bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regular supervised exercise training improves endothelial function, early atherosclerosis, arterial stiffness and endothelial progenitor cells in PCI patients
Authors: Park J , Lim D S , Nam H J , Hong S J , Yu C W , Cha J J , Kim J H , Joo H J , Lim S B 
Published: November 2023

Abstract

Backgrounds
A disrupted balance between endothelial injury and repair induces endothelial dysfunction and endothelial progenitor cells (EPC) augment vascular repair. So, exercise improves endothelial function through increased numbers of EPC. We investigated the effect of training on vascular health by measuring the number of circulating EPC, and assessing flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) in patients with percutaneous coronary intervention (PCI).

Methods
Fifty-nine patients who were done PCI recently were randomized to full medical treatments or additional 3 months regular supervised exercise program (4 times a week, 1 hr a day). FMD, baPWV, carotid IMT, HOMA, hs-CRP and lipid profiles were measured and circulating CD34/KDR, CD34/CD117 and CD34/CD133 EPC were quantified by flow cytometry at baselines and after 3 months.

Results
Finally 23 patients joined exercise program(control, N=28). There was no significant difference of baseline characteristics and medication between 2 groups. After 3 months, FMD improved significantly in exercise group (6.62% to 11.48%) compared with control group (7.61% to 8.45%) (P&lt;0.001) (fig 1). Carotid IMT reduced significantly in exercise group (0.759mm to 0.707mm) compared with control group (P=0.015) (fig 2). ba-PWV reduced significantly in exercise group (1529cmm/s to 1455 cmm/s) compared with control group (P=0.016) (fig 3). Numbers of CD34/KDR, CD34/CD117 and CD34/CD133 EPCs increased significantly after exercise compared with control group (P= 0.041, 0.011, 0.022, respectively) (fig 4). We also could see to reduce waist to hip ratio in exercise group compared with control group (P&lt;0.001).

Conclusions
Three months regular supervised exercise improved FMD, ba-PWV, carotid IMT and waist to hip ratio in PCI patients. and it augmented numbers of circulating EPCs. Our results showed that exercise contributes to additional improvement of vascular health in PCI patients with optimal medical treatments.
exercise-induced cardiac remodelling in elite athletes is characterized by a stronger ventricular mass-volume association in females as compared with males: MRI results from the ELITE cohort
Authors: Van Diepen M , Van Hattum J C , Daems J J N , Verwijs S M , Boekholdt S M , Van Randen A , Planken R N , Groenink M , Nederveen A J , Moen M H , Wilde A A M , Pinto Y M , Jorstad H T 
Published: November 2023

Abstract

Background
Differentiation between exercise-induced cardiac remodelling (EICR) and cardiac pathology constitutes a central challenge in sports cardiology. To assist clinicians, theoretical frameworks have been developed: i.e. dynamic sports are associated with ventricular dilatation, static sports with hypertrophy, and sports containing both components with both dilatation and hypertrophy. However, EICR frameworks have been almost exclusively based on findings in male athletes, and whether these associations are found in female athletes is to date unclear.

Purpose
We aimed to investigate intersex differences in left ventricular (LV) remodelling in the extreme phenotypes of elite athletes.

Methods
We included 227 healthy, elite athletes from the ELITE cohort who underwent cardiac magnetic resonance imaging (CMR). Our outcomes of interest were absolute and body surface area (BSA) indexed LV end-diastolic volume, LV end-diastolic wall mass, LV end-diastolic mass-volume ratio to express cardiac remodelling (LV end-diastolic wall mass / LV end-diastolic volume) and correlations of BSA-indexed LV mass with LV end-diastolic volume to compare LV remodelling between sexes.

Results
A total of 122 male and 105 female elite athletes (age 26±6 years) were included. The age and division in sports categories according to the ESC classification were similar between the sexes. Male athletes showed larger indexed LV end-diastolic volumes (127±19 versus 108±14 ml, p &lt;0.001) and indexed LV wall mass (66±12 versus 50±11 grams, p &lt;0.001) compared to female athletes. Male athletes had a proportionally larger LV mass-volume ratio than women (0.53±0.12 versus 0.46±0.09 g/ml, p &lt;0.001). Female elite athletes showed a moderate association between indexed LV mass increase with indexed LV end-diastolic volume increase (Spearman’s rho 0.45, p &lt;0.001), whereas male athletes showed a weak association (Spearman’s rho 0.25, p =0.006).

Conclusions
Elite male athletes have larger left ventricular volumes and wall mass, with a greater mass-volume ratio, than their female counterparts. However, female athletes demonstrate a stronger mass-volume association than males. Our findings suggest the presence of distinct sex-dependent features of EICR.
Burden and causes of sudden cardiac arrest in children: implications for preparticipation screening
Authors: Graziano F R A , Schiavon M , Cipriani A , Savalla F , De Gaspari M , Bauce B , Rizzo S , Calore C , Thiene G , Paiaro P , Corrado D , Basso C , Zorzi A 
Published: November 2023

Abstract

Introduction
Competitive sports activity may increase the risk of life-threatening ventricular arrhythmias and sudden cardiac death (SCD) in athletes with underlying cardiovascular diseases (CVD). Preparticipation screening (PPS) offers the potential to early identify CVD and reduce this risk, but the optimal age of sport PPS start is not known.

Purpose
The aim of this study is to assess the burden of sudden cardiac arrest (SCA) and the diagnostic yield of PPS for CVD at risk of SCA in two different age groups: 8-11 year-old and 12-15 year-old.

Methods
Data on the incidence and causes of SCA from 2011 to 2020 were retrieved from the sudden death registry of our region, hospital records and local press. During the same period, we assessed 25,251 young competitive athletes aged 8-15 years who underwent 58,185 annual PPS (mean 2.3/athlete) including history, physical examination, ECG and exercise testing. Further tests were required in case of abnormalities at first-line screening.

Results
Over 10 years, 21 sudden deaths and 5 resuscitated SCA occurred: 6 in athletes (incidence 0.7/100.000/year) versus 20 in non-athletes (0.7/100.000/year). 67% athletes versus 5% non-athletes who suffered SCA were successfully resuscitated (aborted sudden cardiac death=aSCD), (results according to the age-group in Figure 1). Idiopathic ventricular fibrillation was the most common diagnosis accounting for 14/26 (54%) cases. The incidence of SCA was 0.2/100.000/year in the age group 8-11 year-old versus 1.3/100.000/year in the age group 12-15 year-old. By PPS, 26 (0.1%) athletes received a diagnosis of at-risk CVD, significantly more often in children ≥12 year-old (0.06%/evaluation) than &lt;12 year-old (0.02%/evaluation, p=0.02), (Figure 2). During follow-up, 2 screened athletes suffered SCA due to idiopathic ventricular fibrillation, both ≥12 year-old at the time of PPS.

Conclusions
The incidence of SCA was 6 times higher in the age group 12-15 years compared with the 8-11 years group. Similarly, the diagnostic yield of PPS for at-risk CVD was significantly higher after 12 years of age. This suggests that systematic PPS may not be justified before 12 year-old.Figure 1Figure 2
Cardiac magnetic resonance imaging in athletes with suspected structural myocardial disease: results of a high volume single-center study
Authors: Vago H , Balla D , Szabo L , Juhasz V , Bodor C S , Fekete B , Csonka K , Sydo N , Csulak E , Kiss O , Czimbalmos C S , Suhai F , Dohy Z S , Becker D , Merkely B 
Published: November 2023

Abstract

Introduction
Structural heart disease is one of the leading causes of sudden cardiac death in athletes. Cardiac magnetic resonance imaging (CMR) has a key role in the diagnosis, providing accurate functional and morphological information.

Aim
To investigate the prevalence of structural heart disease and the etiology of sudden cardiac death (SCD) in athletes.

Methods
We enrolled athletes (training ≥6 hours/week) who underwent CMR due to suspected structural myocardial disease at our Heart and Vascular Center between 2009 and 2022. We also performed cardiogenetic testing with new-generation sequencing (174 genes) in athletes with confirmed structural heart disease and/or malignant arrhythmia who gave consent.

Results
CMR was performed on a total of 556 athletes (445 male, 24±10 age). The indications for CMR were as follows: aborted sudden cardiac death/sustained ventricular tachycardia (3%), ECG (46%) or echocardiographic abnormality (36%), positive family history of SCD or cardiomyopathy (CMP) (3%), or athletes' complaints (31%). Structural myocardial abnormalities were confirmed in 99 athletes: hypertrophic (HCM) in 27, arrhythmogenic (AC) in 11, dilated (DCM) CMP in 7, and left ventricular non-compaction (LVNC) in 9 cases. MR images consistent with Fabry disease were found in 5 patients. We have discovered post-myocardial infarction scars in 10 cases, and atypical non-ischemic scarring (excluding hinge point fibrosis) was observed in 32 athletes. Besides pathological abnormalities, minor alterations were identified in 76 patients. Among the athletes examined after aborted sudden cardiac death/sustained ventricular tachycardia (n=18), we found structural heart disease in 14 patients, AC was confirmed in 7, HCM in two, non-ischemic fibrosis in three cases and LVNC in one athlete. Cardiogenetic test was performed in 26 athletes, we found pathogenic or likely pathogenic mutations in 5 cases, typical of HCM, AC, DCM (MYBPC3, PKP2, LMNA, TTN). The genetic test showed VUS (variant of unknown significance) in 15 additional athletes.

Conclusions
HCM was identified as the most frequent CMP, whereas AC and nonischaemic scar was the leading cause of SCD or SVT in our athletes.Figure A)Short axis late gadolinium ehancement CMR image of a 26-year-old female tennis player with hypertrophic cardiomyopathy and nonischemic fibrosis (arrow) and MYBPC3 pathogenic variant.Figure B)Short axis late gadolinium enhancement CMR image of a 40-year-old male elite discus thrower with sustained ventricular tacchycardia and nonischaemic scar formation (arrows). LMNA and titin pathogenic variants could be detected.
Prediction of genetic cardiomyopathy by whole exome sequencing and myocardial strain in patients with concentric left ventricle hypertrophy
Authors: Soh M , Park J , Shin J 
Published: November 2023

Abstract

Introduction
Genetic cardiomyopathies (CMP) are a group of inherited diseases that can lead to heart failure and sudden cardiac death. Left ventricular hypertrophy (LVH) is common findings in these diseases, but the diagnosis can be challenging due to their heterogeneous clinical presentations. Myocardial strain and whole exome sequencing (WES) are a powerful tool for early detection of genetic CMP.

Purpose
We aim to investigate the utility of the combination of myocardial strain and WES in the diagnosis of genetic CMP in patients with LVH.

Methods
We performed WES with buccal swab test on a total of 65 patients who had concentric LVH and decreased global average strain (GAS) by echocardiography between July 2021 and December 2022. The genetic data was analyzed to identify disease-causing genetic variants, and the clinical data and echocardiographic findings were collected and analyzed. Logistic regression analysis was performed to identify the predictive factors of genetic cardiomyopathy, and receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy of these factors.

Results
Of the 65 patients, we identified 10 patients with genetic cardiomyopathy by WES, including hypertrophic CMP, cardiac amyloidosis, and Fabry disease. The diagnostic yield of WES was 15.4% for genetic CMP. Logistic regression analysis showed that sex, diastolic blood pressure, interventricular septal thickness at end diastole (IVSd) and end systole (IVSs), posterior wall thickness at end diastole (PWd), and GAS were significant predictors of genetic CMP (p&lt;0.05 for all). ROC curve analysis showed that IVSs had the highest area under the curve (AUC) value of 0.711 (p=0.037), with a sensitivity of 60.0% and a specificity of 67.3%.

Conclusion
Our study highlights the utility of WES and myocardial strain with echocardiographic data in diagnosing genetic CMP, especially in patients with concentric LVH. These findings support the integration of genetic testing and advanced imaging techniques in the diagnostic approach for patients with suspected genetic cardiomyopathies.
Association of adverse pregnancy outcomes with cardiovascular risk profile in later life - lessons learned from a large prospective population-based cohort-study
Authors: Unger E , Makarova N , Borof K , Aarabi G , Blankenberg S , Augustin M , Waldeyer C , Zengin-Sahm E , Magnussen C , Behrendt C A , Schnabel R B , Zyriax B C 
Published: November 2023

Abstract

Background
An increased cardiovascular risk profile in parous women in later life has been related to maternal outcomes of pregnancy such as hypertension, diabetes, excessive weight gain as well as fetal outcomes such as preterm birth or excessive birth weight.

Methods
Using data from a large, monocenter, prospective, long-term, population-based cohort, we analysed self-reported data on pregnancy, risk factors and health status of 1,970 women. We examined the correlations between gestational hypertension (gHTN), gestational diabetes (gDM) and excessive weight gain during pregnancy with hypertension (HTN), diabetes (DM), hyperlipoproteinemia (HLP) and body-mass-index (BMI) in later life. Regarding adverse fetal outcomes, we investigated correlations between preterm birth and later hysterectomy/ovariectomy of parous women and birth weight of &gt;4,000 g with parous women’s BMI in later life. The Wilcoxon rank sum test and the Pearson's Chi-squared test were carried out to prove associations. Further logistic regression analyses are planned to assess cardiovascular outcomes such as myocardial infarction, stroke, heart failure and atrial fibrillation in these parous women. The p-value of 0.05 was defined as a standard for significance.

Results
The median age of 1,970 women upon examination was 63 years. The proportion of gestational hypertension was 8.7%. 18% of women gained more than 20 kg and 2.4% had diabetes during pregnancy. 10% delivered newborns with a birth weight of &lt;2,500 g. 14% delivered newborns with a birth weight of &gt;4,000 g. 19% were smokers and had hyperlipoproteinaemia, 59% were hypertensive and 33% had metabolic syndrome. We found positive correlations between gestational hypertension and hypertension in later life as well as between gestational diabetes and diabetes mellitus. Excessive weight gain during pregnancy was found to relate to elevated BMI in later life as well as current smoking status. Excessive weight gain during pregnancy did, however, not relate to HLP. High birth weight of &gt;4,000 g correlated with elevated BMI in later life.

Conclusions
In a population-based sample, we were able to demonstrate that pregnancy-related manifestations of cardiovascular risk factors are indeed related to an increased risk profile in later life. There is a profound need for better individual risk stratification in women based on pregnancy-related data in order to deliver optimised early preventative strategies and potentially reduce cardiovascular events in later life.
Cardiovascular risk in rare autoimmune diseases, lessons from a primary antiphospholipid syndrome patients
Authors: Djokovic A , Stojanovich L , Stanisavljevic N , Zdravkovic M , Djulejic V , Matic P 
Published: November 2023

Abstract

Background
Antiphospholipid syndrome is a thrombo-inflammatory disease driven by circulating autoantibodies (aPL) that recognize cell surface phospholipids and phospholipid-binding proteins. In the absence of an underlying connective tissue disorder, the persistent presence of these antibodies associated with recurrent fetal losses and arterial or venous thrombosis is defined as a primary antiphospholipid syndrome (PAPS) with a prevalence of 1/2000 people, predominantly female.

Purpose
Estimation of cardiovascular risk presence based on markers of subclinical cardiovascular impairment.

Methods
100 PAPS patients, with an average age of 47.70±13.14y, 93.7% females, were included in the study. Anticardiolipin antibodies (aCL IgG/IgM), anti-ß2 glycoprotein-I (anti-ß2GPI IgG/IgM), and lupus anticoagulant (LAC) were determined. Abnormal cut-off values used for left ventricular diastolic dysfunction (LVDD) were septal E ́&lt;7 cm/sec, lateral E ́ &lt;10 cm/sec, average E/E ́ ratio &gt;14, LA volume index (LAVI) &gt;34 mL/m2, and peak tricuspid regurgitation velocity &gt;2.8 m/sec. LVDD was present if more than half parameters were with abnormal values. Endothelial dysfunction was assessed through ultrasound measurement of brachial artery flow-mediated dilation (FMD) and atherosclerosis progression by ultrasound assessment of intima-media thickness (cIMT) on carotid arteries (common carotid artery, CCA, internal carotid artery, ICA). The results were compared to 90 healthy, age and sex-matched controls.

Results
LVDD was significantly more prevalent in PAPS patients compared to healthy controls (24.8% vs. 2.2%, p=0.001). FMD was significantly lower in PAPS patients (10.76±5.15% vs. 14.20±6.76%, p=0.0001) and cIMT values were significantly higher (left ICA 0.80±0.29mm vs 0.56±0.20mm, p=0.001). All markers of subclinical atherosclerosis were significantly related to age and standard atherosclerotic risk factors present. Regarding aPL profile, anti-ß2GPI IgG positive PAPS patients had higher levels of cIMT ICA left (p=0.049) and LAC positive higher prevalence of LVDD (p=0.047) CONCLUSIONS: PAPS patients impose significantly higher prevalence of subclinical cardiovascular involvement compare to healthy population. Timely recognition, along with vigorous control of standard atherosclerotic risk factors and a proper therapeutic (antithrombotic and/or anticoagulant) regime, is of great importance.
Worse outcomes in young women compared to men presenting with ST-elevation myocardial infarction: a 15-year statewide population-linkage cohort study
Authors: Lazarovska S , Brieger D , Hyun K , Ng A , Chow V , Kritharides L , Philip R 
Published: November 2023

Abstract

Background
Gender disparity in outcomes among patients presenting with acute ST-elevation myocardial infarction (STEMI) is well recognised. It is unclear whether the gap has improved with contemporary management and therapies over time. This study compared the 30-day mortality between women and men admitted with STEMI from 2003-2017.

Purpose
To examine whether the gender disparity in 30-day mortality following STEMI is consistent across patient age groups and whether it has changed over time with contemporary management.

Methods
We used the NSW Admission-Patient-Data-Collection (APDC) database which maintains the admission records of more than 97% of the state’s healthcare facilities to identify consecutive STEMI patients admitted from 1-Jan-2003 to 31-Dec-2017. Cause-specific mortality (classified as cardiac, non-cardiac) was identified from death certificates. Multivariable logistic regression analysis was performed to examine the impact of gender on mortality adjusted for comorbidities, admission year-groups, PCI during STEMI, and stratified by age groups of ≤60, 61-70 and &gt;70yo.

Results
The study cohort comprised 65033 STEMI patients: 32% women (n=20825; median age 76.1yrs); 68% men (n=44208; median age 63.8yrs). The overall 30-day all-cause and cardiac mortality was 11.5% and 8.3% respectively, with women having worse outcomes compared to men (all-cause: 17.0% vs 8.9%; cardiac: 12.2% vs 6.5% respectively, both p&lt;0.0001). Following adjustment, higher mortality among women persisted: adjusted odds ratio [aOR]=1.65 (95% confidence interval [CI]=1.40-1.94) and 1.55 (95%CI=1.28-1.87) for total and cardiac mortality respectively. The gender disparity in mortality did not change during the study period. There was an interaction between age and gender so that differences in gender specific mortality were greater in younger than in older patients: total mortality women vs men ≤60yrs aOR=1.65 (95%CI=1.40-1.94), &gt;70yrs aOR=1.19 (95%CI=1.12-1.27), p(interaction)=0.0011; cardiac mortality women vs men ≤60yrs aOR=1.55 (95%CI=1.28-1.87), &gt;70yrs aOR=1.17 (95%CI=1.09-1.25), p(interaction)=0.026. Unexpectedly, a similar age-gender interaction was observed for non-cardiac mortality: women vs men ≤60yrs aOR=1.88 (95%CI=1.41-2.51), &gt;70yrs aOR=1.15 (95%CI=1.03-1.28), p(interaction)=0.0063.

Conclusion
Women admitted with STEMI have significantly higher 30-day mortality than their male counterparts, with no improvement in gender disparity during the study period. The gender-bias is most pronounced in the younger age-group across and is observed for both cardiac and non-cardiac mortality. Further efforts are needed to identify the drivers of worse outcomes following STEMI in younger women.
Tobacco smoking upregulates CRLF1 expression in the atherosclerotic lesions in sex- and plaque-type specific manner
Authors: Lan T , De Kleijn D P V , Den Ruijter H M R , Pasterkamp G P , Mokry M M 
Published: November 2023

Abstract

Background
Tobacco smoking is known to impact the development of atherosclerotic disease. Interestingly, females who smoke have a higher risk of cardiovascular disease( CVD) than males. It is established that smoking can lead to changes in DNA methylation and gene expression. We, therefore, hypothesised that smoking influences gene expression in a sex- and plaque-type-specific manner.

Method
We executed bulk RNA sequencing of 654 carotid plaques and single sequencing in 46 plaques. We analysed the transcriptomes of 625 carotid plaques from smokers (n= 226) and non-smokers (n = 399) and performed the differential gene expression in plaques between smokers and non-smokers. The analysis was repeated separately in males and females. The observed gene expression differences were also associated with pathological and molecular plaque characteristics.

Results
After correction for multiple testing, CRLF1 was found to be significantly higher expressed in smokers than non-smokers (Log2FC=0.48, FDR =0.012) (Figure 1a). Single-cell RNA-seq analyses revealed specific expression of CRLF1 in the synthetic smooth muscle cell population. The smoking-associated CRLF1 overexpression was larger in females (log2FC=0.93) compared to males (log2FC=0.35) (Figure1b). Furthermore, the effect was restricted to plaque types with a higher content of smooth muscle cells.

Conclusion
Our results show the sex and plaque type-specific effect of smoking on gene expression in carotid plaques. The higher upregulation of the CRLF1 gene in female smokers suggests mechanistic clues to a higher risk of smoking-related CVD in women.Figure 1