bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dapagliflozin effect on cardiopulmonary function in HFrEF patients
Authors: Mapelli M , Mattavelli I , Vignati C , Salvioni E , Mantegazza V , Garlasche A , Pezzuto B , Gugliandolo P , Capovilla T M , Marongiu A , Maranzano G , Agostoni P 
Published: June 2024

Abstract

Background
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are currently a standard therapy for patients with heart failure with reduced ejection fraction (HFrEF). This study aims to assess the effects of Dapagliflozin on exercise capacity, cardiac biomarkers, fluid retention, renal and pulmonary function.

Methods
We prospectively enrolled a cohort of stable HFrEF outpatients (left ventricular ejection fraction, LVEF&lt;40%, New York Heart Association, NYHA, class II or III) eligible for SGLT2i therapy and performed serial cardiopulmonary exercise tests (CPET), pulmonary function tests (standard spirometry and diffusing capacity of the lungs for carbon monoxide, DLCO), laboratory and echocardiographic assessments before the beginning of treatment with Dapagliflozin and after 6 months, in order to evaluate its effects on exercise capacity, ventricular remodelling, cardiac biomarkers, fluid retention, renal and pulmonary function.

Results
49 patients (86% males, age 64±12 years) on optimal medical therapy (84% on sacubitril/valsartan; 98% on β-blockers, 84% on MRAs) were evaluated. The main variables are reported in table 1. We observed an increase in LVEF (32.8±7.1 vs. 35.5±8.3%; p&lt;0.001) and a reduction in left ventricular end-diastolic (EDV) and end-systolic (ESV) volumes (EDV: 209±83 vs. 199± 77 mL, p=0.004; ESV: 143±73 vs. 133± 68 mL, p&lt;0.001). There were no significant changes in peak oxygen uptake, while ventilatory efficiency during exercise (VE/VCO2 slope) showed a significant improvement (fig.1). Hemoglobin (Hb) and hematocrit levels improved, while renal function sodium and potassium levels remained stable, as did blood urea nitrogen, while BNP, NT-proBNP, glycated Hb, ST2, and hs-TNI did not reach statistical significance in this sub-population. NYHA functional class improved, together with a significant decrease of MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score, from 3.9% to 2.7% with a positive impact on two-year prognosis.

Conclusion
Medium-term treatment with Dapagliflozin demonstrated beneficial effects on LV remodelling, exercise ventilatory efficiency and functional status. In particular, an improvement in VE/VCO2 slope and MECKI score paralleled with an enhancement in echocardiographic parameters and NYHA functional class was observed. However, our study did not detect medium-term effects of Dapagliflozin on spirometry values, DLCO, fluid retention and NT-proBNP. These results suggest that some favourable effects could unfold over a longer period of time. Further studies with longer follow up are desirable to assess Dapagliflozin effects even in such a well-treated HF population.
Effects of a behavioral psychological intervention in addition to an exercise rehabilitation program in chronic heart failure patients
Authors: Pizga A , Kordoutis P , Delis D , Linardatou V , Ntalianis A , Brouskeli V , Rovina N , Nanas S , Routsi C , Karatzanos E 
Published: June 2024

Abstract

Introduction
Patients with chronic heart failure (CHF) have an increased risk of presenting symptoms of stress and depression compared to the general population. For this reason, mental health components have been integrated into exercise rehabilitation programs. The effectiveness of behavioral interventions has not been evaluated in this clinical population.

Purpose
The aim of this study was to investigate the impact of a behavioral phycological intervention on stress, depression, and life satisfaction in CHF patients.

Method
Thirty-six consecutive stable CHF patients on optimal medication (age: 56±10 years, EF&lt;50%) were randomly allocated to the intervention group (IG, n=18) or the control group (CG, n=18). All the patients participated in a combined exercise rehabilitation program (aerobic exercise and strength training) of 36 sessions (3×/week, 12 weeks). The IG team was additionally given information and emotional support (12 sessions) through psychoeducation, stress management techniques and positive reinforcement of self-care behaviors. Depression, stress and life satisfaction rate were assessed with self-report scales, and aerobic capacity with cardiopulmonary exercise test before and after the intervention. Values are expressed as mean and standard deviation.

Results
In the whole cohort, VO2peak was improved after the program (from 19.4±3.9 to 22.0±6.5 ml/kg/min, p=0.04). Depression rate was reduced in the IG (from 3.4±4.0 to 1.6±2.4, p&lt;0.01) but not the CG (from 3.6±3.4 to 4.0±3.7, p=0.32). Stress rate was reduced (p&lt;0.01) in both IG (from 14.3±8.6 to 9.1±7.4) and CG (from 13.2±9.8 to 8.6±5.9). Finally, life satisfaction was increased in the IG (from 23.8±5.2 to 30.8±3.5, p&lt;0.01), while decreased in the CG (from 26.0±6.9 to 20.2±6.5, p&lt;0.01]. Significant between-group differences were observed in the depression rate and life satisfaction (p&lt;0.01).

Conclusion
Behavioral and emotional support, with psychoeducation, stress management techniques and positive reinforcement, in addition to an exercise rehabilitation program, can have a positive impact in reducing depression symptoms and boosting the mental status of CHF patients. Further research is necessary to explore the effects of different behavioral and psychological techniques.
The relationship between blood pressure and mortality in the general population - it is not as simple as one might think - results from 20 years follow-up in the Study of Health in Pomerania
Authors: Franksmann M , Gross S , Ittermann T , Friedrich N , Markus M , Markus M , Doerr M , Bahls M 
Published: June 2024

Abstract

Introduction
Hypertension is the leading risk-factor for cardiovascular disease (CVD). Whether treatment of hypertension below 140/90 mmHg or 120/80 mmHg is appropriate for optimal CVD risk reduction is unclear.

Purpose
We used data from the population-based Study of Health in Pomerania (SHIP) to assess the relationship between baseline blood pressure and all-cause as well as cause-specific mortality in individuals with and without antihypertensive medication.

Methods
Participants were stratified by use of anti-hypertensive medication (w/ medication and w/o medication), and blood-pressure at baseline: (1) &lt;120/80 mmHg, (2) &lt;140/90 mmHg, and (3) hypertension ≥140/90mmHg. We used adjusted multivariable Cox regression models with a median follow up time up of 13.5 years (IQR: 9.4-20.8). Participants in group (1) w/o antihypertensive medication served as the reference group.

Results
The following participants were included: w/o medication: (1) n=1,602; (2) n=1,766; (3) n=1,216; w/ medication: (1) n=278; (2) n=741; (3) n=951. Participants w/o and w/ antihypertensive medication had a mean age of 43 (SD 14) years and 60 (SD 12) years, respectively. A total of 52.4% (w/o medication) and 48.7% (w/ medication) were women. Overall 876 individuals died during follow-up. Individuals with medication at baseline always had a higher risk for all-cause mortality irrespective of measured blood pressure compared to the reference group: (1) HR 2.29 (95%-CI: 1.49-3.53); (2) HR 1.72 (95%-CI:1.19 -2.47); (3) HR 1.79 (95%-CI:1.26-2.55). Blood pressure in individuals without medication was not related to all-cause mortality. In subjects w/o medication, higher blood pressure levels were not significantly associated with CVD mortality. With intake of medication at the baseline examination, blood pressure &lt;120/80 mmHg was not related to CVD mortality. On the other hand, blood pressure &lt;140/90 mmHg (HR 2.74, 95%-CI: 1.02-7.39) and hypertension (HR 3.36, 95%-CI: 1.26-8.99) was significantly associated with higher CVD mortality in treated individuals. Participants w/o medication had no higher risk of non-CVD mortality compared to the reference group. In contrast, taking medication and a baseline blood pressure &lt;120/80 mmHg was significantly related to a higher non-CVD mortality risk (HR 2.43, 95%-CI: 1.45-4.07), while &lt;140/90 mmHg or hypertension w/ mediaction was not significantly related to higher risk of non-CVD mortality.

Conclusion
Normotensive blood pressure &lt;120/80 mmHg in treated individuals was associated with lower risk of CVD-mortality. However, simultaneously this was also related with higher risk of non-CVD mortality. Thus, intensive antihypertensive treatment seems to shift the mortality risk from CVD to non-CVD without decreasing the risk for all-cause mortality.
Real-world data regarding blood pressure control rates in hypertensive obese patients: a prospective, observational multicentric study performed in Romania
Authors: Vintila A M , Dolofan B M , Trambitas N , Vittos O 
Published: June 2024

Abstract

Background
Achieving optimal blood pressure (BP) control is the most important aspect in the management of hypertension. There are complex mechanisms relating obesity to hypertension, fact that makes the hypertension treatment more challenging among those individuals, both for patients and physicians alike.

Objective
To assess the BP control rates in hypertensive obese patients treated with single pill combination (SPC) antihypertensive medications in real-world conditions.
Design and method: Real-world, prospective, observational, multicenter study, performed in Romania (May-Aug 2023), collecting data from 192 sites (107 GPs and 85 Cardiology sites). The study included hypertensive obese patients, for which the investigator based on his/her best medical judgement and in line with the practice guidelines prescribed one SPC antihypertensive medication. The patient observational period was 12 weeks [including 3 visits- V0 (baseline), V1 (4 weeks), V2 (12 weeks)].

Results
1299 hypertensive, obese patients (56.22±11years; 53.89% females), Body Mass Index (BMI) 34.35±4.21 kg/m2; within "very high" CV risk category (68.82%) (calculated as per SCORE2 and SCORE2-OP), CV family history (56.81%), comorbidities (52.12%). Among patients with comorbidities the most frequently identified were diabetes mellitus type 2 (37.37%), valvular heart disease (20.97%), angina (19.35%) and heart failure (16.24%). At 1-month visit, 723 patients (55.65%) failed to reach BP targeted values of ESC/ESH 2018 guidelines and 768 patients (59.12%) failed to reach BP targeted values of ESH 2023 guidelines. Interestingly, changes in SPC dose or prescription at 1-month visit were made only for patients considered in investigator’s opinion as "uncontrolled" - 292 patients (22.48%). The rest, 1007 patients (77.52%) were considered as "controlled" and no changes in the treatment were implemented. At the end of the observational period (3-month), the optimal BP control was reached in 36.33% patients (as per ESC/ESH 2018 guidelines), and in 33.03% patients (as per ESH 2023 guidelines), respectively. It is important to mention that at 3-month visit, the SBP values were for 86.29% of patients below 140 mmHg (regardless of age or associated comorbidities) (Fig.1).
A small percentage of the "uncontrolled" patients at study end (7.5%) (ESC/ESH 2018), respectively (8.85%) (ESH 2023), were optimally controlled at V1 and no changes in the treatment were performed, nevertheless, the duration of optimal control was not maintained throughout the study.

Conclusions
This real-world evidence study identified an important therapeutic inertia of investigators regarding SPC therapy intensification by dose up-titration and showed that after a 3-month treatment period the optimal BP control was obtained on average in one out of three hypertensive obese patients.
Management of patent foramen ovale; findings from a nationwide survey
Authors: Apostolos A , Drakopoulou M , Trantalis G , Ktenopoulos N , Katsaros O , Aggeli C , Ntaios G , Tsivgoulis G , Tsioufis C , Toutouzas K 
Published: June 2024

Abstract

Background
Several clinical trials have provided evidence supporting the transcatheter closure of patent foramen ovale (PFO) in selected patients following a cryptogenic stroke. However, it remains unknown to what extent these guidelines have been implemented in everyday clinical practice and the familiarity of physicians from different specialties with PFO closure.

Purpose
The aim of our nationwide survey is to explore the implementation of transcatheter PFO occlusion in Greek clinical practice.

Methods
Attending level cardiologists, internal medicine physicians and neurologists involved in the management of PFO-related strokes working in Greece were invited to complete an online questionnaire. The questionnaire consisted of 19 questions and was designed to obtain comprehensive data on provider demographics, PFO characteristics, and specific clinical scenarios.

Results
A total of 51 physicians (56.9% cardiologists, 25.5% neurologists and 17.6% internal medicine physicians) completed the survey, resulting in a response rate of 53%. Cardiologists, internal medicine physicians and neurologists agree on several issues regarding PFO closure, such as PFO closure as first line treatment, management of patients with DVT or prior decompression sickness, and post-closure antithrombotic treatment, but different approaches were reported regarding closure in patients with thrombophilia treated with oral anticoagulation (p=0.012) and implantable loop recorder placement for atrial fibrillation exclusion (p=0.029 and p=0.020).

Conclusions
Our findings show that cardiologists, internal medicine physicians and neurologists agree in numerous issues, but share different views in the management of patients with thrombophilia and rhythm monitoring duration. These results highlight the significance of collaboration among physicians from different medical specialties for achieving optimal results.
An innovative cardiac rehabilitation based on the power-force-velocity profile to further improve cardiorespiratory capacities in coronary artery disease patients
Authors: Hupin D , Fanget M , Roche F 
Published: June 2024

Abstract

Background
Individually optimising the training programme of cardiac rehabilitation (CR) remains a major concern among young coronary artery disease (CAD) patients. Among effective tools, the power-force-velocity profile (PFVP) is usually assessed to improve performance in athletes through individualised training. Therefore, assessing PFVP may allow better personalization of CR. The aim of this study was to compare the effects of a new CR customized based on patient’s PFVP versus a traditional CR in CAD patients on cardiorespiratory, biological and muscular systems.

Methods
A total of 86 patients participated in this study. The 3-week intervention consisted of physical training sessions (4/week) and therapeutic education workshops (1/week). Experimental group patients followed a specific cycling training programme based on their deficient PFVP quality. Control patients attended a conventional, common CR programme. Cardiopulmonary exercise test (VO2 at the first ventilatory threshold, VT1, and the peak), blood tests (low- and high-density lipoproteins cholesterol, LDL-C and HDL-C), handgrip and quadriceps force were performed at baseline and after CR.

Results
The mean age was 60.8 ± 9.6 y, 15% were women. A significantly greater benefit in VO2 peak(experimental: +21.5 ± 19.2% vs. control: +10.5 ± 15.8%, p&lt;0.001), VO2 at VT1 (experimental: +35.5 ± 33.6% vs. control: +8.4 ± 31.2%, p&lt;0.001), and LDL-C (p=0.001) were observed in the experimental group. Both groups significantly increased HDL-C and muscle parameters.

Conclusion
The novel CR, based on initial PFVP, showed greater benefits on cardiorespiratory capacities and lipid profile than a conventional, non-individualised CR. Therefore, PFVP could be used in CR to adapt specifically the content of training sessions.
Enhanced cardiac rehabilitation with ultra-Processed food reduction and time-restricted eating resolves metabolic syndrome and prediabetes in coronary heart patients: the DIABEPIC-1 study
Authors: Iglesies-Grau J , Dionne V , Latour É , Gayda M , Besnier F , Gagnon D , Debray A , Gagnon C , Tessier A J , Simard F , Nigam N , L Allier P L , Juneau M , Bouabdallaoui N , Bherer L 
Published: June 2024

Abstract

Background
Cardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVD) and metabolic comorbidities, including metabolic syndrome (MetS) and prediabetes. However, strategies to reverse these conditions remain to be explored.

Objectives
The DIABEPIC-1 study aimed to assess the feasibility of an enhanced six-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and MetS remission.

Methods
The study’s program combined exercise training with an intensive nutritional intervention involving counseling on reducing ultra-processed foods (UPFs), adopting a Mediterranean diet, and implementing time-restricted eating (TRE). Segmental body-composition measurements, complete blood analysis, maximal exercise testing, a 3-day nutritional diary recorded with the Keenoa artificial intelligence App, and lifestyle questionnaires were completed at baseline, three months, and six months. Complete remission of prediabetes was defined as a HbA1c level below the diagnostic threshold (&lt;5.7%) for ≥3 months without pharmacological therapy. Partial remission was defined when HbA1c was &lt;5.7% at six months. Complete remission of MetS was reached when &lt;3 NCEP/ATP-III Criteria were met at three months and maintained at six months. Partial remission occurred when &lt;3 NCEP/ATP-III Criteria were met at six months.

Results
The study enrolled 36 participants with a six-month completion rate of 88.9% and compliance with all protocol interventions of 92.5%. Waist circumference decreased significantly by -9.2 cm (95%CI: -7.4 to -10.9; p &lt;0.001), and participants lost an average of -8.0 kg (95%CI: -6.3 to -9.7; p&lt;0.001), primarily from fat mass and visceral fat. Participants showed improved glycemic and lipid profiles, insulin resistance markers, and liver health (Table 1). They also improved cardiorespiratory fitness, reduced UPF consumption, and increased adherence to the Mediterranean diet and TRE, leading to lower caloric intake and enhanced nutrient profiles. Notably, 50% of participants achieved prediabetes remission, with higher initial HbA1c levels associated with a 100% remission rate. Additionally, 70% of participants with MetS at the study's outset achieved remission (Figure 1).

Conclusion
Our findings indicate the feasibility of enhancing a cardiac rehabilitation program with a stepwise intensive nutritional intervention, resulting in clinically significant outcomes. This includes the remission of key causal risk factors in a substantial number of ASCVD patients. Baseline Charactersitics and Changes. MetS and Prediabetes Remission.
Exercise-based cardiac rehabilitation for patients with coronary heart disease - the CaReMATCH individual patient meta-analysis
Authors: Stens N A , Buckley B J R , Dibben G O , Buffart L M , Kleinnibbelink G , Van Royen N , Taylor R , Thijssen D H J 
Published: June 2024

Abstract

Introduction
Exercise-based cardiac rehabilitation (ExCR) is an integral part of coronary heart disease (CHD) management.

Purpose
The Cardiac Rehabilitation Meta-Analysis of Trials in patients with CHD using individual patient data (CaReMATCH) initiative has dual aims of: (1) providing contemporary estimates on the effectiveness of ExCR for CHD; (2) examining potential differential effects of ExCR across CHD patient subgroups.

Methods
Individual patient data from randomized controlled trials comparing ExCR to no ExCR (controls) published since 2010 and with at least 6 months of follow-up were sought. The outcomes of health-related quality of life (HRQoL) (EQ-5D, 15D and SF-6D utility scores [UI]), all-cause and cardiovascular disease (CVD)-related mortality and hospitalization were pooled using one- and two-stage individual patient meta-analysis.

Results
Out of 30 eligible trials (10,677 patients), 8 trials were analysed (4,975 patients, 92.9% post-myocardial infarction). Compared to controls, participation in ExCR resulted in a reduced risk of all cause (hazard ratio [HR] 0.68, 95% confidence interval [CI]: 0.53 to 0.87) and CVD-related hospitalisation (HR 0.62, 95% CI: 0.46 to 0.83), and improved HRQoL (mean difference in UI: 0.043, 95% CI: 0.021 to 0.064). No differences were seen in all-cause and CVD mortality (HR 1.13, 95% CI: 0.80 to 1.60; 1.41, 95% CI: 0.32 to 6.15 respectively). There was no evidence of a differential effect of ExCR across subgroups apart for HRQoL at follow-up, as larger ExCR benefits were obtained in those with a low education level (UI of low vs high education level: 0.062, 95% CI: 0.026 to 0.10; -0.0129, 95% CI: -0.035 to 0.0093 respectively) and a low baseline HRQoL (per 0.10 increment in baseline UI: -0.0073, 95% CI: -0.014 to -0.00093).

Conclusion
Reinforcing findings of trial level meta-analyses, our IPD meta-analysis found contemporary ExCR participation to improve HRQoL and reduce risk of hospitalization. Importantly, we reveal little differential treatment effects across patient subgroups, supporting the prescription of ExCR to all patients with CHD to achieve clinical benefit. Figure 1