bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of physical activity levels one year after the start of cardiac rehabilitation
Authors: Heutinck J M , Brouwers R W M , Vromen T , Kemps H M C 
Published: June 2024

Abstract

Introduction
Physical activity levels often decline after cardiac rehabilitation (CR) completion and a significant number of patients remain physically inactive. While CR participation is associated with a 32% risk reduction in all-cause mortality, this effect is expected to increase if patients maintain an active lifestyle. Predicting physical activity levels after CR helps to identify patients at risk of relapsing into an inactive lifestyle.

Purpose
To identify patient characteristics that predict their objectively assessed physical activity level (PAL) one year after the start of a CR programme.

Methods
We used data from the SmartCare-CAD clinical trial, in which 300 patients with coronary artery disease entering phase 2 outpatient CR were randomised between May 2016 and July 2018 to centre-based CR with supervised training or telerehabilitation with relapse prevention. Follow-up was 12 months. PAL was calculated using accelerometer and heart rate sensor data. For the current analysis, patients in the intervention and control group were pooled, as no significant between-group difference in PAL was observed in the response over time. We performed univariate regression analysis to identify possible predictors (p&lt;0.20) for PAL at 12 months, followed by a multiple regression analysis.

Results
Patients with both baseline and 12-month PAL data available (n=206) were included in the analysis (89% male, mean age 61.0 ± 9.7 years). Univariate analysis revealed 4 predictors of PAL at 12 months: higher baseline PAL, higher baseline percentage of expected exercise capacity and greater increase in exercise capacity at 3 months were associated with higher 12-month PAL levels, whereas higher educational level was associated with a lower 12-month PAL level. The overall regression model including these 4 predictors was statistically significant (adjusted R² = 0.202, F(4, 195) = 13.61, p = &lt; 0.001), with all variables being independent predictors (Table 1). Other baseline characteristics (i.e. age, sex, BMI, health literacy, comorbidity index, working status and treatment allocation) were not related to 12-month PAL levels.

Conclusion
Predicting physical activity levels one year after the start of cardiac rehabilitation is partly possible, with 20% of the variability being explained by our regression model. Predictive characteristics for a low PAL at 12 months were low PAL at baseline, low baseline exercise capacity and little improvement of exercise capacity during CR, with PAL at baseline being of most influence. Surprisingly, high educational level was also associated with a lower PAL at 12 months. These findings help identify patients that may benefit from personalised CR programmes and extended guidance.
Effects of thyroid ft3 levels on exercise induced remodelling in elite athletes practicing different sporting disciplines
Authors: Di Gioia G , Maestrini V , Monosilio S , Lemme E , Squeo M R , Buzzelli L , Serdoz A , Zampaglione D , Fiore R , Pelliccia A 
Published: June 2024

Abstract

Introduction
Free triiodothyronine (fT3) profoundly affects the cardiovascular system. Studies in the general population demonstrated that variations in thyroid hormone levels, even within the euthyroid range, can influence cardiac parameters.

Purpose
Aim was to investigate how thyroid hormone, within the limits of normality, affects exercise-induced cardiac remodelling in a large cohort of Olympic athletes.

Methods
We evaluated 1342 Olympic athletes (mean age 25.6±5.1) practising different sporting disciplines (power, skills, endurance and mixed). Athletes underwent blood (thyroid stimulating hormone, fT3 and fT4), echocardiographic and exercise-stress tests. Athletes assuming thyroid hormones, with thyroiditis or TSH out of the normal ranges were excluded.

Results
In all disciplines rest heart rate (HR) was positively correlated to fT3 (power: p=0.0002; R2=0.04,; skills: p=0.0009; R2=0.05; endurance: p=0.007; R2=0.03 and mixed: p=0.04; R2=0.01). Same for peak HR at exercise-stress test in power, skills and endurance (respectively p &lt; 0.0001; R2=0.04; p=0.01; R2=0.04, and p=0.005; R2=0.02). Moreover, a positive correlation was observed with interventricular septum (power: p&lt;0.0001; R2=0.11; skills: p=0.02; R2=0.03; endurance: p=0.002; R2=0.03; mixed: p&lt;0.0001; R2=0.04). Furthermore, fT3 directly correlated with left ventricle end-diastolic volume in skills (p=0.04; R2=0.03), endurance (p=0.04, R2=0.01) and mixed (p=0.04; R2=0.01).
Conversely, thyroid hormones were influenced by type of sporting discipline practiced: endurance athletes presented the lowest TSH (p &lt;0.0001), fT3 (p = 0.007) and fT4 (p &lt; 0.0001).

Conclusions
Our study demonstrated a close, bidirectional relationship between exercise and thyroid function. Chronic aerobic exercise influence thyroid hormones by lowering TSH, fT3 and fT4 as an adaptive mechanism. However, on the other side small variation of fT3 circulating levels, even within the normal range, affect heart morpho-functional parameters (rest and peak heart rate, interventricular septum, left ventricle end-diastolic volume indexed) in all sporting disciplines and influence the athlete’s heart response to exercise induced adaptive mechanisms. Therefore, thyroid function assessment should be taken into account when an evaluation on athlete’s heart is performed. Influence of ft3 on heart rate. Influence of ft3 on IV septum.
The use of myocardial work index for the evaluation of elite endurance athletes with lower ejection fraction
Authors: Ortolina D , Di Gioia G , Maestrini V , Monosilio S , Squeo M R , Lemme E , Serdoz A , Zampaglione D , Fiore R , Pelliccia A 
Published: June 2024

Abstract

Background
Athlete's heart is characterized by cardiac chambers adaptations to physical activity with the subsequent possibly presence of some diagnostic overlaps with dilated cardiomyopathy. In general population, heart failure with preserved ejection fraction (EF) already exhibit altered myocardial work indexes (MWI) and those with reduced global work efficiency (GWE) display lower exercise capacity. However, in the setting of differential diagnosis, thanks to the afterload-independency MWI could be capable to identify those athletes with early subclinical damages.

Purpose
Aim of our study was to study MWI in endurance athletes with lower values of LV ejection fraction in order to evaluate the presence of early subclinical damage.

Methods
We studied 96 endurance Olympic athletes, mean age 27.4±7 years, 63 (67.7%) male, mean BMI 22.5±4.6. Athletes practiced different disciplines including: 9 athletics (&gt;800 mt, marathon, long-distance track&field), 14 canoeing, 37 rowing, 13 cycling, 11 Kayak, 9 long-distance swimming, 3 pentathlon. Athletes were submitted to clinical, anthropometric evaluation, cardio-pulmonary exercise stress test (CPET) and transthoracic echocardiogram (TTE), divided according to ejection fraction (EF) in those with lower EF (&lt;55%) and normal EF (³55%). Strain rate and myocardial work index was performed and the following parameters collected: global longitudinal strain (GLS), global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).

Results
Ten athletes had EF &lt;55%, prevalently male (90% vs. 63%, p=0.086) and older (30±4.9 vs. 26.9±6.7 years, p=0.169) compared to normal EF. At CPET, in those with lower EF, lower HR (47.5±10.1 vs. 54.3±11 bpm, p=0.112), higher watts (374.±72.9 vs. 336.6±91.7, p=0.269), higher VO2\mL/min/Kg (54.8±12.8 vs. 50.9±8.4, p=0.246) and higher O2 pulse, mL/bpm (27.8±4.6 vs. 25±5, p=0.130) were found. At TTE, athletes with EF &lt;55% presented morphological changes characterized by higher left ventricle end-systolic diameter and volume indexed (respectively 19.7±2.4 vs. 17.8±2.2 mm/m2, p=0.013 and 40.2±10.1 vs. 28.1±6.4 mL/m2, p&lt;0.0001) and larger left atrium volume (p=0.007). No differences were found in GLS (-19.1±1.8 vs. -20±4.7%, p=0.579), GWI (1807.6±342.4 vs. 1886.5±262.6 mmHg, p=0.394), GCW (2178.3±431.8 vs. 2253.3±302.3 mmHg, p=0.488), GWW (90.2±32.6 vs. 94±52.3 mmHg, p=0.824) or GWE (95.4±1.3 vs. 95.5±2.1%, p=0.848).

Conclusions
Lower EF in endurance athletes can be considered as an adaptive mechanism according to better functional parameters and similar MWI. MWI can be used as additive echocardiographic tool in differential diagnosis between athlete’s heart and early stage dilated cardiomyopathy. Clinical parameter comparison. Echocardiographic differences.
Estimating uncertainty when providing individual cardiovascular risk predictions: A Bayesian survival analysis
Authors: Hageman S H J , Post R A J , Visseren F L F , Mcevoy J W , Jukema J W , Smulders Y , Van Smeden M , Dorresteijn J A N 
Published: June 2024

Abstract

Background
Cardiovascular disease (CVD) risk scores provide point estimates of individual risk without uncertainty quantification. The objective of the current study was to demonstrate the feasibility and clinical utility of calculating uncertainty surrounding individual CVD-risk predictions using Bayesian methods.

Methods and Results
Individuals with established atherosclerotic CVD were included from the Utrecht Cardiovascular Cohort - Secondary Manifestations of ARTerial disease (UCC-SMART). In 8,355 individuals, followed for median of 8.2 years (IQR 4.2-12.5), a Bayesian Weibull model was derived to predict the 10-year risk of recurrent CVD events. Model coefficients and individual predictions were very similar to that of a traditional (‘frequentist’) model but the Bayesian model also predicted 95% credible intervals (CIs) surrounding individual risk estimates. The median width of the individual 95%CrI was 5.3% (IQR 3.6-6.5) and 17% of the population had a 95%CrI width of 10% or greater. An individual example is shown in Figure 1, for a 70-year old women with coronary artery disease. She has a predicted risk of 17.8%, and her individual 95%CrI was 15.1-21.0% based on the 2.5th and 97.5th quantile from the distribution of individual predicted risks. The figure also shows the possibilities of these methods to quantify the certainty of a patient having a risk higher than a certain treatment target. Figure 2 shows that the uncertainty decreased with increasing sample size used for derivation of the model. Combining the Bayesian Weibull model with sampled hazard ratios based on trial reports may be used to estimate individual absolute risk reduction with uncertainty measures and the probability that a treatment option will result in a clinically relevant risk reduction.

Interpretation
Estimating uncertainty surrounding individual CVD risk predictions using Bayesian methods is feasible. The uncertainty regarding individual risk predictions could have several applications in clinical practice, like the comparison of different treatment options or by calculating the probability of the individual risk being below a certain treatment threshold. However, as the individual uncertainty measures only reflect sampling error and no potential biases in risk prediction, physicians should be familiar with the interpretation before widespread clinical adaption. Figure 2
Trends in burden of atrial fibrillation overthree decades: a population-based study
Authors: Yang S , De Kruijf N L M , Van Oortmerssen J A E , Kavousi M 
Published: June 2024

Abstract

Background
Atrial fibrillation (AF) is the most common sustained arrhythmia, increasing with age. Comprehensive population-based long-term data on AF trends and the associated comorbidities in men and women are scarce.

Purpose
To assess sex-specific trends in AF prevalence and incidence, as well as the impact of AF-associated comorbidities in three epochs.

Methods
We used data from a well-defined ongoing population-based cohort. The number of participants of three consecutive cohorts were 7750, 7675, and 7121, spanning three epochs (epoch 1990s: 1989 - 1993, epoch 2000s: 1997 - 2001, and epoch 2010s: 2008 - 2014) , respectively. We estimated the sex-specific AF prevalence and incidence. For AF-associated comorbidities, we calculated the hazards ratio (HR) (95% confidence intervals – CI), using Cox proportional hazard regression models, and the population attributable fractions (PAFs) .

Results
The mean (standard deviation - SD) age in three epochs were 70.3 (9.6), 70.0 (8.7), and 70.4 (9.8). The 5-year incidence rates for AF in three epochs were 31.4, 22.9, and 44.1 per 1000 person-years for women and 45.0, 34.7, and 65.6 per 1000 person-years for men, respectively. There was no significant trend observed across the three epochs. Hypertension was the only significant comorbidity consistently associated with incident AF over the three epochs; HRs (95% CI) were 2.17 (1.35-3.48) for women and 1.42 (0.94-2.13) for men for epoch 1990s, 1.82 (1.05-3.16) for women and 1.55 (0.93-2.56) for men for epoch 2000s, and 2.95 (1.64-5.30) for women and 1.21 (0.78-1.88) for men for epoch 2010s. Hypertension contributed most to incident AF; PAFs (95% CI) were 46.60 (24.00-68.30), 38.60 (11.90-68.90), and 59.90 (40.50-82.50) in women and 20.70 (-4.54-44.80), 31.70 (11.60-58.90), and 11.90 (-21.80-47.90), in men for the 3 epochs respectively.

Conclusion
The burden of AF has been increasing during the past three decades in the general population. Despite increasing recognition and management of hypertension, it is still an essential AF-associated comorbidity, especially in women. Tailored hypertension management strategies will insert a favorable impact on AF management. Figure 1
No association between increased high-density lipoprotein cholesterol and progressive cardiac damage in 1595 adolescents: a 7-year longitudinal study
Authors: Agbaje A O 
Published: June 2024

Abstract

Background
The inverse relationships between high-density lipoprotein cholesterol (HDL-c) and subclinical atherosclerosis are well documented in the general population. However, recent studies among adults have reported paradoxical relationships in which high HDL-c levels were associated with cardiovascular morbidities and mortality.

Purpose
To investigate the longitudinal association of changes in HDL-c with progressive structural and functional cardiac damage in youth.

Methods
From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma HDL-c measured at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF &lt;1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, moderate-to-vigorous physical activity, low-density lipoprotein cholesterol, and triglyceride.

Results
Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) HDL-c increased in males from 1.21 mmol/L to 1.42 mmol/L and in females from 1.38 mmol/L to 1.69 mmol/L, over 7 years. The prevalence of LVH increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In the fully adjusted model, a 1-mmol/L increase in HDL-c was not significantly associated with higher odds of LVH progression (odds ratio, 1.14; [95% CI, 0.97 – 1.33]), high RWT (0.99; [0.84 – 1.16]), LVD dysfunction (1.02 [0.86 – 1.20]), and high LVFP (1.08; [0.97 – 1.21]) over 7 years. Among males, a 1-mmol/L increase in HDL-c was associated with 1.15g/m2.7 [0.45 – 1.85], p=0.001) increase in LVMI and 0.008 cm [0.002 – 0.013], p=0.006) increase in RWT but not in females, after full adjustments. In both males and females, increased HDL-c was not significantly associated with changes in cardiac function.

Conclusion
Increased HDL-c had no association with cardiac structural and functional damage during growth from adolescence through young adulthood but was paradoxically associated with progressive LV structural remodelling in males.
Prevalence of familial hypercholesterolemia and coronary heart disease in a tertiary referral hospital in Lithuania
Authors: Zubieliene K , Cereskevicius D , Tatarunas V , Zaliaduonyte D , Kabosis T , Zukaite G , Valteryte G , Jonaitiene N , Zebrauskaite G , Zabiela V 
Published: June 2024

Abstract

Introduction
Cascade screening and genetic testing have become one of the most effective methods for early detection of familial hypercholesterolemia (FH) identification and early prevention of coronary artery disease (CAD) [1]. FH is usually caused by variants in the genes coding for the low-density lipoprotein receptor (LDLR). Variants in the genes for apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9) have also been associated with FH [2]. The results of our pilot study showed that APOB was widespread in our population.

Purpose
To estimate the prevalence of APOB variants in FH patient’s cohort.

Methods
This is a retrospective cohort study of patients with a suspected diagnosis of FH who were treated at a tertiary center between February 2022 and June 2023. Patients were included in the study according to the criteria of the Dutch Lipid Clinic (DLC). Patients were divided into three groups according to the results of the genetic tests: 1. patients with APOB variant; 2. patients without previously described variants causing FH; 3. patients with the LDLR variant. Next generation sequencing was used to sequence the coding regions. Statistical analysis was performed using SPSS 29.0.1. statistical software.

Results
A total of 45 patients were enrolled in this study, including 27 (60%) men and 18 (40%) women, with a mean age of 47.93 years (SD=9.391). After genetic sequencing evaluation, 7 (16%) patients were diagnosed with APOB rs5742904 variant causing FH. In addition, 2 (4%) patients were found to have an LDLR rs879254754 variant. As the patients with an LDLR variant had no CHD symptoms, no further screening was performed.
No statistically significant demographic and clinical differences were found between the groups. The distribution of DLC network scores is shown in Figure 1. The only significant difference between the groups was found in the patients with the APOB rs5742904 variant, where more patients had the highest DLC score.
The most frequently affected segments in both groups were: S1, S6 and S7. Conversely, the least affected segments were: S10, S14, S15 (Figure 2). A remarkable result was seen in the S2 segment, where complete occlusion occurred significantly more frequently in patients with an APOB rs5742904 variant than in patients without this variant.

Conclusion
Contrary to what is mentioned in the literature, there were more people with APOB rs5742904 mutation than with LDLR in our study. We also found that patients with the APOB rs5742904 mutation had statistically significantly more occlusions in the right coronary artery.
Association between oxidative balance score and diabetes among PURE Poland study participants
Authors: Rozanska D , Szuba A , Zatonska K , Regulska-Ilow B 
Published: June 2024

Abstract

Introduction
Oxidative stress is caused by an imbalance between free radicals production and antioxidants activity. It plays an important role in the pathogenesis of diabetes mellitus (DM).
The purpose of the study was to assess the relationship between oxidative balance score (OBS) and diabetes prevalence among PURE Poland study participants.

Methods
Study group included 1889 participants of the Polish arm of the Prospective Urban Rural Epidemiological (PURE) study (1185 women, 704 men), aged 35-70 years, from urban and rural area. The study was conducted in the first stage of the PURE Poland study. The study was approved by the Ethics Committee. Diabetes diagnosis was made based on fasting glucose level ≥ 126 mg/dl or declaration about DM occurrence in the medical interview. Impaired fasting glucose (IFG) was diagnosed when fasting glucose level was between 100-125 mg/dl with no statement about DM in the interview. Finally three analysis have been done: diabetes in the interview (DM_int), diabetes in the interview + diagnosis based on fasting glucose (DM_all) and DM_all + IFG (DM+IFG). Food intake was assessed using the Food Frequency Questionnaire (FFQ), which was developed and validated for this population within the PURE study. OBS was calculated taking into account prooxidant factors: smoking, BMI value, fats and iron intake with diet, and antioxidants intake with diet: zinc, copper, selenium, vitamin E and C, carotenoids, lycopene and flavonoids. The value of OBS was calculated by summing the points (from 0 to 2 for tertiles) for individual components. The maximum value of OBS could be 24 points, and higher number of points indicated better oxidative balance.

Results
Among women the prevalence of DM_int was 9.2%, 8.0% and 5.4% in the tertiles of OBS (T1, T2, T3, respectively). When comparing T3 vs T1 the odds ratio for DM_int prevalence was 0.56 (95% CI 0.33-0.96) for crude data, in model 2 with adjusting for energy intake 0.48 (95% CI 0.25-0.93) and in model 3 with adjusting for energy intake, age and place of residence 0.78 (95% CI 0.39-1.56). Taking into account DM_all among women there were no significant differences between OBS tertiles. The risk of DM+IFG prevalence among women was 34% lower (model 2; OR 0.66, 95% CI 0.47-0.94) in T3 vs T1 (31.9% vs 34.6%). Among men there were no significant differences between DM_int prevalence between OBS tertiles. DM_all prevalence was 14.6%, 12.3% and 8.5% in the tertiles of OBS, respectively. When comparing T3 vs T1 the OR for DM_all prevalence was 0.54 (95% CI 0.30-0.98) for crude data, 0.44 (95% CI 0.21-0.94) in model 2 and 0.59 (95% CI 0.27-1.29) in model 3. The risk of DM+IFG prevalence in the group of men was 63% lower (model 2; OR 0.47, 95% CI 0.29-0.77) in T3 vs T1 (31.0% vs 38.1%).

Conclusions
Higher value of the OBS meaning better oxidative balance, was associated with a lower risk of diabetes prevalence in the study group.