bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambient temperature and risk of cardiovascular morbidity and mortality: a nationwide study of vulnerability factors
Authors: Achebak H , Rey G , Lloyd S , Quijal-Zamorano M , Mendez-Turrubiates R F , Ballester J 
Published: June 2024

Abstract

Background
Ambient temperature is a major environmental determinant of cardiovascular health. However, evidence on the association between temperature and cause-specific cardiovascular health outcomes is still limited. Moreover, little is known about the differential effects across population groups and the contextual factors that exacerbate or reduce vulnerability. A comprehensive assessment is therefore needed to fill this literature gap, and thus inform health adaptation policies to best tackle the negative health consequences of climate change in a context of accelerated rising temperatures and population ageing.

Purpose
We assessed the effect of temperature and temperature variability onto cause-specific mortality and emergency hospitalisations from cardiovascular causes of diseases in Spain, as well as the effect modification of this association by individual and contextual factors.

Methods
We collected data on health (hospital admissions and mortality), weather (temperature and relative humidity) and relevant contextual indicators for 48 Spanish provinces during 2004-2019. The statistical analysis was separately performed for the summer (June-September) and winter (December-March) months. We first applied a generalised linear regression model with quasi-Poisson distribution to estimate daily, short-term, province-specific temperature-lag-health associations, and then fitted multilevel multivariate meta-regression models to evaluate the effect modification of contextual factors on heat- and cold-related risks.

Results
Heat did not contribute to the risk of hospitalisation from cardiovascular diseases, but it considerably increased the risk of mortality, with the strongest effect for hypertension (relative risk [RR] at 99th temperature percentile: 1·510 [95% eCI 1·251 to 1·821]) and heart failure (1·528 [1·353 to 1·725]). We found significant risks related to cold for all cardiovascular causes, with heart failure (RR at 1st temperature percentile: 1·537 [1·329 to 1·779]) exhibiting the greatest risk for hospitalisation, and acute myocardial infarction (1·860 [1·546 to 2·238]) for mortality. Women and the elderly were more vulnerable to heat, while people with secondary education were less susceptible to cold compared to those not achieving this educational stage. Results from meta-regression showed that increasing heating access to the highest current provincial value (i.e. 95.6%) could reduce deaths due to cold by 59·5% (57·2 to 63·5).

Conclusions
Exposure to heat and cold was associated with a greater risk of morbidity and mortality from multiple cardiovascular conditions, and heating was the most effective societal adaptive measure to reduce cold-related mortality.
Association of nt-probnp and left ventricular ejection fraction and their utility as predictors of in-hospital mortality among heart failure patients admitted in a tertiary hospital in davao city
Authors: Paulino K , Faderan B S 
Published: June 2024

Abstract

Introduction
N-terminal brain natriuretic peptide (NT-proBNP) levels have been shown to be reliable in diagnosing heart failure. Studies have postulated higher NT-proBNP levels with lower left ventricular ejection fraction and higher in-hospital mortality, necessitating more aggressive interventions and management. This study describes the association between NT-proBNP and ejection fraction and their utility as predictors of in-hospital mortality.

Methods
We evaluated the medical records of patients admitted for heart failure between January 2021 and January 2023 in a tertiary hospital. Pearson-r was used to determine the association between NT-proBNP and ejection fraction. In-hospital mortality was assessed using logistic regression analysis and odds ratio for dichotomous variables.

Results
Of the 147 medical records reviewed, 53.74% were female, the mean age was 64.9 ± 13.5years with ages ranging from 24 to 90 years, average NT-proBNP levels were 5791.3 pg/mL ± 3779.1, and average left ventricular ejection fraction was 49.9% ± 15.1. No age (p=.315) and sex (p=.626) distribution difference was observed. Patients with a higher NT-proBNP quartile had significantly higher systolic (p=0.023) and diastolic blood pressure (p=0.015), worse NYHA functional class (p=0.000), higher creatinine levels (p=0.000), and prevalence of diabetes mellitus (p=0.014). There was a significant difference between the levels of ejection fraction across NT-proBNP quartiles (p&lt;0.03), mortality rates were higher across NT-proBNP quartiles, and NT-proBNP levels and ejection fraction were not predictors of mortality, but a worse NYHA functional class II and III predicted mortality.

Conclusion
High levels of NT-proBNP are linked to lower left ventricular ejection fraction and higher in-hospital mortality rates. In light of this study’s findings, we recommend NT-proBNP as part of the assessment for prediction of in-hospital mortality in heart failure patients.
Metabolomic clusters of new-onset heart failure in general population
Authors: Noordermeer D , Farzaneh A , Van Den Bosch A E , Ghanbari M , Kavousi M 
Published: June 2024

Abstract

Background
Heart failure (HF) is a heterogeneous disorder with sex-specific disease pathophysiology. Identifying metabolomic clusters underlying HF risk may provide insight into HF pathophysiology and prevention for men and women.

Purpose
We aimed to determine the potential of metabolomic profiling in predicting incident HF among community-dwelling men and women.

Methods
1,383 individuals (59% women) without a history of HF from a prospective population-based cohort had available data on 1,087 metabolites. After excluding unknown and highly-correlated (Spearman correlation &gt;0.90) metabolites, analysis was conducted using 765 metabolites. Initially, SHAP values were computed through repeated cross-validation of the XGBoost model to select the, sex-specific, metabolites for survival analyses. The selected metabolites were incorporated into Self-Organizing Maps, along with Kmeans methods, to perform sex-specific clustering, allowing for a nuanced exploration of distinct profiles of HF risk. Extracted distinct clusters were then characterized according to cardiovascular risk factors, echocardiographic, and electrographic variables.

Results
During a median follow-up of 10 years, 306 incident HF occurred. 56 metabolites in men and 46 metabolites in women were selected. The clustering algorithm resulted in three distinct clusters of low-, moderate-, and high-risk based on incident of HF. In men, the incidence rates per 1000 person-years were 15.9 for low-risk, 31.6 for moderate-risk, and 41.2 for high-risk clusters. For women, the corresponding rates were 13.3 for low-risk, 20.0 for moderate-risk, and 29.4 for high-risk clusters. The low-risk cluster in both men and women was characterized by a favorable cardiovascular profile. Men in the moderate-risk cluster exhibited poor cardiovascular profile, based on lower estimated glomerular filtration rate (eGFR), increased left ventricular diastolic diameter, and extended R-to-R interval. The high-risk cluster in men was characterized by larger body mass index, more prevalence of hypertension, and larger left atrial diameter. In women, the high-risk profile was characterized by larger left ventricular diastolic diameter and lower eGFR. Specific metabolites played a role in distinguishing the risk clusters. Salicylate, 4-hydroxyphenylacetylglutamine, and 2,3-dihydroxyisovalerate in men and salicylate, sulfate of piperine metabolite C18H21NO3 (1), and piperine in women were the top 3 metabolites associated with distinct risk clusters.

Conclusion
We identified sex-specific cluster of metabolites characterizing varying HF risk in general population. Each cluster exhibited a unique cardiovascular profile, carrying the potential to improve HF risk management. Survival plot
Comprehensive cardiac rehabilitation in elderly patients with heart failure: age is just a number?
Authors: Adiwinata S , Poetra B , Lampus N S , Joseph V F F , Jim E L , Rampengan S H 
Published: June 2024

Abstract

Background
Growth of older population leads to a high burden of cardiac disease, geriatric syndrome and other comorbidities. Cardiac rehabilitation (CR) is a personalized complex secondary prevention program which improves exercise tolerance, psychological well-being and quality of life. Several studies reported the benefits of CR for several cardiovascular disease, including heart failure (HF), but unfortunately remains underutilized among older patients due to frailty and disability.

Purpose
This study aims to assess the clinical impact of comprehensive phase II CR program among older ((≥60 years) patients with HF.

Methods
This was a prospective study which enrolled 41 patients with HF who have completed 8 supervised CR session, 2 times per week, which consisted of psychological, diet and nutritional counselling, stretching, moderate intensity aerobic and resistance training with heart rate calculated using the Karvonen formula and intensity of 12 to 13 on the Borg Scale as a threshold. The data of medical history including co-morbidities, cardiovascular risk factors and lifestyle were collected. We compared and analysed changes after CR program in metabolic profile (body mass index, lipid, uric acid and A1C profile), autonomic nervous system function (resting heart rate), and quality of life (physical and emotional components) which assessed with Minnesota living with HF questionnaire (MLHFQ). Analysis was done using Statistical Package for the Social Sciences (SPSS) v.22 (IBM-corps, Armonk NY) software. Qualitative variables were compared by chi-square test. Paired sample T-Test was using to compare quantitative variables before and after CR program.

Results
Among 41 patients, there were 18 (44%) older patients and 12 (67%) were males. This study showed significant reductions in older patient’s LDL cholesterol level (126.06±25.9 vs 93.61±17.23, p&lt;0.001). Post training data showed improvement in older patient’s exercise capacity (313.7±72.3 METs vs 385.3±65.3 METs, p&lt;0.001), quality of life which consist of physical component (34.3±1.5 points vs 18.5±1.5 points, p&lt;0.001), emotional component (6.8±1.2 vs 5.17±0.8, p=0.001) and lower resting heart rate (67.3±9.1 vs 63.7±6.9, p=0.141). There were not reported any adverse events in this study.

Conclusions
Elderly patients with HF get benefit from CR program, similarly to younger patients. Under-enrolled of CR in elderly patients remains entrenched. Repeatedly encouragement and individualized exercise prescription must be given to increase the CR enrollment and implementation. Baseline Characteristics of the Study Comparison of Changes within-group
Addressing educational disparities in hypertension: the unmet needs of older women in VR and traditional learning environments
Authors: Jiravska Godula B , Jiravsky O , Matheislova G 
Published: June 2024

Abstract

Background
Hypertension management is challenged by poor patient education adherence. This randomized study compared traditional physician-led education with virtual reality (VR) education for hypertension, assessing their impact on knowledge retention and satisfaction.

Methods
In this trial, 182 hypertensive patients were assigned to receive either traditional education (n=88) or VR education (n=94) using Oculus Quest 2 headsets. A 29-item questionnaire evaluated knowledge post-intervention. Participants were categorized into low (Q1) and medium-high (Q2-Q4) responders based on their scores.

Results
VR education showed a statistically significant higher median objective score (14 IQR 3) compared to traditional education (10 IQR 5). Subjective satisfaction was similarly high in both groups. Notably, low responders had a higher prevalence of older women (57% vs. 40% female; median age 68 vs. 65 years), highlighting a demographic disparity in educational outcomes.0

Conclusion
VR education surpasses traditional methods in knowledge acquisition for hypertension. However, the contrast between subjective satisfaction and objective knowledge retention, especially among older women, underscores the need for tailored educational strategies in this demographic. These findings emphasize the necessity of addressing educational disparities to improve hypertension management in vulnerable groups.
Obesity and underweight in children who undergo catheterization for congenital heart disease: a retrospective study
Authors: Anagnostopoulou A , Eleftherakis N G , Karanasios E S 
Published: June 2024

Abstract

Background
Τhe number of overweight and obesity in the pediatric population has increased dramatically, a trend that is followed by a corresponding increase in the pediatric population with congenital heart disease. Notwithstanding , children with congenital heart disease seem to follow abnormal growth patterns. The aim of the present study is to determine the prevalence of obesity and underweight in children who undergo cardiac catheterization.

Methodology
This is a retrospective study conducted in the cardiac catheterization laboratory of a large pediatric hospital. in the years 2011-2019. The children’s anthropometric data were collected and the body mass index was calculated, according to the Centers for Diseases Control and Prevention definition. The chi -square test was used to identify any associations between catheterization, heart disease, body habitus, sex and age groups, after which a one way analysis of variance was performed to investigate the effects of the above variables on obesity.

Results
The participants included 378 children from 2 to19 years old who underwent cardiac catheterization in the years 2011-2019. Cumulatively, 18.7% of the children in the study were underweight, 54.76% were normal weight, 11.64% were overweight and 14.81% were children classified as with obesity. Overall, 26.45% of the children weighed more than the 85th centile. The Kolmogorov Smirnoff test was used to test form normality and only the height in cms had a normal distribution.
Children with acyanotic heart disease had a mean median age of 8 years old (IQR 6 years). The percentages of underweight were 16.6%, the ones with healthy weight 53.58%, 12.08% overweight and 17.47% with obesity. Children with cyanotic heart disease had a mean median age of 6.51 6 years (IQR 6) while the respective percentages of underweight, healthy weight, overweight and with obesity were 27.7%, 56.63%, 9.05% and 6.02%. These differences were statistically significant. However, the children who underwent a catheterization for other causes had a median age of 8 years old (IQR 8) and their percentages of underweight were 13.3%, the ones with healthy weight 60% and the ones with overweight or obesity 13.3% each.

Conclusions
There is a significant discrepancy in the rate of obesity between the children with acyanotic and cyanotic heart disease. However, the differences between the children with acyanotic heart disease and children who underwent cardiac catheterization for other causes is not statistically significant.
Real-life data on the empowerment of cardiac patients undergoing rehabilitation by using educational videos
Authors: Mayer Hren P , Tasic J 
Published: June 2024

Abstract

Background/Introduction
Active patient involvement in the rehabilitation process improves clinical outcomes. Empowered patients are more motivated during and after cardiac rehabilitation, regularly take their medication, and follow the recommendations given by medical professionals. Active involvement and participation increase patient’s active role in managing their health and rehabilitation process. Patients undergoing cardiac rehabilitation may benefit from short educational videos sent by the rehabilitation center, enabling them to take a more active role in the empowerment process.

Purpose
To acknowledge patients’ active role in the empowerment process.

Methods
31 consecutive cardiac patients involved in cardiac rehabilitation received 19 different short educational videos via emails during the whole duration of the second phase of the rehabilitation. The videos included information about risk factors, exercise, diet, smoking, traveling, and sexuality. After receiving all the educational videos, we investigated the number of patients who watched them and how the proportion of views changed over the course of six weeks. We utilized a combination of follow-up methods, including automatic return emails and telephone calls.

Results
A total of 31 patients, 5 women and 26 men, involved in cardiac rehabilitation were included in the pilot study. The mean age of the participants was 57 years. Among the 31 patients, 29 had coronary heart disease, 1 was with heart failure, and 1 with hypertensive heart disease. Out of 31 patients, 9 (29 %) watched all educational videos, 12 (39 %) watched some, and 10(32 %) did not watch any. Watching of the videos decreased over time, with the first videos being the most watched, but the number of views declined in the following weeks. However, 95% of the patients who watched at least some of the videos found the provided information useful, while 63% of the patients reported that they gained new knowledge from the videos. Additionally, 95% of the surveyed patients would recommend the videos to other patients involved in cardiac rehabilitation. Patients with higher education levels tended to watch more educational videos. Still, patients with medical backgrounds did not find the videos interesting due to their belief that they had all the necessary knowledge.

Conclusion(s)
Patients involved in cardiac rehabilitation benefit from watching short educational videos thus increasing their active role in the rehabilitation process. All the patients in the rehabilitation center received the same educational materials, information, and support from healthcare workers. However, the success of the empowerment process primarily depends on the patient's inner motivation, regardless of the educational opportunities they are given.
Ergophysiological evaluation of heart failure patients with reduced ejection fraction undergoing exercise-based cardiac rehabilitation: a systematic review and meta-analysis
Authors: Christou G , Christou M , Davos C , Markozannes G , Christou K , Mantzoukas S , Christodoulou D , Kiortsis D , Christou P , Tigas S , Nikoletou D 
Published: June 2024

Abstract

Background
The benefit of an exercise programme in heart failure (HF) patients undergoing cardiac rehabilitation is most commonly assessed through measurement of serial changes in peak oxygen uptake (VO2peak), whereas oxygen uptake at the first ventilatory threshold (VO2VT1) has not been widely applied as an end point of efficacy of cardiac rehabilitation in routine clinical practice.

Purpose
This systematic review and meta-analysis aims to explore in HF patients with reduced ejection fraction (EF) undergoing exercise-based cardiac rehabilitation: 1) the comparison of temporal changes between VO2peak and VO2VT1, 2) the association of VO2peak and VO2VT1 changes with physiological factors and 3) the differential effects of continuous aerobic exercise (CAE) and interval training (IT) on VO2peak and VO2VT1.

Methods
A systematic literature search was conducted in PubMed, CENTRAL, and Scopus. Inclusion criteria: 1) original research articles using exercise-based cardiac rehabilitation, 2) stable HF patients with reduced EF, 3) available values of VO2peak and VO2VT1 (in mL/kg/min) for both baseline and after exercise training with comparison between these time points.

Results
Among the 30 eligible trials, 24 used CAE, 5 IT and one CAE and IT. Multivariable meta-regression with duration of exercise training and percentage of males as independent variables and the change in VO2peak as dependent variable showed that the change in VO2peak was negatively associated with duration of exercise training (coefficient= -0.061, p=0.027), implying the possible existence of a waning effect of exercise training on VO2peak in the long term. Multivariable meta-regression demonstrated that both age (coefficient= -0.140, p&lt;0.001) and EF (coefficient=0.149, p&lt;0.001) could predict the change in VO2VT1, whereas only age (coefficient= -0.095, p=0.022), but not EF (coefficient=0.082, p=0.100) could predict the change in VO2peak. The post-training peak respiratory exchange ratio, as an index of maximum effort during exercise testing, correlated positively with the change in VO2peak (coefficient=0.021, p=0.044). The exercise-induced changes of VO2peak (p=0.438) and VO2VT1 (p=0.474) did not differ between CAE and IT.

Conclusions
The improvement of endurance capacity during cardiac rehabilitation may be detected more accurately with the assessment of VO2VT1 rather than VO2peak, since the exercise training-induced change in VO2peak was greatly influenced by the level of maximum effort at post-training exercise testing and slightly waned in the long term of cardiac rehabilitation, as opposed to a more sustained or even gradually augmented improvement of VO2VT1 during the whole process of cardiac rehabilitation. Graphical Abstract
Chronotropic index, heart rate and exercise capacity in diabetes mellitus: comparing two different high-intensity interval training protocols
Authors: Bozdemir Ozel C , Arikan H , Calik Kutukcu E , Durukan B N , Inal Ince D , Kabakci G , Dagdelen S 
Published: June 2024

Abstract

Background
The chronotropic response is associated with a higher risk of cardiovascular disease and exercise intolerance. It has been reported that poor glycemic control and low exercise capacity are associated with chronotropic insufficiency in type 2 diabetes mellitus (T2DM) patients. The effects of different high-intensity interval training (HIIT) protocols on the chronotropic index, heart rate, and exercise capacity are not apparent in the literature.

Purpose
The aim of study was to compare the effects of different HIIT protocols on the chronotropic index, heart rate, and exercise capacity.

Methods
Thirty individuals with T2DM patients (27F, 3M) participated in this study. Demographic and laboratory values were recorded. Exercise capacity was evaluated using an incremental symptom-limited maximal exercise test on a bicycle ergometer. Heart rate, blood pressure, and perceived exertion were assessed. In addition, the peak heart rate and workload reached by the patients were recorded during the test. Abnormal heart rate and chronotropic index were calculated. The patients were divided into two groups according to randomization. The first group was trained with the short-interval HIIT protocol (SI-HIIT) (30 s x 4, Workload peak 100%), and the second group was trained with the long-interval HIIT protocol (LI-HIIT) (4 min x 4, Workload peak 85%) three times a week for eight weeks.

Results
The ratio of patients having chronotropic insufficiency (&lt;0.80) decreased in SI-HIIT (before 60% vs. after 33.3%; p = 0.42) and LI-HIIT (before 47.7% vs. after 40.8%; p = 0.035) with HIIT training. After training, the peak workload achieved during the cycling test increased within each group (p&lt;0.05). The resting heart rate decreased in both groups compared to baseline (p&lt;0.05). The ratio of patients having chronotropic insufficiency, the ratio of patients having abnormal heart rate peak workload achieved during a cycling test, and resting heart rate were similar between the two groups after training (p &gt; 0.05)

Conclusion
Chronotropic index and resting heart rate improve with HIIT in T2DM. A time-efficient protocol should be chosen to restore cardiac autonomic responses in T2DM, as SI-HIIT and LI-HIIT have similar effects on cardiac function.