bluuebunny/crossref_metadata_2025_split huggingface dataset:
History of acute myocardial infarction in patients with acute coronary syndrome: population characterization and impact on prognosis
Authors: Carias M , Paralta M , Almeida A , Claudio F , Rocha R , Picarra B , Bento A , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with a history of Acute Myocardial Infarction (AMI) continue to be underrepresented in large studies on Acute Coronary Syndromes (ACS).

Purpose
To characterize patients with ACS and previous AMI and to evaluate their impact on the therapeutic approach, complications and in-hospital mortality.

Methods
We studied 722 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous AMI and patients without previous AMI. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EF), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, re-infarction, mechanical complications, stroke and major hemorrhage. In-hospital mortality was compared between both groups.

Results
Patients with previous AMI constituted 26.8% (194 patients) of the population studied. These had a higher prevalence of arterial hypertension (92.8% vs 71.2%; p&lt;0.001), diabetes (47.9% vs 30.4%, p&lt;0.001), dyslipidemia (73.6% vs 49 .2%, p&lt;0.001), previous angioplasty (62.1% vs 0.0%; p&lt;0.001), heart failure (14.0% vs 4.7%, p&lt;0.001), arterial disease (13.5% vs 3.6%, p&lt;0.001), chronic renal failure (18.7% vs 9.6%, p=0.009) and previous bleeding (5.3% vs 1.3 %, p=0.002). The D with previous AMI presented more frequently with AMI without ST elevation (62.4% vs 40.7%; p&lt;0.001) and Unstable Angina (10.3% vs 5.3%, p=0.02 ) and less with ST-elevation AMI (22.2% vs 47.3%, p&lt;0.001). At admission, patients with previous AMI received less therapy with unfractionated heparin (20.6% vs 30.7%; p=0.007) and more therapy with angiotensin-2 antagonists (6.2% vs 2.3% , p=0.009), nitrates (62.9% vs 49.2%, p=0.001), ivabradine (5.2% vs 1.7%, p=0.01) and diuretics (34.5% vs 22 .3%, p=0.009). The coronary angiography rate was similar between the groups, however patients with previous AMI underwent more coronary angiography via the femoral route (36.9% vs 15.7%, p&lt;0.0001) and fewer angioplasties (58.5% vs 69 .5%, p=0.006). EF was slightly lower in patients with previous AMI (45.7 ± 9.3% vs 48.3 ± 10.4%, p=0.04). However, there were no differences in the presence of any of the complications considered, as well as in in-hospital mortality.

Conclusion
Patients with previous AMI have a higher prevalence of co-morbidities and a higher prevalence of AMI without ST elevation and Unstable Angina. The presence of previous AMI was not per se a predictor of in-hospital complications or mortality.
Impact of a cardio-oncology rehabilitation framework among high cardiovascular risk cancer survivors: results from the CORE trial
Authors: Viamonte S , Joaquim A , Alves A J , Vilela E , Capela A , Ferreira C , Teixeira M , Guedes H , Rato N , Duarte B , Tavares A , Santos M , Ribeiro F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cancer survivors are challenging patients, as they often present increased cardiovascular (CV) risk. In this background, cardio-oncology rehabilitation frameworks for specific cancer patients have been proposed. However, optimal program designs, as well as their overall safety and efficacy in different subsets of patients, are not fully ascertained.

Purpose
To assess the impact of a cardio-oncology rehabilitation based framework for cancer patients at increased CV risk, compared to a community-based exercise training (CBET), on cardiorespiratory fitness (CRF) and cardiovascular risk factor (CVRF) control.

Methods
The CORE study was a single-center, prospective, randomized controlled trial enrolling adult cancer survivors exposed to cardiotoxic cancer treatment (anthracycline, radiotherapy on thoracic wall, anti-human epidermal growth factor receptor-type 2 drugs) and/or with previous CV disease. Participants were randomized to an 8-week center-based CR program (CBCR) or CBET, twice a week. Primary endpoint was CRF (assessed by the VO2peak, derived from a symptom-limited cardiopulmonary exercise test, performed on a treadmill); secondary endpoints were physical activity [International Physical Activity Questionnaire (IPAQ)], psychosocial parameters [Hospital Anxiety and Depression Scale (HADS)], blood pressure, body composition, lipid profile and health literacy [Newest Vital Sign (NVS) questionnaire].

Results
80 patients were included (mean age 54.5±14,12, 61 women; 66% breast cancer, 27.5% lymphoma); 75 patients completed the intervention (CBCR N= 38; CBET N=37). There was a significant improvement in the CBCR compared to the CBET group in VO2peak (∆ +2.1±2.8 vs +0.8±2.5 mL.kg-1.min-1, p=0.033) and in the following outcomes: resting systolic blood pressure (p&lt;0.0001); body mass index (p&lt;0.0001), lean and fat body mass (p&lt;0.0001), waist circumference (p&lt;0.0001); total cholesterol (p =0.001), triglycerides (p =0.008) and LDL cholesterol (p =0.003); HADS Anxiety score (p =0.003) and Depression score (p =0.009), weekly physical activity levels (p&lt;0.0001) and health literacy scores (p&lt;0.0001). No major CV events were reported.

Conclusion
The CORE trial demonstrates superior results of a CBCR regarding CRF and CVRF control. Given the higher cardiovascular risk in several groups of cancer patients, our data provides novel insights into optimized preventive strategies in this complex patient population.
Left atrial dyssynchrony in veteran athletes with paroxysmal atrial fibrillation
Authors: Sorensen E , Myrstad M , Solberg M G , Oie E , Tveit A , Aaronaes M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): A Ph.D. grant from the DAM Foundation and a grant from the Raagholt foundation.

Background
Prolonged endurance exercise is associated with an increased risk of atrial fibrillation (AF) in men. Increased left atrial (LA) size is associated with AF in the general population. LA dilation in athletes is viewed mainly as a physiological response to exercise, and functional atrial parameters may help distinguish pathological from physiological atrial remodeling in this group. LA mechanical dispersion (LA MD) is a novel marker of LA mechanical dyssynchrony. It is yet to be evaluated whether LA MD could be a marker of pathological remodeling in veteran athletes.

Purpose
To describe LA MD measured by speckle tracking echocardiography in male veteran athletes who had regularly participated in the 54 kilometer cross-country (XC) ski race Birkebeinerrennet in Norway with and without AF, and men with and without AF from a background population.

Methods
In total, 295 men, veteran XC skiers with (n=57) and without (n=88) paroxysmal AF, and men from a non-athletic population with paroxysmal AF (n=62) and without AF (n=88) were examined with echocardiography while in sinus rhythm. LA MD was defined as the standard deviation of time to peak strain (SD-TPS) including all accepted atrial segments, and stated both in milliseconds, and corrected by the cycle length ((SD-TPS(ms)/Cycle length(ms))x100)). The average of three consecutive loops was computed. A two-way between-groups analysis of variance was performed to explore the main effects of AF status, athletic status, and the interaction between AF status and athletic status in LA echocardiographic parameters.

Results
XC skiers (mean age 70.9±5.7 years) reported an average of 40-50 years of regular endurance exercise and had completed an average of 17 annual Birkebeiner races. LA volumes were associated with both AF and athletic status. LA MD in milliseconds was associated with AF, but not associated with athletic status.

Conclusion
LA MD was associated with paroxysmal AF both in veteran endurance athletes and non-athletes, and less affected by athletic status than atrial volumes. This implies that LA MD could be a useful marker when trying to distinguish physiological from pathological atrial remodeling in endurance athletes.
Consequences of diabetes and high-risk dyslipidemia
Authors: Eliche Mozas P , Cruz Romero L , Cubillas Quero A , Huertas Escribano M J , Rus Mansilla C , Cortez Quiroga G A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Diabetic patients develop both, microvascular and macrovascular long-term complications, and have double the risk of cardiovascular (CV) disease being the main cause of death. The 97% of diabetic patients are classified as high or very high CV risk. The 2019 ESC guidelines for the managment of dyslipidaemia, classified patients with LDL-c &gt;190 mg/dL as high-risk patients, with the indication of high-intensity statins (LDLc reduction greater than 50% and LDLc below 70 mg/dL).

Objective
To analyze, in a group of patients with high risk dyslipidaemia (HRD, LDLc &gt;190 mg/dL without secondary cause), the consecuences of its association with type 2 diabetes.

Methods
Observational retrospective cohort of 153 patients with HRD. We compared 35 diabetic patients (G1) vs 118 non diabetic patients (G2), and we analysed clinical characteristics, cardiovascular risk factor’s (CVRF), tase of cardiovascular disease, the baseline blood test with maximum LDL-c (BT1), lipid profile on the last blood test (BT2) and the effects of lipid-lowering treatment.

Results
There were no differences in relation to sex. G1 were older (69.2 (±12.8) vs 56.8 (±12.5) years old, p=0.001), had a higher body mass index (BMI) (31.4 (±5.9) vs 28.9 (±4.4) kg/m2, p=0.018), higher number of CVRF (3 CVRF, 54.3% vs 10.2%, p&lt;0.0001, and 4 CVRF, 37.1% vs 0%, p&lt;0.0001). Regarding mayor CV events, 80% develop CV disease vs 38.1% (p&lt;0.0001), and 40% develop early coronary disease (ECD) vs 25% (p&lt;0.0001).
In the BT1, G1 presented a more atherogenic lipidogram, lower HDL-c &lt;40-45mg/dL values (22.9% vs 9.3%, p=0.033), higher proportion of triglycerides &gt;150mg/dL (74.3% vs 46.6%, p=0.001), higher proportion of small and dense LDL-c (88.6% vs 62.7%, p=0.004) and a higher proportion of VLDL-c &gt;30mg/dL (74.3% vs 45.8%, p=0.003). There were no differences in lipid-lowering treatment (statin 88.6% vs 86.4%, p= 0.7; ezetimibe 68.6% vs 53.4%, p=0.1) or in the lipid-lowering power of LDL reduction &gt;50% (77.1% vs 70.3%, p=0.4), except for a greater prescription of fibrates in G1 (11.4% vs 1.7%, p=0.027). In BT2, lower rates of HDL-c &lt;40-45mg/dL (34.3% vs 16.1%, p= 0.019) and small and dense LDL-c (80% vs 50.9%) persisted in G1, p=0.002) and a higher proportion of chronic kidney disease (25.8% vs 2.6%, p&lt;0.0001).

Conclusions
Patients with HRD and diabetes have higher CVRF, a more atherogenic lipid profile that persists despite lipid-lowering treatment, and double the rate of CV disease, were half of these events occurs at early age. This association of CVRF should alert us, implementing an early and agressive prevention treatment of all CVRF.
What influences the regional variation of heart failure in Poland?
Authors: Roszkowska S , Kuzma Ł , Swieczkowski M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Center, Poland.
In Poland, more than 1.5 million people suffer from chronic heart failure (HF), and the rate of hospitalization for HF is one of the highest in Europe The risk of hospitalization of patients with HF is related not only to lifestyle, but also to environmental, economic, social factors and the organization of the health care system.
The main purpose of the research is an assessment the impact of environmental and socioeconomic factors on hospitalized heart failure prevalence.
We analyzed age- and gender-standardized data on the frequency of hospitalizations due to CHF in Poland in 2012-2019.
In addition, using data from the National Institute of Public Health, the Central Statistical Office and Provincial Environmental Inspectorates, as well as panel data regression techniques, the impact of environmental and socioeconomic factors on HF in Poland in 2012-2019 was estimated.
During the period analyzed, there were 1,618,734 hospitalizations due to CHF (51.3% male; 82.6% over 65 years of age). An increase in the number of physicians by 10/10000 population resulted in a 3% decrease in hospitalizations due to CHF (β=-0.029; 95%Cl -0.004 - -0.013; P=0.001). In addition, the development of a network of outpatient health care facilities resulted in a 0.3% decrease in hospitalizations for each newly established unit per 1,000 residents (β=-0.031; 95%Cl -0.048 - -0.014; P=0.000). The main environmental factors reducing hospitalized prevalence due to CHF were the proportion of green areas in the analyzed environment (2.7% decrease for a percentage point increase in the proportion of green areas; β=-0.027; 95%Cl -0.053 - -0.001; P=0.047) and pollution levels (a 10 µg/m3 increase in PM2.5 and PM10 concentrations in the province resulted in a county-wide increase in hospitalizations of 7.5% [β=0.075, 95%CI 0.013-0.137, P=0.017] and 6% [β=0.060; 95%CI 0.012 -0.108, P=0.015]). The opposite relationship was observed for the number of cars; an increase of 100 cars per 1,000 residents was associated with a 6% increase in hospitalizations due to CHF (β=0.064; 95%Cl (0.008 - 0.121; P=0.026). An injection of PLN 100 per capita per year into the health sector by local governments results in a 3.5% decrease in hospitalizations (β=-0.003; 95%Cl (-0.006 - -0.001; P=0.002). Also, the situation in local labor markets translates into hospitalizations due to CHF - a 1 pp increase in the unemployment rate results in an average one percent increase in HF.
The number of hospitalizations for heart failure has been increasing in the last decade and this trend is most noticeable in regions with low levels of socioeconomic development and poor medical facilities. Health policy measures using environmental and socioeconomic instruments can result in no less positive health effects than the use of health care tools alone.
Doctor-patient communication about personal cardiovascular risk: a missing piece of the prevention puzzle?
Authors: Petrovic J , Radomirovic M , Petrovic Djordjevic I , Petrovic A , Markovic M , Todorovic J , Santric-Milicevic M , Ivanovic B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Widespread awareness of modifiable cardiovascular risk factors (MCRF) may be fundamental to reduce the burden of cardiovascular diseases (CVD). However, the lack of doctor-patient communication (DPC) about personal cardiovascular risk (pCVR) could affect prevention achievement.

Purpose
To assess the frequency of DPC about pCVR as potential target for preventive strategy improvement in a very high risk country.

Methods
The pilot study included convenience sample of 795 adults from Serbia divided in two groups, depending on the presence of at least one of five MCRF (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking). They were compared according to demographics (age, gender, education, incomes, place of residence), awareness of MCRF as contributing factors to CVD, interest in pCVR, preferable source of information about pCVR and frequency of DPC about pCVR. The data were collected by voluntary filling of survey with multiple choice questions from April 1st to June 30th 2022.

Results
There were significantly more respondents with MCRF (75% vs 25%, p&lt;0.01). Those with MCRF were older (50±14 vs 39±11, p&lt;0.01), less educated (49% vs 22% with only high school or less, p&lt;0.01) and had lower incomes (53% vs 40% with less than average incomes, p&lt;0.01). No significant difference was observed according to gender (43% vs 38% of males, p&gt;0.05) and place of residence (85% vs 90% from urban area, p&gt;0.05). The majority in both groups showed high awareness of MCRF as contributing factors to CVD (95% vs 96% for hypertension, 95% vs 95% for hyperlipidemia, 89% vs 85% for diabetes mellitus, 93% vs 91% for obesity, 83% vs 84% for smoking; p&gt;0.05). Both groups were very interested in pCVR (89% vs 89%, p&gt;0.05) and opted for their doctors as the most preferable source of information about pCVR (89% vs 91%, p&gt;0.05). On contrary, only the minority in both groups had DPC about their pCVR, although it was higher in the group with MCRF (34% vs 14%, p&lt;0.01) and increased proportionally to the number of present MCRF.

Conclusions
The study showed high awareness of MCRF and high interest in pCVR, independently of MCRF presence or demographic characteristics. Despite that, there is a notable lack of DPC about pCVR. Since doctors have been chosen as the most desirable source of information, they should make efforts to discuss pCVR with patients, as this may be the crucial part of the preventive strategy.
Hypertensive patients are more likely to develop coronary artery disease on computed tomography coronary angiography
Authors: Tserioti E , Chana H , Salmasi A M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Systemic hypertension (HTN) is the strongest cause for morbidity and mortality all over the world for its association with target organ damage including coronary artery disease (CAD). It creates a great challenge in medical field because it is often asymptomatic. CT coronary angiography (CTCA) being a non-invasive tool can be used to assess the presence of CAD successfully. In this study we aimed to identify the association between HTN and CAD.

Methods
The individual electronic health records of 566 consecutive patients who underwent CTCA between July and November 2020, were retrospectively reviewed. TAVI studies and graft assessment studies were excluded. A total of 485 patient (mean age 60.4) reports were analysed. All risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were also recorded.

Results
Of the 170 patients with moderate-severe CAD, 127 (74.7%) had hypertension, and of the 100 patients with severe CAD, 78 (78%) had hypertension. Univariate analysis for comparison of patients with none (n = 222), mild (n = 93), moderate (n = 70) and severe (n = 100) CAD revealed that hypertension (P &lt; 0.001), diabetes (P = 0.007), gender (P &lt; 0.001), dyslipidaemia (P &lt; 0.001) and smoking (P = 0.005), were all significantly associated with the presence of CAD on CTCA. However, multivariate analysis using a multiple logistic regression model, confirmed a significant association between hypertension and CAD (OR = 1.26, P &lt; 0.001). SHAP-values for model interpretation revealed that hypertension has the strongest impact on CAD presence on CTCA.

Conclusions
Hypertension is the strongest independent predictor for the presence of CAD detected on CTCA, amongst diabetes, gender, dyslipidaemia, positive family history and smoking. These results suggest that hypertension and the other risk factors associated with CAD, should form the main parameters on consideration for CTCA referral. Further studies relating our results to the CTCA reports of same patients after a longer period of aggressive hypertension treatment, would prove essential in establishing the role of blood pressure management in the progress of angiographic coronary disease.
Role of risk assessment using lipid ratios and adiposity markers in young patients with a first acute coronary syndrome
Authors: Fernandez Ruz L , Mora Robles J , Claros Ruiz A , Alcala Ramirez Del Puerto M , Urbano Carrillo C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Low-density lipoprotein cholesterol (LDL-C) remains the gold standard for lipid assessment in atherosclerotic cardiovascular disease (ASCVD). Recent guidelines remark the importance of non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (ApoB) in lipid risk assessment. Moreover, lipid ratios (LR) add information about small, dense LDL-C and other atherogenic lipoproteins. The presence of adiposity confers a higher metabolic and lipidic risk.

Purpose
To describe ApoB, non-HDL-C, remnant cholesterol (RC) and lipid ratios (LR) in young patients admitted for a first acute coronary syndrome (ACS); and to correlate those values with body mass index (BMI) and glycated haemoglobin (HbA1c) as adiposity and metabolic syndrome markers.

Methods
We performed a descriptive and retrospective study including 51 patients under 65 years old, admitted to hospital between July 2022 and October 2022, for an ACS irrespective of the onset (unstable angina, non-ST-segment or ST-segment elevation myocardial infarction (NSTEMI, STEMI)). We assessed a basic lipid profile including, HbA1c, total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG) and ApoB. Non-HDL-C, RC and the following LR (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C, LDL-C/ApoB, TC/ApoB and TG/ApoB) were estimated.

Results
In our study. 76,5% were male. Mean age was 56,1 years (± 7,3). The percentage of history of risk factors was: smoking 68,6%, hypertension 52,9%, diabetes 31,4%, dyslipidaemia 43,1%. 30 patients had STEMI (58,8%), 17 NSTEMI (33,3%). Mean BMI and HbA1c were 29,46 kg/m2 (±5,9) and 6,1% (±1,07), respectively. Mean waist circumference was 98 cm (±13,95) Mean values of the lipid profile were: LDL-C 89,74 mg/dL (±35,58), HDL-C 33,8 mg/dL (±8,4), TG 161,14 mg/dL (±66,26), non-HDL-C 122,28 mg/dL (±38,96), RC 32,54 mg/dL (±14,86), ApoB 97,6 mg/dL (±26,88). Mean LR were: TG/HDL-C 5,04 (±2,33), LDLc/ApoB 0,92 (±0.2). The rest of the characteristics and results are shown in Table 1.
We found statistically significant positive correlation between: TG and ApoB (r: 0,345; P=0,014); TG and TC/HDL-C ratio (r:0,326; P=0,21); TG and HbA1c (r: 0,349; P=0,02); TG an RC (r: 0,978; P&lt;0,001); HbA1c and TG/ApoB ratio (r: 0,392; P&lt;0,01); BMI and HbA1c (r: 0,572; P=0,013); TG/HDL-C and BMI (r: 0,493; P=0,032).

Conclusions
Lipid ratio assessment plays a key role in patients with adiposity, remarkably high in our serie. In our cohort, these patients had TG/HDL-C ratio &gt; 2 and LDL-C/ApoB ratio &lt; 1.3, meaning small and dense circulating lipoproteins. Our results support the implementation of LR in clinical practice as they may guide the intensification of lipid lowering therapies beyond LDL-C.