bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing malnutrition to prevent mortality in patients with advanced heart failure: Hades study
Authors: Munoz M , Calero E , Lopez M , Duran J , Navas E , Alonso S , Argemi N , Casademunt M , Furio P , Casajuana E , Domingo M , Vinyoles E , Verdu-Rotellar J M , Del Val J L 
Published: June 2024

Abstract

Background/Introduction
Altough malnutrition has been associated with higher mortality in heart failure (HF), information about its impact on community-dwelling older patients with advanced HF remains scarce.

Purpose
This study is aimed at determining the prevalence and impact of malnutrition in the mortality of patients with advanced HF.

Methods
A prospective multicenter study included a cohort of community-dwelling older patients with HF in New York Heart Association IV (NYHA) functional status, or those in NYHA III who had needed hospitalisation at least twice in the previous six months.
A total of 22 primary healthcare centres, two university hospitals, one acute-care hospital, and one geriatric rehabilitation unit, participated in the study.
To evaluate nutritional status, the MNA-SF seven-item questionnaire was administered. When the scores were lower than eleven points, an additional questionnaire classified patients into two categories: risk of malnutrition or established malnutrition

Results
A total of 271 patients with HF were included. Women constituted 59.8%, and mean age was 84.2 years (SD 8.3). Patients older than 65 years represented 98.1% of the sample. Median follow-up was 14.9 months (percentile 25-75; 4.9-26.9). Malnutrition risk was observed in 127 and confirmed malnutrition in 33 patients. During follow-up, 134 of the included participants died.
Comorbidity was not observed to be determinant in either malnutrition risk or mortality.
The multivariate model adjusted by sex, age, and Body Mass Index showed that established malnutrition was an independent risk factor for mortality (Odds Ratio 2.91, 95% Confidence Interval 1.14; 8.22)

Conclusion
In a cohort of community-dwelling older patients with advanced HF, malnutrition has been associated with higher rates of mortality. Malnutrition risk should be systematically addressed by primary care healthcare professionals to improve survival rates in these patients
Evaluation of the ability to participate in cardiac telerehabilitation in patients with acute decompensated heart failure: Tele-ADHF substudy
Authors: Van Leunen M , De Lathauwer I , Kemps H 
Published: June 2024

Abstract

Background
Cardiac rehabilitation (CR) is generally recommended in patients with chronic heart failure (CHF), particularly for frail patients admitted to the hospital. However, the referral and attendance rates remain poor worldwide, &lt;20% in Europe and &lt;5% in the USA, respectively [1]. This interim analysis of the Tele-ADHF trial gives insight in the patient selection for a cardiac telerehabilitation (CTR) intervention during hospital admission and the dropout before reaching ‘stabilisation’.

Purpose
The purpose of this interim analysis was to evaluate the dropout rate in CHF patients after hospital admission before starting CTR intervention. Secondary, differences in demographic and clinical characteristics were evaluated between patients that reached 'stabilisation' or not.

Methods
Patients hospitalised for acute decompensated heart failure (ADHF) and meeting study in- and exclusion criteria were asked for study participation. All study participants started with Remote Patient Management (RPM) after hospital discharge. When reaching stable heart failure, defined as optimal medical therapy (OMT) and unchanged heart failure symptoms for at least two weeks, patients were randomised for starting CTR (intervention group) or continuing with RPM alone (control group) [2].

Results
49% of the eligible hospitalised CHF patients were included in the study. 49 patients with a median age of 76 years started the ‘stabilisation period’ with RPM. 15 patients dropped out before reaching stabilisation and randomisation (33.1%); 7 died, 2 got admitted for geriatric rehabilitation, 4 stopped for personal reasons, and 2 were lost for follow-up. Patients that never reached randomisation had more adverse events (64.3% vs. 20.6%; p = 0.004) and a lower quality of life (37.6 vs. 49.4; p = 0.008).

Conclusion
CTR has the potential to reach 2/3 of eligible CHF patients willing to start rehabilitation after hospital discharge. The dropout rate of 1/3 was associated with lower quality of life, poor health outcomes (death and readmission) and personal perspectives. Figure 1. Flowchart
Assessment of heart rate and oxygen consumption during and following a six-minute walk test in patients awaiting liver transplant
Authors: Skow R , Mcmurtry T , Foulkes S , Cruz C , Limon-Miro A , Tomczak C , Tandon P , Haykowsky M 
Published: June 2024

Abstract

Background
People with liver cirrhosis (LC) who are awaiting liver transplant have reduced physical function and quality of life [1,2]. However, the physiologic factors contributing to decreased physical function remain unclear.

Purpose
To test the hypothesis that people with LC will have worse exercise efficiency during a standardized six-minute walk test (6MWT) defined as a shorter walk distance at a higher energy cost (e.g., higher oxygen consumption; VO2). We further hypothesized that patients with LC will have prolonged post-exercise heart rate and VO2 kinetics compared to adults of similar age without LC.

Methods
Nine participants with LC who are being assessed for transplantation (60±7 years, 2 female, 31.3±6.9 kg/m2) and seven age- and sex-matched healthy adults (HA; 60±9 years, 1 female, 27.6±3.9 kg/m2) were recruited for this study. Participants with LC were enrolled as part of a larger pre-habilitation exercise and nutrition intervention and were classified as pre-frail according to the liver frailty index (LFI: 3.8±0.4). The LC group had Child-Pugh scores between 9-12 (Class B and C; n=3 and n=6, respectively) and MELD-Na score of 16.8±4.9. We measured heart rate and VO2 (VO2 Master portable analyzer) prior to (five-minutes seated rest), during the last two-minutes of the 6MWT (i.e., at steady-state exercise), and immediately post-exercise (five- minutes of seated recovery; Figure 1). Blood pressure was also measured at rest and two-minutes after the 6MWT. Post-exercise heart rate and VO2 recovery kinetics were determined using monoexponential modelling (OriginLab, 2023b). Specifically, we determined the time delay to the start of the exponential decline in heart rate or VO2 following exercise termination, and the time to reach 63% of the recovery (τ) during the five-minutes of seated rest. From this, the mean response time (MRT) was computed as MRT= time delay + τ.

Results
Resting heart rate, blood pressure, and VO2 were not different between groups (Table 1). During the last two-minutes of the 6MWT, heart rate was not different between groups. However, owing to a greater total distance walked (HA: 629±50m vs LC: 397±133m; p&lt;0.001), VO2 was higher in the HA group (Table 1). The heart rate MRT was not different between groups (HA: 66±34s vs LC: 46±17s; p=0.164) but VO2 MRT was 25% slower in LC (85±22s) compared to HA (64±14s; p=0.045).

Conclusion
These preliminary data suggest that patients with LC who are awaiting liver transplant have skeletal muscle metabolic alterations and/or reduction in oxygen extraction as evidenced by the lower exercise VO2 and slower post-exercise VO2 recovery. Interventions to improve fitness and physical function such as pre-habilitation programs may improve short- and long-term recovery following liver transplant.
Hyper-trabeculation in olympic athletes: advanced LV function analysis by CMR
Authors: Monosilio S , Spinelli A , Prosperi S , Lemme E , Di Gioia G , Mango R , Tonti G , Pedrizzetti G , Gualdi G , Squeo M R , Pelliccia A , Maestrini V 
Published: June 2024

Abstract

Background
Left ventricular (LV) hyper-trabeculation is frequently observed among high-level athletes and often raises concerns for differential diagnosis with cardiomyopathies.

Aim
To evaluate standard and advanced LV function by CMR in a cohort of elite athletes with LV hyper-trabeculation.

Methods
Thirty Olympic athletes with LV hyper-trabeculation and thirty without LV hyper-trabeculation matched for sex (59% male) and sport disciplines (power 24%, mixed 28% and endurance 48%) were enrolled. They all underwent cardiovascular preparticipation screening that was unremarkable. CMR without contrast administration was performed. Hyper-trabeculation was defined based on Petersen criteria for left ventricular non-compaction (LVNC), but all the athletes presented preserved compacted layer. Differences in standard and advanced LV function parameters between the two groups were evaluated using a dedicated, offline feature-tracking software to analyze the standard three long-axis cine loops. LV global longitudinal and circumferential strain (GLS and GCS) and LV hemodynamic forces (HDFs), representing the forces exchanged between the blood and the myocardium and being novel and validated markers of LV function were evaluated. The ratio between the HDFs two main directions (longitudinal and transversal), meaning the distribution of forces into the LV, was computed in the entire cardiac cycle, systole and diastole.

Results
There were no significant differences between the two groups regarding the amount of training in terms of years and hours of training per week (p=0.065 and p=0.262, respectively). Hyper-trabeculated athletes showed slightly higher LV volumes and lower ejection fraction than non-hyper-trabeculated ones, even if the difference was not statistically significant (EDVi, ESVi and EF: p= 0.397, 0.118 and 0.101, respectively). There were also no significant differences in LV-GLS, GCS and HDFs distribution in the entire cardiac cycle, systole and diastole (Table and Figure).

Conclusions
Olympic athletes with LV hyper-trabeculation but preserved compacted layer did not significantly differ from non-hypertrabeculated ones in terms of dimension and advanced parameters of LV function. CMR advanced study of LV function could help differentiate physiological and pathological remodelling in athletes. Table. Figure.
Exploring low QRS voltages and QRS fragmentation in pediatric and adolescent athletes: prevalence and determinants factors
Authors: Graziano F , Genta E O , Manfrin L , Zorzi A , Corrado D , Brusamolin L , Giada F 
Published: June 2024

Abstract

Background
Low QRS Voltages (LQRSV) in limb leads and QRS fragmentation (FQRS) are possible signs of myocardial fibrosis and cardiomyopathy, but they are not mentioned in the 2017 International Criteria for the interpretation of athlete’s ECG.

Purpose
We aimed to investigate the determinants of LQRSV and FQRS in a cohort of young apparently healthy athletes undergoing preparticipation screening (PPS).

Methods
We analysed a consecutive series of ECG recorded at the time of PPS of young athletes aged 7-18 years. The maximal peak-to-peak QRS voltage was considered and LQRSV was defined when all limb leads have a voltage &lt;0.5 mV. Fragmented QRS morphologies were coded and detected in each individual lead and then grouped into five patterns. Lead aVR was not considered.

Results
We included 2140 children-athletes (mean age 12.5±2.6 years, 48% males) with no overt cardiac diseases. Mean QRS voltage in limb leads was 1.4±0.4 mV, similar between males and females and between younger and older athletes (Figure 1). The correlation between maximal QRS voltages and BMI or exercise intensity was weak. Only 5 (0.2%) children-athletes showed LQRSV. At least one fragmented QRS complex was identified in 831 (39%) of children-athletes, particularly in leads V1 (24%), V2 (12%) and aVL (16%) (Figure 2). If children-athletes with a rSr’ pattern in V1-V2 were excluded, only 10 (0.5%) showed FQRS in ≥2 contiguous leads. These 10 children-athletes were older than those without FQRS, but did not differ in terms of sex, BMI or exercise-intensity.

Conclusions
LQRSV in limb leads and FQRSV in ≥2 contiguous leads excluding V1-V2 are rare in children-athletes undergoing PPS of both sexes and are not training-related: for this reason, they may require additional testing to rule out an underlying disease. Figure 1 Figure 2
Early insulin resistance in low-risk subjects with normal glycemia is associated with subclinical atherosclerosis
Authors: Iglesies-Grau J , Garcia-Alvarez A , Oliva B , Mendieta G , Garcia-Lunar I , Fuster J J , Devesa A , Perez-Herreras C , Fernandez-Ortiz A , Brugada R , Ibanez B , Fernandez-Jimenez R , Fuster V 
Published: June 2024

Abstract

Background
Higher glycated hemoglobin (HbA1c) levels are directly associated with subclinical atherosclerosis burden. However, the association between earlier insulin resistance markers and the development of subclinical atherosclerosis is poorly understood.

Purpose
To assess the association between the Homeostatic Model Assessment of Insulin Resistance Index (HOMA-IR) and subclinical atherosclerosis, on top of cardiovascular risk factors in individuals with normal HbA1c.

Methods
A cohort of 3,741 middle-aged individuals from the PESA study, with basal HbA1c &lt;6.0% and without known CV disease, underwent extensive imaging (multi-territorial vascular ultrasound and coronary artery calcium score, CACS) to assess for the presence, burden, and extent of subclinical atherosclerosis.

Results
Individuals with higher HOMA-IR values had a higher prevalence of both traditional and non-traditional CV risk factors. Higher HOMA-IR values showed a positive association with the multi-territorial extent of subclinical atherosclerosis and CACS (p&lt;0.001), Figure 1, and an increased global plaque volume by 3DVUS (p&lt;0.001), Figure 2. The association was observed in both individuals with HbA1c levels below and above the median value of 5.4% (p &lt; 0.001). This trend held for three individual territories (carotid, femoral, and coronary artery). Overall, after adjusting for key CV risk factors and HbA1c levels, HOMA-IR values ≥3 were associated with both the multi-territorial extent of subclinical atherosclerosis and CACS&gt;0: odds ratio of 1.41 (95CI: 1.01 to 1.95, p=0.041), and 1.74 (95CI: 1.20 to 2.54, p=0.004) respectively, as compared to HOMA-IR &lt;2 (reference). In a stratified analysis, this association remained significant in low-to-moderate SCORE2 risk individuals (75.6% of the cohort) but not in high-risk adults.

Conclusions
The use of HOMA-IR identified low-risk individuals with a higher burden of subclinical atherosclerosis on top of traditional CV risk factors and HbA1c. HOMA-IR is a simple measure in clinical practice that could facilitate earlier implementation of CV primary prevention strategies. HOMA-IR and subclinical atherosclerosis. HOMA-IR and 3D vascular ultrasound.
Association between urinary concentrations of heavy metals and trace elements and renal function in Swiss adults: a cross-sectional study
Authors: Xie S , Vaucher J , Marques-Vidal P 
Published: June 2024

Abstract

Background/introduction
Chronic kidney disease (CKD) is an important public health problem. Heavy metals and trace elements can affect kidney function; however, there are few studies on the association between heavy metals and trace elements and kidney function in the general population.

Purpose
To assess the associations between urinary concentrations of 23 elements (Li, Be, Al, V, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Mo, Ag, Cd, Sn, Sb, Hg, Tl, Pb, Bi, Fe, and Iodine) and kidney function, evaluated by estimated glomerular filtration rate (eGFR).

Methods
Cross-sectional survey of 6204 adults (51.7% women, 52.4±10.7 years). Associations were assessed via Spearman correlation and pairwise comparisons. Concentration of the 23 elements was standardized to the urinary creatinine levels.

Results
Bivariate analysis showed that urinary Mn, Co, Ni, Zn, Cd, and Sn levels were negatively associated, and urinary V, As, Sb, Hg, Pb, and Iodine were positively associated with eGFR (see figure). There were 3224 (52%), 2809 (45.3%) and 171 (2.7%) participants with normal renal function, impaired renal function (IRF, defined as a eGFR between 60 and 90 ml/min/1.73 m²), and CKD (eGFR &lt;60 ml/min/1.73 m²), respectively. After multivariable analysis, compared with participants with normal kidney function, participants with IRF and CKD had lower urinary V, Mn, Cu, Se, Mo, Ag, Cd, Hg, Tl, Pb and Bi levels (all P for trend &lt;0.001).

Conclusion
Urinary heavy metals/trace elements are associated with kidney dysfunction. Further blood heavy metal/trace element analysis and prospective studies are needed to evaluate the potential risks of heavy metal/trace element exposure on kidney function. Matrix of bivariate correlations. Table comparing renal categories.
Unravelling sex disparities in statin dose titration patterns in primary care
Authors: Kiss P , Uijl A , Duk T , Grobbee D , Hollander M , Smits E , Sturkenboom M , Peters S 
Published: June 2024

Abstract

Introduction
Statins are widely recommended by clinical guidelines for the prevention and management of cardiovascular disease. While guidelines make no sex-specific recommendations, studies have shown that women are less likely than men to be prescribed high-intensity statins at initiation and to achieve cholesterol target values. However, the existing literature lacks evidence in sex comparison of statin treatment patterns in real-world clinical practice.

Purpose
This study aims to examine sex differences in titration patterns of statin therapy over a ten-year period in a Dutch primary care setting.

Methods
Data on statin dispensing was extracted from electronic healthcare data banks between 2011-2020. Poisson regression with robust standard errors was used to estimate risk ratios (RR) with 95% confidence intervals (CI) of sex differences in statin uptitration (defined as an increase in statin intensity or the addition of ezetimibe to statin therapy). Analyses were adjusted for age, socio-economic status and Low-Density Lipoprotein (LDL) cholesterol levels at initiation and were stratified by age group, history of cardiovascular disease at initiation and intensity of the first dispensed statin. Missing data were imputed with multiple imputation.

Results
We identified 72,110 new users of statin therapy (46% women) with a mean age of 65 years old. Most patients were dispensed a moderate-intensity statin at initiation (87% of women; 84% of men), followed by high-intensity (8% of women; 13% of men) and low-intensity statins (5% of women; 3% of men). Overall, 17% of women and 19% of men were uptitrated, with median times to uptitration of 535 days (Interquartile range (IQR) 181 – 1216) in women and 559 days (187 – 1240) in men. The adjusted RR of being uptitrated in women versus men was 0.92 (95% CI 0.87 – 0.97) for those without a history of CVD and 0.82 (0.73 – 0.92) for those with a history of CVD (pvalue for interaction = 0.02). Sex differences in statin uptitration were 0.90 (0.84 – 0.97) in those 40-60 years old, 0.91 (0.84 – 0.97) in those 60-70 years old, and 0.95 (0.93 – 1.00) in the older age category (70-99 years old).

Conclusion
Among new-statin users, women receive lower statin intensities than men and are less likely to be uptitrated than men.
Lipoprotein(a) and referrals to a specialist lipid clinic
Authors: Kennedy C , Malone R , Hennessy M , O'connor P 
Published: June 2024

Abstract

Background
Lp(a) is raised in approximately 1 in 5 of the population. Thresholds indicating a raised Lp(a) level vary; &gt;70nmol/L for our assay, &gt;125nmol/L in some studies; with a level &gt;430nmol/L described in guidance as conferring a ASCVD risk equivalent to heterozygous familial hypercholesterolemia (hFH). Higher Lp(a) levels increase measured LDL level.[1] This may lead to increased referrals to a specialist lipid clinic and increased testing for hFH.

Purpose
To determine if raised Lp(a) levels are reflected in referrals as well as downstream investigations and treatment.

Methods
An ethically approved retrospective cohort study was performed including consecutive adult patients attending a specialist lipid clinic over a six-month period. Patient data analyzed included demographics, clinical characteristics, treatments and biochemical profiles. Those with a level &gt;70nmol/L were considered to have raised Lp(a). Groups were compared using Chi-squared tests and t-tests.

Results
330 patients had a Lp(a) result available. 39% had a Lp(a) level &gt;70nmol/L, 33% with &gt;125nmol/L and 5% with &gt;430nmol/L [Figure 1]. 55% of those with a Lp(a) &gt;70nmol/L were female and their mean age was 49 years (SD+/-13), both consistent with the cohort as a whole. The percentages referred due to ‘high cholesterol’ or ‘assessment for familial hypercholesterolemia’ was equivalent for the raised versus normal Lp(a) groups (50% v 47%; p=0.42). The groups were also similar in terms of; family history of early CVD (40% each), baseline cholesterol levels (8.2 v 7.8mmol/L; p=0.12), baseline LDL levels (5.7 v 5.5mmol/L; p=0.34), genetic testing for hFH (61% v 58%; p=0.59), positive hFH genotypes (17% v 21%; p=0.57) and treatment with a high-intensity statin (34% v 30%; p=0.26).

Conclusions
The high proportion of patients with raised Lp(a) in this cohort indicates raised Lp(a) increases the likelihood of referral to a lipid clinic. While limited by the moderate cohort size, increased levels were not reflected by differences in reasons for referral, baseline cholesterol levels, tests for hFH or treatment. Cohort stratified by Lp(a) level.