bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physiological and haemodynamic differences between peak exercise blood pressure and blood pressure-power output slope in healthy women
Authors: Foulkes S , Janssens K , Howden E J , Haykowsky M J , Wallace I , Climie R , La Gerche A 
Published: November 2023

Abstract

Background
A hypertensive response to exercise (HRE) is considered indicative of increased arterial stiffness (1). However, HRE is common in individuals with high cardiorespiratory fitness (CRF) (2), which we hypothesize is due to increased stroke volume (SV) and cardiac output (Qc).

Purpose
This study compared differences in CRF and peak-exercise SV (SVpeak) and Qc (Qcpeak) according to absolute and workload-indexed definitions of exercise hypertension in women.

Methods
Women free of overt CVD (n=142; 52±8years, BMI: 26.3±4.5kg/m2) underwent exercise cardiac magnetic resonance to quantify SVpeak and Qcpeak, and cardiopulmonary exercise testing to quantify peak VO2, power output (PO) and systolic blood pressure (SBP) responses. SBP-PO slope was determined using linear regression of SBP and PO values obtained every 2-minutes throughout exercise. HRE was defined as peak SBP ≥190mmHg (3), and elevated SBP-PO slope was defined as a slope &gt;90th percentile for sex and age based on previously published values (4).

Results
51% and 23% of the cohort met criteria for HRE and elevated SBP-PO slope, respectively, with 16% meeting both criteria. HRE was associated with higher VO2peak (2.03±0.53 vs 1.83±0.44 L/min, P=0.015), peak PO (191±66 vs 167±51 Watts, P=0.014), SVpeak (109±27 vs 98±19 mLs, P=0.008), and Qcpeak (15.1±3.3 vs 13.9±2.8 L/min, P=0.023). In contrast, elevated SBP-PO slope was associated with lower VO2peak (1.57±0.36 vs 2.04±0.48 L/min), peak PO (135±34 vs 192±60Watts) SVpeak (88±13 vs 108±24 mLs) and Qcpeak (12.5±1.8 vs 15.1±3.1 L/min; P&lt;0.001 for all). Overall, the group with HRE and elevated SBP-PO slope had the lowest physical capacity, VO2peak and haemodynamic response to exercise (Figure 1A-D), whilst the opposite trend was seen for those with a HRE and a normal SBP-PO slope. All results remained significant (P&lt;0.05) after adjustment for age, BMI, resting SBP and menopausal status (pre vs peri/post-menopausal).

Conclusion
Contextualising exercise SBP responses against measures of PO better accounts for confounding from increased Qcpeak, and may improve identification of women with increased arterial stiffness.Figure 1A-D
Long-term functional cardiac changes in takotsubo syndrome
Authors: Schweiger V , Schoenberger M , Di Vece D , Wuerdinger M , Gilhofer T , Rajman K , Ghadri J R , Cammann V L , Templin C , Niederseer D 
Published: November 2023

Abstract

Background
Takotsubo syndrome has long been thought to be a benign condition once the acute event has been overcome. However, an increasing number of studies suggest that there might be long-term consequences. The aim of the present study was to evaluate long term functional cardiac changes in patients after Takotsubo Syndrome.

Methods
In the present study, a total of 131 TTS patients were prospectively included and age and gender matched with 131 ACS patients. Out of this cohort, a total of 66 patients (TTS: N=33, ACS: N=33) without any known respiratory diseases (e.g. Asthma or COPD) had a follow-up examination one to six months after the index event, including cardiopulmonary exercise testing (CPET) and echocardiography. CPET indices were compared between TTS and ACS patients in those who achieved an RER of at least 1.05.

Results
Mean age of patients was 65.4 in the TTS group and 65.0 in the ACS group (p=0.541). In each group, 118 (90%) patients were female. At follow-up, TTS patients had a significantly higher LVEF (%, TTS: 59 [56 to 63] vs ACS: 56.5 [51 to 60], p&lt;0.001) and significantly lower levels of BNP (ULN, TTS: 0.5 [0.2 to 0.9] vs ACS: 1.0 [0.5 to 2.6], p&lt;0001), compared to TTS patients. TTS patients were significantly more frequently suffering from persistent symptoms compared to ACS patients (TTS: 78 [60%] vs. ACS: 60 [45.8%], p=0.035, figure 1). Twenty-four TTS Patients (72%) had an RER over 1.05 and were age and gender matched with 24 ACS patients. VO2max was comparable between the two groups (TTS: 20.2 [±5.4] vs ACS: 18.9 [±7.6], p=0.47) as well as Peak Mets (TTS: 5.7 (±1.6) vs ACS: 5.5 (±1.9), p=0.68). However, there was a trend towards a lower oxygen pulse in TTS compared to ACS patients (TTS: 9.4 [±2.2] vs ACS: 10.9 [±3.1], p=0.055) and a significant higher oxygen cost of work (ΔV’O2/ΔW, TTS: 12.9 [11.3 to 15.5] vs ACS: 10.9 [9.7 to 12.2], p=0.019).

Conclusion
TTS patients were more frequently suffering from persistent symptoms compared to ACS patients. Moreover, TTS patients demonstrated long-term functional cardiac changes reflected in impaired CPET parameters comparable to or worse than those of ACS patients. These findings highlight the long-term consequences of TTS and further challenge the concept that TTS is a benign disease.
Effectiveness of hybrid comprehensive telerehabilitation in heart failure patients with permanent atrial fibrillation - subanalysis of the TELEREH-HF RCT
Authors: Piotrowicz E , Kowalik I , Opolski G , Banach M , Zareba W , Orzechowski P , Pluta S , Szalewska D , Glowczynska R , Mierzynska A , Kalarus Z , Irzmanski R , Piotrowicz R 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) negatively impacts physical fitness and quality of life (QoL). Little is known about efficacy of hybrid comprehensive telerehabilitation (HCTR) in heart failure (HF) patients with AF.

Purpose
The purpose of this study was to assess safety and effectiveness of HCTR in HF patients with permanent AF.

Methods
The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation.
The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO2 peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were made before and after intervention/observation.

Results
There were 73 patients with permanent AF in HCTR group and 72 patients with permanent AF in UC group. HCTR resulted in a significant improvement in VO2peak and workload duration. We did not observe these favorable results in the UC group. In the HCTR group, there was a significantly greater improvement in physical component of QoL than in the UC group. All results are presented in Table 1. In neither group were there deaths nor major adverse events.

Conclusion
In HF patients with permanent AF, hybrid comprehensive telerehabilitation is safe and resulted in a significant improvement in physical capacity and physical component of QoL.
Submaximal in addition to peak stress echocardiogram differentiates pathological LV dilatation from physiological dilatation and could help facilitate early heart failure diagnosis
Authors: Marwaha S , Fanton Z , Bulleros P , Simmons R , Bhatia R , Chatrath N , Fyyaz S , Tome M , Finocchiaro G , Ghati S , Prasad S , Papadakis M , Sharma S 
Published: November 2023

Abstract

Background
Left ventricular dimensions in athletes overlap with those observed in patients with dilated cardiomyopathy (DCM). Among athletes with concomitant baseline low left ventricular ejection fraction (LVEF), the differentiation between the two entities may be difficult.

Purpose
We compared the role of changes in left ventricular ejection fraction (LVEF) during submaximal and maximal stress exercise echocardiography to facilitate the differentiation between athlete’s heart and DCM individuals with asymptomatic exercising individuals with a dilated left ventricle (LV) and borderline/low LVEF (48-54%).

Methods
47 highly active asymptomatic individuals with DCM and mildly impaired LVEF, 52 athletes with borderline/low LVEF (grey zone athletes) and 44 athletes with a normal EF (healthy athletes) underwent a stress echocardiography on a semi-recumbent bike with an incremental ramp protocol of 25watt/min.Echocardiographic images were obtained at rest, submaximal (80% of predicted heart rate) and maximal exercise. Maximal exercise was classified as a heart rate 90-100% of the calculated maximum heart rate for their age.

Results
Both grey zone and healthy athletes achieved a greater increase in peak LVEF compared with DCM individuals (20.4% and 20.2% vs 4.6% respectively). The mean increase in LVEF from submaximal exercise to maximal exercise in healthy athletes and grey zone athletes was 7.0% and 3.4% (p&lt;0.001) respectively whereas individuals with DCM showed a mean reduction in LVEF of -4.3% during this period. 8 (17%) of DCM individuals were able to increase LVEF ≥10% from rest to peak exercise, however most (96%) revealed a drop in LVEF as effort progressed from submaximal to maximal exercise.97.7% of control athletes were able to augment an EF ≥10% from rest to maximum exercise and continued to show an increase in LVEF from submaximal to maximal exercise. Whereas 47 (90.4%) grey zone athletes also showed an increase in LVEF &gt;10% from rest to peak exercise, the remaining 5 (9.6%) were unable to augment this response and revealed a drop in contractile reserve from submaximal to maximal exercise, suggesting the possibility of an underlying diagnosis of DCM.

Conclusion
Healthy athletes and grey zone athletes show a greater contractile reserve compared to DCM athletes during exercise.Over 90% athletes and 10% DCM patients reveal an increase in LVEF &gt;10% from baseline to peak exercise.Comparison of changes in LVEF between submaximal and maximal exercise reveals that 96% DCM patients and 9.6% grey zone athletes show a drop in in LVEF during this period. Failure to augment LVEF between submaximal and maximal exercise may identify grey zone athletes with DCM.
Increased risk of decompensated heart failure, acute coronary syndrome, arrythmias and ischemic stroke following exacerbation of COPD: results from a multi-database cohort study
Authors: Hawkins N M , Vogelmeier C F , Simons S O , Garbe E , Manito N , Swart K , Ekwaru P , Kossack N , Hernandez I , Mullerova H , Randhawa A , Van Burk L , Sanchez-Covisa J , Rhodes K , Nordon C 
Published: November 2023

Abstract

Introduction
The risk of acute coronary syndrome (ACS), stroke or death is increased following an exacerbation of chronic obstructive pulmonary disease (COPD). However, little is known about the risk of decompensated heart failure (HF) or acute arrhythmias.

Purpose
To quantify the risk of decompensated HF, ACS, acute arrhythmias and ischemic stroke following an exacerbation of COPD.

Methods
Individuals living with COPD were identified in electronic healthcare and claims databases between 2014 and 2018 in Canada (n=142,787), Germany (n=126,795), the Netherlands (NL, n=8,020) and Spain (n=24,393) and followed until a first non-fatal severe CV event of interest (defined as a hospitalisation for ACS, decompensated HF, arrythmias and ischemic stroke), death or censoring. For each non-fatal severe CV event, a multivariable time-dependent Cox model compared the risk of outcome in the 12 months following the onset of a COPD exacerbation (exposed period, split into granular sub-periods of time) with the risk of outcome during periods outside an exacerbation (unexposed period), providing adjusted hazard ratios (HR) and 95% confidence intervals.

Results
Mean age ranged between 65-68 years old and more than 50% of patients were male, in all countries (Table 1). Cardiovascular risk factors and diseases were common, with 47% to 91% of patients prescribed cardiovascular medications. During follow-up a non-fatal severe CV event occurred in 11% of patients in Canada, 23% in Germany, 8% in NL and 24% in Spain. Decompensated HF was the most frequent event of interest and accounted for 35% to 47% of non-fatal CV events, except in Canada where ACS accounted for 37% of events. In the first 7 days following an exacerbation, the HR ranged between 2.59 (95% CI, 2.32 - 2.89) and 72.34 (64.43 - 81.22) for decompensated HF; 5.59 (5.09 - 6.15) and 24.57 (21.70 - 27.83) for ACS; 9.16 (8.36 - 10.03) and 31.18 (26.84 - 36.21) for arrythmia (mainly driven by atrial fibrillation); and between 2.22 (1.88 - 2.63) and 16.12 (13.39 - 19.41) for ischemic stroke (Table 2). The risks remained elevated for 6 months for decompensated HF and 30 days for ACS in all countries except NL.

Conclusion
The risk of all severe CV events, including decompensated HF and arrhythmias, was increased following an exacerbation of COPD. Despite heterogeneity of findings across countries, our results indicate that an exacerbation of COPD should be considered as an important risk factor for cardiopulmonary events, emphasizing the need for optimized COPD management across specialties.
Age at menopause and the risk of stroke: observational and mendelian randomisation analysis in 204,244 postmenopausal women
Authors: Tschiderer L , Peters S A E , Van Der Schouw Y T , Van Westing A C , Seekircher L , Willeit P , Onland-Moret N C 
Published: November 2023

Abstract

Background
Observational studies have shown that women with an early menopause are at higher risk of stroke compared to women with a later menopause. However, associations with stroke subtypes are inconsistent and the causality is unclear.

Purpose
We conducted a large-scale analysis to investigate the observational association between age at menopause and different types of stroke accompanied by a Mendelian Randomisation analysis to evaluate causality.

Methods
We analysed data of the UK Biobank and EPIC-CVD study. Postmenopausal women without a history of stroke at baseline were eligible for inclusion. The study endpoints were total stroke and stroke subtypes (i.e., ischaemic stroke, haemorrhagic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage). We investigated the observational association between age at menopause and risk of stroke using Cox-regression analysis in each study separately before combining effect sizes using random-effects meta-analysis. Cox-regression analyses were progressively adjusted for (1) age, (2) smoking status, body mass index, glycated haemoglobin, total cholesterol, and hypertension, and (3) ever use of hormone replacement therapy and age at menarche. We used two-sample Mendelian Randomisation analysis to study whether there is a causal relationship between genetically proxied age at menopause and risk of stroke.

Results
A total of 204,244 women were included (7,883 from EPIC-CVD [5,292 from the sub-cohort]; 196,361 from the UK Biobank). Pooled mean baseline age was 58.9 years (SD 5.8) and pooled mean age at menopause was 47.8 years (SD 6.2). Natural menopause occurred in 77.6% of all women. Over a median follow-up of 12.6 years (IQR 11.8, 13.3), 6,770 women experienced a stroke. In multivariable adjusted observational analyses, the pooled hazard ratios per five years younger age at menopause were 1.09 (95% CI: 1.07, 1.12) for stroke, 1.09 (1.06, 1.13) for ischaemic stroke, 1.10 (1.04, 1.16) for haemorrhagic stroke, 1.14 (1.08, 1.20) for intracerebral haemorrhage, and 1.00 (0.84, 1.20) for subarachnoid haemorrhage. The Mendelian Randomization analysis found no evidence for a causal relationship between genetically proxied age at menopause and risk of any type of stroke.

Conclusion
Earlier age at menopause is associated with, but no causally related to the risk of stroke.
Menopausal vasomotor symptoms and subclinical atherosclerotic cardiovascular disease
Authors: Nilsson S , Qvick A , Henriksson M , Sederholm Lawesson S , Spetz Holm A C , Leander K 
Published: November 2023

Abstract

Background
Menopausal vasomotor symptoms (VMS) have been associated with subclinical and manifest atherosclerotic cardiovascular disease (ASCVD) but the scientific basis is limited and VMS have not been studied in relation to image-detected coronary atherosclerosis.

PURPOSE
To assess, in peri- and postmenopausal women, associations between VMS and subclinical ASCVD detected through computed tomography angiography (CCTA), coronary artery calcium score (CACS) or carotid ultrasound, and if potentially determined associations are modified by menopausal hormone therapy (MHT) or regular physical activity (PA).

Methods
This cross-sectional population-based study was conducted on a subset of participants from the Swedish CArdioPulmonary BioImage Study (SCAPIS), including women 50-65 years of age. The women underwent comprehensive cardiovascular assessments and completed an extensive questionnaire, which included questions about current and previous menopause-related symptoms. VMS was assessed on a 4-point scale and analyzed in relation to subclinical ASCVD, detected via CCTA, CACS and carotid ultrasound using multivariate logistic regression analyses.

Results
Of 2995 women included, 14.2% reported severe VMS (n= 425), 18.1% moderate VMS (n=543), and 67.7% no or mild VMS (n=2027). Women with severe, but not those with moderate, VMS had higher prevalence of CCTA detected atherosclerosis (34.1% vs 27.8%, p&lt;0.05), but not CACS &gt;100 (5.8% vs 6.6% p &gt;0.05) or any carotid plaque (47.6% vs 46.6%, p&gt;0.05) than women with no or mild VMS. Using the same reference category, severe but not moderate VMS was significantly associated with CCTA-detected atherosclerosis, odds ratio (OR) before and after multivariable adjustment 1.36, 95% confidence interval (CI) 1.08 – 1.72 and 1.33, 95% CI 1.02 – 1.72, respectively. This association became stronger when requiring an over 5-year duration of severe VMS, multivariable adjusted OR 1.53, 95% CI 1.09 – 2.14. Additional adjustment for MHT strengthened the association (OR 1.64, 95% CI 1.16 – 2.32). No significant association with CACS &gt;100 or with the presence of any carotid plaque was observed. Additional adjustment for PA did not change any associations.

Conclusions
Severe but not moderate VMS were significantly associated with CCTA detected atherosclerosis, independent of a broad range of cardiovascular risk factors. Further research is required to determine the eventual causality of this relationship.Figure 1.Forest plots
Sex differences and survival after TAVI for severe aortic stenosis
Authors: Santos Ferreira D A , Diaz S , Guerreiro C , Silva G , Silva M , Brandao M , Nunes F , Teixeira R , Pereira E , Pires-Morais G , Melica B , Santos L , Rodrigues A , Braga P , Fontes-Carvalho R 
Published: November 2023

Abstract

Background
There is still controversy about survival rates and clinical response of women versus men who undergo transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (SAS).

Purpose
Assess mortality and heart failure (HF) symptoms following TAVI for SAS, according to sex.

Methods
A retrospective analysis of a single-center database including all TAVI performed in 2011-2019 was performed. Clinical, echocardiographic, and blood-analysis data were determined, and all-cause mortality over the five years after the procedure was compared based on sex. A reduction of at least one New York Heart Association (NYHA) class after TAVI was the secondary endpoint.

Results
Of the 488 cases analyzed, 252 (51.6%) were women. They were older (84 vs. 80 years-old, p&lt;0.001), had a lower body surface area, and had a higher estimated surgical risk, as determined by EuroSCORE II (4.5 vs. 3.8, p=0.011) and STS-mortality (4.46 vs. 3.44, p&lt;0.001). However, they had a lower prevalence of diabetes mellitus, coronary artery disease, and peripheral artery disease, a lower estimated creatinine clearance, and a lower frequency of previous pacemaker implantation. Women had more frequently a phenotype of high gradient severe aortic stenosis, with lower functional aortic valve areas. While there was no difference in TAVI design, smaller valves were implanted in women. Median follow-up was 46 months and there was a 40% mortality rate over the five years after treatment, with no statistically significant differences according to sex in both univariate and multivariate analysis, after adjusting for estimated surgical risk. EuroSCORE II had a statistically significant association with the primary endpoint (hazard ratio 1.03 (1.01-1.05), p=0.004). Despite having a similar NYHA class before TAVI, women experienced a lower frequency of functional class improvement (61% vs. 72%, p=0.034).

Conclusions
Although women had a higher estimated surgical risk, no differences were found regarding survival after TAVI for SAS. However, improvement in HF symptoms was less frequent in this subset.Table 1Figure 1
Maternal hypertensive disorders of pregnancy and electrocardiographic findings in newborns
Authors: Noerskov E H , Paerregaard M M , Raja A A , Sillesen A S , Christiansen A H , Boyd H A , Bundgaard H , Iversen K K , Voegg R O B 
Published: November 2023

Abstract

Background
Hypertensive disorders of pregnancy (HDP) - preeclampsia in particular - are important causes of pregnancy complications and death for both the mother and her offspring. Preeclampsia is also associated with both congenital heart defects (CHDs) in the offspring and subtle changes in left ventricular structure and function in the offspring. However, whether preeclampsia also affects the newborn’s cardiac conduction system is unknown.

Purpose
To assess whether newborns born after pregnancies complicated by HDP exhibit changes in their electrocardiogram (ECG) compared with newborns born after pregnancies without HDP.

Methods
This population-based cohort study included newborns, who had ECG data obtained within 30 days of birth. Information on maternal preeclampsia (ICD-10 codes DO14-14.2 and DO15-15.9) and maternal gestational hypertension (ICD-10 codes DO13-13.9) was retrieved from an obstetric database. ECG parameters of interest included heart rate, PR interval, QRS axis, QRS duration, uncorrected and corrected QT intervals, maximum R- and S-wave amplitudes in V1 and V6, respectively. ECG parameters of exposed and non-exposed newborns were compared using summary statistics and linear regression, adjusting for sex, gestational age at delivery and length, weight and age at examination. Sensitivity analyses were conducted with adjustments for maternal smoking, parity, age, and multiple pregnancies and the analyses were repeated after excluding neonates and mothers with CHD, newborns exposed to pre-gestational diabetes and children born preterm (&lt;37 weeks’ gestation).

Results
Our study cohort included 11,826 newborns; 441 were exposed to maternal preeclampsia and 320 were exposed to maternal gestational hypertension (table). Newborns born to mothers with preeclampsia had significantly prolonged QRS duration compared to neonates born after pregnancies without HDP (adjusted mean difference of 0.6 ms, 95% CI [0.04 – 1.16], p=0.04). The maximum amplitude of the R-wave in the V1-recording was significantly lower in newborns born to mothers with preeclampsia by 5% (linear scale: 0.95, 95% CI [0.9 – 0.996], p=0.03). These associations persisted after adjustment for additional covariates and restrictions on the study population. Gestational hypertension was not associated with significant differences in any of the investigated ECG parameters.

Conclusion
The cardiac conduction was affected in children born to mothers with preeclampsia compared with newborns born after pregnancies without HDP, including prolonged QRS duration and lower amplitude of the R-wave in V1 in the ECG. These findings could be an indicator of thickening of the left ventricular myocardium in newborns of mothers with preeclampsia. The potential clinical implications of these changes – short or long-term – are unknown and require further investigation.Table