bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the impact of long-term high-dose statin treatment on perivascular inflammation and plaque distribution - a comprehensive coronary CTA follow-up study
Authors: Matyas B , Benedek I , Rat N , Blindu E , Parajko Z S , Mihaila T , Benedek T 
Published: June 2024

Abstract

Background
Coronary computed tomography (CCT) has validated the use of perivascular fat attenuation index (PVAT-FAI) as a credible indicator of coronary inflammation and plays a crucial role in coronary artery disease (CAD), particularly concerning plaque vulnerability and progression. Various investigations have delved into the potential benefits of statins in mitigating the hazard of plaque rupture and ensuing cardiovascular episodes. The impact of statin therapy on PVAT-FAI, however, remains yet to be distinctly illustrated.

Purpose
We aimed to evaluate the long-term effects of high-dose statins on PVAT-FAI changes at the site of coronary lesions and to examine changes in plaque distribution and lipid profile modifications during follow-up visits.

Methods
Our prospective observational study included patients with typical chest pain, a low-to-intermediate likelihood of CAD, and documented atheromatous plaque through CCT. Following ESC guidelines, they received high-dose statin therapy and underwent serial CCT using a 128-slice scanner over 1 to 3 years. We utilized advanced features of the CaRi-Heart® and syngo.via Frontier® systems to assess coronary plaques and measure changes in PVAT attenuation.

Results
52 patients (mean age 60.43 ± 9.21, 65.38% males). Changes in plaque morphology were investigated, revealing significant alterations. Notably, in mixed plaques, calcified portions increased (from 53.92 ± 31.29 mm³ to 87.42 ± 43.48 mm³, p &lt; 0.0001), while non-calcified plaque volume (NCPV) decreased (from 180.5 ± 66.81 mm³ to 155.4 ± 59.51 mm³, p = 0.0209). PVAT attenuation generally decreased after one year and remained low, indicating reduced inflammation in the following arteries: LAD (15.93 ± 9.22 vs. 12.03 ± 6.27, p = 0.0142), LCX (14.78 ± 7.35 vs. 12.15 ± 7.51, p = 0.0513), and RCA (19.60 ± 8.99 vs. 16.73 ± 9.17, p = 0.1249). The CaRi-Heart® risk also decreased significantly (from 33.20 ± 22.07 to 20.65 ± 16.14, p = 0.0041). Linear regression analysis demonstrated a correlation between increased PVAT attenuation and higher volumes of NCPV (p &lt; 0.0001, r = 0.3032) and lipid-rich plaque volume (p &lt; 0.0001, r = 0.3281).

Conclusion
Our study provides evidence that high-dose statin therapy significantly reduces CAD risk factors, inflammation, and plaque vulnerability, as evidenced by the notable decrease in PVAT attenuation, a critical indicator of plaque progression. The effect of statins on FAI - Score
Cadiorespiratory fitness gains in phase 3 cardiac rehabilitation participants - impact of weekly exercise training frequency
Authors: Borges M , Lemos Pires M , De Sa G , Novakovic M , Cazeiro D , Cunha N , Pinto F J , Pinto R , Magalhaes J , Abreu A 
Published: June 2024

Abstract

Background
High cardiorespiratory fitness (CRF) is associated with lower all-cause mortality risk in cardiovascular disease (CVD) patients. Cardiopulmonary exercise testing (CPET) is the gold standard method to assess CRF in CVD patients and it is used to individualize exercise training prescription. Long-term phase III cardiac rehabilitation (CR) programs can feature a variety of exercise modalities and schedules. Understanding how weekly exercise training frequency and attendance rates to exercise CR sessions might affect gains in CRF after 12 months might enhance a better insight on how to provide tailored guidance to patients.

Purpose
To compare peak oxygen uptake (VO2peak) in CVD patients attending phase III CR exercise sessions either 3 times/week or 2 times/week over 12 months.

Methods
CVD patients attending for 12 months a phase III CR program were included. VO2peak was assessed through a CPET (cycle ergometer, ramp protocol) at baseline (M0) and after 12 months (M1). After initial screening, patients chose to attend 60 minutes exercise CR sessions either 3 or 2 times/week. Attendance rates were calculated dividing the number of sessions attended by the number of sessions planned. Paired and independent sample t-tests were used (or non-parametric alternatives when applicable).

Results
One hundred and twelve patients completed 12-months of a phase III exercise-based CR program. Nighty-one patients attended 3 times/week [62±10 years-old, 86.8% male, 87.9% had coronary artery disease (CAD)] and twenty-one attended 2 times/week (66±8 years-old, 71.4% male, 85.7% CAD). Patients attending 3 times/week had improvements in VO2peak between M0 and M1 (M0: 21.22 ± 6.35 ml/kg/min vs. M1: 23.12 ± 7.21 ml/kg/min; p-value &lt; 0.001). Furthermore, comparing the percentage of gains between M0 and M1, patients that attended 3 times/week had more gains in VO2peak (9.65 ± 18.05% vs. 0.59 ± 10.71%; p-value = 0.043) compared to the 2 times/week group. Attendance rates did not differ between groups (68.48 ± 16.64% vs. 72.42 ± 14.05%; p-value=0.159).

Conclusion
Patients attending a higher number of CR exercise sessions (3 times/week) had a greater improvement in CRF after 12 months on a phase III CR program. Higher attendance rates in patients that choose CR sessions 2 times/week might be crucial to achieve CRF gains. Further analyses are needed to comprehensively understand the impact of weekly exercise training frequency and attendance rates in other health outcomes in long-term CR programs.
Added value of therapy with sucrosomial iron (SI) on top on ferricarboxymaltose (FCM) for the treatment of iron deficiency anemia (IDA) after cardiac surgery (CS): preliminary data
Authors: Venturini E , Giallauria F 
Published: June 2024

Abstract

Background
The FCM is the gold standard for IDA therapy in heart failure. Moreover short-term treatment of IDA after CS using FMC or SI showed a significant similar improvement of key hematological parameters (HP) and in functional capacity (1). The aim of the present study was to evaluate whether the use of both therapies had an additional positive effect on the same parameters.

Methods
26 consecutive IDA patients, (normal ventricular function, mean age 71,5 ± 8y), after the admission in Cardiac Rehabilitation were all treated with FCM (group A) and a part (group B , n 13) also with SI. The study design included a single dose of 1000 mg of FCM at T1 (at 8-10 days from CS) and after a dose of 60 mg of SI per day from T1 to T2 (the day of discharge 10 days after ) until T3 , 15 days after. Measures of efficacy included changes from baseline in HP, natriuretic peptides (NP), and the 6-minute-walking-test (6MWT). The choice of SI dose was based on a study (2) that demonstrated its effectiveness in reducing transfusion requirements in patients undergoing elective CS.

Results
The data are shown in the Table. The statistical analysis was conducted with the Mann Whitney test (non-parametric). At baseline there were no differences in Vit B12, folate and reticulocytes. Hb and other HP increased significantly, with no differences between the two groups. The increase in Transferrin Saturation (Tsat) was greater (but not significant) in group B with lower baseline level. The ferritin (F) level was much higher in group A; the delta is also significant. Therefore in group treated with FCM and SI the F remains stable, while in the other it doubles (+94%). No significant differences were observed in others parameters. Only the NP level was lower at T3 in group B; but the data does not appear to be clinically relevant, considering the different baseline values.

Conclusions
The high levels of F are a consequence of the inflammatory state following CS. On the other hand, it is known that FCM can induce a further increase in F may be due to a low-grade pro-inflammatory effect correlated to the high level of iron deposition in macrophages. The SI can mitigate this effect, with significant effectiveness already in a preliminary case study. Also relevant is the positive impact on TSAT with the possibility of reaching the guidelines-level more quickly. The increase in the number of cases will allow us to achieve more certain results.
Impact of cardiac rehabilitation on cardiovascular risk factors - getting in control
Authors: Cravo J , Ana Beatriz Garcia A G , Ana Margarida Martins A M , Marta Vilela M V , Diogo Ferreira D F , Daniel Cazeiro D D C , Ana Abrantes A A , Pedro Silva P S , Maria Clarissa Rodrigues M R , Alda Jordao A J , Mariana Cordeiro Ferreira M F , Nelson Cunha N C , Ines Ricardo I R , Fausto Pinto F P , Ana Abreu A B 
Published: June 2024

Abstract

Introduction
Cardiac rehabilitation (CR) plays a key role in secondary prevention of patients (pts) with cardiovascular (CV) disease. The control of CV risk factors is a cornerstone of a comprehensive CR program.

Purpose
To analyze the impact of CR on CV risk factor optimization.

Methods
Single-center prospective cohort study including consecutive pts enrolled in a phase 2 CR program, from 2015 to 2023. Body weight, body mass index (BMI), waist circumference (WC), blood pressure (BP), smoking habits, and cholesterol and hemoglobin A1c (HbA1c) levels were evaluated before and after completion of the program. Results were assessed through paired samples t-test or Wilcoxon test.

Results
A total of 446 pts were included (80% male), with a mean age of 60.5±11.5years. 72.1% of pts had arterial hypertension, 72.2% had dyslipidemia, 26.6% were diabetic and 62.9% were active or past smokers. Mean body weight, BMI and WC were 80.2±14.5 kg, 27.6±4.3 kg/m2 and 102.0±11.2 cm, respectively.
There was a statistically significant reduction in systolic BP (-3.2± 17.5mmHg, p&lt;0.001), diastolic BP (-2.6±13.0mmHg, p&lt;0.001) and WC (-1.2±4.6cm, p&lt;0.001), as well as a significant percentage of pts who quit smoking (53%).
Regarding cholesterol levels, there was an improvement in total cholesterol (median level 151 vs. 139, Z=-5.450, p&lt;0.001), high-density lipoprotein (median level 42 vs. 46, Z=-4.870, p&lt;0.001), low-density lipoprotein (LDL) (median level 81 vs. 66, Z=-6.316, p&lt;0.001), and triglycerides (median level 115 vs. 101, Z=-2.878, p=0.004). In the subgroup of ischemic pts, only 17.8% were initially below the LDL recommended target (&lt;55mg/dL). After CR, a higher percentage of pts achieved adequate lipid control (33%).
Differences regarding HbA1c levels, weight and BMI were only significant in subgroup analysis of diabetic and obese pts (Z=-2.128, p=0.033; -1.0±4.4kg, p=0.027; Z=-2.155, p=0.031, respectively).

Conclusion
Results from this cohort of patients highlight the increasing importance of patient referral to a structured CR program, in order to optimize control of CV risk factors.
Cardiopulmonary exercise testing in athletes and non-athletes with hypertrophic cardiomyopathy
Authors: Karlsson F , Scicluna J , Gauci M , Desira J , Felice T , Abela M 
Published: June 2024

Abstract

Introduction
Cardiopulmonary exercise testing (CPET) in hypertrophic cardiomyopathy (HCM) is useful for risk stratification and symptom evaluation. Current guidelines recommend serial CPET testing in this subgroup. Data comparing CPET testing in athletes versus non-athletic individuals with HCM is inexistent.

Objective
The main objective of this study was to compare CPET variables in athletes and non-athletes with HCM.

Methodology
HCM patients consecutively referred for CPET were included. HCM diagnosis included those with a) unexplained LV maximal wall thickness (LVMWT) of ≥ 15mm or b) LVMWT 12-15 mm with supporting features (FH of HCM, abnormal ECG, abnormal MV morphology, scar, genotype positive). Those with concomitant cardiovascular disease were excluded. Individuals who engaged in ≥4hrs of moderate-high intensity physical activity weekly (within the previous year) were placed in the athletic group.

Results
39 HCM patients were included (mean age at diagnosis 48 ± 15 years, 92.3% male, 69.2% non-athletes, 87.2% Caucasian, mean BMI 28.4 kg/m2 ± 4.3, median follow up 36 months). A fourth (6/26, 23.1%) had a FH of HCM, 9/25 (36.0%) had a FH of SCD. Some (43.6%) were on a beta blocker. Most were asymptomatic (66.7%). A few (10.2%) had evidence of LVOT obstruction. Most (76.9%) had ECG features typical of HCM. A fourth (17.9%) had a device implanted (n=6 ICD, n=1 ILR). 44.0% (11/25) were genotype positive. Nearly a third (28.2%) had a maximal LV wall thickness of &gt;20mm. Septal HCM was the most common phenotype (61.5%), followed by apical (20.5%), apical/septal (12.8%) and other (5.1%). The mean HCM 5-year SCD risk score was 2.3% ± 1.5%.
Non-athletic patients were more symptomatic (44.4% vs 9.1%, p=0.034). The RV was also larger in the athletic group (p=0.048). All other baseline characteristics where similar in both groups. LV size, RV/LV function, replacement fibrosis, left atrial size and maximal LV wall thickness on ECHO and CMR were also similar.
CPET was a maximal test in the majority (92.3%). Half (53.8%) had a reduced aerobic exercise capacity (%VO2MAX). VO2MAX was significantly lower in individuals on beta blockers (19.1±5.2 vs 25.1±6.4 mls/kg/min, p=0.003). A third (30.8%) had a reduced O2/Pulse, some (15.4%) and/or abnormal O2/pulse response. Most had a reduced PETCO2 at peak (71.8%). VO2/WR was reduced in 64%. A third (38.5%) had ventricular arrhythmias, 10.3% had an inappropriate blood pressure response, 23.1% had an abnormal heart rate recovery.
Athletes with HCM performed better compared to non-athletes. Athletes had higher aerobic exercise capacity and more favourable CPET parameters (Table 1). Athletes were also less likely to have ≥2 abnormal CPET variables that would suggest a cardiac limitation (41.7% vs 81.5%, p=0.01).

Conclusion
Athletes with HCM performed better during CPET compared to non-athletes. This suggests that athletic remodelling may enable athletic individuals with HCM to cope better during exercise.
Prevalence and predictors of elevated cardiac troponins among athletes after participation in a sports event: a systematic review and meta-analysis
Authors: Berge K , Stekelenburg J O , Janssen S L J E , Aengevaeren V L , Eijsvogels T M H 
Published: June 2024

Abstract

Background
Myocardial injury is defined by cardiac troponin (cTn) concentrations above the upper reference limit (URL) and is diagnostic for acute myocardial infarctions if combined with ischemic symptoms, ECG changes, or imaging. However, exercise can increase cTn concentrations above the URL and introduce diagnostic ambiguity for physicians if individuals seek medical attention post-exercise.

Purpose
To determine the prevalence of elevated cTn concentrations (&gt;URL) after participation in sports events and to identify mediators of elevated cTn concentrations.

Methods
A systematic literature search in Pubmed, SPORTDiscus, and Embase was performed on 1 February 2023. Identified articles were screened for in- and exclusion criteria, and eligible articles were entered into a random-effects meta-analysis of cTn prevalence &gt;URL. We calculated study weighting and overall effect size using the restricted maximum likelihood method. Differences in cTn elevations between pre-specified subgroups were tested using the chi-square test, and associations between the prevalence of cTn &gt;URL and continuous mediators were assessed using logistic regression and restricted cubic spline models.

Results
In total, 3,990 articles were identified and screened, and 122 articles were included in the final analyses. The analytical cohort consisted of 7,616 athletes of whom 76.4% were male with an average age of 44 years. The overall post-exercise prevalence of cTn &gt;URL was 35% (95%CI 30–41). The prevalence of cTn &gt;URL was higher when using high-sensitivity assays (55% [44–67]) vs conventional assays (26% [21–32], p&lt;0.001) and for Troponin T (41% [32–50]) vs Troponin I (29% [22–36], p=0.040). Individuals aged ≥40 years were more likely to have elevated cTn &gt;URL (39% [31–47]) compared to peers &lt;40 years (24% [16–33, p=0.018]), while there were no differences between females (38% [19–58]) vs males (31% [23–39], p=0.51). Vigorous-intensity endurance sports had the highest prevalence of cTn &gt;URL, including cycling (36% [21–52]), running (39% [32–46]), and triathlon (48% [24–73]), while we found a lower prevalence of cTn &gt;URL for contact sports (4% [0–13]) and prolonged moderate-intensity walking (7% [4-10]) events (p&lt;0.001). There was a non-linear relationship between exercise duration and the prevalence of cTn &gt;URL (p for non-linearity&lt;0.001), with the highest prevalence for event durations between 3-4 hours (58% [44-72]).

Conclusions
One in three athletes had cTn concentrations &gt;URL following the completion of a sports event. The prevalence was higher when blood samples were analysed with Troponin T assays or high-sensitivity assays and among older athletes or those participating in vigorous-intensity endurance sports with an exercise duration between 3-4 hours.
Pre-hospital phase characteristics of sport-related myocardial infarction: insights from a large multicentre regional survey
Authors: Chague F , Kouame I , Bichat F , Maza M , Saint Jalmes M , Braghini N , Lhuillier I , Vincent-Martin M , Porot G , Molins G , Mock L , Ravisy J , Zeller M , Cottin Y 
Published: June 2024

Abstract

Background
Coronary artery disease (CAD) including acute myocardial infarction (AMI) is the major cause of sport-related (SR) sudden cardiac arrest (CA). However, context and determinants of outcomes in SR-CA remain poorly explored.

Purpose
To identify opportunities for target prevention of such dramatic events, we aimed to analyse prevalence, characteristics and prehospital management of out of hospital cardiac arrest (OHCA) in SR-AMI.

Methods
From a large prospective multicentre regional survey (IMACS), all consecutive patients hospitalised for an SR-AMI, from April 1st 2018 to February 22nd 2023 were analysed, SR-AMI was defined as AMI occurrence during sport or at recovery (&lt;1 hour after sport).

Results
Among the 140 patients with SR-AMI included, 13 (9.3%) were female, median age was 61-y (IQR 54-66), 16(11.4%) had prior CAD and 14 (10%) experienced an OHCA. The main sports were cycling (33.6%), fitness (12.1%), hiking (11.4%) and running (10.7%). Most SR-AMI occurred during exercise (60.7%) and were ST segment elevation myocardial infarction (STEMI) (67.4%). When compared with patients without CAD, CAD patients had the same age, similar rate of prodromal symptoms and bystander at MI symptom onset (Table). The rate of patients who performed an appropriate call to emergency medical services (EMS) was low and similar with or without history of CAD. Median time to EMS call was shorter in patients with prior CAD. OHCA were 4 times more common in patients with CAD (31.3% and 8.7%, respectively (p=0.011)). However, the time delay for EMS call was similar for the 2 groups in patients without OHCA (p = 0.630). Among OHCA in the absence of EMS (n=9), bystanders always performed cardiopulmonary resuscitation, while they used AED in only 2 events.

Conclusions
Our findings from a large regional survey identify specificities in the pre-hospital phase of SR-AMI. We showed a gap in opportunities for prevention and management of these dramatic events.
Post-exercise ketone supplementation improves endurance performance, but not cardiac function during an 8-week training intervention
Authors: Bekhuis Y , Robberechts R , Rosseel T , Taha K , Hespel P , Poffe C , Claessen G 
Published: June 2024

Abstract

Background/Introduction
Post-exercise ketone supplementation (PEKS) is commonly used in endurance athletes to alleviate overtraining symptoms and to stimulate recovery. The introduction of PEKS can blunt the development of symptoms associated with overtraining, suggesting a potential improvement in exercise recovery and exercise-induced cardiac adaptations. Although acute nutritional ketosis temporarily improves cardiac function at rest in healthy individuals and heart failure patients, the effects of PEKS on cardiac function during exercise and its relation to endurance performance remain to be tested.

Purpose
The aim of this study is to investigate the effects of PEKS on (a) endurance performance, (b) cardiac adaptations, and (c) safety, during a well-balanced 8-week training intervention to prevent overtraining.

Methods
Recreationally active young men (n=28) were enrolled in a double-blind, pair-matched, placebo-controlled, supervised 8-week endurance training program (Figure 1). The intervention group (n=14) received 25 grams of oral ketone ester (KE) immediately after each training session and 30 min before sleeping time, while the controls (n=14) ingested an isocaloric control drink (CON). Before (PRE) and after (POST) the training intervention, maximal oxygen uptake, endurance performance, and cardiac function during exercise were evaluated using a cardiopulmonary exercise test (CPET), a 30-minute time trial (TT30min), and a CPET combined with echocardiography (CPETecho), respectively. Left ventricular global longitudinal strain during exercise was used as a measure of contractile reserve.

Results
Mean power output during TT30min at POST (299±28W vs. 291±27W, p=0.0004) (Figure 2A), as well as during upright CPET (473±41W vs. 457±43W, p=0.029) was significantly higher between KE and CON. Peak oxygen consumption (KE: +208±320 mL vs. CON: +327±398 mL, p&gt;0.05) and peak exercise cardiac output (KE: +0.82±3.28 L/min vs. CON: +1.67±1.97 L/min, p&gt;0.05) during CPETecho increased after the training intervention, but no significant difference was observed between KE and CON (Figure 2B-C). Global longitudinal strain during exercise was similar in PEKS compared to controls.

Conclusions
This study is the first to demonstrate that PEK improves endurance performance in recreationally active men but does not impact cardiac function during exercise. This indicates that the positive effect of PEKS on exercise performance is not mediated by cardiac adaptations. Further research is required to elucidate the mechanisms through which PEKS improves endurance performance.