bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of remote cardiac rehabilitation using wearable devices with and without weekly online coaching in patients with coronary artery disease: J-CARP FIT study
Authors: Nishio R , Dohi T , Yokoyama M , Nakade T , Takahashi N , Chikata Y , Endo H , Nishiyama H , Okai I , Iwata H , Okazaki S , Miyauchi K , Daida H , Minamino T 
Published: June 2024

Abstract

Aim
Cardiac rehabilitation (CR) is effective for preventing cardiovascular diseases, but the impact of remote-CR with wearable devices and online coaching is not well understood. The aim of this study was to investigate its effects on exercise capacity by interactive communication between healthcare providers and patients.

Methods
This randomized controlled trial enrolled 50 coronary artery disease (CAD) patients participating in a remote-CR program (phase III). After baseline cardiopulmonary exercise test (CPET), all patients were given a CPET-based home exercise program and were provided wearable device with real-time monitoring system. They were randomly assigned to an intervention group with online coaching (OLC, n=25) or a control group (CON, n=25). Primary outcomes were changes in peak VO2 and anaerobic threshold (AT) VO2 at 12 weeks, while secondary outcomes were changes in CPET parameters, daily activity, anxiety level, and health-related quality of life (HR-QOL).

Results
Peak VO2 and AT VO2 increased significantly from baseline to 12 weeks in the OLC (+1.6 mL/kg/min, p&lt;0.001; +1.0 mL/kg/min, p=0.001) and CON (+0.6 mL/kg/min, p=0.008; +1.3 mL/kg/min, p=0.002) without significant between-group differences (p=0.65; p=0.9). In the latter half of the intervention, daily distance, and highly active time in the OLC group significantly increased compared to the CON group (all p&lt;0.05).

Conclusion
Exercise tolerance improves with appropriate exercise coaching and the use of wearable devices in CAD patients participating in a remote-CR program. However, the benefits of online coaching using real-time monitoring might be more pronounced in a long-term perspective. Timeline Graphical abstract
Differentiating between circulatory versus non-circulatory causes of exercise intolerance in HFpEF using in vivo 31P magnetic resonance spectroscopy of exercising leg muscle
Authors: Voorrips S N , Jeneson J A L , Dams O C , Sibeijn-Kuiper A J , Renken R J , Van Der Meer P , Westenbrink B D 
Published: June 2024

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) is characterized by severe limitations in exercise capacity. Identifying the etiology of exercise intolerance in HFpEF remains challenging due to heterogeneity of the disease and the presence of several comorbidities.

Purpose
This trial aimed to determine whether we could differentiate between circulatory versus non-circulatory causes of exercise intolerance using 31 phosphorus magnetic resonance spectroscopy (31P MRS) exercise testing.

Methods
This observational trial included 18 HFpEF patients and 6 healthy controls who performed a supine, in-magnet cardiopulmonary exercise test using a prototype LODE MR-compatible cycle ergometer with an incremental workload protocol. Non-invasive in vivo 31P MRS measurements were collected from the quadriceps muscle to quantify dynamics in oxidative skeletal muscle metabolism. Primary outcome measures were end-exercise inorganic-phosphate/phosphocreatine ratio (Pi/PCr) and intramuscular pH. Evidence of circulatory-limited exercise intolerance was defined as increased end-exercise Pi/PCr ratio or decreased intramuscular pH (cut-off values 2.0 and 6.8, respectively).

Results
Patients with HFpEF were 50% female, aged 73 [64 - 76] years, had a mean BMI of 28.0 [25.0 – 29.6] kg/m2. Median LVEF was 51% [48 – 54%] and median NT-pro BNP levels were 626 [343-1931] pg/mL. Control patients were also 50% female, had a median age of 58 [56 - 65] years and a BMI of 22.7 [21.9 – 25.7] kg/m2. Nine patients in the HFpEF cohort exhibited circulatory insufficiency to support skeletal muscle oxidative metabolism, as indicated by acidification of the quadriceps muscle during exercise (Figure). In a subset of 5 HFpEF patients, no evidence for circulatory failure was found despite achieving maximum workload and exertion scores. Four patients were not able to reach a sufficient level of exercise intensity, which could correspond to a pattern of deconditioning. In controls, quadriceps Pi/PCr ratio increased to 1.1±0.8 while intramuscular pH remained neutral during exercise.

Conclusion
This pilot study suggests that dynamics in skeletal muscle metabolism measured by 31P MRS can be used to differentiate between circulatory versus non-circulatory causes of exercise intolerance in HFpEF. Future research is needed to evaluate whether these patterns in oxidative skeletal muscle metabolism could help to unravel the heterogeneity in HFpEF. End-exercise parameters
Evaluation of the pulmonary and muscle oxygen kinetics in heart failure patients with reduced and preserved ejection fraction
Authors: Gerson Cipriano Junior G C J , Gaspar R Chiappa G R C , Luz Goulart C , Marianne Lucena Da Silva M L S , Edson Marcio Negrao E M N , Luciana Bartolomei Orru Davila L B O D , Sergio Henrique Rodolpho Ramalho S H R R , Nadia Oliveira Gomes N O G , Graziella F Bernardelli Cipriano G F B C , Dominique Hansen D H , Lawrence Patrick Cahalin L P C 
Published: June 2024

Abstract

Introduction
Possible differences in the oxygen supply and the dynamics may impact the exercise's response between heart failure (HF) with reduced ejection fraction (HFrEF) and preserved (HFpEF), mainly due to body composition differences. Thus, our study was designed to determine whether pulmonary and muscle oxygen kinetics responses may be present in HFpEF, which may help understand the phenotype differences in muscle microvascular perfusion on exercise capacity and stimulate future investigations.

Objective
I) To assess the kinetics of pulmonary oxygen uptake (V'O2p), skeletal muscle deoxygenation ([HHb]), and O2 microvascular delivery (QO2mv) in HFrEF and HFpEF; and II) To assess the pulmonary and muscle kinetic association with exercise performance and body composition variables.

Methods
10 HFpEF and 11 HFrEF underwent cardiopulmonary exercise tests to assess V′O2 kinetics and near-infrared spectroscopy (NIRS) for [HHb]. Microvascular O2 delivery (QO2mv) was calculated using the Fick principle, and body composition via dual-energy x-ray absorptiometry (DEXA).

Results
Regarding the V′O2 kinetics, time constant (t) was slower in HFrEF (63±10.8 vs. 45.4±7.9s; P&lt;0.05) while the [HHb] were faster (t = 12.4±9.9 vs. 25±11.6s, P&lt;0.05). In addition, QO2mv were greater in HFrEF (3.6±1.2 vs 1.7±0.8, P&lt;0.05) (Figure 1) while time to exercise intolerance shorter (281.6±84 vs. 405.3±96s, P&lt;0.05). Time to exercise tolerance correlated to QO2mv (rho= -0.51; P&lt;0.05) and tV′O2 (rho= -0.63, P&lt;0.05) in both groups. We found that body adiposity negatively correlates with [HHb] amplitude (rho =-0.78) and peak V’O2 (rho =-0.54) in both groups, while lean muscle percentage positively correlates with [HHb] amplitude and tau (rho= 0.74 and 0.57; P&lt;0.05).

Conclusions
Along with oxygen uptake (V'O2p) kinetics reduction, deoxy-hemoglobin kinetics, and microvascular O2 delivery are also more severely affected in HFrEF than HFpEF. We also demonstrated that greater adiposity and less lean mass are related to a reduced oxygen diffusion capacity and poor oxygen uptake kinetics.
Effectiveness of a hybrid cardiac rehabilitation program: a comparative study with standard supervised exercise training
Authors: Naessens S , Van Mechelen M , De Bliek E , Vorlat A , De Cock L , Hens W 
Published: June 2024

Abstract

Introduction
Cardiac rehabilitation (CR) is globally recognized as an effective secondary prevention strategy for heart patients. However, low referral and participation rates persist due to accessibility challenges. This study investigates the effectiveness of a novel Hybrid CR (HCR) program, combining facility-based exercise sessions and home-based exercise sessions facilitated by a smartphone application.

Purpose
The study aims to evaluate the HCR program's effectiveness for a selected population of heart patients. A comparison is made between the HCR program and the standard of care involving solely supervised centre-based cardiac rehabilitation (CBCR). The research focuses on exercise capacity and body composition.

Methods
Participants were allocated to receive either conventional care or the HCR program. The intervention comprised a blend of supervised and home-based exercise sessions, while the control group exclusively received supervised CBCR. VO2 peak, peak load and fat percentage were measured through Cardiopulmonary Exercise Testing (CPET) and multi-frequency bioelectrical impedance analysis. Assessments were conducted at baseline, after a 12-week rehabilitation period, and, for a subset of patients, at one-year follow-up (1YFU).

Results
Eighty-four cardiac patients met the inclusion criteria to be enrolled in the study. Both the HCR group as the CBCR group showed statistically significant (p&lt;0.05) improvements in VO2 peak (mean +3.9 mlO2/kg/min vs +3.2 mlO2/kg/min respectively), peak load (mean +37.7W vs +24.9W respectively) and fat percentage (mean -2.14% vs -1.17% respectively) over the 12-week rehabilitation period. At 1YFU no statistically significant changes have been found. The HCR group exhibited no statistically significant differences compared to CBCR group, indicating comparable effectiveness.

Conclusion
This research supports the integration of hybrid rehabilitation models tailored to individual patient needs, emphasizing their potential to overcome accessibility challenges and enhance the impact of cardiac rehabilitation. Further studies should explore optimal populations and protocols for HCR, acknowledging their equal effectiveness alongside centre-based programs.
User needs and preferences of athletes in cardiac(tele)rehabilitation: a qualitative study
Authors: Fruytier L A , Serban I B , Van De Sande D A J P , Kemps H M C 
Published: June 2024

Abstract

Background
Cardiac (tele)rehabilitation (CTR) is the core strategy in the secondary prevention of coronary artery disease (CAD). Research on patient-specific needs and preferences of athletes within cardiac rehabilitation (CR) is scarce. CTR is a promising approach for tailored rehabilitation in this specific population at risk for exercise-related events.

Purpose
To define the user needs and preferences of the athletic population in cardiac (tele)rehabilitation.

Methods
In this qualitative study we included fifteen athletes with established CAD who participated in a CR program, and twelve health care professionals. All athletes engaged in sports for at least four hours per week. This study consists of four phases: a stakeholder identification session, twenty-five semi-structured individual interviews, six card-sorting focus groups and a data analysis phase with thematic analysis.

Results
Fourteen male and one female athlete (mean age 63 ± 10.6 years) participated in cardiac rehabilitation after acute coronary syndrome, percutaneous coronary intervention and/or coronary bypass surgery. Healthcare professionals invited to participate included cardiac nurse practitioners, cardiologists, sports physicians, physiotherapists, and a clinical psychologist. User needs for athletes in CR encompass personalised exercise plans featuring clear and quantifiable exercise recommendations and limitations; Additionally, there is a need for monitoring health and exercise data, measuring progression and performance longitudinally, easy-to-use, and reliable healthcare information systems with accurate sensors and data; as well as clinical supervision and validation of information and data. Social support from both peers and family is also identified as a crucial need. The preferred technological features for a CTR system tailored for athletes include periodic digital consultations with clinicians, home-based training specific to one’s sport, utilization of technology to monitor workouts, data sharing and remote feedback, personalised exercise recommendations and online educational materials.

Conclusion
Enhancing CR for athletes’ necessities adopting a personalised and sport-specific methodology. The integration of various technological features within a CTR program can play a pivotal role in assisting athletes with CAD to regain their previous athletic performance levels and mitigate the risk of adverse cardiovascular events.
The integration of a hybrid cardiac rehabilitation program for a selected patient population in a clinical setting: a feasibility study
Authors: Hens W , Naessens S , De Cock L , Van Mechelen M , De Bliek E , Vorlat A 
Published: June 2024

Abstract

Background and Aim
Although worldwide participation rates among patients eligible for cardiac rehabilitation are low due to accessibility challenges and conflicting commitments, traditional cardiac rehabilitation programs have a centre-based group approach.
The feasibility of implementing a hybrid cardiac rehabilitation program (HCR) for a selected patient population in a clinical setting of centre-based cardiac rehabilitation (CBCR) was assessed with the aim to bridge the participation gap.

Methods
With the goal of keeping weaker, more unstable or less motivated patients from unsupervised training, inclusion criteria for the HCR were established. A cardiopulmonary exercise test (CPET) and anamnesis were used to get insight in the patient’s exercise capacity, potential risks, motivation and barriers to home-based exercise sessions.
In the HCR, a four-week introductory period with three supervised exercise sessions per week was followed by a combination of supervised sessions (2/w) and home workouts (1/w) for nine weeks. During the introduction period, the patient's response to exercise was examined by monitoring heart rate response and training was provided in the use of the smartphone Polar Beat application. Feedback on the training volume of the home workouts was provided by the physical therapist using the data from the smartphone application.

Results
Between March 2021 and September 2022, 227 cardiac patients were referred to the University Hospital’s cardiac rehabilitation centre. Seventy-four patients (33%) were allocated in the novel HCR and 153 patients (67%) were allocated to the traditional CBCR group. The dropout rate in the HCR group was comparable with the dropout rate in the CBCR group (16% vs. 15%). Since feedback on the training volume of the home-based sessions was provided during a supervised exercise session in the same week, the additional workload was limited for the physical therapist.
There was overlap between the patient flow of the HCR and CBCR program which facilitated clinical implementation.

Conclusions
Integrating a hybrid cardiac rehabilitation program for a selected patient population within the traditional offering of a supervised exercise program may be a possible way to bridge the participation gap with a limited additional workload. Patient flow at the CR centre.
Mortality risk in bodybuilding: a call for action to promote safe sport participation
Authors: Vecchiato M , Da Col M , Berton G , Palermi S , Aghi A , Ermolao A , Niebauer J , Drezner J , Neunhaeuserer D 
Published: June 2024

Abstract

Introduction
Sudden Cardiac Death (SCD) is the leading non-traumatic cause of death in young athletes. Bodybuilding is a sport discipline that exposes the athlete to a series of health risks, including SCD, although studies investigating the associated mortality risk are lacking.

Purpose
The objective of this study was to analyze mortality data in a large worldwide population of male bodybuilders.

Methods
Male athletes who performed in competitions of the International Federation of Bodybuilding and Fitness (IFBB) between 2005 and 2020 were identified by an unofficial but extensive database as well as the event-results of the official IFBB website. A standardized web search tailored to detect deaths was performed for each athlete with specific keywords, providing a follow-up analysis through July 2023.

Results
A total of 19'411 athletes were identified. During the study period, 121 deaths were reported. The leading cause of death was from cardiovascular diseases, with 35 (29%) presumed or confirmed SCD detected. The incidence of SCD was 21 cases per 100'000 athletes per year (AY). Although master athletes (&gt;40 years) had a higher mortality rate than younger athletes (119 vs 60 per 100'000 AY; p=0.001), no differences in incidence rate of SCD were shown (21 vs 22 per 100'000 AY; p=0.912). Professional bodybuilders had a higher risk of SCD than amateurs (180 vs 11 per 100'000 AY; p&lt;0.001).

Conclusions
The risk of SCD is considerably high in bodybuilding athletes, particularly when compared with other sport specific mortality rates. The outcomes obtained from this study should alert the bodybuilding but also medical community, leading to a collective "call for action" to implement and improve preventive measures for the promotion of safe sport participation. Table 1 Figure 1
Effect of metabolic syndrome on mean platelet volume and relationship to extent of coronary artery disease
Authors: Vogiatzis I , Sdogkos E , Spahiu A , Roditis P , Georgakopoulos A , Konstantinou T , Pittas S 
Published: June 2024

Abstract

Introduction
Metabolic Syndrome (MS) is a bundle of cardiometabolic risk factors leading to metabolic, clinical and hemodynamic disorders. It begins as insulin resistance and is followed by systemic disorders, such as abdominal obesity, Diabetes Mellitus (DM), dyslipidemia, hypertension and Coronary Artery Disease (CAD). Mean platelet volume (MPV) is an indicator of thrombotic risk and a predictor of CAD.
The study aims to correlate MS with MPV and the extent and severity of CAD.

Material and Methods
We studied 151 patients (124 males – 27 females, mean age 63.56±11.28 years) who underwent coronary angiography. The existence of MS was defined according to the criteria set by the respective scientific societies. According to these, the patients were classified into Group A (46 patients with MS – 35 males, 11 females – mean age 62.07±11.35 years) and Group B (105 patients without MS – 89 males, 16 females – mean age 65.06±12.54 years). Obstructive coronary artery stenosis was considered at the existence of &gt;50% stenosis in at least one vessel, and severe CAD when there was an obstructive session at the left main coronary artery or disease of all three coronary vessels. Several biochemical and hematological parameters were assessed.

Results
Group A patients had a higher incidence of multivascular disease (20 patients – 43.48% vs. 16 patients – 16.8%, p=0.02), reduced Ejection Fraction (42.4±9.6 vs. 53, 5±6.54 - p=0.01) and higher Syntax Score (19.52±7.68 vs. 9.64±5.32 - p=0.01). They also showed abnormalities in lipid values (total cholesterol, triglycerides, LDL, HDL - p=0.01), higher blood glucose and HbA1c values, and higher values of fibrinogen and MPV (11.91±1.93 vs. 9.84±1.06), which is considered a significant prognostic factor in patients with Acute Coronary Syndrome and congestive Heart Failure. In addition, a significant correlation was observed between MPV and Syntax Score (r=0.64 – p&lt;0.001).

Conclusion
MS and MPV are associated with more severe CAD clinically and angiographically. Addressing and regulating MS factors is essential for the proper management of CAD.
Age-related distribution of cardiovascular risk factors in a Corporate Wellness Program: a case study of occupational cardiology at Ferrari
Authors: Palermi S , Vecchiato M , Brusiani S , De Martino L , Cavarretta E , Biffi A 
Published: June 2024

Abstract

Introduction
Corporate Wellness Programs (CWPs) in workplaces play a crucial role in the primary prevention of chronic non-communicable diseases, especially for early cardiovascular (CV) risk screening in apparently healthy individuals.

Aim
This study explores the prevalence and age-related distribution of CV risk factors among Ferrari car manufacturer employees through a CWP.

Methods
Ferrari employees in Maranello participated in the "Ferrari Formula Benessere" CWP, made by comprehensive medical evaluations, including personal and family history assessments, anthropometric measurements, blood samples, and blood pressure evaluation.

Results
In 2019, 1992 workers (82% male, average age 40 ± 9 years) were evaluated: 693 were overweight, 145 were smokers, and 861 were physically inactive. 6.4% had high fasting glycemia (100-125 mg/dL), 3.8% had high cholesterol (250-299 mg/dL) and 6.8% had high blood pressure (systolic blood pressure ≥140-159 mmHg): almost none of them (98%) were on treatment (Table 1). 799 employees (39.1%) had a medium CV risk according to SCORE2. The distribution of risk factors was spread in all age classes, being more present in older people (Table 2).

Conclusions
The CWP at Ferrari significantly identified crucial CV risk factors in a population not regularly screened, emphasizing the vital role of CWPs in primary CV prevention.
Shared and distinct pathways from anxiety disorder and depression to cardiovascular disease: a mediation analysis of the UK Biobank prospective cohort study
Authors: Nakada S , Celis C , Pell J , Ho F 
Published: June 2024

Abstract

Introduction
Although anxiety disorder and depression increase the risk of cardiovascular disease, no studies have examined their underlying mechanisms systematically, particularly contrasting the difference between the two of them.

Purpose
We aimed to explore the extent to which lifestyle, physical and metabolic factors mediate the associations of diagnosed anxiety disorder and depression with incident cardiovascular disease in the UK general population.

Methods
A prospective cohort study was conducted using UK Biobank. Diagnosed anxiety disorder, depression, and incident cardiovascular diseases were ascertained through linkage to hospital and death records. A causal mediation analysis was performed for anxiety disorder and depression separately examining multiple potential lifestyle (physical activity, TV viewing, diet quality, smoking status and sleep duration), physical (waist-hip ratio, body mass index, and grip strength), and metabolic mediators (systolic blood pressure, haemoglobin A1c, low-density lipoprotein-cholesterol, and C-reactive protein), adjusted for sociodemographic confounders (sex, age, ethnic group, and deprivation level). Cox proportional hazard models and modified quasi-Poisson models were used to derive indirect effect estimates and proportions mediated. Subsequently, the parametric g-formula was used to investigate whether upstream factors (e.g., lifestyle factors) bias downstream mediators (e.g., physical and metabolic factors) as exposure-affected confounders.

Results
Of more than 500,000 UK Biobank participants, 254,695 participants were included, of whom 53.6% were female, with a mean age (standard deviation) of 56.6 (8.1) years (Figure 1). The strongest lifestyle and physical mediators were current smoking and higher waist-hip ratio which accounted for 12.2% and 12.8% of the excess risk from anxiety disorder, and 17.2% and 13.8% from depression, respectively (Figure 2). The strongest metabolic mediators were systolic blood pressure for anxiety disorder (10.2%) and C-reactive protein (10.7%) for depression. Systolic blood pressure was the weakest mediator for depression (4.0%). Adjusting for exposure-affected lifestyle factors only slightly lowered all estimates and little changed overall trends, suggesting mediating roles of physical and metabolic factors were independent of lifestyle factors. Similarly, mediating roles of metabolic factors were independent of any physical factors.

Conclusions
Lifestyle and physical pathways to incident cardiovascular disease may be common to both anxiety disorder and depression, but shared metabolic pathways seem unlikely. Our findings inform which risk factors to target among people with anxiety disorder or depression in order to reduce their higher risk of developing cardiovascular disease. Bar chart of proportions mediated.