bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship of puberty onset and blood pressure in children: a cross-lagged panel analysis
Authors: Quispe-Haro C , Pikhart H , Bobak M , Ksinan A J 
Published: June 2024

Abstract

Background
The difficulties to assess the blood pressure (BP) during young ages have led to the underdiagnose of hypertension. As the long-term consequences of children hypertension seem detrimental for the cardiovascular health, the study of risk factors of hypertension in children and adolescents is urgently needed. Evidence suggests that characteristics of puberty onset—measured as menarche, puberal growth, or voice break—are associated with the increase in BP, however, a full evaluation of the puberal maturation measured with Tanner stages remain underexplored. Onset of puberty at early ages could be associated with increased risk of hypertension, however, body mass index (BMI) seems to have a confounding effect.

Aim
We aim to estimate the longitudinal effect of Tanner stages and BMI on BP.

Methods
We used a cohort of 1,504 children (52% males) assessed at ages 11, 13 and 15. Puberty development was rated using the Tanner scale, as pediatricians rated from one to five the presence of pubic hair for both genders, the size of the breasts among girls, and the size of genitals among boys, with the resulting scale a sum of scores for both genders. The systolic and diastolic BP were measured at each visit and standardized for age, sex, and height and transformed into percentiles. The z-scores of BMI were estimated using individuals’ weight, height, age, and sex. A cross-lagged panel model and maximum likelihood with missing values were used to estimate the causal effect of Tanner stages and BMI on BP.

Results
After controlling for BMI, we found that higher Tanner stage at ages 11 and 13 was not statistically significantly associated with an increase in systolic BP at ages 13 and 15, respectively. However, one standard deviation (SD) increase in BMI at age 11 predicted a subsequent increase of 0.09 SD (95%CI: 0.02 to 0.17) in systolic BP at age 13, and one SD increase in BMI at age 13 predicted a 0.09 SD (0.01 to 0.16) increase in systolic BP at age 15. We had similar findings when we used diastolic BP as outcome: only BMI at age 11 was significantly associated with increased diastolic BP at age 13 (0.13, 0.05 to 0.20).

Conclusion
Our findings suggest that the increase in the Tanner stage was not causally associated with an increase in BP. Like adults, BMI is a potential target for the prevention of hypertension in children. More evidence is needed to explore common causes of children's hypertension and early puberty.
Sex-specific differences in exercise-based rehabilitation of patients with Post-COVID-19 Syndrome
Authors: Schmitz B , Garbsch R , Schaefer H , Kotewitsch M , Mooren J , Waranski M , Teschler M , Vereckei K A , Boell G , Mooren F C 
Published: June 2024

Abstract

Background
Post-COVID-19 Syndrome (PCS) involves multiple lead symptoms, including reduced physical performance, fatigue, dyspnea, cognitive impairment, and psychological distress. While it has been shown that exercise-based rehabilitation in PCS is effective, sex-specific differences are underreported.

Purpose
To compare the effects of exercise-based rehabilitation on pulmonary function, cardiopulmonary exercise capacity, and health-related outcomes in long-term female and male PCS patients.

Methods
A prospective cohort study was performed with PCS patients attending center-based rehabilitation. Cardiopulmonary exercise testing (CPET) and spirometry were conducted at admission and before discharge. Questionnaires were used to assess health-related quality of life, fatigue, wellbeing, and workability for up to 6 months.

Results
145 patients (women, n=52 [36%]) with a mean age of 50.2 ± 10.7 years (women, 47.1 ± 12.7 years; men, 52.0 ± 9.1 years; p=0.018) were referred to rehabilitation 262.0 ± 128.8 days (women, 285.5 ± 140.6 days; men, 248.8 ± 112.0 days; p=0.110) after acute infection. Diagnosed lead symptoms were fatigue/exercise intolerance (81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%). Men presented with lower relative baseline exercise capacity (68.8 ± 13.3%) compared to women (82.0 ± 14.3%, p&lt;0.001), but female PCS patients showed greater improvement in submaximal workload (p=0.026). By contrast, men exhibited higher values for FEV1/VC, MEF, and PEF and lower VC at baseline (p≤0.038), while FEV1/VC showed greater improvements in women (p=0.027). Higher fatigue and lower wellbeing were detected in women at baseline which correlated with impaired pulmonary function (p&lt;0.05). Disease perception including fatigue, health-related quality of life, wellbeing and workability improved for up to six-month after rehabilitation.

Conclusions
Exercise-based rehabilitation improves pulmonary function, cardiopulmonary fitness, and disease burden in women and men with long-term PCS. While women with PCS may benefit from intensified respiratory muscle training, rehabilitation in men with PCS should set a strong focus on physical exercise training. Clinical assessment for all PCS patients should include CPET and pulmonary function tests and assessments of fatigue to document limitations and tailor therapeutical strategies.
Increased nation-wide uptake after establishment of comprehensive outpatient cardiac centres in Slovenia: an interrupted time-series
Authors: Jug B , Furlan T , Ravnikar T , Farkas Lainscak J , Lainscak M , Novakovic M , Dosenovic Bonca P , Fras Z 
Published: June 2024

Abstract
Dedicated centres providing outpatient comprehensive cardiac rehabilitation (CR) programmes were established in seven (out of 15) Slovenian regional hospitals between 2017 and 2020. Implementation encompassed referral pathways, CR centre accreditation, and full reimbursement for mandatory programme content (initial and end-of-programme assessment, exercise training, risk factor and secondary prevention management, patient education and psychosocial support). In the present analysis, we sought to assess the impact of dedicated CR centres initiation on nation-wide CR uptake in patients with myocardial infarction.
Data on patients hospitalised for myocardial infarction in Slovenia between 2015 and 2021 were retrospectively obtained from the Health Insurance Institute of Slovenia by linking the national hospital database and CR reimbursement claims. The impact of CR centres set-up on nation-wide CR uptake (monthly aggregated proportion of eligible patients attending CR, as ) was assessed by interrupted time series analysis with segmented regression.
Of the 11,815 eligible patients, 3,819 (32.3%) attended CR. Comprehensive outpatient CR programmes initiation in 2017 was associated with a 9.7% [95%CI 6.3, 13.1] increase in level and 0.41% per month [95%CI 0.22, 0.6] increase in trend of nation-wide CR uptake, which was partially reversed by the coronavirus pandemic outbreak (–7.2% [95%CI –13.8, –0.6] drop in level). See Figure.
In conclusion, systematic initiation of comprehensive regional outpatient CR programmes increased nation-wide CR uptake (which was, however, partially reversed by the coronavirus pandemic).
Rehabilitation programs in the recovery treatment of patients who have suffered an acute coronary syndrome with chronic heart failure and iron deficiency
Authors: Nesterak R , Nesterak R V , Sovtus V I , Vakalyuk I P , Babliuk L A , Hryhoryshyn R S , Barchyk Y V 
Published: June 2024

Abstract
An important aspect of the recovery treatment of patients who suffer from acute coronary syndrome is the prevention of the development of chronic heart failure along with iron deficiency.
The academic paper aimed to study the effectiveness of rehabilitation programs for chronic ischemic heart failure with iron deficiency within the recovery period after acute coronary syndrome.
We examined 145 patients with chronic heart failure and iron deficiency 3–6 months after acute coronary syndrome, including 74 patients after percutaneous coronary intervention and 71 patients with conservative treatment of acute coronary syndrome. Fifty-two patients with iron deficiency underwent an original recovery treatment program, which included physical training, dosed exercises, diet therapy, and psychological monitoring. Medicinal support included the use of ferric carboxymaltose. Fifty-six patients entered the control group.
We evaluated clinical signs of coronary heart disease and chronic heart failure, indicators of exercise tolerance test, dynamics of tolerance to physical exertion, indicators of echocardiography, and questionnaires on the quality of life. The blood level indicators of iron, ferritin, transferrin saturation of iron, fibronectin, glutathione peroxidase, glutathione reductase, and glutathione transferase were analysed.
The results we have come out to. Controlled use of rehabilitation programs was accompanied by a reduction in clinical signs of heart failure, improvement in quality of life indicators and tolerance to physical exertion. The indicator of the 6-minute test increased from 185.40±15.40 m to 324.90±18.4 m; the emission fraction increased from 47.8±1.4% to 52.5±1.9% under the conditions of reducing the volume indicators of the left ventricle. Along with this, we noted an improvement in the function of iron transport with the correction of the transferrin saturation with iron and the ferritin level.
Conclusions: The use of complex rehabilitation programs in the recovery period after acute coronary syndrome with chronic heart failure and iron deficiency prevents the progression of post-infarction dilatation and remodelling of the heart's left ventricle, contributes to the correction of iron deficiency, increases tolerance to physical exertion, and improves the quality of life of patients.
Comparative performance of mortality prediction using different reference value equations for peak oxygen uptake in cardiopulmonary exercise testing
Authors: Braga F , Milani M , Magalhaes J , Facio M R , Domecg F , Paiva J , Monteiro A , Moraes G , Fonseca B , Milani J G P O , Cipriano Junior G 
Published: June 2024

Abstract

Background
Cardiorespiratory fitness (CRF) is a well-established health indicator with significant prognostic value for all-cause mortality. Peak oxygen uptake (VO2peak) measured through cardiopulmonary exercise testing (CPET) is considered the gold standard method. As VO2peak is influenced by sex and age, it is compared to reference standards, and the percent-predicted value achieved (%VO2peak) is considered a more reliable indicator for individual assessment. However, various reference value equations for VO2peak exist, demonstrating international heterogeneity. Additionally, the new Brazilian prediction equation (BE) has not been evaluated for prognostic performance, and the cut-off value for risk stratification remains unknown.

Purpose
To compare the predictive performance for mortality stratification of three VO2peak reference value equations: Wasserman[1], FRIEND[2], and the Brazilian equation[3].

Methods
A cohort of patients underwent CPET at a private center in Rio de Janeiro state, Brazil, between May 2018 and January 2023. Survival status was determined using death certificates. CRF was assessed by %VO2peak for each prediction equation. Prognostic performances were evaluated using the area under the curve (AUC) of the receiver operating characteristic curve (ROC). The standard error of AUC was calculated using the method of Hanley & McNeil. The optimal cut-off point for %VO2peak in each reference value equation was determined based on the ROC curve's ideal combination of sensitivity and specificity for predicting mortality.

Results
A total of 2,684 individuals (62.4% men; 52.9 ± 14.5 years) were included, with a median follow-up of 451 days (IQR = 422). During this period, 31 deaths (1.15%) were identified. The AUC was 0.812 (95%CI: 0.743 - 0.882) for Wasserman, 0.796 (95% CI: 0.710 - 0.882) for FRIEND, and 0.753 (95% CI: 0.661 - 0.846) for Brazilian equation. The AUC for Wasserman was significantly higher than that of Brazilian equation (p = 0.018). No differences were observed between Wasserman and FRIEND, and between FRIEND and Brazilian equation. The optimal cut-off points were: %VO2peak ≤ 84% [Sens: 80.7%; Spec: 69.4%) for Wasserman; %VO2peak ≤ 82% [Sens: 77.4%; Spec: 57.3%] for FRIEND; and %VO2peak ≤ 76% [Sens = 80.7%; Spec = 57.75%] for Brazilian equation.

Conclusions
In this sample, all reference value equations demonstrated good performance in predicting mortality. The Brazilian equation, although developed for treadmill assessment, exhibited similar accuracy to the FRIEND equation and slightly lower accuracy than Wasserman's equation. The lower cut-off value for the Brazilian equation may be attributed to ergometer specificity, as reference value are generally higher for treadmills.
Cardiopulmonary exercise testing in correlation with magnetic resonance imaging in patients with cardiac amyloidosis
Authors: Ermolaev N , Willixhofer R , Kronberger C , Rettl R , Binder C , Duca F , Nitsche C , Poledniscek M , Gregshammer B , Ahmadi-Fazel D , Kammerlander A , Kastner J , Bergler-Klein J , Badr-Eslam R 
Published: June 2024

Abstract

Introduction
Cardiac magnetic resonance imaging (cMRI) stands as a crucial non-invasive diagnostic tool for monitoring disease progression in individuals with cardiac amyloidosis (CA). Limited functional capacity (FC), assessed by cardiopulmonary exercise testing (CPET) has been described in CA in several studies. The aim of this study was to identify potential concurrent relationships between the two diagnostic modalities.

Methods
112 patients diagnosed with cardiac amyloidosis (CA) were evaluated. Patients were aged 77 ± 7 years with 86% being male. Each participant underwent both cMRI and CPET under best medical therapy and prior to initiation of disease specific therapy.

Results
A mean peak oxygen consumption (VO2) of 15 ± 4 ml/kg×min, with a physical performance of 80 ± 29 watts, a ventilation to carbon dioxide relationship (VE/VCO2) slope of 39 ± 8, and a peak oxygen pulse (O2 pulse) of 11 ± 4 ml/beat were assessed. Furthermore, on cMRI, left ventricle ejection fraction (LVEF) with a mean of 49 ± 12 %, a left ventricular stroke volume (LVSV) of 85 ± 26 ml and a right ventricle ejection fraction (RVEF) of 46 ± 12 % were obtained.
Pearson correlation showed a significant correlation between peak VO2 and LVEF (r = 0.421, P-value &lt; 0.001). Further, a significant correlation was observed between the peak O2 pulse and LVSV (r = 0.411, P-value &lt; 0.001). Moreover, correlations were established between RVEF and both measures of physical performance (r = 0.473, P-value &lt; 0.001) and VE/VCO2 Slope (r = 0.415, P-value &lt; 0.001), as demonstrated in Table 1.

Conclusions
The assessed correlations between CPET variables and cMRI parameters suggest that CPET may serve as a valuable method for assessing the prognosis and diagnosis of CA. Table 1
Impact of left ventricular ejection fraction on cognitive function in chronic heart failure: insights from key-prognostic CPET parameters
Authors: Besnier F , Gagnon C , Berube B , Sellier F , Vachon F , Iglesies-Grau J , Gayda M , Dionne V , Benhalima H , Nigam A , Juneau M , L'allier P , Bouabdallaoui N , Rouleau J L , Bherer L 
Published: June 2024

Abstract

Background
Cognitive impairment is a common comorbidity in chronic heart failure patients (CHF) that negatively affects prognosis. Previous studies reported that higher cardiorespiratory fitness (VO2peak), measured with a cardiopulmonary exercise stress test (CPET), is associated with better cognitive performance in CHF. The impact of reduced or preserved left ventricular ejection fraction (LVEF) and the cardiorespiratory parameters during exercise on cognition remain to be studied.

Objectives
To compare cognition 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 key-prognostic CPET parameters predict cognitive performance in each CHF subtype.

Methods
68 patients with CHF (67±8 years old) performed a CPET (VO2peak, VE/VCO2 slope, Myers score. All have significant prognostic value). Cognitive assessment included global cognition (Montreal Cognitive Assessment for general cognition; MoCA), processing speed and executive function (Stroop) and memory (Rey auditory verbal learning test). LVEF was measured by echocardiography.

Results
Mean LVEF were 32.7±6.2% and 52.6±6.8% for R-LVEF and N-LVEF (p&lt;0.001). Age, NYHA class, VO2peak, VE/VCO2 slope, and Myers’ CPET score were similar between groups (p&gt;0.05). After adjusting for age, sex, and education, MoCA scores were not statistically different between groups (23.5±4.6 vs 25.3±2.9 p=0.24 respectively for R-LVEF and N-LVEF). The Stroop switching task revealed a significantly lower performance in R-LVEF vs N-LVEF (89.7±32.1s vs 74.4±16.4s, p=0.028), as well as at the fifth repetition of the verbal learning test (9.3±2.8 vs 11.1±2.2, p=0.015). A trend was observed for the immediate recall on the memory task (6.4±3.5 vs 8.3±3.1 p=0.061). Simple linear regressions showed that VO2peak (mL.kg.min) (R=0.50, p&lt;0.001), VE/VCO2 slope (R=-0.33, p=0.024), and Myers CPET score (R=-0.43, p=0.003) significantly predicted MoCA score in R-LVEF but not in N-LVEF. VO2peak (mL.kg.min) (R= -0.47 p=0.001), VE/VCO2 slope (R= -0.37 p=0.015), and Myers’ CPET score (R= 0.32 p=0.034) predicted Stroop switching performance in R-LVEF only.

Conclusion
Global cognition, executive function (switching), and verbal memory (encoding) were lower in CHF with reduced LVEF versus those with mildly reduced/normal LVEF despite similar key-prognostic CPET parameters. Key-prognostic CPET parameters predicted global cognition and executive function in CHF participants with reduced LVEF. Future studies are needed to better understand cognitive deficits in CHF and potential intervention to mitigate their impact in patient’s quality of life.
Longitudinal insights into coronary plaque amongst master athletes
Authors: Fyyaz S , Merghani A , Al-Turaihi S , Chatrath N , Bhatia R , Maclachlan H , Finocchiaro G , Papatheodorou S , Parry-Williams G , David S , O'driscoll J , Papadakis M , Alfakih K , Sharma S 
Published: June 2024

Abstract

Introduction
Cross-sectional studies of master athletes with a low risk atherosclerotic risk profile demonstrate a greater prevalence of high coronary artery calcium (CAC) scores, coronary plaque and luminal stenoses than matched controls. We sought to assess the progression of coronary disease amongst an ostensibly fit cohort of lifelong athletes compared with controls.

Methods
72 male master-athletes and 24 controls of similar age without cardiovascular risk factors at baseline underwent evaluation with health questionnaire, cardiopulmonary exercise testing (CPET) and computed tomography coronary angiography (CTCA) with CAC score at baseline and at 8 year follow-up. Athletes were required to continue running at least 10km/week.
CTCA was interpreted in accordance with established guidelines assessing luminal stenosis severity and plaque morphology (i.e. calcified, mixed or non-calcified). CAC was calculated using the Agatston method and adjusted for age and sex. A 3-vessel plaque score was calculated based on the coexisting presence of any plaque in the LAD, LCX or RCA irrespective of severity.

Results
Athletes remained well matched with respect to cardiovascular risk factors at follow-up, weighed significantly less, had higher HDL cholesterol, and achieved significantly greater CPET metrics with respect to maximum workload, peak VO2 and % predicted peak VO2 (p&lt;0.001). Athletes were more likely to demonstrate a peak systolic blood pressure exceeding 220mmHg on exercise than controls.
There were no significant differences between athletes and controls with respect to CAC scores, proximal or 3-vessel plaque at baseline or follow-up. Albeit only athletes demonstrated CACS &gt;300 and 400 AU and luminal stenoses &gt;50% at baseline. Amongst athletes, 80% of plaques were of calcified at baseline versus 20% in controls (p&lt;0.001). The dominant plaque morphology in controls was mixed plaque (67%).
At follow-up, athletes demonstrated a similar proportion of calcific and mixed plaque accounting for 48% and 43% of plaques respectively. However, controls continue to demonstrate significantly more mixed-morphology plaque (67%, p=0.027).

Discussion
Plaque composition amongst athletes changes with increasing age with an increasing prevalence of mixed plaque compared with calcific plaque at baseline, whereas the relative proportion of plaques amongst control subjects remained stable. This may suggest exercise induces plaque stabilising effects which is progressively offset with increasing age. Further longitudinal studies are required to understand cardiovascular event rates relative to plaque composition in athletes. Table. Plaque composition.
Prevalence of arterial (pre-)hypertension and white coat hypertension in competitive athletes according to the classification of the ESC vs. JNC guidelines of arterial hypertension
Authors: Bierschneider E , Schmidt T , Vassiliadis A , Zacher J , Riemer L , Predel H G 
Published: June 2024

Abstract

Background
Arterial hypertension (aHT) is the most common risk factor for cardiovascular disease in competitive sports. The exact prevalence of aHT and prehypertension (preHT) in the cohort of high-performance athletes is unclear due to an often insufficiently standardized measurement methodology and different threshold definitions (ESC vs. JNC). Furthermore, the prevalence of white coat hypertension is unknown.

Methods
Retrospective analysis (n=302, f=39%; 19.8±4.9 years old) of sports medical examinations at one of the Olympic Training Centres in Germany. Detailed information of the athletes’ population can be found in Table 1. Arterial blood pressure values obtained by standardized blood pressure measurement were analysed at 4 different times: At rest (RR1), in the resting phase before the start of bicycle ergometry (RR2), at 100 watts (RR3) and at maximum exertion (RR4). The classification into the categories normotensive, prehypertensive and hypertensive was based on the respective definitions of the ESC and JNC.

Results
The prevalence of aHT in RR1 was high and differed significantly depending on the guideline definition (32%ESC vs. 69%JNC, p&lt;0.001). The further course showed, however, that in the majority of cases aHT could no longer be confirmed in RR2 (20/95ESC and 84/208JNC with aHT in RR2). The observed white coat hypertension was significantly more common in male athletes (m=45.2%ESC vs. f=27.2%ESC, p&lt;0.001). During the exercise test (RR3), only 10 athletes (6%) were still abnormal (≥ 180mmHg systolic). The measured values of preHT were similar (RR1: 29.1% ESC vs. 18.5% JNC; preHT not confirmed in RR2 at: 67/88ESC vs. 41/56JNC). White coat hypertension was present here regardless of gender (m=62.5%ESC vs. f=59.4%ESC). Further results and the relation to the different sports can be seen in Fig. 1.

Conclusion
The prevalence of aHT varied considerably, depending on the respective guideline classification, measurement setting and gender. In competitive athletes the office measurement (RR1) frequently led to false-positive elevated BP values. By changing the measurement setting (RR2), the prevalence of aHT decreased significantly indicating a high number of white coat hypertension in RR1. These results reflect the current diverse study situation on the prevalence of aHT and illustrate the difficulty to make a generally valid statement on this basis. A standardized measurement methodology as well as the consideration of gender and the different guideline classifications are necessary to define the prevalence of aHT in the cohort of athletes. Further studies are requested.