bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical activity and heart failure: a forgotten indicator
Authors: Barradas M , Duarte F , Coutinho Dos Santos I , Resendes De Oliveira L , Serena C , Xavier Fontes A , Viveiros Monteiro A , Machado C , Dourado R , Santos E , Pelicano N , Pacheco M , Tavares A , Martins D 
Published: October 2022

Abstract

Introduction
Low physical activity may be associated with comorbidities, sedentary lifestyle or clinical worsening in heart failure (HF) patients. Cardiovascular implantable electronic devices (CIEDs) detect and analyse physical activity data that is often integrated in multifactorial algorithms for predicting HF decompensations, but its potential is probably underestimated.

Purpose
We hypothesized that low physical-activity levels, obtained from remote monitoring of CIEDs, help predict clinical outcomes in HF patients, independently from multifactorial algorithms.

Methods
We retrospectively evaluated consecutive patients with HF and CIEDs through clinical assessments and remote monitoring (two monitoring systems were used). Low activity was defined as &lt;1 hour/day of physical activity and two groups of patients were defined: patients with low activity alerts (group 1) and patients without low activity alerts (group 2). Primary outcome was defined as death by all causes and secondary outcome as HF hospitalizations and sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes.

Results
From 121 patients with RPM, physical activity data was obtained in 104 (85,9%). Mean age was 63,98±12,44 years, 70,2% were males and follow-up was 59,19±38,491 months. Fifty-four (51,9%) had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D), 46 (44,2%) transvenous implantable cardioverter defibrillator (ICD), and 4 (3,8%) CRT pacemaker (CRT-P). The aetiology was idiopathic in 42,5% and ischemic in 40,2%. Mean left ventricular ejection fraction was 34,08±11,40% and mean physical activity duration was 2,25±1,84 hours/day. Forty-eight (53,7%) had low activity alerts (group 1) and 56 (46,3%) had no low activity alerts (group 2). In group 1 mean period of low activity was 52,978±15,75 days/year. Patients from group 1 were older (p=0,001), had more oncological disease (p=0,041) and peripheral artery disease (p=0,028). Three deaths occurred in total, all in group 1 (p=0,039) and HF hospitalizations were more frequent in group 1 (1,68±2,59 vs 0,69±1,32, p=0,005). Low activity burden was also associated with atrial fibrillation burden (r=0,473, p&lt;0,05) and number of episodes of VT or VF (r=0,267, p=0,007). A decrease of 50% or more in mean duration of physical activity, but above 1 hour/day, was associated with increase HF hospitalizations (1,83±2,13 vs 1,05±1,95, p=0,006).

Conclusion
Low physical activity data obtained from CIEDs was associated with HF hospitalizations, arrhythmic events and death by all causes, independently of multifactorial algorithms. A decrease in basal activity even above alert threshold, was associated with HF hospitalizations and may be an even earlier sign of HF decompensations.

Funding Acknowledgement
Type of funding sources: None.
Association of usual walking with mortality in oldest old adults aged 85 years and older: a nationwide senior cohort study
Authors: Jin M , Yang P , Yu H , Kim T , Lee H , Pak H , Lee M , Joung B 
Published: October 2022

Abstract

Background
Current guidelines recommend moderate to vigorous intensity physical activity (MVPA) for health benefit in adults. However, it is difficult to meet the recommended minimum MVPA in “oldest old” aged over 85. Although walking is simple and easy exercise for oldest old, research on the association between walking and mortality in oldest old are lacking.

Purpose
To investigate the association between walking and the risk of all-cause and cardiovascular mortality among older adults aged 85 years and older.

Methods
7047 participants aged 85 or older underwent the Korean National Health Screening Program, including self-administered questionnaire for physical activity. Reported frequency per week of walking for at least 30 minutes increment was used to classify hours of walking per week. We computed multivariable-adjusted hazard ratios for walking and mutually adjusted for MVPA in relation to all-cause and cardiovascular mortality.

Results
The proportions of participants who engaged in walking, moderate- and vigorous-intensity physical activity were 42.5% (2996/7047), 14.7% (1037/7047) and 11.0% (773/7047), respectively. Only 7.6% (538/7047) of participants met the guidelines recommended minimum MVPA. Compared to inactive individuals, those who walked at least 1 hour per week had lower all-cause (HR 0.60 [95% CI, 0.50–0.74]) and cardiovascular mortality risk (HR 0.61 [95% CI, 0.42–0.89]). Walking 1 hour per week was still significant associated with reduction of risk for all-cause (HR 0.50 [95% CI, 0.40–0.61]) and cardiovascular mortality (HR 0.46 [95% CI, 0.30–0.70]) among participants who reported only walking without any MVPA.

Conclusions
1 hour a week of walking might be of benefit for all-cause and cardiovascular mortality in aged over 85 years, even without MVPA. Promoting walking may be a way to help oldest old avoid inactivity and encourage an active lifestyle for all-cause and cardiovascular mortality risk reduction.

Funding Acknowledgement
Type of funding sources: None.
Effect of exercise training on HDL subclasses and cholesterol transfers to HDL in elderly individuals
Authors: Senger Braga P G , Tavoni T M , Baroni R V , Aldin M N , Alves M J N N , Rocha G A , Bachi A L L , Negrao C E , Vaisberg M W , Freitas F R , Figueiredo Neto A M , Damasceno N R T , Maranhao R C 
Published: October 2022

Abstract

Introduction
Lifestyle habits play a crucial role on coronary artery disease (CAD) prevention. Exercise training promotes increase of HDL-C and decrease of plasma triglycerides is an important tool against atherogenesis. HDL-C determination evaluates only partially the HDL status and anti-atherosclerotic potential. A number of other parameters also relates HDL metabolism and function with CAD, such as HDL subclass distribution and cholesterol transfer to HDL, that have been reported as impaired in CAD. It is known that exercise training can improve those parameters in young individuals, but it has not been explored whether this effect can also be obtained in elderly subjects undergoing moderate training.

Purpose
Investigate the effects of regular practice of moderate exercise training on cholesterol transfer to HDL and HDL subclasses distribution in elderly compared to young subjects.

Methods
111 healthy subjects were enrolled in this study, as divided in four groups paired by sex: active elderly (AE, n=25), inactive elderly (IE, n=21), active young (AY, n=40) and inactive young (IY, n=25). All subjects performed cardiopulmonary test to determine VO2 peak and answered a questionnaire about exercise practice; only subjects practicing regular training for at least one year were selected to the 2 “active” groups. Blood samples were collected to determine lipid and apolipoprotein profile. Lipid subfractions were measured using the Lipoprint system. Cholesterol transfer to HDL was performed by incubating plasma with a donor lipoprotein-like nanoparticle containing radioactively labeled unesterified (UC) and esterified cholesterol (EC), followed by chemical precipitation and radioactive count.

Results
Data are shown on Table 1. Higher VO2 peak in both active groups confirmed the effectiveness of the training. HDL-C was higher in AE and AY than in IE and IY; apo A-I was higher in AY than in IY, but AE and IE were equal. UC transfer was higher in AE and AY than in IE and IY, but EC was higher AY than in IY, AE and IE were equal. Large HDL subfraction was higher in AY than in IY, but AE and IE were equal. The intermediate HDL subfraction was higher in AE than in IE. Comparing AE with AY, no differences in UC and EC, as well as HDL subfractions were observed.

Conclusion
Training had the ability to improve parameters of HDL metabolism not only in young but also in elderly subjects and it is remarkable that, despite their lower VO2 peak, in the AE group the cholesterol transfers and the HDL subfraction profile were similar to those of the AY group. Those results confirm the effectiveness of training to improve HDL anti-atherosclerotic features in the elderly.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo à Pesquisa do Estado de São Paulo
Effects of resistance exercise in the cardiac remodeling of myocardial infarction rats
Authors: Rodrigues E , Souza L M , Pontes T H D , Gomes M J , Pagan L U , Murata G M , Damatto F C , Rego A B G C , Lima A R R , Reyes D R A , Zornoff L A M , Okoshi K , Okoshi M P 
Published: October 2022

Abstract

Introduction
Exercise is an important therapeutic strategy for heart failure (HF). However, the myocardial effects of resistance exercise during HF are not completely understood. In this study, we investigated the influence of resistance exercise on cardiac remodeling and molecular myocardial changes of rats with myocardial infarction (MI)-induced HF.

Methods
Three months after MI induction or simulated surgery, Wistar rats were divided into three groups: Sham (n=14); MI (n=9); and MI subjected to resistance exercise (MI-R, n=13). Exercised rats trained 3 times a week during 12 weeks performing four climbs in a ladder with progressive loads. Cardiac structure and left ventricular function were assessed by echocardiogram. Myocyte diameters were measured in histological sections. Energy metabolism, lipid hydroperoxide, antioxidant enzymes activity, malondialdehyde, and protein carbonylation were evaluated by spectrophotometry. NADPH oxidase subunits (Nox2, Nox4, p22phox and p47phox) gene expression was assessed by RT-PCR. Statistical analysis: ANOVA and Tukey test or Dunn's test.

Results
Mortality did not differ between MI-R and MI groups. MI-R and MI presented dilated left atrium and left ventricle with systolic and diastolic dysfunction. Exercise improved maximum carrying load with no changes in cardiac structure or left ventricle function. Myocyte diameter was lower in MI than Sham and MI-R. Lactate dehydrogenase and creatine kinase activities were lower in MI than Sham. Activity of citrate synthase and catalase was lower in MI and MI-R than Sham. Lipid hydroperoxide concentration was lower in MI-R than MI. Nox2 and p22phox gene expression was higher in MI-R than Sham. Gene expression of Nox4 was higher in both infarcted groups and gene expression of p47phox was lower in MI than Sham.

Conclusion
Resistance exercise is safe and well tolerated by infarcted rats. Exercise increases maximum carrying load and reduces myocardial oxidative stress with no changes in cardiac structure or left ventricle function of infarcted rats.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CNPq - National Council for Scientific and Technological Development
Influence of moderate and high intensity interval training on infarcted rat diaphragm
Authors: Ruiz Lima A R , Janini Gomes M , Urbano Pagan L , Zucoloto L H , Damatto R L , Damatto F C , Mamede Zornoff L A , Okoshi K , Politi Okoshi M 
Published: October 2022

Abstract

Background
Respiratory muscle dysfunction is commonly observed in heart failure (HF) patients and contributes to early fatigue and dyspnea. As there is no specific pharmacological therapy to treat skeletal muscle changes, physical exercise is considered an important strategy to prevent HF-associated skeletal myopathy. However, which exercise type is better during HF is unsettled.

Purpose
To evaluate the effects of aerobic and high intensity interval (HIIT) training on diaphragm morphometric, biochemical, and molecular parameters in infarcted rats.

Methods
Three months after inducing myocardial infarction (MI), male Wistar rats were assigned into three groups: sedentary MI (MI-Sed, n=8), MI subjected to aerobic exercise (MI-A, n=8), and MI subjected to HIIT (MI-HIIT, n=8). Results were compared to a Sham group (n=8). Exercise was performed in treadmill three times a week for three months. Functional capacity test and echocardiogram were performed before and after exercise protocols. Myosin heavy chain (MyHC) isoforms were analyzed by electrophoresis; diaphragm mitogen activated protein kinases (MAPK), NF-κB, TNF-α, and Pax-7 protein expression was evaluated by Western-blot. Statistical analysis: ANOVA.

Results
Functional capacity was similarly improved by both exercise protocols. Infarction size evaluated by histological analysis did not differ between groups (MI-Sed 27.7±10.8; MI-A 29.6±12.9; MI-HIIT 27.4±12.2% of total left ventricle area; p=0.91). Echocardiographic parameters did not differ between MI groups before and after exercise. Cross sectional area of diaphragm fibers (Sham 1922±230; MI-Sed 1808±264; MI-A 1926±209; MI-HIIT 2007±286 μm2), collagen interstitial fractional area (Sham 4.93±1.76; MI-Sed 5.01±1.88; MI-A 4.55±1.18; MI-HIIT 3.94±1.15%), and percentage of MyHC isoforms did not differ between groups. Pax-7 expression was lower in MI-HIIT than MI-Sed and MI-A [Sham 1.15 (0.58–1.44), MI-Sed 1.19 (0.90–2.85), MI-A 1.46 (0.77–2.14), MI-HIIT 0.46 (0.29–0.66) arbitrary units]. Total p-38 expression was higher in MI-Sed than the other groups and lower in MI-HIIT than Sham [Sham 1.00±0.52; MI-Sed 1.77±0.47; MI-A 0.66±0.22; MI-HIIT 0.46±0.31 arbitrary units]. The other proteins did not differ between groups.

Conclusion
Both aerobic and high intensity interval training improves functional capacity with no influence on diaphragm of rats with myocardial infarction.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): FAPESP (São Paulo Research Foundation)
Omega 3 fatty acid supplementation improves physical performance: a systematic review and meta-analysis of RCTs
Authors: Davis I , McCullough D , Banach M , Mazidi M 
Published: October 2022

Abstract

Background
Omega 3 polyunsaturated fatty acids (n-3, PUFA) show promise for improving muscle mass, strength and measures of physical performance that may ameliorate sarcopenia.

Purpose
To perform an updated meta-analysis of n-3 interventions with detailed subgroup analysis on physical performance/strength and muscle mass, with sub-group analysis on duration, age, BMI, sex, and location, amongst others.

Methods
We followed The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) –checklist for systematic reviews and meta-analysis. Literature was searched (ISI, Scopus and PubMed databases up to October 2021) with terms related to n-3 (alpha linolenic acid, docosahexaenoic acid, eicosapentaenoic acid, fish oil etc.) muscle mass, strength and physical performance (using the 30 s Chair Stand Test [30CST] for muscle strength and endurance and the Timed Up an Go Test [TUG] for physical performance; both are useful and simple tools that can be used to assess sarcopenia). Human n-3 randomised controlled trials (RCTs) were included and assessed for methodological quality (Cochrane quality assessment tool). Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and random-effect model analysis, and I-squared (I2) statistic were used to assess outcomes and heterogeneity respectively. Subgroup and sensitivity analysis were performed, and Begg's and Egger's tests evaluated publication bias. Statistical analysis used STATA 11 software and a p-value of &lt;0.05 was considered statistically significant.

Results
The primary meta-analyses for functional performance (TUG, 7 RCTs, 8 interventions, n=259) and strength (30CST, 5 RCTs, 6 interventions, n=180), favoured n-3 PUFA (p&lt;0.001). TUG (weighted mean change (WMD): −0.35 s; 95% CI: −0.53, −0.18; I2=0.0%) (Figure 1A) and 30CST (WMD: 2.23 repetitions; 95% CI: 1.34, 3.32; I2=67.6%) (Figure 1B). Subgroup analysis for TUG was significant for female sex (WMD: 2.92 reps; 95% CI: 2.37, 3.46; I2=33.1%), BMI ≥25 kg/m2 (WMD: −0.36 s; 95% CI: −0.58, −0.17; I2=16.9%), and for 30CST by duration ≥16 weeks (WMD: 2.60 reps; 95% CI: 1.37, 3.83; I2=0.0%) (all p&lt;0.001). There were no significant effects on muscle mass and handgrip strength, and subgroup analysis showed negligible influence. Publication bias was minimal and sensitivity analysis did not influence findings.

Conclusions
We showed novel favourable effects of n-3 PUFA on specific measures of strength and physical performance in some populations but not on measures of muscle mass and other strength tests. The beneficial effects of n-3 on these measures may be due to various mechanisms that regulate muscle quality (rather than quantity). Further studies are needed to elucidate the dose, duration and other influential variables.

Funding Acknowledgement
Type of funding sources: None.
CAVI (cardio-ankle vascular index) as an independent predictor of hypertensive response to exercise
Authors: Wuttichaipradit C , Tunhasiriwet A , Yodwut C , Hengrussamee K , Sukhum P 
Published: October 2022

Abstract

Objectives
Hypertensive response to exercise (HRE) always acts as a relative indication to terminate exercise during treadmill stress test and prohibit the interpretation of inadequate result. We supposed the CAVI (Cardio-ankle vascular index) might be an initial clue to predict hypertensive response to exercise.

Material and methods
Retrospective chart review in cardiology unit, patients who attended health preventive program in our heart hospital, and performed both CAVI and treadmill stress test in the same day between June 2018 and December 2018. Variables for prediction of HRE were analyzed, using univariate analysis and significant variables were entered in multiple logistic regression. ROC curve was created to test the sensitivity and specificity when used CAVI &gt;8 as a cut-point of increased arterial stiffness.

Results
285 patients (157 females, 55.1%) were enrolled in this study. 58 patients (20.4%) who matched with HRE definition (SBP ≥210 mmHg or DBP ≥100 mmHg in male, SBP ≥190 mmHg or DBP ≥95 mmHg in female), mean age 46.4±12.8 years. In univariate analysis; age, diabetes mellitus, hypertension, dyslipidemia, history taking beta-blocker, and CAVI result were statistically significant. Multiple logistic regression revealed only CAVI result was statistically significant predictor of HRE (OR 5.8, 95% CI: 3.5–10.9, P&lt;0.001). ROC curve analysis of the CAVI revealed AUC 0.827 (95% CI: 0.76–0.89, p&lt;0.001) and the sensitivity and specificity of cut-point CAVI ≥8 were 53% and 92% respectively.

Conclusion
This study demonstrated CAVI is an independent predictor for hypertensive response to exercise. CAVI ≥8 is not the sensitive tool but quite specific to detect HRE.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Bangkok Dusit Medical services
Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography
Authors: Mansour M , Chammas E , Winkler M , Aljaroudi W 
Published: October 2022

Abstract

Background
Many hemodynamic parameters are used during exercise stress testing but provide limited information regarding obstructive coronary artery disease (CAD) when exercise is suboptimal. Hemodynamic gain index (HGI) is a recently developed and sensitive indicator of ischemia which has been associated with increased mortality.

Purpose
This study sought to evaluate the clinical impact of HGI in patients who underwent concomitant exercise testing and coronary computed tomography angiography (CCTA).

Methods
Consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) and systolic blood pressure (SBP) were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI [(HRpeak × SBPpeak) − (HRrest × SBPrest)] / (HRrest × SBPrest) were calculated. The latter was divided into quartiles. The presence or absence of any CAD on CCTA was confirmed. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD.

Results
There were 284 patients (mean age 53 years, 83% male). Mean HGI was 1.74±0.67, with severely blunted HGI cut-off of ≤1.25 (Quartile 4). Patients with blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD showed lower HGI when compared to control (1.36±0.53 vs. 1.77±0.67, P-value 0.005) and had more prevalence of severely blunted HGI ≤1.25 (44% vs. 22%, P-value 0.019). In the multivariate analysis, after adjusting for traditional risk factors, HGI remained independent predictor of obstructive CAD while severely blunted HGI ≤1.25 was associated with 3-fold increased odds of obstructive CAD (P-value 0.05). Using artificial intelligence analysis, blunted HGI remained an independent predictor of obstructive CAD an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models.

Conclusions
Among patients who underwent concomitant exercise testing and CCTA, blunted HGI ≤1.25 was strongly associated with obstructive CAD after adjusting for traditional risk factors. HGI is robust, practical, and allows clinicians to reclassify patients, change management, and thus improve prognosis.

Funding Acknowledgement
Type of funding sources: None.
Value of cardiopulmonary exercise test submaximal parameters in the assessment of aortic stenosis patients
Authors: R Santos R , Paiva M , Gomes D , Presume J , Custodio P , Andrade M J , Raposo L , Durazzo A , Moreno L , Mendes M 
Published: October 2022

Abstract

Background
Exercise test is recommended for risk stratification of asymptomatic patients with severe aortic stenosis (AS), although a significant number of patients can't perform a maximal exercise test, increasing the potential value of sub-maximal parameters for the assessment of these patients.

Aim
To assess which parameters could be useful for risk stratification in case of a submaximal Cardiopulmonary Exercise Testing (CPET) in asymptomatic patients with severe AS.

Methods
Retrospective evaluation of adult patients with asymptomatic severe AS, in a single center, who underwent CPET between December 2016 and November 2021. All patients underwent a treadmill CPET using an exercise protocol with progressive increase in workload. Patients were divided in group A (maximal CPET) or group B, respectively, if respiratory exchange ratio (RER) was &gt;1.10 at peak exercise or below this value. Known parameters accessed in a submaximal CPET were evaluated: mean minute ventilation/carbon dioxide production slope (VE/VCO2), VO2 value in first ventilatory threshold (VT1), peak circulatory power, and oxygen uptake efficiency slope (OUES).

Results
CPET was performed in 25 patients with severe asymptomatic AS (80 years ± 7 years, 56% male), median AVA was 0.86 cm2 [IQR 0.65–0.95 cm2] and transaortic pressure gradient was 46 mmHg [IQR 41–55 mmHg]. The most used protocol was a ramp slope. Nineteen patients (76%) didn't reach a RER&gt;1.10 (group B) due to respiratory (26%) or peripheral limitation (53%). Comparing both groups, group B patients showed a shorter duration of exercise of (8±3 min vs. 9±4 min, p=0.422), and a lowest mean peak VO2 (16.3±3.6 vs. 20.5±6.9 ml/kg/min, p=0.207). In our population, bivariate analyses demonstrated that OUES was the only submaximal parameter that could discriminate both groups: Group B patients had the lowest values (1.53 [IQR 1.47–1.70] vs. 1.94 [IQR 1.56–2.11], p=0.042). ROC curve analysis of OUES values revealed an AUC of 0.78 (p=0.042) for maximal CPET prediction. The cut-off point with most sensitivity (S) and specificity (E) obtained using the Youden index (0.62) was 1.9 (S≈67%; E≈95%) (Figure 1).

Conclusions
In our cohort of asymptomatic AS patients, even with submaximal CPET, OUES accurately identify patients with higher degrees of functional limitation. Whether OUES is useful as prognostic marker to the workflow treatment of AS it's worth to be assessed prospectively.

Funding Acknowledgement
Type of funding sources: None.