bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial mechanics and functional capacity in HFpEF patients with paroxysmal atrial fibrillation
Authors: Katbeh A , Kodeboina M , Kodeboina M , Penicka M , Penicka M , Van Camp G , Van Camp G , Bartunek J , Bartunek J , Vanderheyden M , Vanderheyden M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Exercise capacity and ventilatory efficiency are often impaired in heart failure patients with preserved ejection fraction (HFpEF). Since left atrial (LA) pressure, particularly during exercise plays a major role in the exercise intolerance observed in these patients, we aimed to characterize the contribution of resting LA mechanical properties, assessed by two-dimensional speckle tracking echocardiography upon exercise capacity.

Objective
To evaluate relationship between LA mechanics, measured by LA strain (LAS) and parameters of exercise capacity, assessed by cardiopulmonary exercise testing (CPET) in HFpEF patients with dyspnea and paroxysmal atrial fibrillation (AF).

Methods
The study included 23 consecutive patients (63 ± 8 years, 83 % males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%), referred for elective pulmonary vein ablation. The probability of HFpEF was estimated using H2FPEF score. During sinus rhythm, all patients underwent speckle tracking echocardiography and cardiopulmonary exercise testing by treadmill. Peak oxygen uptake (VO2max) served as measure of functional capacity and ventilation/carbon dioxide output (VE/VCO2) slope as surrogate of ventilation/perfusion mismatch.

Results
Out of all the echocardiographic indices, only LA contractile strain and strain rate showed significant correlation with peak VO2 (both p &lt; 0.05). All three strain components of LA phasic function, i.e. reservoir, conduit and contractile LAS, had significant relationship with VE/VCO2 slope (all p&lt;0.050). Patients with LA strain rate above the median had significantly higher VE/VCO2 slope (p=0.025) and lower peak VO2 (p=0.010). In contrast, no correlations were observed between exercise parameters and LA volumes or LA emptying fraction or any other echocardiographic indices.

Conclusions
In HFpEF patients, VO2 max and VE/VCO2 slope are closely related to LA contractile strain, suggesting that abnormalities in LA mechanics may contribute to the blunted exercise capacity observed. Therefore, these markers can be used as an echocardiographic surrogate of functional capacity in HFpEF patients with paroxysmal AF.
Impact of Heart Failure Telemonitoring on unplanned hospitalization: Findings from the non-invasive cardiac telemonitoring programme
Authors: Kaihara T , Falter M , Scherrenberg M , Xu L , Boesmans S , Shkedy Z , Dendale P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Telemonitoring is an intervention that has shown to improve care of heart failure (HF) patients and thus plays a major role in preventing frequent hospital visits.

Purpose
This study examined the impact of HF telemonitoring on unplanned hospitalization.

Methods
Patients admitted to the hospital for HF and who agreed to use the non-invasive telemonitoring system were candidates in the study. It measured body weight, blood pressure and heart rate each day, and an alert was made if they exceeded a certain limit. The study contained data from 97 patients. The primary endpoint was a composite of unplanned cardiovascular hospitalization and all-cause mortality. Patients were classified into three groups: hospitalized (for any of the endpoints) during the telemonitoring period (Group 1 ["monitoring failure"]), hospitalized after the telemonitoring period (Group 2), and not hospitalized (Group 3).

Results
Median telemonitoring period was 222 [141, 518] days. The number of patients in each group was 18, 18, and 61. Patients in Group 1 were older (75 vs. 63 years, p &lt; 0.001) and had poorer estimated glomerular filtration rate (31 vs. 62 mL/min/1.73m2, p &lt; 0.001) than those in Group 3. Length of hospitalization periods at the endpoint tended to be longer in Group 1 than Group 2 (8.5 [6, 14] vs. 5 [4, 10] days, p = 0.084).

Conclusion
If heart failure telemonitoring fails to prevent unplanned hospitalization, the length of that hospitalization period may be longer than if the unplanned hospitalization could have been prevented.
The impact of COVID-19 pandemic on cardiovascular diseases hospitalization, management and mortality in Switzerland
Authors: Maung K , Marques-Vidal P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
COVID-19 pandemic led to a reduction in hospital admissions and intervention for other diseases in many countries.

Purpose
We aimed to assess the effect of COVID-19 pandemic on cardiovascular disease (CVD) hospitalizations, management and mortality in Switzerland.

Methods
Swiss hospital discharge and mortality data for period 2017-2020. CVD hospitalizations, CVD interventions and CVD mortality were assessed before (2017-2019) and during (2020) the pandemic.

Results
Compared to 2017-2019, 2020 was characterized by a reduction of CVD admissions in age groups 65-84 and ≥85 by approximately 3,700 and 1,700 cases, respectively, and by an increase in the percentage of admissions with a Charlson Index &gt;8. The total number of CVD-related deaths decreased from 21,042 in 2017 to 19,901 in 2019, and increased to 20,511 in 2020, with an estimated excess of 1,181 deaths. This increase was due to out-of-hospital deaths (+1400), while the number of in-hospital deaths decreased from 5030 in 2019 to 4796 in 2020. The total number of cardiovascular interventions increased from 55,181 in 2017 to 57,864 in 2019, and decreased in 2020, with an estimated reduction of 4,472 interventions; PTCA was the exception, as the number and percentage of emergency PTCA increased. The preventive measures applied against COVID-19 inverted the seasonal pattern of CVD admissions, the highest number of admissions being found in summer and the lowest in winter. Preventive measures were also followed by a decrease in CVD admission (figure).

Conclusion
The COVID-19 pandemic led to a reduction in CVD hospital admissions, planned CVD interventions, an increase in total and out-of-hospital mortality, and a change in seasonal patterns.
Multimodality imaging for negative T waves among athletes with normal transthoracic echocardiography: prevalence and prognosis of structural heart disease
Authors: Conte E , Pizzamiglio F , Dessanai M , Mushtaq S , Schillaci M , Marchetti D , Melotti E , Volpato V , Tondo C , Bartorelli A , Andreini D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The aim of the present study was to evaluate the prevalence of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram, evaluated at cardiac MRI and cardiac CT.

Methods
From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: 1)not previously known cardiovascular disease; 2)negative T waves in leads other than V1-V2; 3)normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes.

Results
A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5±14.1 years old. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR(95%CI) 7.81(1.24–49.08), p=0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3±12.3 months of follow-up.

Conclusion
In an unselected cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
Right ventricular longitudinal systolic strain as a tool to predict the progression to heart failure with preserved ejection fraction in hypertensive patients
Authors: Marketou M A R I A , Kampanieris E , Maragkoudakis S , Zacharis E , Karagounis T , Alifrangie A , Lasithiotaki G , Fragkiadakis K , Fragkiadoulakis I , Pateromichelakis T , Plevritaki A , Savva E , Kochiadakis G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension.

Purpose
Our aim was to investigate the usefulness of RV longitudinal peak systolic strain (GLS) to predict the risk of future development of heart failure with preserved ejection fraction (HFpEF) in patients with essential hypertension.

Methods
We performed a retrospective observational study that included 453 patients with essential hypertension (266 males, aged 63 ± 18 years) and 175 normotensives (100 males, aged 66 ± 15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results
The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: -16.1 ± 9.7 vs -20.0 ± 5.1, RVLS-B: -11.7 ± 3.7 vs -20.6 ± 3.3, RVLS-M:-16.3 ± 5.4 vs -20.7 ± 4.9, p &lt; 0.05 for all). No significant difference was detected for the RVLS-A (-20.1 ± 3.8 for hypertensives vs -21.31 ± 6.5 for controls, p=NS). Thirty two hypertensive patients developed HFpEF (7 %). A cut-off RVLS-G worse than -17 % was significantly associated with new onset HFpEF (p&lt; 0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3-25.4).

Conclusions
Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.
Determinants of Hospitalisation and Intubation in COVID-19 Infection
Authors: Xuereb R A , Gatt J , Barbara J , Tabone Adami N , Darmanin J , Erasmi R , Xuereb R G , Barbara C , Fava S , Magri C J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The novel Coronavirus disease 2019 (COVID-19), the unexpected pandemic, has resulted in significant morbidity and mortality worldwide, with frail and immunocompromised subjects being more severely affected. Nonetheless, it is still unclear which patients are most adversely affected by COVID-19.

Purpose
To assess determinants of severe COVID-19, as suggested by hospitalisation and need for intubation.

Methods
A cross-sectional survey was conducted in subjects who were diagnosed with COVID-19 following nasopharyhngeal swabbing. All participants were asked whether they required hospitalisation or intubation. Furthermore, they were submitted to a standardized questionnaire regarding past medical history, drug history, smoking history and alcohol intake. This was done via telephone call.

Results
In total, 2,650 subjects accepted to participate in this survey. The median age of the participants was 44 years (IQR: 31-55 years). Of these, 48.6% were males while 51.2% were females. Five per cent of the study population were hospitalised in view of severe illness and of these 0.7% were intubated. Univariate followed by multivariate analysis was performed using IBM SPSS version 23.0. In univariate analysis, age, gender, smoking, hypertension, hyperlipidaemia, ischaemic heart disease, history of cerebrovascular disease, peripheral vascular disease, heart failure, type 1 and type 2 diabetes, atrial fibrillation, obesity, chronic kidney disease as well as being on immunosuppressant treatment either in view of HIV or following transplant surgery, were found to be statistically significant. However, on multivariate analysis, age (OR 1.07, 95% CI 1.05-1.08, p&lt;0.001), male gender (OR 1.84, 95% CI 1.27-2.68, p=0.001), hypertension (OR 1.82, 95% CI 1.21-2.73, p=0.004), chronic kidney disease (OR 66.67, 95% CI 7.04-500, p&lt;0.001) and chronic respiratory disease (OR 3.19, 95% CI 1.92-5.32, p&lt;0.001) were shown to be independent determinants of hospitalisation. Likewise, univariate analysis was performed to assess for variables that are associated with intubation. Here, age, male gender, smoking, hypertension, the presence of heart failure, atrial fibrillation and chronic kidney disease were found to be statistically significant. However, on multivariate analysis, age (OR 1.06, 95% CI 1.004-1.113, p= 0.034) and chronic kidney disease (OR 22.22, 95% CI 1.87-250, p= 0.014) were found to be independent determinants.

Conclusion
In the study population, chronic kidney disease was the strongest predictor of severe COVID-19 disease, followed by chronic respiratory disease, hypertension, male gender and increasing age. Further follow-up with regards outcome of the hospitalised population is merited.
Lipid-lowering therapy and LDL-cholesterol in patients after acute coronary syndromes
Authors: Haider P , Galli L , Schrutka L , Distelmaier K , Wojta J , Hengstenberg C , Krychtiuk K A , Speidl W S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Medical University of Vienna.

Background
Intensive lipid lowering after acute coronary syndromes (ACS) reduces recurrent cardiovascular events, however recent studies have shown that LDL-cholesterol goal achievement is low in patients after myocardial infarction. We compared LDL-C goal achievement in patients after ACS that were discharged with statin monotherapy or with a combination lipid lowering therapy (LLT).

Methods and Results
We included 227 consecutive patients with a median age of 62 (IQR 52-72) years of which 67.8% of patients were male. 59.5% of patients underwent PCI because of ST-elevation myocardial infarction (STEMI) and 40.5% because of NSTEMI. 30.4% were on LLT at time of the ACS. Median LDL-C decreased from 104.8 (IQR 75.3-139.2) mg/dL before the acute event to 52.2 (IQR 37.8-74.6) mg/dL three to six months after the myocardial infarction, resulting in 55.1% of patients on LDL-C goal of 55 mg/dL. Only 5 (2.2 %) patients were discharged without LLT and 5 (2.2 %) patients were treated with PCSK9-inhibitors. 89.4% of patients were treated with high dose and 7.5% of patients with moderate or low dose statins. Patients that were discharged on statin monotherapy (n=160, 70.5%) reached a median LDL-C of 55.0 (IQR 41.0 to 78.8) mg/dL that was significantly higher as compared to patients on combination therapy with ezetimibe (n=62, 27.3%) that was 43.0 (IQR 32.3 to 62.5) mg/dL (p&lt;0.002). The proportion of patients with statin monotherapy that reached the LDL-C goal was only 50.6% as compared to 71.0% of patients with combination therapy (p&lt;0.001). Logistic regression analysis revealed that out of age, gender, type of myocardial infarction and statin-pretreatment only baseline LDL-C (p&lt;0.005) and combination therapy (HR 4.6; p&lt;0.001) were predictors for LDL-C goal achievement.

Conclusions
After acute myocardial infarction, only 50.6% of patients on statin monotherapy reach the recommended LDL-C goal of 55mg/dL. LLT combination therapy with ezetimibe significantly increased the proportion of patients reaching the treatment target and should be mandatory in most of the patients after acute myocardial infarction.
Suboptimal treatment of dyslipidemia in clinical practice
Authors: Gjana A , Pavli E , Kristo A , Metani D , Teferici D , Bileri A , Dibra L , Hoti K , Kastrati A , Dibra A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Recent European Society of Cardiology (ESC) guidelines on the treatment of dyslipidemia recommend a target threshold &lt;55 mg/dL of low density lipoprotein (LDL) cholesterol in patients with coronary artery disease. Some studies have suggested that most patients do not reach their LDL target. There is little evidence about the extend of this problem among patients treated in a University Hospital.

Purpose
Patterns of statin treatment and efficasy based on the achivement of LDL target level according to current and previous ESC guidelines.

Methods
We obtained clinical and laboratory data from 100 consecutive patients, whom were previously diagnosed and treated for coronary artery disease, and were readmitted at our hospital either for planned intervention or for signs or symptoms of ischemic heart disease. During the period between the 2 hospitalizations, all patients were under the supervision of their family physician or local cardiologyst. We analyzed patterns of statin treatment and their effect on cholesterol level regarding achivement of target threshold based on current and previous ESC guidelines.

Results
At first hospitalization, mean age was 65 +/- 9. 80% of the patinets were male. Mean total cholesterol levels were 190+/-52 mg/dl and mean LDL cholesterol levels were 133 +/-45 mg/dl on admission. On discharge a high intensity statin was prescribed in 75% of the patients, and a combination of Ezetimibe with statin was prescribed in 5% of them. On readmission mean total cholesterol levels were 163+/-46 mg/dl and mean LDL cholesterol levels were 109 +/-42 mg/dl. 79% of the patients were on a high intensity statin regime, and none of them were taking Ezetimibe. A target LDL chol &lt;70 mg/dl recommended by 2016 ESC guidelines was reached in 21% of the patients, while a target LDL chol &lt; 55 mg/dl recommended by 2019 ESC guidelines was reached in only 8% of the patients. Between the two hospitalizations, 39 (39%) of the patients had their lipid lowering therapy modified. 26 (26%) of them had an increase in statin dosage, all of them following their cardiologyst reccomendation. 13 patinets (13%) had a reduction in statin dosage and interruption of Ezetimibe treatment, despite the lack of any side effect. 4 of them following their cardiologyst reccomendation, 6 following their family physician, lab physician or pharmacist reccomendation and the last 3 patient decided on their own.

Conclusions
Implementation of guidelines in dyslipidemia treatment for secondary prevention in clinical practice is far from optimal even for patients discharged from an University Hospital. Additional efforts should be done to raise the awareness of all health care actors about the necessity of treatment with high dose statins and achivements of recommendet LDL target threshold for patienst with coronary artery disease.
Can previous therapy with statin be considered a protective factor in acute coronary syndrome?
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Statin therapy is nowadays a cornerstone in primary and secondary prevention of cardiovascular events.

Purpose
This retrospective observational study intends to characterise the influence of previous therapy with statins on clinical and electrocardiographic presentation of acute coronary syndrome (ACS) and on in-hospital morbidity and mortality.

Methods
We evaluated a population of 746 patients admitted in a Cardiac Care Intensive Unit diagnosed with ACS (D). We then considered two groups: patients with previous therapy with statins (D1) and patients without it (D2). We documented demographic factors, personal history, clinical and electrocardiographic presentation of ACS, coronary angiography and angioplasty. The following in-hospital complications were defined: heart failure (HF), cardiogenic shock, reinfarction, stroke, major bleeding and need for blood transfusion. In-hospital mortality was compared between both groups.

Results
D1 consisted of 37.5% of the population (N=280). These patients had a higher prevalence of hypertension (90.7% vs 65.4%, p &lt;0.001), diabetes (45.0% vs 27.8%, p &lt;0.001), dyslipidaemia (81.8% vs. 36.6%, p = 0.001), chronic renal failure (18.6% vs 7.6%, p = 0.001), stroke (10.7% vs. 4.5%, p = 0.003), previous myocardial infraction (MI) (45,0% vs 12,6%, p = 0.001) and previous coronary artery bypass graft (13.2% vs. 2.0%, p = 0.001). They also had more frequently smoking habits (37.4% vs 13.9%, p = 0.001). They were less frequently admitted with ST-elevation MI (24.6% vs 49.2%, p = 0.001) and more frequently with non-ST elevation MI (56.1% vs 40, 9%, p = 0.001) and unstable angina (10.7% vs 5.6%, p = 0.02). The rate of coronary angiography was similar, however patients receiving previous statin therapy underwent less angioplasty. During hospitalization, there were no differences in any of the complications considered, nor in in-hospital mortality between the 2 groups.

Conclusions
In patients with ACS, previous therapy with statins seems to influence the presentation of ACS but it does not affect in-hospital morbidity and mortality. An important percentage of patients with diabetes and of those with previous MI or stroke were not on statins therapy as recommended in the European guidelines.