bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world effectiveness of primary care psychological therapy for depression and anxiety in patients with coronary heart disease
Authors: Suh J , El Baou C , John A , Stott J , Saunders R 
Published: October 2024

Abstract

Background
Depression and anxiety are often inadequately treated in patients with coronary heart disease (CHD), despite mental health issues being associated with poorer quality of life, higher cardiovascular morbidity, and higher mortality. Talking therapies, such as cognitive behavioural therapy, are the recommended first-line treatment for depression and anxiety symptoms in CHD patients. However, the evidence for their effectiveness was considered low in a recent Cochrane review, and trial participants may not represent patients treated in routine clinical settings.

Purpose
To assess the effectiveness of routinely-delivered talking therapies in patients with CHD from nationwide primary care talking therapy services in England, and to compare their treatment outcomes to patients without a CHD diagnosis.

Methods
Healthcare records from 1.9 million patients who completed a course of treatment (≥2 treatment sessions) via NHS Talking Therapies for anxiety and depression (NHS TTad) between 2012-2019 were linked to Hospital Episode Statistics, the Mental Health Services Data Set, and death records. Standard NHS TTad outcome indicators (recovery, reliable improvement, and reliable deterioration) were examined in three groups, with (1) any CHD (n=41,317; ICD-10=I20-I25), (2) acute coronary syndromes (ACS, n=29,991; I21, I22, I20.0), and (3) chronic CHD (n=40,524; I20.1-I20.9, I23-I25) at baseline. Effect sizes for pre-post treatment changes in depression and anxiety symptom measures (PHQ-9 and GAD-7) were calculated using the adapted Cohen’s d for within-subjects design (dav). Outcomes were also compared to those of propensity-score matched control groups without the relevant diagnoses, using logistic regression.

Results
After completing a course of talking therapy, 49.8% (95%CI=49.3;50.3) of patients with CHD recovered from depression or anxiety, 69.4% (95%CI=69.0;69.9) saw reliable improvement in symptoms, and 7.3% (95%CI=7.0;7.5) experienced reliable deterioration in symptoms. There were large reductions in both depression (dav=-1.02) and anxiety symptoms (dav=-1.03) on average. Compared to a control sample of patients with no diagnosis of CHD, those with a CHD diagnosis were less likely to recover (OR=0.87[95%CI=0.84;0.89]) or reliably improve (OR=0.84[95%CI=0.81;0.87]) and more likely to reliably deteriorate (OR=1.28[95%CI=1.21;1.36]), when matched on age, sex, ethnicity, deprivation, baseline depression and anxiety symptom scores, self-reported long-term health condition, and waiting times between referral, assessment, and treatment. The findings were consistent for patients with ACS and those with chronic CHD.

Conclusions
Nearly half of CHD patients who received primary care talking therapy recovered, in line with the UK Government target of 50% recovery for the services. Nevertheless, compared to otherwise similar patients without CHD, those with CHD at baseline had worse psychological treatment outcomes.
Clinical picture, outcomes and predictors of relapse in eosinophilia-associated coronary vasospasm: data from a European multicentric study
Authors: Huang F , Khellaf L R , Lefevre G , Berti A , D'humieres T , Sionis A , Ariza Sole A , Delvino P , Emmi G , Gilles F , Varenne O , Haziza F , Benamer H , Kahn J E , Groh M 
Published: October 2024

Abstract

Background and aims
Eosinophilia-associated coronary vasospasm is an under-recognized and scarcely reported life-threatening condition for whose management is undefined. Preliminary data suggest that eosinophil-targeted therapies could be beneficial. Our aim is to provide an in-depth report of the clinical picture, outcomes and predictors of relapse in patients with eosinophilia-associated coronary vasospasm.

Methods
European multicentric retrospective study, gathering twenty centers across France, Italy and Spain. Patients of 15 years or more with definite or suspected coronary vasospasm according to the 2017 International standardization of diagnostic criteria for vasospastic and concomitant (± 48 hours) eosinophilia (threshold: 0.5 x 109/L) were included in this study. Outcomes included vasospasm relapse and other major cardiovascular events (MACE) during follow-up. Predictors of relapse were assessed using bidirectional stepwise regression analysis.

Results
Thirty-seven patients (median age: 52 [42-64] years, 43% women) were included, among which 16 (43%) had aspirin-exacerbated respiratory disease, 16 (43%) and 13 (35%) fulfilled classification criteria for Eosinophilic Granulomatosis with Polyangiitis (all with negative antineutrophil cytoplasmic antibodies) and Hypereosinophilic syndrome, respectively. There was no predominant coronary territory involved. A iatrogenic trigger was evidenced in 7 (19%) patients, consisting in all cases but one of non-steroidal anti-inflammatory drugs. After a median follow-up of 32 [12-63] months, 20 (54%) patients relapsed (median time to first relapse: 10 [5−29] months), despite vasodilators regimen in 95% of cases. Besides coronary vasospasm(s), 13 (35%) patients experienced an additional MACE. In multivariate analysis, persistent eosinophilia (i.e. absolute eosinophil count &gt; 0.5 x 109/L at the time of coronary vasospasm relapse or at last follow-up for relapsing and non-relapsing patients respectively) was the sole indepedendent predictor of relapse (Odds Ratio 8.87 [3.28-24.82]; p&lt;0.001). All six patients treated with interleukin-5 biologics remained relapse-free under treatment.

Conclusions
Eosinophilia-associated coronary vasospasm can occur in patients with type 2 inflammation. Long-term normalization of absolute eosinophil counts appears crucial in preventing the recurrence of eosinophilia-associated coronary vasospasm, while conventional use of vasodilators seems ineficient.
Clinical, echocardiographic, and pathologic characteristics of patients with pathology-proven nonbacterial thrombotic endocarditis
Authors: El-Am E , Ahmad A , Abbasi M , Akiki E , Bois M , Maleszewski J , Kurmann R , Klarich K 
Published: October 2024

Abstract

Background
Non-bacterial thrombotic endocarditis (NBTE) is a non-infectious condition characterized by thrombotic and/or inflammatory depositions involving the cardiac valves. It is a challenging diagnosis of exclusion.

Purpose
This study aimed to better characterize patients with pathologically proven NBTE and assess its clinical, echocardiographic characteristics and prognostic implications.

Methods
We retrospectively identified patients with pathology-proven NBTE at a single center. Patients with positive preoperative blood cultures, a history of active or treated infective endocarditis, or identification of valvular organisms by special stains were excluded from the study. Patients with pathology reports of valve perforation or chordal rupture were also excluded because of the high likelihood of an infectious etiology for these lesions.

Results
A total of 53 patients with NBTE (median age 57 years; 61% females) were identified. In this cohort, 22% had a history of malignancy, 30% had connective tissue disease, 32% had coronary artery disease, and 11% prior history of NBTE. Neurological events accounted for 18 (34%) of the presenting symptoms (TIA n=17, CVA n=9), while new valvular dysfunction in 7 (13%) and fever in 8 (15%) of patients. Five patients (9%) had NBTE involving more than one valve. NBTE involved the mitral valve in 64%, aortic valve in 38% prosthetic/mechanical valve in 11%, and tricuspid valve in 5%. NBTE was identified at the time of autopsy in 34% of patients. NBTE recurred in 3 patients during follow-up. Excluding patients diagnosed at the time of autopsy, 9% of patients died within 1 year of NBTE diagnosis.

Conclusion
NBTE was diagnosed pathologically in the presence of hyper-inflammatory states due to critical illness or immunological diseases. It was predominantly on the left side of the heart and was associated with embolic phenomena, either clinically or on imaging. Patients diagnosed with antemortem with NBTE have a high mortality in the first year (9%).
Early left atrial changes in patients with systemic sclerosis by two-dimensional speckle tracking echocardiography
Authors: Hassan A , Dawood M , Ammar W 
Published: October 2024

Abstract

Background
Systemic Sclerosis (SSc) is an autoimmune disease that affects multiple organs 1. Primary myocardial involvement is not uncommon in SSc, with poor prognosis when symptomatic2-4. Pulmonary hypertension and right-sided affection of the heart are well-studied in SSC. Changes in the function of the left atrium (LA) in patients with SSc are early signs of left-sided affection of the heart, which has not yet been well investigated. Two-dimensional (2D) speckle tracking echocardiography (STE) is useful for detecting these early changes.

Aim
To assess the LA strain parameters in patients with SSC by 2D STE compared to age and sex-matched healthy subjects.

Methods
This study analyzed prospectively collected data from 30 consecutive SSc patients, excluding those with systemic hypertension and diabetes mellitus and a control group including 30 healthy female volunteers with a mean age of 35.6±7.7. Most SSC patients were females (28/30), with a mean age of 39±10.8. After obtaining informed consent, all participants underwent clinical evaluation and transthoracic echocardiography, including strain analysis.

Results
Left atrial reservoir (38.1±3.8 % vs. 45.33.7 %; p&lt;0.001), conduit (21.82.7 % vs. 25.73.2 %; p&lt;0.001), and contractile (16.23 % vs. 19.6±2 %; p&lt;0.001) strain parameters were significantly reduced in the SSc population than the healthy controls. The LA stiffness index was also significantly higher in SSc patients (0.186±0.042 vs 0.138±0.018; p&lt;0.001). The total emptying fraction (59.9±7 % vs. 64.73 %; p=0.003), expansion index (160.945.8 % vs. 185.224.1%; p=0.007), and passive emptying fraction (37.37.4 % vs. 40.7±8.5%; p=0.012) were significantly lower in SSc patients compared to the controls. However, the active emptying fraction showed no significant difference between the 2 groups. LA maximal volume was similar between the 2 groups.

Conclusion
Patients with systemic sclerosis demonstrate reduced LA phasic function even without LA enlargement, as compared to healthy individuals, based on 2D speckle-tracking echocardiography (STE).
Cardiac structure and function in patients with chronic obstructive pulmonary disease
Authors: Vesterlev D , Reimer Jensen A M , Duus L S , Janner E H , Karsum E , Christensen J , Yafasov M K , Johansen N D , Sivapalan P , Ulrik C S , Lapperre T , Browatzki A , Jensen J U S , Biering-Soerensen T 
Published: October 2024

Abstract

Background
Chronic obstructive pulmonary disease (COPD) is common and strongly associated with cardiovascular disease, but the pathophysiology has not been fully elucidated.

Purpose
We aimed to investigate cardiac structure and function in patients with COPD compared to a matched general population.

Methods
In a prospective cohort study, 796 patients with COPD were included and matched 1:2 on age and sex with controls from a general population study. All participants underwent an examination program including echocardiography.
Standardized linear regression coefficients were used to compare cardiac structure and function in patients with COPD vs. controls.
Impaired left ventricular (LV) function was defined as a left ventricular ejection fraction (LVEF) &lt;50%, or global longitudinal strain (GLS) &lt;16% (numerical). Impaired right ventricular (RV) function was defined as tricuspid annular plane systolic excursion (TAPSE) &lt;1.7 cm. Diastolic dysfunction was defined as having at least two of the following parameters: E/e’ &gt;14, septal e’ velocity &lt;7cm/s, or lateral e’ velocity &lt;10 cm/s, left atrial volume index (LAVi) &gt;34 mL/m2, or tricuspid regurgitation velocity (TRV) &gt;2.8 m/s. Logistic regression was used to assess associations between having COPD and systolic and diastolic dysfunction.

Results
Mean age was 70.2 ± 8.3 years and 52% were females. COPD patients had a mean forced expiratory volume in 1 second (FEV1) of 49.4 ± 18.8% predicted. At baseline, 43% of the patients with COPD had hypertension and 10% had diabetes (DM). Additionally, 57% with COPD had cardiovascular disease at baseline, including 12% with ischemic heart disease (IHD), 15% with atrial fibrillation (AF), 6% with heart failure, and 5% with a previous ischemic stroke.
Patients with COPD had impaired measures of cardiac structure and function including a lower GLS (COPD vs. controls: 16.3 vs. 19.2%), lower TAPSE (2.3 vs. 2.6 cm), larger LAVi (29.0 vs. 24.7 mL/m2), and higher TRV (2.7 vs. 2.3 m/s), p for all associations &lt;0.001. (See figure).
Patients with COPD had a significantly higher prevalence of impaired LV systolic function (OR for GLS &lt;16%: 8.18, 95% CI(6.04; 11.1), p &lt;0.001), impaired RV systolic function (OR for TAPSE &lt;1.7 cm: 2.77, 95% CI(1.63; 4.69), p &lt;0.001), and LV diastolic dysfunction (OR for diastolic dysfunction grade I or higher: 4.00, 95% CI(3.12; 5.13), p &lt;0.001) after adjustment for age, sex, hypertension, smoking, DM, IHD, AF, and lower density lipoprotein. (See figure).

Conclusion
Patients with COPD had significantly impaired LV and RV systolic function as well as impaired diastolic function compared with individuals from the general population. These findings underscore the importance of recognizing and addressing cardiovascular comorbidities in COPD.
Evaluating corticosteroid treatment strategies for cardiac sarcoidosis: analysis of the nationwide claims-based JROAD-DPC dataset
Authors: Kitai T , Sakamoto T , Yoshii T , Kurashima S , Irie Y , Moriuchi K , Amano M , Amaki M , Kanzaki H , Izumi C 
Published: October 2024

Abstract

Background
Corticosteroid-based immunosuppressive therapy is the cornerstone of treatment for cardiac sarcoidosis (CS), aimed at preventing severe adverse events including death, heart failure and lethal arrhythmic events. Nevertheless, data on the optimal initial dosing, appropriate tapering schedules, suitable maintenance dosages, and the recurrence rates among patients are insufficient.

Purpose
This study sought to scrutinize real-world data on corticosteroid therapy regimen for CS and to reassess optimal treatment protocols.

Methods
From the Japanese Diagnosis Procedure Combination database, 6,282 patients with hospitalized CS were identified between 2012 and 2022. Among them, 3,067 CS patients who were initiated on corticosteroid therapy during hospitalization were analyzed. We examined the baseline patient characteristics and treatment strategies for corticosteroid therapy, including starting dose, tapering period, maintenance dose, and their correlation with the onset of adverse events.

Results
The cohort had a mean age was 63±11 years, and 1,256 patients (41.0 %) were female. The starting dose of corticosteroids was 30.3±6.9 mg, with 88.6% of patients receiving a dose of ≧30 mg/day. The doses of corticosteroids at 30, 60, 90, 120, 150 and 180 days post-discharge were 21.4±9.8, 15.7±6.9, 12.2±5.7, 10.4±5.0, 9.3±4.5 and 9.0±4.6 mg, respectively. By day 180, 83.7% of the patients were maintained on ≦10 mg/day. However, 17.1 % of patients required an increase in corticosteroid dosage during the tapering course, primarily due to exacerbation of sarcoidosis. When analyzing only the group without corticosteroid escalation up to 180 days post-discharge, the average corticosteroid dose was 8.7±3.8 mg, with 95.3% of patients on ≦10 mg/day. We observed 965 re-hospitalization (31.5 %) during follow-up, with 58.8% of these patients having corticosteroid escalation to ≧30 mg, and 12.8% of patients received second-line immunosuppressive therapy, such as methotrexate.

Conclusion
The majority of CS patients were initiated on a corticosteroid regimen of 30 mg/day, which was subsequently tapered to below 10 mg/day by day 180. However, non-negligible number of patients experienced clinical events or relapse, underscoring the necessity for vigilant follow-up during corticosteroid therapy.Figure
High-sensitive cardiac troponin T in patients with idiopathic inflammatory myopathies
Authors: Barros E Silva P G , Machado L S G , Oliveira A C D , Mancuso F J N , Sato E I , Dias K T , Correia L A V , Ximenes M C , Lacerda M D V 
Published: October 2024

Abstract

Introduction
Patients with idiopathic inflammatory myopathies (IIM) may have positive blood tests of cardiac troponin in absence of clinically detected cardiac disease. This situation is more common using high-sensitive cardiac troponin T (hs-cTnT) but there is limited information of the expected results according to type of IIM and prognostic value of this test in this group of patients.

Methods
Prospective study with 32 healthy controls and 61 patients with IIM without known cardiac condition. These patients with IIM were followed for 25 months. High-sensitive cardiac troponin T (Roche Elecsys hs-cTnT) was measured at baseline in both groups and a value of 14 pg/ml was the percentile 99th and considered the upper limit of normality (ULN).

Results
The median value of hs-cTnT was higher in patients with myopathies [12.0 (5.0; 35.0) vs. 5.0 (4.0; 6.2) P&lt; 0.001] and the frequency of abnormal values were also more common in patients with IIM compared to controls (45.9% vs 6.2%, p&lt;0.001). The frequency varied according to the type of myositis: Inclusion Body Myosytis (75%), Polymyositis (66.7%) , Dermatomyositis (42.1%) and Antisynthetase syndrome (38.5%). In terms of magnitude, 57% had mild elevations (1 to 3 x ULN) while 11% had levels 3 to 5 times ULN and 32% had troponin values &gt; 5x ULN (Figure 1). Among patients with IIM, elevated levels of hs-cTnT were not associated with left ventricle global longitudinal strain &lt; 18% or lower ejection fraction and was not associated with cardiovascular events during 25 months of follow-up (Figure 2).

Conclusion
Abnormal values of high-sensitive cardiac troponin T are common in patients with idiopathic inflammatory myopathies including levels similar to myocardial infaction. This elevation was not associated with echocardiographic abnormalities or cardiovascular events in patients with IIM.Figure 1Figure 2
Is the female sex a risk factor for heart failure after myocardial infarction?
Authors: Kanic V , Naji F H 
Published: October 2024

Abstract

Background
In previous observations, female sex was associated with heart failure after myocardial infarction (MI). However, women were older and had more risk factors and were not treated the same as men.

Purpose
Our aim was to investigate the differential impact of sex on heart failure (including cardiogenic shock) and outcome in a propensity score matched population with MI who had undergone percutaneous coronary intervention (PCI) and the association between sex, heart failure and long-term mortality.

Methods
Data from 3624 (30.6% women) MI patients who underwent PCI at our institution were analyzed. Propensity-score matching analysis was performed to adjust for differences in baseline characteristics between men and women. After propensity matching, the sample comprised 2170 patients (1085 women and 1085 men). Heart failure was defined by clinical criteria (bilateral pulmonary rales, S3 gallop, edema or cardiogenic shock) and/or pulmonary edema on chest X-ray and/or ejection fraction &lt;30%. The data were analyzed using descriptive statistics. The median follow-up time was 27 months (25th, 75th percentile: 9,48).

Results
In hospital, 329 (16.4%) patients developed heart failure, with a similar incidence in men and women (156(15.5%) vs. 173(17.2%);p=0.33) (Figure 1). Furthermore, female sex was not associated with heart failure either univariately (OR 1.13;95%CI 0.89-1.43;p=0.31) or after adjustment for confounding factors (aOR 1.27;95% CI 0.96-1.66;p=0.093). Age, hypertension, hyperlipidemia, ST- elevation MI, and P2Y12 receptor inhibitors were associated with heart failure.
We followed the patients for up to six years. At the end of the observation period, 330(16.4%) patients had died. The mortality rate was similar in both sexes (159(15.8%) men died compared to 171(17.0%) women; p=0.51) (Figure 2). In addition, sex was not associated with long-term mortality (aHR 1.11;95%CI 0.88-1.40;p=0.38) after adjusting for confounders. In-hospital heart failure was independently associated with long-term mortality (aHR 2.64;95%CI 2.04-3.41;p&lt;0.0001). Hyperlipidemia, age, ST- elevation MI, radial access, P2Y12 receptor inhibitor and GFR were also associated with long-term mortality.

Conclusions
Our results suggest that sex itself is not associated with heart failure after MI when women are treated similarly to men, have similar risk factors, and are of similar age. It is more likely that women are more frequently affected by heart failure because they are older, have more risk factors, are less likely to be revascularized, and are less likely than men to be treated with guideline-recommended therapy,Heart failure in men and womenLong-term all-cause mortality
Cardiovascular profile of women in cardiac rehabilitation programs and its impact on their functional capacity
Authors: Gomez Sanchez M I , Delgado Calva F A , Marschall A F , Basabe Velasco M E , Dejuan Bitria C , Duarte Torres J , Biscotti Rodil B , Tapia Martinez M , Ramos Alejos-Pita C , Peruyero Gil V , D'amato M , Rey Hernandez M , Martinez C , Marti Sanchez D , Coto Morales B 
Published: October 2024

Abstract

Background
The value of cardiac rehabilitation (CR) for patients with a wide spectrum of cardiovascular diseases is supported by a solid body of scientific evidence. It has demonstrated improvement in cardiopulmonary capacity and physical endurance, as well as a reduction in morbidity, mortality and rehospitalization. Despite these benefits, it is an underutilized resource among women.

Purpose
Our objective was to study the clinical characteristics of women included in our CR program, as well as the evolution of their functional capacity, in comparison to men.

Methods
A retrospective observational study was conducted and consecutive patients who had participated in the CR program at our center, between the years 2019 and 2022, were included. Clinical characteristics and the evolution of functional capacity throughout the program were assessed, stratified by gender.

Results
175 patients were included and subdivided by gender into two groups: 144 males and 31 females. The mean age was slightly higher among the female patients, without reaching statistical significance, and the body mass index was similar in both groups. Ischemic heart disease was the primary reason for inclusion in 80% of cases. Within the female patients, 52% had hypertension (p=0.04) and 20% had diabetes (p=0.09), percentages slightly lower than those in males; a similar percentage of patients had dyslipidemia in both groups (see table).
The initial METs in ergometry [7.6 (6.3-10.2) among male patients and 4.6 (4.4-6.9) among female patients], and the final METs [10 (8.1-11.3) and 6.8 (5.6-7.6), respectively], were higher in the male group, with a significant increase in METs at the end of the CR program in both groups. Nonetheless, the absolute increase in METs was similar in both males and females.

Conclusions
Cardiovascular risk factors are more prevalent among males. CR programs demonstrate an improvement in functional capacity (defined as an increase in METs) in both males and females, with a similar absolute increase in METs for both genders. Therefore, we must increase our efforts to include more women in CR programs.