bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac rehabilitation and secondary prevention in COVID-19 times: Single center experience
Authors: Burazor I , Spiroski DS , Terzic J , Otasevic P , Babic R , Nikolic A , Ilic I , Loncar G , Cosic Z , Colic M , Rihor B , Andjic M , Bojic M , Davos D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac rehabilitation (CR) is a class I treatment for cardiovascular disease, still, underutilization of these services remains. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has been present.

Purpose and methods
We aimed to present the cardiac rehabilitation during COVID 19 times in Belgrade. At the beginning of epidemic in Serbia the number of patients in in-house city program was 70 out of 70 beds, with 200 patients who were scheduled (on the waiting list). Similarly to the other countries, we continued to admit only urgent patients with acute coronary settings.

Results
Only one PPCI center in Belgrade (2 million inhabitants plus surrounding area; out of five centers) continue to admit COVID-negative patients with STEMI from 13of March to 11 of May, during the first pick of COVID-19 epidemic in Serbia. Out -patients cardiac rehabilitation programs were stopped. The totals of 80 patients (PCR negative) were transferred to exercised based cardiac rehabilitation secondary prevention program during the first pick of epidemic directly from acute hospital. The majority of patients were males in their 50s. All risk factors were noted and patients were with much less risk factors compared to non- epidemic era. Lipid profile was measured. Six minutes walking test was performed at the beginning and exercise plan was made. Unfortunately, exercise based three weeks in- house cardiac rehabilitation was completed in only 1% of patients while others quite the program.

Conclusion
The COVID-19 pandemic presents a time to highlight the value of home-based models as we search for ways to continue to provide care. Standardization of home based CR models is essential to provide care for a wider range of patients and circumstances in the near future.
Fit, Female or Fifty - is cardiac rehabilitation fit for purpose? A systematic review and meta-analysis with meta-regression
Authors: Smith M , Orchard JJ , La Gerche A , Gallagher R , Fitzpatrick J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention, aimed to address modifiable risk factors for coronary artery disease. It is recommended worldwide for patients following myocardial infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery. A growing body of evidence points towards a lack of uptake in CR in females and younger people.

Purpose
To examine the effectiveness of contemporary CR programs and assess whether they cater for all patients regardless of age, gender and prior level of fitness, via systematic review, meta-analysis and meta-regression.

Methods
MEDLINE was examined for studies involving exercise prescription or CR following MI, PCI and cardiac surgery from January 2010 to May 2020. RCTs and cohort studies of ≥10 patients were included for programs delivering phase II or III CR. Primary outcome measures were peakVO2max, 6-minute walk test (6MWT) and Metabolic Equivalent of Task (METs). Data were extracted using random effects meta-analysis. Epidemiological data were analysed for age, proportion of males to females and prior level of fitness. Baseline level of fitness was assessed by peakVO2max, 6MWT and METs values on entry into CR programs. Meta-regression was then used to determine change in fitness and the influence of age or gender.

Results
Thirty-three of the 713 studies (13 RCT, 20 cohort) were eligible and included in the review. Participants had a mean age of 60.0 years and 6/49 (12%) of study groups had a mean age &lt;55 years. Male participants comprised 81.9% of those who completed CR and 41/58 (71%) participants were below average for cardiorespiratory fitness (CRF) when compared to normative values for those aged 60-69 years on entering CR.
CRF improved in all study groups by the end of CR programs (mean improvement in peakVO2 3.3mL/kg/min, 6MWT 90.8m and METs 1.7). Meta-regression analysis showed that males were more likely to have an increase in 6MWT distance compared to females (mean difference 3.16m (95% CI 0.44-5.89). However, gender and age did not independently affect peakVO2max or METs.

Conclusion
CR following MI, PCI or cardiac surgery improved mean CRF in all study groups. While males were more likely to show an improvement in 6MWT there was no appreciable difference in effect in other outcomes after controlling for age or gender differences.
Females, younger people and those of average or above CRF appear to be under-represented in data and attendance at cardiac rehabilitation. Given that CR outcomes are equal across gender and age, more effort should be made to encourage female and younger patients to attend. A ‘Precision Medicine’ model of exercise prescription may assist in this aim.
Preventive counseling with subsequent remote support does not further improve the quality of life after catheter ablation of atrial fibrillation
Authors: Pogosova N , Ovchinnikova AI , Yufereva YM , Sokolova OY , Davtyan KV , Arutyunov AA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is associated with substantially reduced quality of life (QoL). Both catheter ablation (CA) and education have a potential to improve QoL in AF patients (pts).

Purpose
To assess the impact of preventive counseling with long-term support on QoL in pts after CA performed for paroxysmal AF.

Methods
A prospective randomized controlled study with 2 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation). Pts were randomized (1:1) into 2 groups. Before discharge, both groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge pts from intervention group received biweekly preventive counseling via email for 3 months (6 sessions). Control group received usual care. QoL was assessed at baseline and at 12 months using SF-36 questionnaire.

Results
A total of 90 pts aged 35 to 80 years were enrolled (mean age, 57.4 ± 9.9 years, men, 52.2%). Both groups had a poor QoL at baseline, and both groups experienced improvement in the physical health component at 1 year, but the degree of this improvement in the intervention group was similar to the control (table).

Conclusions
Preventive counseling with remote support via email does not further improve QoL in AF pts after CA.
Intervention group Control group P Integral component of physical health Baseline (points) mean ± SD 44.1 ± 7.9 40.2 ± 8.7 0.028 Mе (25%; 75%) 44.5 (38.7; 50.1) 38.6 (34.4; 47.1) At 12 months (points) mean ± SD 49.4 ± 6.0* 45.7 ± 7.7* 0.010 Ме (25%; 75%) 51.0 (45.2; 53.9) 46.3 (42.4; 50.6) Δ% after 12 months, Ме (25%; 75%) 11.8 (1.4; 32.7) 18.7 (-0.3; 30.4) n/s Integral component of mental health Baseline (points) mean ± SD 46.1 ± 9.0 45.0 ± 8.4 n/s Mе (25%; 75%) 47.8 (39.1; 53.9) 48.0 (37.2; 52.0) At 12 months (points) mean ± SD 48.2 ± 8.1 46.8 ± 8.7 n/s Ме (25%; 75%) 50.1 (46.1; 53.6) 48.0 (41.0; 54.3) Δ% after 12 months, Ме (25%; 75%) 3.6 (-10.8; 32.6) 8.9 (-15.6; 30.8) n/s * p &lt;0.001 vs baseline
The effects of different preventive counseling programs on physical activity in patients with paroxysmal atrial fibrillation after catheter ablation
Authors: Pogosova N , Ovchinnikova AI , Ovchinnikova AI , Yufereva YM , Yufereva YM , Sokolova OY , Sokolova OY , Davtyan KV , Davtyan KV , Arutyunov AA , Arutyunov AA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Physical activity (PA) is associated with lower risk of all-cause death in atrial fibrillation (AF), so interventions to increase PA in AF patients (pts) has a potential to improve their outcomes.

Purpose
To assess the impact of different preventive counseling programs on PA in pts after catheter ablation (CA) of paroxysmal AF.

Methods
A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation). Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. PA was assessed using the International Questionnaire on Physical Activity (IPAQ) at baseline and after 12 months.

Results
A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features and PA level. The baseline proportion of pts with sufficient (moderate or high) PA was high in all 3 groups (86.6%, 88.9% and 91.1%, respectively). At 1 year of follow-up both intervention groups had a significantly higher proportion of pts maintaining high PA levels vs control (table).

Conclusions
Preventive counseling programs combining in-hospital and remote counseling via phone or e-mailsupport higher physical activity levels in AF pts after CA.
Different counseling programs and PA Levels of physical activity 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 Months P for Group 2 vs. control at 12 Months Baseline After 12 months Baseline After 12 months Baseline After 12 months Low,% 13.3 2.2 11.1 0 8.9 2.2 n/s n/s Moderate,% 62.2 71.1 71.1 82.2 60 93.3 &lt;0.01 n/s High,% 24.4 26.7 17.8 17.8 31.1 4.4 &lt;0.005 &lt;0.05
Left ventricular remodeling: is there a real impact of cardiac rehabilitation?
Authors: Cunha NPD , Aguiar-Ricardo I , Rodrigues T , Silverio Antonio P , Couto Pereira S , Alves Da Silva P , Valente Silva B , Brito J , Pinto R , Lemos Pires M , Borges M , Jordao A , Rodrigues C , Pinto FJ , Abreu A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive.

Purpose
Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram.

Methods
Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP.

Results
205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) &lt;40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%).
After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF &lt; 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device.

Conclusions
A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.
The prevalence of short PR interval in adolescent athletes and non-athletes
Authors: Abela M , Grech N , Degiorgio S , Xuereb R , Xuereb S , Yamagata K , Bonello J , Fleri Soler J , Buttigieg L , Camilleri W , Burg M , Sammut MA , Felice T , Grech V , Papadakis M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Malta Heart Foundation and Beating Hearts

Background
Little is known about the prevalence and clinical relevance of an isolated short PR interval in young individuals.

Objectives
To explore the PR interval in adolescent athletes and non-athletes and determine possible association with sex, age, ethnicity, athletic ability and sporting discipline.

Methods
Between 2017-2018, school children aged 14-17 years were invited to participate in a National cardiac screening programme comprised of a health questionnaire and a resting 12-lead ECG. An athlete was defined as an individual participating in &gt;4 hours/week of organised sports. Sport disciplines were categorised as skill, power, mixed and endurance. A short PR interval was defined as &lt;120ms.

Results
A total of 1619 (61.0%) non-athletes and 1036 (39.0%) athletes (median age 15 years, 50.5% females, 93.0% Caucasian) participated in the screening program. Most athletes participated in mixed sports (62.2%).
The mean PR interval was shorter in non-athletes compared to athletes (136.65 ± 19.00ms vs 139.93 ± 19.86ms p &lt; 0.001) and in females compared to males (135.98 ± 18.39ms vs 139.93 ± 20.20ms, p &lt; 0.001). An isolated short PR interval was present in 405 (15.3%) individuals. Associated pre-excitation was present in an additional 5 cases (0.2%). A short PR interval was commoner in females (18.7% vs 11.7%, p &lt; 0.001) and in non-athletes (16.6% vs 13.2%, p = 0.020). Age (p = 0.657) and ethnicity (p = 0.115) did not influence the presence of a short PR interval.
The presence of a short PR interval in adolescent athletes was independent of the sporting discipline category (p = 0.071), in both males (p = 0.400) and females (p = 0.233). The absolute PR interval did not differ significantly between sporting categories (p = 0.065), in both genders (males, p = 0.202, females, p = 0.279).
Symptoms that were suggestive of arrhythmias were present in similar proportions of individuals with short and normal PR intervals (18.8% vs 17.1%, p = 0.393).

Conclusion
An isolated short PR interval was a frequent finding in this cohort, with a predilection for females and non-athletes. The high frequency of short PR in young individuals suggests that in the absence of pre-excitation or symptoms, further evaluation is not warranted. Long-term follow-up studies may further elucidate the clinical relevance of this phenomenon.
Causes of sudden cardiac death in young athletes and nonathletes: systematic review and meta-analysis
Authors: D"ascenzi F , Valentini F , Pistoresi S , Frascaro F , Pietro P , Cavigli L , Focardi M , Cameli M , Bonifazi M , Metra M , Mondillo S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. The etiology of sudden cardiac death (SCD) in young people is still debated. The aim of this meta-analysis was to identify the most frequent causes of SCD in individuals aged ≤35 years, the differences between athletes and nonathletes and among geographic areas.
Methods. Studies published between 01/01/1990 and 01/31/2020 and evaluating post-mortem the etiology of SCD in young individuals (≤35 years) were included. Individuals were divided in athletes and nonathletes. Studies that did not report separately data between athletes and nonathletes were excluded.
Results. Thirty-four studies met the inclusion criteria and a total population of 5,060 victims of SCD were analysed (2,890 athletes, 2,170 nonathletes). Structurally normal heart, hypertrophic cardiomyopathy (HCM), idiopathic left ventricular hypertrophy, and anomalous origin of coronary arteries (AOCA) were the most frequent causes of SCD in athletes while coronary artery disease (CAD), arrhythmogenic cardiomyopathy (ACM), and channelopathies were frequent causes of SCD in nonathletes. The number of SCDs due to ischemic heart disease (19.6% vs. 9.1%, p = 0.009), ACM (11.5% vs. 4.7%, p = 0.03) and channelopathies (8.4% vs. 1.9%, p = 0.02) was higher in nonathletes comparing with athletes. SCD due to non-ischemic left ventricular scar (5.1% vs. 1.1%, p = 0.01) was more frequent in athletes. HCM (p = 0.01) and AOCA (p = 0.004) were more frequently cause of SCD in US while ACM (p = 0.001), structurally normal heart (p = 0.02), and channelopathies (p = 0.02) in Europe.
Conclusions. Structurally normal heart, HCM, AOCA were frequent causes of SCD in athletes while CAD, ACM and channelopathies in nonathletes. The causes of SCD differ between US and Europe.
The impact of image and performance enhancing drugs on bi-ventricular structure and function in strength-trained athletes and the association to fat-free mass
Authors: Morrison B , Chester N , Mcgregor-Cheers R , Kleinnibbelink G , Johnson C , Harrison J , Stansfield B , Henney A , George K , Warburton D , Mckinney J , Sculthorpe N , Cooper R , Fairbairn T , Oxborough D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Canadian Institute of Health Research Michael Smith Foreign Study Supplement

Background
Image and performance enhancing drugs (IPED) cause cardiac enlargement and dysfunction. Previous work has not assessed impact of user status (current [CU] vs. past [PU]) or allometric scaling cardiac dimensions for individual differences in fat-free mass (FFM).

Purpose
To investigate CU and PU of IPED and allometric scaling on LV and RV remodeling in strength-trained athletes.

Methods
Thirty-four (29 ± 6 years; 82% male) strength-trained athletes were recruited. Fourteen were CU, 9 PU and 11 non-users (NU) of IPEDs. Participants underwent bioelectric impedance body composition analysis, IPED and training questionnaire and 2D echocardiography with strain imaging. All structural data was allometrically scaled to FFM according to the laws of geometric similarity.

Results
CU and PU had significantly higher FFM compared to NU (82.4 ± 10.1 kg vs. 72.0 ± 6.3 kg vs. 58.2 ± 14.0 kg). Absolute values of all RV and LV size were larger between CU and NU. LV mean wall thickness (MWT) was larger in CU compared to PU but there were no differences between PU and NU. Allometric scaling eliminated all differences with exception of LV mass and LVMWT. LVEF was significantly lower in CU and PU compared to NU (55 ± 3 vs. 57 ± 4 vs. 61 ± 4) whilst LV GLS was lower in CU compared to PU and NU and LV GCS was lower in CU compared to NU but not PU. There was no significant difference between groups for RV functional indices.

Conclusion
Strength-trained athletes currently using IPEDs have bi-ventricular enlargement as well as reduced LV function. Allometric scaling highlights that increased size is partially associated with a larger FFM, with exception of LVMWT which is independently increased through IPED use. PUs demonstrate reverse structural remodeling whilst functional differences partially remain.
CU PU NU RVD1 (mm) 45 ± 5* 43 ± 6 37 ± 6 Scaled RVD1 (mm/kg^0.33) 10.5 ± 0.9 10.4 ± 1.5 9.7 ± 1.0 LVd (mm) 58 ± 7* 55 ± 4 50 ± 4 Scaled LVd (mm/kg^0.33) 13.4 ± 1.2 13.3 ± 0.7 13.1 ± 0.6 MWT (mm) 10 ± 1*” 8 ± 1 8 ± 1 Scaled MWT (mm/kg^0.33) 2.3 ± 0.2*” 2.0 ± 0.1 2.0 ± 0.2 LVEDV (ml) 169 ± 42* 135 ± 28 116 ± 28 Scaled LVEDV (ml/kg) 2.0 ± 0.4 1.9 ± 0.3 2.0 ± 0.2 LV Mass (g) 255 ± 85*” 179 ± 30 137 ± 40 LV mass index (g/kg) 3.1 ± 0.8* 2.5 ± 0.3 2.4 ± 0.4 * CU and NU “ CU and PU ^ PU and NU
Abstract Figure. Myocardial strain imaging
Racial disparities in prevalence of cardiovascular disease risk factors in head and neck cancer patients
Authors: Mukherjee A , Griffin R , Lenneman C , Lewis C , Nabell L , Shrestha S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): American Heart Association Pre-doctoral Fellowship

Background
Cancer patients and survivors have higher burden of cardiovascular diseases than the age-adjusted general population. However, evidence on distribution of cardiovascular disease risk factors in cancer patients is limited.

Purpose
Our aim was to assess if racial disparities exist in prevalence of cardiovascular disease risk factors in head and neck cancer patients.

Methods
In this clinical cohort, we included 2299 head neck squamous cell carcinoma (HNSCC) patients diagnosed between 2012-2018 at a National Cancer Institute-designated Cancer Center. We used a combination of ICD-9/10 codes, medication use and pharmacy records from electronic medical records data, to identify cardiovascular disease risk factors (hypertension, dyslipidemia and diabetes mellitus). We reported prevalence of cardiovascular disease risk factors at and one year-post HNSCC diagnosis, by race, using Chi-square or Wilcoxon test, as appropriate.

Results
Black HNSCC patients were diagnosed at a slightly younger age (median: 60.0 vs 62.0 years, p-value 0.0745), had a higher proportion of males (p-value 0.0221) and advanced cancer stage at diagnosis (p-value 0.0033), than white HNSCC patients. At diagnosis, 32.63% of black HNSCC patients had hypertension and 34.44% had at least one cardiovascular disease risk factor, compared to 24.59% and 27.74% in whites, respectively (p-values 0.0020 and 0.0127, respectively). At one-year post HNSCC diagnosis, 84.73% of all HNSCC patients had at least one cardiovascular disease risk factor. No statistically significant racial differences were observed for hypertension and diabetes mellitus at one-year post HNSCC diagnosis, however, 37.74% of white HNSCC patients had dyslipidemia compared to 27.49% black patients (p-value 0.003).

Conclusion
Higher prevalence of hypertension and advanced cancer stage at HNSCC diagnosis in black patients highlights issues of racial disparity and unequal access to care. High prevalence of cardiovascular disease risk factors at one-year post HNSCC diagnosis and increase in dyslipidemia in white patients emphasizes the impact of therapeutic agents and need for routine personalized monitoring of cardiovascular disease risk factors and cardiovascular disease preventive services in high risk HNSCC patients.