bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patent foramen ovale closure reduces migraine burden: a meta-analysis
Authors: Beneki E , Dimitriadis K , Aznaouridis K , Soulaidopoulos S , Kostakis P , Sakalidis A , Mantzouranis M , Tsioufis P , Dri E , Aggeli K , Tsiamis E , Tsioufis K 
Published: November 2023

Abstract

Background
Patent foramen ovale (PFO) closure has been shown to reduce the risk of recurrent stroke in selected patients. On the other hand, the efficacy of PFO closure in reducing migraine attacks remains a matter of debate.

Purpose
We performed a systematic review and meta-analysis of randomized controlled trials that compared PFO closure plus medical therapy to medical therapy alone for the management of migraine.

Methods
A comprehensive search was conducted in PubMed through December 10, 2022. The main efficacy endpoints were the complete cessation of migraine, the mean reduction in monthly migraine days and the mean reduction in monthly migraine attacks. The main safety outcome was the occurrence of major procedure related adverse events.

Results
Our search retrieved 667 results. Three randomized controlled trials including 448 patients were included in the final analysis. Of these, 231 patients (mean age 43.4±10.5 years) underwent PFO closure, while 217 (43.7±10.6) were treated conservatively with medical therapy. In the medical treatment group, 190 patients underwent a sham procedure. The follow-up period ranged from 6 to 12 months. Overall, no significant association between PFO closure and complete migraine cessation was observed [Hazard Ration 3.31, 95% confidence intervals (CI): 0.72 – 15.17 – Figure 1). On the other hand, PFO closure was associated with a significant reduction in the mean number of migraine days per month [mean difference (MD): 1.23, 95% CI: 0.44-2.10, p=0.024, Figure 2A] as well as with a significant decrease in monthly migraine attacks (MD: 0.58, 95%CI : 0.25-0.91, p=0.017, Figure 2B). In respect of efficacy endpoint, a total of 9 transient, procedure related adverse events, including access-site bleeding, hematoma and tachycardia were reported in the implantation group.

Conclusions
PFO closure plus medical treatment compared to medical treatment alone was related with fewer and shorter migraine attacks. These results suggest clinical benefit of PFO closure in selected patients with migraine.Figure 1.Figure 2.
Population prevalence of ECG abnormalities and risk of incident CVD outcomes: 5-year follow-up of 25,000 Chinese adults
Authors: Turnbull I J , Camm C F , Halsey J , Du H , Chen Z , Clarke R 
Published: November 2023

Abstract

Background and purpose
Little is known about the utility of automated reporting of electrocardiograms (ECGs) for prediction of cardiovascular disease (CVD) types in low- and middle-income countries. We compared derived ECG phenotypes and a clinical risk score for prediction of incident major CVD types in a population study of Chinese adults.

Methods
CVD risk factors were collected and 12-lead ECGs performed with automated interpretation using Mortara’s VERITAS™ algorithm on 25,239 adults in the China Kadoorie Biobank resurvey in 2013-2014. Incident CVD outcomes were recorded prospectively over a median follow-up of 5 years. We examined the prevalence and prognosis of broad ECG phenotypes developed from automated outputs: (i) atrial fibrillation/flutter (AFib); (ii) ischaemia (possible/probable or definite); (iii) left ventricular hypertrophy (LVH); and (iv) normal ECG. Participants were stratified by modified CHA2DS2-VA score (&lt;3 vs ≥3) and by age at resurvey. Kaplan-Meier curves were plotted to display cumulative CVD event rates during follow-up for ECG phenotypes.

Results
The mean (SD) age at resurvey was 59.5 (10.2) years, 62% were women and 57% were from rural areas. Overall, 44.3% had a normal ECG and 1.2% had AFib (0.4%, 0.9%, and 3.9% at ages &lt;55, 55-69, and 70+). A total of 28.1% had ischaemia, and 13.6% had LVH (Table). The prevalence of all pathological ECG phenotypes increased with age and prior CVD. AFib was more common in individuals with CHA2DS2-VA ≥3 vs &lt;3 (3.6% vs 0.8%). CHA2DS2-VA ≥3 was associated with higher HRs (95% CI) for stroke (1.91; 1.67-2.19), ischaemic heart disease (IHD) (1.79; 1.52-2.11), and heart failure (HF) (1.80; 1.23-2.62), respectively. Compared to CHA2DS2-VA ≥3, HRs for the AFib phenotype were greater for IHD (2.62; 1.97-3.50) and HF (3.79; 2.21-6.49) and similar for stroke (1.88; 1.44-2.77). LVH was most strongly associated with HF (1.83; 1.31-2.55) and positive associations with each CVD type were greater for definite vs probable/possible ischaemic phenotypes. After adjustment for age, 5-year cumulative incidence rates of CVD were 36.8% in individuals with AFib, 19.4% in those with ischaemia (all), 18.0% in those with LVH, and 14.1% in those with normal ECGs. Individuals with CHA2DS2-VA ≥3 had a 3-fold greater cumulative incidence of CVD than those with scores &lt;3 (40.9% vs 13.9%).

Conclusions
All pathological ECG phenotypes were associated with higher risks of CVD outcomes, but AFib was most strongly predictive and comparable to moderate-high CHA2DS2-VA scores. However, absolute risks of subsequent CVD events were similar in those with ischaemia, LVH and a normal ECG. When combined with clinical risk scores, automated ECG interpretation is a useful adjunct in low-resource settings for CVD risk prediction in population studies and in clinical practice.
Association of extent and severity of coronary atheromatosis with clinically undetected depression
Authors: Babic R , Dimitrijevic S , Burazor I 
Published: November 2023

Abstract

Background
Comorbid depression is recognized among patients with cardiovascular diseases; however, it frequently remains clinically unrecognized. The reported prevalence of clinical depression among patients with cardiovascular diseases varies depending on the population characteristics and the clinical presentation of underlying cardiac disease. The association of comorbid depression with coronary artery disease is broadly reported; however, the causation is still putative. The data on the relation between the severity and extent of coronary atheromatosis versus the intensity of depressive symptoms are scarce.

Purpose of the study
Primary endpoint of this study was to determine the prevalence of previously undetected clinical depression among patients with chronic coronary syndromes referred for coronary angiography. The secondary endpoint was to assess the relationship between the extent and severity of coronary atheromatosis (evaluated by Gensini score) and the level of depression (assessed by Beck's Depression Inventory-II (BDI-II) questionnaire).

Methods
Single-center, cross-sectional observational study.

Results
Eighty-eight consecutive patients were enrolled in the study following signing the informed consent. The mean patient age was 63.8 ± 9.0 years, including 47 male and 41 female patients. Clinical depression (mild, moderate, or severe) was found in 20.5% of patients. The median value of BDI-II score was 6.5, with IQR of 8.25. The median value of Gensini score was 33.0, with IQR of 41.0. A strong positive linear correlation was found between BDI-II value and Gensini score (r=0.42, p&lt;0.01). Significant differences in Gensini scores were found between 1st and 4th quartiles of BDI-II (p&lt;0.01), and between the 1st and 2nd quartiles taken together and the 3rd and 4th taken together (p&lt;0.05).

Conclusion
Unrecognized clinical depression (mild, moderate, and severe) is present to a sizable extent among patients with chronic coronary syndromes. Patients with chronic coronary syndromes and more pronounced depressive symptoms present with more severe and more extensive findings on coronary angiography compared to the patients with minimal depressive symptoms or without depression. These findings may be of significance for our future decision making in preventive cardiology.Correlation of BDI-II and Gensini scores
Association of red cell omega-3 fatty acids, particularly EPA, with cognitive performance in atrial fibrillation
Authors: Lee P , Bosshard L , Aeschbacher S , Springer A , Saeedi S , Allemann M , Bonati L , Kuhne M , Reichlin T , Moschovitis G , Muller A , Rodondi N , Conen D , Osswald S , Beer J H 
Published: November 2023

Abstract

Introduction
Atrial fibrillation (AF) is associated with cognitive impairment and dementia. Whether or not omega-3 Fatty Acids (n-3 FAs) have neuroprotective effects is controversial. We therefore aimed to determine the correlation of n-3 FAs with cognitive function in a large cohort of AF patients.

Methods
Red cell n-3 FAs levels were determined by gas chromatography and mass spectrometry in 2359 patients from the prospective ongoing multicenter Swiss Atrial Fibrillation study (Swiss-AF). To assess the overall cognitive performance of patients, we used several validated neurocognitive assessment tools, including the Montreal Cognitive Assessment (MoCA), Semantic Fluency Tests (SF), Trail Making Test (TMT A&B), and the Digit Symbol Substitution Test (DST). We also used a summary score that we have previously developed (the cognitive construct (CoCo) score). We performed mixed-effect linear regression analyses. Two adjustment models were applied; model 1 (adjusted for age, sex, and educational level) and model 2 (adjusted for age, sex, educational level, history of stroke/TIA, AF type, heart rate, arterial hypertension, diabetes, coronary artery disease, BMI, chronic kidney disease, smoking status, alcohol consumption, geriatric depression scale, use of oral anticoagulation and antiplatelet medication). We also included a random intercept to control for center-effect in both models.

Results
The mean age of our study population was 73 years (standard deviation [SD] 8.4), and 662 patients were females (28%), 318 had a history of stroke (13%), and 716 suffered from coronary artery disease (30%). We observed statistically significant associations of total n-3 FAs levels (EPA + DHA + DPA + ALA) with all neurocognitive assessments, as seen in figure a. Individual n-3 FAs levels (EPA and ALA) were positively associated with MoCA score in both models. EPA was significantly associated with multiple neurocognitive assessments including MoCA, SF, TMT-B, DST, and overall CoCo score in both models (figure b). We found that a 1% red cell EPA level increase was associated with 0.19 (Model 1, 95%CI 0.06-0.31, p=0.003) and 0.14 (Model 2, 95% CI 0.01-0.26, p=0.02) units increase in the standardized MoCA score.

Conclusions
Red cell n-3 FAs levels are associated with better cognitive performance in AF patients. We observed a particularly strong association of EPA levels with all neurocognitive assessments.
Exercise-based interventions for preventing and treating cancer therapy-related cardiovascular toxicity: a systematic review and meta-analysis
Authors: Huang Z , Chair S 
Published: November 2023

Abstract

Background
Cardiovascular toxicity is one of the most common side effects of cancer therapies. Physical exercise is regarded as a promising non-pharmacological therapy to prevent and mitigate cancer therapy-related cardiovascular toxicity (CTR-CVT) for cancer patients. Nevertheless, research evidence on its effects and optimal design remains unclear.

Purpose
This review aims to synthesize available data to evaluate the effects of exercise-based interventions on CTR-CVT in cancer patients and identify the potentially effective characteristics of exercise prescriptions.

Methods
Four databases (MEDLINE, Embase, Web of Science, and CENTRAL) were searched from the inception to October 2022 to identify eligible studies. Randomized controlled trials (RCTs) examining the effects of exercise-based interventions on CTR-CVT in cancer patients published in English were included. Risk of bias of included studies were assessed using the revised Cochrane "Risk of bias" tool for randomized trials (RoB 2.0). The meta-analysis was performed using statistical software R.

Results
Twenty studies with 1705 cancer patients were included. Our findings revealed that the VO2peak was significantly improved in the exercise-based intervention groups compared to the controls (standardized mean difference: 0.24, 95% confidence interval: 0.09 to 0.40). Evidence on other study outcomes remains unclear. The optimal characteristics of exercise programs could not be determined.

Conclusion
This review suggests that exercise-based interventions have the potential effects to prevent and treat CTR-CVT among cancer patients. Future well-designed RCTs are required to evaluate the impact of exercises on comprehensive CTR-CVT indicators.
Exercise-induced troponin I elevation is associated with alterations in regional longitudinal strain
Authors: Erevik C , Kleiven Ø , Froysa V , Bjorkavoll-Bergseth M , Chivulescu M , Klaebo L G , Dejgaard L , Auestad B , Skadberg Ø , Melberg T , Urheim S , Haugaa K , Edvardsen T , Orn S 
Published: November 2023

Abstract

Background
Mechanisms of exercise-induced troponin elevation in healthy individuals are unclear. This study aimed to determine if exercise-induced cardiac troponin elevation (cTn) is associated with alterations in the myocardial response to physical stress.

Methods
This study assessed regional and global myocardial function by strain echocardiography at rest and following exercise of increasing workloads in individuals with either a high- or a normal cTnI response to exercise. High-cTnI responders (n=34) were individuals with a previous exercise-induced cTnI level above the 92.5% limit (cTnI &gt; 200 ng/L) in the NEEDED population (n= 1002). Normal-cTnI responders comprised 25 reference individuals with a post-exercise cTnI &lt; 200 ng/L. All study participants were healthy individuals with normal CT coronary angiography. The first exercise was a cardiopulmonary exercise test (CPET) of 43 (40,45) minutes. The second exercise was a 91 km recreational mountain bike race of 230 (210, 245) minutes. Myocardial function was assessed by echocardiography before and within 10 minutes and 24 hours after both exercises.

Results
Study individuals were 51±10 years old, and 46 (74 %) were male. At baseline, there were no differences between the High- and Normal-cTnI responders regarding demographics, training condition, cardiac risk factors, peak oxygen consumption and conventional echocardiographic parameters. Maximal cTnI levels 3 hours after exercise were significantly higher in the High- compared with Normal-cTnI responders: CPET: cTnI 13 (9-32) vs 9 (5-17) ng/L (p 0.027) and Race: cTnI: 101 (76-198) vs 37 (25-69) ng/L (p &lt;0.001). Following exercise, there were no differences in global ventricular function between the two groups, assessed as left ventricular (LV) global longitudinal strain (GLS) and right ventricular (RV) GLS. When comparing regional longitudinal strain between the two groups, High-cTnI responders had significantly lower regional strain values in the anteroseptal segments following both exercises (p-values 0.005-0.041, 8-14% relative difference, Figure 1 and 2). The changes were more profound after the most intensive exercise (the Race).

Conclusion
High-cTnI responders have larger reductions in post-exercise systolic longitudinal strain in anteroseptal segments than Normal -cTnI responders. The reduction in regional strain was most profound following the highest workload (the Race). These findings suggest that highly elevated exercise-induced cTnI levels may reflect vulnerable regional alterations in the myocardial response to increasing workloads.Figure 1CPETFigure 2Race
Physical activity and cause-specific mortality among 150,000 participants in the Mexico city prospective study
Authors: Gnatiuc Friedrichs L , Alegre-Diaz J , Ramirez-Reyes R , Trichia E , Aguilar-Ramirez D , Wade R , Collins R , Peto R , Berumen J , Emberson J , Kuri-Morales P , Tapia-Conyer R 
Published: November 2023

Abstract

Background
Previous studies of high-income populations have found that physical activity is associated with reduced mortality risk. We investigated the association of recreational physical activity intensity with cause-specific mortality at ages 35-74 in a Mexican population with high levels of adiposity and diabetes.

Methods
Between 1998 and 2004, 150,000 adults (age ≥35 years) were recruited into the Mexico City Prospective Study, and followed for median 19 years. Cox regression was used to assess the association of baseline-reported intensity of recreational physical activity (none, &lt;30 minutes, ≥30 to &lt;60 minutes, or ≥60 minutes per activity session) with death before age 75 years. Analyses were adjusted for age at risk, sex, residential district, education, smoking and alcohol consumption. They excluded those who at recruitment were aged ≥75 years, had incomplete data, or had vascular disease or any other chronic condition (except diabetes) recorded.

Results
Among the 45,291 men and 93,627 women aged 35-74 years, 70% of men and 81% of women reported taking no regular recreational physical activity, mean (SD) body mass index was 29.1 (4.9) kg/m2 and 13% had previously-diagnosed diabetes. There were 12,605 deaths from any cause at ages 35-74 years, including 3368 from vascular causes. Physical activity at recruitment was associated with lower all-cause mortality risk in a dose-dependent manner. Compared with those reporting no regular physical activity, those exercising ≥60 minutes per activity session had 28% lower all-cause mortality at ages 35-74 years (HR=0.72; 95% CI 0.67-0.78), including 22% lower vascular mortality (RR 0.78, 0.68-0.90). Associations were similar for the different types of vascular mortality and were similar in those with and without diabetes, so the absolute benefits of physical activity were larger in those with diabetes. Those who exercised for the longest durations per activity session had lower baseline blood pressure and a more favourable lipid profile than those who reported doing no regular recreational physical activity.

Conclusions
In this Mexican cohort, higher recreational physical activity was associated with a lower risk of premature death, with particularly high absolute benefits in those with diabetes.
Risk factor burden in familial hypercholesterolaemia with early onset coronary artery disease
Authors: Thein P M , Guerreiro C , Fhadil S , Hamedi N , Zalin A , Kapil V , Choudry F , Abhishek J , Siddiqi A , Patel R 
Published: November 2023

Abstract

Background
Familial hypercholesterolaemia (FH) is considered a causal risk factor for premature coronary artery disease (CAD) with a priority placed on identifying index cases and their relatives for preventative interventions. However recent population sequencing studies have identified that not all FH mutation carriers develop CAD. We hypothesised that a significant burden of traditional risk factors is required in addition to genetic risk to develop CAD.

Methods
We interrogated the clinical registry of patients attending the CVD risk and Lipids clinic at St Bartholomew’s Hospital in London which serves a large multi-ethnic population. Patients were prioritized for genetic testing based on Simon Broome and Dutch Lipid criteria. A second cohort of patients from the clinic consisted of premature CAD patients without phenotypic FH. CAD was defined as &gt; 50% stenosis in an epicardial vessel by invasive or non-invasive imaging.

Results
We identified 40 patients with genetically confirmed FH and CAD (FH+/CAD+) and 116 people with FH and without CAD (FH+/CAD-). Of 10 traditional risk factors evaluated, prevalence of each was higher in FH +/CAD+ compared to FH+/CAD- patients.
Collectively, FH+/ CAD+ patients had a median number of risk factors of 5(4,6) compared to 4(3,5) for FH+/CAD- patients, (P&lt;0.001). In non-FH patients, risk factors burden was higher in those with CAD (FH-/CAD+), compared to those without CAD: 5(4,6) V. 4(3,5) risk factors, respectively(P&lt;0.001). Importantly, in patients who developed CAD, the traditional risk factor burden was greater in FH- patients than that of FH+ patients whereas, the genetic risk burden was greater in FH+ patients (Figure-1).
The mean age of onset of CAD in both FH+ and FH- patients was comparable: 43± 10 V. 43± 12years. Patients with FH+/CAD+ were older (53± 11 V 49± 13 years, P=0.276) but had an earlier onset of CAD, when risk burden was greater (43± 8 years if ≥ 5 risk factors v 49± 15 years if &lt; 5 risk factors, P=0.192).

Conclusion
In a selected population from a large specialist lipid clinic, we demonstrate that traditional risk factor burden is additive to genetic risk for the development and age of onset of CAD, supporting a disease liability threshold model in FH.Figure-1.Risk Burden in FH with CAD
Ideal cardiovascular health metrics and cardiovascular mortality in patients with renal insufficiency
Authors: Huang R , Chen W H , Tu J B , Xiao G T , Li Z Y , Chen K L 
Published: November 2023

Abstract

Background
With high cardiovascular mortality, the benefits of cardiovascular health (CVH) metrics to renal insufficiency populations remain unclear.

Objectives
To investigate ideal cardiovascular health metrics (ICVHMs) associations with cardiovascular mortality in a renal insufficiency population compared to normal individuals.

Methods
We analyzed data from the National Health and Nutrition Examination (NHANES) 2007–2018 Survey, with mortality follow-up through December 31st, 2019. We divided 29,682 participants into three groups based on the estimated glomerular filtration rate. CVH was updated in the latest 2022 American Heart Association recommendations. Cox regression analyses based on NHANES data were used to determine associations between ICVHMs and cardiovascular mortality in patients with renal insufficiency.

Results
In 29,682 participants, the mean (standard error) age ranged from 40.2 (0.2) to 71.6 (0.4) years. When compared with participants with normal renal function, participants with mild renal insufficiency who had ideal CVH reduced their risk of cardiovascular mortality (Hazard Ratio (HR) = 0.34; 95% confidence interval (CI): 0.14–0.81), while the HR for cardiovascular mortality gradually decreased from 1.47 (95% CI: 0.85–2.52) in participants who had ≤ 1 ICVHMs, to 0.30 (95% CI: 0.12–0.77) in those who had ≥ 6 ICVHMs. In participants with renal insufficiency, for each ICVHMs increment, a 25% reduction in cardiovascular mortality risk was observed (95% CI: 0.69–0.82).

Conclusions
More ICVHMs counteracted renal impairment harm when compared with populations with normal functions, and cardiovascular benefits increased with ICVHMs in patients with renal insufficiency.