bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular rehabilitation delivery and outcomes in Switzerland: data from a national database over the last decade
Authors: Tessitore E , Schmid J P , Hermann M , Capoferri M , Kiencke S , Schmied C , Tschanz H , Wilhelm M , Meyer P 
Published: October 2022

Abstract

Background
Cardiac rehabilitation (CR) is a multidisciplinary, comprehensive, exercise-based intervention strongly recommended by current guidelines to improve symptoms and quality of life and to reduce cardiovascular adverse outcomes, mainly in patients with coronary artery disease and heart failure. CR activities have not been reported on a Swiss national base so far.

Purpose
To report CR outcome variables from a Swiss national base.

Methods
As part of the Swiss working group for cardiovascular prevention, rehabilitation, and sports cardiology (SCPRS) quality standards, all Swiss CR centres provide yearly a quality indicator report on an online questionnaire. Annual data from 2010 to 2019 were transferred as medians or means of all individual patients' data from each centre. We used the t-Student test to compare changes of outcome variables between entry and exit of the programme.

Results
A total of 133,060 CR patients were included (68,690 inpatients and 64,370 outpatients) with a progressive increase reaching its climax with 14'909 patients/year in 2018. Mean age ± standard deviation (SD) in outpatient and inpatient programmes was 60±1 and 68±1 years, and women percentage 21% and 32%, respectively. The most common CR indication was acute coronary syndrome (51%) in outpatient, whereas cardiovascular surgery of various types (60%) was the main indication in inpatient programmes. Mean improvement ± SD of functional capacity was 38% ±3.6 using the six-minute walk test in inpatient (p&lt;0.001) and 21% ±2 using cycle-ergometer maximal exercise testing in outpatient programmes (p&lt;0.001). Quality of life mainly assessed with the 12-item Short Form Survey (SF-12) in outpatient CR improved by 13% ±4.5. MacNew Heart questionnaire systematically performed in inpatient programmes showed significant improvement at emotional level by 12% ±0.4, at physical level by 30% ±0.9, and at social level by 18% ±0.6.

Conclusion
Even if still underutilised in certain groups of patients such as women or heart failure, CR has gained growing importance in Switzerland during the last decade. Functional capacity, as well as quality of life, was significantly improved. Individual CR patient data should be collected in the future to improve assessment of outcome parameters and benchmarking of centres.

Funding Acknowledgement
Type of funding sources: None.
Comparing the findings and diagnostic accuracy of cardiac magnetic resonance imaging in patients with biopsy confirmed acute myocarditis presenting with infarct-like and heart failure symptoms
Authors: Hassan K M , Kyriakakis C G , Doubell A F , Robbertse P P , Joubert L H , Zaharie S D , Van Zyl G U , Herbst P H 
Published: October 2022

Abstract

Introduction
Cardiac magnetic resonance imaging (CMR) is considered the reference imaging modality in providing a non-invasive diagnosis of acute myocarditis (AM), as it allows for the detection of myocardial injury associated with AM. However, the diagnostic accuracy and pattern of CMR findings appear to differ according to clinical presentation.

Methods
This is a retrospective cross-sectional study. Consecutive adult patients presenting to a single tertiary centre in South Africa between August 2017 and November 2021 with endomyocardial biopsy (EMB) confirmed AM presenting with infarct-like (IL) or heart failure (HF) symptoms who had undergone CMR were included.

Results
Thirty-eight patients were enrolled. Twenty-two presented with IL symptoms and sixteen with HF symptoms. On CMR, the IL group had significantly higher ejection fractions of both ventricles (LVEF 54.3±14.9% vs 35.4±14.0%, p&lt;0.001; RVEF 56.8±10.9% vs 43.6±18.6%, p=0.03), despite similar end diastolic dimensions (LVEDVi 83.2±30.9 ml/m2 vs 104.4±38.0 ml/m2, p=0.07; RVEDVi 74.4±22.1 ml/m2 vs 85.8±29.9 ml/m2, 0=0.19). Myocardial oedema was detected more frequently on T2-weighted imaging (90.9% vs 62.5%, p=0.05) and in more myocardial segments (3.0 (IQR 2.0–4.0) vs 1.0 (IQR 0–1.0), p 0.003) in the IL group. Despite no significant difference in the prevalence of late gadolinium enhancement (LGE) between the two groups (95.5% vs 68.8%, p=0.06), the IL group had LGE detectable in significantly more ventricular segments (4.5 (IQR 2.3–6.0) vs 2.0 (IQR 0–3.3), p=0.01) and in a different distribution. The sensitivity of the original Lake Louise Criteria (LLC) was 90.9% in IL patients and 56.3% in HF patients, which improved to 95.5% and 68.8% with the updated LLC respectively.

Conclusion
The pattern of CMR findings and its diagnostic accuracy appears to differ in AM patients presenting with IL and HF symptoms. Although the sensitivity of the LLC improved with the addition of parametric mapping in the HF group, it remained lower than that of the IL group, and suggests that EMB should be strongly considered in patients with clinically suspected AM presenting with HF.

Funding Acknowledgement
Type of funding sources: None.
Effect of early hysterectomy on a risk of incident cardiovascular disease in women: a nationwide population-based cohort study
Authors: Kim B G , Yuk J S , Kim G S , Seo J K , Jin M N , Lee H Y , Seo Y S , Kim M H , Yang S W , Yoon S H , Byun Y S , Kim B O 
Published: October 2022

Abstract

Aim
Women who inevitably underwent surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron than women who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) early. We aimed to evaluate the association of women with hysterectomy vs. without hysterectomy before their 50s with the risk of incident CVD.

Methods
This was a retrospective-cohort study, 135,575 women aged 40 to 50 years in 2011–2014 were extracted from the Korean Health Insurance Review and Assessment Service data and after propensity score matching, 55,539 pairs were included in hysterectomy and non-hysterectomy group respectively. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiovascular death, myocardial infarction (MI), stroke, and coronary artery revascularization.

Results
After adjustment for confounding factors, hysterectomy group had an increased risk of MACCE compared with non-hysterectomy group (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.09–1.44). Regarding individual outcomes, cardiovascular death, MI, and coronary revascularization were comparable between the groups, whereas, the risk of stroke was significantly higher in hysterectomy group than non-hysterectomy group (HR, 1.31; 95% CI, 1.12–1.53). Even after excluding women who underwent oophorectomy, hysterectomy group had a higher risk of MACCE than non-hysterectomy group (HR, 1.24; 95% CI 1.06–1.44).

Conclusions
Early surgical menopause due to hysterectomy, not hormonal menopause, was associated with an increased risk for a composite of CVD, especially stroke. This suggest that the role of “uterus” as well as sex hormones may be important for the sharp increase in the risk of CVD in women after menopause.

Funding Acknowledgement
Type of funding sources: None.
Sex disaggregated analysis of risk factors for adverse outcomes in hypertrophic cardiomyopathy
Authors: Butters A , Arnott C , Sweeting J , Claggett B , Atherton J , Semsarian C , Lakdawala N K , Ho C Y , Ingles J 
Published: October 2022

Abstract

Background
Patient sex has been associated with differences in disease penetrance and clinical expression in HCM. We sought to investigate sex-disaggregated differences in risk factors for adverse outcomes in a large international HCM registry.

Methods
This is a retrospective study of HCM patients from the Sarcomeric Human Cardiomyopathy Registry. Cox proportional hazards models were fit with a sex interaction term to determine significant differences between sexes.

Results
6647 (38% women) probands with HCM were included. After a mean follow-up of 6.4 years from first encounter, women had a higher risk of heart failure (HF) composite (HR 1.77; 95% CI 1.56–1.99, p&lt;0.0001), and death (1.22; 1.03–1.45, p=0.02) compared to men. No sex difference existed for ventricular arrhythmia composite (p=0.2) or atrial fibrillation (p=0.6). Sarcomere positive status (Sarc+) and causative variants in MYBPC3 reduced the risk of the HF composite for women, while for men there was no change in risk (P-heterogeneity=0.016 and &lt;0.0001, respectively). Baseline LVEF &lt;35% and larger LA size increased the risk of the HF composite for both sexes but to a greater magnitude in men (P-heterogeneity=0.0003 and 0.04 respectively) (Figure 1). Sarc+ increased the risk of death in men but not women (P-heterogeneity=0.041). Having the HF composite increased the risk of death by 45% in and 240% in men (P-heterogeneity=0.003) (Figure 2).

Conclusion
There are important sex differences in the risk of heart failure and death in those with HCM, with significant heterogeneity of outcomes based on subgroups defined by genetic and imaging factors.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Sarcomeric Human Cardiomyopathy Registry (SHaRe) is supported by an unrestricted research grant from Bristol Myer Squibb, including funds to individual sites for database support.
Prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women. from the multi-ethnic study of atherosclerosis (MESA)
Authors: Pezel T , Michos E D , Varadarajan V , Shabani M , Ambale Venkatesh B , Vaidya D , Kato Y , De Vasconcellos H , Heckbert S , Wu C , Post W , Bluemke D , Allison M A , Lima J 
Published: October 2022

Abstract

Background
Endogenous sex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in peri-menopausal women, but the association of menopause status with left atrioventricular coupling is not well established.

Purpose
To assess the prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women without a history of cardiovascular disease (CVD) at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods
In women participating in the MESA study, the LACI was measured as the ratio of the left atrial (LA) end-diastolic volume to the left ventricular (LV) end-diastolic volume using cardiovascular magnetic resonance (CMR). Cox proportional hazard models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), and hard CVD defined by myocardial infarction, resuscitated cardiac arrest, stroke, or coronary heart disease death.

Results
Among the 2,087 women participants (61±10 years), 485 cardiovascular events were observed during the mean follow-up period of 13.2±3.3 years. A higher LACI was independently associated with AF (HR 1.70; 95% CI [1.51–1.90]), HF (HR 1.62; [1.33–1.97]), and hard CVD (HR 1.30; [1.13–1.51], all p&lt;0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to currently used standard models used to predict the incidence of AF (C-statistic=0.82 vs. 0.79; NRI=0.325; IDI=0.036), HF (C-statistic=0.84 vs. 0.81; NRI=0.571; IDI=0.023), hard CVD (C-statistic=0.78 vs. 0.76; NRI=0.229; IDI=0.012).

Conclusion
In a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, and hard CVD. In both pre- and post-menopausal women, the LACI has an incremental prognostic value for predicting cardiovascular events over traditional risk factors and sex hormone levels.
ClinicalTrials: gov Identifier: NCT00005487

Funding Acknowledgement
Type of funding sources: None.
Increased risk of atrial fibrillation in patients with uterine fibroids: a nationwide population-based study
Authors: Han S , Choi E K , Han K D , Ahn H J , Kwon S , Lee S R , Oh S 
Published: October 2022

Abstract

Background
Uterine fibroid, the most common benign neoplasm of the uterus, is associated with an elevated risk of cardiovascular disease. The link between incident atrial fibrillation (AF) and the uterine fibroid is unclear because earlier studies focused primarily on the development of atherosclerosis and hypertension. We aimed to investigate the risk of AF in patients with uterine fibroid.

Methods
This is a retrospective cohort study using the Korean National Health Insurance Service database (NHIS). From 2009 to 2012, a total of 2,574,349 women (20 to 40 years old) who underwent general health examinations were included. Diagnosis of uterine fibroids and surgical treatment status was defined by the international classification of diseases, 10th revision codes, and procedural codes from the Korean NHIS. The primary outcome was newly diagnosed AF. The risk of AF according to the uterine fibroids and their surgical treatment status was evaluated using Cox proportional-hazard models.

Results
Of the total population, the mean age was 29.76±4.27 years, and 20,682 (0.8%) were identified to have uterine fibroid. Incident AF was identified in 3,868 patients (61 in the fibroid group, 3,807 in the control group) during a mean follow-up of 7.3±1.1 years. Patients of the uterine fibroid group showed a higher incidence of AF compared to the control group (0.41 and 0.20 per 1000 person-years, respectively, Figure 1). Multivariate Cox-regression analysis presented that uterine fibroid was an independent risk factor of AF: hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.16–1.93, p=0.002. Compared to the control group, uterine fibroid patients who underwent surgical treatment tend to show a lower risk for AF (HR 1.22, 95% CI 0.79–1.90) than patients without surgical treatment (HR 1.69, 95% CI 1.24–2.30), though statistical significance was indeterminate (Figure 2). After propensity score matching, patients of the uterine fibroid group showed higher risk of AF when compared to the control group (HR 1.77, 95% CI 1.32–2.63, p&lt;0.001), which was in line with our main results. The presence of uterine fibroid was consistently associated with higher risk of AF among all subgroups except for the stroke subgroup.

Conclusion
Patients with uterine fibroids are predisposed to an increased risk of AF compared to the control group. Careful monitoring of arrhythmia development would be warranted in patients of uterine fibroid and surgical treatment as it is associated with a modest risk decrement of incident AF.

Funding Acknowledgement
Type of funding sources: None.
Assessment of cardiac involvement in patients recovered from corona virus disease-19 (COVID-19) infection using magnetic resonance imaging
Authors: Florentino M , Javier S , Sawit S , Geron V , De La Rosa J , Quetua P , Rosas N 
Published: October 2022

Abstract

Background
Cardiac sequelae after recovery from COVID-19 infection has not been well-established. Recent studies have used cardiac magnetic resonance (CMR) imaging to assess myocardial involvement or ongoing myocarditis in patients with prior COVID-19 infection.

Objectives
The primary objective of this study was to identify the CMR imaging findings in adult COVID-19 recovered patients.

Methods
This was a single-center retrospective observational cohort study of adult COVID-19 recovered patients who underwent cardiac magnetic resonance imaging. Patient demographics, CMR findings, blood marker results, and treatment received were obtained.

Results
Of the 77 included patients, 42 (54.55%) were male, and the median age was 45 years. Only 6 patients had completely normal scans, making the prevalence of an abnormal CMR 92.21% (95% CI 83.5%–96.5%). All those with an abnormality demonstrated late gadolinium enhancement (LGE), and of these, 64 (90%) had preserved left ventricular ejection fraction (LVEF). Thirty-four patients (44%) had evidence of myocardial edema. Among patients with myocardial edema and LGE, the median numbers of involved segments were 4 (range 1–16) and 7 (range 1–15), respectively. Myocardial edema was most frequently found in the mid inferolateral segment (53%), followed by the basal inferior septum, basal anterior septum, and basal inferolateral segments (each with 41%). Meanwhile, late gadolinium enhancements were most commonly located in the basal inferior septum (75%), mid inferior septum (80%), and basal anterior septum (73%).

Conclusion
Cardiac involvement, particularly edema and late gadolinium enhancement, affecting multiple myocardial segments were observed in a considerable number of patients recovered from COVID-19.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 vaccination in the pediatric age and risk for myocarditis
Authors: Aimo A , Cantinotti M , Panichella G , Clerico A 
Published: October 2022

Abstract

Background
There are some concerns about the cost/benefit ratio of Covid-19 vaccination in children and young adolescents age due to the greater response to immune stimulation. Myocarditis is a feared adverse event (AE).

Methods
On January 4, 2022 we searched the Pubmed and EMBASE datasets for population studies assessing myocarditis events in pediatric subjects, and US nationwide data about COVID-19 vaccinations and AEs.

Results
The studies selected (n=10) were highly heterogeneous, and did not include subjects &lt;12 years. The estimated incidence of myocarditis in the US was 2.80 over 100,000 in fully vaccinated individuals (i.e., receiving two doses of mRNA vaccines or received one dose of a single-dose vaccine) aged 6–17 years. No events were reported &lt;5 years (n=9,985). The incidence of myocarditis was 1.05 over 100,000 in those aged 18–64 years, and 2.75 over 1,000,000 ≥65 years. The incidence of fatal or life-threatening myocarditis was 3.78 over 1,000,000 6–17 years, 1.78 over 1,000,000 18–64 years, and 8.54 over 10,000,000 ≥65 years, with the same order of magnitude than the odds of being struck by lightning. The incidence of COVID-19 myocarditis is 1.33 in 1000 &lt;16 years, i.e., 47.5-fold higher than fully vaccinated individuals.

Conclusions
The reported incidence of myocarditis in subjects aged ≥12 years is slightly higher in males and after the second dose, but extremely low. No case of myocarditis &lt;5 years were reported in the US. In fully vaccinated individuals aged 6–17 years, the estimated incidence of myocarditis was far lower than the risk of COVID-19 myocarditis.

Funding Acknowledgement
Type of funding sources: None.
Cardiovascular autonomic nervous function in 7–12 years old children conceived naturally or by ART with frozen and fresh embryo transfer
Authors: Mizrak I , Lund M A V , Landgrebe A V , Asserhoej L L , Gorm G , Clausen T D , Main K M , Vejlstrup N G , Jensen R B , Pinborg A , Madsen P L 
Published: October 2022

Abstract

Background
Cardiovascular autonomic nervous functions (CANF) exert important homeostatic mechanisms to prevent major arterial blood pressure fluctuations by adjusting heart rate (HR), cardiac contractility, and peripheral vascular tone. Children conceived by assisted reproductive technologies (ART) are at risk of increased carotid intima-media thickness, insulin resistance, arterial stiffness, and hypertension. CANF is impaired in children with obesity and diabetes mellitus, and conductance artery stiffness is documented to influence CANF. CANF may therefore be hypothetized to be impaired in children conceived by ART.

Purpose
This is the first study to investigate whether children conceived by ART have impaired CANF as compared to naturally conceived children.

Method
CANF was studied in 105 singletons aged 7–12 years conceived naturally (NC, N=33) or by ART (frozen embryo transfer (FET, N=34) and fresh embryo transfer (Fresh ET, N=38)). CANF was evaluated with continuous non-invasive hemodynamic measurements (Finapres®) by the HR and blood pressure changes seen relative to rest during active standing, deep breathing and Valsalva, respectively.

Results
The descriptive data showed no difference in CANF measurements between our study groups (Table 1). In the multivariate analysis, only the Valsalva HR-ratio to rest was significantly higher in children conceived by FET as compared to NC children after adjustments for age, sex, BMI and maternal age at delivery (Figure 1). For all meaures, the effect size (Hedges d) ranged from 0.02 to 0.48.

Conclusion
In this study only the Valsalva HR-response between FET and NC groups were statistically significant after adjustment for confounders, and in general effect sizes were small. Our study suggests that children conceived by ART do not have a significantly impaired cardiovascular autonomic nervous function as compared to naturally conceived children.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation
NOAC in adult congenital heart disease patients: a single-center experience
Authors: Rocha B , Maltes S , Cunha G , Paiva M , Brizido C , Aguiar C , Madeira S , Mendes M 
Published: October 2022

Abstract

Background
Adult Congenital Heart Disease (ACHD) patients at increased risk for thromboembolic events are often treated with oral anticoagulation. While vitamin-K antagonists have been the agent of choice for decades, the use of non-vitamin K oral anticoagulants (NOAC) is increasing. We aimed to assess the safety and effectiveness of NOAC in ACHD patients at our centre.

Methods
This is a single-centre study enrolling all patients with ACHD treated with a NOAC from inception to November 2021. Data was collected using a standardized questionnaire applied to all patients by means of a telephone visit, in parallel with a detailed retrospective chart review. The endpoints of interest included thromboembolic and haemorrhagic events, defined as per the standardized International Society on Thrombosis and Haemostasis (ISTH) scale.

Results
Overall, 36 ACHD patients were enrolled [mean age 53±15 years; female sex – 66.7%; previous stroke – 33.3%; median HAS-BLED and CHA2DS2-VASc score – 1 (1–2) and 3 (2–5), respectively], predominantly with moderate or complex congenital defects (52.7%), of whom 14, 8, 8 and 4 were treated with rivaroxaban, apixaban, edoxaban and dabigatran, respectively. Two-thirds had their first NOAC prescription in the latest 3 years (Figure 1). The most common indication for anticoagulation was atrial fibrillation or flutter (77.8%). Over a median time of 36 (18–63) months on NOAC treatment, there were no patients with thromboembolic events, whilst 13 (36.1%) had a haemorrhagic event – annualized event rate of 12.0 (6.9–24.1%). All bleeding events were minor, most often self-limited gingival haemorrhage or epistaxis (n=7) or menorrhagia (n=3). Nasal cautery was needed to treat recurrent epistaxis in 3 patients, whilst 3 other required oral iron supplementation. The strongest predictor of any haemorrhage was a prior cardiovascular hospitalization (HR 3.88; p=0.027).

Conclusions
The use of NOAC in ACHD patients has been increasing in our centre, with encouraging results. The present findings suggest that NOAC are safe and may be effective for thromboembolic event prevention in heterogeneous forms of ACHD.

Funding Acknowledgement
Type of funding sources: None.