bluuebunny/crossref_metadata_2025_split huggingface dataset:
The frequency of coronary artery atherosclerotic plaques in patients with newly diagnosed type 2 diabetes mellitus
Authors: Hyseni V , Bakalli A , Gjikolli B , Elezi S , Olloni-Nikaj R , Vela-Gaxha Z 
Published: June 2024

Abstract

Introduction
Complications due to diabetes mellitus usually appear after long-standing disease. Furthermore, coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). The calcium score in the coronary arteries is a reliable predictor of CAD. There are very scarce data in the literature regarding the frequency of CAD in newly diagnosed (ND) T2DM.

Purpose
The aim of this study was to assess the presence, extent and composition of subclinical atherosclerotic plaques in coronary arteries by means of Computed Tomography Calcium Score (CTCS) in asymptomatic patients with ND T2DM (&lt;1 year duration).

Methods
In this prospective cross-sectional study 101 patients with ND T2DM according to the criteria of the American Diabetes Association were included. CTCS was performed on all patients by 64-slice cardiac CT, with a thickness of 2-5 mm. Calcification was identified as a structure &gt;1 mm attached to or located within the lumen of a coronary vessel with intensity &gt;130 HU. The Agatston method was used to determine the CTCS. Exclusion criteria were: stable angina pectoris, acute coronary disease, severe anemia, patients with history of stroke, moderate/severe renal insufficiency, liver insufficiency, claustrophobic patients, and pregnant women.

Results
Of the 101 asymptomatic patients with ND T2DM, 48 (47.5%) were females, with mean age of 54.4 ± 11.6 years. The risk factors were as follows: 61.4% with arterial hypertension, 37.6% smokers, 36.6% with dyslipidemia, 34.7% with positive family history for CAD, mean body mass index of 31.0 ± 5.6 kg/m2, while the duration of T2DM was 2.8 ± 5.3 months. Only 8 (7.9%) patients did not have atherosclerotic plaques or had a CTCS of 0; 7 (6.9%) patients had a CTCS of 1-10; 43 (42.6%) patients had a CTCS of 11-100; 23 (22.8%) patients had CTCS 101-400 and 20 (19.8%) patients had CTCS &gt;400 (Figure). The mean total volume and mass of calcium in these patients was 210 and 180, respectively. The table displays CTCS parameters for specific coronary arteries.

Conclusions
Asymptomatic patients with ND T2DM in more than 85% of cases may present with atherosclerotic plaques, while the most loaded artery seems to be the LAD. Nearly half of these patients fall into the second category of calcium burden, characterized as a mild risk for CAD. Our study emphasizes the significance of comprehensive care for individuals with ND T2DM. In addition to maintaining glycemic control, there is a crucial need for early prevention of cardiovascular complications. CTCS of 7587 in a patient with NDT2DM CT Calcium Score of the studied patients
Air pollution in relation to brain health indicators and global cognitive functioning in patients with cardiovascular disorders along the heart-brain axis
Authors: Timmermans E , Bron E , Bots M , Leeuwis A , Moonen J , Wolters F , Biessels G J , Vaartjes I 
Published: June 2024

Abstract

Background/Introduction
Exploring, understanding, and preventing the effects of exposure to air pollutants on the brain, and possible links to cognitive functioning, have been indicated as major global health challenges that urgently need to be addressed. Yet, relatively little work has been conducted to examine the associations of air pollution with indicators of brain health that are potentially related to cognitive functioning in patients who are at increased risk to develop cognitive impairments.

Purpose
This study aimed to examine cross-sectional and longitudinal associations of air pollution with global cognitive functioning, white matter hyperintensities (WMH), total brain volume (TBV), and cerebral blood flow (CBF) in individuals without or with heart failure, carotid occlusive disease, or vascular cognitive impairment. Additionally, this study examined whether the cross-sectional associations of air pollution with global cognitive functioning were mediated by WMH, TBV, and CBF.

Methods
For the cross-sectional and longitudinal analyses, we used data from 341 and 180 participants of the Dutch multi-center Heart-Brain Study, respectively. Cognitive functioning was measured using neuropsychological tests at baseline and two-year follow-up. Brain Magnetic Resonance Imaging provided WMH and TBV in mL, and CBF in mL/100g/min. WMH and TBV were divided by total intracranial volume. Annual average outdoor concentrations of particulate matter with diameters &lt;2.5µm (PM2.5) and &lt;10.0µm (PM10), and nitrogen dioxide (NO2) in µg/m3 in residential six-digit postal code areas were linked to participants at baseline. Adjusted multi-level regression analyses were applied to assess the associations of interest.

Results
No significant cross-sectional (βPM2.5=0.014, 95% CI=-0.076-0.104; βPM10=0.034, 95% CI=-0.043-0.111; βNO2=0.020, 95% CI=-0.004-0.045) and longitudinal associations (βPM2.5=0.041, 95% CI=-0.029-0.110; βPM10=0.016, 95% CI=-0.045-0.078; βNO2=-0.001, 95% CI=-0.022-0.022) of air pollution with global cognitive functioning were observed. No significant associations of air pollution with WMH, TBV, and CBF were found. The associations of PM2.5, PM10 and NO2 with global cognitive functioning were not significantly mediated by WMH, TBV, and CBF.

Conclusions
No supportive evidence was found for associations of air pollution with global cognitive functioning, WMH, TBV and CBF in healthy and vascularly compromised individuals.
Relationship between changes in cardiac function (HFrecEF, HFworEF) and physical function characteristics in heart failure patients
Authors: Fukuta Y , Tanaka S , Kawaguchi T , Arizono S , Sawai S , Yoshida A , Tsugita N , Fuseya T , Segawa T 
Published: June 2024

Abstract

Introduction
Recent research has categorised changes in LVEF in response to treatment into three distinct groups: improvement, worsening, and maintenance 1). Nevertheless, the relationship between the degree of EF change (ΔLVEF) and physical function remains unclear. Therefore, this study assessed the association between physical characteristics and Δleft ventricular ejection fraction(ΔLVEF) and physical function in two distinct categories: HF with recovered EF (HFrecEF) characterised by improved EF and HF with worsened EF (HFworEF) marked by worsened EF.

Methods
This retrospective cohort analysis included heart failure patients aged 65 years or older who underwent cardiopulmonary exercise testing between April 2016 and December 2022, called the pre-old age group starting at age 65, as the pre-older age group. LVEF (%) was measured using the modified Simpson method. Patients were assigned to two categories based (HFrecEF and HFworEF) on improvement (Δ) in LVEF. The relationship between ΔLVEF and physical function was analysed using the Spearman rank correlation. Multiple regression analysis was performed with ΔLVEF as the dependent variable for variables significantly related to ΔLVEF (P&lt;0.05). The study subjects were classified into three groups based on LVEF, according to the JCS/JHFS 2021 guidelines 1). Among two, improvements and deteriorations were extracted.

Results
A total of 229 heart failure patients aged 65 years and older were included, with 40 patients who did not undergo follow-up echocardiography were excluded; HFuncEF excluded 144 patients, 45 patients, age 76.0 (67.5–79.5) years [HFrecEF 71.5(95% CI:66.0–78.5) vs HFworEF 78.0(72.5–81.5):P&lt;0.01], were incorporated. Peak oxygen uptake (peak VO2) was significantly different between the two groups [HFrecEF 13.6(95% CI:11.9–15.4) vs HFworEF 10.1(7.8–11.8):P&lt;0.01], and (peak ETCO2) was also significantly different, with lower values in HFworEF [HFrecEF 5. 36(5.02–5.96) vs HFworEF 4.7(4.5–5.2):P&lt;0.05], (peak VE/CO2) was also significantly different and higher in HFworEF [HFrecEF 36.2(30.3–39.8) vs HFworEF 42.0(36.3–45.8):P&lt;0.05] (minimum VE/CO2) was also significantly higher in HFworEF [HFrecEF 34.2(29.2–39.4) vs HFworEF 40.7(34.2–44.7):P&lt;0.05].
Peak oxygen uptake/watt (peak VO2/w) was correlated with (ρ=0.547, P&lt;0.01). In addition, peak oxygen uptake (peak VO2) (ρ=0.512, P&lt;0.01) and peak carbon dioxide output (peak VCO2) (ρ=0.512, P&lt;0.01) were also correlated. Peak VO2/w (β=0.492, P&lt;0.01) was an independent predictor (R=0.492, F=13.72, P&lt;0.01).

Conclusion
Patients with HF and recovered EF tended to be younger and more physically functional than those with worsened EF. In addition, peak VO2/w was an independent determinant of ΔLVEF.
Estrogen and the estrogen receptor in ZSF1 rats with heart failure with preserved ejection fraction
Authors: Buettner P , Werner S , Thiele H 
Published: June 2024

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) is more prevalent in women, so declining estrogen levels after menopause may be involved in genesis of the disease. Estrogen is cardio-protective, affecting blood pressure and vasodilatation and endothelial dysfunction is discussed as HFpEF pathomechanism. However, the potential connection between HFpEF and estrogen levels remains poorly understood. The well-established HFpEF ZSF1 rat model was used to analyze endothelial dysfunction, and a pronounced imbalance of the NO synthase substrates arginine and homoarginine was observed. Of note, estrogen levels in woman are directly and positively associated to homoarginine levels.

Purpose
We characterized serum estrogen levels and the expression of the estrogen receptor alpha (ERα) in the hearts of female ZSF1 HFpEF rats to investigate a possible contribution of estrogen signaling in HFpEF manifestation and to evaluate the suitability of this animal model in the context of estrogen and HFpEF.

Methods
In total, 12 obese ZSF1 rats with HFpEF (O-ZSF1) and 12 lean healthy ZSF1 rats (L-ZSF1) at 20 weeks of age and 5 animals of either phenotype aged 32 weeks were analyzed. Further, six O-ZSF1 rats were supplemented with homoarginine (hArg) when HFpEF was manifest and were observed up to 32 weeks of age. The manifestation of HFpEF was confirmed by echocardiography and determination of NT-proBNP by ELISA. Circulating estradiol (E2) in serum was determined using ELISA. Expression of the estrogen receptor alpha was determined by Western Blot analysis in the left ventricle (LV), septum and right ventricle (RV).

Results
Serum estradiol levels were similar in age-matched L-ZSF1 and O-ZSF1, but were ~2-fold increased at an age of 32 weeks compared to 20 weeks (p=0.002). The canonical ERα-66kDa was very weakly expressed in all tissues. ERα-45kDa expression in the LV was lower in O-ZSF1 at an age of 20 weeks (-46%, p=0.008) and at 32 weeks (-46%, p=0.002).
ERα-45kDa expression in LV was 2-fold higher than in septum and 5-fold higher than in RV in rats aged 20 weeks (p&lt;0.001). In RV, no differences in ERα-45kDa expression were observed. Supplementation of O-ZSF1 with hArg reestablished the ERα-45kDa expression in the LV (p=0.005 vs. O-ZSF1 without supplementation).

Conclusion
The manifestation and progression of HFpEF in ZSF1 rats is accompanied by a decrease of the ERα-45kDa expression in the LV, whereas the RV is not affected. Supplementation with homoarginine normalizes ERα-45kDa expression. The ERα-45kDa isoform was found to suppress the transcriptional activity of the classical ERα-66kDa isoform and to be an acute regulator of endothelial NO synthase in response to estrogen. These results suggest that altered ERα expression in the LV may represent a novel pathomechanism in HFpEF. In combination with decreasing estrogen levels in woman, adverse consequences for NO production in the LV seem likely.
Early detection and management of heart failure and its associated risk factors: prospect for task shifting among healthcare workers
Authors: Sharma S K , Gautam U , Bhattarai U , Gautam A 
Published: June 2024

Abstract

Background
Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality in low- and middle- income countries (LMICs) like Nepal. CVDs contribute to a major share, along with other NCDs, in causing poverty due to catastrophic health expenditures. There is a need for countries to identify context specific public health strategies and clinical interventions which are feasible, affordable and could act on the local disease burden.

Purpose
Heart failure remains a major cause of morbidity for CVDs. A community-based initiative was undertaken to identify undetected cases of heart failure and associated risk factors.

Methods
Purposively selected communities in Eastern Nepal for early detection of cardiovascular diseases. The initiative involved initial screening of the population for risk factors for CVDs like hypertension, diabetes and hyperlipidaemia by paramedical health workers at primary healthcare centres. Training was provided to identify complications and evaluate necessity of prompt referral based on clinical evaluation, blood glucose estimation (Fasting blood glucose, HbA1c), serum creatinine, lipid profile (HDL, LDL, TG, TC), and urine analysis (albumin, creatinine, ACR). The referrals to secondary or tertiary care centres were made considering need of immediate intervention or further diagnostic procedure like echocardiography. Echocardiography was performed as per the standard of care by a team of specialist physicians from a publicly funded tertiary level teaching institution at the primary health centres as a part of initiative. Patients requiring in-patient care were subsequently referred to higher institutions.

Results
Out of 4788 adult population screened, 240 (5%) individuals had clinical features suggestive of heart failure and were advised echocardiography. The mean age of heart failure cases was 62.1 years and almost half (49.2%) cases were male. Structural heart disease was detected among 151 cases of heart failure. The aetiology for heart failure comprised of dilated cardiomyopathy (16.3%), hypertensive heart disease (10.8%), ischaemic heart disease (7.5%), and valvular heart diseases (7.1%); while other factors included rheumatic heart disease (5%) and hypertrophic cardiomyopathy (2.9%). Diastolic dysfunction was noted among 43 (17.9%) cases of heart failure.

Conclusion
High burden of heart failure was identified in the screened communities. Early assessment of at-risk population can prevent progression, hospitalization, and death from heart failure. A protocol guided task shifting can be employed for timely detection of preventable aetiological factors and avoid late CVD complications.
Cardiovascular and haemodynamic changes in resistant hypertension: relation to blood pressure control in a longitudinal study
Authors: Alsharari R , Alsharari R , Thomas N , Lip G , Shantsila A 
Published: June 2024

Abstract

Introduction
Cardiovascular alterations and autonomic nervous abnormality exist in patients with resistant hypertension (RH) (1, 2). The effects of optimised antihypertensive treatment on cardiac, vascular and autonomic system are well-documented in essential hypertension. However, less is known about antihypertensive treatment optimisation on cardiovascular and autonomic function in the RH population.

Methods
Cardiac haemodynamics, strain function, vascular (brachial artery flow-mediated dilation, (FMD); pulse wave velocity, (PWV)) and autonomic functions (heart rate variability, (HRV)) were evaluated in patients with confirmed RH (n=17, mean age 58 years). The patients were followed up after eight weeks of optimised antihypertensive treatment to assess the changes in myocardial mechanics, vascular function and autonomic function.

Results
Following eight weeks of optimised antihypertensive treatment (Table 1), global longitudinal strain (GLS) and global circumferential strain (GCS) improved in RH group (GLS -17±1.5% vs. -19±2.8%, p=0.002; GCS -29.7±4.3% vs. -31.1±5.4%, p=0.04). FMD showed significant improvement (6.7±3 vs 5.3±3%, p=0.04). There were no significant changes in central systolic blood pressure (BP) (154 [139-193] mmHg vs. 177 [159-193] mmHg, p=0.11), central diastolic BP (82±20 mmHg vs 87±15 mmHg, p=0.28); PWV (9.3 [8-11] m/s vs. 9.8 [8-11] m/s, p=0.81); SDNN (p=0.16), rMSSD (p=0.28), pNN50 (p=0.42), and LF/HF (p=0.98), HRV (p=0.08), LF normalised (p=0.71), and log (LF/HF) (p=0.73).

Conclusion
After 8 weeks of antihypertensive treatment, cardiac strain function, endothelial function and 24h BP significantly improved compared with baseline in patients with true RH; however, arterial stiffness did not significantly change. Changes of cardiovascular and autonomic
Exercise cardiac magnetic resonance imaging across the lifespan
Authors: Hathorn B , Zamani S K , Zaha V G , Babb T , Hussain T , Haykowsky M J , Levine B D , Zia A , Grodin J L , Nelson M D 
Published: June 2024

Abstract

Introduction
Exercise cardiac magnetic resonance imaging (cMRI) offers several advantages over contemporary stress imaging approaches, including improved spatial resolution, free of ionizing radiation. With exercise cMRI becoming increasingly popular, more work is needed to better understand the hemodynamic response across the lifespan.

Purpose
To compare the cMRI response to exercise across the lifespan.

Methods
To accomplish this purpose, we leveraged data from several ongoing imaging studies in which healthy control participants completed exercise cMRI across at least two discrete workloads, ranging in intensity from mild to moderate. Imaging was performed using either a 1.5T or 3T Phillips MRI scanner. Exercise was performed using an MR compatible ergometer (Cardio Step, Ergospect GmbH, Innsbruck, Austria). Volumetric data were measured from a stack of short axis images spanning the length of the left ventricle from base to apex.

Results
Exercise cardiac magnetic resonance images were available from 48 participants, ranging in age from 10 to 81 years. On average, end-diastolic volume remained unchanged with exercise (73±14 vs. 75±15 vs. 74±14 mL, rest vs. mild vs moderate, p = 0.107), while end-systolic volume was reduced (27±7 vs. 25±7 vs. 23±6 mL, p = &lt;.001), resulting in a modest increase in stroke volume (46±9 vs. 50±10 vs. 51±10 mL, p = &lt;.001). To evaluate the influence of age, we compared the youngest participants (n = 13, 10-30 yrs) against the oldest participants (n = 18, 65-81yrs). As illustrated in Figure 1, while baseline volumes differed significantly with age, the relative response to exercise was similar between groups. Likewise, to evaluate the influence of sex, we compared male (n = 21) versus female (n = 27) participants. As illustrated in panels D-F, ventricular volumes were greater in men compared with women, but the exercise relative responses were similar.

Conclusions
Taken together, these data add to a growing body of literature highlighting the feasibility of exercise cardiac magnetic resonance imaging across the lifespan, and begin to define the normative response for future clinical comparison.
Feasibility of exercise cardiac magnetic resonance imaging for the concurrent assessment of oxygen uptake and its Fick determinants
Authors: Foulkes S , Thompson R B , Grenier J , Skow R , Sherrington R , Pituskin E , Nelson M D , La Gerche A , Haykowsky M J 
Published: June 2024

Abstract

Background
The concurrent assessment of oxygen uptake (VO2) and it’s Fick determinants (cardiac output x arterio-venous oxygen content difference [Qc x a-vO2diff]) provides key insights into the physiologic underpinnings of exercise intolerance across the spectrum of health and disease. However, the accurate assessment of the Fick-determinants is limited by the need for invasive measures of hemodynamics and arterial and venous O2 saturation and content (SaO2 and SvO2, and CaO2 and CvO2, respectively).

Purpose
To determine the feasibility of an exercise cardiac magnetic resonance imaging (ExCMR) approach that combines real-time free-breathing cardiac volumetric analysis with magnetic susceptometry-based oximetry to non-invasively quantify Qc, a-vO2diff, and VO2peak.

Methods
Bi-ventricular volumes and Qc were quantified from real-time, free-breathing steady-state free-precession imaging, whilst SvO2 in the inferior vena cava was quantified using magnetic susceptometry-based oximetry. These measures were combined with arterial oxygen saturation (from finger pulse oximetry) and haemoglobin concentration (from venous blood draw) to quantifyCaO2,and CvO2), a-vO2diff and VO2 in accordance with the Fick equation. Imaging was performed in 24 older women free of cardiovascular disease (68±4 yrs; VO2peak: 21.1±5.2 mL/kg/min) at rest, and during light- (Power output: 42±10W; 0-10 rating of perceived exertion [RPE]: 3.6±1.5) and moderate-intensity (Power output: 60±9W; RPE: 5.4±1.8) supine stepping exercise on an MRI compatible ergometer.

Results
Biventricular volumes and Qc were evaluable in all cases, whilst SVO2 could not be calculated in two participants (due to aliasing artefact or excessive motion during exercise). Consequently, VO2 and Fick determinants were assessed at rest and during exercise in 22 participants (92%). Resting VO2 was 223±77 mL/min (3.3±1.2 mL/kg/min) and increased linearly with increasing power output to 597±191 mL/min (8.9±2.5 mL/kg/min) at light-intensity and 819±225 mL/min (12.2±3.3 mL/kg/min) at moderate-intensity exercise (Fig 1A). The increase in VO2 from rest to exercise was the result of a progressive increase in Qc (Fig 1B), and a widening of a-vO2diff (Rest: 4.2±1.5vs Mod: 9.2±2.0 ml/dL) secondary to a decrease in CvO2 (Fig 1C; Rest: 13.4±1.5 mL/dL vs Mod: 8.3±2.0) and SvO2 (Rest: 73±7% vs Mod: 45±10%).

Conclusion
A combined non-invasive real-time cardiac and venous susceptometry ExCMR approach was feasible for measuring VO2 and its Fick determinants, and demonstrated normal physiologic responses to light and moderate intensity exercise. Further work is needed to determine the feasibility and utility of this approach during peak exercise in individuals with health and established disease.
Evolving information needs in cardiac rehabilitation 2.0
Authors: Tenbult - Van Limpt N C C W , Van Asten I , Brouwers R , Kemps H M C 
Published: June 2024

Abstract

Background
Despite individual preferences for the provision of health information, health education often follows a one-size-fits-all approach in cardiac rehabilitation (CR) programmes. This study evaluates changes in information needs of patients during the first twelve months after a cardiovascular event.

Methods
Quantitative data were collected from 259 patients who participated in CR because of symptomatic coronary artery disease. Information needs regarding nutrition, physical activity, smoking, psychosocial wellbeing and medication were assessed at baseline, three months, and twelve months using questionnaires. Furthermore, we conducted semi-structured interviews with 10 CR participants.

Results
Information needs were highest at baseline, decreased for all domains from baseline to three months of follow-up, and remained stable thereafter for most patients. No predictive factors were found for changes in information needs. After twelve months, 41% of patients still had a need for information regarding at least one of the 5 domains. Qualitative analyses supported these findings and highlighted individual preferences for health education, with timing of education as a critical element.

Conclusion
Baseline differences in information needs and their change over time indicate that there is a need for personalised provision of health information, as opposed to current one-size-fits-all health education programmes for patients with cardiovascular disease.