bluuebunny/crossref_metadata_2025_split huggingface dataset:
Respiratory exchange ratio overshoot during exercise recovery: a novel prognostic marker in heart failure
Authors: Vecchiato M , Zanardo E , Borasio N , Quinto G , Battista F , Ermolao A , Neunhaeuserer D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In recent years considerable new evidence has been added on the analysis of the recovery phase in patients with heart failure. Transient increases (overshoot) in respiratory gas variables have been observed during exercise recovery, but their clinical significance is not clearly understood. Respiratory Exchange Ratio (RER) at peak exercise (RER peak) is an objective index of exercise intensity. The overshoot phenomenon of the RER is commonly observed during recovery from maximal cardiopulmonary exercise testing (CPET) but initial studies have found a decreased RER-magnitude in patients with heart failure with reduced ejection fraction (HFrEF).

Purpose
To characterize the functional and prognostic significance of RER recovery kinetics in individuals with HFrEF.

Methods
This cross-sectional study included all patients with HFrEF who underwent functional evaluation with maximal CPET for the heart transplant checklist at the Sports and Exercise Medicine Division of the Padova University Hospital between January 2018 and December 2021. The presence of overshoot phenomena of different respiratory gas indices was evaluated during the recovery phase, focusing on the RER. The RER behaviour has been evaluated assessing the maximal value during recovery phase (RER max) and the magnitude of the RER overshoot (RER mag).

Results
164 patients with HFrEF and 128 controls were included in the study. RER recovery parameters were significantly lower in patients with HFrEF compared to healthy subjects. The RER overshoot showed significant correlations with prognostically relevant CPET parameters and these RER metrics were significantly higher in patients presenting better ventilatory and Weber classes. 24 patients with HFrEF did not present a RER overshoot showing worse cardiorespiratory fitness and efficiency compared to patients with overshoot. Mean follow-up period was 2.57 years during which there were 55 first major cardiovascular events, 22 deaths, 21 heart transplants, and 9 ventricular assist device implantations. The absence of RER overshoot predicted major adverse cardiac events- and transplant-free survival in univariate and multivariate Cox regression analysis.

Conclusions
RER overshoot represents a new index to monitor respiratory gas kinetics during the recovery phase, since it is a feasible and reproducible parameter for clinical practice. A reduced overshoot or its absence are significantly associated with functional impairment, cardiorespiratory inefficiency and worse prognosis. Thus, the evaluation of the respiratory gas indices during recovery from maximal CPET should be included in routine test interpretation, particularly for patients with HFrEF.
Incentives for physical activity in cardiac patients in Germany: pre-trial health economic modelling
Authors: Mohebbi D , Ogurtsova K , Dyczmons J , Dintsios C M , Kairies Schwarz N , Icks A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Düsseldorf
Cardiovascular disease (CVD) is the most prevalent non-communicable disease and the leading cause of death globally. Evidence suggests that exercise-based interventions in secondary prevention can mitigate adverse health events. Implementing incentive schemes for patients to engage in physical activity (PA) might be a promising approach to improve adherence. The INPHY trial, a complex intervention that is currently being developed at the University Hospital Düsseldorf, aims at improving PA in people with coronary heart disease (CHD) using monetary and social incentives. The UK Medical Research Council (MRC) framework for the development and evaluation of complex interventions recommends pre-trial health economic modelling to inform the design of the trial.
A decision-analytic Markov model was developed to evaluate the costs and benefits of exercise-based, incentivized secondary prevention interventions from a health services provider. A cohort of individuals with a history of myocardial infarction was followed in the model from age 65 years through a total of 25 1-year Markov cycles. Primary outcomes included costs, quality-adjusted life-years (QALY) gained and incremental cost-effectiveness ratios (ICERs). Sensitivity and scenario analyses were performed to reflect parameter and model uncertainty.
In the base-case, the incremental QALYs gained from the monetary and social incentives, relative to control, were respectively estimated at 0.01 [95% CI 0.00-0.01] and 0.03 [95% CI 0.02-0.05]. In comparison to control, the implementation of the monetary and social incentive interventions increased the costs by 795€ [95% CI 697-884] and 831€ [95% CI 593-1,191], respectively. ICERs were 24,473€ [95% CI 15,871-38,868] and 112,015€ [95% CI 81,140-169,888] per QALY gained for the social and monetary incentive interventions, respectively. At a per-capita gross domestic product threshold (GDP) of 43,000€/QALY for Germany, the probability that the social and monetary incentive intervention would be seen as cost effective was 100% and 0%, respectively.
Exercise-based secondary prevention using incentivized reinforcement schemes might offer a cost-effective strategy to reduce the burden of CHD, offering good value for money in preventing a significant non-communicable disease. Translation of these findings into policy and practice alongside rigorous monitoring and evaluation is important. More epidemiological research from Germany is recommended to reduce the remaining model uncertainty surrounding this decision.
Coronary calcium score (CAC) appears to be independent of lipid profile in treated patients with Heterozygous Familial Hypercholesterolaemia
Authors: Haggag A , Jumdally R U M I , Moustafa I B R A H I , Madani D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary artery calcium (CAC) score has been shown to improve the risk stratification and prediction of Atherosclerotic Cardiovascular Disease (ASCVD) in cohorts of patients with Heterozygous Familial Hypercholesterolaemia (FH) [i].

Objectives
We sought to examine the CAC score in patients with FH who are on treatment and correlate to the therapy, Total Cholesterol (TC), Low Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) levels.

Method
Retrospective Analysis of patients with established diagnosis of FH from a specialist lipid clinic who underwent CAC for risk stratification.

Results
The study included 64 patients, of which 33 patients (52%) were males with an average age of 57.4 years. At diagnosis, the mean elevated TC level was 7.40 ±1.60 mmol/l.
37 patients (58%) were on statin, (7 patients were on Rosuvastatin 20 mg, 20 patients were on Atorvastatin 40 mg, 8 patients were on Atorvastatin 20 mg, 2 patients were on Atorvastatin 80 mg), 8 patients (12%) were on a combination of PCSK9 and statins, 3 patients (5%) were on fibrates (fenofibrates) 160 mg, 3 patients (5%) were on Ezetimibe 10 mg, 4 patients (6%) were on Bempedoic Acid 180 mg, 9 patients (15%) were on lifestyle modifications and did not prefer to start on any lipid lowering agents.
71% of patients with TC level of 7.29 ±1.87 mmol/l had a calcium score of less than 100. CAC of &gt;100 was observed in 29% of patients with a TC level of 7.44 ±1.50 mmol/l. (p value of 0.741)
CAC score &gt;100 appeared independent of (A) LDL level (27% with a mean LDL level of 4.81±1.81 mmol/l versus 73% with a CAC &lt;100 and a mean LDL level of 4.40 ±1.38mmol/l) (p value of 0.424) and of HDL level (29% of patients with a mean HDL level of 1.45 ±0.64mmol/l versus 71% with a CAC score&lt; 100 with a mean HDL level of 1.44 ±0.61mmol/l) (p value of 0.768).
Despite therapy, 45 patients (27 %) had high LDL level with a mean LDL level of 4.5 ±1.50mmol/l though we found no difference in CAC score between the two groups (p value of 0.424).

Conclusion
In a single centre retrospective analysis of patients with Heterozygous Familial Hypercholesterolaemia on therapy, there appears to be no correlation between the CAC score of more than 100 and baseline therapy, Total Cholesterol, LDL or HDL levels achieved. We postulate that more stringent LDL reduction to ~1.4mmol/l should be adopted with further analysis of Coronary calcium score in the long term.
Some results are striking - what about lung function in adults with congenital heart disease?
Authors: Hock J , Bessar M , Dalla Pozza R , Ewert P , Hager A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Stiftung KinderHerz Weserstr. 101 45136 Essen.

Background
During the last years, lung function tests became of high interest in patients with a congenital heart defect (CHD). However, data are still rare and mostly concentrate on spirometry, investigating forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and its ratio (FEV1/FVC).

Purpose
This study prospectively examined patients with CHD regarding their lung function. Data reported were FVC, FEV1, and FEV1/FVC (spirometry) as well as total lung capacity (TLC) and residual volume, presented as its ratio to TLC (RV/TLC) and compared to the latest Global Lung Initiative reference values (2021).

Methods
From April 2018 to October 2022, one hundred eighty-six adults with CHD (32 ± 10 years, 83 female) participated in the study. Their results (z-scores) were compared with the student’s T-test against zero.

Results
Patients mostly reached normal values but differed significantly in FVC-z (-1.1 ± 1.2, p&lt;0.001), FEV1-z (-1.2 ± 1.2, p&lt;0.001), its ratio (FEV1/FVC-z: -0.3 ± 1.0, p&lt;0.001), TLC-z (-0.6 ± 1.2, p&lt;0.001) and RV/TLC-z (1.1 ± 0.9, p&lt;0.001). However, with the border of z&gt;-1.645 as normal results, 33% had striking results: 43 showed a reduced FVC (FVC-z&lt;-1.645), and 10 an obstructive pattern (FEV1/FVC&lt;-1.645). Out of the patients with reduced FVC, 17 patients (40%) had a normal TLC (TLC-z&gt;-1,645), which stands for a non-specific pattern, and 26 patients (60%) had a real restriction, which was only detected via body plethysmography.

Conclusions
Patients with CHD and a reduced FVC in spirometry need to undergo body plethysmography. Most of them have unrevealed ventilatory restrictions that should be further analyzed and treated if needed.
Pilot study: The LIPL-PLATELET study postprandial LIPid paneLs and PLATELET activity in coronary heart disease after treatment with PCSK9-inhibitors
Authors: Pogran E , Ahmed A A , Burger A B , Kaufmann C K , Rega-Kaun G R , Fasching P F , Huebl W H , Huber K H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Sanofi AVentis
Reports about a pleiotropic potential of pro-protein convertase subtilisin/kexin type 9 inhibitor are scarce. This hypothesis-generating study investigates the platelet reactivity after standardized oral fat tolerance testing (OFTT) under an optimized lipid-lowering therapy (statin plus ezetimibe) alone and during the add-on treatment with the alirocumab.
We investigated ten patients with the chronic coronary syndrome (CCS). Lipid variables and markers of platelet function were assessed during the fasting state and 3 and 5 hours after OFTT using a milkshake with 90g of fat. Measurements were performed in the same CCS patients under dual lipid-lowering therapy (DLLT) alone and after three months of add-on therapy with alirocumab.
Postprandial inflammatory reaction did not change, irrespective of alirocumab. Neutrophile to lymphocyte ratio increased during the OFTT more significantly when on dual lipid-lowering therapy (p=0.021). The multiplate electrode aggregometry test with ASPI reagents (p=0.037) showed a paradoxically higher platelet reactivity five hours after OFTT with the addition of alirocumab compared to the DLLT only. Platelet reactivity remained unchanged during OFTT in CCS patients before or after alirocumab therapy.
Altogether, alirocumab showed a trend of decreased postprandial inflammation and an increase in platelet reactivity.
Cardiac rehabilitation using a virtual trainer in patients with heart failure
Authors: Lacraru A , Busnatu S , Pana M A , Andrei C L , Sinescu C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): European Union’s Horizon 2020.

Background/Introduction
According to WHO cardiovascular diseases (CVDs) are the leading cause of mortality. Heart attacks and strokes account for more than four out of every five CVD fatalities. Early identification of patients at risk to developing cardiovascular diseases and prompt initiation of appropiate treatment can prevent premature deaths. After a patient overcomes an acute cardiovascular event, he is referred for rehabilitation to help him restore most of his normal cardiac functions.

Purpose
This study is part of a European project called vCare (Virtual Coaching Activities for Rehabilitation in Elderly), which aimed to test a rehabilitation program carried out by patients at home with the help of a virtual coach. In Romania, we evaluated the effectiveness of the cardiac rehabilitation program using the vCare system in reducing cardiovascular risk and improving quality of life in patients with heart failure (HF).

Methods
We conducted a prospective interventional pilot study in which we enrolled a total of 30 patients with HF who were divided into 3 groups: 10 patients in the experimental group (EG), 10 patients in ambulatory group (AG) and another 10 in the control group (CG). The follow-up period lasted 3 months.
The patients in the EG performed cardiac rehabilitation (CR) at home using vCare app, patients in the AG underwent conventional CR at Bagdasar Arseni Hospital and those in the CG only received advice at discharge to perform regular physical activity at home and reduced cardiovascular risk factors.
At the time of inclusion (time 0) all patients were clinically examined, blood tests and echocardiography were performed and also ECG exercices test for the assessment of exercices capacity and personalization of the CR program in the case of those from EG and AG. Furthermore they filled out several questionnaires (Minnesota, HADS scale, Fagerstrom). At the end of the rehabilitation program (time 1) all patients were reassessed in the same way as at enrollment.

Results
Patients with HF in EG had an increase in quality of life by up to 30% from time 0 to time 1, in exercices capacity by 4% and a significant decrease in cardiovascular risk factors was identified. Similar data were observed in patients from the AG, while in patients from the CG, a decrease in exercices capacity and a worsening of anxiety and depression were found.

Conclusions
Patients with HF who perform cardiac rehabilitation using vCare system had similar results compared to the AG and better results compared to CG, especially in terms of quality of life and their activities of daily life.
This kind of cardiac rehabilitation can represent a safe and efficient solution for ensuring continuity of medical care and access to personalized motor treatments for patients with cardiological disease.
SPREAD multicentre study: sports practice and its effect on bicuspid aortic valve disease
Authors: D'ascenzi F , Cavigli L , Claessen G , Van Craenenbroeck E , Cavarretta E , D'andrea A , Sanz De La Garza M , Eijsvogels T , Halle M , Andreini D , Moreo A , Schreurs B , Sitges M , Stefani L , Pelliccia A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Bicuspid aortic valve (BAV) is the most common congenital cardiac condition among the general population and competitive athletes. BAV could be associated with progressive aortic dilatation, stenosis and/or regurgitation. There are concerns about the possible detrimental effects of exercise training on aortic size and valve function due to the hemodynamic stress on the aorta during exercise. However, data in the literature are scarce and sometimes discordant.

Objectives
This multicenter study aimed to analyze the influence of sport on aortic size and valve function in BAV patients.

Methods
Three groups were analyzed: competitive athletes with BAV, athletes with tricuspid aortic valve (TAV) and sedentary controls with BAV, age- and sex-matched. We assessed the morphology and degree of aortic valve stenosis, regurgitation, aortic dimension, and left ventricular (LV) characteristics by 2D echocardiography. Individuals with moderate-severe stenosis and regurgitation or relevant aortic dilation (&gt; 45 mm (men) or &gt;41 mm (women) were excluded from the study.

Results
The study population was composed of 500 subjects:184 BAV athletes (84% males; mean age 30±11 years), 191 TAV athletes (82% males; mean age 30±11 years), 125 BAV sedentary controls (82% males; mean age 34±10 years). The aortic annulus was greater in BAV athletes (25.0±3.6 mm) than in TAV athletes (21.7±2.9 mm) and BAV controls (23.9±3.6 mm), p&lt;0.005. Sinuses of Valsalva, sinotubular junction and ascending aorta diameters were smaller in TAV athletes than in BAV subjects (&lt;0.005), but there were no significant differences between BAV athletes and BAV controls. LV index volumes and mass were greater in BAV athletes than in the other two groups (p&lt;0.005). Moreover, BAV athletes showed higher gradients than sedentary controls (p&lt;0.005).

Conclusions
This multicenter study demonstrated that athletes with BAV have larger aortic diameters than athletes with TAV. However, no differences between BAV athletes and sedentary controls were observed, suggesting that exercise training does not significantly affect aortic dilation, with the exception of aortic annulus. Conversely, sports practice negatively influenced valve function in BAV athletes. Valvular dysfunction seems to affect the LV geometry, with a trend for being more dilated and hypertrophic in BAV athletes than in the other groups.
Performance of the Systematic COronary Risk Evaluation 2 (SCORE2) in the EPIC-Norfolk prospective population study
Authors: Van Trier T , Snaterse M , Boekholdt M , Scholte Op Reimer W J M , Visseren F L J , Hageman S H J , Dorresteijn J A N , Wareham N J , Peters R J G , Jorstad H T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): EPIC-Norfolk is supported by programme grants from the Medical Research Council UK (MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (CRUK 8257).

Introduction
The latest European guidelines recommend the use of the Systematic COronary Risk Evaluation 2 (SCORE2) to assess 10-year risk of fatal and non-fatal cardiovascular disease (CVD) in individuals aged 40-70 years. Therefore, validation of the SCORE2 algorithm in a large population is needed.

Purpose
To assess the predictive performance of SCORE2 in individuals without prior myocardial infarction, stroke or diabetes mellitus.

Methods
Individuals aged 40-70 without prior myocardial infarction, stroke or diabetes mellitus were included from the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. We assessed discriminative power using the C-statistic; calibration was assessed by plotting calculated SCORE2 (low-risk algorithm) 10-year risks against observed CVD event rates. We defined the composite cardiovascular outcome as death due to ischemic heart disease, cardiac failure, cerebrovascular disease or peripheral-artery disease, or non-fatal myocardial infarction or non-fatal stroke. Observed probabilities were adjusted for competing mortality events.

Results
We included 20,318 individuals (56% women) with a median (IQR) age of 56 (50-63) years, with baseline measures between 1993-1997. Mean predicted 10-year risk was 3.7% (95% confidence interval (CI) 3.7-3.8) versus adjusted observed 4.2% (95% CI 3.9-4.5) 10-year CVD incidence, yielding a ratio of 1.1 (95% CI 1.1-1.2).(Figure) Observed events consisted of 1.5% (95% CI 1.3-1.7) fatal CVD events, 1.8% (95% CI 1.6-2.0) non-fatal myocardial infarctions, 1.5% (95% CI 1.3-1.6) non-fatal strokes and 23.4% (95% CI 22.1-23.2) competing mortality events. Overall C-statistic was 0.75 (95% CI 0.73-0.77).

Conclusion
SCORE2 demonstrates reasonable discriminative ability and accurate risk estimations in low-risk individuals in a large, prospective population cohort. However, as actual CVD incidence is expected to be lower given the baseline between 1993-1997, these findings do not indicate that SCORE2 is suitable for current use for risk assessment in individuals from the United Kingdom.
The role of tele-rehabilitation in post-myocardial infarction populations during the covid-19 pandemic in a tertiary care centre
Authors: Kyaw K K K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The role of teleconsultation has been highly valued for health care professionals in cardiovascular field in recent years as the ongoing Covid-19 pandemic has affected the face-to-face patient visits to specialist heart centres. Moreover, the cardiac rehabilitation is the key element of post-coronary care, and the role of remote real-time tele-rehabilitation would play a promising future for post-myocardial ischaemia patient populations during the covid-19 crisis. (1)

Purpose
Our primary aim was to study the role of tele-rehabilitation on long-term patient safety and positive compliance rates. Further objectives were to understand the reasons for patient satisfaction following remote consultation.

Methods
A total of 50 patients were enrolled into cardiac rehabilitation clinics from 1st April 2022 to 31st October 2022. Out of them,40 attended virtual tele-rehabilitation service due to ongoing covid-19 pandemic. The study questionnaire was created upon the level of perception of patient satisfaction in three domains, including easy access to remote consultations, positive compliance and quality of overall teleconsultation especially the voice quality, and delivery of exercise regimes with remote control. A final survey of patient satisfaction was recorded from the day patients receiving the first virtual appointment up to next 6 weeks remote consultations.

Results
It was found that 32 out of 40 patients (80%) received a positive response upon overall virtual consultations and tele-rehabilitation services. In 8 (20%) of the 40 patients who did not meet the level of satisfaction, the main reasons were lack of clear instructions among exercise regimes and poor explanation of patient concerns during the remote tele-rehabilitation sessions. However, we identified the main reasons for which positive satisfaction in virtual rehabilitation sessions, and these revealed reduced patient waiting times, avoidance of infection risks in vulnerable post-coronary intervention patient groups and flexible accessibility for varieties of cardiac tele-rehabilitation sessions during the ongoing covid-19 crisis. (3)

Conclusion
The implementation of remote real-time consultations in cardiac rehabilitation services has led to significant improvement in patient quality of care especially reduced patient waiting times, and cost-effectiveness due to flexible opportunities for tele-exercise sessions. Moreover, it can provide speedy, focused interaction on specific issues of care during the post-coronary rehabilitation periods, often circumventing the need for patient travel. (2)