bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond phase 2: The impact of phase 3 cardiac rehabilitation on physical activity
Authors: Vilela M , Joao Cravo J C , Ana Margarida Martins A M , Ana Beatriz Garcia A G , Pedro Silva P S , Daniel Cazeiro D C , Diogo Ferreira D F , Pedro Bartolo P B , Catarina Gregorio C G , Ana Abrantes A A , Nelson Cunha N C , Ines Ricardo I R , Fausto Pinto F P , Ana Abreu A A 
Published: June 2024

Abstract

Introduction
Phase 3 Cardiac Rehabilitation (CR) is a maintenance exercise program for which clinical benefits are less well defined comparing to phase 2.

Purpose
To assess impact of phase 3 CR on physical activity (PA) levels.

Methods
A single-center cohort study was conducted, involving patients (pts) who completed a phase 2 CR program at least 6 months prior to the study and who answered the International Physical Activity Questionnaire (IPAQ) short form version 2.0. The patients were divided in 2 groups according to progression to phase 3 program to a specialized CR center (group 1) and non-CR center (group 2). The populations were compared.

Results
A total of 110 pts were included (78% male; mean age 61,5±11 years). Regarding clinical data, 59% had hypertension, 10% were diabetic, 79% had dyslipidemia and 20% were smokers, 86% pts with ischemic heart disease. Concerning exercise program methodologies, only 25,5% of pts enrolled a structured phase 3 CR center (group 1).
Regarding the intensity of PA, the group 1 had a higher number of minutes (min) per week undertaking moderate to vigorous activity (211±108 min vs 147±132 min, p=0,028) and a higher energy requirement in total metabolic equivalents (METs) per week (1033±356 vs 734±684), p &lt;0,001) comparing to group 2. Concerning the categorical score, a higher proportion of pts were attributed a moderately or higher level of total PA (OR 4.485 [CI 1.549-12.984]) after computing activity on all domains accessed by the IPAQ form in group 1. These positive outcomes were consistent across gender and body mass index categories.
The subgroup analysis of younger pts (&lt;70years) showed similar results when evaluating min/week of moderate-vigorous PA, total MET/week (p=0,018 and p=0,002 respectively) and categorical score of total PA (OR 5.9 [CI 1.6-22.4]), while the older population did not exhibit significant differences.

Conclusion
These findings are promising, suggesting that continuing with a structured phase 3 program may contribute to sustained physical activity and potentially better overall cardiovascular health, especially for the younger population. This underscores the importance of continued research in this area, namely whether there are specific factors influencing the outcomes in different age groups.
Cardiac rehabilitation in young patients post acute coronary syndrome: the keystone in cardiovascular care
Authors: Abrantes A , Ana Beatriz Garcia A B G , Ana Margarida Martins A M M , Miguel Raposo M R , Catarina Gregorio C G , Joao Fonseca J F , Joao Cravo J C , Daniel Cazeiro D C , Marta Vilela M V , Paula Sousa P S , Pedro Alves Da Silva P A S , Nelson Cunha N C , Ines Aguiar-Ricardo I A R , Fausto J Pinto F J P , Ana Abreu A A 
Published: June 2024

Abstract

Introduction
Cardiac Rehabilitation (CR) programs are recommended as part of cardiovascular management for patients (pts) following an Acute Coronary Syndrome (ACS). However, despite the well-established benefits, pts are frequently under-referenced.

Purpose
To compare risk factor management and adverse outcomes in young pts with ACS undergoing either a CR program or standard care (SC).

Methods
Single center retrospective study of pts younger than 55 years, with an ACS from January 2017 to May 2023. Following a cardiac event, pts could undergo SC or integrate CR program alongside SC. Adverse outcomes were defined as re-infarction, cardiovascular admissions and death, major cardiovascular events (MACE) was a composite of prior variables. For risk factor management we assessed cLDL, HgA1C, obesity (BMI ≥ 30kg/m2) and smoking status at baseline and during follow-up (FUP). Propensity score matching based on age and sex was used to generate comparable groups. Student T, chi-square and linear regression were used for statistical analysis.

Results
We included 424 pts, 226 pts were selected based on propensity score matching (1:1), 86% males, mean age 47土6 years, 65% had 1 vessel disease and 84% underwent complete revascularization. At baseline, 51% of pts had hypertension, 66% dyslipidemia (mean cLDL 99±45 mg/dl), 15% diabetes, 70% smoker, 15% obese, with no differences between groups. During a FUP of 3.5土2 years, significant cLDL reduction was noted in both groups but CR pts had a 2.4 fold increased odd of meeting cLDL goal (&lt;55 mg/dl) compared to SC pts (30 vs 17%, OR 2.4, CI1.7-4.6). In CR pts, a 12.5-fold lower odds of smoking was noted (OR 0.08, CI 0.03-0.17) and significantly lower obesity rates, with a 30% odd reduction of obesity (OR 0.7, CI 0.6-0.8) when compared to SC. During FUP, SC pts experienced significantly higher incidence of all adverse outcomes expect for death (MACE: 33vs4 p=&lt;0.001; re-infarction: 17vs2 p=&lt;0.001; CV admission: 27vs2, p=&lt;0.001; death:6vs3, p=0.3). SC was an independent predictor of MACE, re-infarction and CV admission after adjustment for confounders.

Conclusion
These results highlight the pivotal role of CR in not only achieving optimal risk factor control but also in substantially reducing adverse outcomes in this young ACS population. Efforts should be intensified to enhance CR referral rates, particularly in the younger demographic, to optimize cardiovascular management and improve long-term outcomes post-ACS.
Exploring the effect of urban environment on cardiovascular health: a feasibility study using machine learning to predict heart rate variability responses to environmental attributes in CHF patients
Authors: Van Es V A A , De Lathauwer I L J , Lopata R G P , Kemperman A D A M , Van Dongen R P , Kemps H M C 
Published: June 2024

Abstract

Aims
The global shift towards urbanization has been associated with a rise in non-communicable diseases, including congestive heart failure (CHF). Understanding the influence of diverse living environments on physiological variables such as heart rate variability (HRV) in patients with chronic cardiac disease may contribute to more effective lifestyle advice and telerehabilitation strategies. This study aims to investigate the feasibility of machine learning (ML) models to predict autonomic nervous system (ANS) responses, quantified through HRV metrics, to environmental attributes in uncontrolled real-world settings. The goal is to validate whether this approach can help ascertain and quantify the presence of a connection between separate environmental attributes and cardiovascular health in patients with CHF.

Methods
20 participants, comprising 10 healthy subjects and 10 patients with CHF, irrespective of type or etiology, were enrolled in the study. Over a 3-week period, activities at specific GPS locations, along with heart rate (HR) data, were collected using smartwatches. Environmental attribute quantification was accomplished through semantic sementation of Google Street view (GSV) images. The collected data were utilized to train and test machine learning models for predicting ANS dynamics, as demonstrated by HRV metrics, associated with environmental attributes. The predictive performance of ML models was assessed using Spearman’s correlation coefficient (R), root mean square error (RMSE), prediction intervals, and Bland-Altman analysis.

Results
The findings demonstrate the satisfactory efficacy of ML models in predicting HRV metrics associated with vagal nerve activity (R &gt; 0.8, p &lt; 0.05 for HR; 0.8 &gt; R &gt; 0.5, p &lt; 0.05 for RMSSD and SD1; 0.5 &gt; R &gt; 0.4, p &lt; 0.05 for HF, and LF/HF). However, predictive accuracy for metrics reflecting overall autonomic activity exhibited limitations due to the intricate interplay between sympathetic and parasympathetic modulation.

Conclusion
This study highlights the potential of ML-based models to discern vagal dynamics influenced by living environments in healthy individuals and patients diagnosed with CHF. Ultimately, this strategy could offer rehabilitation and tailored lifestyle advice, leading to improved prognosis and enhanced overall patient well-being in CHF.
The impact of cardiorespiratory fitness on COVID-19 related outcomes: the ETHOS Study
Authors: Myers J , Kokkinos P , Cadenas-Sanchez C , Liappis A , Goraya N , Weintrob A , Pittaras A , Ladas A , Heimall M , Faselis C 
Published: June 2024

Abstract

Background
Comorbidities such as cardiovascular disease, diabetes, obesity and hypertension are associated with more severe COVID-19 outcomes, but the relative impact of cardiorespiratory fitness (CRF) on outcomes in COVID-positive patients is largely unknown.

Objective
To assess the association between objectively measured CRF and COVID-19-related health outcomes including mortality, hospitalization, and mechanical ventilation in non-COVID vaccinated patients.
Design, Setting and Participants. Retrospective analysis of 750,302 subjects (23,140 [mean age 65.8±12.0 years] with a positive COVID-19 test between March 2020 and September 2021) who underwent a maximal exercise test between 1999 and 2020.
Main Outcomes and Measures. Association between all-cause mortality, hospitalization due to COVID-19, and need for intubation with risk for severe COVID-19 outcomes after adjustment for 15 covariates. Subjects were stratified into five age-specific CRF categories (Least-fit, Low-fit, Moderate-fit, Fit and High Fit), based on peak metabolic equivalents achieved.

Results
During a median of follow-up of 100 days, 1,643 (7.1%) patients died, 4,995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19 related reasons. When compared to the Least-Fit subjects (referent), the Low-Fit, Moderately-Fit, Fit, and High-Fit subjects had hazard ratios for mortality of 0.82 (95% CI; 0.72-0.93), 0.73 (95% CI; 0.63-0.86), 0.61 (95% CI; 0.53-0.72), and 0.54 (95% CI; 0.45-0.65), respectively (Figure). Subjects who were more fit also had significantly lower need for hospital admissions and intubation. Similar patterns were observed for elderly subjects and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category.

Conclusion
Among subjects positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, BMI, or the presence of comorbidities.
Differences of left ventricular morphology by gender and sports discipline in Japanese elite athletes
Authors: Ashikaga K 
Published: June 2024

Abstract

Background
The cardiac morphology of elite athletes is related to sports disciplines and race but there have been no studies of the effects of sports discipline in oriental athletes. This study aimed to assess left ventricular (LV) remodeling using transthoracic echocardiography, morphological characteristics, and determinants of LV remodeling in elite Japanese athletes.

Methods
We retrospectively reviewed elite Japanese athletes who underwent transthoracic echocardiography between January 2011 and December 2021. The athletes were divided into four sports discipline groups (skill, power, mixed, and endurance). We evaluated the differences in LV volume and LV mass between the groups for each sex. In addition, we evaluated the impact of age, sex, body surface area (BSA), and sports discipline on LV end-diastolic volume (LVEDV) and LV mass.

Results
Data of 1406 elite athletes were analyzed. The LVEDV and LV mass indexed to BSA in the endurance group (LVEDV BSA: 72.4 ± 11.6 mL/m2 in males and 68.7 ± 11.0 mL/m2 in females, LV mass/BSA: 121.4 ± 19.7 g/m2 in males and 107.5 ± 18.5 g/m2 in females) were significantly larger than that of any other groups (p &lt; 0.05). Both values were affected by age, sex, BSA, and sport type (LVEDV: age, p = 0.049; other variables, p &lt; 0.001) (LV mass: age, p = 0.040; other variables, p &lt; 0.001).

Conclusion
In elite Japanese athletes, cardiac remodeling is proportional to the type of sport, with a greater effect in endurance sports.
Chronic adaptations to exercise in thin-walled chambers of the heart: a longitudinal study echocardiographic study of elite athletes
Authors: Aaroe M , Tischer S G , Christian Have Dall C H D , Jens Jacob Thune J J T , Hanne Kruuse Rasmusen H R 
Published: June 2024

Abstract

Background/Introduction
Longitudinal studies of cardiac detraining in former athletes are sparse, though studies of master endurance athletes have documented increased risk of atrial fibrillation[1]. Cardiac adaptations to exercise are characterized by uniform dilation of cardiac chambers due to increased volume load[2]. Examinations of finishers at long-duration events have demonstrated examples of acute right ventricular dilation and dysfunction[3]. This raises concerns regarding the susceptibility of thin-walled cardiac chambers to repetitive acute overload, posing a potential risk for the development of left atrial fibrosis and cardiac rhythm disorders over the long term.

Purpose
The aim of this investigation was to assess the pattern of inverse cardiac remodelling in retired elite athletes.

Methods
In this longitudinal study of elite athletes from sports of high cardiac demands we performed a 10-year follow-up examination, including a standard resting echocardiogram. Baseline echocardiograms was performed in 2009-2014. All measures of size were indexed to body surface area (BSA). Age adjusted ratios of left atrium maximum (maxLAVi), right ventricle end systolic area (RVEDVi) and left ventricle end diastolic volume (LVEDVi) were compared between baseline follow-up. Analysis of Covariance models was used to allow for adjustments for categorical variables and continuous covariates. Results are presented with 95% confidence intervals.

Results
MaxLAVi was increased at the time for follow-up examination compared to baseline (31.39ml/m2 CI: 29.28 -33.51ml/m2 to 33.32 ml/m2 CI: 31.06-35.58 ml/m2; p=0.04), while RVEDVi (14,57cm2 CI: 13.90-15.23 to 12.79 CI: 12.21-13.37cm2; p&lt;0.01) and LVEDVi both dropped significantly (82.40ml/m2 CI: 79.34-85.45ml/m2 to 74.35ml/m2 71.50-77.21ml/m2; p&lt;0.01). A comparison of cardiac chamber size ratios showed a significant increase in maxLAVi/RVEDVi ratio from baseline to follow-up examination (baseline: 2.21 CI: 2.05-2.38; follow-up: 2.63 CI: 2.47-2.79; p&lt;0.01), this difference persisted when adjusting for age (p&lt;0.01). MaxLAVi/LVEDVi ratio also increased (baseline: 0.38 CI: 0.36-0.41; follow-up: 0.45 CI: 0.42-0.47; p&lt;0.01), however, when we adjusted for age, this difference was no longer significant (p=0.15). A comparison of ventricular size (RVEDVi/LVEDVi) showed no difference over the course of the study period (baseline: 5.80 CI: 5.47-6.13; follow-up: 5.91 CI: 5.63-6.19; p=0.31), adjusting for age did not affect this difference (p=0.12).

Conclusion
In our population of elite endurance athletes, both ventricles were smaller after the end of their sporting career, while LA increased in size. Cardiac chamber size ratios showed similarly a relative increase in LA size compared to either ventricle, though after adjusting for age no significant change was present between LA and LV.
Sex- and cardiac magnetic resonance imaging septal thickness demonstrate the strongest associations with maximal oxygen uptake and oxygen pulse in elite athletes: findings from the ELITE cohort
Authors: Van Steijn N , Beerman F , Van Hattum J C , Daems J J N , Van Diepen M A , Planken R N , Boekholdt S M , Moen M , Van Randen A , Snaterse M , Jorstad H T 
Published: June 2024

Abstract

Background
Prolonged and intensive physical exercise is associated with cardiac remodelling and more efficient gas exchange profiles. However, it remains unclear which morphological changes have the strongest associations with maximal oxygen uptake (VO2max) and maximal oxygen pulse (O2pulse) in elite athletes when using advanced imaging techniques like Cardiac Magnetic Resonance Imaging (CMR).

Purpose
To determine the associations between VO2max and O2pulse, and left- and right ventricular and atrial volumes, and ventricular mass and diameters.

Methods
We included healthy, elite athletes from the Evaluation of Lifetime participation in Intensive Top-level sport and Exercise (ELITE) cohort who had undergone a Cardio-Pulmonary Exercise Test (CPET) and CMR. Sex and CMR measures of cardiac remodelling were selected for univariate linear regression models for VO2max and O2pulse. Due to sample size, a maximum of 5 variables were retained in the multivariate models, according to their adjusted R2. Backward linear regression was used to identify independent predictors, avoiding multicollinearity by excluding variables with a Variance Inflation Factor of more than 5.

Results
We included a total of 108 athletes (59% female) with a median age of 27.0 years [23.0, 31.0]. Men had larger maximal left- (81.5 ml [66.4, 100.9] vs. 57.4 ml [46.0, 71.5], p &lt;0.001) and right atrial volumes (140.3 [112.5, 159.3] vs. 101.00 [83.4, 122.0] mL, p &lt;0.001), as well as left- (255.0 ± 37.5 vs. 198.1 ± 32.5 mL, p &lt;0.001) and right ventricular end-diastolic volumes (270.2 [217.1, 294.8] vs. 255.0 ± 37.5 mL, p &lt;0.001). Left ventricular mass (LVM) was higher in men (129.1 [111.7, 158.9] vs. 91.0 [74.8, 101.1], p &lt;0.001). Men had higher VO2max (4.47 ± 0.75 vs. 3.16 ± 0.64 L/min, p &lt;0.001) and higher O2pulse (24.6 ± 3.6 vs. 17.8 ± 3.6 mL, p &lt;0.001) than female athletes. In the multivariate model, VO2max was associated with male sex (0.490, p = 0.002), interventricular septal end-diastolic diameter (IVSEDD) (0.107, p = 0.014), LVEDV (0.007, p &lt;0.001) and LVM (0.006, p = 0.037). O2pulse was associated with male sex (3.120, p &lt;0.001), IVSEDD (0.791, p &lt;0.001), RVEDV (0.038, p &lt;0.001) and right atrial minimal volume (0.021, p = 0.110).

Conclusion
Next to sex, septal thickness as measured on CMR is strongly associated with measures of maximal oxidative capacity, more so than cardiac cavity volumes. Our findings refine current understanding of cardiac remodelling and performance measures in elite athletes.
Does physical activity influence Brugada pattern at 12-lead holter 24-hour monitoring?
Authors: Tarditi F , Toso E , Koumantakis E , Jorfida M , Alunni G , Gaita F , Benso A , Giustetto C 
Published: June 2024

Abstract

Introduction
Brugada Syndrome (BrS) is a hereditary ion channel disease predisposing young patients to sudden death, characterized by a dynamic electrocardiogram (ECG) pattern with coved ST-segment elevation in right precordial leads, often not apparent at basal ECG assessments. Various factors, such as increased vagal tone, fever and the use of sodium channel-blocking medications, can either reveal or accentuate the pattern; the impact of physical activity (PA) remains unclear.

Purpose
To evaluate the effects of PA on Brugada (Br) ECG pattern through the assessment of serial Holter monitoring during a follow up of 5 years. The main endpoints were: 1- to investigate the potential accentuation of spontaneous type 1 ECG pattern in physically active Br patients compared to the sedentary group; 2- to verify if there is a significant difference in unmasking spontaneous type 1 ECG pattern between the two groups with induced type 1 ECG; 3- to determine the prevalence of major arrhythmic events during PA.

Methods
153 Brugada patients aged between 18 and 55 years were enrolled in the study. Data regarding demographic information, levels of PA, basal ECG and 12-lead Holter were prospectively collected. The cutoff between trained and untrained subjects was set at 4 hours per week, defining trained individuals as "recreational athletes" according to ESC Guidelines. To assess differences between groups, the Mann-Whitney U and Chi-squared test were performed, as appropriate. Logistic regression was employed to evaluate the association between PA and the presence of the pattern, adjusted for sex and age.

Results
153 patients were included in the analyses: 121 males (79.1%), median age of 35.2 years.
39 patients (25%) were trained, while 114 (75%) were untrained. Overall sample characteristics are shown in Table.1. 64 Br patients (41.8%) showed a spontaneous type 1 ECG, 89 (58.2%) had a drug-induced type 1 ECG. The median of the average heart rates at the first Holter was significantly lower in trained vs untrained (71 vs 75 bpm, p=0.025). No significant differences were observed regarding prevalence of type 1 pattern in both subgroups with spontaneous (p=0.606) or drug induced type-1 ECG (p=0.363), see Table.2. No significant association emerged between PA and presence of diagnostic Br pattern (OR:1.66; 95%CI:0.75-3.83; p=0.229). Male sex and age were confirmed as risk factors for identifying the pattern during Holter monitoring (OR:5.85; 95%CI:1.89-25.84; p=0.006; and OR per year of age: 1.04; 95% CI:1.00-1.09; p=0.059, respectively). At last, no symptoms or arrhythmic events occurred during PA.

Conclusion
in the sample population we observed that trained individuals with Br pattern showed significantly lower heart rate during Holter monitoring. However, there was neither a higher prevalence nor a significant unmasking of the type 1 pattern when compared to sedentary patients.
During sports activities, we did not observe any events.
Co-existence of hypovitaminosis D and diabetes mellitus triple the incidence of severe CAD in women
Authors: Aleksova A , Fluca A , Zandona L , Stenner E , Chicco A , Derin A , Pani B , Barbati G , Marketou M , D'errico S , Sinagra G , Janjusevic M 
Published: June 2024

Abstract

Background
Vitamin D deficiency is associated with the development of several diseases and metabolic syndromes. The lack of this steroid hormone alters calcium and glucose homeostasis, lipid metabolism and promotes oxidative stress, endothelial dysfunction and inflammation. Despite a higher prevalence of hypovitaminosis D in women, defined as vitamin D ≤ 20 ng/ml, little is known about vitamin D levels and the severity of coronary artery disease (CAD) and gender implication.

Purpose
To investigate the gender differences between hypovitaminosis D levels and the severe CAD incidence in individuals suffering from acute myocardial infarction (AMI).

Methods
Blood samples were collected from patients with AMI on hospital admission. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three-vessel disease.

Results
In total, 1484 patients were included in the study. The mean age of the cohort was 66.25 (11.47) years and majority of patients were male (71.8%). Overall, 86.2% and 32.9% of patients had CAD and severe CAD, respectively. The median vitamin D concentration was 17.25 [10.3 - 24.7] ng/ml, and 59,7% of patients had hypovitaminosis D.
The prevalence of hypovitaminosis D was higher in women with severe CAD (74.1% vs. 58.1%, p=0.002), while no significant difference was observed in men (61.3% vs. 57.1%, p=0.193).
Hypovitaminosis D (OR: 1.85 [1.14 – 3.03], p=0.013), along with diabetes mellitus (DM) and older age, was found to predict severe CAD in female patients after correction for confounders as glomerular filtration rate &lt;60 mL/min/1.73 m2, higher cholesterol levels and body mass index. However, hypovitaminosis D was not found to be an independent predictor of severe CAD in men. In female patients, individuals with both hypovitaminosis D and DM had more than three times higher risk of severe CAD diagnosis compared to women who had neither hypovitaminosis D nor DM (OR: 3.56 [1.8 – 7.03], p=0.021).

Conclusions
Hypovitaminosis D predicts severe CAD in women and not in man which is the novelty and strength of our research. Furthermore, our results stand that vitamin D deficiency and DM together triple the incidence of severe CAD in women.