bluuebunny/crossref_metadata_2025_split huggingface dataset:
The risk of life-threatening arrhythmias and sudden death forecast scale
Authors: Vytrykhovskiy A , Nesterak R , Sovtus V 
Published: June 2024

Abstract
In order to develop and implement the concept of prevention and treatment of fatal complications in the population of people with a high and very high cardiovascular risk, a risk calculation scale of emergence and progression of life-threatening arrhythmias and sudden death was created. It was based on the assessment of the state of heart rate variability and heart rate turbulence, the value of the coefficient - deceleration capacity (DC), and the length of the QTc interval on ECG.
The creation of this scale was based on recommendations, protocols, and standards developed by the following: American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death (2013); Task Force of European Society of Cardiology and The North American Society of Pacing and Electrophysiology (2009). Sudden Death Forecast scale (SDFS) values are expressed in points from 1 to 10. From indicators of heart rate variability, we selected: (Total Power, Low Frequency, High Frequency, Low Frequency/High Frequency) and the duration of the QTc interval – and valued each indicator with 1 point. The change of heart rate turbulence indicators - parameters of acceleration (То) and deceleration (Тs) of sinus rhythm, and the coefficient of deceleration capacity (DC) are estimated at 2 points each. The distribution of points was made according to the prognostic value of each of the indicators. Points are awarded when the indicator goes beyond physiologically acceptable norms. The value of the points indicates the degree of adaptation of the cardiovascular system, necessary to maintain the active balance of the body with the environment, as well as the risk of life-threatening arrhythmias and sudden cardiac death. 1-2 points are very low risk, and 3-4 points are low risk. SDFS = 5-6 points: indicates a state of pronounced tension of regulatory systems and mobilization of protective mechanisms, the risk of life-threatening arrhythmias is moderate. SDFS=7-8 points: a state of insufficiency of protective and adaptive mechanisms and excessive activation of regulatory systems which is no longer supported by appropriate functional reserves – the risk is high. 7 points - the body's hemostasis is preserved and works in a state of compensation, 8 points - the appearance of non-specific premorbid conditions. SDFS = 9-10 points: state of exhaustion, specific changes clearly prevail over non-specific ones, the risk of life-threatening arrhythmias and sudden death is very high. This scale is available in a specially created program for PC. Sudden Death Forecast scale (SDFS)
Klotho protein inhibits extracellular matrix degradation and apoptosis during heart ischemia/reperfusion injury via regulation of the NOS/MMP signalling axis
Authors: Olejnik A , Krzywonos-Zawadzka A , Bil-Lula I 
Published: June 2024

Abstract

Background
Ischemia/reperfusion injury (IRI) of the heart involves the activation of oxidative and apoptotic pathways [1]. It is known that nitric oxide synthase (NOS) and oxidative stress activate extracellular matrix degradation by matrix metalloproteinase (MMP). It results in apoptosis and damage to the heart tissue [1]. Klotho is a membrane-bound or soluble antiaging protein with potential protective activity, since it supports redox balance and metabolic functions of the cardiomyocytes [2].

Purpose
This study aimed to evaluate the influence of Klotho protein on the NOS/MMP signalling pathway and apoptosis that followed in the heart subjected to IRI.

Material and Methods
Isolated rat hearts perfused with the Langendorff method were subjected to ischemia, followed by reperfusion in the presence or absence of recombinant Klotho protein (0.5 ng/mL). Heart hemodynamic parameters, as well as factors related to oxidative stress (inducible NOS (iNOS), endogenous NOS (eNOS), asymmetric dimethylarginine (ADMA), nitrate/nitrite (NOx-), carbonyl content), extracellular matrix degradation (MMP-2, MMP-9, tissue inhibitor of metalloproteinase-4 (TIMP-4)) and apoptosis (caspase 3 and 8) were evaluated.

Results
Reduced left ventricle (LV) work in the IRI group (p=0.009) was observed, as compared to the aerobic control. There was a decreased level of iNOS protein (p=0.002) and slightly increased production of NOS inhibitor - ADMA (p&gt;0.05) in the hearts after IRI. Reduced expression of the eNOS gene (p=0.006) and increased level of eNOS protein (p=0.009) in the IRI group were observed. Then, IRI resulted in a decrease in MMP-2 (p=0.019) and MMP-9 (p=0.039) gene expressions, and enhanced production of MMP-2 (p=0.042), MMP-9 (p=0.041) and TIMP-4 (p=0.043) proteins, as compared to aerobic conditions. Administration of Klotho protein during IRI significantly increased LV work (p=0.001) and recovery of heart mechanical function (p=0.0003). Then, Klotho regulated the production of iNOS protein (p=0.020), ADMA (p=0.007), eNOS mRNA (p=0.021) and eNOS protein (p=0.041) to the levels observed in aerobic control. It resulted in the inhibition of oxidative stresss, expressed as decreased (NOx)- level (p=0.022) and low carbonyl content (p=0.036) in the IRI+Klotho group. Then, Klotho significantly contributed to the reduction in MMP-2 (p=0.024) and MMP-9 (p&lt;0.0001) protein levels and regulated MMP-9 gene expression (p=0.038) during IRI. Finally, there was restrained caspase 3 (p=0.043) and caspase 8 (p=0.040) release after supplementation of IRI hearts with Klotho.

Conclusion
Administration of Klotho protein resulted in full preservation of heart mechanical function, and suppression of extracellular matrix degradation and apoptosis in hearts subjected to IRI. Thus, Klotho can be recognized as a novel cardiopreventive agent in ischemic damage. Fig. 1.The level of eNOS protein Fig. 2.The level of MMP-2 protein
Platelet-endothelial aggregation receptor 1 inhibits reendothelialization of injured arteries
Authors: Li T , Yuan J 
Published: June 2024

Abstract

Background
Platelet-endothelial aggregation receptor 1 (PEAR1) is primarily expressed in endothelial cells and platelets. Previous studies have revealed that PEAR1 inhibits neoangiogenesis and suppresses the proliferation of pulmonary microvascular endothelial cells.

Purpose
The study aims to explore the impact of PEAR1 on the reendothelialization of injured arteries.

Methods
The role of PEAR1 in injured endothelial cell proliferation and migration was determined in vitro with human coronary artery endothelial cells (HCAECs). All experiments were performed under IL-1α conditions to replicate an inflammatory environment following wire injury. We constructed three recombinant lentiviral vectors: short hairpin RNA against PEAR1 (sh-PEAR1), PEAR1 overexpression (OE-PEAR1), and non-targeting sh-PEAR1 (sh-PEAR1 NC) as control. The PEAR1-/-knockout mice and wild-type (WT) controls were studied for the response of femoral arteries to angioplasty wire injury. The study adhered to the "Principles of Laboratory Animal Care" and received approval from the Institutional Animal Care and Use Committee (IACUC) (Issue Number: 20230040).

Results
In comparison to the sh-PEAR1 NC group, PEAR1 knockdown significantly enhanced HCAEC proliferation and migration. Conversely, PEAR1 overexpression strongly inhibited HCAEC proliferation and migration (Figure 1). The reendothelialized area in PEAR1-/- arteries was significantly larger than in WT arteries on days 3 and 7 after injury. Moreover, on day 28, PEAR1-/- arteries halved neointima formation compared with WT arteries (Figure 2).

Conclusion
PEAR1 suppresses HCAEC proliferation and migration in the presence of IL-1α. PEAR1 delays reendothelialization and accelerates neointima formation of wire-injured arteries in mice. Figure 1 Figure 2
Is high intensity interval training superior to moderate intensity continuous training in older adults with cardiovascular disease? The Generation 100 study
Authors: Stensvold D S , Haavard Dalen H D , Elisabeth Kleivhaug Vesterbekkmo E K V , Jon Magne Letnes J M L , Ulrik Wisloeff U W 
Published: June 2024

Abstract

Background
Aerobic exercise is widely used as a secondary prevention strategy to improve health and prognosis in patients with various forms of cardiovascular disease (CVD). Although high-intensity interval training (HIIT) has been shown to induce superior health benefits compared to moderate-intensity continuous training (MICT) in the short term, the evidence from long-term randomized trials regarding the effects of different exercise intensities in older adults is lacking.

Purpose
The aim of this study was to compare the effects of five years of supervised HIIT and supervised MICT with a control group instructed to follow the physical activity recommendations, with respect to recurrent CVD events, peak oxygen uptake (VO2peak), and health related quality of life in patient with established CVD.

Methods
In total 274 patients with CVD (mean age 72.3±2.1) of our city, were included in the present study. The patients were randomized (1:1:2) to two weekly sessions of HIIT at about 90% of peak heart rate (n=60), MICT at about 70% of peak heart rate (n=78), or controls instructed to follow the national guidelines for physical activity (n=136), for five years. Clinical outcomes were identified by diagnoses in the community hospital medical records and reported according to International Classification of Diseases (ICD-9 and ICD-10). CVD events were defined as a valid diagnosis of CVD or death from CVD, whichever came first. In addition, cardiopulmonary testing was used to assess VO2peak, and The Short Form-8 (SF-8) was used to measure health related quality of life at baseline and at 5-year follow-up.

Results
The number of CVD events during the five-year follow-up was not significantly different between groups, with an incident rate of 28.3%, 27.3%, and 38.2% in HIIT, MICT, and controls, respectively. Atrial fibrillation was the most common CVD event during the intervention, with an incidence rate of 6.7%, 9.1% and 6.6% in HIIT, MICT and controls, respectively. Importantly, there were no acute adverse CVD events during testing or training during the five-year follow-up. After five years, HIIT showed a strong tendency towards a higher VO2peak compared to controls (1.49 mL/kg/min, 95% CI -0.10 to 3.09). No significant differences were observed in MICT compared to controls (0.32 mL/kg/min, 95% CI -1.12 to 1.77). There were no between-group differences in health-related quality of life after the intervention.

Conclusions
After 5 years, the recurrent CVD events was similar across groups randomized to HIIT, MICT and controls. This is the first study to show that HIIT is a feasible and safe exercise modality in older adults with established cardiovascular diseases.
Cardiac rehabilitation and long-term prognosis in cardiovascular disease patients with cancer history
Authors: Miki T , Kamiya K , Hamazaki N , Nozaki K , Uchida S , Noda T , Ueno K , Hotta K , Maekawa E , Sasaki J , Yamaoka-Tojo M , Matsunaga A , Ako J 
Published: June 2024

Abstract

Background
Cancer and CVD both tend to cause skeletal muscle mass loss, and their combined effects are associated with a poor prognosis. In response, studies have shown comprehensive cardiac rehabilitation (CR) to be associated with an improved prognosis, as well as reduced risk of rehospitalization, in CVD patients. However, the benefits of comprehensive CR for patients with CVD and cancer remain unclear.

Aim
The purpose of this study was to examine whether participation in outpatient CR is associated with a favorable long-term prognosis for CVD patients with a cancer history.

Methods
We retrospectively reviewed 1,502 CVD patients with a cancer history (median age: 76 [69–81] years, 968 males) who were hospitalized between 2007 and 2022. The primary and secondary outcomes were all-cause death and a composite of all-cause death and CVD-related rehospitalization, respectively. We performed propensity score matching, followed by Kaplan–Meier curves and Cox regression analysis to evaluate the association between CR and prognosis, with CR participation defined as partaking at least once within three months of discharge.

Results
Of the 1,502 patients in this study, 136 deaths and 133 CVD-related rehospitalizations occurred (median follow-up 1.6 [0.5–3.3] years). After propensity score matching, 1,036 patients (n = 518 pairs) were included, with standardized mean differences were &lt;0.1 for all covariates. Further, CR hazard ratios for all-cause mortality and the composite outcome were 0.60 (95% CI: 0.43–0.84, P = 0.003) and 0.72 (95% CI: 0.55–0.94, P = 0.015), respectively.

Conclusions
Participation in outpatient CR was associated with a favorable prognosis in CVD patients with a cancer history.
Effects of urinary tract infection and stopping sodium-glucose cotranspoter-2 inhibitors in patients with type 2 diabetes mellitus: a population-based study
Authors: Wu M Z , Tung M O , Tsang T W , Guo R , Huang J Y , Ren Q W , Zhang J N , Gu W L , Yiu K H 
Published: June 2024

Abstract

Background
Sodium-glucose cotranspoter-2 (SGLT2) inhibitors are widely prescribed in patients with type 2 diabetes mellitus (T2DM). Yet these patients are susceptible to urinary tract infection (UTI).

Purpose
This study aims to investigate the efficacy of continuing SGLT2 inhibitors after an episode of UTI.

Methods
Patients with T2DM who were prescribed SGLT2 inhibitors from January 2015 to June 2022 were identified from Clinical Data Analysis and Reporting System (CDARS). The primary outcomes were major adverse cardiovascular events (MACE: a composite of heart failure hospitalization, stroke, myocardial infarction, and cardiovascular mortality), renal-specific composite outcomes (defined as 50% decline in eGFR, end-stage renal failure, and kidney mortality), cardiovascular mortality, and all-cause mortality. Multivariable Cox proportional hazards model was employed to estimate the hazard ratios (HRs), while Fine-Gray model was used to account for competing events. Incident UTI was treated as time-varying covariate in the model.

Results
A total of 61,661 patients (mean age 63 years, 64.1% male) with T2DM who were prescribed SGLT2 inhibitors were included in this study, of whom 3,976 (6.45%) patients had an episode of UTI in follow-up. Patients who had an incident UTI were associated with a higher risk of MACE (HR 1.98, 95% CI 1.78-2.21), renal-specific composite outcomes (HR 2.17, 95% CI 1.95-2.40), cardiovascular mortality (HR 4.60, 95% CI 3.86-5.48) and all-cause mortality (HR 4.25, 95% CI 3.89-4.65) compared to those without an incident UTI. Among patients who experienced a UTI, stopping SGLT2 inhibitors conferred a 76% reduction in the risk of long-term recurrent UTI (HR 0.24, 95% CI 0.14-0.40), but entailed a significantly higher risk of MACE (HR 1.29, 95% CI 1.05-1.57), renal-specific composite outcomes (HR 1.46, 95% CI 1.21-1.77), cardiovascular mortality (HR 1.69, 95% CI 1.27-2.24), and all-cause mortality (HR 2.77, 95% CI 2.37-3.23).

Conclusion
Using real-world data of patients with T2DM who were prescribed SGLT2 inhibitors, this study found that new-onset UTI increased the risk of MACE, renal-specific composite outcomes, cardiovascular mortality, and all-cause mortality. Moreover, stopping SGLT2 inhibitors after a UTI conferred a lower risk of long-term recurrent UTI, but a higher risk of MACE, renal-specific composite outcomes, cardiovascular mortality, and all-cause mortality.
Efficacy of early versus late b-blocker administration after primary PCI
Authors: Ntalianis A , Kondylis M , Makavos G , Chaldoupis A , Anninos E , Misegianidis A , Zografos N , Konstantinou G , Zenetos D , Repasos E , Mpalaska A , Papadopoulou E , Kanakakis J , Paraskevaidis I 
Published: June 2024

Abstract

Introduction/Purpose
Administration of B-Blockers (BB) in patients presenting with STEMI is strongly recommended during the first 24 hours after admission. Early initiation of BB might confer favorable effects via a significant reduction in myocardial energy consumption. The aim of this prospective single-centre randomized study was to investigate the safety and efficacy of early po BB administration in patients with STEMI submitted to primary PCI (pPCI).

Methods
60 consecutive patients referred for pPCI because of an acute STEMI were randomly assigned (3:1) into the following groups : a) Early initiation of BB (Group A) and b) Late initiation of BB (Group B). Patients with cardiogenic shock (CS), acute heart failure (AHF) with Killip class &gt;2, bradycardia (&lt;60 beats/min) and systolic blood pressure (SBP) less than 100 mmHg were excluded from the study. The Group A received 12,5mg of oral metoprolol tartrate within 3 hours after pPCI and two additional doses of 25 mg and 50 mg 6 and 12 hours after the intervention, provided that the heart rate (HR) was &gt; 60 beats/min. The Group B received orally 12,5 mg of metoprolol tartrate 8 hours after pPCI and 25mg of the drug 24 hours after the procedure, as long as the HR was &gt; 60 beats/min. The safety endpoints were as follows: a) severe bradycardia (defined as HR &lt;50 beats/min), b) arterial hypotension (defined as SBP &lt; 90mmHg), and c) the development of signs and symptoms of AHF/CS. The efficacy endpoints were the following: a) the infarct size as assessed by cardiac troponin levels (TnI) 24 hours after admission and b) left ventricular function at 6 months after STEMI as reflected by ejection fraction (EF) and global longitudinal strain (GLS), both measured with heart ultrasound.

Results
There was no statistically significant difference between Group A and B regarding the HR at baseline (BL) (78,4±4 vs 83,3±4bpm, p=ns), at 6 hours (73,8±4 vs 73,1±4bpm, p=ns) and 24 hours (71,2±4 vs 69,4±4bpm, p=ns) (Figure 1). SBP was slightly higher in Group A at BL (137,2±7 vs 119,9±6mmHg, p=0,02), but neither at 6 hours (127,2±7 vs 126,5±6mmHg, p=ns) nor at 24 hours (124±7 vs 121,5±6mmHg, p=ns). Interestingly, no episode of AHF/CS was noted. The infarct size was similar in both groups (TnI; 27009±3005 in Group A vs 27369±4765 ng/Dl in Group B, p=ns). Finally, no statistically significant difference was observed in the EF at BL between Group A and B (44,2±5 vs 45,3±4%, p=ns) and 6 months later (45,2±5 vs 46,2±4%, p=ns) nor in the GLS both at BL (-14,6±7 vs -16,2±6%, p=ns) and at 6 months (-15,3±7 vs -16,8±6%, p=ns) (Figure 2).

Conclusion
The strategy of an early administration of BB after pPCI in patients with STEMI is safe but not superior to a delayed administration strategy with regard to myocardial salvage and left ventricular function recovery.
Temporal trends in all-cause and cause-specific mortality following non-ST-elevation myocardial infarction in Israel, 2000-2013
Authors: Menipaz A , Gerber Y , Halabi M , Fluk-Gmach S , Halabi M , Beigel R , Orvin K , Iakobishvili Z 
Published: June 2024

Abstract

Background
International studies report a decline in 30-day and 180-day all-cause mortality after non-ST-elevation myocardial infarction (NSTEMI). However, studies on temporal trends of more extended follow-up periods after NSTEMI are lacking; similarly missing are studies on temporal trends of cause-specific mortality after NSTEMI.

Purpose
To assess temporal trends in the long-term (5-year follow up) all-cause and cause-specific mortality of patients admitted in the years 2000 to 2013 with NSTEMI.

Methods
We obtained baseline characteristics and admission data from the Acute Coronary Syndrome Israeli Surveys (ACSIS). ACSIS surveys have been conducted since 2000, once every 2 or 3 years, each year for eight consecutive weeks, among all patients admitted with acute myocardial infarction or unstable angina pectoris (ACS) in all public hospitals in Israel. Additionally, we obtained data on all-cause and cause-specific mortality (until 2017) from the Israel Centre for Disease Control. Cox regressions and competing risks models were employed to assess survival temporal trends.

Results
Among the 4,437 patients admitted with NSTEMI [mean age 65.9 (SD 13.1) years, 75.4% male], 1,127 deaths (25.4%) occurred during the 5-year follow-up. There were no changes over time in the percentage of male patients or the patients’ average age. However, the burden of comorbidities increased over time: the proportion of NSTEMI patients admitted with at least 2 comorbidities increased from 50.8% in 2000 to 64.4% in 2013 (Ptrend&lt;0.001).
Compared to NSTEMI patients admitted during 2000-2004, and adjusted for age and sex, NSTEMI patients admitted during 2006-2008 and during 2010-2013 faced 14% and 19% lower risk (respectively) of all-cause mortality (HR=0.86, 95% CI: 0.75-0.98 and HR=0.81, 95% CI: 0.70-0.94, respectively; Ptrend &lt;0.001). However, trends diverged between cardiovascular (CV) and non-CV deaths (see Figure). Whereas, adjusted for age and sex, patients admitted during 2010-2013 had 46% lower risk of CV deaths than patients admitted during 2000-2004 (HR=0.54, 95% CI: 0.42-0.68; Ptrend&lt;0.001), the risk of non-CV deaths remained unchanged (HR=0.99, 95% CI: 0.80-1.22). As a result, the percentage of 5-year CV deaths among all fatalities consistently decreased (51.0% in 2000-2004, 44.4% in 2006-2008, and 39.0% in 2010-2013; Ptrend=0.002).

Conclusions
Substantial improvement in 5-year mortality was observed among patients admitted in Israel between 2000 and 2013 with NSTEMI. Given that the decline was mainly due to reduction in CV mortality, it is advisable to adopt a more comprehensive approach to NSTEMI patients and address comorbidities.