bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical review of the studies identifying determinants of a change in fitness following a cardiac rehabilitation outpatient programme
Authors: Alotaibi J A S S A S , Doherty P 
Published: June 2024

Abstract

Purpose
To critically review the studies which identified the determinants of a change in fitness in patients enrolled in CR outpatient programmes and to conclude the determinants of a change in fitness from the analysis.

Method
The literature search was performed using Medline, CINAHL plus (EBSCO), Cochrane Library (Wiley), EMBASE, AMED and web of science. Inclusion criteria for studies were (1) having adult patients (&lt;18) who participated in a CR programme after a cardiac event (2) reporting determinants, predictors, factors or characteristics that influence the change in physical fitness expressed as Vo2 max or peak, METs, or distance walked (3) having measured physical fitness objectively using incremental tests before and at the end of CR using a treadmill, cycle ergometer, step test or incremental shuttle walk test as these tests are the ones commonly used in a CR population (4) having used multivariable analysis to clearly demonstrate the independent association between the potential determinant and the change in fitness and (5) having been written in English.

Results
Seventeen studies met the inclusion criteria. Thirteen were observational studies, two were randomised clinical trials and two were meta-analyses. The determinants were identified namely age, gender, BMI, waist circumference, baseline fitness levels, diabetes, depression,total of comorbidities, reason for referral, number of sessions, time from referral to start of CR, self-reported physical function (36-sf), fasting glucose level, treadmill protocol, exercise intensity and handgrip strength.

Conclusion
There continues to be huge variation in the studies in terms of identifying the determinants of a change in fitness. In this review, there are some determinants which are highly likely to determinants of a change in fitness namely diabetes, self-reported physical function (SF[1]36), handgrip strength and exercise intensity. Other variables such as baseline fitness levels, age, comorbidities, time from referral to start, and waist circumference were categorised as likely to be determinants. However, the ability to draw conclusions is hindered by significant inconsistencies in how studies were analysed with additional limitations in the studies with reference to sample size, population characteristics, potential confounders. Finally, the quality of study designs and reporting of study details in journal publications needs to improve so that critical and systematic reviews can be performed to the highest level.
The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post acute myocardial infarction: a systematic review and meta-analysis
Authors: Paddock S , Meng J , Johnson N , Chattopadhyay R , Tsampasian V , Vassiliou V 
Published: June 2024

Abstract

Aim
To systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock.

Methods
Comprehensive search of medical databases (Cochrane Register, PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included.

Results
The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomised-controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared to standard medical therapy (OR 0.91; 95% confidence interval (CI) 0.65-1.27). Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31, CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate and successful revascularisation are independent predictors of mortality.

Conclusions
VA-ECMO does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction, however there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.
Young hearts, old challenges: analyzing stemi under 50
Authors: Raposo M , Abrantes A , Gregorio C , Cazeiro D , Ferreira D , Cravo J , Vilela M , Cardoso P , Pinto F 
Published: June 2024

Abstract

Introduction
Acute ST segment elevation myocardial infarction (STEMI) remains a leading cause of premature mortality and morbidity, even in younger patients (pts), with an important loss of quality adjusted life years. Recent studies have tried to identify specific characteristics of young pts with STEMI to help stratify risk factors and optimize prevention measures.

Purpose
To characterize and evaluate outcomes in a population of young pts with STEMI.

Methods
Retrospective, single-center study of consecutive pts, with age below 50 years, who were admitted with STEMI and underwent percutaneous coronary intervention (PCI), between 2017 and 2021. Demographics, clinical characteristics, and clinical outcomes, including major cardiovascular events (MACE) and mortality, were analyzed. Multivariable cox proportional hazard model was performed to identify predictors of long-term prognosis.

Results
We included 257 pts, 82,5% were men, with a mean age of 44.4 ± 4.9 years. 73% of pts were smokers, a 7 fold increase when compared with Portuguese populational data regarding smoking habits. 63% of pts had dyslipidemia, with a mean cLDL of 120 ± 41mg/dL. 39,6% of pts were overweight, with a BMI ≥ 25. Regarding other risk factors, 35% of pts had arterial hypertension and 15% were diabetic. Most pts had STEMI presentation in class 1 of the Killip-kimball classification, with only 4 presenting with Killip 4. The majority of pts had one vessel disease and were submitted to angioplasty with coated stent implantation, with the anterior descendent coronary artery (CA) and right CA identified as culprit lesions in 58% and 28% of pts, respectively. During a mean follow-up (FUP) of 2.9 ± 1.4 years, 16 pts died, 12 of which within the first 30 days. 27 pts developed heart failure, 18 suffered reinfarction and 7 were admitted with stroke. In our analysis, ejection fraction (EF) at presentation (mean 48.9 ±11%) was the only variable associated with MACE and mortality during FUP (p&lt;0.001).

Conclusion
Despite having an apparently more benign initial presentation, STEMI in young pts is associated with high risk mortality and MACE. Close follow-up and risk factor management have a major role, particularly in this population.
Combined effects of gamma-glutamyltransferase and high-sensitivity C-reactive protein on cardiovascular events in patients with diabetes and chronic coronary syndrome
Authors: Li T , Yuan J 
Published: June 2024

Abstract

Background
Gamma-glutamyltransferase (GGT) is widely used for the diagnosis of liver and obstructive biliary diseases and as an indicator of alcohol consumption. Recently, the role of GGT in cardiovascular fields has attracted attention due to the growing awareness of the interaction between the heart and other organs such as the liver and kidney. Epidemiological studies suggest an association between GGT levels and all-cause mortality in patients with coronary artery disease. It has also been observed that an elevated GGT level is associated with cardiovascular risks such as systemic inflammation and metabolic syndrome.

Purpose
The study aimed to investigate the combined effects of GGT and high-sensitivity C-reactive protein (hs-CRP) on cardiovascular events in patients with diabetes and chronic coronary syndrome (CCS).

Methods
This secondary analysis of a multicentre prospective cohort included 4467 diabetic CCS patients. A GGT level of &lt;55 U/L for males or &lt;33 U/L for females is considered to be low. A low hs-CRP level is defined as &lt;2 mg/L. The primary endpoint was all-cause death. The secondary endpoints include cardiac death, non-fatal myocardial infarction, non-fatal stroke, and revascularisation. Associations of GGT and hs-CRP with cardiovascular events were estimated using Cox regression.

Results
Over a median follow-up period of 2.1 years, 82 all-cause deaths occurred. Patients with elevated levels of GGT and hs-CRP experienced the highest risk of all-cause death (adjusted hazard ratio=3.70, 95% confidence interval: 1.86–7.35, p&lt;0.001). Patients with elevated levels of GGT and low levels of hs-CRP had a 2.56-fold risk of all-cause death than those with low levels of both markers. Similar trends were observed for cardiac death. In addition, elevated levels of both GGT and hs-CRP significantly increased the risks of non-fatal myocardial infarction and any revascularisation.

Conclusion
In diabetic CCS patients, GGT and hs-CRP synergistically increased the risk of cardiovascular events. Combining GGT and hs-CRP may help identify high-risk patients. Table 1.Cox analysis Figure 1. Kaplan-Meier curves
Life essential 8 associated with a lower risk of stroke: ideal cardiovascular health in the EPIC-NL prospective cohort study
Authors: Spronk M , Van Der Schouw Y T , Te Hoonte F , Boer J M A , Verschuren W M M , Bots M L , Vernooij R W M , Uijl A 
Published: June 2024

Abstract

Introduction
The American Heart Association (AHA) introduced the concept of Life’s Essential 8 (LE8) to measure and monitor cardiovascular health (CVH) to prevent cardiovascular diseases.

Purpose
This study aims to identify the association between LE8 and the risk of incident total stroke, ischemic stroke, and haemorrhagic stroke.

Methods
We included 37,358 participants from the EPIC-NL (European Prospective Investigation Into Cancer and Nutrition- Netherlands) population-based cohort. The LE8 score was calculated according to the AHA’s definition using the LE8 metrics; diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, and blood glucose. The overall LE8 score (range 0-100) was categorised into low (0-49), moderate (50-79), and high (80-100) CVH. A Cox proportional hazard model adjusted for age, sex, educational levels, alcohol consumption and history of atrial fibrillation, was used to assess the association between LE8 and the risk of stroke.

Results
The mean age of participants was 49 years ± 12 years and 75% of participants were female. The mean LE8 score of the participants was 72 ± 11. During the median follow-up of 15.3 years (interquartile range: 14.1-16.5 years), 1323 (3.5%) total stroke, 873 (2.3%) ischemic stroke, and 247 (0.7%) haemorrhagic stroke cases occurred. Moderate and high CVH scores were associated with a lower risk of total stroke compared with low CVH scores: hazard ratio (HR) 0.52 [95% confidence interval (95%CI) 0.41-0.65] for moderate and HR 0.33 [95%CI 0.25-0.43] for high CVH). For ischemic stroke we observed similar associations (HR 0.46 [95%CI 0.35-0.61] for moderate and HR 0.31 [95%CI 0.23-0.44] for high CVH) as well as for haemorrhagic stroke (HR 0.68 [95%CI 0.37-1.25] for moderate and HR 0.38 [95%CI 0.19-0.75] for high CVH).

Conclusions
Our findings suggest an inverse graded relationship between LE8 and stroke. A higher baseline LE8 score was associated with an impressive lower risk of total stroke, ischemic stroke, and haemorrhagic stroke among Dutch adults. Improving the LE8 score could therefore potentially be a valuable tool to prevent the risk of stroke.
Effect of statins on thoracic aortic disease: results from a meta-analysis and experimental data
Authors: Poggio P , Rega S , Valerio V , Moschetta D , Massaiu I , Rusconi V , Bertolini F , Perrucci G L , Myasoedova V A 
Published: June 2024

Abstract

Background
Thoracic aortic aneurysms (TAAs) that progress to acute aortic dissections are often fatal. Numerous risk factors, such as smoking, uncontrolled hypertension, and dyslipidemia, lead to increased wall stress and adverse outcomes. Nowadays, there is no pharmacological treatment that can reduce or even halt TAA progression.

Purpose
To evaluate the effect of statins on TAA growth rate and outcomes in TAA patients using a meta-analysis approach and testing the anti-fibrotic effect of satins in an in vitro model.

Methods
A detailed search related to the effects of statins on TAA was conducted according to PRISMA guidelines. The qualitative and quantitative analyses of statin effects on TAA growth rate were performed on 4 studies including 1850 patients, and for statin impact on outcomes were performed on 3 studies (2867 TAA patients). In vitro, the anti-fibrotic effect of 6.6 μM Atorvastatin were tested on vascular smooth muscle cells (VMSC) isolated from tunica media of ascending thoracic aorta of patients with aneurysm.

Results
We observed significant positive effect of statins on TAA growth rate. In particular, patients under statin treatment showed a reduced growth rate difference in means of -0.36 (95%CI: -0.64, -0.08; p=0.013) compared with controls, patients that did not take statins. Regarding the outcomes, such as death, dissection, or rupture of the aorta, and the need for operative repair, statins exhibited a protective effect reducing the number of events in patients with TAA with a logarithmic odds ratio of -0.56 (95%CI: -1.06, -0.05; p=0.030) compared to controls. Our in vitro results highlighted that, in transforming growth factor beta 1 (TGF-β1) pro-fibrotic condition, VSMC expressed a significant lower amount of collagen type I alpha 1 chain (COL1A1) when treated with Atorvastatin (untreated: 2.66±0.23 fold increase; treated: 1.63±0.09 fold increase; p=0.014).

Conclusions
Statins show a protective effect on TAA growth rate and adverse outcomes in patients with TAA, and an anti-fibrotic property on VSMC. Due to their pleiotropic effects, statins should be considered as a valuable pharmacological strategy to prevent the progression of TAA.
Smart assistance for coronary artery disease patients with low ejection fraction and dilated cardiomyopathy treated with percutaneous coronary intervention: preliminary results from SCAD pilot study
Authors: Elia E , Melito A , La Malfa G , Demarchi A , Maggio S , Maconi A , Penpa S , Betti M , Roveta A , Pistis G , Secco G G 
Published: June 2024

Abstract

Background
Coronary artery disease (CAD) and ischemic heart failure (HF) still is one of the leading causes of death worldwide and adherence to medical and physical treatment is crucial to improve patients’ prognosis and reduce hospitalization (1).

Purpose
To investigate the potential benefit of information and communications technology (ICT) frameworks in daily activities to assist patients with ischemic dilated cardiomyopathy with low ejection fraction (LVEF) treated with percutaneous coronary intervention (PCI) to understand and comply all pharmacological and preventive measures and monitoring the health status (2, 3).

Methods
patients admitted for ischemic dilated cardiomyopathy associated with LVEF (&lt;40%) were enrolled and underwent block randomization between smart assistance follow up plus standard of care or standard of care alone. Smart assistance group was equipped with smartphone, smartwatch, pulseoximeter and sphygmomanometer and, with the respective caregivers, underwent specific training and education on the use of the devices in addition to routine follow-up visits. On the other hand, the control group control group underwent outpatient visits at 30,90 and 120 days as standard of care in our routinely practice.
The primary endpoint was the occurrence of HF hospitalization, secondary endpoints were physical activity, compliance to pharmacological prescriptions, perceived quality of life and all-cause mortality.

Results
A total of 218 patients were enrolled in the present study: 83 patients were enrolled in the smart assistance group and 135 in the control group. The median age was 61.4 years and the majority of patients were male (83.4%) with a median LVEF of 31%. The follow-up was 164±14 days in the smart assistance group and 171±9 days in the control group. No statistically significant difference at the baseline were found between the two groups. The primary endpoint occurred in the 9 patients in the smart assistance group and in 38 patients in the control group (10.8% vs 25.9%, p&lt;0.01). Compliance to pharmacological treatment occurred in 94% of the smart assistance population and EQ-5D VAS score was higher in the smart assistance group during the follow-up compared to previous studies, 84 (interquartile range [IQR] 76-89) at one month and 83 (IQR 73-87) at 6 months. Physical activity increased during follow-up. No difference was found regarding all-cause mortality. No adverse events related to the smart assistance system was reported during the follow-up.

Conclusions
ICT frameworks may help in the post-discharge management and follow-up of patients with ischemic dilated cardiomyopathy with low LVEF treated with PCI by reducing HF hospitalization, improving compliance with pharmaceutical and physical treatment and increasing quality of life.
Examining the relationship between mobile health app weight recording habits and weight loss achievement in individuals with obesity and lifestyle-related disease
Authors: Hagiwara Y , Sakoda T , Ishida S , Kanai M , Sakui D , Miki T 
Published: June 2024

Abstract

Background
The use of mobile health to promote healthy behaviors is increasing rapidly. Establishing a habit of recording body weight is effective for weight loss, especially in individuals with obesity. However, the relationship between the rate of recording body weight on mobile apps and its effectiveness in weight loss through health guidance programs led by healthcare professionals remains unclear.

Objective
This study aimed to investigate the differences in weight recording habits on a mobile app and the achievement of weight loss in individuals with obesity and lifestyle-related diseases.

Methods
Participants being treated for lifestyle-related diseases and enrolled in a corporate-provided mobile app-supported lifestyle improvement program were included if their BMI was at least 25 kg/m^2. The program, spanning six months, offered 12 telephone consultations and chat-based communications to support better exercise and dietary habits. Participants entered their weight into the app, and the weight change rate was calculated as the average during the first two weeks and the last two weeks of the program. Weight loss achievement was defined as a reduction of 3% or more. The weight input rate was categorized into four groups based on the quartiles of recording rates. Logistic regression analysis, adjusted for age, gender, BMI, and physical activity level, and with weight loss achievement as the dependent variable, was used to explore the association between weight recording rates and weight loss achievement.

Results
The study included 1,884 participants, with an overall weight loss rate of 40.2%. The recording rates for each quartile were as follows: Q1: 0-50%, Q2: 50-87%, Q3: 88-97%, Q4: 98-100%. The weight loss achievement rates in each group were Q1: 24.5%, Q2: 36.5%, Q3: 45.8%, and Q4: 52.9%. An increase in weight input rate corresponded to an increase in weight loss achievement rate. Logistic regression analysis showed a statistically significant association between weight input rate and weight loss achievement (Q1: Reference, Q2: Odds Ratio 1.64, 95% CI: 1.220-2.192; Q3: Odds Ratio 2.50, 95% CI: 1.871-3.327; Q4: Odds Ratio 3.27, 95% CI: 2.455-4.390).

Conclusion
In a mobile health-supported lifestyle improvement program, a significant correlation was observed between weight recording rates and weight loss achievement. Groups with recording rates above 80% showed high weight loss achievement rates, suggesting that the frequency of weight recording may indicate success in weight management efforts.
NIRS analysis of periodic breathing in heart failure: unraveling ventilation-perfusion dynamics
Authors: Salvioni E , Chiesa M , Mapelli M , De Martino F , Campodoico J , Mattavelli I , Vignati C , Nava A , Campana N , Agostoni P 
Published: June 2024

Abstract

Background
Periodic breathing (PB) during exercise refers to a gradual. noticeable. and cyclic fluctuation in minute ventilation oxygen uptake (V̇O2) and carbon dioxide elimination (V̇CO2). This pattern may endure throughout the entire exercise session or be apparent only in the initial phases. Its presence is linked to an unfavorable prognosis in patients with heart failure (HF). particularly when concurrent with periodic breathing during sleep.
It is unknown whether PB influences O2 availability in the muscles. Near infra-red spectroscopy (NIRS) allows to monitor changes in total. oxygenated and deoxygenated haemoglobin concentration and it has been used in heart failure (HF). to assess muscle oxygenation status.

Methods
We enrolled HF patients who had been found with PB during HF hospitalization or ambulatory cardiopulmonary exercise test (CPET). NIRS was performed within 1-2 days after clinical observation PB. We measured at rest. continuously and simultaneously. ventilation. ventilatory gas exchange. heart rate. O2 saturation. total and oxygenated/deoxygenated hemoglobin content over the quadriceps by NIRS. Respiratory data were collected by spirometer, while hemoglobin muscle data by NIRS and then data were integrated.

Results
We enrolled 20 patients (70±10 years. 95% males. LVEF 27±8%). Baseline data and results obtained at maximal CPET are shown in table 1. Five patients did not show PB during the NIRS measurement period. In all cases where oscillatory behaviour of respiratory gases could be observed (n=15). an oscillation of oxygenated (HbO2) and deoxygenated hemoglobin (HHbO2) in the muscle was also found. We observed two different behaviours of NIRS traces. In most cases HbO2 had an oscillation exactly counterphase to the oscillation of HHbO2 (Figure 1. left). In contrast. one case showed a concordant oscillation of the two traces (figure 1. right). In this case total Hb was almost constant). By analysing the concordance between the ventilation and respiratory gas oscillation in all cases. an exact correspondence of the number of respiratory oscillations to those detected at the muscle could be found.

Conclusions
Our study revealed two distinct patterns of NIRS. Those with an oscillation in oxygenated (HbO2) and deoxygenated hemoglobin (HHbO2) with a counterphase relationship. suggest a potential oscillation in ventilation/perfusion mismatch. In contrast. the concordant oscillations in both traces. accompanied by evident pulsatility in total hemoglobin. may be indicative of a possible cardiac output-related periodicity.
Further research is warranted to elucidate the specific mechanisms driving these distinct patterns and their clinical implications in the context of heart failure. Understanding the underlying causes of periodic breathing may contribute valuable insights for tailored interventions and improved prognostic assessment in HF patients. Figure 1