13, and 13%; respectively (Figure 1).

Conclusions
Based on the data from analysis of over 4 million patients, the overall SI prevalence is low, and even lower based on the recognized international definitions. These results support the concept that complete intolerance might be often overestimated and highlight the need for very careful examination of patients with statin intolerance.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Prevalence of statin intolerance
Impact of DAPT duration on clinical outcome after stent implantation for coronary bifurcation lesions: multicentre experience
Authors: Jariwala P , Jadhav K , Jadhav K 
Published: October 2021

Abstract

Background
The period of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) or stable coronary artery disease (SCAD) that is managed with coronary stenting is still under consideration. In real-world registries, the association between length of DAPT, bifurcation intervention and its effect on clinical outcome has been poorly studied. In sequential all-comer patients treated with stenting of coronary artery bifurcation lesions we examined the effect of DAPT length on clinical results including our single centre registry.

Methods
Responses were extracted from January 2017 to December 2018 on 536 consecutive patients who had PCI on coronary bifurcation at three centres in India. The primary endpoint of the analysis was the cumulative incidence of major adverse cardiac cerebrovascular events (MACCE), identified as a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke during follow-up; the secondary objectives were the single occurrence of any of the aforementioned incidents. 496 patients (92.5 percent) had data on the length of DAPT. Group 1) DAPT&lt;6-months (n=174); group 2) DAPT&gt;6-months but &lt;12-months (n=162); group 3) DAPT &gt;12-months (n=160).

Results
In 490 (98.8 percent) patients with an 18-month median (CI: 12–28) follow-up was concluded. MACCE developed more often in the 18 Group 1 patients (10.3%) than in Group 2 and 3 versus 14 [8.6%] and 8 [5%], HR: 0.76, 95% CI: 0.67- 0.92, p&lt;0.001), respectively. After correction for clinical and angiographic features this disparity persisted (HR: 0.68, 95% CI: 0.68–0.79, p&lt;0.001). At Kaplan-Meier analysis, in patients who received DAPT with less than 6 months (p&lt;0.001) the freedom from MACCE survival was substantially lower.

Conclusions
In a real-world registry of hospitalized patients with DES-PCI for coronary artery bifurcation stenosis, short DAPT length (&lt;6 months) is correlated with a considerably higher risk of MACCE relative to longer DAPT.

Funding Acknowledgement
Type of funding sources: None.
Early detection of exacerbation of the severe acute respiratory syndrome coronavirus 2 infection using Fitbit (DEXTERITY pilot study)
Authors: Yamagami K , Nomura A , Kometani M , Shimojima M , Sakata K , Usui S , Furukawa K , Takamura M , Okajima M , Watanabe K , Yoneda T 
Published: October 2021

Abstract

Some patients with coronavirus disease 2019 (COVID-19) experienced sudden death because of sudden symptom deterioration. Thus, an alarm system that could detect early signs of COVID-19 exacerbation beforehand, to prevent serious illness or death of patients while receiving outpatient treatment at home or in hotels is necessary. Here, we tested whether estimated oxygen variations (EOV), a relative physiological scale that represents users' blood oxygen saturation level during sleep measured by Fitbit, predicted COVID-19 symptom exacerbation. Study period was from August to November 2020. We enrolled 23 COVID-19 patients diagnosed by SARS-CoV-2 polymerase chain reaction-positive (mean age ± standard deviation, 50.9±20 years; 70% female), let each patient wore the Fitbit for 30 days; COVID-19 symptoms were exacerbated in 6 (26%). High EOV signal (a patient's oxygen level exhibits significant dip and recovery within the index period) had 80% sensitivity before symptom exacerbations, whereas resting heart rate signal only had 50% sensitivity. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in a patient by consistently high EOV signals. This pilot study successfully detected early COVID-19 symptoms exacerbation by measuring EOV and may help to identify early signs of COVID-19 exacerbation.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The investigational device used in this study, Fitbit Charge 3, was provided by Fitbit Japan. Summary of high EOV signals and eventsThe clinical course of COVID-19
Cost-effectiveness analysis of screening for first-degree relatives of patients with bicuspid aortic valve
Authors: Tessler I , Leshno M , Shmueli A , Shpitzen S , Durst R , Gilon D 
Published: October 2021

Abstract

Introduction
Bicuspid aortic valve (BAV) is the commonest congenital heart valve defect, found in 1% to 2% of the general population and associated with life-threatening complications. Given the high heritability index of BAV, many experts recommend echocardiography for first-degree relatives (FDRs) of an index patient. However, the cost-effectiveness of such cascade screening for BAV has not been fully evaluated.

Materials and methods
Using a decision-analytic model, we performed a cost-effectiveness analysis of echocardiographic screening of FDRs of BAV index cases. Data on BAV probabilities and BAV complications among FDRs were derived from our institution's BAV familial cohort and from the relevant literature on population-based BAV cohorts with long-term follow-up. Health gain was measured as quality-adjusted life years (QALYs). Cost inputs were based on list prices and literature data. One-way and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables.

Results and disscusion
Screening of FDRs was found to be the dominant strategy, being more effective and less costly than no screening, with savings of €208 and gains of 1.6 QALYs. Results were sensitive to the full range of reported BAV rates among FDRs across the literature, with the benefit gradually decreasing from the screening age of 55 years, with trend shifting at the age of 69.

Conclusions
This economic evaluation model revealed that echocardiographic screening of FDRs of BAV index case is not only clinically important but also highly cost effective and cost-saving. Health gains could be achieved from initiating screening program, along with costs saving. Sensitivity analysis supported the model's robustness, suggesting its generalization.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Center for Interdisciplinary Data Science Research fellowships grant
Multi-species transcriptomic data analysis reveal three candidate genes, responsible for the transition from compensated left ventricle hypertrophy to heart failure
Authors: Abreu M , Ferreira C , Baptista R 
Published: October 2021

Abstract

Introduction
Heart failure (HF) is the common final event for a wide spectrum of compensated left ventricle hypertrophy (LVH), including hypertrophic cardiomyopathy, hypertension, aortic stenosis and aortic coarctation. Despite its importance, the transition from hypertrophy to HF in humans is poorly understood. In this study, we aimed to find a molecular signature for the transition from compensated hypertrophy to decompensated HF conserved within species and disease induction methods.

Methods
Four datasets, containing gene expression data of hypertrophy and heart failure samples, were selected from GEO data repository. The selected datasets include three different species: Rattus norvegicus (GSE4286 and GSE47495), Canis lupus familiaris (GSE5247) and Cavia porcellus (GSE78077); with different models of left ventricle hypertrophy (pressure-overload, genetic, and both). The CEL files containing the expression data were analyzed using the Transcriptome Analysis Console 4.0 (TAC 4.0.2.15, Applied Biosystems). To identify differentially expressed genes a p-value cutoff of 0.05 was applied.

Results
The lists of DEGs obtained in the comparison hypertrophy versus HF, in each dataset, were uniformized to human identifiers and merged, resulting in a list containing 8307 genes. Most of the genes were differentially expressed in only one dataset (6252, 75.3%). DEGs present in two datasets were 1850 (22.3%), in three datasets 202 (2.4%), and finally, present in all datasets were only 3 genes. The first gene identified was CDKS1B, which belongs to a family of proteases related to the cell cycle. CKS1B upregulation activates the STAT3 and MEK/ERK pathways and promotes cell proliferation. Indeed, negative regulation of the MEK/ERK reduces cardiac hypertrophy induced by pressure overload. Secondly, type 2 phosphatidylinositol-5-phosphate 4-kinase (PI5P4K) converts phosphatidylinositol-5-phosphate to phosphatidylinositol-4,5-bisphosphate, and plays an important role in inflammatory response and autophagy. However, its role in the heart remains unknow. Lastly, the adipokine MEDAG was also differentially expressed in HF. Its role in myocyte metabolism is not defined but may parallel nutrient uptake role seen in adipose and reflect reliance on lipid oxidation.

Conclusions
We identified three genes that are differentially expressed in HF compared to compensated hypertrophy, involved in cell proliferation, autophagy, inflammation and lipid metabolism. This data requires confirmation in human studies. Such advance would be an important step toward identifying those risk factors, especially genetic variation, that predispose individuals to develop HF.

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