bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flow mediated dilatation: searching high and low for a technique
Authors: Koca C , Kozluca V , Esenboga K , Tan Kurklu TS , Kurklu HA , Kilickap M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Endothelial dysfunction has a central role in atherosclerosis physiology. Flow mediated dilatation (FMD) is a non-invasive method for determining endothelial function. Cuff occlusion of forearm for 5 minutes followed by sudden release cause hyperaemia response with increased flow rate and shear stress in brachial artery. FMD measures the ratio of arterial diameter change mediated by nitric oxide (NO) in response to this increase in shear stress. FMD was first defined in 1992 but has not gained wide clinical utility due to contradictory study results. The main reason for inconsistencies is the lack of standardized definition of FMD technique. We need more studies on different steps of FMD procedure.

Purpose
The optimal cuff position for FMD measurements is not precisely defined. When brachial arterial flow is disturbed by occlusion, different mediators play role in hyperaemia induced dilatation. Occlusion distal to brachial artery causes mainly NO and endothelium mediated dilatation upstream. Therefore, a forearm occlusion cuff position is proposed. Currently, there is no precise definition of the cuff position in forearm. We compared proximal and distal forearm cuff occlusion positions for FMD measurements.

Methods
We analysed FMD in fifty healthy volunteers (mean age 31,9 ± 9,5 years; 54 % female). The subjects underwent measurements with two different occlusion positions on the same day. The sequence of occlusion cuff position was determined with randomization. We have waited for an appropriate interval between measurements. We made sure that brachial artery has returned to its basal diameter and flow conditions before second measurement. Flow and diameter measurements were made with strict adherence to predefined timelines after cuff release. Same operator performed and recorded all FMD measurements.

Results
Measurements of basal diameter (p=0,97) and basal flow (p=0,53) were not different. We used random intercept mixed effects model for comparison of proximal and distal occlusion positions. This enabled interpretation of FMD results with refinement of sequence and basal diameter’s possible effects. The FMD values of proximal forearm occlusion cuff position were 2,2 % higher compared to distal position. (p=0,027) The sequence of occlusion cuff position did not have significant effect on consecutive FMD measurements. (p=0,405).

Conclusions
We have shown that the forearm occlusion cuff position affects FMD measurements. This effect can be responsible for inter-study differences of FMD. Further research is required for interpretation of this difference in terms of molecular mechanisms and its applicability in clinical practice.
Heart rate recovery is improved after locomotor training in persons with incomplete spinal cord injury: implications for health and prevention
Authors: Cahalin L , Cohen M , Nash M , Field-Fote E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Heart rate recovery after exercise provides meaningful information about physical fitness and prognosis in both health and disease. A more rapid decrease in heart rate after exercise has been associated with higher levels of fitness as well as better health and survival. In fact, heart rate recovery (HRR) ≤ 12 beats at one minute after maximal and sub-maximal exercise is a significant prognostic index of poorer health and survival. However, little research has examined HRR in persons with spinal cord injury (SCI) despite the need for a responsive measure of fitness and health in this population.

Purpose
The purpose of this study was to examine HRR before and after locomotor training (LT) in persons with SCI.

Methods
Twenty-nine subjects with incomplete SCI performed LT 5 days per week for 12 weeks using one of four training approaches: treadmill-based training with manual assistance (TMM), treadmill-based training with stimulation (TMS), over-ground training with stimulation (OGS), and treadmill-based training with robotic assistance (TMR). Before and after 12 weeks of LT the HRR was measured one minute after 2-3 minutes of walking at each subject’s maximal capacity. Heart rate data was captured via a recording band placed on each subjects’ chest that transmitted wireless signals to a data collection system which recorded heart rate data continuously.

Results
The peak HR during maximal walking of the cohort before and after LT was 75 ±15% and 71 ±14% of the age-predicted maximal HR, respectively. Fifteen of the 29 subjects (52%) had an abnormal HRR (≤ 12 beats) at baseline; following LT, HRR was improved in 11/15 (73%) of these subjects. In addition, 50% of subjects with a normal baseline HRR improved HRR after LT. There was no significant difference in HRR among training approaches at baseline or after LT.

Conclusions
Twelve weeks of LT was associated with an improvement in HRR in almost three-quarters of the subjects with an abnormal HRR at baseline, and HRR improved in one-half of the subjects with a normal HRR at baseline. These findings suggest that HRR may be of value for tracking fitness and prognosis in persons with SCI. Further investigation of HRR in subjects with SCI is warranted.
Piloting opportunistic cardiovascular risk assessment at a faith community event
Authors: Faizur Rahman ME , Ajumal HA , Latif A , Waqar S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ethnic minority populations in the United Kingdom (UK) are known to have higher rates of undiagnosed and poorly controlled hypertension and metabolic disease (1). Muslims in the UK make up a significant proportion of these populations, and have lower reported rates of well-being and satisfaction with health services (2). Tailoring interventions to target under-served populations and activate positive health behaviours has been shown to improve uptake and outcomes (3).

Purpose
We undertook an opportunistic pilot intervention to explore the potential of using faith-placed community assets to identify undiagnosed and poorly managed cases of hypertension, diabetes, and explore cardiovascular disease (CVD) risk.

Methods
A community event was organised for Indian-origin Tamil speaking Muslims who gathered from across the UK in November 2021. We piloted a short CVD risk assessment intervention to take place during this event, delivered by doctors from the same community. Participants consented for assessment of body mass index (BMI), blood pressure (BP), random capillary blood glucose (CBG), and manual pulse rhythm check (with a commercially available smartphone based single-lead electrocardiogram device where needed). We also calculated the 10-year CVD risk using a nationally validated 10-year CVD risk calculator. The intervention was culturally tailored, specifically with men and women examined by the same sex and participants being given an Islamic reminder on good health to encourage their involvement.

Results
35 attendees were assessed in total. 33/35 (94%) attendees were 60-years-old or less. 18/35 (51%) had an elevated blood pressure reading (systolic BP ≥ 140mmHg or diastolic BP ≥ 90mmHg on both arms), with only 3/18 (17%) having a prior diagnosis of hypertension. Only 17/35 consented to CBG measurement, of which 4/17 (23%) had random CBG levels of &gt;11.1 mmol/L with 3/17 having CBG levels of &gt;25 mmol/L - none of them were known to have diabetes. 9/35 (26%) had 10-year CVD risk of &gt;10%. 6/9 (67%) of these were not on statin therapy. 24/35 (69%) had elevated BMI, with 9/24 (37%) having a BMI of ≥ 30 kg/m2. None of the attendees had an irregular pulse to suggest arrhythmia. Full characteristics are shown in Figure 1 and results are further detailed in Figure 2. In Summary, 29/35 (83%) had at least one abnormal finding on assessment. All participants with abnormal findings were signposted to seek formal diagnosis and management through their general practitioner, and were offered lifestyle advice.

Conclusions
This brief and targeted intervention was successful at detecting undiagnosed cases of probable hypertension and hyperglycaemia, as well as identifying cases who would benefit from primary CVD risk prevention. Further research is needed to understand the scalability and feasibility of this approach to wider populations.
Exergaming in cardiac rehabilitation: a systematic review and meta-analysis
Authors: Blasco-Peris C , Fuertes-Kenneally L , Vetrovsky T , Sarabia-Marin JM , Climent-Paya V , Manresa-Rocamora A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Valencia Region Innovation Agency (INNOAVI)

Background/Introduction
Cardiovascular disease (CVD) is the leading cause of death in Europe. The lack of physical activity is related to the onset of CVD. Despite the evidence of the effects of exercise-based cardiac rehabilitation (CR) on mortality risk in patients with CVD, the benefit of adding exergaming is unclear.

Purpose
The aim of this systematic review and meta-analysis was to (a) summarize the characteristics of previous studies regarding exercise-based CR programmes based on exergaming and (b) determine the effects of exergaming on functional capacity (i.e., distance covered in the 6-min walk test [6MWT]) and other outcomes (i.e., quality of life and motivation).

Methods
We carried out a systematic search in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (without language restrictions) up to June 2021. Our search strategy included terms related to patients (e.g., chronic heart failure, cardiovascular disease, and coronary artery disease) and the interventions (e.g., exergaming and cardiac rehabilitation). We included controlled and uncontrolled studies and extracted data regarding the characteristics of the study, patients, and intervention. In regards to the quantitative analysis, we used the standardised mean difference (SMD) or mean difference (MD) to measure the effect size and random-effects models to perform a pooled analysis of outcomes reported in at least three studies.

Results
Eight studies fulfilled our inclusion criteria, of which seven were randomised controlled trials and all of them had an active control group. The studies included were published from 2006 to 2021. Three studies recruited patients with diverse diagnoses, four articles included patients diagnosed with coronary artery disease, and one study with heart failure. Five studies performed supervised training sessions. The type of VR varied between studies: four of them used Oculus glasses or 3D constructed reality in screens, three used a game console, and one combined several devices. The mean intervention length was 17 weeks and six studies performed less than four training sessions a week. There was a non-significant increase in the distance covered in the 6MWT in favour of the experimental groups compared to the control groups (MD = 13,89 m [95% confidence interval -18,01 to 45,79]). Moreover, there was no intervention effect on symptoms of depression (SMD = -0,21 [95% confidence interval = -0,56 – 0,13]).

Conclusion(s)
Exergaming is feasible in patients with cardiovascular disease. However, the effects of adding VR to improve functional capacity and symptoms of depression are questionable. Future research is needed to clarify the role of exergaming in CR.
The demographic, psychosocial and clinical characteristics associated with cardiac risk factor control: an analysis of secondary prevention in adults with established coronary heart disease
Authors: Brennan S , Avalos G , Mc Evoy J W 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Purpose
Achieving risk factor (RF) control in patients with established coronary heart disease (CHD) reduces the risk of CHD events.(1) Cross-sectional studies have shown that the implementation of current prevention guidelines is poor, with most patients failing to meet recommended targets.(2,3) This study aims to identify demographic, psychosocial and clinical characteristics associated with the non-achievement of RF targets in a population with CHD.

Methods
In this post-hoc cross-sectional analysis, multivariable logistic regression identified characteristics significantly associated with poor RF control in participants of the iASPIRE study which recently assessed secondary CHD prevention in Ireland.

Results
An unhealthy diet (Odds Ratio [OR] 1.6, 95% CI 1.1-2.4, p=0.015), male sex (OR 1.8, 95% CI 1.2-2.8, p=0.007) and type of acute coronary syndrome event (OR 0.6, 95% CI 0.4-0.9, p=0.012) were associated with failure to achieve blood pressure recommendations. Female sex (OR 2.3, 95% CI 1.4-3.8, p=0.002), lack of high-intensity statin (OR 2.4, 95% CI 1.5-3.8, p&lt;0.001) and recurrent hospitalisation for CHD (OR 1.9, 95% CI 1.3-2.8, p=0.001) were associated with poor LDL-C control. Decreasing age (OR 0.9, 95% CI 0.9-1.0, p=0.018), marriage (OR 4.3, 95% CI 1.5-12.1, p=0.007) and insulin use (OR 9.7, 95% CI 1.9-50.4, p=0.007) were associated with a HbA1c of ≥53mmol/mol. The absence of a longstanding illness or disability and decreasing resting heart rate were associated with composite RF control.

Conclusion
Several demographic, psychosocial and clinical characteristics are associated with achieving guideline-recommended RF targets. These findings will support the development of targeted solutions that will improve guideline implementation and the practice of CHD prevention in a high-risk population.
Bempedoic acid and PCSK9 inhibitor eligibility in a contemporary population with atherosclerotic cardiovascular disease
Authors: Brennan S , Mc Evoy J W 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Purpose
The reduction of low-density lipoprotein cholesterol (LDL-C) in patients with established coronary heart disease (CHD) reduces the risk of atherosclerotic cardiovascular disease (ASCVD) events.(1) Many CHD patients fail to achieve guideline-recommended LDL-C targets without prohibitively expensive proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9 inhibitors).(2, 3, 4) This study aims to assess the impact that bempedoic acid may have on PCSK9 inhibitor eligibility in a population with CHD and ascertain whether its universal adoption would lead to overall cost-savings and a cost-effective reduction in ASCVD events.

Methods and Results
This retrospective analysis included 635 participants from the iASPIRE study, which recently assessed secondary prevention in an Irish cohort of CHD patients. We applied the 2019 ESC/EAS dyslipidaemia guideline LDL-C target of &lt;1.4mmol/L and simulated the average treatment effect of improved lipid-lowering therapy with statins, ezetimibe and bempedoic acid. 86.3% of iASPIRE participants did not have LDL-C control and qualified for treatment intensification. Optimisation of statin therapy would allow 24.4% of patients to achieve their LDL-C goal, while the addition of ezetimibe would improve this to 55.7% leaving 44.3% eligible for a PCSK9 inhibitor. Utilising bempedoic acid would further reduce the proportion eligible to 18.7%. Based on current market prices and the universal application of ESC/EAS recommendations,(1, 5) the adoption of bempedoic acid would reduce the annual treatment costs associated with PCSK9 inhibitor use by almost 50% and result in cost savings per prevented CVD event.

Conclusions
The vast majority of CHD patients currently fail to achieve the recommended LDL-C target in everyday clinical practice. Ezetimibe and optimised statin therapy would enable most patients to meet their LDL-C goal. Employing bempedoic acid in patients with poor LDL-C control would significantly reduce the requirement for PCSK9 inhibitors and lead to cost savings per prevented CVD event.
Effect of cardiac rehabilitation on intensity of physical activity according to type of surgery and Eurscore II after open heart surgery
Authors: Bolatbekov B , Baibolova M , Trusheva K , Kuramys S , Bolatbekova Z , Baimagambetov A , Kudaiberdieva GZ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients after open heart surgery require cardiac rehabilitation (CR), as reconstructive surgery reduces the quality of life. A perioperative EuroSCORE II score is used for assessment of risk of worse outcomes after surgery. Few is known whether CR is feasible in patients undergoing open heart surgery with moderate and high risk Euroscore II and whether the intensity of physical activity (PA) varies according to the type of heart surgery.

Objective
To evaluate effect of CR on perceived intensity of PA and target heart rate in patients who underwent open heart surgery and different EurSCORE II scale.

Methods
The retrospective cohort study included 104 patients who underwent open heart surgery and stage 2 CR: group 1- 64 patients with coronary artery bypass surgery (CABG), group 2 - 40 patients with valvular heart disease (VHD) surgery. We evaluated following parameters: subjective assessment of PA intensity on the Borg scale and objective assessment on the achievement of the training heart rate before and after CR. The perioperative risk of worse outcomes was assessed using EuroSCORE II scale.

Results
According to the EuroSCORE II scale: 1st group patients were at: -low risk -21%, moderate risk -68%, high risk -11% and 2nd group - low risk 29%, moderate risk 54%, and high risk 17%. None of patients had adverse effects of CR. In the first group, the subjective assessment on the Borg scale before CR was slightly higher than in the second group: -2.43 ± 0.09 points vs. 2.22 ± 0.11 points before CR. At the end of the CR, there was a significant increase (p&lt;0.05) in perception of intensity of PA in both groups - the 1st group –4.37 ± 0.06 points and in 2nd group - 4.35 ± 0.07 points. Target heart rate before CR did not differ between groups: group 1 - 75 ± 5.7 beats per minute and group 2 - 89 ± 7.7 beats per minute (p=0.552): after CR there was a significant decrease in heart rate: group 1 - 55 ± 2.2 bpm, group 2 - 61 ± 3.2 bpm (p =.0012).

Conclusion
1. CR increases significantly intensity of physical activity in pts after open heart surgery 2. Though the VHD surgery pts might have lower intensity of PA before CR, the intensity of PA after CR did not differ between CABG and VHD surgeries, increasing in both groups. 3. Patients with moderate and high EurSCORE II risk comprised 80 and 69% of patients in our cohort, none of them experienced adverse effect of CR and had improvement of PA and achieved target heart rate.
Assessing the prevalence of hypertension in patients with chronic coronary artery disease in Cyprus
Authors: Christou V , Karataraki F , Diakonikolaou S , Eid O , Eid R , Styliou T , Abdelrahman R , Moutiris J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary Heart Disease (CHD) is the most common type of heart disease and a major cause of mortality worldwide, since according to CDC and WHO, it accounts for 18.2 million cases and 17.9 million deaths annually, respectively. Hypertension can precipitate the condition significantly, thus controlling it plays an important role in the secondary prevention of the disease.

Aim
The aim of this study is to highlight the significance of hypertension as a risk factor in patients with CAD, as well as, to compare its prevalence to those of the EUROASPIRE IV and the statistics published from the ESC Atlas of Cardiology in 2019.

Methods
A retrospective, observational study was created, from the Registry of Cyprus Heart Survey, where 375 individuals (88% Males, 66 years old on average) were examined in Nicosia General Hospital Cardiology Clinics with CAD, between the years 2011 and 2014. Their past medical history in regards to hypertension was noted and the data was analyzed by using Microsoft Excel software.

Results
The total prevalence of hypertension, based on the past medical history of the patients was 59% (females 61% and males 68%). Out of these, 44% still had abnormally elevated blood pressure on their visit to the Cardiology Clinic (females 36% and males 45%). Additionally, the EUROASPIRE IV study showed a prevalence of hypertension of 42.7% and ESC Atlas 24.8%, with median rates 22.3% for females and 27.0% for males. The total mean systolic blood pressure amongst all patients in our study was 136 mmHg, with no significant differences between males and females (136 mmHg and 137 mmHg respectively), while in ESC Atlas, the median SBP levels were noted to be 123.0mmHg in females and 130.0 in males.

Conclusion
Comparing the results from this group of consecutive patients from the Cyprus Heart Survey to the results of EUROASPIRE IV and ESC, it is made clear that all three studies point to the same conclusion. Firstly, it is important to acknowledge the difference between the two genders, with males recording a higher prevalence of hypertension. Moreover, despite the improvement observed in the management of hypertension that has been noted in our study, the secondary prevention guidelines are still not appropriately met. Managing appropriately hypertension, is of utmost importance in lowering the risk of recurrence of CAD in the context of secondary prevention measures.
The impact of nonoptimal lipids on the progression of coronary artery calcification in asymptomatic young adults: results from the KOICA registry
Authors: Lee H , Park HE , Chun EJ , Chang HJ , Sung J , Jung HO , Choi SY 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recently, as cumulative exposure of lipids for a lifetime has become important to prevent and predict atherosclerotic cardiovascular disease (ASCVD), it is recommended to obtain the optimal lipid levels from a young age. However, questions remain regarding the vascular changes in young adulthood by nonoptimal lipid levels.

Purpose
We aimed to investigate the progression of coronary artery calcification (CAC) according to lipid profiles in Korean young adults.

Methods
From the KOrea Initiative on Coronary Artery calcification registry, we collected 2,940 statin-naïve adults under 45-year-old, undergoing serial coronary artery calcium scans for the purpose of routine health check-ups between 2002 and 2017. CAC progression was assessed according to the optimality of lipid levels and each lipid variable.

Results
In this cohort (mean age, 41.3 years; man 82.4%), only 477 subjects (16.2%) had the optimal lipid profile, defined as triglycerides &lt;150 mg/dl, LDL cholesterol &lt;100 mg/dl, and HDL cholesterol ≥45 mg/dl. During follow-up (median 39.7 months), CAC progression was observed in 438 participants (14.8%) and more frequent in nonoptimal lipid group (16.5% vs 5.9%; p&lt;0.001). Nonoptimal lipid levels during young adulthood increased the risk of CAC progression after adjusting for other cardiovascular risk factors (adjusted HR, 2.36; p=0.001), with a stepwise risk increase according to lipid levels. In particular, in the subjects with an initial calcium score of zero (adjusted HR, 2.13; p=0.014), those in their 20s or 30s (adjusted HR 2.70; p=0.029), and those without any other risk factors (adjusted HR 2.51; p=0.025), deemed as very low-risk groups, nonoptimal lipid levels more than doubled the risk of CAC progression, respectively. Among lipid variables, high triglycerides appeared to provide the greatest impact on CAC progression of young adults.

Conclusions
The proportion of young adults with optimal lipid levels was lower than expected. Nonoptimal lipid level was significantly associated with the risk of CAC progression in young adults, even with low-risk. Triglycerides had the strongest association with the risk of CAC progression. Screening and intervention for nonoptimal lipid levels, particularly triglycerides, from an early age might be of clinical value.