bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of a cardiac screening program: are those referred worse off?
Authors: Abela M , England K , Grech V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): 1. Cardiovascular PHD Scholarship awarded by Research, Innovation and Development Trust Malta (supported by Beating Hearts Malta). 2. Tertiary Education Scholarship Scheme.

Introduction
Awareness of sudden cardiac death in young individuals is gaining momentum. The evidence supporting screening in non-athletic individuals is also growing, but outcome data in this subgroup is lacking.

Objective
This study assessed the short-term outcomes of a large cohort of screened Maltese adolescent individuals. Outcome analysis was also extended to a large group of age matched individuals who were not offered systematic screening.

Methodology
Fifth form students (born 2002) were systematically invited to undergo cardiac screening in the 2017/2018 scholastic year. Most were cleared at screening (Group 1). The rest were referred at enrolment or had an abnormal ECG with a known diagnosis (Group 2). Events since enrolment were obtained from hospital databases.
Outcome analysis for adolescents born in 2001 who were alive and residing in Malta in 2017 was also conducted (Group 3). Data was collected through public registries. These individuals were not offered systematic cardiac screening.
An event was defined as death, hospitalisation (cardiac symptoms with abnormal findings, arrhythmias or heart failure) or cardiac intervention. Kaplan Meier and log rank analysis (IBM SPSS Statistics vs23) were used to determine the event free proportion in both groups. Events deemed to be of an acquired nature (inflammatory disorders or trauma) were disregarded.

Results
The cohort consisted of 6580 adolescents. Groups 1 and 2 included 2672 adolescents (mean age 15.0±0.33 years, 50.4% female). 109 (4.1%) were referred for further evaluation.
After a median follow-up of 52±2 months, 9 (0.3%) subjects experienced an event. No deaths were recorded. Events included hospitalisation (Group 1: n=2, Group 2: n=5) and interventions (Group 1: Pacemaker n=1, Group 2: EPS & ILR n=6). One subject (Group 2) had 3 events. Group 2 were more likely to experience an event (p&lt;0.001). 99.9% in Group 1 and 94.8% in Group 2 remained event free.
Group 3 consisted of 3913 subjects. This group was also followed up for 52±1 months. Three subjects (0.1%) had an event (n=1 hospitalisation with a new diagnosis of cardiomyopathy, n=2 EPS & ILR) at a similar rate as group 1 (p=0.097) and lower compared to group 2 (p&lt;0.001). 99.9% remained event free.

Conclusion
Participants in group 2 were more likely to experience an event. Cardiac screening does not offer any outcome benefit in the short term. Studies with longer follow-up periods are required to determine the efficacy of a cardiac screening program.
Secondary prevention of Coronary Heart Disease (CHD) in the Moroccan population. Survey of Risk Factor (SURF) CHD II Morocco
Authors: Tazi Mezalek A , Squalli Houssaini Z , Soufiani A , Mouine N , Marza Florensa A , Alami M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Global Cardiovascular (CV) mortality is highly increasing, mainly in low and middle-income countries because of lifestyle change and the rise of cardiovascular risk factors. Controlling these risk factors is very important to reduce cardiovascular disease morbidity and mortality. Risk factor control is particularly important in patients with established cardiovascular disease since these patients are at very high cardiovascular risk.
SURF is an international and simple clinical audit that aims to record and manage cardiovascular risk factors in patients with established coronary heart disease (CHD).
The goal of this analysis is to investigate risk factor recording and management in secondary prevention of CHD in the Moroccan population, a country considered as a very high CV risk according to the European Society of Cardiology.

Methods
Data of Moroccan patients with documented coronary heart disease (including stable angina pectoris, acute coronary syndrome, PCI and CAGB) were collected via an online survey during routine clinic visits. Patients’ demography, risk factors, physical and laboratory measurements, and medications were recorded.

Results
A total of 324 patients were recruited in 3 different centers in Morocco. There was a male predominance (81.5%) and mean age was 66.5 (SD 10.6) years.
Recording of risk factors was high for smoking (96.7%), physical activity (97.3%) and blood pressure (87.8%). However, for some risk factor measurements like LDL cholesterol (recording 29.9%), information was often missing. Risk factor recording in Morocco was higher than the North Africa and Eastern Mediterranean (NAEM) regional and global estimates for smoking and physical activity; similar for blood pressure; and lower for LDL levels.
Considering the attainment of risk factor goals defined by clinical guidelines, 79.6% of patients never smoked or quit smoking, and 25.0% were practicing physical activity at least 30 min 3-5 times a week. Regarding risk factor measurements, 38.2% had blood pressure &lt;140/90mmHg and 27.3% had LDL &lt;1.8mmol/L. Cardiac rehabilitation programs were attended by 3.5 % of participants. The level of target attainment in Morocco was like regional and global levels for smoking; like regional but lower than global results for physical activity; and lower than regional and global estimates for blood pressure and LDL.

Conclusion
The patients enrolled in our registry have multiple modifiable risk factors, with a poor control. The results underline the need for interventions to improve secondary prevention of CHD in Morocco.
For lifestyle recommendations, better be rich and well educated
Authors: Patriota P , Marques-Vidal P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Management of cardiovascular risk factors (diabetes, hypertension, and high cholesterol levels) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient’s socio-economic status has not been recently assessed in the Brazilian population.

Aims
To assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population.

Methods
We used survey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of diabetes, hypertension and high cholesterol levels by a healthy diet, an adequate weight, and quitting smoking. Information on the participant’s educational level and income (in multiples of the basic salary per capita) was also collected.

Results
Of the 81,197 participants included, 7,293 (9.0%), 23,065 (28.4%) and 13,304 (16.4%) reported being diagnosed with diabetes, hypertension, and high cholesterol levels, respectively. Dietary recommendations were the most frequently provided (94.8%, 94.6% and 88.6% for diabetes, hypertension, and high cholesterol levels, respectively), while recommendations to stop smoking were the least frequently provided (72.6%, 62.0% and 68.2% for diabetes, hypertension and high cholesterol levels, respectively). After multivariate adjustment, participants with a higher educational level or a higher income had a higher likelihood of being given lifestyle recommendations for hypertension or high cholesterol, while no significant trends were found for most recommendations for diabetes; see table, significant (p&lt;0.05) trends are in grey background.

Conclusion
Better educated, wealthier Brazilians benefit more from lifestyle recommendations regarding cardiovascular risk factor management. This could impact the incidence of CVD according to socioeconomic groups.
Retrospective cohort study at two centers, systolic blood pressure response during exercise testing
Authors: Pesova P , Jiravska-Godula B , Jiravsky O , Sovova M , Moravcova K , Ozana J , Sovova E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Palacky University Olomouc Faculty of Medicine Czechia.

Introduction
Measurement of blood pressure (BP) is a standard part of the exercise testing protocol in the general population and in athletes, however, we do not have a sufficient definition of normal and abnormal blood pressure response to exercise and we don´t know the prognostic impact of exercise systolic blood pressure.

Purpose
To present systolic blood pressure values during exercise in athletes examined by an exercise test.

Methods
Retrospective analysis of blood pressure response to exercise in a selected cohort of athletes who performed a bicycle ergometer exercise test at two centers. We excluded individuals with prevalent cardiovascular disease. An individual ramp protocol to maximum was used and blood pressure was measured by auscultation method. Resting BP and the highest systolic blood pressure during exercise (SPBmax), maximum heart rate (TF), and maximum workload were recorded for each individual. The SBP/Watt-slope and the SBP/Watt-ratio at peak exercise were calculated. The SBP/Watt-slope was calculated as the ratio of the difference in the rest SPB and peak SPB measurement over the increment of workload. The SBP/Watt-ratio at peak exercise was calculated as the ratio of peak SBD over the peak workload. Sex-specific mean values, standard deviations, and 5th, 25th, 75th and 95th percentiles were determined.

Results
Between the years 2015 and 2021, 14 702 individuals – 3821 females (27,2 %) and 10 251 males (72,8 %) – underwent the exercise test, with an average age of 19 years (±14). The average Body Mass Index (BMI) was 21,1. The average maximum heart rate achieved was 183/min (±16) and the average peak workload achieved was 3,9 W/kg regardless of gender. The following values were calculated for the whole cohort: peak SBP/Watt-ratio and SBP/Watt-slope. More detailed results are in Table 1. Sex-specific values can be seen in Table 2.

Conclusion
The values of BP response during exercise testing in our cohort are comparable to recently published data. These data can change the interpretation of SPB response to exercise in the future. There is also a strong need for further research-the multivariate analysis of factors associated with a higher blood pressure response to exercise and determination of sex and age-specific values.
Measurement of small, dense lipoproteins. Usefulness of the Tg/HDL index compared to direct LDL measurement
Authors: Morales Alcazar C , Morales Alcazar C , Martinez Rodriguez A , Martinez Rodriguez A , Fernandez Olmo R , Torres Llergo J , Torres Llergo J , Segura Aumente J , Segura Aumente J , Puentes Chiachio M , Puentes Chiachio M , Fernandez Anguita M , Fernandez Anguita M , Garcia Ruano A , Garcia Ruano A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None. Main funding source(s): Ninguna

Introduction
The Triglyceride/HDL (Tg/HDL) ratio when &gt; 2 is translated into the presence of small, dense lipoproteins (sdLDL), which are more atherogenic and help us measure global lipid risk regardless of LDL levels. There is the possibility of measuring sdLDL directly, but it is not performed in routine clinical practice. The objective of our study was to analyze the correlation of the TG/HDL index with the direct measurement of sdLDL and cardiovascular risk (CVR).

Materials and methods
Patients who were treated in cardiology from July 1 – July to September 30, 2022 were analyzed consecutively and the determination of the lipid profile with direct measurement of sdLDL was requested. This measurement is considered risk when sdLDL&gt; 50 mg/dl.

Results
n 75. Mean age 60 ± 15 years. 37.3% were women. 49.3% were hypertensive, 48% dyslipidemic, 22.7% diabetic, 32% smokers, 58.7% very high CVR and 54.7% with lipid-lowering treatment. Mean LDL levels were 84.3±37 mg/dl, non-HDL 110±39 mg/dl, triglycerides 139±75 mg/dl, remnant cholesterol 27.8 ±15 mg/dl, LDL-sd 34±20 mg/dl and Tg/HDL 3.5±±2. Patients with Tg/HDL&gt;2 had mean sdLDL levels 36± 23 mg/dl vs 29.7 ± 14 mg/dl (p0.06) and those with Tg/HDL&gt;3 39.8± 26 mg/dl vs 28.9± 12 mg/dl ±(p&lt;0.02). All patients with LDL&gt; 50 mg/dL levels had Tg/HDL&gt;2, however 60% of patients with Tg/HDL&gt;2 had LDL&lt;50 mg/dL levels (p0.01), but only 37% Tg/HDL&gt;3 (p&lt;0.001). (Table 1. Relationship between lipid profile, Tg/HDl and LDL-SD) 20% of very high/high RCV patients had LDL&gt;50 mg/dl, 9.1% moderate RCV and 12.5% low RCV.

Conclusions
The Tg/HDL index may be more useful in identifying patients with LDL&gt; 50 mg/dl primarily when it is &gt; 3.
Effect of hybrid cardiac rehabilitation using a smart device: a randomized controlled trial
Authors: Lee J W , Yoo J Y , Cho H Y , Kim C , Sung J , Han J Y , Jee S 
Published: May 2023

Abstract

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

Background
Although cardiac rehabilitation (CR) has been proven to be effective in secondary prevention for patients with cardiovascular diseases, the actual participation in CR is still unsatisfactory. Because home-based CR provides better access to patients and is as effective as center-based CR, it is considered a promising alternative that can overcome various barriers impeding CR implementation. However, home-based CR has not garnered enough attention due to a lack of proper communication, concerns about unexpected adverse events caused by non-monitored exercises, and the absence of supporting insurance services.

Purpose
We utilized a smart ring with a photoplethysmography to monitor heart rate. Recorded data were stored on a website where the researchers could remotely access and check the uploaded measurements. This study aims to identify the clinical effects of hybrid CR by weekly telephone counseling based on the patients' actual physical activities obtained from the device.

Methods
Cardiovascular disease patients were educated on concrete methods of home-based CR, including the type, intensity, and time of exercise as well as precautions. They were also instructed to wear the device during exercise. The patients were randomly enrolled into two groups: intervention and observation groups. The patients of the intervention group were given weekly telephone counseling and encouraged to maintain optimal physical activities. In the observational group, only exercise data were recorded without additional interventions. Before and after three months of training, the results of the symptom-limited cardiopulmonary exercise test between the two groups were compared.

Results
A total of sixty-four patients were enrolled (thirty-two in each group). The subjects were 59.8 ± 9.0 years old and fifty-three (82.8%) were male. There were no significant differences in diagnosis and results of baseline symptom-limited cardiopulmonary exercise test between the two groups (Table 1). After three months of training, peak oxygen consumption was significantly improved in both groups. However, the improvement was greater in the intervention group compared to the observation group (Table 2).

Conclusion
Home-based CR using a smart device was effective in improving oxygen consumption. For greater effectiveness, proper monitoring and timely counseling by medical experts are likely to be necessary.
Physical fitness in patients with diabetic dyslipidemia: Diabetes or dyslipidemia to blame?
Authors: Yigit S , Akinci B , Ulker Eksi B , Korkmaz Dayican D , Calikoglu B F , Yeldan Karagoz I , Satman I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Diabetic dyslipidemia is common in individuals with type 2 diabetes mellitus (T2DM), as a result of the atherogenic lipid profile seen due to deficiency in insulin hormone. Metabolic disorders such as poor glycemic control, endothelial dysfunction and increased free fatty acids may affect health-related physical fitness parameters in diabetic dyslipidemia.

Purpose
The aim of our study is to examine health-related physical fitness parameters in T2DM patients with and without dyslipidemia.

Methods
65 T2DM patients (mean age=51.9±6.5/years, F:48, M:17) diagnosed with diabetic dyslipidemia (low-density lipoprotein (LDL-C) ≥ 100 mg/dL) and 36 T2DM patients (mean age=52.8±6.4/years, F:25, M:11) without dyslipidemia were included in the study. All patients with diabetic dyslipidemia were on statin treatment. Glycosylated haemoglobin (HbA1c), fasting blood glucose (FBG), high-density (HDL-C) and low-density lipoprotein (LDL-C), triglyceride, and total cholesterol were noted. Body composition (TANITA), right and left quadriceps muscle strength (J-Tech Commander Muscle Tester), grip strength for dominant hand (Jamar dynamometer), functional capacity (6 Minute Walk Test) and physical activity level (pedometer, Omron HJ 321E Walking Style) were assessed.

Results
HbA1c, FBG, body composition, muscle strength, functional capacity and physical activity levels of the groups were all similar in T2DM patients with or without dyslipidemia (p&gt;0.05) (Table 1). LDL-C and triglyceride were significantly higher in T2DM patients with dyslipidemia (p&lt;0.0001). There was a significant negative correlation between LDL-C and right (r=-0.349, p=0.004) and left quadriceps (r=-0.354, p=0.004) muscle strength in T2DM patients with dyslipidemia.

Conclusions
In this study, it was observed that dyslipidemia did not have a distinctive effect on health-related physical fitness parameters in individuals with T2DM. It was also observed that LDL-C was associated with lower extremity muscle strength in diabetic dyslipidemia.
Predictors of cardiovascular disease in a familial hypercholesterolemia unit
Authors: Cubillas Quero A , Eliche Mozas P , Cruz Romero L , Diaz Caler A B , Duran Torralba M C , Cortez Quiroga G A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Screening and cascade screening for familial hypercholesterolemia (FH) is advised in patients with early coronary heart disease (ECHD) or high-risk dyslipidemia LDL-c &gt;190 mg/dL without secondary cause. The diagnostic rates of FH by genetic testing are 5-9% in patients with ECHD and 2-5% in patients with high-risk dyslipidemia.

Methods
Observational retrospective study of a cohort of 615 patients over 18 years of age, included in an HF unit (177 index cases and 438 first-grade relatives). The population was divided into 201 (32.7%) patients with cardiovascular disease (CVD) (Group A), and 414 patients without CVD (Group B). Clinical characteristics, variables of the inclusion blood test in the HF unit and the lipid-lowering treatment implemented were compared.

Results
Group A patients were older, wiht a higher proportion of male, higher rates of hypertension and diabetes, higher body mass index (BMI), higher percentage of obese, and no difference in historical maximum LDL-c levels compared to Group B.
Group A patients, as a result of CVD, receivedmore potent lipid-lowering treatment, had lower levels of LDL-c but without differences in meeting their LDL-c objective (45.7% vs 39%, p=0.19), presented a higher rate of small and dense LDL-c either measured by LDL-c/ApoB ratio &lt;1.3 or Triglycerides/HDL-c &gt;2, and lower HDL-c values with a higher percentage of values minor than 40 mg/dL in men and less than 45 mg/dL in women (HDL-c &lt;40-45). Group A had higher lipoprotein (a) values and higher lipoprotein (a) &gt;180 mg/dL (equivalent to FH), a higher proportion of chronic kidney desease and increased uric acid (table 1).

Conclusions
In a population of patients with suspected FH, the presence of CV risk factors (male sex, older age, high blood pressure, diabetes, obesity, chronic kidney desease), and atherogenic blood test (HDL&lt;40-45, increased lipoprotein (a), increased uric acid, small and dense LDL-c) were associated with CVD. The detection of these in this patient population of patients should lead us to act early and aggressively to prevent the development of CV events.
Right ventricle adaptation to high intensity training assessed by cardiac magnetic resonance in olympic athletes
Authors: Monosilio S , Prosperi S , Ciuffreda A , Lemme E , Di Gioia G , Mango R , Tonti G , Pedrizzetti G , Gualdi G , Pelliccia A , Squeo M R , Maestrini V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Several determinants affect cardiac remodelling in athletes, including sport discipline, body size and sex. Recently, interest in myocardial deformation (MD) imaging as reliable functional index is growing. Available MD data are usually derived by echocardiography and mostly related to the evaluation of the left ventricle. Data on right ventricle (RV) deformation assessed by CMR are lacking and, currently, specific reference values in athletes have not been explored.

Purpose
To assess RV deformation in a cohort of Olympic athletes and to evaluate possible inter-individual differences related to type of sport and sex.

Methods
A cohort of Olympic athletes with unremarkable cardiovascular pre-participation screening tests was enrolled. A group of sedentary individuals was also enrolled for comparison. All subjects underwent CMR without contrast. Cine-images were post-processed to assess RV volume, ejection fraction (EF) and MD by computing global longitudinal strain (GLS) by feature-tracking software. Athletes were divided in subgroups based on sex, ESC sport classification and RV enlargement (RVEDV/LVEDV&gt;1 or ≤1).

Results
265 Olympic athletes (15% skill, 19% power, 25% mixed, 41% endurance; 58% male) and 21 sedentary controls were enrolled. Endurance athletes showed the greatest RV remodeling in terms of volumes (Table). No differences in RV-EF were found comparing athletes of different sport categories, but between athletes and sedentary controls. Median value of RV-GLS of the whole athletic cohort was -23 (-21, -25). There were no significant differences among the different sport disciplines other than endurance vs. sedentary controls for RV-GLS. Female athletes showed higher values of RV-GLS when compared with males. When examined with regard to presence of RV enlargement, no differences were observed (Figure).

Conclusion
Endurance athletes showed the greatest right ventricle remodelling in terms of RV volumes and function. Specifically, they showed the highest values of RV volumes and the lowest values of RV-GLS of the entire athlete’s population, but still within the normal range. Female athletes had higher RV-GLS values when compared with males. No difference was observed between athletes with dilated RV compared to non-dilated RV.