bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated BNP and NT-proBNP levels as prognostic biomarkers of short-term walking independence in post-acute stroke rehabilitation
Authors: Kai G , Noda T , Ueno K , Ogura K , Miki T , Yamashita M , Kanai M , Nozoe M , Kamiya K 
Published: June 2024

Abstract

Background
The comorbidity of heart failure (HF) and stroke is associated with delayed stroke recovery, prolonged hospitalization, and a decreased quality of life. HF can lead to acute cerebral injury, while conversely, acute cerebral injury can exacerbate HF by disrupting neural and cardiovascular regulation. This association is now recognized as the "cardio-cerebral syndrome" and the "stroke-heart syndrome," endorsed by the European Society of Cardiology (ESC). However, in many cases of newly diagnosed stroke patients, the appropriate diagnosis of HF is often overlooked.
Brain natriuretic peptide (BNP) and the N-terminal prohormone of BNP (NT-proBNP) are used for HF screening and risk assessment. Nevertheless, their potential as predictive markers for functional independence in post-acute stroke patients remains uncertain.

Purpose
This study aimed to investigate the correlation between BNP or NT-proBNP levels and walking independence in patients with ischemic or hemorrhagic stroke during the post-acute phase.

Methods
This retrospective observational study included 650 post-acute phase ischemic or hemorrhagic stroke patients admitted to our hospital for rehabilitation between February 2019 and December 2022, all of whom underwent BNP or NT-proBNP testing upon admission. Patients were categorized into two groups: those with BNP≥200 pg/ml or NT-proBNP≥900 pg/ml ("High group") and those without ("Low group"). We examined the relationship between BNP or NT-proBNP levels and ambulatory independence within 90 days using multivariable logistic regression analysis. We also performed subgroup analyses to take into account factors such as age, atrial fibrillation, obesity and renal function that may affect BNP or NT-proBNP levels. Walking independence was defined as the ability to walk without assistance or supervision, irrespective of the use of walking aids and orthoses.

Results
The mean age of the subjects was 75.1±11.2 years, with males comprising 53.2% of the population. One hundred and seven patients (16.4% of the total) were classified as the High group. High BNP or NT-proBNP levels were significantly associated with difficulty walking independently within 90 days after adjusting for other functional prognostic factors (odds ratio, 2.62; 95% confidence interval, 1.30-5.27; p=0.007). Furthermore, even in subgroup analyses with factors influencing BNP or NT-proBNP levels, elevated BNP or NT-proBNP levels were associated with difficulty walking independently within 90 days (p&lt;0.05, respectively).

Conclusions
Our findings suggest that elevated serum levels of BNP or NT-proBNP may serve as functional prognostic indicators in post-acute stroke patients.
Personalized pre-interventional risk stratification of mortality, length of stay and hospitalization costs in transcatheter aortic valve implantation using a machine learning algorithm a pilot trial
Authors: Zisiopoulou M , Berkowitsch A B , Redlich L R , Walther T W , Fichtlscherer S F , Leistner D L 
Published: June 2024

Abstract

Introduction
Risk stratification based on Euroscore II (ESII) is currently used by clinicians to assist their decision to perform transcatheter aortic valve implant (TAVI) procedures. ESII is a generic, non-TAVI-specific metric. We investigated if a TAVI-specific predictive model could achieve improved predictive pre-interventional accuracy of 1-year mortality compared to ESII.
Patients & Methods: In this prospective pilot study, 284 participants with severe aortic valve stenosis who underwent TAVI were enrolled. Standard clinicals metrics (ASA, NYHA, ESII) and patient-reported outcome measures (EuroQol-5D-VAS, Kansas City Cardiomyopathy Questionnaire, Clinical Frailty Scale-CFS) were assessed one day before TAVI. Using these data, we tested predictive models (logistic regression, decision tree algorithm- DTA) with 1-year mortality as the dependent variable.

Results
Logistic regression yielded the best prediction, with ASA and CFS as the strongest predictors. Our logistic regression model score showed significantly better prediction accuracy than ESII (AUC = 0.659 vs. 0.800; p = 0.002). By translating our results to a DTA, cut-off score values regarding 1-year mortality risk emerged: &lt; 0.02 points for low, 0.02 – 0.15 for intermediate, &gt; 0.15 for high risk. Treatment costs and length of stay significantly increased in high-risk patients.

Conclusions & significance
A novel TAVI-specific model predicts 1-year mortality, LoS and costs after TAVI using simple, established, transparent and inexpensive metrics before implantation. Based on this preliminary evidence, TAVI team members and patients can make informed decisions based on a few key metrics. Validation of this score in larger patient cohorts is needed. Comparison of ROC curves
Physical functioning predicts cognition in systolic heart failure
Authors: Besnier F , Gagnon C , Sellier F , Berube B , Vachon F , Dupuy E , Iglesies-Grau J , Gayda M , Dionne V , Benhalima H , Nigam A , L'allier P , Bouabdallaoui N , Rouleau J L , Bherer L 
Published: June 2024

Abstract

Background
Physical and cognitive deficits often coexist as comorbidities in individuals with chronic heart failure (CHF). Commonly used in clinical settings, the 6-minute walking test (6MWT), Timed-Up and Go (TUG) and the 10m walking speed (WS) are functional tests that have demonstrated associations with global cognition and specific cognitive domains such as processing speed and executive functions in the elderly. However, there is limited understanding regarding their association with cognition in individuals with chronic heart failure (CHF) with reduced or preserved left ventricular ejection fraction (LVEF).

Objectives
To compare cognition and physical functions in CHF patients with reduced LVEF versus those with mildly reduced or normal LVEF (R-LVEF ≤40% vs N-LVEF &gt;40%). To examine if functional tests predict cognitive performance in each CHF subtype.

Methods
42 patients with CHF (66.8±8.1 years old) performed the 6MWT, TUG, and 10m walking test. Neuropsychological tests involved the Montreal Cognitive Assessment (MoCA), the Stroop task and the Rey auditory verbal learning test to assess global cognition, executive functions, processing speed, and episodic memory. LVEF was measured by echocardiography.

Results
mean LVEF were 32.3±6.9% and 52.6±7.7% for R-LVEF and N-LVEF (p&lt;0.001). Age, education, NYHA class, 6MWT, TUG and WS were similar between groups (p&gt;0.05). After adjusting for age, sex, and education, there was no group difference in the MoCA (23.2±3.9 vs 24.9±3.9 p=0.22 respectively for R-LVEF and N-LVEF). The Stroop inhibition and the Stroop switching task revealed significantly lower performances in R-LVEF vs N-LVEF (81.8±28.7s vs 62.6±13.5s p=0.013 and 89.5±32.8s vs 69.5±14.1s, p=0.016 respectively), as well as fewer words recalled on the fifth repetition of the verbal learning test and the immediate recall (9.2±2.7 vs 11.3±2.3, p=0.020 and 6.2±3.4 vs 8.5±2.6 p=0.013 respectively). Simple linear regressions showed that the 6MWT (R=0.46, p=0.002) and TUG (R= -0.52, p=0.007) significantly predicted MoCA scores in R-LVEF but not in N-LVEF. 6MWT (R= -0.39 p=0.013), TUG (R= 0.47 p=0.016) and WS (R= -0.46 p=0.003) also predicted performances in the Stroop switching condition in R-LVEF only.

Conclusion
Physical functions are similar between CHF patients with reduced LVEF versus those with mildly reduced or normal LVEF.Global cognition, executive function, and verbal memory (encoding) were lower in CHF with reduced LVEF versus those with mildly reduced/normal LVEF. Functional tests predicted global cognition and executive function in CHF participants with reduced LVEF. Future studies are needed to better understand the pathophysiology of cognitive and physical function deficits in CHF with reduced and preserved LVEF.
Fitness impact on left ventricle GLS and left atrial strain in cardiac rehabilitation of heart failure patients
Authors: Adam C , Marcu D T M , Mitu O , Mitu F 
Published: June 2024

Abstract

Background
Cardiac rehabilitation (CR) is an essential pillar of the management of patients with heart failure (HF), regardless of the degree of systolic dysfunction, having both a therapeutic and prognostic role. The improvement of symptoms and functional status together with the improvement of quality of life are some of the arguments that support the referral of all HF patients to centers specialized in such integrative, multidisciplinary programs.

Purpose
We aimed to evaluate the impact of physical training on echocardiographic parameters (left ventricle global longitudinal strain [LV GLS], left atrial strain) among HF patients on a CR program.

Methods
We conducted a prospective cohort study on 105 patients with HF admitted to a single tertiary referral center. According to the functional class assessed by cardiopulmonary exercise testing (CPET), we divided patients into two groups: mild to moderate functional limitation (n=46) and moderate-severe functional limitation (n=59).

Results
We analyzed demographics, anthropometrics, clinical and paraclinical parameters, focusing on echocardiographic parameters of systolic function (ejection fraction, LV GLS) and atrial function (left atrial strain). Patients with HF in the second group had lower mean values of EF (p=0.046), LV GLS (p=0.021) and left atrial strain (p=0.039). After completing the CR program, patients in the second group had an improvement of the parameters compared to baseline values. LV GLS and left atrial strain values were statistically significantly correlated with serum NT-proBNP values (p=0.009), peak oxygen uptake (p=0.013), pain-free walking distance (p=0.034) and maximum walking distance (p=0.029). Left atrial strain also positively correlates with peak oxygen uptake (p=0.047). GLS value less than -8.9% is also a predictor for the persistence of severe functional limitation in HF patients (AUC=0.648 , p=0.041) (Figure 1).

Conclusion(s)
CR program improves systolic dysfunction in HF patients, with low GLS values being a negative predictor of functional status.
Pulse wave velocity among urban and rural dwelling rwandans
Authors: Thomas A , Baggish A B , Nuhu N A , Ojambo R O 
Published: June 2024

Abstract

Background
Carotid-femoral arterial pulse wave velocity (PWV), a direct measure of aortic stiffness, predicts morbidity and mortality. At present, reference values for PWV are only available for Europeans and North / South American populations.

Purpose
To measure PWV in Central African people (Rwanda), to compare PWV among urban versus rural-dwelling Rwandans, and to compare these data with established European reference values.

Methods
PWV (SphygmoCor® XCEL) was measured in rural-dwelling Rwandans (RR, n = 41 ; Butaro Sector) and urban-dwelling Rwandans (UR, n= 37 ; Kigali). Anthropometric data including height, weight, and skinfold thickness measurements were collected for all participants.

Results
Compared to RR (age = 37 ± 11 y, 54% female), UR (age = 41 ±15 y, 46% female) demonstrated higher BMI (25.1 ± 6.6 vs. 21.0 ± 5.4 kg/m2, p &lt; 0.001), percentage body fat (28.6 ± 9.7 vs. 21.0 ± 12.1%, p = 0.005), and a trend toward higher systolic blood pressure (134 ± 22 vs. 129 ± 19 mmHg, p =0.27). However, PWV was similar between groups (UR = 6.6 ± 1.7 vs. RR = 6.6 ± 1.2 m/s, p= 0.82). There were similar direct linear relationships between PWV and age among both UR (R=0.58, p &lt; 0.001) and RR (R= 0.65, p &lt; 0.001). Rwandans demonstrated overall lower PWV progression with aging compared to age-matched European reference standards (Figure).

Conclusion(s)
To our knowledge, we report the first data examining arterial stiffness in Central African people. Our data demonstrate no differences among PWV as a function of urban versus rural living but show significantly lower PWV values across the age spectrum compared to European populations. Further investigation into the physiologic determinants and prognostic implications of these findings is warranted.
Non-stenotic aortic valve fibro-calcific content association with clinical outcomes in coronary artery disease patients
Authors: Myasoedova V , Chiesa M , Valerio V , Moschetta M , Rusconi V , Massaiu I , Bertolini F , Mancini M E , Poggio P 
Published: June 2024

Abstract

Background
Aortic stenosis (AS) is the most common valve disorder, characterized by fibro-calcific remodeling of valve leaflets, which occurs even before hemodynamic changes. Progressive aortic valve calcification (AVC) leads to worse cardiovascular outcomes. However, the fibrotic component (AVF) of non-stenotic aortic valve leaflets and its role in negative outcomes have not yet been explored.

Purpose
To evaluate whether fibro-calcific content of aortic valve can be a predictor of outcomes in high risk CAD patients without AS.

Methods
We included 203 coronary artery disease (CAD) high-risk patients without AS who underwent cardiac contrast-enhanced computed tomography (CT). The calcium and fibrosis volumes were indexed by dividing the volume by the aortic annular area. The composite outcome, including all-cause mortality, cardiovascular mortality, acute heart failure, and re-infarction, was assessed at 5-year follow-up.

Results
The mean age of our cohort was 68.4±10 years, 24% had diabetes, 72% had dyslipidemia, 65% had hypertension, and 58% were former or current smokers. CT quantifications were as follows: AVC 51.6±94.8 mm3/cm2 and AVF 231.3±148.7 mm3/cm2. After 5 years of follow-up, 40 (23%) events occurred, where patients with AVC above the median (9.88[0-58.1] mm3/cm2) or AVC&gt;0 were associated with an increased risk of adverse events (all p&lt;0.05). The AVF component did not show any influence on negative outcomes in these patients.

Conclusion
AVC, but not AVF, assessed in CAD high-risk patients without AS, predicts the worst outcome. Our results on valvular fibrosis could be altered by treatments in secondary prevention. Studies in a population without pharmacological influence are needed to better understand the effect of AVF on the development and progression of valve pathology as well as outcomes.
Diagnostic pathways for women with suspected coronary artery disease including cardiac SPECT/CT. 6-year experience in Latvia
Authors: Vitola B , Mintale I , Trusinskis K , Kalnina M , Kedrova J , Erglis A 
Published: June 2024

Abstract

Introduction
Myocardial perfusion imaging with cardiac SPECT/CT is one of the most performed non-invasive cardiac imaging tests evaluating myocardial viability, assessing prognosis, and estimating the efficacy of therapy. The diagnostic algorithm should be applied individually for every patient group.

Purpose
To analyze the diagnostic pathways for women with suspected coronary artery disease (CAD) in Latvia including cardiac nuclear imaging and to investigate prescribed further diagnostic approaches to establish the diagnosis and appropriate treatment.

Methods
For women included in Latvian cardiac SPECT/CT registry the cardiac SPECT/CT was performed in a single University Hospital from 2018 till 2023. For all of them the previous exercise stress test was performed. The patients were divided into 2 groups: normal myocardial perfusion and true myocardial perfusion defect, defined as area of ischemia ≥ 10% of the left ventricle myocardium. Patients with perfusion defect were analyzed according to prescribed further diagnostic test or treatment option.

Results
916 women with known or suspected CAD were analyzed. True myocardial perfusion defect was detected in 175 patients (19.1%). The previous exercise stress test was positive only in 92 (52.6%) women with perfusion defect in SPECT/CT. As further diagnostic approach in 40 (22.9%) cases cardiac computed tomography angiography (CTA) was suggested and the invasive coronary angiography (ICA) - in 135 (77.1%) cases. The patients without performed further diagnostic tests were excluded. Analyzing results of all performed CTAs’ (n=32), stenosis in main coronary arteries were found in 2 cases (6.25%) and patients were referred to percutaneous coronary intervention (PCI). Of all performed ICA(n=113), in 71 (62.8%) women atherosclerosis in main coronary arteries was not observed and INOCA (ischemia with non-obstructive coronary arteries) as a primary diagnosis was suspected. In 34 (30.1%) patients the significant stenosis in main coronary arteries was present and PCI was performed, of whom 13 (38.2%) women were primarily diagnosed. 2 patients (1.8%) underwent coronary artery bypass surgery (CBP).

Conclusion
The diagnostic algorithm including cardiac SPECT/CT is valuable and highly recommended for the diagnostics of women with known or suspected CAD. Knowing the relatively low specificity of exercise stress test for women, the cardiac SPECT/CT should be performed as an initial diagnostic test for women with intermediate and high pre-test probability. In patients with defined perfusion defect, but non-obstructive coronary arteries – the invasive physiology testing should be performed to assess microvascular function.
Trends in antithrombotic treatment after cryptogenic stroke and prior transcatheter patent foramen ovale closure
Authors: Apostolos A , Papanikolaou A , Trantalis G , Drakopoulou M , Katsaros O , Ktenopoulos N , Simopoulou C , Oikonomou G , Koliastasis L , Aggeli C , Tsioufis C , Toutouzas K 
Published: June 2024

Abstract

Background
Approximately 35% of ischemic strokes worldwide are cryptogenic, with a significant proportion attributed to paradoxical embolism through a patent foramen ovale (PFO). Diagnosing PFO-related strokes involves excluding common causes like atrial fibrillation or carotid stenosis, often requiring time before deciding on transcatheter PFO closure. While current guidelines suggest dual antiplatelet therapy for 21 days followed by tailoring with a single antiplatelet agent, such as aspirin, the actual antithrombotic treatment administered in routine clinical practice remains unclear.

Purpose
This analysis aims to investigate the combinations of antithrombotic treatments—antiplatelet or anticoagulant—chosen by physicians for bridging the time gap between cryptogenic stroke onset and transcatheter PFO closure.

Methods
We included consecutively patients that have undergone transcatheter PFO closure at a tertiary hospital in our analysis. We analyzed baseline demographic details, comorbidities, and pharmaceutical characteristics.

Results
Data on pre-closure antithrombotic treatment were available for 67 patients, predominantly female (77.6%) with a mean age of 46.0 ± 4.3 years. Hypertension was present in 20 (29%) patients, dyslipidemia in 34 (50%), and diabetes mellitus in 6 (8%). Only one patient had known coronary artery disease before the cryptogenic stroke. Of the 55 (82%) patients receiving antithrombotic treatment, 50 (90%) were on antiplatelets, 2 on anticoagulants, and 3 on a combination of both. Among those receiving only antiplatelet agents, 34 (68%) received a single agent (aspirin or clopidogrel), and 16 (32%) received dual antiplatelet treatment (aspirin and clopidogrel). Patients on anticoagulation, with or without antiplatelet medication, were exclusively treated with a newer oral anticoagulant agent. No recurrent ischemic stroke occurred during the cryptogenic stroke or transcatheter PFO closure.

Conclusion
Despite current guidelines recommending a 21-day course of dual antiplatelet therapy followed by tailoring with aspirin or clopidogrel after an ischemic stroke, our findings highlight variations in the current practice of antithrombotic treatment for PFO-related strokes. Further studies in this population are essential to provide better guidance for neurologists and cardiologists managing cryptogenic strokes.
Could breathing frequency become a pragmatic means to monitor exercise intensity in atrial fibrillation and coronary heart disease?
Authors: Buckley J P , Terada T , Lion A , Reed J L 
Published: June 2024

Abstract

Introduction
Innovations Fund of the Alternate Funding Plan for the Academic Health Sciences Centre of the Ministry of Ontario, Canada; New Investigator Award in Clinical Rehabilitation from the Canadian Institute for Health Research; Heart and Stroke Foundation of Canada Emerging Research Leaders Initiative.

Aim
Moderate-intensity aerobic exercise, near to the 1st ventilatory threshold (VT1), in adults with atrial fibrillation (AF) and coronary heart disease (CHD) is recommended as a minimum level to derive safe and beneficial physiological gains. The irregular and rapid heart rate (HR) in AF or other heart rhythm disturbances in CHD create challenges for using HR to monitor exercise intensity. The aim of this study was to assess whether breathing frequency (BF) can be used to measure and monitor exercise intensity in people with AF and CHD.

Methods
An observation study of 30 AF participants with CHD (19M, 11F, 70.7 +/- 8.7 yrs) and 67 non-AF participants with CHD (38M, 29F, 56.9 +/-11.4 yrs) who performed incremental maximal exercise testing with continuous pulmonary gas exchange measures.

Results
Peak aerobic power (VO2 peak) in AF (17.8 +/- 5.0 ml.kg-1.min-1) was lower than in CHD (26.7 ml.kg-1.min-1) (p &lt;.001). BF peak in AF and CHD were similar (p =.106); 34.6 +/- 5.4 and 36.5 +/- 5.0 breaths.min-1, respectively. In spite of a 14 year age difference, BFs at VT1, were similar in CHD patients with and without AF (23.2 +/- 4.6 and 22.4 +/-4.6 breaths.min-1 respectively). The same was true for BF at %VO2 peak (AF ~59%; CHD ~57%; p = .656).

Conclusion
In light of newly emerging affordable wearable technologies, this first study of its kind provides an encouraging potential and pragmatic approach for using BF to monitor exercise intensity in AF and CHD.
Exergaming system for promoting hospital early mobilisation and disease knowledge in heart failure patients: HEFMOB development and usability assessment study
Authors: Blasco-Peris C , Climent-Paya V , Carrion C , Manresa-Rocamora A , Baladzhaeva S , Fuertes-Kenneally L , Garcia-Alvarez M I , Sanz-Rocher A , Sempere-Ruiz N , Hernandez-Perez I , Sarabia J M 
Published: June 2024

Abstract

Aims
This study aimed to develop and test usability for an exergaming prototype with remote monitoring of biometric parameters and autonomous management for promoting hospital early mobilisation and disease knowledge in patients with heart failure (HF).

Methods
The study included two phases: 1) the design and development of the exergaming prototype encompassing a lower limb aerobic endurance game and an upper limb coordination and mobilization game, 2) its usability assessment. The usability evaluation involved several steps, starting from the initial assessment by the researchers, followed by a comprehensive analysis of the video recordings of 10 patients (4 females) with HF and reduced (4) or mildly reduced (6) ejection fraction engaging in individual sessions with the prototype. Finally, all 10 participants completed the System Usability Scale (SUS; scale ranging from 0 to 100) and Intrinsic Motivation Inventory (IMI; scale ranging from 0 to 35) to rate the usability of the exergaming prototype and the intrinsic motivation scale, respectively.

Results
During the usability assessment and after implementing experts’ improvements, participants successfully engaged with 63% and 32% of the elements of the two exergames. No participant experienced dizziness except for one patient who reported it at the curves in the road cycling tour. The mean IMI score of 25.1 (SD = 3.5) indicates a high level of interest and enjoyment following the prototype session. Additionally, with the SUS, the mean score of 71.5 (SD = 17.8) suggests that the users rated the system´s usability as excellent.

Conclusions
This study suggests that HEFMOB is a safe, engaging and user-friendly device for patients with HF. Future research is required to demonstrate the efficacy and effectiveness of HEFMOB conclusively. Figure 1. Prototype scheme diagram Figure 2. Virtual road cycling tour