bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAFETY AND FEASIBILITY OF HYPOXIA EXPOSURE IN PATIENTS WITH PRIOR MYOCARDIAL INFARCTION
Authors: Hönemann Jan-Niklas , Gerlach Darius , Hoffmann Fabian , Kramer Tilmann , Weis Henning , Zaha Vlad G. , Sadek Hesham , Herwarden Andonuis E. , Olthaar Andre , Reuter Hannes , Baldus Stephan , Levine Benjamin D , Jordan Jens , Tank Jens , Limper Ulrich 
Published: June 2023

Objective:
In mice, normobaric hypoxia exposure corresponding to 8,000 m altitude after myocardial infarction reactivated cardiomyocyte proliferation and improved left ventricular ejection fraction (LVEF). Translating these findings to patients might be limited by hypoxia-induced pulmonary hypertension and myocardial ischemia.

Design and method:
We conducted a feasibility and safety study at the: envihab facility in 4 patients who had experienced myocardial infarction with fully revascularized LAD-stenosis as culprit lesion 37-104 months prior study entry. Their peak VO2 ranged from 32 - 43 ml/kg/min. The study comprised a two-days baseline, 19 days normobaric hypoxia, and two-days recovery. We gradually lowered atmospheric oxygen to 0.118 FIO2, which is equivalent to 4500 m, and maintained that level for 4.5 days. We obtained transthoracic echocardiography, magnetic resonance imaging, and determined Troponin I, NTproBNP at baseline, during 0.118 FIO2, and recovery.

Results:
Except for symptoms of acute mountain sickness, hypoxia was well tolerated as severe adverse reactions did not occur and pulmonary hypertension rapidly abated during recovery. During the last 10 days of hypoxia, peripheral oxygen saturation was continuously <90%.
LVEF was 50.7±11.0 % (mean±SD) baseline, 57.6±11.2% at 0.118 FIO2, and 57.3±11.2% during recovery. Furthermore, echocardiographic LV global longitudinal strain was -15.28±5.4% at baseline and -17.28±7.56 % in recovery. Magnetic resonance imaging confirmed these findings.
NTproBNP diminished (baseline: 203±209 pg/ml, 0.118 FIO2: 122±101/pg/ml, recovery: 85±66 pg/ml) and Troponin I concentrations remained in the reference range throughout the study. In the patient with the largest LVEF increase following hypoxia, an additional 12 weeks follow-up measurement showed stable improvements in LVEF (baseline: 36%, recovery: 48%, 12 weeks follow-up: 47%), left ventricular strain, NTproBNP, and exertional dyspnea.

Conclusions:
Our study provides evidence regarding safety and potential of hypoxia exposure after myocardial infarction and lays the foundation for future studies assessing hypoxia-influences on cardiac regeneration.
However, our findings have to be interpreted with caution given the small sample size and the selected patient population.
MINOCA: HYPERTENSION IS NOT AN IMPORTANT RISK FACTOR
Authors: Fethi Moussaoui , Radia Bali Tabet , Tyeb Bensaada , Abderrahim Meziane Tani 
Published: June 2023

Objective:
We studied the epidemiological, clinical and prognostic profile of the MINOCA population then compared them to patients with obstructive coronary artery disease and finally we established an etiological analysis of the MINOCA population.

Design and method:
Descriptive prospective study spread over a period of 36 months from January 2018 to January 2021 involving a total number of 585 patients undergoing coronary angiography at the cardiology department of CHU Tlemcen for a reason for acute myocardial ischemia. We defined the patients as having acute myocardial ischemia with obstructive coronary artery disease (AMI-CO) if there was revascularization or plaque > 50% and as having MINOCA if there was < 50% obstruction or a mechanism without plaque. Patients who did not have coronary angiography or who received thrombolytics before angiography were excluded.®

Results:
Of 585 patients undergoing angiography, 525 (89.74%) had AMI-CO, 60 (10.25%) had a MINOCA.
Men were 4 times more likely to have MINOCA than women (78.3% versus 21.7%; odds ratio at 3.61). MINOCA patients were more likely to be without traditional cardiac risk factors (7.9% vs. 2.1%; P < 0.001) but more predisposed to non-traditional risk factors than AMI-CO patients (3.7% against 1.8%; P = 0.026).
Smoking is the only traditional risk factor frequent in the MINOCA population versus AMI-CO (P at 0.001).
Hypertension is not an important risk factor for MINOCA (38% versus 51%; P = 0.066).
Depression, stress, drug addiction, DVT history and autoimmune disease history are more frequent in the MINOCA population versus AMI-CO (P < 0.05).
STEMI are more found in the MINOCA population versus AMI-CO (P = 0.001).
In terms of prognosis, the MINOCA population had a better prognosis: less risk of recurrence than the AMI-CO population 6.7% versus 10.45% (P = 0.03) also less mortality 0% versus 2.3% (P = 0.237).

Conclusions:
The patients with MINOCA were more men, smokers, depressed, stressed, drug addicts with hypercoagulable states compared to patients with obstructive coronary artery disease (AMI-CO) however they had a better quality of life and a good prognosis.
CARDIOPROTECTIVE EFFECT OF TERIFLUNOMIDE IN AN EXPERIMENTAL MODEL OF MYOCARDIAL INFARCTION
Authors: Bhargava Poorva , Sharma Jatin , Bhatia Jagriti , Arya Ds 
Published: June 2023

Objective:
MI is a major cause of mortality worldwide. Inflammation plays a key role in the pathology of MI. Teriflunomide (TERI), an orally active Dihydroorotate Dehydrogenase inhibitor, inhibits de novo pyrimidine synthesis. It decreases production of inflammatory cytokines and suppresses the activity and proliferation of activated lymphocytes.
Hypothesis: TERI, on account of its potent anti-inflammatory activity may attenuate Isoproterenol induced cardiac injury in rats. Thus, we aimed to investigate the cardio-protective effect of Teriflunomide in isoproterenol (Iso) induced myocardial infarction.

Design and method:
To induce myocardial infarction in rats, we administered 2 doses of Isoproterenol (85 mg/kg/day, s.c.) on days 13th and 14th, at an interval of 24 hours. Male albino Wistar rats were divided into 5 groups (n = 6); namely normal control, isoproterenol control, Teriflunomide groups to receive saline, isoproterenol, or Teriflunomide (1, 3 or 5 mg/kg/day, p.o.) for 14 days. On the 15th day, rats were anaesthetized and right coronary artery was cannulated to record hemodynamic parameters. Blood sample was collected via cardiac puncture, heart was excised and preserved for analysis of biochemical, histopathological and ultrastructural studies.

Results:
Isoproterenol administration to rats resulted in induction of MI with impairment of hemodynamic parameters. Teriflunomide pretreatment showed significantly improved hemodynamic (systolic, diastolic and mean blood pressures) and cardiac function parameters (normalized ± LV dP/dt and LVEDP) with reduction in the levels of cardiac injury markers (CK-MB, LDH). Further, Teriflunomide significantly reduced oxidative stress (enhanced levels of SOD, GSH, decreased MDA levels) and inflammation (reduced levels of TNF-alpha, IL-6), led to inhibition of active JNK and p38 proteins and activation of ERK1/2, a pro-survival kinase. Furthermore, it also ameliorated apoptosis by reducing the expression of pro-apoptotic proteins (Bax and Caspase-3) and increased expression of Bcl-2, an anti-apoptotic marker. In addition, pretreatment with Teriflunomide preserved morphological and ultra-structural architecture of the myocardium as seen by H & E staining and electron microscopy.

Conclusions:
Teriflunomide at 1 mg/kg offered cardio-protection by improving hemodynamic profile, oxidative stress profile, reduced inflammation, normalization of myocardial architecture.
COVID-19 AND CARDIOVASCULAR COMPLICATIONS. AN INAUSPICIOUS COMBINATION
Authors: Zbroch Edyta , Waszak Julia , Siwik Marcin , Bazarewicz Jakub , Piotrowska Weronika , Sielatycki Piotr 
Published: June 2023

Objective:
The case report presents patient with COVID-19 history. Although the course of COVID-19 in most people is mild, most cases, including severe ones, mainly involve the respiratory system. In less common cases, association of SARS-CoV-2 infection with other systems, including cardiac, has been reported. Pericarditis is often associated with viral infection, mostly with Coxsackie B virus but it has been also reported as one of the rare cardiovascular manifestations of SARS-CoV-2 infection.

Design and method:
Case report of patient with COVID-19 and multiple comorbidities, including secondary hypertension and kidney transplantation. Observation of the symptoms suggested myocardial involvement in the course of SARS-CoV-2 infection and demanded further specialist treatment.

Results:
A 67-year-old female patient with secondary to chronic kidney disease hypertension, after kidney transplantation, with diabetes type 2 and many other comorbidities was admitted to the Department of Internal Medicine and Hypertension due to worsening of kidney function and COVID-19 infection, in a general bad condition with the shortness of breath and reduced exercise tolerance and low SatO2 - 79%. Chest angio-CT showed COVID-19 pneumonia and pericardial effusion. Echocardiography revealed severe left ventricular systolic failure with left ventricular ejection fraction 20%. Laboratory results showed a high level of inflammatory markers, creatinine and NT-pro-NBP as well as cardiac enzymes activation. The typical treatment was implemented. On the third day of hospitalization, a rapid attack of atrial fibrillation occurred. Attempted pharmacological cardioversion was unsuccessful. Due to respiratory failure, electrical cardioversion was rejected. Continuous intravenous infusion of amiodarone was introduced. The patient's condition deteriorated significantly. Myocardial involvement in the course of COVID-19 infection was suspected. The patient, in a serious general condition, was transferred to the Department of Cardiology and then to ICU where patient died.

Conclusions:
SARS-CoV-2 is mainly associated with the respiratory tract, but it also has multiple adverse effects on the cardiovascular system. Patients with many comorbidities, especially after organ transplantation on immunosuppression, are more likely to develop severe courses of the disease. This case highlights that although pericarditis is a rare cardiac complication of COVID-19, we should stay alerted about it.
MEDICAL STUDENTS’ EVALUATION BY SERIOUS GAME IN THE ERA OF COVID-19 INFECTION
Authors: Chamtouri Ikram , Jomaa Walid , Hamda Khaldoun Ben 
Published: June 2023

Objective:
The aim of our study was to compare the results of medical students’ evaluation by virtual simulation using online SG and clinical case-based multiple choice questions (MCQ), and to assess the degree of satisfaction with these two evaluation methods.

Design and method:
Medical students from the same level of study voluntarily participated in this study. SG group had an evaluation by SG dealing with diagnosis and management of ST-segment elevation myocardial infarction (STEMI), already prepared on the following website: www.Mediactiv.com. Clinical case-based MCQ group was evaluated by clinical case-based MCQ having the same topic as SG group. Results of the two groups were compared. A satisfaction questionnaire was filled out by the two groups. The satisfaction degree was compared between the two groups.

Results:
In this study, 64 medical students (G1:31 and G2: 33) were enrolled. Obtaining complete notes in the questioning and clinical examination parts was significantly more important in SG group compared to clinical case-based MCQ group. No significant difference was noted between the two groups in terms of ECG interpretation and diagnosis of STEMI parts. A greater number of students in SG group obtained a full mark compared to clinical case-based MCQ group in the initial treatment part (54.8% vs. 39.4%; p = 0.04). A total of thirty learners (96.8%) in SG group obtained a total score more than 50% versus 69.7% in clinical case-based MCQ group (p = 0.004). The full score of 100% was obtained by three learners in SG group; however, no student scored 100% in clinical case-based MCQ group (p = 0.027). Medical evaluation using SG was reported to be more innovative, fun, and realistic compared to evaluation by clinical case-based MCQ. No significant difference was noted between the two methods in terms of stress.

Conclusions:
Simulation by SG could be an innovative and effective method in evaluating medical students, with a higher degree of satisfaction.
COVID-19: RISK AND CARDIOVASCULAR DISEASE. SYSTEMATIC REVIEW 2022
Authors: Rodero Eulalia Amador , Miranda Santiago Rodriguez , Segura Ana Maria , Esmeral Leslie Montealegre , Charris Martha Arteta 
Published: June 2023

Objective:
To identify through a review of scientific literature the association between cardiovascular diseases and severity in the clinical picture of patients with Covid-19

Design and method:
To answer the PICO question: is there an association between cardiovascular diseases and the severity of the clinical picture of patients with Covid-19? An exhaustive review of scientific articles based on the PRISMA methodology was carried out, between June 16 and July 26, 2022, in the PubMed, UpToDate, ScienceDirect, Scielo, and National Library of Medicine databases. The terms Mesh, Patient, Men, Womans, Age, Sex, COVID-19, Coronavirus, Sars-Cov-2, Cardiovascular Diseases, Heart Disease, Risk Factors, Myocardial infarction, Stroke, were combined with Boolean AND OR NOT operators and were entered into database search engines. The established limits were type of study, type of document, language, date of publication. Studies referring to children and adolescents, pregnant women were excluded; Studies referring to adult patients with Covid-19 with and without a history of cardiovascular disease were included. The studies identified after passing the established filters were assessed for methodological quality with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) applied to observational studies. Those preselected underwent an assessment of the level of evidence with the proposal of the Oxford Center for Evidence-Based Medicine (CEBM), those who obtained a high level and grade of recommendation were included in this review.

Results:
Six studies that passed all the filters were selected. An association was identified between diseases and cardiovascular risk with the severity of the clinical picture and in some cases fatal outcome. Associated comorbidities were: diabetes (OR 3.39 95% CI, 2.14-5.37); p = 0.0001, z = 5.206; (OR 2.61, 95% CI: 2.02–3.39), (OR: 2.27, 95% CI: 1.87–2.74); cerebrovascular disease (OR 4.85, 95% CI: 3.11–7.57); cardiovascular disease (OR 4.81, 95% CI: 3.43–6.74), (OR:3.44, 95% CI: 2.65–4.48); hypertension (OR: 2.51, 95% CI: 2.13–2.95).

Conclusions:
The cardiovascular risk and diseases predispose to the development of critical illness, with longer hospital stays, admission to intensive care units, application of mechanical ventilation, and in some cases the death of patients who contract Covid-19.
PROTECTIVE EFFECTS OF CALCIUM CHANNEL BLOCKERS IN HYPERTENSIVE NON-VACCINATED PATIENTS WITH COVID-19
Authors: Stojanovic Milovan , Ilic Marina Deljanin , Trickovic Ljiljana , Stojanovic Sanja , Ilic Stevan 
Published: June 2023

Objective:
Analysis of the effects of antihypertensive therapy on the prognosis and outcome of hypertensive non-vaccinated patients with COVID-19.

Design and method:
The study included 90 hypertensive non-vaccinated patients who underwent cardiovascular assessment in 2019 and suffered from COVID-19 in 2020. The cardiovascular evaluation included laboratory, heart ultrasound, exercise stress test, and 24h Holter ECG. The aim of our study was to analyze the effects of clinical and demographic characteristics and antihypertensive therapy on the prognosis and outcome of hypertensive non-vaccinated patients with COVID-19. Data were obtained by completing a telephone-based questionnaire. All pts were divided into three groups according to the way of treatment – pts who were treated ambulatory (A group, 56 pts), pts who were hospitalized and required oxygen therapy (H group, 25 pts), and patients who died due to COVID-19 (D group, 9 pts).

Results:
Groups didn’t differ in the presence of dyslipidemia. Obesity was the most prevalent in the A group (A 30.4%, H 20%, and D 11.1%), and smoking status in the H group (H 48%, A 33.9%, and D 33.3%). Diabetes was highly present in the D group (D 44.4%, H 25%, and A 32%), coronary artery disease in the H group (H 52%, A 41%, and D 33.3%), as well as atrial fibrillation (H 32%, A 28.57%, D 22.22%). Complex heart arrhythmias on 24h Holter ECG were the most prevalent in the H group (H 50%, A 20%. D 19.44%), and pts from the H group had the worst strain tolerance on exercise stress test (H 5.62 ± 2.37min, A 5.86 ± 2.77, and D 6.84 ± 3.39). Groups didn’t differ in using beta-blockers, diuretics, angiotensin II receptor antagonists, or angiotensin-converting enzyme inhibitors. On the other hand, only 28.57% of pts from the D group were taking calcium channel blockers (CCBs), while this percentage was significantly higher in the H (75%) and in the A group (52%).

Conclusions:
Our study showed that CCBs had a protective effect on the prognosis and outcome in hypertensive non-vaccinated pts with COVID-19.
PECULIARITIES OF THE COURSE OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER A CORONAVIRUS INFECTION
Authors: Stasyshena Oksana , Sychov Oleg , Romanova Olena , Getman Taisia , Sribna Olga , Mikhalieva Tatiana , Marchenko Olena 
Published: June 2023

Objective:
Arterial hypertension is one of the most common comorbid pathologies in patients with atrial fibrillation (AF). The aim of our study was to evaluate blood pressure indicators as a predictor of the development of AF after experiencing a coronavirus infection (CI).

Design and method:
187 patients (pts) aged 62,5±0,9 years (47% men, 53% women) were included in the study. The vast majority of pts (89%) had arterial hypertension (stage2 – 80%, stage3 – 9%). The first three groups formed 116 pts who had AF and underwent CI. The first group (G1) consisted of 36 pts who did not have AF before CI. The second group (G2) was represented by 25 pts in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 pts in whom the form of AF did not change. Two control groups were formed: K1 - 49 pts with AF who did not have a history of CI, and K2 - 22 pts with extrasystole who experienced CI, but who did not develop AF.

Results:
Arterial hypertension affected the possibility of developing and worsening the course of AF after CI in G2 pts compared with K1 pts (88,0% vs. 80,0%, p< 0,05), G1 compared with K2 patients. Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, G2, compared to G3, was characterized by more frequent detection of both 2nd degree hypertension (72% versus 65,5%; p<0,05) and 3rd degree hypertension (12% versus 3,6%, p<0.05).

Conclusions:
Arterial hypertension are predictors of the development of AF in patients after CI. The presence of AH significantly worsens the course of AF after CI, increasing the frequency of paroxysms of this arrhythmia and their duration.
IMPACT OF POST-COVID MENTAL STRESS DISORDERS ON BLOOD PRESSURE RESPONSE TO EXERCISE
Authors: Curcio Rosa , Mordeglia Lorenzo , Morgana Giovanni , Caparvi Camilla , Zacchero Lorenzo Andrea , Santoni Edoardo , Dominioni Irene , Sanesi Leandro , Cavallo Massimiliano , Santuro Emanuela , Meloni Sara , Bartoli Stefano , Pasticci Maria Bruna , Vaudo Gaetano , Pucci Giacomo 
Published: June 2023

Objective:
Patients recovered from COVID-19 are at high risk of developing mental stress disorders over the long-term. Post-traumatical stress disorders (PTSD) are associated with increased BP and hypertension incidence. We tested the hypothesis that PTSD, occurring in patients after hospital discharge for severe COVID-19, is associated with an impaired BP response to exercise.

Design and method:
108 patients previously hospitalized for severe COVID-19 were evaluated after 5 months from hospital discharge. A Revised Impact of Event Scale (IES-r) score>33 indicated probable COVID-related PTSDs All subjects underwent maximal cardio-pulmonary exercise test on a cycle ergometer with incremental ramp protocol. Submaximal BP was recorded after 4 minutes, at a workload threshold of 75W.

Results:
95 subjects (mean age 58±10 years, 71% men) had complete data. Mean baseline BP was 128/82±12/11 mmHg. 51% were hypertensive. 32% had a IES-r score>33 (PTSD group). These patients were more frequently women (45% vs 20%, p = 0.01), whereas no differences in terms of age, BMI, hypertension history, other CV risk factors or diseases were found compared to non-PTSD group. Baseline BP did not differ between PTSD and non-PTSD groups (127/82±10/8 mmHg vs 129/82±15/9 mmHg, p = 0.43/0.88). By contrast, submaximal exercise SBP (eSBP) was increased in PTSD vs non-PTSD group (155±16 mmHg vs 146±14 mmHg, p<0.05). A strong sex-specific effect was found, being eSBP higher in PTSD vs non-PTSD women, but not in PTSD vs non-PTSD men (p for sex interaction = 0.01). Intrusion symptoms, such as unwanted and upsetting memories, nightmares and flashbacks, were more markedly associated with increased BP response to exercise.

Conclusions:
In people with mental stress disorders related to previous COVID-19 hospitalization, we showed increased submaximal BP during exercise. This finding showed a sex-specific association, being observed in women but not in men. Mental stress disorders could negatively impact on future CV risk in post-COVID-19 women through an exaggerated BP response to physical stressors.