bluuebunny/crossref_metadata_2025_split huggingface dataset:
LDL-C target attainment in the secondary prevention of atherosclerotic cardiovascular disease in Albania: barriers and strategies to reach the goals
Authors: Rrapo A , Gina M , Cabeli A , Pane E , Kondi L , Berbiu E , Goda A 
Published: June 2024

Abstract

Background
Even though the ESC guidelines tend to be more demanding towards the lipid management and recommend lower LDL-C targets, studies have consistently shown very low rates of achieving dyslipidemia treatment goals and a large gap between clinical practice and guideline-recommended practice.

Aim of the study
To investigate the implementation of guidelines and the achievement of LDL-C target in secondary prevention (according to ESC 2019 guidelines), in a group of patients 6 months after an acute coronary syndrome (ACS); identification of barriers for not achieving the target: assessment of adherence, and optimization of lipid lowering therapy.

Materials and methods
We enrolled patients with ACS admitted in the cardiology unit of a university hospital during the period February-June 2022, and collected the data from medical records. Follow-up of patients was carried out through phone calls 6 months after discharge from the hospital, evaluating changes in the lipid profile and therapy. For analysis purpose, we divided the patients in two groups according the achievement of treatment goal.

Results
We enrolled 571 patients in the study, but were able to reach only 435 patients for a phone interview after six months, and only 257 of these patients performed the required lipid profile. At discharge, 95.7% of patients were prescribed statin monotherapy (84% high-intensity statin); 3.9% of patients were prescribed the statin + ezetimibe combination. In 0.4%, lipid lowering therapy was not prescribed. At the 6-month follow-up, fewer patients were being treated with statins (91.05% of patients were receiving statin monotherapy) and even fewer with high-intensity statins (62.3%); 4.7% of patients were taking the statin + ezetimibe combination; 4.25% of patients were not receiving lipid-lowering therapy (LLT). In 257 patients included in the study, only 55 of them (21.4%) reached LDL-C target after 6 months. Overall adherence to treatment was 94.2%, 100% in the group that reached the LDL-C target compared to 92.6% in the group that didn't reach the treatment goal. Optimization of LLT was performed in 14% of the cases. 58.2% of the patients in the group that reached the treatment goal had the LLT optimized after being discharged, compared to only 2% in the group that didn’t reach the target. Of the 36 patients who had the therapy optimized, 88.9% reached the LDL-C target. Optimization increases the likelihood of achieving the LDL-C goal by 14 times.

Conclusions
The results of our study show that most coronary patients have a less than optimal management of LDL-C, with only a small part of them achieving treatment goals. Lack of intensification of statin therapy and underutilization of combination therapy suggest gaps between real-world practices and guideline recommendations. Strategies directed at both the health care system and providers are needed to attain secondary prevention goals.
impact of different cardiometabolic risk factors in MASLD: rethinking overweight/obesity criteria
Authors: Zeng G , Wang P Z , Yuan J Q 
Published: June 2024

Abstract

Background/introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a newly proposed nomenclature that requires any one of five cardiometabolic risk factors (CMRF) including hypertension, hyperglycemia, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C) and overweight/obesity as a prerequisite for diagnosis. However, the specific impact of these CMRFs on all-cause and cardiovascular mortality in the MASLD population is not well understood.

Purpose
To assess the prognostic impact of CMRFs in MASLD using data from the third National Health and Nutrition Examination Surveys 1988-1994 (NHANES □).

Methods
A total of 11,397 nonpregnant adults (20-74 years) with complete ultrasound measures, key covariates, data for MASLD definition and mortality status from NHANES □ were included in our analysis. The definition of MASLD and CMRFs definitions aligned with the Delphi consensus statement. The mortality status of the participants was obtained through the linkage to the National Death Index until December 31, 2019.

Results
Of 2,644 categorized MASLD participants, the prevalence of hypertension, hyperglycemia, hypertriglyceridemia and low HDL-C was similar (45.1%-57.4%), The prevalence of overweight/obesity was higher at 88.6%. During a median follow-up period of 26.1 years, hypertension, hyperglycemia and hypertriglyceridemia were all significantly associated with the increased risk of all-cause mortality and cardiovascular mortality after multivariable adjustment. Low HDL-C was significantly associated with risk of all-cause mortality and borderline significantly associated with risk of cardiovascular mortality. Conversely, overweight or obesity was not associated with mortality risk (all-cause HR: 1.01, 95%CI: 0.77-1.32; cardiovascular HR: 1.04, 95%CI: 0.63-1.72). When overweight/obesity was stratified into WC-based or BMI-based types, Neither WC-based nor BMI based overweight/obesity were associated with mortality risk. Compared to non-MASLD individuals without any CMRFs, MASLD patients with only overweight or obesity was not associated with mortality risk (all-cause HR: 0.84, 95%CI: 0.51-1.39; cardiovascular HR: 0.78, 95%CI: 0.28-2.18). However, patients with the other four components had higher mortality risk, regardless of obesity status.

Conclusions
hypertension, hyperglycemia, hypertriglyceridemia and low HDL-C are positively associated with higher mortality risk. The criteria for defining overweight and obese in MASLD should be reconsidered in the context of CMRFs. Figure 1
Prolonged troponin elevation after high-intensity exercise may indicate coronary artery disease
Authors: Hove I , Kleiven O , Bjorkavoll-Bergseth M F , Svane J , Erevik C B , Hansen M W , Bugge C , Skadberg O , Melberg T , Orn S 
Published: June 2024

Abstract

Background
Physical activity is beneficial for individuals with chronic coronary artery disease (CAD). Cardiac troponin (cTn) levels increase following exercise, but the mechanisms are not fully understood. There is limited data on the serum cardiac troponin response to different exercise intensities and durations in individuals with established CAD. This study aimed to explore the serum cardiac troponin I (cTnI) release pattern after high-intensity exercise of increasing duration in individuals with- and without revascularized CAD.

Methods
We included 36 middle-aged (60.4 ±8.7 years) recreational athletes. 14 individuals with successfully revascularized CAD, stable for at least six months before and 30 days after inclusion. 22 were healthy controls without obstructive CAD proven by CT coronary angiography. Both groups had a mean left ventricular ejection fraction &gt;55%, assessed by echocardiography. The maximum exercise capacity of all participants was assessed by a cardiopulmonary exercise test (CPET). The CPET determined the maximal power output (watt) at max VO2. Following the CPET, all individuals exercised once weekly with sessions of alternating 15 seconds at maximal power and 15 seconds of passive recovery. In the first week, participants were exposed to a total exercise duration of 20 minutes. The duration was then increased by 20 minutes each week, ending with a 60-minute session. CTnI was measured before, 3 hours after and 24 hours after each exercise session.

Results
The duration of the CPET was similar in the two groups and there were no significant differences in VO2 max, maximal power output, heart rate or blood pressure during the test (Table 1). CTnI values were significantly higher 3 hours after the 60-minute session than after the CPET and the 20-minute session. There were no significant differences in absolute cTnI values between the two groups before or after any of the exercise sessions. In subjects with CAD, there was no reduction in cTnI from 3 hours to 24 hours following the CPET (Figure 1). In comparison, healthy individuals showed significant reductions in cTnI at 24 hours following all the exercise sessions.

Conclusion
No differences were seen in absolute values comparing the exercise-induced cTnI response in individuals with- and without chronic CAD. However, following the highest intensity exercise session (CPET), individuals with CAD had a sustained cTnI elevation 24 hours after exercise compared to healthy individuals where the cTnI levels significantly decreased. These findings may suggest an association between prolonged post-exercise cTnI elevation and CAD following high-intensity exercise.
Table 1: Data from the cardiopulmonary exercise test (CPET) in both groups. Figure 1 Table 1
Sex-differences in self-reported cardiorespiratory fitness, symptom severity, and quality of life in patients with atrial fibrillation
Authors: Marcal I R , Way K L , Reed J L 
Published: June 2024

Abstract

Background
Patients with atrial fibrillation (AF) often report low cardiorespiratory fitness (CRF), a strong predictor of all-cause mortality, troubling symptoms, and poor quality (QoL). Scarce literature suggests there are sex-differences in cardiovascular outcomes between females and males with AF. Despite sex-based analysis being encouraged in research practices, it is often overlooked, and this research gap in those with AF merits examination.

Purpose
We aimed to assess the sex-differences in CRF, symptom severity, and disease-specific QoL in patients with AF.

Methods
This is an observational study in patients with AF within Canada. Estimated CRF (i.e., peak oxygen uptake [V̇O2peak], and metabolic equivalents [METs]) was measured using the Duke Activity Status Index (DASI). Symptom severity including AF frequency, AF duration, symptom severity, and total AF burden was assessed using the Atrial Fibrillation Severity Scale (AFSS). Disease-specific QoL was examined using the Atrial Fibrillation Effect on Quality of Life (AFEQT) which includes domains of symptoms, physical functioning, treatment concerns, and treatment satisfaction. Mann-Whitney U tests were performed to determine sex-differences on the above-mentioned variables. A P value of &lt; 0.05 was considered significant. Data are presented as medians and 95% confidence intervals.

Results
This study included 210 (33%) females (66.0 [63.5-68.0] years) and 409 (66%) males (66.0 [64.0-67.0] years). Females reported lower levels of CRF as assessed by V̇O2peak (25.5 [23.3-27.2] vs. 30.0 [27.6-30.2] mL/kg/min, P &lt; 0.001) and METs (7.2 [6.6-7.7] vs. 8.5 [7.9- 8.6], P &lt; 0.001) compared to males. Females showed worse symptom severity (5.5 [5.2-6.0] vs. 5.0 [4.5-5.0] points, P &lt; 0.001) and were more bothered by AF symptoms (7.0 [5.0-8.0] vs. 5.0 [4.0-5.0] points, P &lt; 0.001) than males. Females also demonstrated poorer QoL than males (AFEQT total score: 80.6 [77.8-83.3] vs. 83.3 [80.6-86.1] points, P = 0.04).

Conclusion
Our findings show that females with AF reported clinically and statistically poorer CRF, and worse symptom severity and QoL when compared to males with AF. Our findings emphasize the need for sex-specific strategies to improve AF management, particularly in females.
The benefit of early phase 2 cardiac rehabilitation on exercise capacity in worsening anxiety and depression patients after open-heart surgery
Authors: Astuti A W , Rampay D E T R I , Radi B A S U N I , Desandri D R , Putra B D , Ambari A M 
Published: June 2024

Abstract

Background
Cardiac rehabilitation (CR) has benefit effect in improving exercise capacity, quality of life, and reducing the risk of cardiovascular events. Anxiety and depression show detrimental effect for self-management behaviour patients after heart surgery and frequently under-recognized. It might represent risk factors for CR outcomes. Screening by Hospital Anxiety and Depression Scale (HADS) is recommended to check at the start and end of CR. However, exercise capacity (EC) improvement in worsening anxiety (WA) and depression (WD) patients after CR still need to be investigated.

Purpose
This study aims to investigate exercise capacity improvement of post open-heart surgery patients with worsening anxiety and depression after completing CR.

Methods
A cross-sectional study with a pre-post design enrolled 300 post open-heart surgery patients completing 12-session of early phase 2 cardiac rehabilitation in July-November 2023. Anxiety and depression (HADS) category and exercise capacity by 6-minutes walking distance (6MWD) was measured at the beginning (T1) and end of cardiac rehabilitation (T2). The change of 6MWD calculated by subtracting 6MWD at T2 from T1.

Results
There were 63% post coronary artery bypass (CABG), 12% post congenital heart disease correction, and 22.7% post valvular surgery patients divided into category: 7% mild anxiety and 1% mild depression at T1, then 10.3% mild anxiety, 3.3% moderate anxiety and 6% mild depression at T2. The change in T1 to T2 HADS category showed 11% worsening anxiety, 6% worsening depression, 83% constant normal/anxiety (CA) and 93% constant normal/depression (CD). Worsening anxiety and depression patients achieved significant improvement in exercise capacity (change of 6MWD 70.1 meters in WA and 74.6 meters in WD, p&lt;0.001) also fulfill 25 meters minimal clinically important difference in 6MWD for coronary artery patient. No significant difference in 6MWD changes between WA and CA (-13.7 meters, p= 0.077) also WD and CD (-7.74 meters, p= 0,569).

Conclusion
Early phase 2 cardiac rehabilitation gave beneficial effect in improvement of exercise capacity in worsening anxiety and depresion patients after open-heart surgery.
Cardiovascular rehabilitation - determinants of long-term outcomes
Authors: Santos Fonseca J , Simoes Oliveira C , Martins A M , Garcia A B , Abrantes A , Gregorio C , Raposo M , Roxo D , Ramalhinho M , Poupino J , Alves M , Cunha N , Aguiar-Ricardo I , Pinto F , Abreu A 
Published: June 2024

Abstract

Introduction
Recent clinical evidence reinforces cardiac rehabilitation as a cornerstone for patient recovery and improvement after a serious cardiovascular event. Therefore it’s important to study what are the measures with the highest impact on outcomes.

Purpose
To study determinants of long-term success in cardiovascular rehabilitation.

Methods
A retrospective study in patients involved in a cardiovascular rehabilitation program at a tertiary hospital from 2013 to 2023. The main endpoint of major events was a composite of: hospital admission, hospital admission due to cardiac disease, re-infarction, death and death from cardiac causes. Statistical analysis was conducted using dedicated statistical software.

Results
This study involved 446 patients, the majority were male (80.5%) and the average age was 60.5 ± 11.5 years [28; 90]. Patients were followed, on average, for 30.5 ± 21.2 months [1.2; 109.3].
In terms of comorbidities: 72.2% had dyslipidemia, 72.1% hypertension, 26.4% diabetes, 15.3% atrial fibrillation, 13.0% pulmonary disease, 5.9% chronic kidney disease (CKD); and 31.2% were smokers.
The average initial values for: body mass index was 27.6 ± 4.3 Kg/m2, low density lipoprotein (LDL) was 88.8 ± 41.8 mg/dL, glycated hemoglobin was 6.1 ± 1.1%.
Overall, patients attended 13.3 ± 4.3 sessions (92.1 ± 12.2% of the target).
Fifty four (12.1%) patients reached the composite endpoint; 44 (9.9%) were admitted to the hospital, 26 (5.8%) of which due to cardiovascular disease; 4 (0.9%) had a re-infarction; 17 (3.8%) died, 9 (2.0%) of which due to a cardiac cause. Mean time to reach the composite endpoint was 6.3 ± 3.3 months.
The major determinants of the composite endpoint were: being a smoker at baseline (p = 0.009), number of coronary arteries affected (p = 0.027), CKD (p = 0.023), peripheral artery disease (PAD) (p = 0.005), LDL at follow-up (FU) (p = 0.050), final arm strength (p = 0.021), final metabolic equivalent of task (MET) (p = 0.010), and initial end-tidal carbon dioxide pressure (EtCO2) (p = 0.045).

Conclusion
In this study, it was possible to identify initial smoker status, number of coronary arteries affected, CKD, PAD, LDL level at FU, final arm strength, final MET and initial EtCO2 as determinants of cardiovascular rehabilitation success.
Smoking plays a pivotal role in cardiac diseases, making it mandatory to address it in a preemptive way; lipid lowering measures must be taken aggressively and programs ought to include activities to improve a patient's physical conditioning.
Beneficial effects of music listening during treadmill exercise in coronary artery disease patients with a history of percutaneous coronary intervention
Authors: Dritsas A , Laoutaris I D , Iakovou I 
Published: June 2024

Abstract

Background
Music has been shown to potently reduce the perception of fatigue and exertion through dissociation and distraction during exercise. Listening to music prior to and during exercise has been shown to increase motivation and effort, leading to improved performance outcomes.

Purpose
To study the effects of music listening on clinical, ECG and hemodynamic indices measured during exercise in patients (pts) with documented coronary artery disease (CAD) and a history of percutaneous coronary intervention (PCI).

Methods
Thirty two asymptomatic pts (29M/3F) with CAD and a history of previous PCI (12-36 months) were studied during follow-up treadmill exercise test (Bruce Protocol). All pts maintained good LV function assessed by standard echocardiography. Sixteen pts consisting music group (MG) (mean age 60±9) were openly exposed to instrumental classical music delivered during exercise via high quality audio system connected to speakers. Another group of 16 pts (NMG) (mean age 59±8) was not exposed to music during exercise and acted as a control group. All pts were assessed according to standard hemodynamic and ECG measurements obtained during exercise testing in CAD pts. All pts were asked post-exercise to indicate levels of anxiety-stress felt during the procedure on a Visual Analogue Scale (VAS) (range 0-10 cm).

Results
All pts achieved &gt;85% of their max predicted heart rate and no pt developed angina symptoms during the test. ST-T segment exercise ECG abnormalities were detected in 4(25%) pts in MG compared to 5(31%) pts in NMG group (p=ns). Twelve (81%) pts in MG and 13 (87%) in NMG group were on a b-blocker during the test. Exercise duration was longer in MG (9.4±1.6 min) compared to NMG (8.0±1.2 min) (p=0.009). In addition, VAS score was lower in M (4.8±1.8 cm) vs NM group (6.2±1.3 cm) (p=0.017) indicating a reduced level of perceived anxiety-stress in MG .

Conclusion
Music listening improves exercise tolerance during treadmill exercise in pts with CAD and history of PCI. This improvement may be related to a reduction in the perception of anxiety induced by music listening on exercise. Music may be a useful tool to achieve maximal performance and optimize exercise testing diagnosis in cardiovascular pts.
Genetic background determines the severity of age-dependent cardiac structural abnormalities and arrhythmia susceptibility in Scn5a-1798insD mice
Authors: Marchal Gerard A , Rivaud Mathilde R , Wolswinkel Rianne , Basso Cristina , van Veen Toon A B , Bezzina Connie R , Remme Carol Ann 
Published: June 2024

Abstract

Aims
Patients with mutations in SCN5A encoding NaV1.5 often display variable severity of electrical and structural alterations, but the underlying mechanisms are not fully elucidated. We here investigate the combined modulatory effect of genetic background and age on disease severity in the Scn5a1798insD/+ mouse model.

Methods and results
In vivo electrocardiogram and echocardiograms, ex vivo electrical and optical mapping, and histological analyses were performed in adult (2–7 months) and aged (8–28 months) wild-type (WT) and Scn5a1798insD/+ (mutant, MUT) mice from the FVB/N and 129P2 inbred strains. Atrio-ventricular (AV) conduction, ventricular conduction, and ventricular repolarization are modulated by strain, genotype, and age. An aging effect was present in MUT mice, with aged MUT mice of both strains showing prolonged QRS interval and right ventricular (RV) conduction slowing. 129P2-MUT mice were severely affected, with adult and aged 129P2-MUT mice displaying AV and ventricular conduction slowing, prolonged repolarization, and spontaneous arrhythmias. In addition, the 129P2 strain appeared particularly susceptible to age-dependent electrical, functional, and structural alterations including RV conduction slowing, reduced left ventricular (LV) ejection fraction, RV dilatation, and myocardial fibrosis as compared to FVB/N mice. Overall, aged 129P2-MUT mice displayed the most severe conduction defects, RV dilatation, and myocardial fibrosis, in addition to the highest frequency of spontaneous arrhythmia and inducible arrhythmias.

Conclusion
Genetic background and age both modulate disease severity in Scn5a1798insD/+ mice and hence may explain, at least in part, the variable disease expressivity observed in patients with SCN5A mutations. Age- and genetic background–dependent development of cardiac structural alterations furthermore impacts arrhythmia risk. Our findings therefore emphasize the importance of continued assessment of cardiac structure and function in patients carrying SCN5A mutations.
Implementation of cardiac enhanced recovery after surgery at Lausanne University Hospital, our roadbook to certification
Authors: Ltaief Zied , Verdugo-Marchese Mario , Carel Dan , Gunga Ziyad , Nowacka Anna , Melly Valentine , Addor Valerie , Botteau Caroline , Hennemann Marius , Lavanchy Luc , Kirsch Matthias , Rancati Valentina 
Published: June 2024

Abstract

OBJECTIVES
Enhanced recovery after surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing healthcare costs. Initially developed for colorectal surgery, ERAS principles have been successfully applied across various surgical specialties, including cardiac surgery. This study outlines the implementation and certification process of the ERAS program in a tertiary cardiac surgical centre within the Heart-Vessel Department at Lausanne University Hospital.

METHODS
The implementation involved forming a multidisciplinary team, including cardiac surgeons, anaesthesiologists, intensivists, a cardiologist, clinical nurse specialists and physiotherapists. The ERAS nurse coordinator played a central role in organizing meetings, promoting the program, developing protocols, and collecting data. The certification process required adherence to ERAS guidelines, structured training and external evaluation. Key phases included pre-ERAS data collection, protocol dissemination, inclusion of the 1st patients, followed by analysis and full implementation.

RESULTS
Achieving certification required maintaining a compliance rate of over 70% with established protocols. The process involved overcoming various barriers, such as inconsistent practices and the need for multidisciplinary collaboration. In this paper, we provide some solutions to these challenges, including team education, regular meetings and continuous feedback loops. Preliminary data from the initial cohort showed improvements in early mobilization, opioid use, respiratory complications and shorter hospital stays.

CONCLUSIONS
The successful implementation of the ERAS program at our institution demonstrates the feasibility and benefits of a structured, multidisciplinary approach in cardiac surgery. Continuous self-assessment and adherence to guidelines are essential for sustained improvement in patient outcomes and healthcare efficiency.