bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute effect of aerobic exercise on brain-derived neurotrophic factor levels in patients with chronic heart failure
Authors: Fuertes-Kenneally L , Manresa-Rocamora A , Baladzhaeva S , Sempere-Ruiz N , Hernandez-Perez I , Blasco-Peris C , Sanz-Rocher A , Garcia-Alvarez M , Climent-Paya V , Sarabia J 
Published: June 2024

Abstract
Brain-derived neurotrophic factor (BDNF), known for its pivotal role in neuroplasticity, has emerged as a promising diagnostic and prognostic biomarker for chronic heart failure (CHF). BDNF, through its interaction with the tropomyosin-related kinase receptor B (TrkB), has been linked with the pathogenesis of various cardiovascular diseases, including coronary artery disease, cardiomyopathy, and hypertension. Patients with CHF exhibit diminished BDNF levels compared to their healthy counterparts. Notably, exercise has been shown to elevate BDNF levels in healthy individuals. However, no study has explored the potential effects of acute exercise on BDNF levels in patients with CHF. Therefore, the aim of the current study was to analyse the acute effect of aerobic exercise on BDNF levels in patients with CHF. Additionally, we investigated the influence of different patient characteristics (e.g., age, weight, and cardiorespiratory fitness) and exercise variables (e.g., duration) on BDNF concentrations. Eleven patients (53.2 ± 5.5 years; seven males) with CHF were finally included. BDNF levels were measured before and immediately after a cardiopulmonary exercise test on a cycle ergometer. Paired t-test, mean change with its 95% confidence interval (CI), and Pearson correlation were used to conduct statistical analyses. Moreover, Mann-Whitney U test was used to carry out between-group comparisons (e.g., sex) in changes in BDNF. Correlations were interpreted as weak (&lt; 0.30), low (0.30 – 0.49), moderate (0.50 – 0.69), strong (0.70 – 0.89), or very strong (&gt; 0.90). The findings showed a statistically significant increase (p = .005) in BDNF levels of 320.7 (CI = 136.4, 505.1) pg·ml-1. No differences were found between male and female patients (p = .269). Moreover, a moderate yet non-significant negative correlation was observed between the acute exercise-induced effect on BDNF levels and patients’ weight (r = –0.593; p = .054) and body mass index (BMI) (r = –0.530; p = .094). Aerobic exercise acutely increases BDNF levels in male and female patients with CHF. Further studies are required to determine the influence of patient characteristics (i.e., weight and BMI).
Heart failure with preserved ejection fraction incidence in hypertensive patients according to cardiorespiratory fitness
Authors: Kokkinos P , Samuel I B , Pittaras A , Panagiotakos D , Doumas M , Grassos H , Howard D H , Faselis A F , Myers J 
Published: June 2024

Abstract

Introduction
Heart failure (HF) with preserved ejection fraction (HFpEF) is closely associated with traditional cardiac risk factors including hypertension. Strategies to prevent the incidence of HFpEF include lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and HFpEF incidence in hypertensive patients has not been evaluated.

Purpose
Evaluated the association between CRF and HFpEF incidence in hypertensive patients.

Method
We assessed CRF in 390,880 hypertensive patients (mean age 62.7 ± 8.6 years by a standardized exercise treadmill test (ETT) performed across US Veterans Affairs Medical Centers. All had no evidence of HF or myocardial infarction prior to completion of the ETT. We established five age-and-gender-specific CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved during the ETT. Q1 (n=80,569; METs=4.6±1.2); Q2 (n=101,358; METs=7.0±1.1): Q3 (n=77,649; METs=8.4±1.2); Q4 (n=97,624; METs=10.3±0.9); Q5 (n=33,680; METs=13.2±1.5)

Results
During 5,471,090 person-years of follow-up (median 14.0 years), there were 16,493 HFpEF events with an average annual rate of 2.4 events per 1,000 person-years. The adjusted risk of HFpEF decreased progressively across CRF categories as CRF increased, independent of comorbidities. Compared to Q1 (Referent; 4.6±1.2 METs), the risk was 27% lower (hazard ratio [HR] 0.73, 95% CI 0.69-0.75) for individuals within Q2 (7.0 ±1.1 METs) and 61% lower (HR 0.39, 95% CI 0.36-0.43) for those in Q5. Being unfit carried the highest risk (HR, 2.22; 95% CI, 2.33-2.80) of any other comorbidity. Similar findings were observed for those &lt;65.0 and ≥65 years.

Conclusions
Higher CRF levels were independently associated with lower HRpEF incidence in a dose-response manner in hypertensive patients. The lower risk was observed at relatively low CRF levels (7.0 METs) achievable by most middle-aged and older individuals by engaging in approximately 25-30 minutes of brisk walk daily.
Effect of SGLT2 inhibitors in the management of moroccan patients with heart failure with reduced ejection fraction
Authors: Mouine N , Loudiyi N , Zaimi A , Malki M , Bouzelmat H , Chaib A , Lakhal Z , Benyass A 
Published: June 2024

Abstract

Introduction
Chronic heart failure became more frequent in Moroccan patients. The aim of our study is to determinate the benefit of SGLT2 inhibitors in patients with heart failure with reduced ejection (HFrEF) fraction.

Materials and methods
It's a prospective study included 140 patients with heart failure with reduced ejection fraction (HFrEF), admitted in Cardiac Rehabilitation unit, Cardiology centre, Morocco. All of them had clinical evaluation, echocardiography and cardio respiratory evaluation.

Results
The average of patients was 67,13 ± 7,4 years with male predominance, they have more than three cardiovascular risk factors dominated by diabetes and hypertension, coronary artery disease is the most frequent etiology, they had reduced ejection fraction (EF : 32 ± 6,4%).
After 20 sessions of exercise training and therapeutic education specially optimisation of treatment by introducing precociously Quadruple theray ( Betablockers, MRA, ARNi, and SGLT2inhibitors), patients have a good quality of life, they become less symptomatic (dyspnea class III to II of NYHA); they significantly improve 6 min walk test and maximal work load (from 59, 6 ± 10,7 to 71, 2 ± 19,2 watt) and VO2max (from 14,2 ± 5,3 to 19,7 ± 6,9 ml/kg/min)

Conclusion
This study demonstrated that exercise training and optimisation of treatment specially SGLT2inhibitors is clearly benefit for patients with HFrEF to improve their exercise capacities and quality of life
The usefulness of the tidal Volume difference(Peak-rest) as a prognostic indicator in patients with heart failure with reduced ejection fraction
Authors: Moriya S , Iwata H , Nakade T , Sunayama T , Maeda D , Yatsu S , Ishiwata S , Nakamura Y , Suda S , Kato T , Hiki M , Matsue Y , Yokoyama M , Kasai T , Minamino T 
Published: June 2024

Abstract

Background
The diaphragm is not only a crucial respiratory muscle but also plays a vital role in the cardiovascular system. It supports venous return to the right atrium and regulates heart rate variability and sympathetic activity. The capacity to increase the tidal volume of the lungs varies depending on the diaphragm's function. We hypothesized that the more severe the heart failure, the lower the diaphragm's functionality and, consequently, the less increase in tidal volume (TV). Thus, we proposed that the TV difference between peak exercise and rest during cardiopulmonary exercise testing (CPET) could predict prognosis in heart failure patients with reduced ejection fraction (HFrEF).

Purpose
To investigate whether ΔTV (Peak-rest) in milliliters helps in predicting prognosis in HFrEF patients.

Methods
We enrolled 136 HFrEF patients who underwent CPET, with data available on TV increase from rest to peak exercise point (ΔTV (Peak-rest) in milliliters). The primary endpoint was a combined outcome of all-cause mortality and heart failure hospitalization.

Results
During a median follow-up of 4.0 years (interquartile range: 2.4-5.3 years), we observed 56 combined events. The cutoff value for ΔTV (Peak-rest) in milliliters, defined by the median, was 714ml. Patients with ΔTV (Peak-rest) below 714ml exhibited a significantly higher event rate compared to those with ΔTV (Peak-rest) of 714ml or higher (Log-rank: p&lt;0.001). This association remained significant even after adjusting for age and sex (HR: 0.27, P&lt;0.001).

Conclusions
ΔTV (Peak-rest) in milliliters is a promising prognostic indicator in patients with HFrEF and could serve as a new tool for prognosis assessment in these patients.
Safety and efficacy of home-based neuromuscular electrical stimulation on physical function in frail older patients with heart failure: a randomized crossover study
Authors: Kato M , Ono S , Seko H , Nakatani E , Seo Y , Omote T , Omote S 
Published: June 2024

Abstract

Introduction
Neuromuscular electrical muscle stimulation (NMES) therapy is a non-volitional method used to elicit muscle contractions without inducing dyspnea. By stimulating skeletal muscles, NMES therapy enhances exercise capacity, increases muscle mass, and improves muscle function in patients with heart failure (HF). Recently, supervised NMES has been reported to safely increase lower limb motor function in frail older patients hospitalized for acute HF. However, the safety and effectiveness of home-based NMES therapy remain uncertain, particularly in frail older patients with HF.

Purpose
This study aimed to examine the safety and efficacy of home-based NMES therapy on lower extremity function in frail older patients with HF.

Methods
Eight frail older patients (age ≥ 75 years) with HF undergoing home or ambulatory cardiac rehabilitation (CR) were enrolled in this randomized, open-label, crossover study. Participants underwent CR plus home-based NMES therapy and CR alone for 8 weeks each in random order, separated by a 4-week washout period. NMES with a 50-Hz frequency was administered for 50 minutes per day, five times per week with electrodes placed on the quadriceps, gastrocnemius, and soleus muscles. Patients participated in a supervised exercise program, a combination of endurance and resistance training with light to moderate intensity, once or twice times weekly at the hospital or at home. Adverse cardiac events and plasma brain natriuretic peptide (BNP) and creatine kinase (CK) levels were assessed as indicators of NMES safety. The Short Physical Performance Battery (SPPB) and the Barthel Index (BI) were measured as parameters of lower extremity function and activities of daily living.

Results
The average age of the patients was 85 years, and three were men. All patients completed the study without experiencing any adverse cardiac events. In comparison with CR alone, there were no significant effects of CR plus home-based NMES therapy on BNP (P = 0.51), CK (P = 0.34), or BI (P = 0.17). The 8-week treatment with CR plus home-based NMES therapy resulted in a significant increase in SPPB score compared to CR alone (P &lt; 0.05).

Conclusions
Home-based NMES therapy was safe and improved lower extremity function in frail older patients with HF undergoing CR.
Addition of inspiratory muscle training to a combined exercise rehabilitation program improves systemic microcirculation of chronic heart failure patients
Authors: Katsoula C , Karatzanos E , Vasileiou I , Briasoulis A , Papadopoulou E , Kontogeorgos C , Kalampakos N , Papazachou O , Routsi C , Nanas S , Vasileiadis I 
Published: June 2024

Abstract

Introduction
Chronic heart failure (CHF) has been characterized with microcirculation and endothelial abnormalities, as well as impaired function of the respiratory system. Exercise training programs have been an important component of CHF rehabilitation. Inspiratory muscle training (IMT), a supplementary form of exercise, induces beneficial effects on the functional status of patients; however, there have not been much data on its effects on the systemic microcirculation.

Purpose
The aim of the study was to evaluate the effect of the addition of an IMT regime to a combined exercise rehabilitation program on the microcirculation of non-exercising muscles (systemic effect) in CHF patients.

Method
Twenty-five (22♂/3♀) stable CHF patients, on optimal medication, [age: 60.3±8.9 years, ejection fraction (EF): 32.3±7.7%, maximal inspiratory muscle pressure (MIP): 81.9±23.8 cmH2O, predicted MIP (%): 89.1±25.6, VO2peak:17.9±3.9 ml/kg/min, NYHA≥ΙΙ] were randomly assigned to the intervention group (IG, n=12) or the control group (CG, n=13) and trained 3×/week for 12 weeks. Both groups participated in a combined regime (aerobic exercise and muscle training). In addition, IG performed IMT (5 sets × 10 repetitions, 35-60% MIP) and CG sham-IMT (5 sets × 10 repetitions, 10% MIP). Systemic microcirculation was assessed with near-infrared spectroscopy (NIRS) and the 3-min vascular occlusion technique at the thenar muscle. Cardiorespiratory exercise testing and muscle strength assessment were also performed, before and after the program. Microcirculation variables evaluated included oxygen consumption rate and reperfusion rate. Values are expressed as mean and standard deviation.

Results
Reperfusion rate improved in the IG compared to the CG (from 3.5±1.6 to 4.5±1.4 %/min vs 3.2±1.6 to 3.2±1.8 %/min, p&lt;0.05), while oxygen consumption rate did not change (IG: from 12.9±3.6 to 14.1±2.9 %/min, CG: 12.4±4.8 to 12.9±5.5 %/min, p&gt;0.05). There was a significant between-group difference for MIP (IG: from 74±29 to 98±21 cmH2O, CG: from 90±16 to 91±16 cmH2O, p&lt;0.05). Not any between-group differences (p&gt;0.05) were found for VO2peak (IG: from 18.2±3.7 to 19.2±4.3 ml/kg/min, CG: from 17.6±4.1 to 18.5±4.7 ml/kg/min), maximum workload (IG: from 120±52 to 132±49 watt, CG: from 119±43 to 129±45 watt), maximum leg extension load (IG: from 42±14 to 48±14 kg, CG: from 42±16 to 47±18 kg), or any other cardiorespiratory and strength variables evaluated.

Conclusions
An IMT regime, in addition to a combined exercise training rehabilitation program, improved the systemic microcirculation in CHF patients; in particular, the reperfusion rate index, which reflects the endothelial function.
Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)
Authors: Postadzhiyan A , Garkov K I R I L 
Published: June 2024

Abstract

Background
Hypertension poses a significant public health challenge in Bulgaria, requiring comprehensive strategies for prevention and management.

Purpose
The aim was to assess the evolution of blood pressure (BP) control and antihypertensive therapy compared to one year earlier in patients with hypertension.

Methods
SNAPSHOT was a cross-sectional, observational, multicentre, epidemiological study conducted in Bulgaria. It involved 129 investigators and included 3366 patients with hypertension. Patients’ data were collected from both a single visit and medical records dating back one year.

Results
A total of 3363 patients were analysed, with a mean (standard deviation [SD]) age of 67.2 (10.8) years. Most patients were female (60.9%), educated at secondary school level (63.4%), overweight or obese (77.9%), and non-smokers (76.5%). The mean (SD) systolic and diastolic BP were 143.1 (18.4) mmHg and 84.3 (11.8) mmHg, respectively, during the study visit, compared with values of 135.9 (14.9) mmHg and 82.3 (8.2) mmHg obtained from medical records on average 11.1 (5.5) months earlier. Systolic/diastolic BP was assessed as &lt;140/90 mmHg in 39.1% of patients at the study visit, compared to 55.1% one year earlier. At the study visit, BP was considered as controlled according to stricter age and diseases specific targets in the guidelines in 22.8% of patients, compared to 16.0% one year earlier (Figure 1). For most patients (73.8%), BP control status, as per guidelines, remained consistent between the study visit and one year earlier. Most patients (67.5%) did not achieve controlled blood pressure at either time (Figure 2).
At the study visit, almost all patients (99.5%) were treating their hypertension, took their treatment once or twice daily (94.7%). The most used medications were beta blockers (61.2%), diuretics (57.5%), and/or angiotensin-converting enzyme inhibitors (48.6%) and medications were mostly combined as bitherapy (32.2% patients) or as combination of 3 drugs (36.4% patients). No change in therapy was recorded for most patients (68.1%) between the medical records and the study visit one year later. However, a mean systolic BP of 150.6 mmHg triggered a treatment dose increase in 13.8% of patients, while the number of antihypertensive drug class was increased in 15.3% of patients in response to mean systolic BP of 148.0 mmHg. There was a switch from free combinations to a single pill combination in 7.1% of patients.

Conclusion
This study revealed a concerning prevalence of uncontrolled hypertension, with similar rates observed in one year observation. This emphasised the need for more effective management strategies to improve BP control in patients with hypertension. Figure 1 Figure 2
Pyridoxal-5'-phosphate as a cost-effective treatment option for hypertension
Authors: Lellig M , Munoz-Castaneda J M , Hermann J , Noels H , Rodriguez M , Tepel M , Jankowski J , Jankowski V 
Published: June 2024

Abstract

Background/Introduction
Hypertension is a worldwide health problem and treatment options in low-income countries are still limited. This results in high mortality. Therefore, the availability of drugs that are affordable and accessible to patients in low-income countries is still an urgent need. Angiotensin II, one of the essential vasoconstrictive peptides in the human organism, is post-translationally modified to pyruvamide-angiotensin II by pyridoxal-5’-phosphate. Pyridoxal-5’-phosphate is a less expensive vitamin B6 derivative and therefore could be a novel, cost-effective drug for the treatment of hypertension.

Purpose
We analysed the impact of post-translational modification of angiotensin II to pyruvamide-angiotensin II by pyridoxal-5’-phosphate on blood pressure.

Methods
The post-translational modification of angiotensin II to pyruvamide-angiotensin II by pyridoxal-5’-phosphate was investigated in vitro by mass spectrometry. Calcium ion influx into vascular smooth muscle cells treated with angiotensin II or pyruvamide-angiotensin II, respectively, was also investigated in vitro. In ex vivo experiments, the vasoconstrictive effect of angiotensin II and pyruvamide-angiotensin II, respectively, was analysed by using the bioassay of the isolated perfused rat kidneys. Furthermore, angiotensin II and pyruvamide-angiotensin II were investigated in in vivo experiments. Both Wistar Kyoto rats and spontaneously hypertensive rats were treated with pyridoxal-5’-phosphate by using mini-osmotic pumps and the blood pressure was measured time-dependently.

Results
Calcium ion influx in vascular smooth muscle cells after stimulation with pyruvamide-angiotensin II was lower compared to angiotensin II. Perfusion pressure of isolated perfused rat kidney increased less by pyruvamide-angiotensin II than by angiotensin II. Furthermore, the systolic and diastolic blood pressure of SHR treated with PLP decreased to physiological levels after three days of treatment (syst./diast.: 171 ± 1 / 139 ± 5 mmHg vs. 129 ± 1 / 98 ± 2 mmHg; p&lt;0.0001). The blood pressure of WKY rats treated with Ang II increased to hypertensive values after three days of treatment, while the blood pressure of WKY rats treated with Ang II and PLP is within the physiological range (syst./diast.: 167 ± 1 / 133 ± 3 mmHg vs. 129 ± 1 / 99 ± 2 mmHg; p&lt;0.0001).

Conclusions
Pyridoxal-5’-phosphate significantly decreased rat blood pressure and might be a cost-effective drug for hypertension treatment. Respectively, an increased pyridoxal-5’-phosphate intake recommendation in the form of vitamin B6 intake might have a decreasing effect on blood pressure in the hypertensive population.
Assessing the reliability of coronary artery calcium score in symptomatic patients: challenging the 'power of zero'
Authors: Basaran O , Beyoglu B , Bastug H , Demirci E , Akdeniz H , Dereli H , Uyanik B S 
Published: June 2024

Abstract

Background
The concept of a zero coronary artery calcium (CAC) score has been associated with a favorable prognosis and a high negative predictive value for excluding obstructive coronary artery disease (CAD), commonly known as the "power of zero." However, this approach has certain limitations, such as its inability to detect non-calcified plaques. In this study, we aimed to investigate the prevalence of both obstructive and non-obstructive plaques in patients with a CAC score of zero.

Methods
We conducted a retrospective evaluation of symptomatic patients who had undergone coronary artery calcium scoring and coronary computed tomography angiography (CCTA) between January 2020 and December 2021 at our institution.

Results
Out of the 884 patients enrolled in the study, 516 were found to have a CAC score of zero. Among these patients, the mean age was 51.9±11.0 years, and 51.6% were male. Surprisingly, 81 patients (15.7%) with a CAC score of zero exhibited some degree of plaques, while 435 patients (84.3%) had no detectable plaques. Among those with plaques, 25 (4.8%) had mild plaques, 47 (9.1%) had moderate plaques, and 9 (1.7%) had obstructive plaques as revealed by CCTA. Further details on the severity and extent of plaques can be found in the figure.

Conclusion
Our study unveiled a significant number of symptomatic patients with a CAC score of zero who actually had atherosclerotic plaques. This finding challenges the notion of the infallible "power of zero" in symptomatic patients. While CAC scanning remains valuable for risk stratification, it should be acknowledged that relying solely on a CAC score of zero may overlook cases with underlying atherosclerotic plaques. As a result, clinical decision-making should involve a comprehensive assessment, and further investigation might be necessary to ensure an accurate diagnosis and appropriate management in symptomatic patients.