bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxidative stress was significantly associated with peak oxygen uptake in patients with dilated cardiomyopathy
Authors: Ojima S , Kubozono T , Kawasoe S , Kawabata T , Salim A A , Ikeda Y , Ohishi M 
Published: October 2022

Abstract

Background
Systemic oxidative stress is known to be associated with the severity and prognosis in patients with cardiovascular diseases (CVD), including chronic heart failure. On the other hand, exercise tolerance is closely related to the prognosis in heart failure patients. However, no report has examined how oxidative stress is involved in each parameter evaluated by cardiopulmonary exercise testing (CPET) in patients with dilated cardiomyopathy (DCM).

Purpose
To examine the relationship between oxidative stress and CPET parameters such as peak VO2 and VE/VCO2 slope in patients with DCM

Methods
We recruited 214 patients with CVD who were performed CPET and measured brain natriuretic peptide (BNP) and haemoglobin (Hb). Finally, we enrolled 96 patients with DCM who have dilated dimensions of the left ventricular lumen by echocardiography and are diagnosed by endomyocardial biopsy. All patients underwent CPET using 0W warm-up and 10W ramp protocol on an upright electrical bicycle ergometer. We defined low peak VO2 as peak VO2&lt;14 ml/min/kg and high VE/VCO2 slope as VE/VCO2 slope&gt;34. The oxidative stress level was evaluated by a d-ROMs test, in which the amount of organic hydroperoxide converted into radicals oxidizing N, N-diethyl-p-phenylenediamine hydroperoxide is measured. The high level of d-ROMs was defined as d-ROMs≥401 U.CARR.

Results
Mean age was 56±15 years old. Mean ejection fraction, peak VO2 and VE/VCO2 slope were 37±15%, 16.3±5.0 ml/min/kg, and 31.0±11.8, respectively. The percentage of the high level of d-ROMs was 25%. In univariable logistic regression analysis, Hb, log BNP, and the high level of oxidative stress were significantly associated with low peak VO2, whereas, in multivariable logistic regression analysis, age, Hb, and log BNP were significant factors for high VE/VCO2 slope. In multivariable logistic regression analysis, only the high level of d-ROMs was independently associated with low peak VO2 (OR 3.18, CI 1.12–9.04, p=0.030). While, in multivariable logistic regression analysis, Hb (OR 0.51, CI 0.32–0.81, p=0.004) and log BNP (OR 2.77, CI 1.33–5.76, p=0.006) were significantly related to high VE/VCO2 slope.

Conclusions
In patients with DCM, low peak VO2 was associated with the high level of d-ROMs, and high VE/VCO2 slope was associated with BNP. These results suggested that oxidative stress was only related to peak VO2.

Funding Acknowledgement
Type of funding sources: None.
Low chronotropic index predicts rehospitalization in post-acute myocardial infarction patients with preserved or mildly reduced left ventricular ejection fraction
Authors: Smarz K , Tysarowski M , Ziolo J , Jaxa-Chamiec T , Zaborska B , Budaj A 
Published: October 2022

Abstract

Background
There are limited data about the clinical utility of combined stress echocardiography and cardiopulmonary exercise testing (CPET-ESE) in predicting prognosis in patients after acute myocardial infarction (AMI) with preserved left ventricular ejection fraction (LVEF).

Aim
To assess prognostic parameters using CPET-ESE in post-AMI patients with preserved or mildly reduced LVEF.

Methods
Eighty-seven patients after the first AMI with LVEF &gt;40% were followed for 2 years (median 1.93 years IQR 1.16–2.41). The composite end-point was all-cause mortality or rehospitalization due to ischaemic heart disease (AMI, unstable angina, percutaneous coronary intervention/coronary artery bypass grafting) or heart failure exacerbation. All patients underwent symptom-limited CPET-ESE on a semi-supine cycle ergometer 3 to 5 weeks after AMI. The chronotropic index was calculated as the percent of heart rate reserve. Six patients refused to complete the survey and they were not included in the analysis.

Results
Follow-up was conducted in 81 consecutive patients (mean age 59±10 years, 62% males, 50% AMI with ST-segment elevation, 85% on beta-blockers). Mean LVEF was 56±9% and peak VO2 18.5±5.0 mL/kg/min. There were no deaths during follow-up. The composite end-point occurred in 13 patients. In multivariate Cox regression analysis after correction for demographic and clinical variables, only chronotropic index correlated with the composite end-point (HR 0.93, 95% CI 0.87–0.99, p=0.026). A positive predictive value of 33.3% and a negative predictive value of 91.3% (sensitivity 61.5%, specificity 76.5%, area under the curve, AUC 71%) for predicting the composite end-point was established for the chronotropic index ≤36.8% (Fig. 1). There was a statistically significant difference in the composite end-point occurrence (p&lt;0.01) between subgroups with the chronotropic index above and below that threshold (Fig. 2).

Conclusions
In patients after the first AMI with preserved or mildly reduced left ventricular systolic function, a lower chronotropic index is a predictor of rehospitalization in 2-year follow-up.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education, Warsaw, Poland
“Innocent” ventricular arrhythmia – can cardiovascular magnetic resonance augment diagnosis of structural heart disease?
Authors: Costa C , Calvao J , Amador J , Proenca T , Carvalho M , Pinto R , Cabrita A , Marques C , Oliveira C , Santos L , Pinho A , Madureira A J , Lebreiro A , Pinho T , Macedo F 
Published: October 2022

Abstract

Background
Ventricular arrhythmias (VA) include a spectrum that ranges from premature ventricular beats (VPBs) to ventricular fibrillation (VF) and account for approximately 50% of all cardiovascular deaths. Echocardiography is commonly used to identify structural heart disease (SHD), the most frequent substrate of VA. Cardiovascular magnetic resonance (CMR) is recommended to complement echocardiography when image quality is suboptimal.

Purpose
This study sought to determine whether CMR may identify SHD in patients (pts) with VA, who had normal baseline ECGs and whose echocardiogram with fair technical conditions, ruled out pathological findings.

Methods
We included consecutive pts followed in arrythmia outpatient clinic of one clinical center from June 2014 to June 2021 for significant VA; this was categorized as &gt;1,000 but &lt;10,000 VPBs/24 h; ≥10,000 VPBs/24 h; nonsustained ventricular tachycardia (NSVT), sustained VT, or a history of resuscitated cardiac arrest, and no pathological findings at echocardiography, requiring a clinically indicated CMR. Primary endpoint was CMR detection of SHD. Data were collected at the end of the study.

Results
A total of 75 pts were included (no SHD: N=59; 45±15 years old; SHD: N=16, 53±15 years). All pts performed CMR, and Table 1 shows pts' baseline characteristics, VA diagnosis and CMR measurements. Definite SHD was diagnosed in 8 patients (11%): ischemic cardiopathy (three pts), myocarditis (1 pt), hypertrophic cardiomyopathy (1 pt), right ventricle arrhythmogenic disease (1 pt), non-compaction cardiomyopathy (1 pt); 1 patient presented higher myocardial T2 signal and was later diagnosed with sarcoidosis. Furthermore, abnormal findings not specific for a definite SHD diagnosis were found in other 8 pts (10%) who showed unspecific intra-myocardium enhancement.

Discussion and conclusion
CMR imaging identified SHD in around 20% of patients with normal ECG and echocardiogram. Among patients with identified SHD, ischemic cardiopathy was the most common finding, differently from the largest study that showed myocarditis as the main diagnosis. This may be associated to higher age in the SHD group. In conclusion, CMR allowed diagnosis of clinically relevant SHD even when echocardiography excluded it.

Funding Acknowledgement
Type of funding sources: None.
Exercise intensity domains determined by heart rate at ventilatory threshold: a comparison of the guideline-directed exercise intensity domains for cardiovascular rehabilitation prescription
Authors: Goulart Prata Oliveira Milani J , Milani M , Cipriano G F B , Hansen D , Cipriano Junior G 
Published: October 2022

Abstract

Background
Appropriate exercise prescription for cardiovascular diseases patients is a keystone for efficient and safe cardiovascular rehabilitation (CR). Exercise intensity prescribed according to the first and second ventilatory threshold (VT1 and VT2), identified by cardiopulmonary exercise testing (CPET), is considered the gold-standard method. However, because CPET is often not available, percentages of peak heart rate (%HRpeak) or heart rate reserve (%HRR), according to heart rate (HR) response during a conventional exercise test, are very commonly used.

Purpose
To compare the HR at VT1 and VT2 identified by CPET with the recommended exercise intensity prescription domains according to the Brazilian, American, and European CR guidelines/recommendations.

Methods
This retrospective cohort study assessed 1,465 treadmill CPETs from adult patients with stable cardiovascular diseases. Inclusion criteria were available VT1 and VT2 identification, sinus rhythm during exercise, and had reached maximal effort (respiratory exchange rate ≥1.10). HR at VT1 and VT2 were compared with the exercise intensity prescription domains recommended by Brazilian CR Guideline 2020, European Position Statement 2022, and the American College of Sports Medicine Guideline 2017, according to the obtained %HRpeak and %HRR.

Results
After applying the inclusions criteria, a sample of 972 CPETs were included (mean age 57.7±12.0 years, 80.8% males, 81.4% with coronary artery disease, and 26.6% with heart failure). VT1 and VT2 were identified, respectively, at 68.8% (63.8, 74.7) and 89.1 (85.8, 92.2) of the peak HR, and 39.0 (32.9, 45.8) and 78.0 (71.6, 84.5) of the HR reserve, indicating a greater heterogeneity of the latter (Figure 1). We found substantial heterogeneity between the measured %HRpeak and %HRR correspondent to the VT1 and VT2 and the estimated HR exercise intensity domains by compared international recommendations (Figure 2).

Conclusion
The disparities among currently established guideline-directed exercise domains limits the clinical validity of the use of %HRR and %HRpeak, and further strengthens the importance of performing CPET for an accurate exercise intensity prescription in CR. In the absence of CPET, HR values identified in our study at VT1 and VT2 could be used for guiding moderate-intensity exercise prescription for CVD patients, and the suggested range would be 69 to 89% of %HRpeak or 40 to 78% of %HRR. Current established exercise domains limits should be revised to improve HR-based prescription efficiency and safety.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPq).
Athlete status and gender strongly influence CMR T1 mapping times: an athlete-control study
Authors: Daems J J N , Verwijs S M , Van Luijk-Snoeks R D , Van Hattum J C , Ercan A , Moen M H , Nederveen A J , Planken R N , Van Randen A , Pinto Y M , Groenink M , Jorstad H T 
Published: October 2022

Abstract

Background/Introduction
In the general population, cardiac magnetic resonance imaging (CMR) T1 mapping is an established tool used for cardiac tissue characterisation. Such characterisation is of particular interest in athletes, as differentiation of the “grey zone” between physiological adaptation to sports and myocardial pathology can be highly challenging. To correctly interpret individual T1 times, T1 times are conventionally compared with normal values derived from healthy controls. However, whether these normative T1 values can be applied to elite athletes, who commonly demonstrate the most extreme cardiac adaptation, is unknown.

Purpose
To determine whether there are gender-specific differences in normative T1 times between elite athletes and healthy controls.

Methods
This study is a cross-sectional assessment of healthy athletes included the ELITE-cohort. ELITE includes athletes at national, international, and Olympic level in the Netherlands, aged sixteen years or older and without a history of cardiovascular disease. All athletes undergo standard periodic preparticipation screening with cardiovascular magnetic resonance imaging (Phillips 1.5 Tesla), including native T1 mapping. For the current study, we compared athletes to healthy controls per gender group. T1 inversion times were calculated in Circle Cardiovascular software (v5.12); means for global and segmented myocardium, according to the AHA 16-segment model, were determined using R (v4.1.4).

Results
A total of 81 elite athletes (35 women, 43.2%) with a median (IQR) age of 26 (22.0–29.55) years and 55 healthy controls (27 women, 49.1%), with a mean age of 38.4±15 years were included (Table 1). Overall, mean global T1 times were markedly shorter in athletes compared with controls (959±21.1ms vs. 984±26.6ms, P&lt;0.001). This difference was also present in both women (athletes 968±18.5ms vs controls 999±26.5ms, P&lt;0.001) and men (athletes 952±20.3ms vs controls 970±18.0ms, P&lt;0.001). We observed gender differences in T1 times within both the athlete (men 952±20.3ms vs women 968±18.5ms, P&lt;0.001) and the control group (men 984±26.6ms vs women 999±26.5ms, P&lt;0.001). Gender specific differences in T1 times were consistent between athletes and controls in the basal-, mid- and apical slices, as well as across all 16 segments (Figure panels A and B).

Conclusion(s)
Athletes demonstrate markedly shorter T1 times as compared with healthy controls, both in women and men. Sex-specific, athlete-normative T1 times should be taken into account when interpreting T1 times in athletes undergoing cardiac evaluation.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Amsterdam Movement Sciences and the Dutch Olympic Committee*Dutch Sports Federation
Extracellular inflammasome specks are released after marathon running and induce proinflammatory effects in endothelial cells
Authors: Kogel A K , Fikenzer S F , Uhlmann L U , Opitz L O , Kneuer J M K , Haeusler K G H , Endres M E , Kratzsch J K , Schwarz V S , Werner C W , Kalwa H K , Gaul S G , Laufs U L 
Published: October 2022

Abstract

Objectives
The intracellular NLRP3 inflammasome is an important regulator of sterile inflammation. Recent data suggest that inflammasome particles can be released into the circulation. The effects of exercise on circulating extracellular apoptosis-associated speck-like protein (ASC) particles and their effects on endothelial cells are not known.

Methods
We established a flow cytometric method to quantitate extracellular ASC specks in human serum. ASC specks were quantitated in 52 marathon runners 24–72 hours before, immediately after, and again 24–58 hours after the run. For mechanistic characterization, NLRP3 inflammasome particles were isolated from a stable mutant NLRP3 (p.D303N)-YFP HEK cell line and used to treat primary human coronary artery endothelial cells (HCAEC).

Results
Athletes showed a significant increase in serum concentration of circulating ASC specks immediately after the marathon (t1, +52% compared to baseline, p&lt;0.05) and a decrease during follow-up after 24–58 hours (t2, 12% reduction compared to immediately after the run, p&lt;0.01). Confocal microscopy revealed that HCAEC can internalize extracellular NLRP3 inflammasome specks. After internalization, endothelial cells showed an inflammatory response with higher expression of the cell adhesion molecule ICAM1 (6.9-fold, p&lt;0.05) and increased adhesion of monocytes (1.5-fold, p&lt;0.05).

Conclusion
These findings identify extracellular inflammasome specks as novel systemic mediators of cell-cell communication that are transiently increased after acute high-intensity exercise.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Leipzig
Coronary inflammation by computed tomography pericoronary fat attenuation in young male anabolic androgenic steroid users
Authors: Souza F , Rochitte C E , Silva D C , Gomes A M R , Santos M R , Fonseca G W P , Battaglia A C B F , Correa K T S , Yonamine M , Pereira R M R , Negrao C E , Alves M J N N 
Published: October 2022

Abstract

Background
The illicit use of anabolic androgenic steroids (AAS) has been associated with diminished cholesterol efflux mediated by HDL, remarkable decrease in high-density lipoprotein (HDL) plasma concentration and subclinical coronary artery disease (CAD). Inflammation is the key to the atherogenic process associated with atherosclerotic plaque vulnerability. The pericoronary mean fat attenuation (pFAM) has emerged as a marker of coronary inflammation and can predict future cardiovascular events, which is measurable from standard coronary computed tomography angiography (CCTA). However, whether AAS abuse has a role in pFAM in young male AAS users is unknown.

Purpose
The aim of this study was to evaluate whether AAS abuse could leads to higher pFAM and premature coronary inflammation in young male AAS users.

Methods
Twenty strength-trained AAS users (AASU) age 29±5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled in this study. Coronary inflammation was assessed by pFAM-CCTA in the right coronary artery (RCA), left anterior descending artery (LDA) and left circumflex coronary artery (Cx).

Results
pFAM in the RCA was significantly higher in AASU compared with AASNU and SC (−64.59±9.45 vs. −79.21±6.67 vs. −80.97±7,91 Hounsfield Units (HU), respectively, p&lt;0.001]. Also, the pFAM in the LAD was higher in AASU compared with AASNU and SC (−72.83±7.21 vs. −79.41±6.72 vs. −80.97±7.72 HU, p=0.006). However, no difference to pFAM in the Cx between AASU, AASNU and SC (−74.30±5.85 vs. −79.77±7.13 vs. −78.19±5.82 HU, respectively, p=0.069) was found.

Conclusion
This study indicates that AAS abuse may be associated with higher pFAM and premature coronary inflammation in the RCA and LAD. The higher pFAM may be linked to early development of CAD in young AAS users.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Fundação Zerbini
Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care
Authors: Manten A , De Clercq L , Rietveld R P , Lucassen W A M , Moll Van Charante E P , Harskamp R E 
Published: October 2022

Abstract

Background/Introduction
Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest pain-specific risk scores originally developed for diagnostic purposes may perhaps outperform current, expert-based and unvalidated telephone triage protocols.

Purpose
To evaluate the performance of the Marburg Heart Score (MHS) and INTERCHEST as stand-alone triage tools, and to compare their performance with the current “Netherlands Triage Standard (NTS) protocol on differentiating major events”.

Methods
This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the MHS and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool (NTS). The outcomes of interest were; C-statistics, calibration and diagnostic accuracy for optimized thresholds with major events as reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent conditions requiring in-hospital treatment, occurring within 6 weeks of initial contact.

Results
We included 1,433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (n=235), of which acute coronary syndrome (ACS) accounted for 6.8% (n=98). For predicting major events, C-statistics for MHS and INTERCHEST were 0.74 [95%-CI: 0.70–0.77] and 0.76 [0.73–0.80], respectively. In comparison, NTS had a C-statistic of 0.66 [0.62–0.69]. All had appropriate calibration. Both scores (at threshold ≥2) reduced the number of referrals (with lower false positive rates) and maintained equal safety compared with NTS.

Conclusion
Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising on triage safety. Further validation is warranted.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Cardiovascular Research InstituteZonMw-HGOG
The effects of human papillomavirus vaccination on cardiovascular diseases. The United States National Health and Nutrition Examination Survey
Authors: Chou O H I , Liang X , Cheung B M Y 
Published: October 2022

Abstract

Aims
We investigated the association between HPV and CVDs in women with and without HPV vaccination.

Methods and results
We studied 9353 women aged between 18 to 59 years old who were tested for vaginal HPV DNA in the National Health and Nutrition Examination Survey (NHANES) 2003–2016. The CVDs were defined as the self-reported coronary heart diseases, heart attack, angina pectoris and stroke. The HPV vaccination status was extracted from the NHANES 2007–2016 database. The association between HPV and CVDs was studied using logistic regression, with adjustment for the potential confounders.
Among the participants, 40.8% (95% CI, 39.4–42.4) were HPV DNA positive, and 3.0% (95% CI, 2.6–3.5) had CVDs. 9.0% (95% CI, 8.0–10.0) of women received the HPV vaccine. The presence of vaginal HPV infection was associated with CVD [OR=1.66, 95% CI (1.28–2.16), P&lt;0.01], which remained significant [OR=1.53, (95% CI 1.13–2.07), P&lt;0.01] after adjustment for sociodemographic characteristics, smoking, alcohol use, number of sexual partners, cervical cancer, BMI, hypertension, diabetes, and hyperlipidemia. Women younger than 38 years old showed a stronger association between HPV and CVDs [OR=2.15, 95% CI (1.01–4.77), P&lt;0.01]. The association was absent among those who wereHPV vaccinated [OR= 0.44, 95% CI (0.07–2.79), P=0.83], but only present among those who were not [OR=1.60, 95% CI (1.15–2.24), P&lt;0.01].

Conclusions
In this large nationally representative survey, HPV infection was associated with CVDs. The association was absent in women vaccinated against HPV. Our findings regarding early HPV vaccinations may pave the way for new strategies for CVD prevention.

Funding Acknowledgement
Type of funding sources: None.