bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationships between physical capacity and depression in heart failure patients undergoing hybrid comprehensive telerehabilitation vs usual care results of the TELEREH-HF randomized clinical trial
Authors: Piotrowicz E , Mierzynska A , Jaworska I , Opolski G , Banach M , Zareba W , Kowalik I , Pencina M , Orzechowski P , Szalewska D , Pluta S , Glowczynska R , Kalarus Z , Irzmanski R , Piotrowicz R 
Published: October 2021

Abstract

Introduction
The novel hybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of cardiovascular implantable electronic devices might be an option to improve both physical capacity and depressive symptoms.

Purpose
The aim of the study was to investigate the influence of HCTR on depressive symptoms and physical capacity in heart failure (HF) patients in comparison with usual care (UC) alone.

Methods
The present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (New York Heart Association class I–III, left ventricular ejection fraction ≤40%). Patients were randomized 1:1 to HCTR plus UC or UC only. Patients underwent either an HCTR program (1 week in hospital and 8 weeks at home; exercise training 5 times weekly) or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Beck Depression Inventory II (BDI II) score (cut point for depression ≥14) was used to assess depression and the physical capacity was measured by peak oxygen consumption (peak VO2). Measurements were made before and after a 9-week intervention (HCTR group)/ observation (UC group).

Results
Both groups were comparable in terms of demographic, clinical characteristics and medical therapy. In HCTR group at entry 23% of the sample (n=88/382) obtaining BDI-II scores ≥14 vs 27.5% (n=107/389) in UC group. The BDI II score at study entry was 9.8±6.6 and after intervention was 9.2±6.6, p=0.016 (HCTR group) vs at entry 10.6±8.2 and after observation 10.0±8.3, p=0.022 (UC group). There were no significant differences between groups regarding ΔBDI II score p=0.992. There was a significant improvement in physical capacity assessed by peak VO2 only in the HCTR group, both in patients with (p=0.033) and without (p&lt;0.001) depression (Table 1). These beneficial effects have not been observed in UC group.

Conclusions
In heart failure patients, HCTR provided similar reduction of depressive symptoms as UC. Hybrid comprehensive telerehabilitation resulted in a significant improvement in physical capacity both in patients with and without depression.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland.
Endurance training increases ventricular refractoriness and wavelength of the cardiac impulse without participation of parasympathetic postganglionic neurons. A study in isolated rabbit heart
Authors: Rodrigo-Garcia A , Such-Miquel L , Parra G , Calvo C J , Arias-Mutis O J , Lozano W M , Such L , Alberola A , Chorro F J , Zarzoso M 
Published: October 2021

Abstract

Background
Endurance physical training plays a protective role in against ventricular fibrillation (VF), but the exact underlying mechanisms are not completely understood. It is well-known that modifications in myocardial ventricular properties such as refractoriness, conduction velocity and wavelength are key in the initiation and maintenance of VF; furthermore, vagus nerve stimulation has prophylactic effects on malignant arrhythmias and VF. On the other hand, parasympathetic nervous system activity is increased in trained individuals, which in turn affects different ventricular electrophysiological properties. We hypothesized that physical training increases conduction velocity and wavelength, and that these changes are mediated by myocardial cholinergic neurons.

Methods
To test this hypothesis, ten rabbits were submitted to a six-week endurance training protocol and twenty controls were not trained (divided in control group, n=10 and sham group n=10). After training, rabbits were euthanized and their hearts excised, isolated and perfused in a Langendorff system. A pacing electrode and a plaque with 240 recoding electrodes acquiring at 1 KHz were positioned on the left ventricle (LV). Extraestimulus test using four different pacing cycle lengths (90% basal cycle length, 250, 200 and 150 ms) was performed before and after atropine (1μM, control and trained groups) or vehicle (tyrode, sham group) infusion. We studied 1) LV effective refractory period (ERP), 2) LV functional refractory period (FRP), 3) LV conduction velocity (CV), and 4) LV wavelength, determined as LV FRP x CV. Factorial ANOVA (mixed model) was used for statistical analysis (p&lt;0.05).

Results
Before parasympathetic blockade, LV FRP increased in trained animals (Figure, B) whereas no difference was found in LV CV between trained and control animals at any pacing cycle length (Figure, A). In consequence, LV wavelength increased in trained animals (Figure, C). There were no changes in LV ERP, FRP, CV and wavelength when comparisons were made within groups before and after atropine infusion. In sham animals, vehicle infusion or time-course of the experiment did not modify LV FRP, ERP, CV and wavelength.

Conclusion
Physical training increases LV wavelength, which can be one electrophysiological mechanism by which endurance training could protect against VF. Since modifications of ventricular refractoriness and wavelength do not seem dependent of intrinsic parasympathetic nervous system activity, other intrinsic mechanisms could be implied and warrant further research.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Generalitat Valenciana
Endocannabinoids and heart rate variability alterations after exposure to prolonged intensive physical exercise of the Hellenic Navy SEALs
Authors: Mourtakos S , Vassiliou G , Kontoangelos K , Philippou A , Bersimis F , Geladas N , Koutsilieris M , Sidossis L , Papageorgiou C H , Papageorgiou C 
Published: October 2021

Abstract

Background
Recent research indicates that endocanabinoids (eCB) and heart rate variability (HRV) are associated with stress-induced experiences. However, these underlying mechanisms have not been elucidated.

Purpose
The aim of the present study is to investigate if exposure to acute and chronic stress promotes measurable changes concurrently to the peripheral eCB ligands and the HRV.

Methods
13 candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (H.N.S.) participated in the study. All subjects underwent mental state examination, while HRV variables in time and frequency domains recordings were acquired. Furthermore, at baseline and 30 days after prolonged and intensive physical exercise hair were collected in order to measure eCB ligands, such as anandamide (AEA), 2-arachidonoylglycerol (2-AG), and the N-acyl ethanolamine (NAE) molecules: palmitoylethanolamide (PEA) and oleoylethanolamide (OEA).

Results
Comparing basal hair concentrations of eCB ligands before and after intensive physical exercise, we found that AEA, PEA and OEA were notably increased (p&lt;0.01, p&lt;0.05 and p&lt;0.01 respectively) whereas no differences were observed regarding the ligand 2-AG. Regarding time domain features of HRV, a strong positive correlation was found between mean HR, AEA and PEA [r(13)=0.934, p&lt;0.05, (r(13)=0.902, p&lt;0.05]. Regarding frequency domain, a strong negative correlation was found between low frequency (LF) HRV and PEA (r(13)=−0.853, p&lt;0.01). No statistically significant associations were noted between high frequency HRV and EC ligands.

Conclusions
These findings suggest that endocannabinoid-HRV interrelations might share a short-term, and long-term adaptability of the changes in self-regulation associated with stress. Further studies are required to determine the validity of peripheral eCB signaling and HRV as a biomarker for different aspects of stress response.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica
Apremilast improves endothelial glycocalyx and microvascular perfusion: a possible protective mechanism against COVID-19
Authors: Ikonomidis I , Pavlidis G , Thymis J , Rafouli-Stergiou P , Makavos G , Kostelli G , Katsimbri P , Lambadiari V , Parissis J , Kapniari E , Katogiannis K , Kountouri A , Korakas E , Theodoropoulos K , Papadavid E 
Published: October 2021

Abstract

Background/Introduction
The phosphodiesterase 4 inhibitor apremilast is an approved treatment option for psoriasis.

Purpose
We aimed to investigate the effects of apremilast on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in psoriasis.

Methods
Ninety patients with psoriasis were randomized to receive apremilast (n=30), anti-tumor necrosis factor-a (etanercept, n=30), or cyclosporine treatment (n=30). At baseline and 4 months post-treatment, we measured: (1)Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, Glycocheck). Increased PBR indicates reduced glycocalyx thickness. Perfused microvascular density (PMD), an index of microvascular perfusion, was also measured. (2)Pulse wave velocity (PWV - Complior; ALAM Medical) and central systolic blood pressure (cSBP), and (3)LV global longitudinal strain (GLS) and percent difference between peak twisting and untwisting at mitral valve opening (%dpTw-UtwMVO) using speckle-tracking echocardiography.

Results
Compared with baseline, PBR20–25 decreased only after apremilast treatment (−13% at 4 months, P&lt;0.05) whereas no statistically significant changes in PBR20–25 were observed after etanercept or cyclosporine. Compared with etanercept and cyclosporine, apremilast resulted in a greater increase of PMD (+12% versus +3% versus +3%) and in a higher reduction of PWV (−10% versus −3% versus +8%) and cSBP (−8% versus −2% versus +7%) at 4 months. Apremilast showed a greater increase of GLS (+12% versus +5% versus +2%) and %dpTw-UtwMVO (+15% versus +3% versus +3%) than etanercept and cyclosporine (P&lt;0.05 for all comparisons). Changes of PBR and PMD post-apremilast treatment correlated with a concomitant reduction of PWV and cSBP (P&lt;0.05).

Conclusions
In psoriasis, apremilast confers a greater improvement of endothelial glycocalyx, microvascular perfusion and LV myocardial function compared with etanercept or cyclosporine treatment. Apremilast restores glycocalyx integrity and thus reduces vascular permeability to pro-inflammatory molecules. This may explain the beneficial effects of apremilast on COVID-19.

Funding Acknowledgement
Type of funding sources: None.
Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance
Authors: Marcos Garces V , Minana G , Nunez J , Monmeneu J V , Lopez-Lereu M P , Gavara J , Rios-Navarro C , Perez N , De Dios E , Fernandez-Cisnal A , Nunez E , Chorro F J , Sanchis J , Bodi V 
Published: October 2021

Abstract

Introduction
The prognostic value and therapeutic implications of ischemia as derived from vasodilator stress cardiovascular magnetic resonance (CMR) could differ in men and women, but it has not been stablished.

Purpose
We assessed the influence of the ischemic burden as derived from CMR on the risk of death and the effect of revascularization across sex.

Methods
We evaluated 6,237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischemia was defined as &gt;5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used.

Results
A total of 2,371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularization. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived ischemic burden across sex (p-value for interaction=0.039). Women exhibited an adjusted lower risk of death along most of the continuous ischemic burden but equalled men's risk when extensive ischemia was present. Likewise, CMR-related revascularization was shown to be differentially associated with the risk of mortality across sex (p-value for interaction=0.025). In patients with non-extensive ischemia, revascularization was related to a higher risk of death, with a greater extent in women. At higher ischemic burden, revascularization was associated with a lower risk in men, with more uncertain results in women.

Conclusions
CMR-derived ischemic burden allows predicting the risk of death and gives insight into the potential effect of revascularization in men and women with CCS. Compared to men, women with nonextensive ischemia displayed a lower risk and a similar risk with a higher ischemic burden. The impact of CMR-related revascularization on mortality risk was also significantly different according to ischemic burden and sex.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the Instituto de Salud Carlos III and cofunded by the European Regional Development Fund (ERDF).
Rheumatic heart disease: a school-based experience in guinea bissau
Authors: Beltrani V , Tersalvi G , Romana Scopigni F , Bruzzone G , Assaiemo F , Biasco L , Pedrazzini G B , Valgimigli M 
Published: October 2021

Abstract

Introduction
Rheumatic heart disease (RHD) remains a major cardiovascular issue in developing countries. Currently, large population-based data regarding RHD in Guinea Bissau are lacking and most of the patients are diagnosed with advanced stages. Our school-based echocardiography screening aimed at determining the prevalence of RHD and its socioeconomic distribution in Guinea Bissau.

Methods
Children (5–15 years old) from the Bissau region were enrolled from March 2017 to April 2020 in selected primary and secondary schools. Every child underwent echocardiography and group A streptococcus swab test. Presence of RHD was defined according to the World Heart Federation criteria for individuals ≤20 years.

Results
A total of 6784 children were screened: 585 (8.6%) participants had a positive swab test and received single dose of benzathine-penicillin-G, with the majority, 417 (71.3%) living in rural areas.
A total of 6784 out-clinic echocardiography exams were performed; 1121 (16.5%) were positive for RHD (possible or definite), of which 606 (54.1%) were from rural areas.
Every child with RHD (definite or probable) was invited for an outpatient visit in a clinic in Bissau, 863 (77%) attended the visit and echocardiography was repeated. RHD was confirmed in 659 cases (58.8%).
Every child with confirmed RHD started secondary prophylaxis with BPG (or oral erythromycin in case of known penicillin allergy) every 21–28 days. At a median follow-up of 3 years only 391 (59.4%) continued regular administration.
Estimating a population of 798370 subjects aged 5–15 years, we calculated a national prevalence of silent RHD of 77522 subjects, almost 1 every 10 children.

Conclusions
A school-based echocardiographic screening has an important role in the detection of subclinical RHD. In our population the prevalence of RHD is 9.7% with a significant difference between rural and urban areas, which is an additional challenge for health care providers. Additionally, regular administration of secondary prophylaxis is jeopardised by high attrition rate and lost-to-follow-ups.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Public fundraising on social media and at local events
The predictive role of neutrophil-to-lymphocyte ratio in post-operative arrhythmias in pediatric patients after cardiopulmonary bypass surgery
Authors: Bucciarelli V , Bianco F , Biasi A , Primavera M , Baldinelli A , Colaneri M , Gallina S , Pozzi M 
Published: October 2021

Abstract

Background
Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery.

Purpose
To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB.

Methods
We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27±10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 hours from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed.

Results
Diagnoses of 146 patients included atrial septal defect (n=36), ventricular septal defect (n=20), pulmonary atresia/stenosis (n=10), tetralogy of Fallot (n=20), endocardial cushion defect (n=8), left ventricular outflow tract obstruction (n=14), anomalous origin of coronary artery (n=6), complex CHD (n=13), interrupted/hypoplastic aortic arch (n=12), anomalous pulmonary artery venous return (n=3). The mean CPB time was 121.6±84.6 minutes. The median ICU hospitalization was 48 hours [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P=0.034 and P=0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (Log-rank, P=0.029), especially when associated with POA (Log-rank, P=0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P=0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P=0.012, respectively], but not with JET.

Conclusions
24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.

Funding Acknowledgement
Type of funding sources: None.
Insights on clinical outcomes in according to age in patients undergoing Transcatheter Aortic Valve Replacement
Authors: Munoz-Garcia M , Munoz-Garcia E , Munoz Garcia A J , Dominguez-Franco A J , Alonso-Briales J H , Jimenez-Navarro M F , Hernandez-Garcia J M , Gomez-Doblas J J 
Published: October 2021

Abstract

Transcatheter Aortic Valve Replacement (TAVR) is considered the treatment in patients older or at high or intermediate risk. Results form contemporary randomized trials in low-risk patients will likely broaden the indication of TAVR, but the data regarding long-term are limited by older population.
The aim of this study was to evaluate the survival and the factors predicting mortality after TAVR in according to age.

Methods
From April 2008 to December 2019, the self-expandable and balloon-expandable prostheses were was implanted in 765 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, &lt;80 years and ≥80 years old. The rate of acute complications was defined by the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke.

Results
The mean age in patients &lt;80 compared with ≥80 years, was 73.69±6.5 vs. 83.4±2.1 years and the logistic EuroSCORE and STS score were 15.9±11% vs. 18±11%, 4.8±3 vs. 6.3±4, p&gt;0.001, respectively In-hospital mortality was 4% vs. 3.4%, p=0.404, and the rate of acute complications was 19.6 vs. 16.5%, p=0.168. The late mortality (beyond 30 days) was 36.9 vs. 35.2%, p=0.352.
When compared in both groups, there were no differences for the presence of threatening bleeding 3.4% vs. 3.2% (HR = 1.028 [IC95% 0.722–1.463], p=0.516), myocardial infarction 4% vs. 2.5% (HR = 1.263 [IC95% 0.814–1.960], p=0.167), stroke 8% vs. 9.1% (HR = 1.149 [IC95% 0.686–1.925], p=0.347) and acute kidney innjury 14.1% vs. 19.1% (HR=0.1.14 [IC95% 0.969–2.141], p=0.071) and there was difference in between groups in hospitalizations for heart failure 14.6% vs. 7.9% (HR = 1.398 [IC95% 1.075–1.817], p=0.008
Survival at 1, 3, and 5were similar in both groups (88% vs. 89.5%, 73.3 vs. 78.2%, 58.8 vs. 62.6%, log Rank 0.992, p=0.319), respectively, after a mean follow-up of 42.3±27 months.
The main predictors of cumulative mortality in young patients were: Charlson index [HR 1.18 (95% CI 1.06–1.30), p=0.001], Acute Kidney Injury [HR 2.21 (95% CI 1.42–3.47), p=0.001], Left ventricular ejection fraction [HR 1.02 (95% CI 1.009–1.035), p=0,001], and protective factor was a higher Karnosfky index [HR 0.98 (95% CI 0.97–0.99) p=0.006]. And in older patients were: Frailty [HR 1.67 (95% CI 1.13–2.47), p=0.010], COPD [HR 2.09 (95% CI 1.41–2.91), p=0,001], Stroke [HR 3.01 (95% CI 1.54–5.89), p=0.001] Charlson index [HR 1.14 (95% CI 1.02–1.27), p=0.015], Acute Kidney Injury [HR 1.57 (95% CI 1.06–2.32), p=0.001.

Conclusions
TAVR is associated with low complications rate in young and older patients. Survival during follow-up was similar in both groups, but the predictive factors of mortality differ, with greater impact on the comorbidtiy in the elderly patients

Funding Acknowledgement
Type of funding sources: None.