bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of peak VO2 in prognosis in patients undergoing a Cardiac Rehabilitation program
Authors: Alves Da Silva P , Aguiar-Ricardo I , Martins A M , Cunha N , Abrantes A , Rodrigues M C , Fiuza S , Caldeira E , Roxo D , Ramalhinho M , Santos L , Miguel S , Pinto F J , Abreu A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Peak oxygen uptake (peak VO2) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation.
Although guidelines suggest a peak VO2&lt;14mL/(kg.min) as a cut-off for transplant and a peak VO2&lt;12mL/(kg.min) in patients under beta-blockade (BB), recent data emerged, questioning the suitability of such cut-offs.

Purpose
To correlate CPET and echo data with outcomes after CR programs and to determine the best cut off for peak VO2 in a population with a high percentage of BB therapeutics.

Methods
Single center prospective study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psychologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program. Multivariate analysis with Cox regression was used to correlate with events and survival was analyzed with Kaplan Meier curves.

Results
We analyzed 349 patients who underwent CR (82% male, mean age 60 ±11,4 years). The majority was referred for ischemic heart disease (83%) followed by valvular heart disease (7%). Mean follow-up was 36,7± 19,2 months. During FUP, 7,2% pts had CV related admissions (n=25), 4 of which were myocardial infarction. Sixteen pts died (4,6%) of which 2,3% were from cardiovascular causes. On multivariate analysis peak VO2 (HR 0.827 CI 95% 0.72-0.949, p=0.07), ejection fraction (HR 0.962 CI 95% 0.933-0.991, p=0.01) and test duration (HR 0.756 CI 95% 0.712-0.778, p=0.01) correlated with hospital admissions. Regarding mortality only peak VO2 showed statistical significance (HR 0.8 CI 95% 0.69-0.93, p=0.04). On this matter we further analyzed the best cut-off in predicting events: a peak VO2 &gt; 14 mL/(kg.min) was a better predictor of event free-survival in these patients when comparing with a peak VO2 of 12 mL/(kg.min).

Conclusions
Cardiac rehabilitation has an established impact in prognosis. Echo and CPET data obtained at the beginning of the CR program can be used to identify patients who might benefit from a more closed surveillance in order to reduce risks of hospitalization.
Moreover, in our population, a peak VO2 cut-off of 14mL/(kg.min) seemed to better correlate with event-free survival.
Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study
Authors: Goevaerts W F , Tenbult - Van Limpt N C C W , Brouwers R W M , Kemps H M C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation.

Purpose
The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement.

Methods
In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals.

Results
All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (&gt;68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2).

Conclusions
The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.
Cardiac rehabilitation designed for obese patients with atrial fibrillation: OPTICARE XL results on burden, frequency and severity of Atrial Fibrillation
Authors: Tenbult - Van Limpt N , Brouwers R , Ter Hoeve N , Den Uijl I , Spee R , Van Den Berg - Emons R , Boersma H , Lu Y , Kemps H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Fibrillation (AF) is associated with substantial morbidity, mortality and low quality of life. Obesity is an important risk factor for AF and weight reduction is associated with a decrease in AF burden. Previous studies showed that conventional CR programs lead to insufficient weight reduction in obese patients. The OPTImal CArdiac REhabilitation XL (OPTICARE XL) study was an open label randomized controlled trial (RCT), evaluating effects of a CR program specifically designed for weight reduction in patients with obesity and non-valvular AF.

Objective
We hypothesize that this novel tailor-made CR program (OPTICARE XL) will lead to reduced AF burden, as compared to conventional CR.
Design and setting: Multi-center RCT, conducted between February 2017 and January 2019 in 2 large Dutch CR centers. Patients were randomized to the OPTICARE XL CR intervention-program or a conventional CR-program.

Methods
The primary endpoint was AF symptom burden, assessed by the Atrial Fibrillation Severity Scale (AFSS). Secondary endpoints were AF symptom number, AF symptom frequency and AF symptom severity. Data were collected at baseline (prior to CR, T0), at the end of the intervention and conventional program (T1) and 1.5 year after inclusion (T2).

Results
Of 68 included patients, 28 were randomized to conventional CR and 40 to OPTICARE XL CR. Patients were predominantly male (60%), had a mean age of 62.4 ± 10.4 years and a mean BMI of 36.1 ± 4.4 kg/m2.
With regards to AF burden, no significant within and between-group differences were observed between T0 and T1, T1 and T2, and T0 and T2 (OPTICARE XL: T0 14.6 ± 4.4, T1 14.1 ± 5.9, T2 14.3 ± 6.9; conventional CR: T0 16.4 ± 6.5, T1 15.3 ± 6.3, T2 15.9 ± 7.6; Figure 1).
There was a significant difference (p=0.02) in the AF symptom number at T2 in favor of the intervention group (Figure 2). AF symptom frequency decreased in the intervention group from T0 to T2 (31.5 to 25.8; p=0.027) and in conventional CR from T0 to T1 (32.2 to 28.2; p=0.010). However, for both AF symptom frequency and symptom severity, no significant between-group differences were observed.

Conclusion
Compared to conventional CR, OPTICARE XL CR did not result in a reduced AF burden. However, it did reduce the AF symptom number at long-term follow-up. Novel CR programs such as OPTICARE XL may have added value in the treatment of obese patients with AF.
What makes athletes with extra training volume at a sports cardiology center different
Authors: Jiravsky O , Pesova P , Pleva M , Krausova D , Sknouril L , Sterbova T , Kantor M , Spacek R , Raskova I , Jiravska Godula B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Athletes have always recognized the importance of training, but in modern times there has been a dramatic increase in the volume and intensity of training that athletes undergo. This has led to concerns about the potential risks associated with such high levels of training. However, there is also evidence to suggest that athletes who train the hardest may actually be at lower risk of developing cardiovascular problems.

Objective
To determine the proportion of athletes with arrhythmias screened at a sports cardiology center. To define the differences in care between an athlete with and without an arrhythmia.

Methodology
Retrospective analysis of the registry of all athletes of the one Sports Cardiology Centre. Statistical comparison of the cohort of athletes with weekly training volume above the 95th percentile versus the rest of the cohort.
File: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 males and 15 females (13%), aged 26 (+/-11 years) were examined and definitively closed at CSK. Median 95th percentile group training volume was 18 hours, mean 22 (+/3) hours vs 9 (+/- 3) hours (p&lt;0.001), detailed in Table 1.

Results
The cohort of athletes in the greater than 95th percentile of weekly training volume sides differed statistically significantly from the rest of the cohort only in the type of sport according to ESC (typically endurance athletes, p=0.021) and the percentage of medication used regularly (50% vs 16.9%, p=0.039). Data summarized in Table 2.

Conclusion
Apart from the statistically significant greater use of regular medication, there was no difference from the rest of the cohort in workflow and sports cardiology centre outcomes in the cohort of those athletes with the highest training volume. The difference in heart dimensions and volumes on echocardiographic and MRI scans will be the subject of further investigation.
Benefits of patient-managed ECGs to verify the time of recurrent atrial fibrillation after electrical cardioversion in the PRE-ELECTRIC study
Authors: Andersen E , Solberg M G , Enger S , Onarheim S , Olufsen M , Christophersen I E , Ulimoen S R , Walle-Hansen M M , Berge T , Tveit A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Vestre Viken Hospital Trust.

Background
Electrical cardioversion (ECV) is a common procedure to terminate persistent atrial fibrillation (AF). The recurrence rate after ECV is high, and recurrence is often unrecognized by the patients.

Purpose
To investigate the benefits of patient-managed out-of-hospital electrocardiography (ECG) to diagnose recurrence of AF after ECV.

Methods
PRE-ELECTRIC (predictors for recurrence of atrial fibrillation after electrical cardioversion) is a prospective, observational study. We included 200 adult patients with persistent AF referred for ECV at Bærum Hospital between 2018 and 2022. Time to recurrence of AF was verified by digital thumb ECG, recorded twice daily and whenever experiencing symptoms. The observation period was 28 days. We defined patient motivation as expected number of days with ECG recordings minus missed days with ECG recordings divided by expected number of days with ECG recordings. Shortly after recurrence of AF, we called the patients and investigated their awareness of recurrence.

Results
Mean age was 66.2 (± 9.3) years, and 42 (21.0%) were women. The most frequent comorbidities were hypertension (n=94, 47.0%) and heart failure (n=51, 25.5%). A total of 164 patients underwent ECV of AF, and the procedure was initially successful for 90.6%. Recurrence of AF had occurred in 50.3% of the successfully cardioverted patients after 4 weeks, and median time to recurrence was 5 days. Of all the cardioverted patients, 123 patients (75%) had 100% motivation with no missed days of measured thumb ECGs during the observation period. Nearly 97% of the patients had above 89% motivation with three or less missed days. More than 37% of the patients with recurrence of AF were not aware of the recurrence at the time of contact.

Conclusions
Recurrence of AF after ECV was frequent. Patients showed high motivation to self-managed out-of-hospital ECG-recordings, and this was useful for diagnosing recurrence of AF.
The LIPL Study Postprandial lipid profile, inflammation and platelet activity in patients with chronic coronary syndrome
Authors: Pogran E , Haller P H , Wegberger C W , Tscharre M T , Vujasin I V , Kaufmann C K , Dick P D , Jaeger B J , Wojta J W , Huber K H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In general, most people spend their day in a non-fasting state. Hence, it is suggested that the changes in atherosclerosis happen mainly under the influence of non-fasting lipids. Up to date, the studies in the postprandial state were primarily performed on healthy subjects.

Aim
This exploratory, cross-sectional study investigates the change in lipid profile, in biomarkers of inflammation, as well as markers of platelet activation in patients with different cardiovascular risk profiles in the postprandial state.

Methods
The studied population consists of 66 patients with different cardiovascular risk: patients with a history of chronic coronary syndrome (CCS) and diabetes mellitus type 2 (DM2) (n=20), CCS without DM2 (n=25), and a healthy control group (n=21). Lipid variables and markers of platelet function were assessed during the fasting state (baseline) and three and five hours after a standardized fat meal using a standardized oral fat tolerance test (OFTT), a milkshake with 90g of fat. Platelet activity was measured with the Multiplate Assay using adenosine diphosphate (ADP), arachidonic acid (ASPI) and thrombin-receptor activating peptide (TRAP) as stimulants.

Results
Patients with CCS and DM2 were significantly older and had the highest BMI. All patients with CCS were on acetylsalicylic acid, and 95% of CCS patients were on high-dose statins. HDL-c decreased significantly during the OFTT, with a peak after five hours (3.46±0.4 mg/dL, p&lt;0.001). Triglycerides (TG) increased significantly during the OFTT, with a peak after five hours (130.2 ± 14.5 mg/dL, p&lt;0.001) irrespective of the group. All other variables of the lipid profile remained stable during the OFTT. The absolute leucocyte and neutrophile count and the neutrophile to lymphocyte ratio (NLR) increased significantly during the OFTT in the whole study population, whereas the absolute lymphocyte count increased significantly only in the control group. A significant increase in platelet activity during OFTT was shown in the control group by the increased absolute platelet count, increased reticulated thrombocytes, and increased platelet reactivity measured by the ASPI and TRAP tests, respectively. There was no significant change in the markers of platelet activity during the OFTT in patients with CCS with/without DM2.

Conclusion
This study showed that a standardized fatty meal changes HDL-c and TG concentrations and leads to an increased postprandial inflammation response irrespective of the cardiovascular risk and to increased platelet activity in healthy subjects, while there was no increase in platelet activity in higher-risk CCS patients.
Pulsed-field ablation for redo procedures after failed radiofrequency or cryo ablation for atrial fibrillation
Authors: Tanner H , Kueffer T , Madaffari A , Muehl A , Maurhofer J , Seiler J , Thalmann G , Servatius H , Kozhuharov N , Noti F , Haeberlin A , Baldinger S H , Roten L , Reichlin T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulsed-field ablation (PFA) has recently been introduced for pulmonary vein isolation (PVI). It might also be of potential value for redo procedures after failed radiofrequency or cryo ablation for atrial fibrillation (AF).

Purpose
To describe our initial experience using a multipolar PFA catheter for redo procedures after failed AF ablation.

Methods
Consecutive patients undergoing a redo procedure for recurrent atrial arrhythmias at our institution using a multipolar PFA catheter from Mai 2021 until October 2022 were included. A 3D electro-anatomical bipolar voltage map was generated to identify pulmonary vein (PV) reconnection, quantify the level of isolation (antral vs. ostial isolation), and characterize the extent of extra-PV low-voltage tissue. In case of PV reconnection, re-isolation was performed using PFA, with at least four applications in both basket and flower configuration. In case of only ostial PV isolation, additional PFA applications in flower configuration were delivered to widen the isolation to a more antral level. If all veins were already isolated on an antral level and/or if low-voltage areas were found on the posterior wall, a posterior wall ablation was added with the same PFA device at the discretion of the operator.

Results
We identified 170 patients (mean age: 64 ±11years, 45 (27%) women), undergoing a redo procedure using PFA. The median number of previous ablations was 1 (range 1-6), the most recent ablation was performed using radiofrequency in 122 (72%), cryo in 42 (25%), and surgery in 5 (3%) patients. In 104 (61%) patients, at least one reconnected PV was found. In total, 244 of 680 PV (36%) showed reconnection. In addition to PV reisolation, additional antral applications were delivered in 205 of 436 still isolated veins (47%). Posterior wall ablation was added in 112 (66%) patients (43% in paroxysmal AF, 78% in persistent AF, Figure). Median procedure duration was 101 minutes (IQR 80-137).
There was no cardiac tamponade, no stroke, and no esophageal fistula observed in this cohort.

Conclusion
For patients with recurrence after catheter ablation of atrial fibrillation, re-ablation using PFA is feasible and safe. Most common ablation targets were the pulmonary veins and the posterior wall. Whether the complementary effect of a different technology improves outcome needs further investigation.
When does phrenic nerve injury recover after cryoballoon ablation? Data from Japanese multicenter registry
Authors: Shigeta T , Miyazaki S , Isonaga Y , Arai H , Miwa N , Inaba O , Hachiya H , Yamauchi Y , Goya M , Sasano T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although phrenic nerve injury (PNI) is most frequently encountered complication in cryoballoon ablation, it recovered in most cases. However, the duration of persisting PNI has not been fully investigated yet.

Purpose
This study sought to confirm the clinical course of PNI after the procedure in cases in which reduction of diaphragmatic compound motor action potential (CMAP)was confirmed during cryoballoon ablation of right-sided pulmonary veins (PVs).

Methods
We retrospectively analyzed a total of 237 patients who experienced right PNI confirmed by the CMAP amplitude reduction during cryoballoon ablation in 4 Japanese centers. Cryoballooon ablation of right-sided PVs were performed under CMAP monitoring in all cases, and once CMAP amplitude reduction was observed, freezing was immediately interrupted with a double stop technique. The recovery of PNI was confirmed by chest X-ray, and transient PNI was defined as one recovering before the discharge.

Results
Among 237 patients, PNI occurred during cryoballoon ablation of right superior PV and right inferior PV in 166 and 71 patients, respectively. The mean freezing time to PNI was 126.9±45.6 seconds and the mean balloon temperature when PNI occurred was -50.2±7.5°C. After PNI was confirmed, additional cryoballoon ablation of the same PV or the other ipsilateral PV was performed under CMAP monitoring in 29 and 97 patients, respectively. Transient PNI accounted for 53.2% of patients with PNI (126 out of 237 patients). Among the remaining 111 patients, the PNI recovery was confirmed within 3 months, 6 months or 12 months after the procedure in 42(37.8%), 55 (49.5%), 74 (66.7%) patients, respectively. When we excluded 32 patients who did not undergo sufficient follow-up of chest X-ray, only 5 patients (2.4%) still suffered from PNI at 12 months after the ablation, and the PNI recovery was confirmed after more than 12 months in 3 out of them. When we compared patients who suffered from PNI at 6 months after the procedure with those who did not, there was no significant difference in nadir balloon temperature (-50.4±6.9°C; for PNI recovery [-] vs -50.0±7.8°C; for PNI recovery [+], p=0.75). When freezing time was less than 60 seconds, PNI recovered within 6 months after ablation in all cases, although 23.2% of the patients in whom freezing time was 60 seconds or more still suffered from PNI at 6 months after the procedure (p=0.045).

Conclusion
The right-sided PNI confirmed by the CMAP amplitude reduction during cryoballoon ablation recovers within a couple of days in half of cases, and it rarely persists more than 12 months after the procedure. When freezing was interrupted less than 60 seconds, it is highly expected that PNI recovers within 6 months.
Should we shift warfarin to non-vitamin K antagonist oral anticoagulants for patients with atrial fibrillation staying well on warfarin for years?
Authors: Chao T , Lip G Y H , Chen S A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended over warfarin for stroke prevention for patients with atrial fibrillation (AF) in 2020 ESC guidelines. However, whether warfarin should be shifted to NOACs for patients who stayed very well with warfarin for years remains unknown.

Methods
From 2007 to 2010, a total of 167,176 newly-diagnosed AF patients aged ≥20 years were identified from the Taiwan National Health Insurance Research Database. Among these patients, 83,604 were alive to June 1st, 2015 and 54,803 of them who did not experience ischemic stroke or intra-cranial hemorrhage (ICH) have constituted the study population. Among the study population, 8,007 patients who continuously received warfarin and survived for at least 90 days after June 1st, 2015 were defined as the "original warfarin cohort". These patients were then categorized into 2 groups according to the stroke prevention strategies they received after June 1st, 2015; that is, staying on warfarin (n = 6,635) and shifting to NOACs (n = 1,372).

Results
Compared to patients staying on warfarin, the risk of ischemic stroke was lower for patients who were shifted NOACs (aHR 0.886; p=0.002). Also, the risk of major bleeding was lower for shifting to NOACs (aHR 0.849; p&lt;0.001)(Figure). Compared to staying on warfarin, NOACs use was associated with a lower composite risk of ischemic stroke or ICH (aHR 0.842; p&lt;0.001) and ischemic stroke or major bleeding (aHR 0.880; p&lt;0.001).

Conclusions
Even for patients staying well on warfarin for years, shifting to NOACs was still associated with better clinical outcomes.