bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise prescription to patients with cardiovascular disease is in greater agreement with ESC/EAPC recommendations after using the EXPERT Training tool
Authors: Hansen D , Marinus N , Cornelissen V , Ramakers W , Coninx K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Flemish Research Fund (FWO, FWO-ICA: G0F4220N).

Background
Exercise prescriptions by clinicians to patients with cardiovascular disease (CVD) often disagree with recommendations, thus requiring improvement.

Aim
To assess whether exercise prescriptions by clinicians to patients with CVD are better in agreement with ESC/EAPC recommendations when the EXPERT Training tool is used for digital training.
Design: Prospective non-randomized intervention study.

Methods
Twenty-three Belgian physiotherapists first prescribed exercise intensity, frequency, session duration, program duration and exercise type (endurance or strength training) for the same three patient cases, from which the agreement with ESC/EAPC recommendations (based on a maximal score of 60/per case: agreement score) was assessed. Next, they completed a one-month digital training by using the EXPERT Training tool and completed 31±13 (out of 45 available) training cases. Thereafter, the same three patient cases as at entry of study were filled out again, with re-assessment of level of agreement with ESC/EAPC recommendations.

Results
After using the EXPERT Training tool the clinicians’ prescribed significantly greater exercise frequencies, program durations and total exercise volumes in all three patient cases (p&lt;0.05). In case 1, 2 and 3, the agreement score increased from 29±9 (out of 60) to 41±9, from 28±9 to 41±10, and from 34±7 to 45±8, respectively (p&lt;0.001). Hence, the total agreement score increased from 91±17 (out of 180) to 127±19 (p&lt;0.001, +44±32%). A lower starting agreement score and younger age correlated significantly with a greater improvement in total agreement score (p&lt;0.05).

Conclusions
Exercise prescriptions to patients with CVD, generated by clinicians, are significantly better in agreement with ESC/EAPC recommendations when the EXPERT Training tool is used.
Timed up and go test associated and may predict peak vo2
Authors: Danilo Silva Dos Santos D S S , Ciro Oliveira Queiroz C O Q , Celso Nascimento De Almeida C N A , Eduardo Sahade Darze E S D , Gustavo Freitas Feitosa G F F , Fernanda Matos E Oliveira F M O , Davi De Jesus Lopes D J L , Luiz Eduardo Ritt L E R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None. Main funding source(s): No funding.

Background
the Timed Up And Go test (TUG) is a form of mobility and functional capacity evaluation, but is still not well studied in cardiac patients.

Objective
test TUG association and prediction capacity for peak VO2.

Methods
cross sectional study. Patients with cardiophaties, admitted to a cardiac rehabilitation facility, who were submitted to TUG and a cardiopulmonary exercise test (CPET). Pearson correlation, multiple linear regression, ROC curves and Bland-Altman analysis were applied. From the total 2/3 were designated to the creation and 1/3 to the validation population. A p value &lt; 0.05 was admitted as significant.

Results
201 patients, mean age of 67±13 years, 30% were female, 70% had ischaemic cardiopathy. Heart failure was present in 30%, 53% were NYHA I, 37% NYHA II, the mean left ventricle ejection fraction was 56±16%. Mean peak VO2 was 17±6 ml.kg-1.min-1 and mean TUG was 7±2.5 seconds (s). The correlation between TUG and peak VO2 was: r= -0.53 (IC95%= -0.62 -0.42; p&lt;0.001) with a R² of 0.28. The AUC to predict a peak VO2 ≥20 ml.kg-1.min-1 based on TUG was 0.80 (IC95% 0.74-0.86; p&lt;0.001) and the best cut point ≤5.47s (sensitivity 83% and specificity 63%). Based in 134 patients (2/3 of the total), the following equation was described to peak VO2 prediction based in TUG results: peak VO2= 33.553+ (-0.149*age) + (-0.738*TUG) + (-2.870*sex); male=0, female=1. In the validation population (1/3 of the total), the peak VO2 estimated by TUG was 18.8±3.2 ml.kg-1.min-1 and the CPET measured was 18.1±5.9 ml.kg-1.min-1 (p &gt; 0.05).

Conclusion
TUG and peak VO 2 were moderately but significantly associated. A equation to predict peak VO2 based on TUG was described and validated with good performance. Achieving 5.47s or less in TUG was related levels of peak VO2 that are related to better prognosis.
Enhancement of left ventricular compliance in twin pregnancy
Authors: Pellegrino A , Toncelli L , Pasquini L , Mecacci F , Pedrizzetti G , Modesti P A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The knowledge of maternal left ventricular adaptation in twin pregnancies is incomplete.

Purpose
The objective of this study was to longitudinally investigate maternal changes of left ventricular (LV) function and compliance in twin pregnancies.

Methods
Thirty-five women (age 35.3±4.8 years) with uncomplicated twin pregnancy were enrolled to undergo transthoracic echocardiography at 10-15 (T1) and 30-38 (T3) week’s gestation. Left atrial (LA) and LV dimensions, LV volumes and mass, diastolic parameters (at pulsed wave Doppler and tissue Doppler), global longitudinal strain (GLS) at speckle-tracking imaging, and non-invasive pressure-volume curves (PV loops) were measured and calculated.

Results
Maternal LA and LV dimensions, LV volumes and mass had an increasing trend from T1 to T3 (p&lt;0.001 for all). E/A remained stable, while E/e’ ratio slightly increased during gestation. GLS showed no changes between the two visits. At PV loops analysis (Figure 1), LV end-systolic elastance (Ees) and arterial elastance (Ea) both decreased, with no changes in ventricular-arterial coupling (VAC). LV end-diastolic volumes increased from T1 to T3 with no changes in LV end-diastolic filling pressure; the rightward shift of the end-diastolic pressure-volume relationship (EDPVR) suggested enhanced LV cavity compliance (Figure 2). An increase in stroke work was observed.

Conclusions
During twin pregnancy GLS and VAC were not modified showing functional adaptation to enhanced haemodynamic load. Importantly, stroke work increase was sustained by enhancement in LV end-diastolic volume with unaltered filling pressure.
Differences in trends in blood pressure and lipid assessment in patients with and without depression with atherosclerotic cardiovascular disease
Authors: Summers R , Ellins E A , Halcox J P J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation.

Background
Patients who have atherosclerotic cardiovascular disease (aCVD) and depression are at increased risk of future CVD events compared to those without depression. The reasons for this are not fully understood. Appropriate management of aCVD risk factors (RF) including blood pressure (BP) and Lipids are essential for secondary prevention.

Aim
To explore BP and lipid assessment over time in patients with aCVD with and without depression, in the Welsh population.

Methods
A retrospective observational cohort study of patients with aCVD was conducted using individual level linked electronic health record data between 2009 & 2019 using the all-Wales SAIL databank. Clinical codes were used to identify aCVD and depression diagnoses, and BP and lipid assessments from GP data. Numbers having assessment of BP and/or lipids during each calendar year were documented.

Results
In 2009, the cohort consisted of 183,275 (F=44.2%, mean age= 69.6 (SD=12.3)). 58.5% of patients had both BP and lipid assessments in that year, with 15.1% having BP only, 2.8% lipid only and 23.6% with neither. Over the subsequent 10y, the proportion with neither BP or lipid checks (23.6% 2009 vs 31.7% 2019, Fig 1.A) and the proportion with only one or neither RF checked increased (Fig 1.A). When comparing those with a history of depression to those without, the worsening trend over time was similar, but patients without depression were more likely to have neither RF checked (13.6% in those with depression vs 26.4% in those without in 2009 and 22.3% vs 35.7% respectively in 2019 Fig 1.B).

Conclusion
These data show a concerning trend for BP and lipids to be checked less rigorously for secondary prevention of aCVD. Although historically aCVD patients with a history of depression are more likely to have a worse outcome, RF assessment is more comprehensive in these patients in Wales. Whether differences in RF control may contribute to variation in outcomes between those with and without depression remains to be determined.
Long-term clinical impact of patients with multi-vessel involved non-obstructive coronary artery disease
Authors: Jung J , Lee S N , Her S H , Yoo K D , Moon K W , Moon D G , Jang W Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Yuhan Corporation, Seoul, Korea.

Background
Although non-obstructive coronary artery disease (CAD) was a relatively common finding in patients undergoing coronary angiography (CAG), it had previously been characterized as "insignificant CAD" and underestimated in importance. However, recent studies have increasingly showed that non-obstructive CAD is also associated with poor clinical outcomes. But the long-term clinical impact of multi-vessel involved non-obstructive CAD are not yet well-known.

Purpose
The aim of the present study was to determine the long-term clinical impact on patients with multi-vessel involved non-obstructive CAD.

Methods
A total of 2,083 patients without obstructive CAD and revascularization history were enrolled between January 2010 and December 2015. They were classified into 4 groups according to the number of vessels involved non-obstructive CAD (25%≤ luminal stenosis &lt; 70%): 0, 1, 2, 3 diseased vessel (DV). We followed patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs) defined as a composite of cardiac death, myocardial infarction (MI) and stroke. The secondary outcomes were each component of the primary outcome and all-cause death.

Results
2,083 patients were classified into four groups according to the number of non-obstructive DVs (0 DV: 251 [60%],1 DV: 506 [24%], 2 DV: 250 [12%], 3 DV: 76 [4.0%]). The occurrence of MACCEs numerically increased as the number of non-obstructive DV increased, especially in 3 DV (MACCEs, 0 DV: 78 [6.2%], 1 DV: 33 [6.5%], 2 DV: 17 [6.8%], 3 DV: 14 [18.4%], p&lt;0.001). After adjustment, patients with non-obstructive 3 DV still showed significantly poorer clinical outcomes than 0 DV in terms of MACCEs, MI and stroke. (MACCEs: hazard ratio [HR] 2.09, 95% confidence interval [CI] 1.15-3.79, p=0.016; MI: HR 15.17, 95% CI 2.37-97.25, p=0.004, Stroke: HR 2.04, 95% CI 1.01-4.16), P=0.049) Conclusions. Multi-vessel involved non-obstructive CAD, especially in 3 DV, was associated with poor long-term (5 years) clinical outcomes. Theses finding suggested that more intensive treatment may be required in this subset of patients.
Comparison of SCORE and SCORE 2 model for cardiovascular risk stratification in men and women from high risk European country
Authors: Giga V , Boskovic N , Djordjevic-Dikic A , Beleslin B , Nedeljkovic I , Stojkovic S , Burazor I , Tesic M , Jovanovic I , Paunovic I , Aleksandric S , Dedic S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
European Society of Cardiology has recently introduced new SCORE 2 algorhythm for cardiovascular risk assessment in apparently healthy individuals. However, there are limited data from high risk countries on CV risk stratification and potential gender differences in risk estimation using SCORE 2 model.
The aim of the current study was to compare risk prediction using SCORE 2 and previous SCORE model and to assess the potential gender differences in risk estimation.

Methods
Our study included 1361 apparently healthy individuals (mean age 56±9 years, 61% women) without known CV disease or risk factors aged 40 to 70 years old. Data on CV risk factors were prospectively collected in 20 primary care centers throughout Serbia from January 2020 to December 2020. CV risk was assessed both by SCORE and SCORE 2 model. Based on CV risk profile individuals were stratified in three categories: low to intermediate, high and very high risk category.

Results
In overall population using SCORE model 57.6% of individuals were in low-intermediate group, 20.9% were classified as high risk group and 21.5% as very high risk group. By the use of SCORE 2 model 1046/1361 (77%) individuals were shifted to higher risk category (Figure). In comparison to men women had lower both systolic (139 ± 19 mmHg vs 144 ± 18 mmHg in men p &lt; 0.001) and diastolic (84 ± 9 mmHg vs 88 ± 10mmHg in men, p &lt; 0.001 )blood pressure, lower BMI (26.4 ± 0.5 kg/m2 vs 27.4 ± 5.0 kg/m2 in men, p= 0.036) and higher values of HDL cholesterol (1.5 ± 0.5 mmol/L vs. 1.3 ± 0.4 mmol/L in men, p &lt; 0.001). Smoking was more prevalent in men (49%) than in women (42%), p=0.04. There were no gender differences in age (56 ± 9 years for both genders) and non-HDL cholesterol ( 4.86 ± 1.24 mmol in men vs. 4.75 ± 1.23 mmol/l in women, p= 0.100). More women (85.9%) than men (62.6%) were shifted in higher risk category using SCORE 2 in comparison to SCORE (p &lt; 0.001) (Figure).

Conclusion
By the use of SCORE 2 instead of SCORE prediction model for CV risk stratification in contemporary high risk European population significant proportion of apparently healthy individuals are shifted to higher risk category. In spite of having better CV risk factors profile, more women than men were shifted in higher risk category.
Cardiac Rehabilitation Phase 3 - Who are those who continue down the path?
Authors: Alves Da Silva P , Aguiar-Ricardo I , Martins A M , Gregorio C , Abrantes A , Pinto R , Bento B , Caldeira E , Miguel S , Pinto F J , Abreu A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac Rehabilitation is recommended as secondary prevention in those patients with cardiovascular disease. Efforts to increase referral of patients after hospitalisations have been made in order to increase adherence to phase 2 CR programs. However, there are still few data regarding adherence after completion of phase programs regarging progressing to phase 3 programs.

Purpose
To characterize a population of patients who enrroled in a phase 3 CR program.

Methods
Prospective cohort study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. We analyzed prevalence of risk factors, lab echocardiographic and CPET data at beggining and 6 months after FUP. Possibility of attendance of a phase III CR program on a nearby gym was offered to everyone. Statistical analysis between both groups was performed with Chi-Squeare and Wilcoxon tests.

Results
We analyzed 336 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. Phase 3 program in a nearby facility was offered to everyone. Of those, 217 pts (mean age 59 +- 11,4 years-old, 80% male) chose not to continue and 119 pts (mean age 61 +- 11,3 years old, 81% male) were enrolled in the program. There were some differences among the two groups: ischemic heart disease was more prevalent in those who didn’t progress to Phase III (83% vs 66%, p=0.02) and, regarding risk factors, we noted a higher prevalence among those who enrolled in phase III, namely hypertension (77% vs 88%, p=0.04) and previous smoking habits (64,2% vs 71,1%, p=0.02). There were no significant differences regarding lab and echo data at the end of the program, especially ejection fraction, NTproBNP and LDL cholesterol. We failed to find differences between CPET data after 6 months follow up, although such findings might be limited by the scarcity of data in the group who transitioned to phase III.

Conclusions
Patients with a higher burden of risk factors showed higher interest in progressing to a phase III program. We did not find differences in cardiorrespiratory fitness evaluated by CPET, although more robust data would be needed to back such observations.
Characterization of atrial substrate to predict AF ablation success
Authors: Bergonti M , Spera F , Gonzalez Ferrero T , Nsahlai M , Heidbuchel H , Valderrabano M , Rodriguez Manero M , Sarkozy A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The study has been financially supported by an investigator-initiated research grant by Biosense Webster (Study ID – IIS-532) (MRM)

Background
Left atrial (LA) substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low-voltage zones (LVZ), transition-zones (TrZ) and AF recurrence in patients undergoing pulmonary vein isolation (PVI).

Methods
We conducted a prospective multicenter study on consecutive patients undergoing PVI-only approach. LVZ and TrZ (0.5-1mV) were analyzed offline on high-density electroanatomical maps collected prior to PVI.

Results
262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow-up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF were associated with recurrence (HR=4.4 [2.0-9.8], p&lt;0.001 and HR=1.9 [1.1-3.7], p=0.045, respectively). Significant linear association was found between LVZ and TrZ and between LVZ and left atrial volume index (LAVI) (both p&lt;0.001). One-third of patients had significantly increased LAVI without LVZ. Eight percent of the patients had LVZ despite normal LAVI. Older age, female sex, oncological history and increased AF recurrence characterized this latter subgroup.

Conclusions
In patients undergoing first PVI, the impact of LVZ on outcomes occurs with lower burden in paroxysmal than persistent AF suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZ, suggesting a continuous fibrotic substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZ but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI.
Opposite evolution on voltage and thickness from paroxysmal to persistent AF
Authors: Silva Garcia E , Banez V , Gonzalez M , Puche J E , Gomez A , Cano L , Fernandez R , Fernandez M , Fernandez-Armenta J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is a controversy about correlation between voltage and thickness in the atrial myocardium and their evolution from paroxysmal to persistent atrial fibrillation (AF).

Purpose
This is an observational study to compare voltage and thickness of different areas on the left atrium in paroxysmal and persistent atrial fibrillation.

Methods
43 patients underwent first procedure atrial fibrillation ablation. Points with electrical information from an electroanatiomical map in sinus rhythym were acquiered during the ablation procedure covering the whole atrial surface. CT was acquired in all patients before the procedure and endo- and epicardium from the atrium was segmented for the atrial thickness calculation. All the points from the electromecanical map were projected on the thickness map to have both information on the same location. 3D atrium was segmented in 5 areas for the analysis: Lateral, Anterior, Septal, Posterior and Roof (Figure 1). Voltage and thickness values among different areas and between AF type were compared.

Results
30 paroxysmal and 13 persistent AF patients were analyzed acquiring 435±192 points per patient and 87±55 points per patient/area (20884 points in total). There was no linear correlation between voltage and thickness comparing all the patients nor among different areas nor between AF type (R&lt;0.2 in all cases).
Regarding paroxysmal AF patients, septum showed significatly lower voltage compared with the other segments, posterior, lateral, anterior and roof (1.4±1.3mV*, P&lt;0.001). The roof showed the highest voltage (2.3±1.7mV). The thickness analysis showed the septal segment as thinner segment and lateral as thicker segment (1.4±0.6mm,1.7±0.9mm, P&lt;0.001) (Figure 2).
Regarding persistent AF patients: septum showed significatly lower voltage (1±0,9mV*)compared with the other segments. Roof showed higher voltage(2±1.7mV) (Figure 2). The thickness analysis showed the anterior segment as thinner segment and lateral as the thickest segment (1.6±0.8mm, 1.9±0.9mm, (P&lt;0.001) different like on paroxysmal AF population.
Comparing voltage and thicknes between paroxysmal and persistent AF, all the segments on persistent population showed lower voltage values, with significant differences on all segmentes but the lateral one. On the other hand, all segments on persistent population showed statisticaly signignificant thicker myocardium in camparison with paroxysmal population (Figure 2).

Conclusions
According to our findings, there is no linear correlation between voltage and thickness. Persistent AF atria show thicker walls but with lower voltages in comparison with paroxysmal AF atria.