bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimising screening of intermediate to high-risk asymptomatic sportsmen with exercise electrocardiogram
Authors: Hupin D , Oriol M , Laukkanen J A , Roche F 
Published: June 2024

Abstract

Aims
The importance of exercise electrocardiogram (ECG) is still controversial in the prevention of cardiovascular events among sportsmen. The aim of this study was to assess the relevance of exercise ECG as a screening tool for cardiovascular events when any cardiovascular disease (CVD) risk factors are present.

Methods
The study included leisure time asymptomatic sportsmen evaluated from 2011 to 2016 in a university hospital. Major adverse cardiovascular events (MACE) and atrial fibrillation were collected at 3 years.

Results
Of the cohort of 2457 sportsmen (mean age 50.2 ± 9.4 years), 50 (2%) had a high risk SCORE2. A total of 256 exercise ECGs (10%) were defined as positive, most of them due to silent myocardial ischemia (SMI) (n = 196; 8%). These 196 SMI cases led to 33 coronary angiograms (1%), which revealed 23 significant coronary stenoses requiring revascularization. In multivariate logistic regression analysis, having at least 2 CVD risk factors was independently associated with (1) positive exercise ECG [OR=1.80 (CI 95%: 1.29-2.52), p=0.0006], with (2) suspected SMI [OR=2.57 (CI 95%: 1.10-6.02), p=0.0304], with (3) confirmed SMI [OR=8.20 (CI 95%: 3.46-19.46), p&lt;0.0001] and with (4) cardiovascular events (MACE or atrial fibrillation) [OR=6.95 (CI 95%: 3.49-13.81), p&lt;0.0001] at 3 years.

Conclusions
The study supports the European recommendations for the use of exercise ECG in evaluation of asymptomatic leisure time sportsmen. Having at least 2 CVD risk factors was the best predictors for presence of coronary artery stenosis that may increase the risk for adverse events.
Left ventricular filling pressure correlates with exercise capacity during exercise stress test in cardiovascular disease patients
Authors: Satoto H H , Widiastuti A Z 
Published: June 2024

Abstract

Background
Cardiovascular disease patients with lower exercise capacity have higher risks for cardiovascular mortality and outcomes. Diastolic dysfunction is also correlated with cardiovascular mortality. E/e’ is one of the diastolic dysfunction parameters and it showed left ventricular filling pressure. The previous study showed that diastolic dysfunction correlates with decreased exercise capacity, but not left ventricular ejection fraction.

Purpose
This study aims to determine the relationship between left ventricular filling pressure using E/e’ and exercise capacity in cardiovascular disease patients.

Methods
Cardiovascular patients who underwent exercise stress tests and echocardiography at our hospital in 2022 – 2023 were enrolled in this study. We assessed diastolic dysfunction using E/e’ parameter during the echocardiography examination. We used predicted METs from Bruce protocols treadmill test time to determine each patient’s exercise capacity.

Results
There were 282 patients (Age 54+10 years; 74.8% male; 71.3% with chronic coronary syndrome, 22% with chronic heart failure, 6.7% with hypertensive heart disease). The mean E/e’ was 9.33+3.36 and the mean exercise capacity was 6.3+2.2 METs. Left ventricular filling pressure had a significant negative weak correlation with predicted exercise capacity (r=-0.228; p=0.000) in cardiovascular disease patients. We performed receiver operating characteristic analysis that showed the area under the curve for E/e’ was 8 and found the exercise capacity cut-off was 6 METs. Patients with E/e’ more than 8 were likely to have exercise capacity less than 6 METs (OR= 1.75 (95% CI, 1.07 – 2.84) p=0.032).

Conclusions
There is a correlation between high left ventricular filling pressure and lower exercise capacity. In cardiovascular disease, patients with higher left ventricular filling pressure were likely to have lower exercise capacity.
Impact of long-term endurance sport on the association between atrial fibrillation and mortality. a prospective cohort study
Authors: Johansen K , Hylen Ranhoff A , Sorensen E S , Heitmann K A , Lochen M L , Morseth B , Myrstad M 
Published: June 2024

Abstract

Introduction
Endurance athletes live longer than non-athletes, however, a high prevalence of atrial fibrillation (AF) has been documented in this population, suggesting that vigorous endurance exercise promotes AF. Moreover, AF is associated with increased mortality in the general population, but it is unclear whether this association is attenuated in athletes. Thus, we aimed to explore the association between AF and mortality in a cohort of veteran endurance athletes and non-athletes.

Method
All 658 veteran endurance athletes aged ≥65 years who completed a 54-kilometer cross-country ski race in 2009/-10 were invited to attend a prospective cohort study. Furthermore, a cohort of non-athletes of the same age attending a population-based study in 2007/-08 was included for comparison. AF and covariates were self-reported with a questionnaire while all-cause mortality was available through linkage with national registries. Athletes also reported prevalence of AF and cardiovascular disease on a follow-up questionnaire in 2014 and 2020, while non-athletes did the same in 2015-2016. Participants with AF were followed from the time they reported AF until death or end of follow-up (participants without AF followed from baseline survey). We analyzed the association between AF and mortality overall and in analyses stratified by athlete status. Cox proportional hazards models (adjusted for age, sex, body mass index, education, smoking, antihypertensive medication, cardiovascular disease and diabetes) were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI).

Result
We included 549 (AF: n=152) athletes (women: n=46) and 3242 (AF: n=469) non-athletes (women: n=1375) (median age: 70, range: 65-92). Athletes annually participated in a 54 km long-distance ski race (median years of participation: 14, range: 1 – 53). Among athletes (n=62) and non-athletes (n=339) with AF, 41 and 72%, respectively, reported at least one concomitant cardiovascular risk factor. During a mean follow-up of 10.9 ± 3.3 years, 20 (13.6%) athletes and 184 (39.2%) non-athletes with AF died. AF was associated with an overall increased risk of mortality (HR: 1.52, 95% CI: 1.28-1.80). We observed no interaction between AF and athlete status (P=.679). In stratified analyses the magnitude of the association with AF was similar for athletes (HR: 1.58, 95% CI: 0.89 – 2.80) and non-athletes (HR: 1.53, 95% CI: 1.28 – 1.84).

Conclusion
Although long-term endurance sport practice is associated with improved survival, the relative increase in mortality associated with AF was not diminished in athletes. Thus, our findings suggest that AF may be a risk marker for mortality, also in an ostensibly healthy cohort of veteran endurance athletes.
Exploring the role of genetics in a family screening program
Authors: Abela M , Debattista J , Scerri J , Felice T , Grech V , Scerri C 
Published: June 2024

Abstract

Introduction
Genetic testing plays a key role in the management of inherited cardiac conditions (ICCs). Personalized medicine in cardiology has evolved substantially, with guidelines now recommending genetic testing in patients with ICC for phenotypic characterisation and risk stratification. It plays a central role in predictive testing, especially in relatives with concealed phenotypes.

Study objective
The main objective of this study is to explore the clinical manifestations and outcomes of gene positive (G+) versus gene negative (G-) family members, complimenting a national cardiac screening program in adolescents.

Methodology
As part of a large nationwide cardiac screening program in adolescents (BEAT-IT), probands with a pre-clinical and clinical phenotype suggestive of an ICC were enrolled into a family screening program. A comprehensive clinical evaluation that also included genetic testing and counselling was offered to these probands. Mutations were classified according to the ACMG criteria. G+ probands included those with a hot variant of unknown significance, likely or definite pathogenic mutation. Relatives were then grouped according to the proband’s genotype (G+/G-).

Results
Eighteen probands (n=1 HCM, n=1 LQTS, n=16 pre-clinical) from the BEAT-IT program were included. A fourth (27.8%) were G+ (n=2 MYH7, n=1 MYBPC3, n=1 ACTC1, n=1 KCNQ1).
Their families were subsequently offered family screening, 87 relatives gave consent to a screen (58.6% female, mean age at evaluation 40.5 ± 17.1 years, 100% Caucasian, 62.1% first degree relatives). A minority (n=3, 3.4%) reported symptoms. A few (n=11, 12.6%) were &lt;18 years at the first evaluation.
Most relatives were in the G- group (n=51, 58.6%). Relatives of G+ probands were more often referred (44.4% vs 9.8%, p&lt;0.001). The presence of an abnormal ECG was also more frequent (36.1% vs 9.8%, p=-0.006). The presence of a definite/possible ICC on echocardiography was also more likely in G+ families (14.3% vs 0.0%, p=0.014).
Most relatives were G- (n=70, 80.5%). The ECG was more frequently abnormal in G+ relatives (n=12/17 [70.6%] vs n=6/70 [8.6%], p&lt;0.001). All relatives given a diagnosis were G+ (n=10, 27.8%) (n=7 LQTS, n=2 HCM, n=1 DCM). Most (n=9, 90.0%) needed lifestyle advice, medical therapy, or a cardiac intervention.
In the U18 group (n=11), 3 (27.3%) needed referral (n=2 (18.2%) abnormal ECG, n=1 (9.1%) LQTS diagnosis).

Conclusion
G+ relatives were more likely to be referred and/or given a clinical diagnosis. In the presence of an appropriate infrastructure, phenotyping pre-clinical probands with genetic testing may help identify family members harbouring a pre-clinical or clinical phenotype.
Endurance training protects the heart during maximal exercise in long-distance runners
Authors: Kocic A , Ristanovic L J , Macura M , Mirkovic S , Seman S , Ilic V , Labudovic D , Mrdakovic V , Jakovljevic S , Okwose N , Stojiljkovic S , Jakovljevic D 
Published: June 2024

Abstract

Introduction
Cardiac function (cardiac output) and oxygen extraction (arterio-venous O2 difference) are key physiological determinants of maximal oxygen consumption and endurance performance.

Purpose
The aim of the study was to determine differences in maximal cardiac function represented by cardiac output and cardiac power output and oxygen extraction represented by arterio-venous O2 difference between long-distance runners and age- and gender-matched healthy individuals.

Methods
In a prospective observational study, 63 healthy males were recruited: 47 long-distance (half- and full-marathon) runners (aged 32.6 ± 8.6 years, body mass index 23.4 ± 2.2 kg/m²) and 16 healthy untrained individuals (control group, aged 30.9 ± 11.2 years, body mass index 24.8 ± 2.4 kg/m²). All participants underwent maximal graded cardiopulmonary exercise stress seting using an electromagnetic cycle ergometer with simultanous monitoring of metabolic (gas exchange) and hemodynamic (bioreactance) measurements. Cardiac power output, expressed in watts, as a measure of overall function and pumping capability of the heart, was determined as the product between cardiac output and mean arterial blood pressure. Oxygen extraction (arterio-venous O2 difference) was calculated as the ratio between O2 consumption and cardiac output.

Results
Maximal O2 consumption was significantly lower in the control group compared to runners (absolute values, 3.44 ± 1.12 vs. 3.99 ± 0.52 L/min, p &lt; 0.01; and relative values, 45.3 ± 16.4 vs. 53.6 ± 6.9 ml/kg/min, p &lt; 0.01). However, maximal cardiac output and cardiac power output were significantly higher in the control group compared to runners (21.4 ± 3.9 vs. 18.7 ± 3.0 L/min, p = 0.02; 5.94 ± 1.35 vs. 5.01 ± 1.00 watts, p = 0.01). Maximal stroke volume was significantly higher in control group compared to runners (126 ± 28 vs. 109 ± 21 ml/beat, p = 0.04), whereas maximal heart rate was not significantly different betwen the groups (174 ± 12 vs. 177 ± 22 beats/min, p = 0.70). Arterio-venous O2 difference was significantly higher in runners compared to control group (21.6 ± 3.7 vs. 14.5 ± 3.6 mlO2/100 ml blood, p &lt; 0.01).

Conclusion
During maximal exercise stress testing long-distance runners demonstrate higher cardiorespiratory fitness and oxygen extraction but lower cardiac output and cardiac power output compared to untrained indivuduals. Ability to extract and utilise more oxygen at lower cardiac output during maximal physiogical stress suggests cardiac protective role of endurance training in long-distance runners.
Distribution of cardiovascular risk severity among Egyptian patients with established cardiovascular diseases
Authors: Francis V F , Elshamy S L , Mahgoub A , Shelbaya K , Zarif B 
Published: June 2024

Abstract

Background
The Secondary Manifestations of Arterial Disease (SMART) risk score was recommended by the European Society of Cardiology (ESC) to estimate a 10-year risk for myocardial infarction, stroke, or vascular death in individual patients with clinically manifested atherosclerotic vascular disease (ASCVD).(1) An updated SMART2 algorithm was developed and recalibrated according to the population risks in the different world regions except for Africa. The expected-observed ratio of recurrent ASCVD in the very high-risk region of the SMART2 study was 0.2.(2).

Purpose
Describe the calculated 10-year risk using the SMART score, and the prevalence of contributing risk factors among a sample of Egyptian patients with ASCVD.

Methods
Cross-sectional study included 180 consecutive patients diagnosed with ASCVD and had their first follow-up visit at the Egyptian National Heart Institute. The ESC- certified SMART score web application was used to calculate the estimated 10-year risk of future CV events. The population mean option was used for CRP and serum creatinine as they were not available at the follow-up. All patients were diagnosed within a short duration before the follow-up visit (i.e. 0 years since the first event).

Results
The median and IQR of 10-year risk, using SMART were 17.5 (14-24)%. The percentage of patients who had calculated risk &lt;15% and ≥ 30% were 23% and 13%, respectively. Patients with calculated risk ≥ 30 tend to be older and have more prevalent hypertension, diabetes, and previous statin. Risk factors prevalence and lipid profile medians were elevated in the total study sample (Table).

Conclusion
The calculated risk of recurrent ASCVD among Egyptian patients using the conventional SMART score is beneficial for the individual relative risk assessment but may not reflect the absolute risk among the Egyptian population who have more prevalent risk factors. Large cohort studies are needed in Egypt and other African countries to recalibrate the calculated risk of recurrent ASCVD.
The value of pregnancy-related factors in the prediction of cardiovascular disease and hypertension: a systematic review
Authors: Yang Z , Van Os H , Kist J , Vos R , Vos H , Chavannes N , Petrus A 
Published: June 2024

Abstract

Background/Introduction
Commonly used prediction models for CVD do not consider female-specific risk factors and tend to underestimate the cardiovascular risk in women. Pregnancy-related factors are associated with an increased risk of CVD, hence may improve the performance of prediction models for CVD. Hypertension is one of the most important risk factors for CVD, therefore could be regarded as an intermediate cardiovascular outcome.

Purpose
This study aims to provide an overview of prediction models for CVD and hypertension which included pregnancy-related factors as predictors, and to evaluate the impact of these factors on the model performance.

Methods
PubMed and Embase were searched until March 30, 2023. Studies were eligible for inclusion if they i) reported on the development or validation of at least one multivariable model predicting CVD and hypertension in women, ii) were based on a population-based sample of either only parous women or a combination of nulliparous and parous women, iii) included at least one pregnancy-related factor, iv) were available as full-text publications, and v) were originally written in English. The risk of bias was assessed using the prediction model risk of bias assessment tool (PROBAST).

Results
Seven studies reporting on the development of prediction models for CVD with pregnancy-related factor(s) were included. No models with hypertension as outcome were found. The C-indices of all models ranged between 0.63 and 0.79. In the six studies comparing models with and without pregnancy-related factors, the C-index difference was statistically significant in four studies (point estimate ranging from 0.0033-0.004). The net reclassification improvement for events and non-events was statistically significant in two studies (point estimate: 0.01-0.038) and three studies (point estimate: 0.002-0.02) respectively. The integrated discrimination improvement was statistically significant in three studies (point estimate: 0.0002-0.0013). Only two studies showed low risk of bias and low concern regarding applicability. Subgroup analysis for different age groups were performed in three studies, indicating that prediction models with pregnancy-related factors perform better in younger women.

Conclusion(s)
The addition of pregnancy-related factors results in limited improvements in model performance for the prediction of CVD. Given that improvements appear more pronounced in younger women, pregnancy-related factors may improve prediction especially in women directly after pregnancy. More research should focus on using hypertension as outcome in this group of women, because it requires shorter follow-up to reveal possible cardiovascular risk in an early stage.
Improved sex-specific cardiovascular disease risk prediction using machine learning and explainable artificial intelligence
Authors: Bye A , Wiig-Fisketjon A , De Martin Topranin V , Dalen H , Langaas M 
Published: June 2024

Abstract

Aims
Several risk prediction models are available for determining the 10-year risk of cardiovascular disease (CVD), including the Norwegian NORRISK 2 model. However, the existing models explain only a modest proportion of the incidence. Therefore, this study aimed to develop improved models for predicting the 10-year risk of myocardial infarction (MI) for both sexes.

Methods
Data from 31,946 participants without prior CVD were analyzed. The data set was divided into a training set (for estimation) and a test set (for model evaluation). Prediction models were developed on the training set for each sex using XGBoost and logistic regression, using 96 (men) and 100 (women) variables. The models were evaluated on the test set using Receiver-Operating-Characteristic (ROC) and Precision-Recall (PR) curves. Age and sex-specific thresholds for intervention were explored through cross-validation on the training set. Model performance was compared to the NORRISK 2 model using the test set.

Results
The XGBoost model improved CVD risk prediction for men across all age groups (AUCROC for XGBoost and NORRISK 2, respectively, 0.72 and 0.65 (age 45-54), 0.63 and 0.62 (age 55-64), 0.69 and 0.62 (age 65-74)). For women, NORRISK2 performed better than XGBoost in ROC curve evaluation. However, XGBoost were superior to NORRISK2 when evaluated by PR-curves in women aged 55-64 (PR-AUC for XGBoost and NORRISK 2, respectively, 0.20 and 0.12 compared to 0.06 for a no-skills model). Potential new risk predictors, such as alkaline phosphatase (ALP) for men and thyroid stimulation hormone (TSH) for women, were identified. The results also indicate that the thresholds for intervention should be sex specific.

Conclusion
By employing machine learning and incorporating sex-specific risk factors, we propose improved risk prediction models for CVD, particularly in men. Introducing sex-specific thresholds for intervention could enhance CVD prevention for both women and men.
Prevention of life threating arrythmias in relatives of cardiac arrest survivors; results of family cascade screening in a representative cohort in Czech Republic
Authors: Krebsova A , Kutilkova E , Votypka P , Peldova P , Haskova J , Segetova M , Peichl P , Adamova M , Tavacova T , Macek M , Janousek J , Kautzner J 
Published: June 2024

Abstract

Background
Cardiac arrest (CA) is often the very first sign of an inherited cardiomyopathy or arrhythmic syndrome. The detailed cardiogenetic work up in CA survivors may contribute to individualized therapy in patients and lead to prevention of life threating arrythmias in their relatives.

Purpose
To assess the molecular architecture of non-ischemic CA in a representative cohort in Czech Republic and test the effectiveness of a family cascade screening.

Patients and Methods
Between 2013 and 2023 we ascertained 221 non ischemic SCA survivors (137 M / 84 F), age at cardiac arrest 36±16 years. The initial clinical diagnosis in SCA were mostly idiopathic ventricular fibrillation (iVF 120 – 54%), followed by cardiomyopathy or arrhythmic syndrome. Genetic counselling and next generation sequencing of 100 – 5500 genes (Sophia Genetics, Switzerland) were performed. The family cascade screening was carried out in 514 (2,3 per case) relatives, in order to detect their risk of the disease.

Results
Very likely or certain molecular aetiology (i.e. based on presence of ACMG.net Class 4 to 5 variants) was disclosed in 60/221 (27%) of CASs. Most frequently identified genes were PKP2 (12/60 cases), RYR2 (7/60), KCNH2 (7/60) and SCN5A (7/60). Clinical and/or genetic diagnosis of inherited condition was detected in 134/514 (26%) relatives, where 30/134 were already under medical care for heart failure and/or ventricular arrhythmia of unknown aetiology. ICD was implanted in 3 cases after careful risk stratification.

Conclusion
Relatives of Czech CASs have mostly interest in family cascade screening. It led to identification of potentially lethal condition in 26% of them and allowed so the prevention of cardiac arrest. Our results further underline a role of genetic analysis in diagnostic work up in non-ischemic cardiac arrest and even in iVF as cause of cardiac arrest.