bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial micro-alternation index (MMI) does not associate with the ischemic response in coronary artery disease patients
Authors: Tiksnadi B B , Putra A P , Ikhsani R , Tarsidin N F 
Published: June 2024

Abstract

Background
ECG dispersion mapping (ECG-DM) was one of non-invasive parameters to observe micro-electrical changes in the ECG signal. This was assessed using the Myocardial Micro-alternation Index (MMI), whose reflect abnormalities in the myocardium at a metabolic level, indicating ischemia, based on small-invasive test. Until now there has been no study that specifically examines the ischemic response to MMI in the coronary artery disease (CAD) population. Finding ischemic with treadmill test still frequently performed in our daily practice due to lack availability and feasibility of imaging test, and somehow the specificity of the test is moderately-high and similar with imaging test.

Purpose
Aim to determine the association between Myocardial Micro-alternation Index (MMI) and the ischemic response in CAD patients.

Methods
This was a cross-sectional observational study done in Tertiary General Hospital. Subjects included were 18-79 years old patients who were hospitalized with CAD in 6 months to 2 years prior, either because of acute coronary syndrome or underwent elective revascularization procedures (primary coronary intervention/PCI or coronary artery bypass graft/CABG). All patients were assessed for ECG dispersion mapping with 3-minute recordings. The ECG dispersion mapping was analyzed by the system and reported as MMI. Ischemic response was obtained for treadmill test results with maximal test or symptom limited protocol. Positive or suggestive ischemic response was defined by ST-depression more than 0.05 mv if downslope or horizontal, or 0.1mv if upsloping, in minimal two leads and in three consecutive beats.

Results
Among 68 patients included in this study, two was excluded due to inability to perform exercise test. Form 66 patients, 58 (87.9%) were men and the mean age was 57 ± 10.2 years. The median of MMI was 18 (1-61)%. Twenty-four patients (36.4%) had a positive or suggestive ischemic response, while the rest was negative. The median of MMI in positive ischemic was 18 (1-52)% and in the negative ischemic response was 18 (14-61)%. The Mann-Whitney analysis showed that there were no associations between MMI and ischemic response (p 0.707).

Conclusion(s)
There are no associations between Myocardial micro-alternans index with ischemic response in patients with chronic stable coronary artery disease patients. The utility of MMI to predict ischemia might need imaging test to confirm. ECG Positive Ischemic Response MMI Picture
The role of intracoronary physiology measurements and acetylcholine provocation testing in patients with INOCA. First data from Latvia
Authors: Vitola B , Trusinskis K , Mintale I , Erglis A 
Published: June 2024

Abstract

Introduction
For diagnosis of exact INOCA endotype the invasive measurements of coronary flow reserve (CFR), index of microvascular resistance (IMR), which both represents the microvascular function, and acetylcholine (ACH) provocation test to diagnose vasospasm is mandatory.

Purpose
To perform the intracoronary physiological testing, including measurements of CFR, IMR and ACH provocation test for defining the INOCA endotypes – microvascular angina (MVA), vasospastic angina (VSA), microvascular spasm (MVS), or combination of them.

Methods
The invasive examination was performed in a single University Hospital from March 2023 till December 2023 in patients presented with cardiac symptoms, significant ischemic signs at exercise ECG test and non-obstructed epicardial coronary arteries during invasive or computed tomography coronary angiography (epicardial stenosis less than 50% and/or fractional flow reserve (FFR) &gt;0.80). The criteria for MVA were CFR ≤ 2.5 and IMR ≥ 25. The VSA was assessed if significant (&gt;90%) vasospasm occurred during ACH provocation test with subsequent ischemic signs in ECG and chest pain during the test. In patients presented with the ischemic signs in ECG and chest pain during the ACH provocation test, without vasospasm – the MVS was defined.

Results
Invasive functional testing was performed for 20 patients. 15 patients (75.0%) were women. The mean age of the patients was 59.9 ± 9.4 years. The most common cardiac symptoms were chest pain (18, 90.0%), dyspnea (15, 75.0%), fatigue (14, 70.0%), headache (8, 40.0%) and excessive sweating (6, 30.0%). 3 (15.0%) patients were current or ex-smokers. Dyslipidemia was present in 20 (100.0%), arterial hypertension in 17 (85.0%) and type 2 Diabetes mellitus (T2DM) in 3 (15.0%) patients. In 8 (40.0%) patients the somatoform autonomic dysfunction was suggested as a primary diagnosis after the first tests.
3 patients (15.0%) showed normal values of all measurements. 8 (40.0%) patients were diagnosed with MVA, 6 (30.0%) with VSA, MVS was assessed in 1 (5.0%) patient and the combination of MVA and VSA was observed in 2 (10.0%) cases.

Conclusion
The first clinical data of INOCA diagnostics of patients in Latvia are very promising since the amount of INOCA patients is high. The patients are underdiagnosed and remains symptomatic without tailored medical treatment, emphasizing that every INOCA endotype requires different treatment. More clinical evidence will be needed to routinely adapt coronary function testing during invasive management.
Colchicine additional effect on atrial fibrillation onset prevention in patients with chronic coronary diseases, depending on the level of non-high-density lipoprotein cholesterol
Authors: Malidze D , Jojua N , Gognadze T , Noniashvili M , Hamza M 
Published: June 2024

Abstract

Introduction
Colchicine may be beneficial for decreasing the incidence of AF in post-cardiac surgery and post-pulmonary vein ablation patients but may not decrease the incidence of AF in patients with coronary artery disease.
The purpose was to learn, whether colchicine is effective in maintaining sinus rhythm in patients with high risk on atrial fibrillation incidence, with coronary artery disease, considering patients Non-HDL cholesterol level.

Materials and methods
A total 114 patients with a high risk of developing AF by the FIND-AF algorithm underwent randomization by 2 groups. The group A, 62 patients with high non HDL cholesterol ≥160 mg/dl and the group B, 52 patients with low level non HDL cholesterol &lt;160 mg/dl. The group A patients were divided into 2 subgroups, group 1A, 32 patients were assigned to the colchicine in a low dose (0.5 mg per day), and 30 patients - Group 1B, non-colchicine group, also group 2 was divided by two group, group 2A, 28 patient assigned to the low dose colchicine and group 2B, 24 patient not receiving colchicine. The groups did not differ significantly in terms of baseline significant comorbidities, treatment and age. The primary endpoint was incidence of AF episode &gt; 30 second during a 6-month period. Data were analyzed using IBM SPSS version 20. P &lt; 0.05 was considered statistically significant.

Results
in Group 1A there were significantly low rate of AF onset, then in Group 1B, 4 (12.52%) versus 9 (33.33%), without colchicine, respectively; p = 0.016), As in group 2 A, and 2B, the rates of AF onset were not significantly differentiated from each other’s, 5(17.85 %) with colchicine group versus 5 (20.83 %) without colchicine, respectively; p=0.181.

Conclusion
The effect of colchicine on reducing AF in patients with chronic coronary artery disease is not neutral on all patients. In patients category with high non-HDL level ≥160 mg/dl - colchicine treatment was associated with significantly lower AF incidence. colchicine 1A1B 2a2b colchicine
Usefulness of cognitive assessment in the prediction of documented atrial fibrillation and ischaemic stroke: a cross-sectional study
Authors: Pal T , Baba D F , Preg Z , Nemes-Nagy E , German-Sallo M 
Published: June 2024

Abstract

Background/Introduction
Atrial fibrillation (AF) is sometimes detected when thromboembolic events occur, commonly ischaemic stroke (IS). In patients with AF, the prevalence of cognitive dysfunction (CD) is higher, independently from IS.

Purpose
Evaluating the usefulness of cognitive evaluation and the CHA2DS2-VASc score for the prediction of documented AF and IS.

Methods
In this cross-sectional retrospective study, we included 469 patients with cardiovascular diseases. Between December 2016 and November 2019, all patients completed two cognitive tests during hospitalization. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were used. The associations between cognitive test scores (standard and optimal cut-off values) and AF/IS were analyzed by logistic regression. We determined the area under the curve (AUC) of CD tests and optimal cut-off values using the receiver operating characteristic curves and the maximum Youden index.

Results
We found a significant association between the standard MoCA cut-off value for CD (&lt;26 points) and the presence of documented AF (OR: 1.83, 95% CI: 1.11-3.01, p= 0.0174) and IS (OR: 2.09, 95% CI: 1.04-4.22, p= 0.0379). The standard MMSE score of &lt;24 points was a risk factor for the presence of a previous IS (OR: 2.43, 95% CI: 1.3-4.53, p= 0.0051). For the prediction of documented AF, the optimal cut-off score was &lt;26 for MoCA and &lt;28 points for MMSE. For MoCA, the optimal cut-off was &lt;23 points in the prediction of IS and &lt;28 points for MMSE. The determined CHA2DS2-VASc cut-off score for AF was &gt;3 points and for IS &gt;5 points. The receiver operating characteristic curve analyses showed non-inferiority between CD tests and CHA2DS2-VASc score in anticipating documented episodes of AF and were superior to CHA2DS2-VASc score in the prediction of a previous IS (MoCA: AUC dif: 0.128; p= 0.0110, MMSE: AUC dif: 0.130, p= 0.0084).

Conclusions
In this study, we demonstrated that the MoCA and MMSE tests can detect the presence of documented AF and IS. Risk factors for AF were MoCA &lt;26 points and MMSE &lt;28 points while for IS MoCA &lt;23 points and MMSE &lt;28 points. In patients who present cognitive impairment AF screening may be appropriate.
Impact of a mobile health-based disease management program on coronary risk factors among chronic ischemic heart disease holders
Authors: Miki T , Yamada J , Ishida S , Sakui D , Kanai M , Hagiwara Y 
Published: June 2024

Abstract

Background
Ischemic Heart Disease (IHD) is a leading global cause of death. Management often involves controlling factors such as low-density lipoprotein (LDL) cholesterol.[1] In recent years, mobile health (mHealth) technologies have significantly impacted chronic disease management, offering novel, personalized healthcare approaches.[2] These technologies enable continuous monitoring and real-time interventions, making them particularly suitable for managing conditions like IHD. mHealth has become integral to modern healthcare, especially for long-term conditions, due to its ability to provide personalized care and enhance patient engagement. While there is growing evidence of mHealth's efficacy in cardiac failure and other aspects of cardiovascular health, studies focusing specifically on LDL cholesterol as a primary outcome in the context of IHD are limited. Previous studies have focused primarily on the acute phase.[3] Furthermore, it's recognized that mHealth's success often hinges on the inclusion of professional guidance and feedback, which enhances its effectiveness.[2]

Purpose
This study investigates the effectiveness of a Mobile Health-Based Disease Management Program in reducing LDL cholesterol in individuals with chronic IHD.

Methods
In this retrospective study, IHD patients participated in a Mobile Health-Based Disease Management Program from December 2018 to October 2022. The program involved bi-weekly phone consultations, app-based monitoring, and regular physician updates over 6 months. The primary measure was the change in LDL cholesterol levels, with secondary outcomes including body weight, HDL cholesterol, triglycerides, HbA1c, uric acid, blood pressure, salt intake, and sleep duration. Effectiveness was evaluated using paired t-tests, with analyses conducted in R software.

Results
Of the 266 participants, results included a significant reduction in LDL cholesterol levels from an average of 98.82 (SD 40.92) to 86.62 (SD 39.86) mg/dL. Other health indicators also improved: average body weight dropped from 77.51 (SD 17.53) to 72.39 (SD 19.84) kg, and triglyceride levels decreased from 145.83 (SD 98.52) to 115.89 (SD 77.12) mg/dL. These results indicate a positive effect on overall metabolic health. Stratified analysis showed that participants with higher initial LDL levels experienced more substantial improvements in various health metrics.

Conclusion
This study demonstrates that the Mobile Health-Based Disease Management Program effectively lowered LDL cholesterol, particularly in individuals with higher initial levels, showcasing its potential in managing cardiovascular risk in chronic IHD. Future research should focus on the broader application and long-term sustainability of such programs.
Branched chain amino acids and physical activity in a sample of healthy, non-obese people
Authors: Liu K , Borreggine R , Gallart-Ayala H , Ivanisevic J , Marques-Vidal P 
Published: June 2024

Abstract

Background
Physical activity (PA) has been demonstrated to improve insulin sensitivity and reduce the risk of cardiovascular diseases. BCAA (branched chain amido acid) metabolism play a role in maintaining system energy homeostasis at rest and during activity, high BCAA levels being associated with an increased risk of cardiovascular disease (CVD) and diabetes. However, there is still limited research on the relationship between PA intensity and human plasma BCAA.

Aims
To assess the associations between BCAA (Valine, Leucine and Isoleucine) and PA in a somple of healthy, non-obese, middle-aged people.

Methods
Cross-sectional study using data from the CoLaus|PsyCoLaus study conducted in our city. BCAA concentrations were measured by stable isotope dilution liquid chromatography – mass spectrometry (LC-MS) assay. Time spent in PA was assessed by questionnaire and categorized into sedentary, light, moderate and vigorous intensity.

Results
On bivariate analysis, BCAA levels were significantly and positively associated with total energy expenditure and negatively with light PA and sleep time. Those findings were confirmed after multivariable analysis, a negative association between BCAA levels and duration of sleep, light and moderate PA, and a positive association between BCAA levels and total energy expenditure, sedentary behaviour and vigorous PA being observed (table).

Conclusion
sleep time, light and moderate intensity PA are negatively associated with BCAA, suggesting that the beneficial effects of PA on CVD could partly be mediated by decreases in BCAA levels. The unexpected positive association between total energy expenditure and vigorous PA with BCAA levels should be further explored.
Characteristics of Japanese patients with heart failure with sarcopenia - a study using cardiopulmonary exercise testing
Authors: Takeda S , Harada K , Mamiya K , Terashima S , Matsunaga S , Kataoka T , Harada K , Nagao T , Shinoda T , Yamada S , Murohara T 
Published: June 2024

Abstract

Background
Sarcopenia has been frequently associated with comorbidities among patients with heart failure; it probably contributes to their poor prognosis despite the pathophysiology of the relationship between these two conditions being unclear. Furthermore, there are insufficient data to evaluate sarcopenia in patients with heart failure using cardiopulmonary exercise testing (CPX).

Purpose
This study aimed to elucidate the clinical characteristics of patients with heart failure with sarcopenia using CPX.

Methods
We examined 635 Japanese patients (mean age 65 ± 13 years, 77% men) who were hospitalised for heart failure and could undergo cardiac rehabilitation between November 2014 and November 2021. Patients with severe heart failure for whom CPX testing was not feasible were excluded.
Blood testing, echocardiogram, physical performance measurement and CPX were performed during hospitalisation. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 criteria using handgrip strength, skeletal muscle mass and walking speed.
Oxygen uptake (VO2), carbon dioxide output (VCO2) and minute volume of ventilation (VE) were measured during CPX. The oxygen pulse at peak exercise (peak oxygen pulse) was calculated as peak VO2 divided by peak heart rate. The dead space to tidal volume ratio (minimum VD/VT), minimum ventilator equivalent for carbon dioxide (minimum VE/VCO2) and respiratory exchange ratio were measured using the single-breath analysis of carbon dioxide.

Results
Of the 635 patients, 54 (8.5%; 44 men) had sarcopenia complications; they were older, had a lower ejection fraction and higher B-type natriuretic peptide (BNP) levels than patients without sarcopenia (Table 1).
Multivariate analysis revealed that age (r = −0.062, p &lt; 0.01), BNP level (r = 0.110, p &lt; 0.01), peak VO2 (r = −0.016, p &lt; 0.01) and minimum VE/VCO2 (r = 0.011, p &lt; 0.01) were significantly associated with sarcopenia in patients with heart failure.
Logistic regression analysis indicated that peak VO2, peak oxygen pulse, minimum VD/VT and minimum VE/VCO2 were independently associated with sarcopenia complications (Table 2).

Conclusions
The CPX results demonstrated that patients with heart failure with sarcopenia had lower cardiac output and worse ventilation efficiency than those without sarcopenia, suggesting that sarcopenia complications further reduce cardiopulmonary function in patients with heart failure, which in turn contributes to the poor prognosis of the disease.
Acute effects of inspiratory muscle training on microcirculation in chronic heart failure patients
Authors: Katsoula C , Karatzanos E , Vasileiou I , Briasoulis A , Papadopoulou E , Kalampakos N , Dimopoulos S , Routsi C , Nanas S , Vasileiadis I 
Published: June 2024

Abstract

Introduction
Patients with chronic heart failure (CHF) have been presented with microcirculation alterations and vascular endothelial dysfunction. Exercise training programs, including inspiratory muscle training (IMT) as an alternative/additional means of exercise, have been shown to improve the functional status of these patients. However, there has not been much data on the acute effect of IMT on systemic microcirculation.

Purpose
The aim of this study was to investigate the acute effect of an IMT session on the microcirculation of non-exercising muscles (systemic effect) in CHF patients.

Method
Thirty-four (30♂/4♀) stable CHF patients [age: 61±9 years, EF: 34±8%, VO2peak: 17.5±4.0 ml/kg/min, NYHA class ≥II) participated in a single IMT session (5 sets/10 repetitions at 60% of maximum inspiratory pressure). Systemic microcirculation was assessed with near-infrared spectroscopy (NIRS) and the 3-min vascular occlusion technique at the thenar muscle, before and after the session. Variables evaluated were the basal tissue oxygen saturation (StO2), the oxygen consumption rate and the reperfusion rate. Values are in mean and standard deviation.

Results
After the IMT session, the reperfusion rate was increased (from 3.4±1.6 to 3.9±1.7 %/min, p=0.007). The oxygen consumption rate was also increased (from 12.7±3.8 to 13.2±3.9 %/min, p=0.021). Finally, the basal tissue oxygen saturation values tended to increase (from 85.5±6.4. to 84.7±6.2%, p=0.065), an alteration of not any clinical significance.

Conclusions
An IMT session had a beneficial effect on the systemic microcirculation of CHF patients, particularly on the reperfusion rate which reflects endothelial function.
Diagnostic performance of single-lead electrocardiograms for arterial hypertension diagnosis: a machine learning approach
Authors: Angelaki E , Barmparis G , Fragkiadakis K , Maragkoudakis S , Zacharis E , Plevritaki A , Malikides O , Kalomoirakis P , Lasithiotaki G , Vardas P , Kochiadakis G , Tsironis G , Marketou M 
Published: June 2024

Abstract

Background
Awareness and early identification of hypertension is among the most crucial components in reducing the burden of cardiovascular disease (CVD). Artificial intelligence-based analysis of electrocardiograms (ECGs) can improve diagnosis and patients’ management. ECG technology is now ubiquitous in smartwatches and other wearables and can record a single-lead ECG which is equivalent to lead I on a standard 12-lead ECG. Our aim was to develop machine learning (ML) algorithms to diagnose hypertension from single-lead ECGs.

Methods
We enrolled 1254 subjects (539 male, aged 60.22±12.46 years),with and without essential hypertension, and no indications of CVD. A 12-lead ECG of 10 seconds duration in resting position was performed on each subject using a digital electrocardiograph. A Random Forest (RF) was then trained on features derived only from lead I tracings.

Results
The RF model was able to distinguish hypertensive from normotensive subjects on a hold-out test set, with 81% accuracy, AUC/ROC 0.82, sensitivity 88%, and specificity 70% (both using a threshold of 0.5) using only features from lead I. Age, body mass index, the area under the T wave divided by the QRS complex area, the area under QRS segment adjusted for BMI, the QT corrected interval, and the PQ interval, were the most important anthropometric and ECG-derived features in terms of the success of our model (Figure 1).

Conclusions
This study demonstrates the promising potential of detecting an undiagnosed hypertension opportunistically, using a single-lead ECG. Our findings offer the opportunity to evolve innovative technologies to improve hypertension awareness at the community level.