bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis
Authors: Simantiris S , Antonopoulos AS , Angelopoulos A , Papanikolaou P , Oikonomou EK , Vamvakaris K , Koumpoura A , Farmaki M , Trivella M , Vlachopoulos C , Tsioufis K , Antoniades C , Tousoulis D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance.

Methods
We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome.

Results
We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. &lt;5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with &lt;5% cumulative event incidence, D)

Conclusions
The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication.
Abstract Figure.
CT coronary angiography in Selected Group of patients with Chest pain of new onset predicts and prevents hospital admissions & Outpatient Clinic referrals
Authors: Cameron M , Wang I , Ashikodi E , Dhir N , Raja Y , Baig M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
NICE (National Institute of Clinical Excellence) guidelines currently recommend the use of CT coronary Angiogram (CTCA) as the initial test to investigate coronary artery disease in patients with new onset of chest pain.
Our aim was to evaluate the relationship between the CT coronary angiogram findings on index presentation, and hospital admissions and re-referral to outpatient clinics in following 2 years.

Method
Data was accrued via a retrospective analysis of electronic medical records at Sunderland Royal Hospital pertaining to patients who presented to the Rapid Access Chest Pain Clinic (RACPC) and underwent CTCA in 2017.Data included:
Presentation – Typical & atypical angina
Risk factors profile
Investigations including ECG, ECHO, CTCA, perfusion scan and invasive coronary angiography
Severity of coronary artery lesion on CTCA
Hospital admissions or re-referral to outpatient clinics in 2 year follow up

Results
In the 235 patients studied, mean age was 56 years with 130 (55.5%) men and 195 (82.9%) presented with atypical angina as shown in table.
Out of 195 patients with atypical chest pain only 17 (8.7%) were diabetics and most of them 178 (91%) had Coronary Calcium score of 1-400. Most patients (184) underwent CT coronary angiogram with 39 (21%) having normal coronary arteries, 126 (68%) with mild to moderate coronary artery disease and 19 (11%) with severe coronary artery disease. Subsequent assessments with invasive coronary angiography, myocardial perfusion scan and Treadmill exercise did not reveal significant disease warranting coronary revascularization.
Patients with normal or mild -moderate CAD on CTCA 24 (15%) represented with acute chest pain (only one needed PCI) and 6 (3.5%) were referred to outpatient clinics over 2 years follow up. In patients with severe CAD on CTCA, 6 (32%) presented with acute chest pain and 4 (21%) needed PCI. Almost all patients were treated with statins and antiplatelets following CTCA results.

Conclusion
CT coronary angiography is sensitive and specific in assessment of hemodynamically significant coronary artery disease in non-diabetic patients presenting with angina in outpatient setting.
CTCA in patients with normal or mild to moderate CAD also gives confidence to the clinician and prevents further un-necessary investigation and hospital admissions/outpatient referrals.
Primary and Secondary Prevention of Cardiovascular Diseases educational programme on the Instagram
Authors: Alexandra D , Ryabinina MN , Aksenova GA , Benimetskaya KS , Vasilyeva IA , Isaeva AV , Lobzhanidze FA , Novikova DS , Pivenstein AL , Savonina OA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Purpose. To study the possibility of conducting the ‘Primary and Secondary Prevention of Cardiovascular Diseases’ educational programme aimed at promoting health literacy among cardiology blog followers on Instagram.
Material and methods. In the present study the methodology for conducting the educational programme on Instagram included the following: choosing the agents of influence and format of audience engagement; determining the most relevant topics and time frames; identifying the frequency and characteristics depending on the selected format of audience engagement; developing evaluation metrics; conducting the programme; evaluation of study results; defining the scaling strategy. The educational programme was conducted daily from 19 to 30March 2020 through professional medical accounts on Instagram. The programme format included posts of up to 4,000 characters on primary (healthy diet, smoking cessation, physical activity, obesity, vegetarian diet) and secondary prevention (drug treatment) of cardiovascular diseases. The study results were evaluated by descriptive statistics for standard social network metrics.
Results. The total number of cardiology blog followers is 367,727. The audience of professional doctors" blogs is mostly female (89 to 95%), the age group of 25 to 34 years accounts for 40 to 47% of the followers. Ten posts of the educational programme were viewed by a total of 104,794 users, gathering a total of 9,692 audience engagements (comments, shares, likes and saves). Such topics as consumption of vegetables, salt and sugar, physical activity and obesity accounted for the highest audience engagement (1,146; 1,100; 2,195; 1,052 and 1,534 users, respectively).
Conclusions. The Instagram social network can be used for educational programmes aimed at promoting health literacy among Russian people. It is necessary to further improve the methodology for conducting research in social networks in order to select the most effective technologies that contribute to the preservation of public health.
The effect of age and gender on heart rate variability in healthy individuals
Authors: Alyahya A , Fuller A , Okwose N , Charman S , Macgowan G , G Jakovljevic D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
Cardiovascular autonomic function, represented by heart rate variability (HRV) is a simple, non-invasive measure used to determine alteration of sympathetic and parasympathetic control. The aim of the present study was firstly to evaluate the effect of age and gender on HRV measures, and secondly to determine the relationship between measures of HRV and functional capacity in healthy individuals

Methods
This was a retrospective, single centre, cross-sectional, observational study. Data were collected between January 2018 and July 2019. Sixty-eight healthy participants (age range: 19-78 years) were stratified according to age into the younger age group (&lt;40 years of age, N = 43, males, N = 26; females, N = 17) or the older age group (&gt;55 years of age, N = 25, males, N = 14; females, N = 11). Frequency domain HRV measures (i.e. absolute and normalised low frequency power (LF), high frequency power HF and their ration i.e. LF/HF ratio) were derived from RR interval and recorded at rest (supine position) for 30 minutes. Simultaneous non-invasive gas-exchange and central haemodynamic measurements (bioimpedance) were collected at rest and during maximal graded cardiopulmonary exercise stress test using semi-recumbent cycle ergometer.

Results
The mean age of the younger group was 26 ± 6 years and older 64 ± 6 years. Cardiorespiratory fitness (i.e. peak oxygen consumption) was significantly reduced in older compared to younger age group (1.60 ± 0.57 vs. 2.38 ± 0.74 L/min, p &lt; 0.01). The mean absolute values of HF power declined with age in males by 32% (younger, 1156 ± 806 ms2 vs. older, 835 ± 488 ms2, p = 0.18), but not in females 3% difference (younger, 1182 ± 958 ms2 vs older, 1150 ± 843 ms2, p= 0.92). There was no significant difference in HF power between males and females in the younger age group (young male, 1156 ± 806 ms2 vs. young female, 1182 ± 958ms2, p = 0.92), but older males demonstrated 32% lower HF power than older females (835 ± 488 ms2 vs. 1150 ± 843 ms2, p= 0.25). Further analyses revealed no significant relationship between measures of heart rate variability and functional capacity i.e. the HF power was not significantly related to peak oxygen consumption in males (r= - 0.15, p= 0.36) or females (r= 0.05, p = 0.80).

Conclusions
High frequency power of the heart rate variability declines with age more in men but not women. Gender difference in high frequency power is apparent in older but not younger age, with older women showing nearly one third higher HF than older men. Measures of heart rate variability do not predict cardiorespiratory fitness
Skeletal muscle status, autonomic balance and short-term results of cardiac surgery
Authors: Oleinik P , Sumin AN , Bezdenezhnykh AV 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Research Institute for Complex Issues of Cardiovascular Diseases
The aim - investigate the association of the lower extremities skeletal muscle state, status autonomic nervous system (ANS) and short-term results of the cardiac operations.
Design
Study included 64 patients, who underwent planned cardiac surgery. All subjects before surgery performed a routine laboratory and instrumental examinations, six-minute walk test (6MWT), and static-dynamic tests on the training device. ANS was carried out, using ORTOexpert software. Were formed 2 groups – with the combined endpoint CEP (n = 9) and without CEP (n = 55). CEP included: perioperative development stroke, myocardial infarction, persistent arrhythmias and heart block, multiple organ dysfunction syndrome, death.
Results
Not found difference between the groups in gender, age, in main clinical data and laboratory tests indicators, and in endurance of the skeletal muscles or the 6MWT. In the CEP group, strength of skeletal muscles of the upper and lower extremities was lower, initially more pronounced sympathetic activation and larger values of the power of the frequency spectrum (TF).
Stress index (IS) was lower in the CEP group, but after transitioning orthostatic position it surpassed the number without CEP. One-factor logistic regression analysis established factors associated with the development of CEP - poor muscle status, peripheral atherosclerosis; high EuroSCORE, cardiopulmonary bypass duration (CBD) and ANS disbalance. Multivariate regression analysis to establish the relationship of poor skeletal muscle status, pronounced sympathicotonia and a high incidence of postoperative complications.
Logistic regression analisys Odds ratio [ -95%; +95%CL] p One-factor logistic regression Stenosis ICA ≥ 30% 9,545 [1,030; 88,467] ,043 Shoulder Girdle Muscle Strength (Kg) 0,893 [0,786; 1,001] ,048 Knee extensors strength (kg) 1,012 [0,997; 1,029] ,098 Amo (basic) 0,958 [0,920; 0,998] ,037 IS (basic) 0,996 [0,990; 1,000] ,096 EuroSCORE (points) 1,643 [1,003; 2,694] ,043 CBD (min) 1,010 [1,001; 1,022] ,068 Multiple-factor logistic regression p=,001 LF/HF 1,175 [0,972; 1,420] ,088 Amo (basic) 0,950 [0,905; 0,997] ,034 Shoulder Girdle Muscle Strength (Kg) 0,863 [0,750; 0,993] ,036 LF/HF-ratio Low frecuency/High frecuency Amo-mode amplitude
Outcomes in nonagenarians with acute coronary syndrome. Is medical treatment important?
Authors: Echarte-Morales JULIO , Tundidor Sanz ELENA , Martinez Gomez E , Cepas-Guillen PEDRO , Borrego Rodriguez JAVIER , Viana Tejedor ANA , Caldentey Adrover G , Vidal PABLO , Rodriguez Santamarta MIGUEL , Flores Umanzor E , Fernandez Ortiz A , Quiroga XAVIER , Sabate MANEL , Fernandez-Vazquez FELIPE 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up.
Purpose
The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction.
Methods
A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded.
Results
680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had a higher GRACE score compared to the conservative treatment group (177 versus 172; p = 0.001). Patients with ST-segment elevation myocardial infarction (STEMI) were more likely to receive an invasive strategy than the non-ST segment elevation myocardial infarction (NSTEMI) (61.5% versus 41.5%; p= 0.001). 263 patients died at 1 year follow up with in-hospital mortality of 17%. In STEMI group, patients with statins and dual antiplatelet therapy at discharge had lower mortality during follow up compared to those who did not received (26.7 % versus 41.5%; p = 0.001 and 31% versus 22%; p = 0.02, respectively) (Image 1).
Conclusions
Nonagenarian patients with ACS have a high prevalence of hypertension and ICP procedures are not performed frequently. They also have a high mortality rate, although statins and dual antiplatelet therapy could be an effective secondary prevention.
Abstract Figure.
A comprehensive secondary prevention benchmark (2PBM) score identifying differences in secondary prevention care in patients after acute coronary syndrome
Authors: Liu Y , Haegele M , Frey S , Strebel I , Jordan F , Lange R , Burkard T , Clerc OF , Pfister O 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grands from AstraZeneca, Boehringer Ingelheim and Sanofi

Background
Reaching secondary prevention targets improves long-term prognosis in patients after acute coronary syndrome (ACS). Although prevention targets are defined by guidelines, their achievement rates are insufficiently documented. Suitable benchmarking tools are lacking.

Purpose
We aimed to determine the degree of secondary prevention care by creating a secondary prevention benchmark score (2PBM) and using it in patients undergoing ambulatory cardiac rehabilitation (CR) after an acute coronary syndrome.

Methods
In this observational cohort study, 472 consecutive ACS patients who completed the local ambulatory CR programme between 2017-2019 were included. Benchmarks for secondary prevention medication, clinical and lifestyle targets were predefined and combined in the complete 2PBM with maximum 10 points. The association of patient characteristics and achievement rates of individual components and the complete 2PBM were assessed using multivariable logistic regression analysis.

Results
Patients were on average 62 ± 11 years old and predominantly male (n = 406; 86%). Type of ACS was ST-elevation myocardial infarction (STEMI) in 241 patients (51%) and non-ST-elevation myocardial infarction in 216 patients (46%). Achievement rates for individual components of the 2PBM were 71% for medication, 35% for clinical and 61% for lifestyle benchmarks. Achievement of medication benchmark was associated with younger age [odds ratio (OR): 0.979, 95% confidence interval (CI) 0.959-0.996, p = 0.021] and history of STEMI [OR: 2.05, 95% CI 1.35-3.12, p = 0.001]. Achievement of clinical benchmark was associated with medication benchmark [OR: 1.66, 95% CI 1.03-2.71, p = 0.042]. The complete 2PBM was achieved by 74 patients (16%), while 362 patients (77%) reached ≥8 points. Achievement of complete 2PBM was independently associated with a history of STEMI [OR: 1.79, 95 CI 1.06-3.08 p = 0.032].

Conclusion
Benchmarking with 2PBM identifies gaps and achievements in secondary prevention care. A history of STEMI was associated with the highest 2PBM score, suggesting best secondary prevention care in patients after STEMI. 2PBM may be used for internal quality control, comparison of cohorts and future correlation studies between CR targets and outcomes.
Abstract Figure.
Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with monocyte subsets in patients with stable coronary artery disease
Authors: Krychtiuk KA , Lenz M , Hohensinner P , Distelmaier K , Schrutka L , Kastl SP , Huber K , Hengstenberg C , Wojta J , Speidl WS 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWF
Background and aims
Proprotein convertase subtilisin/kexin type-9 (PCSK9) is an enzyme promoting the degradation of low-density lipoprotein receptors (LDL-R) in hepatocytes. Inhibition of PCSK9 has emerged as a novel target for lipid-lowering therapy. Monocytes are crucially involved in the pathogenesis of atherosclerosis and can be divided into three subsets. The aim of this study was to examine whether circulating levels of PCSK9 are associated with monocyte subsets.

Methods
We included 69 patients with stable coronary artery disease. PCSK9 levels were measured and monocyte subsets were assessed by flow cytometry and divided into classical monocytes (CD14++CD16-; CM), intermediate monocytes (CD14++CD16+; IM) and non-classical monocytes (CD14 + CD16++; NCM).

Results
Mean age was 64 years and 80% of patients were male. Patients on statin treatment (n = 55) showed higher PCSK9-levels (245.4 (206.0-305.5) ng/mL) as opposed to those without statin treatment (186.1 (162.3-275.4) ng/mL; p = 0.05). In patients on statin treatment, CM correlated with circulating PCSK9 levels (R = 0.29; p = 0.04), while NCM showed an inverse correlation with PCSK9 levels (R=-0.33; p = 0.02). Patients with PCSK9 levels above the median showed a significantly higher proportion of CM as compared to patients with PCSK-9 below the median (83.5 IQR 79.2-86.7 vs. 80.4, IQR 76.5-85.2%; p = 0.05). Conversely, PCSK9 levels &gt;median were associated with a significantly lower proportion of NCM as compared to those with PCSK9 &lt;median (10.2, IQR 7.3-14.6 vs. 14.3, IQR 10.9-18.7%; p = 0.02). In contrast, IM showed no association with PCSK-9 levels.

Conclusions
We hereby provide a novel link between PCSK9 regulation, innate immunity and atherosclerotic disease in statin-treated patients.
Tailored clinical management after blinded statin challenge improved long-term lipid control in coronary patients with self-perceived muscle side-effects
Authors: Sverre E , Peersen K , Kristiansen O , Fagerland MW , Perk J , Husebye E , Vethe NT , Dammen T , Munkhaugen J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helse Sør-Øst, Vestre Viken Trust

Background
Statin discontinuation due to self-perceived muscle side-effects is a major challenge in clinical practice. Strategies are needed to improve lipid control in these patients.

Purpose
We studied if information about the results of a blinded statin challenge experiment, followed by tailored lipid lowering treatment, had long-term effects on lipid control in coronary patients with self-perceived muscle side-effects.

Methods
A post-trial intervention study of patients classified with statin dependent (N = 20) and independent (N = 50) muscle complaints in the MUscle Side-Effects of atorvastatin (MUSE), a randomized, double-blinded, crossover trial. All participants were informed of the MUSE trial results in an individual consultation and provided tailored lipid-lowering treatment according to protocol with 1-2 follow-up calls. Lipids were controlled at the end of follow-up.

Results
Mean age was 64 (SD 9.5) years and 33% (N = 23) were females. During an average follow-up of 13 months (SD 3.3), mean LDL-cholesterol was reduced by 0.3 (SD 0.6) mmol/L (p = 0.005) in patients with statins and by 1.7 (SD 1.0) mmol/L (p = 0.005) in patients without statins at inclusion in the MUSE trial (Table). We found no changes in the overall use of high-intensity statins, but ezetimibe was used by 11 additional patients and 4 patients were prescribed a PCSK9-inhibitor. Participants in the subgroup without statins at inclusion used; atorvastatin (N = 2), rosuvastatin (N = 3) or a PCSK9-inhibitor (N = 2) at follow-up. 90% found their own trial results useful in making decisions about future statin use.

Conclusions
Information about the results of a statin challenge experiment combined with tailored and systematical prescription of lipid-lowering agents had favourable long-term effects on lipid control in coronary patients with self-perceived muscle side-effects.
Characteristics of the study population Using statins at inclusion (n = 62) Not using statins at inclusion (n = 8) Classified with statin-dependent side-effects, n (%) 15 (24) 5 (63) LDL-cholesterol at inclusion, mean (SD) 2.2 (0.8) 4.2 (1.1) LDL-cholesterol at follow-up, mean (SD) 1.9 (0.7) 2.5 (0.8) High intensity statin (ie. ≥40 mg atorvastatin or ≥20 mg rosuvastatin) at inclusion, n (%) 40 (55.6) 0 (0) High intensity statin at follow-up, n (%) 38 (61) 2 (25) Ezetimibe at inclusion, n (%) 13 (21) 3 (38) Ezetimibe at follow-up, n (%) 26 (42) 1 (13) PCSK-9 inhibitor at follow-up, n (%) 2 (3) 2 (25) Usefulness of own trial result in making decisions about future statin use on a 0 to 10 Likert scale, mean (SD) 8.1 (2.0) 9.6 (0.6)