bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart rate response and recovery in bicycle exercise testing - reference values and association with mortality
Authors: Jou J , Zhou X , Lindow T , Brudin L , Hedman K , Ekstrom M , Malinovschi A 
Published: October 2024

Abstract

Introduction
Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific recommendations for reference values on HR recovery assessment.

Purpose
To define normal values for HR response and recovery in individuals referred for a bicycle exercise stress test and to relate these factors to risk of mortality.

Methods
We included 9,917 subjects (46% females) aged 18–85 years who performed a bicycle exercise test. We defined age- and sex-specific reference equations for peak HR, HR reserve, and HR recovery at 1 and 2 minutes (HRR1 and HRR2) using a subgroup of individuals without apparent cardiovascular (CV) risk nor comorbidities (N=2,774). Associations between blunted HR indices (&lt;5thpercentile) and mortality were analysed using Cox regression in all subjects and in individuals with normal exercise capacity (N=8,070).

Results
All HR indices were age-dependent. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with previously reported reference values. During median follow-up of 8.6 years 1,110 (11%) died. HR recovery variables were the strongest predictors of all-cause (HRR1, hazard ratio 1.66 (95% confidence interval, 1.45–1.90)) and CV mortality (HRR2, 1.59 (1.26–2.00)) after adjustments for potential confounders. Blunted HR response (peak HR) increased risk of all-cause (1.32 (1.14–1.53)) and CV mortality (1.41 (1.09–1.83)). Combined blunted HRR1 and HRR2 or HR response and HRR1 further increased risk of all-cause (1.92 (1.64–2.24) and 1.85 (1.55–2.22), respectively) and CV mortality (1.95 (1.50–2.54) and 1.94 (1.42–2.65), respectively). HR recovery variables (HRR1, 1.97 (1.63–2.39) and HRR2, 1.76 (1.46–2.12)) remained stronger predictors of mortality than peak HR (1.38 (1.10–1.72)) in individuals with normal exercise capacity.

Conclusions
All HR variables were age-dependent and associated with mortality. Blunted HR recovery was more strongly related to mortality than chronotropic incompetence, and their combination added prognostic value. Furthermore, blunted HR recovery variables, rather than blunted HR response, remained strongly associated with mortality even in the presence of normal exercise capacity.
Third ventilatory threshold in heart failure patients undergoing CPET: a prognostic analysis
Authors: Certo Pereira J , Amador R , Carvalho R , Bello R , Lima R , Maltes S , A Gomes D , Rocha B , Durazzo A , Mendes M , Adragao P , Cunha G 
Published: October 2024

Abstract

Introduction
One crucial element in cardiopulmonary exercise testing (CPET) involves identifying the first and second ventilatory thresholds (VT), VT1 and VT2, which hold known prognostic implications. If the individual can sustain exercise considerably beyond VT2, a third breakpoint (VT3 – Figure A) may emerge, coinciding with heightened hyperventilation to counter metabolic acidosis. Historically, this point has been mainly described among athletes and its meaning is still not entirely clear. We aimed to assess the prognostic value of VT3 in patients with heart failure (HF).

Methods
Retrospective, single-center study enrolling HF patients undergoing CPET from 2015 to 2021. We evaluated the typical CPET parameters along with the three ventilatory thresholds: VT1, VT2, and the newly introduced VT3. The primary outcome was a composite of cardiovascular death, urgent heart transplant, need for left ventricle assistance device and HF hospitalizations.

Results
We included 221 patients (82% men, mean age 58±12 years), among whom 69% had ischemic heart failure aetiology. The mean left ventricular ejection fraction (LVEF) was 34±9%, with a mean respiratory exchange ratio 1.15±0.082, mean pVO2 18.5±6.3, and a mean VE/VCO2 slope of 41.3±12.9. VT3 was attained by 43% (n = 94) of the patients.
In comparison to those who did not achieve VT3, patients who reached this threshold were younger (56±11 vs 60±12; p = 0.05), had a higher pVO2 (20.5±6.9 vs 17±5.4; p = 0.05), higher RER (1.16±0.86 vs 1.13±0.78; p = 0.05), and lower VE/VCO2 slope (39±10.3 vs 43±14.3; p = 0.05).
Regarding the three ventilatory thresholds (VT1, VT2, VT3), 7% (n=17) achieved a maximum of one threshold, 50% (n=110) achieved two thresholds, and 43% (n=94) reached all three thresholds. After a median follow-up of 2,3 years patients with identifiable VT3 had significantly better prognosis (HR 0,434; 95%CI 0,246-0,767; p=0,004) than those without this threshold. Furthermore, the number of identifiable ventilatory thresholds correlated positively with prognosis. In fact, patients with only 2 thresholds have twice the probability of developing an event and those with one or zero identifiable thresholds have a 4-fold increase in the probability of events (Figure C).

Conclusion
In a cohort of patients with HF, those with identifiable VT3 had a lower incidence of events. This parameter may aid in prognostic stratification in this population. However, this findings warrant further prospective validation.Figure 1
Signal-morphology impedance cardiography is a non-invasive tool to predict responses to exercise based cardiac rehabilitation in chronic heart failure patients
Authors: Bour F , Iliou M C , Vitiello D , Lepretre P M 
Published: October 2024

Abstract

Background
All the studies and meta-analyses showed beneficial effects of the exercise based cardiac rehabilitation (ExBCR) on peak value of oxygen uptake (VO2peak) in patient with chronic heart failure (CHF). It is widely recognized that changes in VO2peak induced by training (ΔVO2peak) have a prognostic value. A 5.0% increase in ΔVO2peak has been associated with a significant clinical improvement1. However, 20 to 30 % of CHF are non-responders to ExBCR. The Signal-Morphology Impedance Cardiography (SM-ICGTM) technology has allowed previous researchers to show the role of cardiac output (CO) on DVO2peak2. CO responses may be partly attributed to the peak ejection flow velocity that can explain the impaired response to ExBCR.

Purpose
The study aimed to establish whether SM-ICGTM is an appropriate technology to predict responses to ExBCR in CHF patients.

Methods
A retrospective study was conducted on 65 CHF patients (LVEF: 29.0±8.3%). All patients performed a cardiopulmonary exercise test (CPET) on bicycle to determine ventilation (VE) and VO2peak before and after 20 ExBCR sessions. In addition, stroke volume (SV), heart rate (HR), and CO were continuously monitored by SM-ICGTM (PhysioFlow® Lab1). The value of peak ejection flow velocity, so called CTi by the manufacturer, was calculated as the peak of the first mathematical derivative over the time of the impedance waveform during the systole and measured by PhysioFlow® throughout the test. For the analysis of training response patients were divided in two groups: the normal CTi profile which was characterized by an initial increase followed by a plateau until CPET exhaustion, and the abnormal CTi response if CTi decreased at the onset of CPET or increased then decreased before exhaustion. Statistical analyses were performed with JASP. The significant level was set at p value &lt; 0.05 for 95% confidence interval.

Results
Our study population consisted in 32 patients who presented a normal CTi profile and 33 with an abnormal CTi profile. As shown in Table 1, no significant difference was found at baseline between both groups. ExBCR induced significant changes in VO2peak even if 29 % patients were non-responders. Patients with normal CTi profile presented a greater DVO2peak compared to patients with abnormal CTi profile (28 ± 30 vs. 14 ± 19 %, p&lt;0.01). 78% of patients with normal CTi profile versus only 64% of patients with abnormal CTi profile were ExBCR responders. The logistic regression showed that patient with normal CTi profile were 3.3 time more likely to present a ΔVO2peak ≥ 5%.

Conclusion
Exercise CTi profiles determined by SM-ICGTM prove to be an interesting tool to help predicting ExBCR responses in CHF patients and maybe highlighting the hemodynamic determinants of VO2 responses to exercise training.
Effectiveness of hybrid comprehensive telerehabilitation in women with heart failure - subanalysis of the TELEREH-HF RCT
Authors: Piotrowicz E , Kowalik I , Opolski G , Banach M , Zareba W , Orzechowski P , Szalewska D , Glowczynska R , Irzmanski R , Kalarus Z , Pluta S , Mierzynska A , Jaworska I , Piotrowicz R 
Published: October 2024

Abstract

Background
Despite the known benefits of cardiac rehabilitation, it remains underutilized among women. In particular, little is known about the effectiveness of hybrid comprehensive telerehabilitation (HCTR) in women with heart failure (HF).
Purpose: The purpose of this study was to assess effectiveness and safety of HCTR in women with HF.
Methods: The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in
peak oxygen consumption (VO2 peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were made before and after intervention/observation.
Results: Women constituted 11.5 % of population in the TELEREH-HF study. Forty women in HCTR group and 44 women in UC group completed HCTR and observation respectively. HCTR resulted in significant improvement in VO2peak, workload duration and QoL. We did not observe these favorable results in the UC group except for an increase workload duration. In the HCTR group, there was a significantly greater improvement in physical component of QoL than in the UC group. All results are presented in Table 1. In neither group were there deaths nor major adverse events related to exercise training.

Conclusion
In women with HF, hybrid comprehensive telerehabilitation is safe and resulted in a significant improvement in physical capacity and QoL.
Effect of sacubitril/valsartan and dapagliflozin on athletic performance; can the popular cardiac medications of recent years be used as doping agents?
Authors: Kilic S , Asal S , Torun A , Babaoglu M , Yavuz S , Demirtas C , Dilmen S , Orhan A L , Uzun M 
Published: October 2024

Abstract

Background/Introduction
Recent guidelines have highlighted the positive impacts of sacubitril/valsartan and dapagliflozin on heart failure management [1]. Given their potential misuse as doping agents in professional sports, this study evaluates their effects on athletic performance.

Purpose
To investigate the effects of sacubitril/valsartan and dapagliflozin on athletic performance and cardiac functions in a rodent model.

Methods
The study had a randomized double-blind design. 24 Sprague-Dawley male rats aged 4 months, divided into control, sacubitril/valsartan, and dapagliflozin groups. The rats were weighed at the start of the experiment. The medications (dapagliflozin 1,5 mg/kg/1 ml/once a day, sacubitril/valsartan 60 mg/kg/1 ml/once a day to their respective groups, and normal saline for control group) were administered via gastric gavage for 30 days. The rats were weighed, examined with transthoracic echocardiography and put on rotarod at the start of the experiment, and on 15th and 30th days. The rats were put on forced swimming tests for 20 days. Exhaustion, loss of coordinated movements and failure to surface for 3 seconds after submersion in the water were defined as indications for ending the test as per the guidelines regarding rat exercise testing [2]. M-mode and Doppler measurements, forced swimming test durations, rotarod durations and weight were recorded on 0th, 15th and 30th days.

Results
Initial performance metrics, including echocardiography, weight, and rotarod tests, showed no significant differences among the groups at baseline. The distributions in data were non-normal. Over the course of the study, median swimming times significantly differed from the 9th session, with dapagliflozin-treated rats exhibiting a substantial increase in endurance. Specifically, dapagliflozin group's swimming times increased to a median of 3580 seconds by the 20th session, compared to 2382 seconds in the control group and 2591 seconds in the sacubitril/valsartan group, indicating a pronounced improvement in exercise capacity (P&lt;0.0001)(Figure-1). Echocardiographic assessments revealed enhanced cardiac output and ejection fraction, particularly in the sacubitril/valsartan group, suggesting increased cardiac efficiency and potential athletic performance enhancement.

Conclusion(s)
The study demonstrates a significant improvement in athletic performance with dapagliflozin compared to sacubitril/valsartan. These findings suggest a potential for misuse in sports doping, emphasizing the need for stringent regulation and monitoring within competitive athletics.Figure-1
Cardiac screening with ECG in the young: significance of T wave inversion, T wave depth and T wave/QRS ratio
Authors: Alzarka A , Abioye D , Maclachlan H , Bhatia R , Sharma S , Papadakis M , Finocchiaro G 
Published: October 2024

Abstract

Background
In young apparently healthy individuals, repolarization changes at the ECG may suggest an underlying cardiomyopathy.

Purpose
This study aims to investigate the clinical significance of T waves depth and T/QRS ratio in young individuals who underwent cardiac screening and exhibited T wave inversion (TWI) at the ECG.

Methods
We analysed a database of individuals aged 14 to 35 years who underwent cardiac screening, which included a health questionnaire and 12-lead ECG with a charitable organisation, between 2008 and 2013. All individuals included had recently responded to a follow-up online health questionnaire or had documented outcomes on a national digital database. The amplitudes of QRS (peak to peak) and T waves (mV) were measured in the leads where TWI was present; the average T/QRS ratio and average TWI depth were calculated.

Results
Our cohort comprised 5360 subjects (mean age of 21 ± 6 years, 61% males). Of the 358 (7%) who were referred for further investigations based on their screening findings, 255 (5%) had an abnormal ECG. TWI was documented in 120 (2%) individuals [anterior TWI in 78, inferior TWI in 16, lateral TWI in 6, and overlaps in 20 cases]. After further investigations, 16/120 (13%) individuals were diagnosed with cardiomyopathy [9 hypertrophic cardiomyopathy (HCM), 5 arrhythmogenic cardiomyopathy (ACM), 1 dilated cardiomyopathy (DCM), and 1 left ventricular non-compaction cardiomyopathy (LVNC)]. Of the remaining 104/120 individuals, 18 were diagnosed with other cardiac conditions and 86 were not found to have a cardiac disease. During a mean follow-up of 8.1 ± 1.2 years, no deaths were documented among the 16 individuals diagnosed with a cardiomyopathy, but 3 of them experienced a sudden cardiac arrest (all of them had ACM). In individuals diagnosed with a cardiomyopathy both average T/QRS ratio and average TWI depth were higher compared to the rest (0.128 vs 0.117; p = 0.54 and 0.281 vs 0.162 mV; p = 0.03, respectively). Average T/QRS ratio and average TWI depth were higher in individuals diagnosed with HCM compared with the ones diagnosed with other cardiomyopathies (0.133 vs 0.115; p = 0.68 and 0.336 vs 0.164 mV; p = 0.05, respectively).

Conclusion
T wave inversion is a relatively common ECG finding in young apparently healthy individuals and this feature leads to a diagnosis of cardiomyopathy in 13% of cases. Among subjects exhibiting TWI, T/QRS ratio and T wave depth appear higher in the ones who are eventually diagnosed with cardiomyopathies.Figure 1.Flowchart of patient selection
Long-term cardiovascular outcomes of patients experiencing intra-cranial hemorrhage with or without acute cardiovascular events
Authors: Chao T , Kuo L I N G , Lip G Y H , Chen S A 
Published: October 2024

Abstract

Background
Acute cardiovascular (CV) events would happen during the acute stage of ischemic stroke or intra-cranial hemorrhage (ICH), so called "Stroke-Heart Syndrome". However, long-term outcomes of patients who experienced acute CV events during the acute stage of ICH were unclear. In the present study, we aimed to report and compare long-term prognosis of patients with or without acute CV events after ICH.

Methods
A total of 104,955 patients who experienced ICH and survived longer than 90 days without past history of acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and ventricular arrhythmia (VA) were identified from the Taiwan National Health Insurance Research Database. Among them, 1,888 patients experienced CV events (AMI, HF, AF or VA) within 90 days after ICH, while 103,067 did not.

Results
Compared to patients without acute CV events, patients with acute CV events were older (73.53 vs 62.46 years, p&lt;0.001), less males (57.89% vs 61.83%, p&lt;0.001) and had more comorbidities , such as hypertension (77.17% vs 61.58%), diabetes mellitus (35.81% vs 26.54%), vascular diseases (3.5% vs 2.02%) and chronic obstructive pulmonary disease (15.57% vs 9.88%), all p&lt;0.001. Compared to patients without acute CV events, those experiencing acute CV events had a higher adjusted risk of ischemic stroke (adjusted hazard ratio [aHR] 1.564), recurrent ICH (aHR 1.266), HF (aHR 4.693), AF (aHR 19.116), VA (aHR 3.485), AMI (aHR 2.463), sudden cardiac death (aHR 1.609) and mortality (aHR 1.855)(Figure).

Conclusions
Acute CV events occurring during acute stage of ICH were not a benign course simply related to acute stress and were associated with a poor long-term outcome. How to improve long-term clinical outcomes of these patients deserves more attentions, efforts and studies involving both cardiologists and neurologists.
Attention as the dimension that deteriorates first in patients with cognitive impairment after myocardial infarction
Authors: Kasprzak D , Kaczmarek-Majer K , Grabarczyk A , Ganowicz-Kaatz T , Rzezniczak J , Slomczynski M , Budzianowski J , Hiczkiewicz J , Burchardt P 
Published: October 2024

Abstract

Background
Previous publications by our team indicated a high prevalence (approximately 35%) of cognitive impairment (CI) in patients after myocardial infarction (MI). Moreover, we observed that the presence of peri-infarction deficits was not always associated with their occurrence after 6 months of follow-up and vice versa. This was the basis for distinguishing 4 groups of patients: a) group 1 – CI present peri-infarction and after 6 months; b) group 2 – CI present only peri-infarction; c) group 3 – CI present only after 6 months; d) group 4 – no CI during the study.

Purpose
The aim of the current study is to analyse the type of CI in patients after MI with a focus on its changes within the 4 groups mentioned.

Methods
The study included 326 patients hospitalised for MI treated by percutaneous coronary intervention. Cognitive function was assessed twice using the Mini–Mental State Examination (MMSE) and the Clock Drawing Test (CDT)-Shulman version during the first hospitalisation (on day 2-3 after MI) and 6 months later. In addition, the occurrence of sleep, aggression and mood disorders was assessed. The constructed research model was analysed with artificial intelligence algorithms.

Results
Persistent CI (group1) was found in 8.9%, peri-infarct CI (group 2) in 16.3%, and only after 6 months (group 3) in 7.7% of study participants (as assessed by MMSE). Analysis of the cognitive domains showed that in those who improve (group 2) or worsen cognitive function (group 3), analogous changes in attention function occurred, respectively improving in 81% and worsening in 100% of subjects in a given group. It was observed that there is a group of patients with a CI on the MMSE who perform CDT correctly, 12% peri-infarct and 11% at 6-month follow-up, respectively. Patients with a normal CDT score but CIs found in the MMSE have impaired attentional function regardless of the time of assessment.

Conclusion
CIs can occur both immediately after MI and during subsequent follow-up. However, after 6 months of intensive anti-atherosclerotic treatment (post-MI), cognitive functions improve in some patients, and deteriorate in others. At the same time, the cognitive function that undergoes similar changes in these groups is attention. The uniform type of impaired cognitive function and the lack of specific differences between the 4 groups allow us to assume a uniform etiology of cognitive deficits. Patients with normal CDT and disorders present in MMSE show deficits in attention functions. Performing CDT and using the MMSE component assessing attention function could prove sufficient for the initial assessment of cognitive functions in the population of patients after MI. The results require confirmation in a larger patient population.
Mood instability and cardiovascular modification in cardiovascular disease outpatients. The ABC study on heart disease
Authors: Berton G , Mahmoud H , Palmieri R , Cordiano R , Selvestrel E , Merotto D , Cavuto F , Dal Bo A , Mahmoud M M 
Published: October 2024

Abstract

Introduction
Mood instability (MI) is a condition characterized by unpredicted frequent fluctuations in a person's emotional state. It is a common personality trait observed in the general population, and it has been reported to be associated with a range of adverse health outcomes, and may also serve as an additional risk factor for cardiovascular morbidity.

Purpose
To assess mood instability and its effects on cardiovascular function among CVD outpatients.

Methods
Consecutive patients who were presented to the cardiac outpatient clinic in the last 5 years were recruited and divided into 2 groups according to the presence or absence of MI symptoms based on the patient’s self-assessment psycho-emotion questionnaire. Cardiovascular functions were assessed and compared between both groups.

Results
A total of 415 patients were included in this preliminary analysis. Patients' mean age was 66±18 years, and 57% were males. Coronary artery diseases were registered in 93(22%) patients. 137 (33%) patients suffered mood instability symptoms, and they shared most demographic and clinical characteristics with patients who did not suffer from MI. However, males were more frequent among patients with no MI symptoms.
Interestingly, we observed a significant difference in systolic blood pressure values (SBP) between both groups, (SBP= 150±23 Vs 145±21 mmHg, p= 0.02, for patients with and without MI, respectively). Yet, no difference was observed in diastolic blood pressure (DBP) values (80±12 Vs 79±11 mmHg for patients with and without MI, respectively, p&lt;0.19). Patients with MI symptoms had also a higher heart rate (HR) (77±15 bpm) than patients without symptoms (72±13 bpm, p=0.0003).
Using multivariable linear regression models, mood instability (β±SE= 4.3±2.2, p&lt;0.049) and age (β±SE= 0.4±0.05, p&lt;0.0001) were independent predictors for higher SBP values. Mood instability was also independently associated with a higher heart rate (β±SE= 5.1±1.4, p=0.001). Results Kept true even stronger with repeated BP and HR measurements.

Conclusion
Our results showed that mood instability is associated with a significant increase in systolic blood pressure and heart rate values in cardiac outpatients.