bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of excessive epicardial adipose tissue accumulation on cardiorespiratory fitness in adults without cardiac disease: a cross-sectional magnetic resonance imaging study
Authors: Piche M , Chartrand D , Almeras N , Pibarot P , Larose E , Lamarche B , Poirier P , Despres J P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research.

Background/Introduction
Excessive epicardial adipose tissue (EAT) is associated with worse exercise capacity and is thought to play a role in the pathophysiology of heart failure with preserved ejection fraction. Few studies have explored the relationship between EAT, cardiorespiratory fitness in men and women without cardiovascular disease.

Purpose
To investigate the association between EAT, cardiorespiratory fitness, and physical activity levels in asymptomatic men and women of variable degree of adiposity.

Methods
A total of 239 participants (43% women) free from cardiovascular disease who underwent concurrent quantification of EAT volume assessed by cardiac magnetic resonance and a cardiopulmonary exercise testing (CPET) (VO2peak [ml/kg/min]) were studied. Physical activity levels/intensity were measured by questionnaire and using pedometer. Participants were categorized into low-EAT, moderate-EAT, and high-EAT groups on the basis of EAT volume.

Results
Mean age of participants was 49.8 ± 8.3 years, BMI 26.0 ± 3.7 kg/m2 (15% with obesity), waist circumference 89 ± 11 cm, visceral adipose tissue volume 91.3 ± 51.3 cm3, and EAT volume 9.8 ± 3.1 cm3. EAT volume decreased with increment in cardiorespiratory fitness in men and women of variable adiposity (p&lt;0.05). Men and women with high-EAT had worse cardiometabolic profile (visceral adiposity, insulin resistance, high blood pressure, dysglycemia, atherogenic dyslipidemia), and lower cardiorespiratory fitness (VO2peak) than those with low-EAT (all p&lt;0.05). Physical activity levels were comparable across EAT tertiles (p=NS). The association between EAT and cardiorespiratory fitness was no longer significant after controlling for visceral adiposity.

Conclusions
In men and women of variable degree of adiposity, excessive EAT accumulation is associated with visceral adiposity and worse cardiorespiratory fitness. Further longitudinal studies are needed to understand the interplay between EAT and cardiorespiratory fitness, and the development of obesity-related heart failure features.
Tumour necrosis factor receptor 1 inhibition and cardiovascular disease: a cis-Mendelian randomization study
Authors: Rajasundaram S , Gill D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health and Care research (NIHR).

Background
Tumour necrosis factor receptor 1 (TNFR1) is a newly proposed drug target that has emerged from a growing understanding of the inflammatory basis of cardiovascular disease[1]. A range of pre-clinical models and observational data in humans support the potential efficacy of TNFR1 inhibition. However, pre-clinical models are poor predictors of therapeutic efficacy in humans and observational data is inherently vulnerable to confounding and reverse causation[2,3]. Mendelian randomization (MR) is a genetic epidemiological approach that overcome these limitations and are capable of robust causal inference[3], rendering them better able to investigate the potential efficacy of novel drug targets[2].

Purpose
To leverage MR to investigate the causal effect of TNFR1 inhibition on the risk of developing coronary artery disease (CAD), ischaemic stroke (IS), atrial fibrillation (AF), and heart failure (HF) (see Figure 1).

Methods
cis-Mendelian randomization was performed to estimate the causal effect of TNFR1 inhibition (weighted by serum C-reactive protein (CRP) levels) on liability to coronary artery disease (CAD), ischaemic stroke (IS), atrial fibrillation (AF), and heart failure (HF). Anti-TNF therapies are a cornerstone treatment modality for Crohn’s disease and so Crohn’s was included as a positive control to validate the genetic instrument for TNFR1 inhibition. Furthermore, Bayesian colocalization (coloc) was performed to assess the likelihood that a shared causal variant underlies both TNFR1 signalling and each of these four cardiovascular diseases, thus allowing for interrogation of the risk of confounding by linkage disequilibrium in MR estimates[4]. Genetic association estimates were leveraged from the largest genome-wide association studies (GWAS) for which full publicly available summary data were available.

Results
As expected, a significant cis-MR effect for genetically proxied TNFR1 inhibition was observed for Crohn’s disease (odds ratio (OR) per 1 standard deviation (SD) reduction in CRP = 0.05, 95% CI = 0.01 to 0.28, P = 5.32 x 10-4). However, no evidence of a causal association was observed between genetically proxied TNFR1 inhibition and the odds of developing CAD (OR per SD reduction in CRP = 0.99, 95% CI = 0.55 to 1.76), IS (OR per SD reduction in CRP = 1.55, 95% CI = 0.30 to 8.03), AF (OR per SD reduction in CRP = 1.11, 95% CI = 0.54 to 2.29), or HF (OR per SD reduction in CRP = 1.02, 95% CI = 0.46 to 2.29) (see Figure 2). No evidence of colocalization was observed between TNFR1 signalling and any of these four cardiovascular diseases.

Conclusions
These findings do not support TNFR1 signalling inhibition as likely to be an efficacious therapeutic target for coronary artery disease, ischaemic stroke, atrial fibrillation, or heart failure.
Lower exercise capacity correlates with slower heart rate recovery in post-coronary artery bypass surgery patients
Authors: Satoto H , Lampus N , Febrianora M , Desandri D R , Dwiputra B , Ambari A M , Radi B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart rate recovery (HRR) describes the ability of the autonomic nervous system changes from the sympathetic to the parasympathetic nervous system. The slower heart rate recovery means there is an autonomic dysfunction of the nervous system. Heart rate recovery has been known to be a predictor of mortality in patients undergoing exercise stress test. Patients with slow heart rate recovery have a higher risk of cardiovascular death. Decreased exercise capacity is also known to increase the risk of cardiovascular death.

Purpose
This study aims to determine the relationship between low exercise capacity and slow heart rate recovery.

Methods
Patients who underwent post-coronary artery bypass (CABG) surgery cardiovascular rehabilitation program at our national cardiovascular center in 2022 were enrolled in this study. We assessed heart rate recovery during the maximal exercise stress test, by subtracting from maximal heart rate during the exercise stress test with heart rate at the first and second minute after exercise stress test. We used predicted METs from Bruce protocols treadmill test time to determine each patient’s exercise capacity.

Results
There were 238 patients (age 58±7 years old, 89.9% male). The mean exercise capacity was 6.42±2.21 METs and the mean first and second-minute heart rate recovery was 14±11 and 26±15 beats per minute. Predicted exercise capacity had a significant positive weak correlation with first-minute heart rate recovery/HRR1 (r=0.279; p=0.000) and a significant positive moderate correlation with second-minute heart rate recovery/HRR2 (r=0.409; p=0.000) in post-CABG patients. We performed receiver operating characteristic analysis that showed the area under the curve for exercise capacity was 0.69 for HRR1 and 0.71 for HRR2, and found the exercise capacity cut-off was 5.5 METs . Patients with exercise capacity less than 5.5 METs were likely to have slower HRR1 (OR=4.4 (95% CI, 2.7 – 7.2) p=0.000) and slower HRR2 (OR=3.8 (95% CI, 2.4 – 6.0) p=0.000).

Conclusions
There is a correlation between low exercise capacity and slow heart rate recovery. Patients with lower exercise capacity were likely to have slower heart rate recovery in post-CABG patients.
Cardio-protective effect of trimetazidine in patients with disseminated breast cancer
Authors: Sadigova T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Relevance of the problem. Anthracycline cardiotoxicity is the most unfavorable form due to irreversible complications of cardiovascular system caused by anthracyclines during the chemotherapy (CT) of the breast cancer (BC). Despite the fact that this type of cardiotoxicity has been studied better than others, the problem of preventing such complications remains relevant to this day. In our study, we suggest Trimetadizine (TMZ) as a cardioprotective agent in patients with disseminated breast cancer receiving Doxorubicin chemotherapy.

Material and methods
The study included 93 patients (aged 41.2±8.3 years) who underwent surgery for breast cancer and several courses of chemotherapy with Doxorubicin (according to the stage of breast cancer). Patients were randomized into 2 groups: the first group (n=47; G1) received TMZ at a dose of 70 mg daily, in the control group (n=46; G2) patients didn't receive TMZ. All patients before the start of the study underwent a complete echocardiographic examination and checked cardiac biomarkers such as troponin and brain natriuretic peptide (BNP). The exclusion criterion was patients with any kind of cardiovascular pathology. The primary endpoint of the study was a reduction in left ventricular ejection fraction (LVEF) deterioration as assessed by series of echocardiographic studies conducted after each course of chemotherapy, and then every 3 months after completion of chemotherapy for 1 year. Secondary outcome measures included echocardiographic (EchoCG) measurements of LV diastolic dysfunction, structural myocardial changes assessed by echocardiography, and control cardiac biomarkers.

Results
Both groups achieved the same cumulative dose of Doxorubicin. No patient died or discontinued chemotherapy during the study. There were no significant differences between the two groups in terms of baseline clinical findings, echocardiographic parameters, and changes in biomarkers. 3-5 months after the start of CT, standard echocardiography showed unreliable changes in LVEF, shortening fraction, and LV measurements. However, tissue Doppler showed a decrease in myocardial velocity (P = 0.001) in G2, indicating LV diastolic dysfunction. While no such changes were observed in G1.

Conclusion
Tissue Doppler proved to be more sensitive than standard echocardiography for early diagnosis of cardiac dysfunction, and TMZ appears to have a cardioprotective effect in case of anthracycline cardiotoxicity.
A randomized controlled study investigating the impact of dietary education and counselling with a smartphone application on secondary prevention of coronary artery disease (TeleDiet Study)
Authors: Kaihara T , Falter M , Scherrenberg M , Xu L , Maes J , Meesen E , Dendale P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Daiichi-Sankyo, Inc.

Background
In secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimization. While face-to-face nutritional follow-up is part of standard of care in many centres, few studies have investigated the potential of remote follow-up using digital solutions.

Purpose
We investigated the effectiveness of a smartphone application for nutrition education and feedback with pictures of meals by a dietitian for CAD patients.

Methods
Sixty patients with CAD were randomized 1:1 to either a TeleDiet group or a Control group. Patients in the TeleDiet group participated in dietary education using a messaging application. The primary outcome was the change of the Mediterranean diet score (MedDietScore). Blood tests (blood lipids, blood glucose and kidney function), body mass index, self-efficacy, medication adherence, and health-related quality of life (HRQoL) and the Nutrition-Score during the observation period were analysed as secondary outcomes. The Nutrition-Score is a modification of the MedDietScore in which parameters about salt and sugar intake are added to the score, and an intake of zero alcohol is considered positive (in contrast to the MedDietScore).

Results
Sixty patients participated in the study. The difference in the MedDietScore in the TeleDiet group was greater than in the control group, but not significant (2.0 [-1.0, 4.0] vs. 0.0 [-3.0, 1.5], p = 0.066). The difference in the Nutrition-Score in the TeleDiet group from baseline to week 12 was significantly greater than in the control group (3.0 [1.0, 3.5] vs. 0.0 [-3.0, 2.0], p = 0.029). There was a significant difference in the within-group analysis only in the TeleDiet group (32 [30, 38] at baseline vs. 36 [33, 41] at week 12, p = 0.045). Nutrition knowledge of the TeleDiet group improved significantly compared to the control group (1.9 ± 1.7 vs. 0.8 ± 2.1, p = 0.048). The change in HRQoL in the TeleDiet group was greater than in the control group, but not significant (7.4 ± 8.9 vs. 3.2 ± 7.0, p = 0.063).

Conclusion
A feedback system using a simple messaging application that allows CAD patients to simply send a picture of their food has a positive effect on nutrition knowledge and the implementation of the Mediterranean diet.
Discordance between LDL cholesterol and apolypoprotein B. Which to prefer to guide treatment?
Authors: Cobarro L , Martinez R , Ugueto C , Contreras C , Saldana J , Torremocha A , Rivero B , Juarez V M , Severo A , Canales L , Lara A , Vila J , Castro A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Current cardiovascular risk guidelines recommend target values of low-density lipoprotein cholesterol (LDLc) &lt; 55 mg/dL and apolipoprotein B (apoB) &lt; 65 mg/dL. However, they don’t clarify what the attitude should be when one of the two targets is not achieved.
Our objective was to establish the prevalence of LDLc and ApoB discordance in a secondary prevention population in our cardiac rehabilitation unit and describe the size of LDLc particles in this cohort of patients.
We conducted a retrospective observational study including patients with previous ischemic heart disease with lipid-lowering treatment in secondary prevention followed up in our cardiac rehabilitation unit between February 2022 and September 2022.
We present a series of 100 patients with a mean age of 60.5 years (S.D. 9.7), 79% male, with high prevalence of cardiovascular risk factors (59% hypertension, 26% diabetes mellitus, 52% smokers). All patients received lipid-lowering therapies, with statins alone or in combination with Ezetimibe. 30 patients (30%) had LDLc &gt; 55 mg/dL and ApoB &lt; 65 mg/dL, 37 (37%) reached target LDL and ApoB levels (LDLc &lt; 55 mg/dL and ApoB &lt; 65 mg/dL), and 33 (33%) did not reach any of the target levels (LDLc &gt; 55mg/dL and ApoB &gt; 65 mg/dL). No patient had LDLc &lt; 55mg/dL and ApoB &gt; 65mg/dL. Among patients with ApoB target level achieved and LDLc &gt; 55mg/dL, the mean LDLc/ApoB ratio was 1.1 (S.D. 0.1). The mean ratios stratified by LDLc level are represented in Figure 1 and specified in Table 1.
The conclusion of our study is that in clinical practice we find a group of patients with discrepancy between LDLc and ApoB levels that is not represented in the main studies of cardiovascular outcomes. Therefore, we do not know what therapeutic approach we should take. It is known that these relatively high LDLc values when apoB is in range correspond to larger and less dense particles, and therefore less atherogenic, and it has been suggested that ApoB levels better reflect residual risk than LDLc in statin-treated patients.
At this point, the question that arises is: should we take these patients to an LDL &lt; 55mg/dL or is their lipid risk controlled?
Prevalence of atrial fibrillation and its associated factors among type 2 diabetics attending a tertiary hospital
Authors: Kalokola F , Salla A , Kalluvya S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Self funding.

Introduction
Type 2 Diabetes Mellitus (T2DM) is an increasing public health burden associated with increase morbidity and mortality among adults and is a risk factor for the development of atrial fibrillation (AF). When these two conditions coexist, they confer an increased risk of symptom burden and mortality. In Africa, few studies have reported the prevalence, and associated factors of atrial fibrillation among adults with T2DM.

Purpose
This study was aimed to determine the prevalence and associated factors of (AF) among adults with T2DM attending outpatient clinic at Bugando Medical Centre (BMC).

Methods
Hospital based cross-sectional study was conducted between April 2022 to June 2022 at the medical clinic. A total of 215 patients were enrolled after meeting the inclusion criteria. Structured questionnaires were used to capture social demographic and clinical information including glycated hemoglobin (HbA1c) levels, duration of diabetes, type of hypoglycemics, body mass index (BMI), waist to hip ratio, estimated glomerular filtration rate (eGFR) and history of hypertension. All participants underwent a resting 12-lead electrocardiogram (ECG) for assessment of AF. Data was analyzed by the use of STATA software version 15.

Results
215 patients with T2DM and a median age of 62 (IQR):(53-69) years, 60.5% were females and 42.3% had hypertension. The median duration since diagnosis of DM was made was 8 years with more than a third (67.9%) of participants having a HbA1c ≥7% while 80.7% were either overweight or obese. Thirteen (6.1%) of 215 patients (10 women, 3 men) had AF. Only eGFR &lt; 60ml/min/1.73m² (OR 5.49; 95% CI 1.1-27.3, p=0.037) was associated with AF.

Conclusion
Prevalence of atrial fibrillation was high in this population of type 2 diabetes mellitus and it was significantly associated with low eGFR.
Effects of first presentations of 12 cardiovascular disease phenotypes on cardiovascular, non-cardiovascular and all-cause mortality in the general population
Authors: Prugger C , Perier M C , Gonzalez-Izquierdo A , Hemingway H , Denaxas S , Empana J P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular diseases (CVD) present as diverse phenotypes, which have considerably different effects on subsequent prognosis. However, studies quantifying these differences in prognosis after various first presentations of CVD are so far lacking.

Purpose
Our main study objective was to investigate the effects of first presentations of 12 distinct CVD phenotypes on the risk of cardiovascular mortality (primary outcome) and non-cardiovascular as well as all-cause-mortality (secondary outcomes) in the general population. Further objectives were to assess whether the effects differ by sex, age and ethnicity and to what extent referral to cardiac rehabilitation within 6 months can mitigate the effects.

Methods
Based on England-wide linked electronic health records, we set up a cohort study of 1,310,518 people aged 30 years and older who were initially free of CVD. We followed them up from 2010 to 2016 for 12 validated CVD phenotypes (exposures) and cardiovascular as well as non-cardiovascular mortality (outcomes). We estimated hazard rate ratios (HRRs) and 95% confidence intervals (CIs) using Cox’s proportional hazards models with CVD presentations as time-dependent variables.

Results
During a median follow-up of 4.2 years, 10,906 cardiovascular deaths and 81,516 first presentations of CVD phenotypes occurred. Presentations of all 12 phenotypes increased cardiovascular mortality, with HRRs (95% CIs) ranging from 1.67 (1.47-1.89) for stable angina and 1.68 (1.44-1.95) for transient ischaemic attack to 7.85 (6.62-9.31) for haemorrhagic stroke. Non-cardiovascular and all-cause mortality also increased with all phenotypes, but to a lesser extent. Subgroup analyses indicate CVD phenotypes with markedly heterogeneous impact on prognosis in women and men, middle and older age groups and ethnic groups. Referral to cardiac rehabilitation recorded in 3,018 (3.70%) first CVD presentations attenuated the effects of haemorrhagic stroke, heart failure and myocardial infarction (HRRs (95% CIs): 2.46 (1.55-3.90), 2.22 (1.37-3.60) and 0.89 (0.57 -1.40), respectively) on cardiovascular mortality when compared to no referral (HRRs (95% CIs): 8.18 (6.80-9.83), 6.50 (6.10-6.92) and 4.32 (3.90-4.80), respectively).

Conclusions
First presentations of 12 CVD phenotypes are associated with heterogeneous but significantly increased risks of cardiovascular mortality. Referral to cardiac rehabilitation is a missed opportunity in high-risk CVD phenotype presentations.
Effects of concurrent exercise training on blood pressure variability and values are blunted in subjects with non-dipping blood pressure nocturnal pattern
Authors: Caminiti G , Sposato B , Iellamo F , Perrone M A , Di Carlo R , Cascelli G , Franchini A , Volterrani M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
The purpose of this study was to investigate the effects of 12-weeks concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks patients underwent six minute walk test, ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM). After CT exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the nondipping group (between groups changes: -1.0 mmHg and -1.3 mmHg; p 0.02 and p 0.006 respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while were unchanged in the non-dipping group (between groups changes: -7.1 mmHg and -7.8 mmHg; p 0.004 and p 0.0002 respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small not significant changes in both groups. In conclusion: the effects of CT on BPV and BP were blunted in hypertensive subjects with non.dipping BP pattern