bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study
Authors: Elnegaard C , Brandes A , Borregaard B , Tveskov C , Zwisler A D , Risom S 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF.

Purpose
To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center.

Methods
This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials.

Results
43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting.

Conclusion
It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.
Clinical and angiographic features of patients experiencing exercise-induced out-of-hospital cardiac arrest
Authors: Kuroki N , Takayama T , Kohsaka S , Nagao K , Nakata J , Kuwabara M , Ashida T , Masaki R , Murata N , Hirose K , Yagi T , Yamamoto T , Takayama M 
Published: October 2024

Abstract

Background
Out-of-hospital cardiac arrest (OHCA) is a devastating condition that exhibits significant clinical heterogeneity. Previous studies have reported coronary artery disease (CAD) as the most common cause of OHCA. Possible causes of exercise-induced OHCA in patients with CAD include ST-elevation myocardial infarctions (STEMI), exercise-induced myocardial ischaemia and other triggers. We investigated whether there are differences in the clinical and angiographic features between 'exercise-induced (EX)' and 'non-exercise-induced (non-EX)' OHCA secondary to CAD.

Methods
In total, resuscitated 2300 patients (from 72 institutions) with OHCA due to CAD were registered within our regional CCU network database between 2010 and 2021. The population of the coverage area is 16.8 million during the day and 14.1 million at night. Patients with a trigger were grouped based on their triggering event: at rest, sleeping, eating, drinking, watching television, bathing, excretion, mild physical activity, driving, exercise and other activity. We classified the patients into 2 groups based on their triggering event as exercise: exercise (EX) group(n=169) and Non-Ex group(n=2131). The primary clinical outcome of interest was favorable 30-day neuroprognosis.

Results
Baseline characteristics was shown in the Table (below). Acute coronary syndrome (ACS) was the most common type of clinical presentation in each group. In ACS, the EX group had less ST elevation and/or left bundle branch block in electrocardiogram (57% vs. 68%; P=0.01), and initial good flow (TIMI grade 3) of culprit lesion in coronary artery was more frequently seen in the EX group than in the Non-EX group (23% vs. 12%; P&lt; 0.01). A Kaplan-Meier survival curve analysis showed that EX group had favorable clinical outcome compared with Non-EX group (71% vs 58%, p&lt;0.001:log-rank test). Multivariate analysis demonstrated that exercise-related trigger for OHCA was an independent predictor of favorable outcome (OR:0.59, 95%CI:0.38-0.90; P=0.015).

Conclusion
EX-OHCA had favorable clinical outcome compared with non-EX-OHCA. Reason may be that these patient present with culprit lesion that has good blood flow, possibly leading to fewer STEMI events.Baseline charactaristicComparison in Patients with ACS
Sizing of the aortic valve using virtual reality - next step towards personalized medicine?
Authors: Kanschik D , Haschemi J , Heidari H , Klein K , Afzal S , Maier O , Piayda K , Oezaslan G , Antoch G , Lichtenberg A , Fleissner F , Scherner M , Kelm M , Zeus T , Jung C 
Published: October 2024

Abstract

Background
High-quality imaging is integral throughout the transcatheter aortic valve implantation (TAVI) process, from patient selection and preprocedural planning to real-time guidance during the procedure and postprocedural follow-up. Multislice computed tomography (MSCT) is currently the gold standard. The next step in this area is the three-dimensional (3D) visualization of cardiac and extra-cardiac structures using virtual reality (VR).

Purpose
This study aimed to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in the planning of TAVI procedures.

Methods
Based on the preprocedural MSCT data of 60 patients who underwent TAVI at our heart center, measurements using 3mensio software were compared with 3D visualizations and measurements using VR software. Additionally, eight physicians evaluated the application of VR using a structured questionnaire to define its benefits and limitations.

Results
VR measurements correlated well with the 3mensio software measurements, and there were no significant differences between the two methods. The VR measurements were mentioned first: Annulus perimeter 77.4 ± 7.8 vs. 77.0 ± 8.1 (p=0.182), r = 0.929; Annulus diameter 24.6 ± 3.2 vs. 24.4 ± 2.6 (p=0.483), r = 0.868; LVOT diameter 23.5 ± 3.1 vs. 23.7 ± 2.8 (p=0.442), r = 0.785; SoV left 32.9 ± 4.1 vs. 32.7 ± 3.7 (p=0.331), r = 0.920; SoV right 30.8 ± 4.3 vs. 30.7 ± 3.7 (p=0.653), r = 0.909; noncoronary SoV 32.9 ± 3.6 vs. 32.6 ± 3.7 (p=0.209), r = 0.913; STJ 30.0 ± 3.6 vs. 29.7 ± 3.2 (p=0.175), rs = 0.882; Ascending aorta 34.5 ± 3.4 vs. 34.5 ± 3.1 (p=0.469), r = 0.921, RCA height 15.1 ± 3.2 vs. 15.4 ± 3.2 (p=0.179), rs = 0.910, LCA height 12.4 ± 2.7 vs. 12.3 ± 3.0 (p=0.252), rs = 0.924. Furthermore, users reported that VR simplified anatomical understanding (1.3 ± 0.5 vs. 1.9 ± 0.4, p = 0.046), and improved 3D comprehension (1.1 ± 0.4 vs. 2.3 ± 0.5, p = 0.023).

Conclusion
The use of VR in the planning of TAVI procedures enables precise and reproducible measurements. In addition, VR can help assess the often complex anatomy, which can increase the safety and efficiency of procedures. Further clinical studies are needed to evaluate the potential benefits of VR application in planning and performing other structural interventions.
Potential impact of cold water immersion on arrhythmogenesis: a pilot exploratory study surrounding the Geneva christmas cup
Authors: Craviari C , Merkt B , Baggish A L , Namdar M , Meyer P 
Published: October 2024

Abstract

Background
Cold-water immersion (CWI) is gaining popularity and is regulated by sports federations with guidelines for various cold temperature ranges. Small studies suggest cardiovascular and stress reduction benefits from regular CWI, yet acute effects and cardiac risks remain underexplored.

Purpose
This study aimed to assess the impact of CWI on arrhythmogenesis among participants of the 2023 Geneva Christmas Cup, the world's largest cold-water swimming event.

Methods
Volunteers aged 45 and older were recruited through the organizing committee. Each underwent baseline cardiovascular risk assessment 10 days prior to the event, including medical interviews, physical exams, blood tests, and 12-lead ECGs. A waterproof ECG recorder (BodyGuardian Mini®) was attached to participants, monitoring them for 10 days up to the end of the race. An activity diary recorded training sessions, CWI exposure, and any symptoms. Data from BodyGuardian Mini® were analyzed for CWI-induced arrhythmias and conduction disturbances. The local ethics committee approved the study.

Results
Twenty volunteers (11 women, mean age 56 ± 6.4 years) participated. Their mean SCORE2/SCORE2-OP was 4 ± 1.8%, with 60% at low to moderate and 40% at high cardiovascular risk. Average weekly training was 5.5 ± 2.9 hours. Lake temperature was 7.0 degrees. One participant could not race but all completed CWI training and wore ECG recorders for an average of 226 ± 32 hours. Sixteen participants (80%) exhibited non-sustained atrial tachycardia (average 12.4 ± 8.8 events), and four (20%) had non-sustained ventricular tachycardia events (average 1.2 ± 0.5), with no significant pauses or &gt;1st degree AV block observed. No arrhythmic events were directly linked to CWI.

Conclusion
This exploratory study of active, middle-aged participants with moderate cardiovascular risk found no association between CWI and arrhythmias. Further, larger-scale studies are necessary to conclusively determine CWI's safety.
Absence of coronary artery disease in high-risk sickle cell anemia patients: a new illustration supporting the protective effect of Bilirubin against atherosclerosis?
Authors: Stevenard M , Derbel H , Iles S , De Luna G , Tacher V , Amorouayeche Z , Ibrahim C , Boyer L , Alassaad L , Guillet H , Savale L , Derumeaux G , Bartolucci P , Dhumieres T 
Published: October 2024

Abstract

Background
Sickle cell anemia (SCA) is associated with both cardiac and systemic vascular disorders, which are the leading cause of morbi-mortality. Although these patients cumulate multiple cardiovascular (CV) risk factors, along with chronic inflammation and endothelial activation, some pre-clinical studies underlined a paradoxical protection against atherosclerosis.

Purpose
The aim of this study was to evaluate the prevalence of coronary artery disease in a high-risk SCA population.

Methods
From January 2019 to December 2023, consecutive adult patients with SCA were prospectively included in the DREPACOEUR registry to specifically analyze cardiac structure and function. They all had a comprehensive CV evaluation at steady-state in day-hospital including clinical exam, cardiac imaging, rhythm monitoring along with biology analysis. Only patients that underwent coronary imaging (CT coronary angiogram) were included in this study.

Results
Ninety patients were included. Mean age was 44±12, 50% were male with a high prevalence of systemic hypertension (57%), obstructive sleep apnea (21%) and 10% smokers. Only one patient had history of diabetes while no dyslipidemia (or lipid lowering therapy) was reported. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 58±5%. Expectedly, patients showed low hemoglobin level 8,7±1.4g/dL with high hemolysis markers. Glomerular filtration rate was 109 [62; 122] mL/min/m² with 21% having chronic kidney disease. Plasmatic LDLc level was low (0.7±0.3g/L, with 20% &lt;0.5g/l) while triglycerides (TG) were highly variable (1.1±0.7mg/dL). Strikingly, no patient showed signs of significant coronary artery disease, with 87% presenting a calcium score of 0, 77% had a CAD-RADS of 0 while no patient was higher than 2. Correlation and linear regression analysis were performed to find independent parameters associated with LDLc and TG. Total bilirubin was the only variable that correlated with both LDLc and TG (R= -0.37, p&lt;0.001 and R= -0.33, p=0.001 respectively).

Conclusion
Despite systemic vasculopathy and chronic inflammation, ageing SCA patients showed no significant coronary artery disease. These data are in line with pre-clinical studies suggesting a lipid-lowering role of bilirubin and its protective effect against atherosclerosis.
Cardiac morphology and function in patients with primary biliary cholangitis (PBC) without cirrhosis
Authors: Bidiuk J , Szmigielski C , Lewandowski J , Sinski M 
Published: October 2024

Abstract

Background
Primary biliary cholangitis (PBC) is a chronic, autoimmune liver disease causing destruction of the small intralobular bile ducts in the liver. PBC patients can also develop extrahepatic manifestations. Though patients with PBC have often elevated levels of serum lipids, data concerning cardiac involvement is inconsistent and cardiovascular changes may be underdiagnosed.

Purpose
The purpose of the study was to assess cardiac morphology and function in patients with PBC without cirrhosis and comparison with control subjects.

Methods
We studied 52 females with PBC, and included in the analysis 22 females without cirrhosis, who were compared to 44 healthy female controls matched for age (53.4 ± 9.2 and 51 ± 8.3 yrs., respectively, p =0.312). Transthoracic echocardiography (TTE) was performed with the analysis of the left ventricular (LV) global longitudinal strain (GLS) and myocardial work. Additionally, impedance cardiography was conducted, with the analysis of the autonomic function using BRS (baroreceptor sensitivity), HRV (heart rate variability) and BPV (blood pressure variability).

Results
Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) differed between PBC and control group (128 ± 17 mmHg vs. 116 ± 11 mmHg, p=0.007 and 78± 12 mmHg vs. 75 ± 8 mmHg, p=0.024, and 73.5 ± 12 bpm vs. 71 ± 8 bpm , p=0.024, respectively). PBC group had larger diameter of the cardiac chambers when adjusted for body surface area (BSA), including left atrium (LA/BSA) and right ventricle (RV/BSA), as well as left ventricular mass (LWMI) and relative wall thickness (RWT), with no difference in the left ventricular end diastolic diameter (LVEDD/BSA). LV ejection fraction (EF) measured by bi-plane Simpson method was higher in PBC group. LV diastolic function parameters (E/A, E/e’) differed in patients with PBC when compared with controls, however, without signs of diastolic dysfunction. LV GLS indices (GLSAVG, GLSLAX, GLS4C, GLS2C) were significantly higher in PBC group, as well as global myocardial work indexes: global myocardial work (GWI) and global constructive work (GCW). Non-invasive autonomic assessment showed lower BPV in patients with PBC without cirrhosis, but no differences in baroreceptor sensitivity and HRV. Impedance cardiography did not show differences between both groups.

Conclusion
Our study shows that PBC patients without cirrhosis are characterized by remodeling and functional changes of the heart, when compared to age-matched controls. These changes could imply hyperkinetic circulation even before the development of cirrhosis in PBC patients.
Vascular thrombosis and relapse-associated factors in Behcet's syndrome: a comprehensive analysis of 136 patients
Authors: Chadli S , Khibri H , Maamar M , Moatassim N , Ammouri W , Harmouche H , Adnaoui M , Tazi Mezalek Z 
Published: October 2024

Abstract

Background
Vascular thrombosis in Behçet syndrome (BS) is frequent and associated with high morbidity and mortality rates.

Purpose
To investigate BS patients presenting with a thrombotic event (TE) and identify the factors associated with relapse.

Methods
We retrospectively conducted a single-center, descriptive, and analytic study, from 2000 to 2022, enrolling all BS patients presenting TE, including venous thrombosis (VT) and/or arterial thrombosis (AT).

Results
TE was observed in 136/531 patients (25%), mostly men (83%), aged 29 ± 9 years (11-50) at BS onset. TE was the initial presentation of BS (32%) or occurred after a median of 4 years [0;25]. It included VT (92.5%), AT (18%), and both (13%). VT mostly consisted of DVT in the lower extremities (60%), vena cava (30%), and cerebral (15%) veins. It involved one (55%), two (27%), and multiple (16%) veins (Figure 1). AT mainly affected the pulmonary (42%), femoral (21%), coronary (17%), cerebral (8%) arteries, and aorta (8%). Arterial aneurysms were common (18%), especially in the pulmonary arteries (11%). Intracardiac thrombosis was also visualized (10%). Noncardiovascular manifestations mainly included aphthous ulcers (96%), pseudofolliculitis (36%), ocular lesions (41%), and arthralgias (22%). Hemostasis parameters were within normal ranges. Patients were treated with colchicine (98%), corticoids (98%), and immunosuppressants (80%). Anticoagulation and anti-platelet aggregation were administered in 90% and 15% of the cases, respectively. Six patients underwent vascular surgery. Post-thrombotic syndrome was noted in 14% of the patients. Relapse was common (25%), mainly occurring in men (81%), of younger age (24 ± 6) at first TE. Relapse consisted of one (55%), two (32%), or multiple episodes (13%). It occurred in the same vascular system initially affected (69%), a different one (12%), and both at the same time (19%). Multivariable analysis revealed TE at onset (OR= 2.99, 95% CI[1.14 ; 7.82], p=0.02), arterial thrombosis (OR= 2.91, 95% CI[1.10 ; 8.40], p=0.04), and arterial aneurysms (OR= 2.58, 95% CI [1.09 ; 8.45], p=0.02) as factors significantly associated with TE relapse (Figure 2).

Conclusion
Our study highlights several particularities of TE in BS, with TE at onset, arterial thrombosis, and arterial aneurysms emerging as significant relapse factors.
Type 2 diabetes mediating the increased cardiovascular risk in patients with rheumatoid arthritis: a bidirectional mendelian randomisation approach
Authors: Fokina A , Fill J , Mehmeti D , Taylor H , Klappacher G 
Published: October 2024

Abstract

Background
Patients with rheumatoid arthritis (RA) are at increased risk of developing coronary artery disease (CAD) as is evident from epidemiological studies. This however is not a causative association, as we have shown by two-sample mendelian randomisation (MR) in previous work. Mediators linking RA to cardiovascular phenotypes have yet to be identified.

Purpose
The present study seeks to determine whether type 2 diabetes (DM II) is such a mediator conferring the increased cardiovascular risk of patients with RA.

Methods
The associations between the phenotypes RA, CAD and DM II were tested for causality with two-sample MR using genetic instruments from genome-wide association studies (GWAS) in largely non-overlapping cohorts. For RA, genetic instruments were obtained from 14,361 cases and 43,923 controls of European ancestry in the dataset by Okada, comprised of 18 studies (1). For the trait DM II, the DIAbetes Genetics Replication and Meta-analysis (DIAGRAM) Consortium was used (2). This GWAS covered 120,000 SNPs from the Metabochip array in mixed European and Pakistani Population (34,840 cases and 114,981 controls). Genetic instruments for CAD were obtained from the CARDIoGRAMplusC4D consortium with 60,801 cases and 123,504 controls from 48 studies (3). Several MR regression methods such as MR Egger regression and inverse-variance weighted meta-analysis and sensitivity tests for pleiotropy and heterogeneity were performed for each exposure-outcome pair.

Results
Genetic predisposition to RA was not significantly associated with higher risk of CAD (OR = 1,02 [0,99-1,05]), see figure. In contrast, DM II was significantly, albeit weakly related as outcome to genetically determined manifestation of RA as exposure (OR = 1,04 [1,01-1,08]) and, conversely, genetic instruments of DM II conferred an increased risk of developing CAD ((OR = 1,11 [1,05-1,17]).

Conclusions
Despite the high prevalence of CAD among RA patients in observational studies, cardiovascular outcomes are not casually linked with RA. Instead, DM II could serve as a mediator, based on its significant associations with both RA and CAD in two-sample MR.
Association of inflammation with left ventricular mass index in patients with rheumatoid arthritis
Authors: Linde A , Gerdts E , Fevang B T , Ulvik A , Ueland P M , Meyer K , Kringeland E , Midtbo H 
Published: October 2024

Abstract

Background
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease associated with cardiovascular organ damage.

Purpose
We explored the association of inflammatory markers with left ventricular (LV) mass index during 22 months of follow-up in patients with RA.

Methods
Eighty-three outpatients with RA (age 55±12 years, 71 % women) with indication for biological (b) or targeted synthetic (ts) disease modifying antirheumatic drug (DMARD) therapy were examined with echocardiography at baseline and after 22 months. LV mass was indexed for height in the allometric power of 2.7. Serum concentrations of the inflammatory markers, C-reactive protein (CRP), serum amyloid A (SAA) and calprotectin were measured by MALDI-TOF mass spectrometry.

Results
At baseline, 37% had hypertension, 6% diabetes, 21% obesity and 100% were using b/ts DMARDs. The inflammatory markers decreased during follow-up (all p&lt;0.001), while the LV mass index did not change (33.1±8.1 g/m^2.7 vs. 33.5±7.3 g/m^2.7, p=0.57). The prevalence of hypertension, diabetes and obesity were unchanged at follow-up (p&gt;0.05), but the percentage of patients using b/ts DMARDs had decreased to 83% (p&lt;0.001). In multivariable analyses, higher CRP and SAA at baseline were associated with higher LV mass index at both baseline and follow-up independent of presence of obesity, hypertension, age, sex or treatment with b/ts DMARDs at follow-up (Table 1). Inflammatory markers at follow-up were not associated with LV mass index (Table 1), but use of b/ts DMARDs at follow-up were associated with lower LV mass index after adjusting for inflammatory markers, age, sex, presence of obesity and hypertension (Table 1).

Conclusion
Higher levels of inflammatory markers at baseline were associated with greater LV mass index in RA patients. The use of immunosuppressive treatment throughout the study period was associated with lower LV mass index at follow-up, pointing to a role of chronic inflammation in LV hypertrophy.