bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of the method of calculating the Ve / VCO2 slope on its value in a cohort of 700 successive Cardiopulmonary exercise testing
Authors: Lamotte M , Chaumont M , Forton K , Gillet A , Strapart J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
The Cardiopulmonary exercise testing (CPET) is the gold standard for cardiorespiratory and metabolic function at exercise. This CPEThighlight the limiting factors, but also provides prognostic indicators. Among the prognostic factors, maximal oxygen uptake (peak VO2) has been used for many years, particularly in heart failure, but some studies have highlighted the limitations of isolated use of peak VO2. The measurement of the Ve / VCO2 slope is currently recognized as having a complementary prognostic value. However, the manner of determining the Ve / VCO2 slope is not universally established. A single CPET could therefore deliver several slope measurements depending on the method used to calculate it. This lack of clarity would lead to possible variations affecting the reflection of the severity of the disease or the prognostic power of this parameter.
Our work consisted in calculating and comparing, over nearly 700 successive CPET, the slope Ve / VCO2: 1) by calculating it up to SV1, 2) by calculating it up to SV2, 3) by the calculating on all the data beyond SV2 (in the 44% of patients in whom SV2 could be determined). The patients were classified according to the indication of the examination in 1) cardiac (54%), 2) pulmonary (15%), 3) dyspnea assessment (10%) and 4) various (oncology, obesity, diabetes, rheumatic disease: 21%). The "cardiac" category was subdivided into HTP, IC, operated CPI and non operated CPI) (results not detailed in this abstract).
We have found systematic and significant differences depending on how the slope is calculated. On the whole population: in patients who did not reach SV2 (n = 389), the Ve / VCO2 slope reaches 33.8 +/- 8.5 when it is calculated up to SV1 while it reaches 38.5 + / - 8.7 (p &lt;0.001) when it is calculated over the entire CPET. On the whole population: in patients with SV2 (n = 308), the Ve / VCO2 slope reaches 29.4 +/- 5.9 when it is calculated up to SV1, 33.5 +/- 6 (p &lt;0.001) when it is calculated up to SV2 and 37.8 +/- 6.9 (p &lt;0.001 and p &lt;0.001) when it is calculated over the entire examination. When we analyze in more detail the population according to the indication of the examination, we observe differences of 3.8 to 5.2 units depending on the calculation method in patients not achieving SV2 and from 7 to 8.5 units. depending on the method of calculation in patients exceeding SV2. In subdivisions of the cardiac population the differences are also large : for example in HTP, the values ranging from 34.7 +/- 7.1 to 42.9 +/- 8.9 (p &lt;0.001) depending on the calculation method.
Our work highlights that the way of determining the Ve / VCO2 slope greatly influences its value. The significant variations observed certainly limit the prognostic value of the Ve / VCO2 slope and homogenization of the calculation method seems essential in order to improve its prognostic value.
Moderate-to-vigorous physical activity of HFrEF patients is strongly associated with age, but not with functional capacity (6MWT), ejection fraction, NYHA, NT-proBNP, sex or BMI
Authors: Siranec M , Vetrovsky T , Parenica J , Miklikova M , Pelouch R , Precek J , Vesely J , Griva M , Linhart A , Belohlavek J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council of the Ministry of Health of the Czech Republic

Introduction
Patients with heart failure with reduced ejection fraction (HFrEF) commonly have impaired functional capacity and exercise intolerance which negatively affect their daily living activities and quality of life. Patients’ level of moderate-to-vigorous physical activity (MVPA) remains low. A popular, easily incorporated into everyday life activity is walking, which at a pace of 5 km/h can be considered moderate intensity physical activity. We explored whether the level of MVPA in HFrEF patients is associated with certain demographic and clinical parameters.

Methods
We analysed baseline values of HFrEF patients recruited in a multicentre randomised controlled trial of a six-month walking intervention (WATCHFUL trial, ClinicalTrials.gov identifier: NCT03041610). Their physical activity was objectively measured over seven days using accelerometer ActiGraph wGT3X-BT worn on the waist. Weekly minutes of MVPA were calculated using Freedson (1998) algorithm. The association between minutes of MVPA and sex, age, body mass index (BMI), HF symptoms (NYHA class), left ventricular ejection fraction (LVEF), serum levels of NT-proBNP, and distance walked in a six-minute walk test (6MWT) was explored in a series of univariate and multivariate linear regression models.

Results
One hundred twenty-two patients were included in the analysis (31 females and 81 males, age 63.2±11.7 years, BMI 30.1±5.4, NYHA class II/III: 99/13, LVEF 30.5±7.0%, NT-proBNP 1169±1888 ng/L, 6MWT 365±61 m). They accumulated 33.8±40.3 min/week of MVPA. The weekly minutes of MVPA were negatively associated with patients' age: being one year older was associated with 1.8 min (SE 0.3) less MVPA (p &lt; 0.001). Neither sex, BMI, NYHA Class, distance walked in 6MWT, nor serum levels of NT-proBNP were associated with weekly minutes of MVPA.

Conclusion
Our results show that moderate-to-vigorous physical activity of HFrEF patients was strongly associated only with age. Surprisingly, commonly used prognostic markers of heart failure such as ejection fraction, NYHA, NT-proBNP, and functional capacity (6MWT) did not show significant. Neither did sex nor BMI. Exercise rehabilitation and increased physical activity improve functional capacity and should be regularly recommended, and even emphasised with age.
Home-based cardiac rehabilitation can reduce anxiety and depression in heart failure patients
Authors: Gois P , Magalhaes S , Alexandre A , Barreira A , Fernandes P , Ribeiro F , Schmidt C , Santos M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). CIAFEL, UnIC and UMIB are supported by national funds through Fundação para a Ciência e Tecnologia, I.P. [(UIDB/00617/2020), (UIDB/00051/2020 and UIDP/00051/2020), and (UIDB/00215/2020 and UIDP/00215/2020), respectively]. CS received an individual grant from CAPES [BEX 0554/14-6].

Introduction
The current COVID-19 pandemic has led to significant changes in physical and mental health and has become a major challenge for cardiac rehabilitation (CR) programs. CR is an essential component in the treatment of heart failure (HF), as it improves cardiorespiratory fitness and quality of life, as well as reducing hospitalization rates. COVID-19 pandemic increased social isolation, and the CR centers were closed. Center-based CR requires the patient to travel to the hospital, which increases the risk of SARS-CoV-2 infection in this high-risk population. In this context, home-based CR can be an excellent strategy to reduce the physical and mental consequences of the social isolation imposed by the COVID-19 pandemic.

Objective
To test the effectiveness of a home-based CR program on cardiorespiratory fitness and anxiety and depression levels in individuals with HF during covid-19 pandemic.

Methods
Forty-two individuals with HF (age: 61.3±12.0; LVEF: 37.5±11.2) were included in this study. The exercise training program consisted in 12 weeks of combined exercise training (2x/week; 60min/day, 60-80% VO2peak), with 4 supervised exercise sessions in the hospital context and the remaining at home. Patients were monitored using a heart rate monitor and weekly phone calls. The following parameters were evaluated: cardiorespiratory fitness through the 6-minute walk test (6MWT) and anxiety and depression levels through the Hospital Anxiety and Depression Scale (HADS).

Results
After the home-based CR program, there was a significant increase in the 6MWT of 49 meters (95%IC: 38 to 60; p&lt;0.001) and a significant decrease in anxiety levels of -1.12 points (95%CI: - 2.163 to -0.075 p=0.036). No significant changes were found in depression levels (p=0.954). Furthermore, the improvements in cardiorespiratory fitness were significantly associated with the reduction in the levels of anxiety (r= -0.281; p=0.028) and depression (r=: -0.278; p=0.030).

Conclusions
The home-based CR program was able to improve cardiorespiratory fitness and this improvement was associated with a decrease in anxiety and depression levels in individuals with HF. The results suggest that home-based CR can be an important strategy to minimize the physical and mental impact induced by social isolation imposed by COVID-19 pandemic in HF patients.
Left ventricular remodeling in patients with NSTEMI depending on the risk by the GRACE score
Authors: Maslovskyi VI , Mezhiievska IA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To identify the features of the structural and functional condition of the myocardium and diastolic transmitral blood flow in patients with NSTEMI depending from GRACE score.

Methods
90 patients with NSTEMI were examined. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes.
All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association.

Results
Patients were divided into two groups: the first - low and moderate risk, the second - high risk by GRACE score. Thus, it was determined that the patients of the second group in comparison with the first group there was a significant increase in the value of left atrium (40 mm vs. 36 mm, p = 0.03), the index of LA (20.9 mm / m2 vs. 19.2 mm / m2, p = 0.005). Arterial stiffness (AS) was 0.65 mm Hg / ml vs. 0.53 mm Hg / ml (p = 0.02), and aortic diameter index (idA) was 17.3 mm / m2 vs. 17.0 mm / m2 (p = 0.53). The ratio of LA to RA was 1.10 vs. 1.06 (p = 0.04). The Ve / Va ratioin the comparison groups was 0.61 vs. 0.74 (p = 0.02) (Tab. 1).
Analysis of structural-geometric remodeling of the left ventricle showed no statistically significant differences in the studied parameters in all comparison groups. In turn, the analysis of the nature of diastolic transmitral blood flow showed significant differences in the type of pseudonormalization in patients with low and moderate risk compared with high risk by GRACE score (9 (16.7%) vs. 14 (38.9%), p = 0.02).

Conclusion
The main statistical differences between the groups of low and medium risk compared to high according to GRACE score relate mainly to structural parameters.
Effects of once-weekly semaglutide on coronary outcomes in patients with type 2 diabetes mellitus with or at high risk for cardiovascular disease: insights from the SUSTAIN-6 trial
Authors: Kolkailah A , Aharonovich A , Lingvay I , Dobrecky-Mery I , Rasmussen S , Tetens Hoff S , Mcguire DK 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Nordisk A/S

Background/introduction
In the randomised, double-blind, placebo-controlled SUSTAIN-6 cardiovascular (CV) outcomes trial, once-weekly (OW) semaglutide (a glucagon-like peptide-1 receptor agonist), compared with placebo, reduced the risk of major adverse CV events (CV death, non-fatal myocardial infarction [MI], or non-fatal stroke) and the risk for revascularisation (pre-specified secondary outcome) in patients with type 2 diabetes mellitus (T2DM) with or at high risk for CV disease (CVD). However, the effects of OW semaglutide on composite coronary-specific outcomes have not been explored.

Purpose
The aim of these post-hoc, exploratory analyses was to assess the effects of OW semaglutide, compared with placebo, on composite coronary outcomes in the SUSTAIN-6 trial population.

Methods
In these post-hoc analyses of the SUSTAIN-6 trial, the following coronary outcomes were assessed with OW semaglutide (0.5 and 1.0 mg doses pooled) vs placebo, both in addition to standard of care: the main coronary outcome (composite of MI [both fatal and non-fatal] or coronary revascularisation [defined as coronary artery bypass graft surgery or percutaneous coronary intervention]); and the expanded coronary outcome (composite of MI, coronary revascularisation, or unstable angina). Coronary outcomes were assessed overall, as well as in subgroups with or without a prior coronary event (MI or coronary revascularisation) at baseline. Cox proportional hazards regression models were used to analyse time to first event for the outcomes.

Results
Overall, 3,297 patients were included in these analyses. Key cohort characteristics included a mean age of 64.6 ± 7.4 years with an average T2DM duration of 13.9 ± 8.1 years; 39.3% were female and 48.3% had prior MI or coronary revascularisation (32.5% and 40.3% for each prior event, respectively). The median follow-up duration was 2.1 years. The proportion of patients experiencing a first event was lower with OW semaglutide vs placebo for the main coronary outcome (6.1% vs 8.1%; hazard ratio [HR] 0.74 [95% confidence interval (CI) 0.57–0.97]) and the expanded coronary outcome (6.3% vs 8.6%; HR 0.73 [95% CI 0.56–0.94]) (Figure 1). The time to the first main coronary outcome event is shown in Figure 2. Prior coronary event status at baseline did not modify the treatment effects of semaglutide (all p-interaction &gt;0.05) (Figure 1).

Conclusions
In these post-hoc analyses of the SUSTAIN-6 trial, OW semaglutide reduced the risk of composite coronary outcomes vs placebo in patients with T2DM with or at high risk for CVD, irrespective of prior MI or revascularisation status. These findings support the beneficial effects of OW semaglutide in this high risk population.
Admission HbA1c and post-MI prognosis in patients without known diabetes: a meta analysis
Authors: Soman B , Sathyapalan T , Chattopadhyay S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The association between newly diagnosed abnormal HbA1c and post-MI prognosis is unclear. Previous meta-analyses have included studies with both diabetic and non-diabetic patients or subsets of these patients.

Purpose
To assess the association between HbA1c and post-MI prognosis in patients without known diabetes.

Method
Cohort studies (up to Oct 2021) were retrieved from PubMed and Embase. We included studies that compared events in patients with newly diagnosed hyperglycaemia on admission HbA1c to those without. Studies where the hyperglycaemic groups had mixed known and newly diagnosed patients were excluded. Pooled risk ratios (RRs) and the 95% confidence interval (CI) were calculated using random effect model to assess the association between newly diagnosed diabetes and pre-diabetes and in-hospital, 30-day and ≥1-year mortality and MACE.

Results
29 studies comprising 279719 patients were included. The pooled RR for in-hospital, 30-day and ≥1 year mortality in diabetic patients (Fig 1) were 1.94 [1.41-2.67], p&lt;0.0001; 1.55 [1.02-2.34], p=0.04 and 1.69 [1.50-1.90], p&lt;0.0001 respectively. Corresponding data for MACE were 1.78 [0.51, 6.18], p=0.36; 1.14 [1.01-1.28], p=0.03 and 1.40 [1.19-1.65], p&lt;0.0001. In prediabetic patients (Fig 2), the corresponding RR for mortality was 1.28 [1.06, 1.55], p=0.009; 1.05 [0.85, 1.29], p=0.66 and 1.49 [1.21, 1.84], p=0.0002 and for MACE it was 4.63 [1.80, 11.90], p=0.001; 1.19 [1.05, 1.36], p=0.008 and 1.57 [1.24, 1.99], p=0.0002.

Conclusions
High HbA1c at admission in patients without known diabetes is associated with worse post-MI outcomes both in diabetic and prediabetic groups.
Tricuspid valve repair versus a conservative approach in patients with functional tricuspid regurgitation undergoing mitral valve surgery. A systematic review and meta-analysis
Authors: K Awad A , Elseidy S , Elgenidy A , Elbadawy M A , Mohamad T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Tricuspid valve repair (TVR) at the time of mitral valve (MV) surgery is still a debatable part of literature whether to do a concomitant valve repair or not, and if TVR is indicated, whether to perform it in patients with severe functional tricuspid regurgitation (TR) or mild-to-moderate TR. We assessed the benefits of a concomitant TVR during MV surgery, focusing on mortality and echocardiographic TR-related outcomes.

Methods
Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of concomitant TVR during MV surgery on all causes, cardiovascular, non-cardiovascular mortality. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated using random-effects models.

Results
27 studies were included for a total of 5460 patients with mean follow up period of 80 months. During MV surgery doing a concomitant TVR has been associated with significant reduction in all-cause mortality (RR: 0.35, 95% CI [0.21 to 0.52], p&lt;0.00001), cardiac-related mortality (RR: 0.34, 95% CI [0.30 to 0.42], p&lt;0.00001), and non-cardiac related mortality (RR: 0.42, 95% CI [0.31 to 0.72], p=0.005). Furthermore, regarding echocardiographic TR outcomes, the presence of more-than-moderate TR (RR: 0.19; 95% CI [0.11–0.34], p = 0.001), TR progression (RR 0.04; 95% CI [0.01–0.07], p =0.001) were significantly lower in the TV repair group at a mean weighted follow-up of 60 months.

Conclusions
A concomitant TVR during MV surgery showed a significant improvement not only in cardiac-related mortality, non-cardiac-related mortality, but also in TR echocardiographic outcomes with long period of follow up.
The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme: a pilot randomised controlled study
Authors: Elfghi M , Jordan F , Dunne D , Gibson I , Mcevoy JW , Jones J , Sultan S , Tawfick W 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atherosclerotic risk factor modification plays an important role in reducing adverse outcomes in patients with atherosclerotic disease1. Despite the high prevalence of peripheral arterial disease (PAD) and strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive structured treatment for their atherosclerotic risk factors than patients with coronary artery disease2,3.

Purpose
We aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.

Methods
This is a pilot randomised controlled study comparing a risk factor modification intervention programme to standard healthcare, for the reduction of modified risk factors in PAD patients. Patients randomised to the intervention arm underwent a 12-week supervised programme adjusting their risk factors. Primary outcome was patients reaching target risk factor improvement.

Results
Seventy-five patients were randomised. 36 were allocated to Standard Healthcare. 39 completed a 12-week Structured Programme. There was no significant difference between groups in baseline demographics, incidence and severity of risk factors, mobility and quality of life.
At 12-weeks the intervention group showed a significant improvement in target body weight (6.7±9.57 p=0.002), waist circumference (7.4±9.5 p=0.001), HbA1c (4.12±7.22 p=0.009), total cholesterol (0.63±0.99 p=0.004), low-density lipoprotein (0.59±1.040 p=0.00), triglycerides (0.24±0.38 p=0.005), Mediterranean diet score (2.48±1.35 p=0.0001), Absolute Walking Distance (8.2±7.8 p=0.0001), Claudication Distance (9.2±7.4 p=0.0001). There was no significant difference in the change of any of the other risk factors.

Conclusion
Risk factor modification intervention programme can significantly aid PAD patients reach their target risk factor improvement goals.
Factors associated with hospital arrival time of acute stroke patients in rural India
Authors: Inamdar ANIKET 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Delays in the treatment of acute stroke leads to unfavorable prognosis. Shortening the delay time in the health care of these patients is essential in order to reduce the morbidity and mortality rates of this disease. Eligibility for acute stroke interventions depends on the time from symptom onset to hospital arrival. The socio-cultural profile in rural India is different from that in urban India. Lot of people in rural India prefer living in joint families, general level of education and awareness is low and they opt for alternative modalities of treatment for stoke. There is lack of adequate and fast transport facilities that worsen the scenario. Delay in arrival of acute stroke cases may be caused by organizational, educational, socioeconomic and demographic factors.

Purpose
This study was conducted to understand the factors associated with hospital arrival time of acute stroke patients in Rural India.

Materials and Methods
Hospital data of 27 acute stroke patients admitted to our clinic from January 2019 to December 2019 was retrospectively studied. Stroke was defined, according to the WHO definition, as 'rapidly developing clinical sign of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than of vascular origin'. Chi square test and Mann Whitney U tests were used to analyze the data.

Results
Only 8 (29.62%) patients arrived within 3 hours of stroke onset whereas 3 (11.11%) patients arrived after 12 hours. Mean and standard deviation of hospital arrival time in minutes for patients &lt; 50 years was 125±116, for 51-60 years was 279±127, for 61-70 years was 379±191 and for &gt;70 years was 1127±716.Younger patients reported significantly earlier than older ones (p &lt;0.001). Males reported earlier than females (p: 0.032). Patients with stroke onset in the night time arrived significantly late compared to stroke onset in the day time (p:0.001). Prior ayurvedic treatment delayed hospital arrival (p &lt;0.001).

Conclusions
A nationwide public awareness campaign is needed to improve the public awareness of stroke and importance of timely treatment when acute stroke symptoms are suspected. Lot of patients in rural India still delay emergency treatment of acute stroke due to preference to ayurvedic remedies which should be strongly discouraged. Gender and age bias need to be further studied and strategies to reduce the bias should be considered. This study shows that there is substantial room for reducing the time from symptom onset to hospital arrival in acute stroke. Strategies to improve stroke awareness and referral protocols together with the use of tele-medicine and mobile stroke unit should be considered to reduce the hospital arrival time.