bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel equation for skeletal muscle mass estimation is useful for predicting mortality in patients with heart failure
Authors: Honma S , Katano S , Nagaoka R , Numazawa R , Kouzu H , Ohori K , Nishikawa R , Ohwada W , Nagano N , Koyama M , Katayose M , Kobayashi C , Yoshioka N , Hashimoto A , Yano T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Skeletal muscle mass in heart failure (HF) patients is closely related to exercise tolerance and prognosis. Although the dual-energy X-ray absorptiometry (DEXA) method is a standard method for measuring skeletal muscle mass, it is not suitable in a daily clinical setting since it is a costly and hospital-based modality. We recently reported that an equation for appendicular skeletal muscle mass index (ASMI) estimation using anthropometric parameters predicted DEXA-measured ASMI in HF patients with reasonable accuracy. Here, we examined the prognostic impacts of ASMI predicted by the equation (predicted ASMI) in HF patients.

Methods
Data for 539 patients with HF ( 73 ± 14 years old, 43% female) who received the DEXA method and measurements of calf circumference (CC) and mid-arm circumference (MAC) between August 1, 2015, to August 31, 2020, were used for analyses. DEXA measured-appendicular skeletal muscle (ASM) was calculated as the sum of bone-free lean masses in the arms and legs, and ASMI was defined as ASM/height². Predicted ASMI was calculated as we previously reported: predicted ASMI (kg/m²) = [0.214 × weight (kg) + 0.217 × CC (cm) - 0.189 × MAC (cm) + 1.098 (male = 1, female = -1) + 0.576]/height² (m²). Low ASMI was defined as &lt;7.0 kg/m² in males and &lt;5.4 kg/m² in females, respectively. The primary endpoint was all-cause death. Multiple imputation using chained equations was used for the substitution of missing values.

Results
The median follow-up period was 1.75 years (interquartile range, 0.96 to 2.37 years), and 73 patients (15%) has died. Kaplan-Meier survival curves showed that patients with low DEXA measured-ASMI and patients with low predicted ASMI had significantly lower survival rates than those with high ASMI (Figure 1). In a multivariate Cox proportional hazard analyses adjusted for age, sex, logarithmic B-type natriuretic peptide, cystatin C based-estimated glomerular filtration rate, and gait speed, DEXA-measured ASMI [hazard ratio (HR), 0.982; 95% confidence interval (CI), 0.967 to 0.988; p&lt;0.001] and predicted ASMI (HR, 0.979; 95% CI, 0.962 to 0.996; p=0.018) were independent predictors of all-cause mortality, respectively. Inclusion of predicted ASMI into the adjustment model improved the accuracy of prediction of the mortality after discharge [continuous net reclassification improvement, 0.338, p&lt;0.01; integrated discrimination improvement, 0.020, p &lt; 0.05] (Figure 2).

Conclusions
ASMI estimated by an equation using CC and MAC predicted the prognosis of HF patients at a similar level of accuracy to DEXA-measured ASMI, and it can be applied to the assessment of skeletal muscle mass in a daily clinical setting and in large population-based studies.
Telerehabilitation in patients with recent hospitalization due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial
Authors: Van Leunen M , Spee RF , Lu Y , Kemps HMC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/introduction
Cardiac rehabilitation (CR) has favourable effects in chronic heart failure (CHF) patients on exercise capacity, the risk at hospital (re-)admission and quality of life. Although CR is generally recommended, it is still under-utilized in the daily clinical practice partly due to logistics reasons, limited availability, and patient-related barriers. Cardiac telerehabilitation (CTR) could solve some of these barriers, and have the same favourable outcomes.

Purpose
The aim of this study is to investigate if CTR in recently hospitalized CHF patients improves their physical functional capacity when compared to no rehabilitation.

Methods
This randomised controlled trial compares CTR with no rehabilitation after hospitalization for acute decompensated heart failure (ADHF). 64 patients will be included during hospitalization, and start with Remote Patient Management (RPM). After a short period of stable CHF, the patients will be randomised for RPM combined with CTR (intervention group), or RPM alone (control group). The intervention group will start with an 18-weeks program with exercise training, supported by a (remote) technology-assisted dietary intervention and mental health guiding. The training program starts with three centre-based and two home-based video training sessions followed by video coaching sessions. The primary endpoint is physical functional capacity, evaluated using the Short Physical Performance Battery (SPPB) score. Secondary endpoints are recovery after submaximal exercise by evaluating VO2 recovery kinetics (τ-rec), subjective health status, health related quality of life, compliance and acceptance, and readmission rate.

Future implications
This will be the first study to use an CTR program with integrated RPM after hospitalization for ADHF.
Effects of the addition of high- vs. low-intensity resistance training on top of endurance training in patients with heart failure: preliminary results from a randomized clinical trial
Authors: Gojevic T , Turri Da Silva N , Gelade K , Jacobs G , Pirlotte R , Tulleneers B , Kissembeek B , Duchateau A , Mullens W , Hansen D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University

Background
Adding resistance training on top of endurance training is recommended in the rehabilitation of patients with heart failure. However, it is unknown which intensity of resistance training should be preferred.

Purpose
To compare the effects of the addition of high- vs. low-intensity resistance training on top of endurance training in patients with heart failure.

Methods
Nineteen patients with heart failure were block randomized (by gender and sex) in a combined high-intensity resistance and endurance group (HIG; n=8, age=61±12y, 7 males, LVEF=38±10%) vs. combined low-intensity resistance and endurance group (LIG; n=9, age=68±21y, 8 males, LVEF=38±13%). Patients trained 3x/week for 45 sessions. The resistance exercises were volume-matched between groups and consisted of three sets of leg press, pull down and dip exercises, separated by 30s of rest, done at 55-70% 1RM in HIG vs. 35-40% 1RM in LIG. Both groups did moderate-intense endurance training on a bicycle, cross-trainer, treadmill and arm ergometer for 30 min per training. Maximal oxygen consumption was evaluated with an incremental cardiopulmonary cycling test and muscle strength by 1-RM testing, while quality of life was assessed with the Minnesota questionnaire, and walking distance by a 6-minute walking test. Mann-Whitney U test was used for analyzing differences between groups in all variables and Wilcoxon signed-rank test for evaluating pre-post difference of the entire sample. P values &lt;0,05 (2-tailed) were considered statistically significant.

Results
Training adherence was similar in both groups (LIG vs HIG: 41±6 vs 37±9 sessions, p=0,370; Table 1). Overall, the intervention improved maximal oxygen consumption, walking capacity and muscle strength (p&lt;0,05), but the between-group changes in maximal oxygen consumption (LIG vs HIG: 3±2 vs 3±4 ml/kg/min, p=0,963), quality of life (LIG vs HIG: -8±23 vs -1±5 points, p=0,931) and muscle strength (LIG vs HIG: Dip 34±34 vs 18±20kg, p=0,481; Leg press, 66±87 vs 47±53kg, p=0,486; Pull down, 9±6 vs 9±7kg, p=0,574) were similar.

Conclusion
Adding either high- or low-intensity resistance training on top of endurance training seems equally effective for improving aerobic capacity and walking performance in patients with heart failure. The study is ongoing.
The efficacy of high-load resistance training in combination with aerobic training in patients with coronary artery disease: a dose-dependent randomised, controlled clinical trial
Authors: Kambic T , Hadzic V , Sarabon N , Lainscak M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency

Background
The combination of resistance training (RT) and aerobic training (AT) was shown to be superior compared to AT, although most studies applied only low-loads (LL) to moderate-loads in RT. Therefore, it remains to be elucidated whether high-load (HL) RT elicits greater improvement in maximal aerobic capacity and maximal muscle strength compared to low-load (LL) RT in combination to AT in patients with coronary artery disease (CAD).

Purpose
The aim of our study was to investigate the effects of HL-RT and LL-RT combined with AT in comparison to AT on maximal aerobic capacity, muscle strength and health-related quality of life.

Methods
We randomised 79 patients with CAD to HL-RT+AT (70 %-80% of one repetition maximum [1-RM]), LL-RT+AT (35%-40% of 1-RM) or AT group and 59 patients with mean (SD) age 61 (8) years and left ventricular ejection fraction 53 (9) % completed 12 weeks (36 training sessions) of the study. After the initial ambulatory screening by cardiologist and cardiopulmonary exercise test, patients were familiarised with proper lifting and breathing technique, and performed 1-RM test on leg press machine. During the training, the RT load progressively increased from 70% of 1-RM (6–11 repetitions per set) to 80% of 1-RM (6–8 reps per set) in HL-RT group and from 35% of 1-RM (12–22 reps per set) to 40% of 1-RM (12–16 reps per set) in LL-RT group in the first seven weeks of the intervention. Following re-evaluation of 1-RM, the training load in HL-RT group was progressed from 70% 1-RM (11 reps per set) to 80% 1-RM (6–8 reps per set), and the load in LL-RT group was progressed from 35% 1-RM (22 reps per set) to 40% 1-RM (12–16 reps per set). All patients performed AT consisted of 3-5 min of work-load interval cycling separated by 2 min of unloaded cycling progressing from 50% to 80% maximal workload achieved at baseline cardiopulmonary exercise test. We measured maximal aerobic capacity (VO2 max), maximal voluntary contraction (MVC) and quality of life at baseline and post-training.

Results
Exercise training was safe and associated with improvement in VO2 max (p &lt; 0.01) in all training groups, whereas only LL-RT and HL-RT group improved MVC (both p &lt; 0.001). Following training, VO2 max increased more in HL-RT group compared to AT group (+18 %, p = 0.032), and MVC increased more in HL-RT group compared to LL-RT group (+7 %, p = 0.018) and AT group (+16 %, p &lt; 0.001). HL-RT group improved mental functioning component of short form 12-item quality of life questionnaire (+6 points, p = 0.003), with no significant difference compared to other training modalities.

Conclusions
RT on top of routine CR management, is safe and efficacious training modality for patients with CAD enrolled in cardiac rehabilitation.
High prevalence of complex coronary artery lesions in sport-related myocardial infarction. Contemporary data from the RICO survey
Authors: Chague F , Kouame I , Porot G , Lhuilier I , Maza M , Saint Jalmes M , Bichat F , Laurent G , Zeller M , Cottin Y 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Agence régionale de santé de Bourgogne Franche-Comté

Background
Underlying mechanisms for sport-related acute myocardial infarction (SR-AMI) are only poorly understood. Moreover, their coronary artery disease (CAD) characteristics and lesion complexity are poorly described.

Purpose
To characterize coronary angiographic feature of patients with SR-AMI

Methods
From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were retrospectively analysed. SR-MI was defined as MI occurring during sport activity or within the first hour of recovery.

Results
Among the 174 patients included, most were male (n=157(91%)). Median (IQR) age was 59 y (48-66), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The SR-MI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced pre-hospital (PH) sudden cardiac arrest (SCA) (17%). Atherothrombotic risk factors were dyslipidaemia (32%), current smoking (31%) or hypertension (28%). A history of CAD was documented in 31 (18%) patients. Most (n=156(91%)) had significant lesions, of whom 140 (81%) were considered as culprit. Culprit lesions were located on left anterior descending (39%), circumflex (14%) and right coronary artery (33%). Median (IQR) Syntax score was 10.5 (6-15). The vast majority of patients (n=152 (87%)) had at least one complex lesion; 114 of them had several characteristics of complex lesion. Lesions were eccentric in 68 (39%) patients; an intraluminal thrombus was documented in 85 patients (49%), in 55% of STEMI and 37% of non-STEMI (p =0.027). However, 18 subjects (10%) had optically normal coronary angiogram or non-significant lesions, suggesting alternative mechanism such as type 2 MI. Treatment of the lesions was mainly achieved by PCI and/or stenting (n=132(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 11 patients (6%), of whom 10 experienced a PH-SCA and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Among the 5 patients treated with extracorporeal membrane oxygenator, only one survived.

Conclusion
In our large retrospective study, SR-MI was commonly associated with complex coronary lesions, often characterized by intraluminal thrombus. Our findings suggest that the mechanisms of these events could be mainly related to type 1 MI patterns Moreover, PH-SCA was frequent, thus justifying mass-education to basic life support and deployment of automated external defibrillators, especially in the sport settings.
SARS-CoV-2 infection and return-to-play in junior competitive athletes: is systematic cardiac screening needed?
Authors: Cavigli L , Cillis M , Mochi V , Frascaro F , Mochi N , Hajdarevic A , Roselli A , Capitani M , Alvino F , Lisi C , Mandoli GE , Valente S , Focardi M , Cameli M , D'ascenzi F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
SARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents that are less susceptible to adverse clinical outcomes and are often asymptomatic.

Purpose
We conducted this prospective multi-centre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return-to-play.

Methods
Junior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting electrocardiogram (ECG), echocardiogram, and exercise ECG testing. Further investigations were performed in cases of abnormal findings.

Results
A total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%), and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation were found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return-to-play was achieved after complete clinical resolution.

Conclusions
The prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms, ECG abnormalities and arrhythmias at rest and/or during exercise should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.
Cardiovascular screening in olympic athletes before and after SARS-CoV-2 infection
Authors: Maestrini V , Filomena D , Birtolo L I , Monosilio S , Tatangelo M , Penza M , Serdoz A , Fiore R , Lemme E , Squeo M R , Fedele F , Gualdi G , Spataro A , Pelliccia A , Di Giacinto B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Conflicting results on the cardiovascular involvement after SARS-CoV-2 infection generated concerns on the safety of return-to-play (RTP) in the athletic population. However, these data are mainly based on Troponin and imaging findings.

Purpose
Aim of the study was to evaluate the prevalence of cardiac involvement after COVID-19 in Olympic athletes, who had previously been screened in our pre-participation program.

Methods
Since November 2020, all consecutive Olympic athletes presented to our Institute after COVID-19 prior RTP were enrolled. The protocol was dictated by the Italian governing bodies and comprised: 12-lead ECG, blood test, cardiopulmonary exercise test (CPET), 24-hours ECG monitoring, spirometry. Cardiovascular Magnetic Resonance (CMR) was also performed. All Athletes were previously screened in our Institute as part of their periodical pre-participation evaluation.

Results
Forty-seven Italian Olympic athletes were enrolled: 83% asymptomatic, 13% mildly asymptomatic, 4% had pneumonia. The evaluation was performed after a median of 9 days from negative SARS-CoV-2 swab. Uncommon premature ventricular contractions (PVCs) were found in 13% athletes, however, only 6% (n=3) were newly detected. All newly diagnosed uncommon PVCs were detected by CPET. One of these three athletes had evidence for acute myocarditis by CMR, along with Troponin raise; another had mild pericardial effusion. No one of the remaining athletes had abnormalities detected by CMR (Figure).

Conclusions
Cardiac abnormalities in Olympic athletes screened after COVID-19 resolution were detected in a minority and were associated with new ventricular arrhythmias. Only one had evidence for acute myocarditis (in presence of symptoms and elevated biomarkers). No one of the remaining athletes had abnormalities by imaging or laboratory test. Our data support the efficacy of the clinical assessment including exercise-ECG to raise suspicion for cardiovascular abnormalities after COVID-19. Instead, the routine use of CMR as a screening tool appears not justified.
Low prevalence of cardiac abnormalities in competitive athletes before the return-to-play after COVID-19 based on the italian strategy
Authors: Penza M , Filomena D , Birtolo L , Monosilio S , Serdoz A , Fiore R , Mango R , Lemme E , Squeo M , Fedele F , Gualdi G , Spataro A , Pelliccia A , Di Giacinto B , Maestrini V 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Conflicting results on the cardiovascular involvement after SARS-CoV-2 infection generated concerns on the safety of return-to-play (RTP) in the athletic population. However, data are limited to the approached based on Troponine, ECG and echocardiogram while the data on exercise test are scarce.

Purpose
Aim of the study was to evaluate the prevalence of cardiac involvement after COVID-19 in competitive athletes for the RTP applying a comprehensive cardiovascular evaluation.

Methods
Since October 2020, all consecutive competitive athletes (age≥14 years) presented to our Institute after COVID-19 prior RTP were enrolled. The protocol was dictated by the Italian governing bodies and comprised: 12-lead ECG, blood test, cardiopulmonary exercise test (CPET), 24-hours ECG monitoring, spirometry. Cardiovascular Magnetic Resonance (CMR) was performed based on clinical indication.

Results
219 competitive athletes were enrolled (59% male), age 23 years (19,27): 20% asymptomatic, 77% mildly asymptomatic, 2% had pneumonia. The evaluation was performed after a median of 10 days (6-17 days) from negative SARS-CoV-2 swab. All athletes had a good performance at CPET. Uncommon premature ventricular contractions (PVCs) were found in 10% (n=21) and were detected by CPET. Two athletes (1%) were finally diagnosed with acute myocarditis (confirmed by CMR) and another had newly diagnosed mild pericardial effusion (Figure). All the three athletes were temporally refrain from sport participation.

Conclusions
Cardiac abnormalities in competitive athletes screened after COVID-19 resolution were detected in a minority of the cases (1.4%). No one of the remaining athletes had abnormalities by imaging or laboratory test neither reduction in cardiopulmonary fitness. Our data are in line with those reporting low prevalence of cardiovascular complication in mildly symptomatic or symptomatic athletes.