bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise cardiac magnetic resonance imaging in heart failure with preserved ejection fraction
Authors: Zamani S K , Zaha V G , Sarma S , Macnamara J P , Wakeham D J , Hearon C M , Haykowsky M J , Levine B D , Nelson M D 
Published: June 2024

Abstract

Background
Exercise intolerance is the primary manifestation in heart failure with preserved ejection fraction (HFpEF); yet the pathophysiologic mechanism(s) remains incompletely understood. Exercise cardiac magnetic resonance imaging offers a unique opportunity to examine the cardiac response to simulated activities of daily living, with high spatial resolution, independent of body habitus.

Purpose
To compare the cardiac response to exercise in HFpEF and age-matched healthy controls.

Methods
Twenty-seven individuals with HFpEF (10 Males, BMI: 36 ± 7 kg/m2, age: 71 ± 7 years) and 21 age-matched healthy controls (10 Males, BMI: 27 ± 5 kg/m2, age: 68 ± 5 years) participated. Left ventricular (LV) volumes were assessed by the method of disks, using high-resolution short-axis cine imaging. Brachial artery blood pressure was measured using a brachial oscillometric cuff. Imaging was performed at rest and during supine cycle exercise at 30 Watts using an MRI-compatible ergometer. Control participants also completed a second bout of exercise at 40% of their upright maximum to mimic the average relative intensity that 30 Watts represented in the HFpEF group.

Results
The left ventricular response to exercise in HFpEF patients and age matched controls is summarized in Table 1. At the same absolute workload (i.e., 30 Watts), both groups demonstrated a similar rise in stroke volume and ejection fraction, which was primarily driven by an increase in end-diastolic volume. In contrast, when the control group exercised at a similar relative intensity (i.e., 40% maximum), the increase in stroke volume and ejection fraction was driven almost entirely by a reduction in end-systolic volume.

Conclusions
Taken together, these data provide novel insight into the cardiac response to supine exercise in HFpEF. That left ventricular end-systolic volume was reduced in control participants— but not HFpEF patients— when exercising at a similar relative intensity, highlights a potential cardiac limitation in HFpEF that warrants further investigation.
Safety and efficacy of antiplatelet cessation after transcatheter patent foramen ovale closure
Authors: Apostolos A , Papanikolaou A , Drakopoulou M , Trantalis G , Ktenopoulos N , Simopoulou C , Koliastasis L , Katsaros O , Karmpalioti M , Korovesis T , Vlachakis P , Kachrimanidis I , Aggeli C , Tsioufis C , Toutouzas K 
Published: June 2024

Abstract

Background
Recent large-scale randomized controlled clinical trials have substantiated the safety and efficacy of transcatheter patent foramen ovale (PFO) closure for secondary prevention in patients with a history of cryptogenic stroke. Both European and American guidelines advocate for tailoring with a single antiplatelet agent, either aspirin or clopidogrel, following a 3-6 month course of dual antiplatelet therapy (DAPT). However, the precise duration of single antiplatelet treatment remains uncertain, with varying viewpoints endorsing either lifelong administration or cessation after five years post-intervention with aspirin or clopidogrel following transcatheter PFO closure.

Purpose
The aim of our analysis is to explore the safety and efficacy of antiplatelet cessation after transcatheter patent foramen ovale closure.

Methods
Consecutively treated patients undergoing transcatheter PFO closure at a tertiary hospital were included in our analysis. We meticulously scrutinized baseline demographic details, comorbidities, and pharmaceutical characteristics. This analysis specifically includes patients who were not treated with any type of antithrombotic treatment—antiplatelet or anticoagulant—during follow-up.

Results
A total of twenty-two patients discontinued any antiplatelet agent after transcatheter PFO closure. The majority were female (N=12, 54%), with a mean age of 44.4 ± 6.7 years. Hypertension, dyslipidemia, and diabetes mellitus were present in 3 (13%), 5 (22%), and 3 (13%) patients, respectively. Following transcatheter PFO closure, all patients initially received antithrombotic therapy; however, only one patient did not continue with DAPT at discharge but treated with aspirin per se. The mean duration of DAPT was 4.1±2.5 months; nine patients (40%) continued their treatment with aspirin or clopidogrel after DAPT cessation for a mean duration of 7.7±4.8 months, while the remaining 13 (60%) discontinued the antiplatelet therapy. Over a mean follow-up of 1,026 ± 485 days, only one patient was presented with transient diplopia 985 days after the procedure, which resolved automatically. Subsequent magnetic resonance imaging revealed no new findings.

Conclusion
Our analysis suggests that antiplatelet cessation after PFO closure could be considered in patients without known additional cardiovascular risk factors. However, further validation through larger studies is imperative to solidify these findings and guide clinical decision-making.
Women-focused cardiac rehabilitation delivery around the world and program enablers to support broader implementation
Authors: Ghisi G L M , Supervia M , Turk-Adawi K , Beleigoli A , Contractor A , Mampuya W M , Grace S L 
Published: June 2024

Abstract

Background
Cardiovascular disease prevalence in women is high globally, which leads to a great burden of disability, and it is their leading cause of death. Cardiovascular rehabilitation (CR) is an outpatient model of secondary preventive care proven to mitigate this burden; however, significantly fewer women access CR than men, and those that do are less likely to complete the program. Accordingly, women-focused (W-F) models of CR have been developed, to better engage women and optimize their outcomes.

Purpose
The objectives of this study were to investigate: (1) the implementation of W-F CR by programs around the globe, (2) barriers to delivery of W-F CR, as well as (3) what they would want and need in order to apply the recommendations in their CR programs, particularly with regard to patient education and counselling.

Methods
In this cross-sectional study, a survey was administered to CR programs via REDCap from May-July/2023. Potential respondents were identified via the International Council of Cardiovascular Prevention and Rehabilitation’s (ICCPR) network.

Results
223 responses were received from 52/111 (46.8% country response rate) countries in the world with any CR, across all 6 World Health Organization regions. Thirty-three (14.8%) programs from 30 countries reported offering any W-F programming. Programs did commonly offer elements preferred by women and recommended, namely: patient choice of session time (n=151, 70.6%), informal care providers/partners invited to sessions (n=121, 57.1%), having CR staff with expertise in women and heart diseases (n=112, 53.3%), separate changerooms for women (n=38, 52.8%), and discussing CR referral with patients (n=112, 52.1%). Main barriers to delivery of W-F exercise were physical resources (n=33; 14.8%), space (n=30, 13.5%), as well as staff time (n=26, 11.7%) and expertise (n=33, 10.3%). Main barriers to delivery of W-F education were human resources (n=114, 51.1%), educational resources (n=26, 11.7%) and expertise in the content (n=74, 33.2%). Enablers of W-F education delivery were availability of materials, in multiple modalities, as well as educated staff, and financial resources.

Conclusions
Despite the benefits, W-F CR is not commonly offered globally. Considering the barriers and enablers identified, ICCPR is developing resources to expand delivery. Results from this survey will be used to support implementation of the W-F CR Guideline recommendations such as increasing exercise modality options and psychosocial counselling, and development of W-F educational resources. Map.
The effectiveness of antihypoxic and cardioprotective drug in the rehabilitation of patients with COVID-19 associated pneumonia
Authors: Bondarev S , Stulikova I , Nasrulaev M 
Published: June 2024

Abstract

Introduction
The ability to recover from SARS-CoV-2 depends on the patient's rehabilitation potential and the degree of hypoxia. The possibility of improving the effectiveness of rehabilitation in patients on medications with antihypoxic and cardioprotective properties is relevant and requires study.

Purpose
To study the effectiveness of rehabilitation in patients with COVID-19 pneumonia who were taking phosphocreatine sodium salt.

Material
46 patients 63±25 years old, including 26 men and 20 women, who underwent COVID-19 associated pneumonia with 60±10% lung damage and were discharged from the hospitals for infectious diseases 14.6±5 days ago. According to recommendations of the European Respiratory Society for the 2nd stage of SARS-CoV-2 rehabilitation from 2021, all patients also received breathing exercises and physical therapy. 15 patients, out of 46, received a phosphocreatine sodium 2 g per100mL of saline once per day for 10 days. The duration of the entire rehabilitation was 21 days. The following instrumental examinations were performed: 24-hour Holter ECG monitoring, spiroergometry, and spirometry. For functional assessment and monitoring of patients, the following scaled were used: Borg rating of perceived exertion for dyspnea and fatigue, Hospital Anxiety and Depression Scale (HADS), and the EQ-5D Health-Related Quality of Life Questionnaire.

Results
The following differences were obtained between groups 1 and 2: In group 1, the frequency of supraventricular rhythm disorders (premature supraventricular contractions (PSC) more often than 5000 per day and supraventricular tachycardia (SVT) or atrial tachycardia more than 5 complexes with a heart rate of 120-170 per minute) was 51±6%, whereas in group 2, 19± 5% (P&lt;0.05). The frequency of ventricular heart rhythm disturbances (premature ventricular contractions more than 5000 per day) in group 1 was 20±7%, whereas in group 2, 9±3 (P &lt;0.05). The workload increased from 2.2 ± 0.7 up to 4.1 ± 2.0 MET and from 2.2±0.5 to 5.2±1.2 MET in 1 and 2 groups accordingly. Rating of perceived exertion decreased from 9±2.8 to 4 ±1.4 points in 1 group and from 8.1±1.8 to 2±0.8 points in 2 group. The quality of life increased from 11±3.2 to 6±3.4 points and from 12±2.7 to 1.5±1.2 points. p&lt;0.05.
For the rest of the indicators, there was a positive trend. However, there were no significant differences between groups 1 and 2, p&gt;0.05. For groups 1 and 2, it was, respectively, tidal volume increased from 26±7.0 to 49±8.4 ml/kg, and from 25±6.0 to 52±6.5 ml/kg; anxiety decreased from 10±2 to 4±1.8 and from 10±1.0 to 2±2.0 points; depression decreased from 11±3.0 to 5±2.0 and from 11±0.5 to 4±2.0 points.

Conclusion
Drug with antihypoxic and cardioprotective properties can significantly increase the effectiveness of rehabilitation in patients with COVID-19, reduce the incidence of ventricular and supraventricular heart rhythm disorders, and increase the degree of physical recovery.
Effects of cardiac rehabilitation on the renal function in patients aged 75 years and older with moderate to severe renal dysfunction
Authors: Hama T , Amano K , Ushijima A , Ikari Y , Yoshimachi F 
Published: June 2024

Abstract

Background
As a conservative treatment is an option for end-stage renal failure patients aged 75 years and older in some countries around the world, an effective treatment for the renal function in patients of that age with moderate to severe renal dysfunction might be essential. Our previous study reported that cardiac rehabilitation (CR) improved the renal function in chronic kidney disease (CKD) patients using serum cystatin C (Scys). However, it is unknown whether CR has a favorable effect on the renal function in patients aged 75 years and older with moderate to severe renal dysfunction.

Methods
We conducted a retrospective cohort study of patients admitted to our hospital for evaluating and treating cardiovascular disease from April 2014 to June 2022. The subjects were patients who participated in our 3-month CR program with moderate to severe CKD (estimated glomerular filtration rate based on an Scys [eGFRcys]&lt;45 ml/min/1.73m²) at the beginning of the program. The controls were patients referred to the program but that did not participate. For both groups, patients with the Scys measured upon program referral and approximately 3 months after referral were selected. Dialysis patients were excluded. First, we compared whether there was a significant change in eGFRcys in each group, and then examined whether there was an interaction between the changes in the two groups. Second, to determine the association of any changes in the renal function due to the effects of the CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome.

Results
Out of 182 patients, there were 136 in the subject group and 46 in the control group. In the subject group, the eGFRcys improved (33.3±8.9 to 35.0±10.5 ml/min/1.73m², p=0.007), but it worsened in the control group (63.4±21.5 to 60.4±22.9 ml/min/1.73m², p=0.014) (Figure 1). There was a significant interaction between the two groups regarding the change in the eGFRcys (p&lt;0.001). The %ΔeGFRcys was larger among the patients that participated in CR (6.69% greater improvement in the %ΔeGFRcys/CR participation; 95% CI, 2.73-10.64%). This association remained significant after adjusting for potential confounders (6.75% greater improvement in the %ΔeGFRcys/CR participation; 95% CI, 1.62-11.88%).

Conclusion
CR might improve the renal function in patients aged 75 years and older with moderate to severe renal dysfunction.
Perception and use of relaxation techniques in cardiovascular disease patients two years after cardiac rehabilitation
Authors: Brito Da Silva H 
Published: June 2024

Abstract

Background
Current literature indicates that stress might accelerate the atherosclerotic process and precipitate the occurrence of cardiovascular events. (1-4) In the framework of risk factor management and secondary prevention, stress reduction through the instruction of relaxation techniques is a standard in Swiss cardiac rehabilitation (CR) institutions. (5) While a spectrum of techniques is applied and instructed, research regarding their impact on perceived quality of life and sustainability in cardiovascular disease (CVD) patients is scarce. (6-9).

Purpose
The objective of this research project was to detect the perceived impact of relaxation techniques on the self- reported quality of life and the stress levels of coronary artery disease patients who underwent cardiac rehabilitation. A further goal was to investigate the adherence of these patients to applying relaxation techniques on a regular basis two years after completing cardiac rehabilitation.
In a further step, the aim was to determine factors for an adequate adherence, in order to improve the instruction and use of relaxation techniques as a secondary prevention measure.

Methods
A semi-structured interview consisting of 10 questions was performed with 18 patients two years upon completion of an outpatient CR program at the Universitätsspital Zürich. The interviews were transcribed after the Kuckartz transcription criteria (10), deductively coded and analyzed with the help of artificial intelligence (AI) for qualitative data.

Results
Regarding the Quality of Life, factors as the ability to work, functional fitness, relationships with relatives and concerns regarding the state of health were reported as more impacting on the state of relaxation in all daily life than relaxation techniques themselves. However, the impact of relaxation techniques on acute stress showed a correlation with quality of life during the time of rehabilitation.
Although the majority of the participants perceived the impact of relaxation techniques on immediate Stress as moderate to high, only 47% of the interviewed reported to apply them regularly two years after the conclusion of cardiac rehabilitation and only 20% used the techniques that were instructed in the rehabilitation setting. Reasons given for the decay in adherence after rehabilitation were a low practicability and a lack in accompaniment and group dynamic, as well as the preference for alternative activities, such as spending time in nature or with relatives.

Conclusions
Although relaxation techniques are reported as moderately to highly impacting on immediate stress, their impact on quality of life is outweighed by other factors. Further, the adherence to a regular relaxation practice declines after CR. In order to improve adherence, patients need easy and practicable techniques and sustainable instruction. The option of a remote or in- person post- rehabilitation setting might be helpful in providing an accompaniment and group dynamic.
Validity of a non-linear heart rate variability index for intensity threshold determination in chronic heart failure patients
Authors: Sempere-Ruiz N , Fuertes-Kenneally L , Manresa-Rocamora A , Baladzhaeva S , Hernandez-Perez I , Blasco-Peris C , Sanz-Rocher A , Garcia-Alvarez M , Climent-Paya V , Sarabia J 
Published: June 2024

Abstract
Experiencing an increasing incidence, chronic heart failure (CHF) demands effective prevention and treatment. Aerobic exercise-based cardiac rehabilitation plays a vital role in managing these patients. However, diverse patient responses underscore the need for precision in intensity prescription. Heart rate variability (HRV), specifically the DFA a1 index, emerges as a cost-effective biomarker for exercise intensity distribution (Rogers et al., 2021a). Previous associations between HRV and ventilatory thresholds in CHF patients suggest its potential utility (Rogers et al., 2021b). This study aims to evaluate the agreement between ventilatory thresholds (VT1 and VT2) and HRV thresholds (HRVT1 and HRVT2) in male and female CHF patients during a cardiopulmonary exercise test. Seventeen males and ten females performed a symptom-limited incremental ramp test on a cycle ergometer. Ventilatory thresholds were determined using a mixed method, and HRV thresholds were calculated using DFA a1 values of 0.75 and 0.5 as the first and second thresholds, respectively. Statistical measures, including the Pearson’s r correlation coefficient, determination coefficient, and Bland-Altman plot with limits of agreement (LoAs), were employed to evaluate the agreement between these methods. Initial findings indicate that HRVT1 shows a non-significant, low positive correlation (r = .36) with VT1, with a determination coefficient of .13, and a mean bias of -5 bpm (LoAs from -35 to 25 bpm). Conversely, HRVT2 demonstrates a significant, strong positive correlation with VT2 (r = .78), presenting a determination coefficient of .62 and a mean bias of 6 bpm (LoAs from -16 to 28 bpm). This suggests promising potential validity for HRVT2 in estimating ventilatory thresholds. In conclusion, while HRVT1 requires further investigation in this population and caution is advised in its application, HRVT2 emerges as a compelling candidate, demonstrating good agreement with VT2 and suggesting its potential validity as a valuable tool for exercise intensity determination in CHF patients.
OUES and mortality in heart failure: a comparison of absolute and percent-predicted values across different equations
Authors: Silveira A D , Leopoldino G , Caceres R C , Garbin H I , Barros F C , Costa G D , Menegazzo W R , Saadi M P , Milani J G P O , Milani M 
Published: June 2024

Abstract

Background
The oxygen uptake efficiency slope (OUES) serves as a prognostic measure derived from cardiopulmonary exercise testing (CPET) in heart failure. Various equations are utilized as references to calculate predicted OUES (1,2). Recently, a new equation, specifically derived from a South American population, has been validated (3). Nevertheless, a comprehensive comparative analysis between mortality prediction in heart failure using the percent-predicted approach based on these equations and absolute values remains to be addressed.

Purpose
To investigate and compare mortality prediction in heart failure using the percent-predicted approach and absolute values of the oxygen uptake efficiency slope (OUES), incorporating Hollenberg (1), Buys (2) and Milani (3) equations.

Methods
This is a retrospective cohort study involving heart failure patients assessed at a tertiary university hospital from 2010 to 2022. All patients underwent symptom-limited maximal cardiopulmonary exercise testing (CPET) and regular follow-ups in a specialized outpatient clinic. The primary outcome was all-cause mortality. We performed a ROC curve analysis to compare the accuracy of the equations and absolute values and to determine the best cut-points. Cox proportional hazards regression was used to assess uni- and multivariate effects of different OUES metrics.

Results
A total of 1,219 patients were included, with 57% being male and a mean age of 55 ± 13 years. The median follow-up was 4.9 years (IQR 3.1 years), resulting in 157 deaths (13%). Ischemic heart disease was present in 31%, and the mean ejection fraction (EF) was 37 ± 15%. Based on EF classification, 66% had reduced EF, 10% had mildly reduced EF, and 24% had preserved EF. ROC curve analysis demonstrated similar accuracy for absolute values and all three equations (Figure 1). The overall model quality was 0.64 for Hollenberg and Buys equations, 0.63 for absolute values, and 0.62 for Milani equations. Absolute OUES had an unadjusted hazard ratio (HR) of 0.999, and percent-predicted OUES using Hollenberg had a HR of 0.973, Buys a HR of 0.967, and Milani a HR of 0.976 for death (P &lt; 0.001 for all comparisons). All comparisons remained significant after age and sex adjustment (P &lt; 0.001).

Conclusions
Our results demonstrate that the oxygen uptake efficiency slope (OUES), whether assessed through percent-predicted or absolute values, exhibits comparable accuracy in predicting mortality among heart failure patients. Distinct cut-offs were established for individual equations. The consistent significance of hazard ratios, even after adjustments for age and sex, underscores the robust prognostic value of OUES metrics. These findings highlight the potential of both OUES and percent-predicted OUES as valuable tools for mortality prediction in heart failure. ROC curve analysis.