bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of metabolic dysfunction-associated fatty liver disease and its association with physical function in patients with acute coronary syndrome
Authors: Noda T , Kamiya K , Hamazaki N , Nozaki K , Ichikawa T , Yamashita M , Uchida S , Maekawa E , Yamaoka-Tojo M , Matsunaga A , Ako J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Background
It is widely known that patients with acute coronary syndrome (ACS) are at increased risk of nonalcoholic fatty liver disease (NAFLD), which is linked to sarcopenia and physical dysfunction. However, the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and physical dysfunction remains unclear.

Purpose
The purpose of this study was to investigate the prevalence of MAFLD in patients with ACS to assess the relationship between MAFLD and muscle strength, walking speed, and 6-minute walking distance (6 MWD).

Methods
We reviewed patients with ACS who were assessed for hepatic steatosis using the fatty liver index, and the results were further assessed to determine the presence of MAFLD. Multiple regression analysis was used to examine the association between MAFLD and physical function.

Results
Among 479 enrolled hospitalized patients, MAFLD was identified in 234 (48.9%) patients. We conducted a multiple regression analysis in which MAFLD was independently associated with lower leg strength, gait speed, and 6 MWD (leg strength, P = 0.023; gait speed, P = 0.002 and 6 MWD, P = 0.017). Furthermore, having more metabolic impairment was still associated with lower physical function decline (leg strength, P for trend = 0.002; gait speed, P for trend = 0.019 and 6 MWD, P for trend = 0.003).

Conclusions
MAFLD is common in hospitalized patients with ACS, and most patients with MAFLD have many overlapping metabolic abnormalities. MAFLD is associated with impaired physical function, and the greater the number of overlapping metabolic abnormalities, the worse the motor function.
Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF
Authors: Porcari A , Merlo M , Baggio C , Gagno G , Andreis A , Rosmini S , Raafs A , Bromage D , Cannata' A , Di Bella G , Nucifora G , Perazzolo Marra M , Heymans S , Imazio M , Sinagra G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization (1).

Purpose
Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF (2,3).

Methods
Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized vs. diffuse, subepicardial vs midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF &lt;50%.

Results
Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 [2-12] days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF &lt;50%). Compared to the others, patients experiencing ACEs had lower median LV-GLS values (-13.9% vs -17.5%, p=0.001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as &gt;-20% or quartiles), diffuse and midwall LGE were associated with ACEs (Figure 1). Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for diffuse and midwall LGE.

Conclusions
In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort (Figure 2).
The role of electrocardiographic findings in pulmonary embolism risk assessment
Authors: Devesa Neto V , Correia J , Pires INÊS , Santos JOÃO , Cabral C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The electrocardiogram (ECG) is helpful in patients (P) with pulmonary embolism (PE), but it is not present in the existing risk prediction tools, such as the Pulmonary Embolism Severity Index (PESI). Intermediate risk PE encompasses a heterogeneous group of P, with different prognoses, some of whom will need fibrinolytic treatment.
This study aims to determine the prognostic impact of ECG in intermediate-risk PE.

Methods
All P admitted for intermediate-risk PE in an Intensive Cardiac Care Unit between 2007 and 2016 were included. P were followed up for two years for all-cause mortality. Clinical and analytical variables, ECG, echocardiographic, and computed tomography (CT), were collected. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions, Kaplan-Meier curves, and Cox regression.

Results
This study included 209 P: mean age 63±18years; 38.5% male. T-wave inversion in leads V1-V3 was present in 81 (38.8%), S1Q3T3 pattern in 51 (24.4%), incomplete right bundle branch block (RBBB) in 27 (12.9%), and complete RBBB in 22 (10.5%). T-wave inversion in leads V1-V3 was associated with syncope at presentation (p=0.032); presence of echocardiographic right ventricle dilation (p=0.003) and abnormal interventricular septal (IVS) motion (p=0.001). S1Q3T3 pattern was associated with syncope (p=0.028); higher heart rate at admission (p=0.001); higher troponin (p=0.013) and BNP (p=0.010) levels; abnormal IVS motion (p=0.004); and increased CT-derived right-to-left ventricle diameter (RV/LV) ratio (p=0.014). RBBB were associated with syncope (p=0.020); higher troponin and BNP levels (p=0.001); and increased RV/LV ratio (p=0.029). For each increase in the number of these ECG findings, there was an increase in the odds of fibrinolytic treatment (OR 1.573, 95%CI 1.150-2.151, p=0.005), and the number of ECG findings was a predictor of fibrinolysis independently from PESI (OR 1.535, p=0.008).
In survival analysis, T-wave inversion in leads V1-V3 was associated with decreased survival during follow-up (x2=4.398; p=0.036), even after adjustment for PESI (OR 0.322, p=0.041).

Conclusions
ECG findings of PE were associated with clinical, analytical and imagiological risk features. They were also predictors of fibrinolysis, and T-wave inversion in leads V1-V3 was associated with decreased survival after adjustment for PESI. Therefore, in the future, incorporation of ECG findings in risk scores might allow better risk assessment in intermediate-risk PE.
The angiotensin 1-7 blood levels decreasing in the patients with arterial hypertension and type 2 diabetes is associated with the development of the hypertensive heart disease
Authors: Koval S , Snihurska I , Yushko K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Angiotensin 1-7 (Ang-(1–7) - one of the components of the renin-angiotensin system, is the main counterparty of Аngiotensin II (AII). It implements protective effects opposite to the action of AII. Ang-(1–7) induces vasodilatory, anti-inflammatory, antifibrotic, antiangiogenic and antihypertensive effects. Alterations in left ventricle (LV) geometry such as LV dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the mechanisms are still not well-understood in patients with arterial hypertension (AH) and type 2 diabetes (T2D)
The aim of the work was to study the Ang-(1–7) levels in blood plasma of patients with arterial hypertension (AH) with hypertensive heart disease (HHD) and concomitant T2D.

Methods
A total of 70 patients with grade 2–3 AH and HHD with concomitant T2D aged 42 to 69 years (48 patients had LV diastolic dysfunction (DD) and 22 patients had normal LV diastolic function) and 20 practically healthy individuals of comparable gender and age were examined. The survey included standard clinical, laboratory and instrumental methods. Diagnosis of AH and HHD was carried out according to the 2018 ESC/ESH recommendations. LV DD was determined according to the 2016 ASE/EACVI recommendations. The blood levels of Ang-(1–7) were determined by the enzyme immunoassay.

Results
We have found that in patients with AH and T2D plasma Ang-(1–7) levels were significantly lower than in practically healthy individuals – 105,51(89,13;121,17) ng/l versus 128,77(120,02;276,49) ng/l, p&lt;0,05. Among patients with АН and T2D the following types of l LV ventricular remodeling were identified: 35 patients had concentric LV hypertrophy, 25 patients had eccentric LV hypertrophy, 10 patients had concentric remodeling of LV. The patients with concentric LV hypertrophy and eccentric LV hypertrophy had significant lower levels of Ang-(1-7) than in patients with concentric remodeling of LV - 107,5(88,2;119,6) ng/l and 101,4(84,2;111,8) ng/l versus 129,3(117,5;136,8) ng/l (р&lt;0,01 and р&lt;0,01 respectively) but did not differ between themselves (p&lt;0,05). In all this among patients with LV DD levels of Ang-(1-7) were significantly lower than in patients with normal diastolic function - 101,1(87,9;116,6) ng/l versus 121,1(105,5;128,9) ng/l, р&lt;0,01. In the in patients with AH and T2D there was a statistically significant negative relationship between plasma Ang-(1-7) level and next LV parameters: LV mass index (R = −0.41, p &lt; 0.001 and LV mass (R=-0,40, p&lt;0,001).

Conclusion
The findings suggest the significant role of decreased Ang-(1-7) levels in blood plasma of patients with AH and concomitant T2D in the development and progression of HHD.
Long-term impact of different triple antihypertensive drug treatments on blood pressure control, metabolic pattern and incident events: data from the Brisighella Heart Study
Authors: Cicero A , Fogacci F , Rizzoli E , D'addato S , Borghi C 
Published: May 2022

Abstract

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

Purpose
The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized population cohort.

Methods
We considered data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2008 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with &lt;3 or ≥3 high blood pressure (BP) medications without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with ACE-inhibitors/CCBs/Thiazide, ARBs/CCBs/Thiazide or Perindopril/Amlodipine/Indapamide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive medications. The long term effects of the different antihypertensive medications were compared among the pre-defined groups.

Results
On the long-term, combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with better control of diastolic BP and lipid pattern than other triple combination antihypertensive medication. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow-up they neither developed type 2 diabetes nor had a need for a greater number of antihypertensive drugs to improve BP control.

Conclusion
Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other combination antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/amlodipine/indapamide is associated with better lipids’ profile than any other considered combination antihypertensive medication.
Long-term effect of obstructive sleep apnea and CPAP treatment on blood pressure control in patients after acute coronary syndrome
Authors: Aldoma A , Manuel Sanchez-De-La-Torre M , Gracia-Lavedan E , Benitez ID , Zapater A , Torres G , Sanchez-De-La-Torre A , De Batlle J , Targa A , Minguez O , Pascual L , Cortijo A , Martinez D , Dalmases M , Barbe-Illa F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Instituto de Salud Carlos III (ISCIII) (PI10/02763, PI10/02745, PI18/00449, PI19/00907), co-funded by FEDER “Una manera de hacer Europa”, SEPAR, Catalonian Cardiology Society, ResMed Ltd. (Australia), EsteveTeijin (Spain), Oxigen Salud (Spain), Associació Lleidatana de Respiratori (ALLER), CIBERES. MS received financial support from a "Ramón y Cajal" grant (RYC2019-027831-I) from the“Ministerio de Ciencia e Innovación - Agencia Estatal de Investigación” co-funded by the European Social Fund (ESF)/“Investing in your future”. AZ held the predoctoral fellowship “Ajuts 2021 de Promoció de la Recerca en Salut-9ª edició” from IRBLleida/Diputació de Lleida. JdB acknowledges receiving financial support from ISCIII (Miguel Servet 2019: CP19/00108), co-funded by the European Social Fund (ESF), “Investing in your future”.

Rationale
Obstructive sleep apnea (OSA) is prevalent in acute coronary syndrome (ACS) patients and is a cause of secondary hypertension.

Objectives
To evaluate the long-term effects of OSA and CPAP treatment on blood pressure (BP) control in patients discharged after an ACS.

Methods
Post hoc analysis of the ISAACC study included 1803 patients admitted for ACS (NCT01335087). Patients with OSA (apnea-hypopnea index ≥15 events/h) were randomly assigned to receive either CPAP or/and usual care and followed up for one to 5 years. Office BP was determined at each visit.

Measurements and Main Results
We included 596 patients without OSA, 605 patients in the CPAP group, and 602 patients in the usual care group. 52% of the patients had a diagnosis of hypertension at baseline. Median age and body mass index were 59 [52.0;67.0] years and 28.2 [25.6;31.2] kg/m2, respectively. After a median [25th;75th percentile] follow-up of 41.2 [18.3;59.6] months, BP changes were similar between OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI&gt;40 events/h) with a maximum difference in mean BP of +3.3 mmHg at 30 months. OSA patients with good CPAP adherence (≥4 hours/night) reduced mean BP after 18 months compared to non-OSA and poor CPAP adherence patients, maximum mean difference (95% CI) of -4.7 (-6.7,-2.7) mmHg. In patients with severe OSA we observed a maximum mean difference of -7.1 (-10.3,-3.8) mmHg.

Conclusions
In patients discharged after an ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence.
Unhealthy behaviours of patients with cardiovascular diseases during the second COVID-19 lockdown in Northern Greece
Authors: Ioannidis A , Pechlevanis A , Paraskelidou M , Fragkiskou A , Giakoumi V , Lakias D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Unhealthy behaviours can be amplified during lockdown and organisations, like WHO and CDC, campaign on how to stay healthy at home. Lifestyle choices are of paramount importance for primary and secondary prevention of cardiovascular diseases (CVDs). Northern Greece was forcefully hit by the second wave of the COVID-19 pandemic and a hard lockdown was implemented in November 2020.

Purpose
The aim of the study was to assess the (un)healthy behaviours of patients with CVDs during the second COVID-19 lockdown in Northern Greece.

Methods
This is a cross-sectional short questionnaire telephone-based survey conducted in February 2021. Responders with known CVDs were primarily questioned (using a Likert-like scale) about smoking, diet and physical activity, along essential medical history. Beliefs about COVID-19 pandemic and vaccination were also considered. Sociodemographic details were noted. Patients who were placed under quarantine were excluded in this analysis.

Results
The response rate was high (247 out of 400 calls, 61.8%) with the majority of the participants willing to speak for longer time than initially estimated. In total, answers by 216 patients (female 132/61.1%, mean age 56.6 years old) were incorporated. There were 119 active smokers questioned, half of whom (56, 47.1%) reported increased smoking with a minority of them (18, 15.1%) smoking less. None of the questioned participants attempted to quit smoking. The mean BMI was 27.5 ± 4.3 kg/m² (vs. 26.8 ± 3.8 kg/m² before lockdown) corresponding to a mean weight gain of about 2 kg. The rise in mean BMI could be explained, partly, by the increased eating as reported by almost half of the participants (121, 56.0%). Almost half of the responders (113, 52.3%) reported increased alcohol consumption during the lockdown, while one fifth reported unchanged drinking. One in four patients stated lower alcohol consumption mainly due to difficult supply and bar closure. The majority of the participants (177, 81.9%) answered that they exercised similarly or less in comparison to their pre-lockdown habits, while only 39 (18.1%) have been more physically active. There was no difference between the patients who were favourable about vaccination (had already been vaccinated/ had arranged an appointment/ were willing to get) and those who objected/ were hesitant. Sample size would not allow thorough comparison between age groups or socioeconomic status. Nevertheless, younger patients reportedly adopted healthier choices than older patients (who were also more like to be pensioners).

Conclusion
The hard lockdown in Greece during the second wave of the COVID-19 pandemic was accompanied with an aggravation of unhealthy choices by patients with CVDs. Further research is warrant to assess the clinical impact of these behaviours. Public campaigns are anxiously needed to promote healthy behaviours.
Time trends in cardiovascular risk factors across levels of education in a general population
Authors: Hagen A , Eggen AE , Hanssen TA , Lappegard KT , Lochen ML , Njolstad I , Wilsgaard T , Hopstock LA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Northern Norway Health Authority

Background
Favourable changes over time in population cardiovascular disease (CVD) risk has not benefitted all socioeconomic groups equally. Social inequality in health also exists in high-income countries with an egalitarian welfare system.

Purpose
We aimed to study CVD risk factors across educational groups over time in a Norwegian general population.

Methods
We used multivariable linear regression and generalised estimating equation models with age-adjusted means and proportions to examine CVD risk (smoking, physical activity level, obesity [body mass index ≥30 kg/m2], blood pressure, total- and low-density lipoprotein [LDL] cholesterol, and total risk of CVD [estimated 10-year risk with NORRISK 2]) across four levels of education: Primary/partly secondary up to 10 years of schooling, upper secondary, tertiary &lt;4 years, tertiary ≥4 years in women and men aged 40-79 years attending a population-based study with two consecutive surveys in 2007-2008 (N=11,941) and 2015-2016 (N=20,322).

Results
In women, the difference between the lowest and the highest education level in risk factors in 2007-2008 versus 2015-2016 was for smoking 22.0 vs 19.2 percentage points (pp), obesity 8.7 vs 8.8 pp, sedentary physical activity level 10.5 vs 11.5 pp (p=0.012), systolic blood pressure 5.5 vs 3.4 mmHg (p=0.001), total cholesterol 0.2 mmol/L vs no difference (p&lt;0.001), LDL cholesterol 0.3 vs 0.1 mmol/L (p&lt;0.001), and total CVD risk 0.9 vs 1.8 (p&lt;0.001), respectively. In men, the corresponding numbers were for smoking 20.1 vs 16.8 pp, obesity 9.9 vs 12.9 pp, sedentary physical activity level 10 vs 11.5 pp (p=0.027), systolic blood pressure 1.7 vs 1.7 mmHg, total cholesterol 0.2 mmol/L vs no difference (p&lt;0.001), LDL cholesterol 0.1 mmol/L vs no difference (p&lt;0.001), and total CVD risk 1.2 vs 0.9, respectively. No difference across educational levels and time regarding blood pressure or total- or LDL cholesterol in users of antihypertensives and lipid-lowering drugs was found, except for an educational difference in the first but not the second time period in female antihypertensive users.

Conclusion
We found a clinically relevant educational gap in CVD risk factors, with more favourable levels with higher education. Over time, the educational gap increased in physical activity in both sexes, and in total CVD risk in women. Further, the educational gap declined in blood lipids in both sexes, and in systolic blood pressure in women. While medication use seems to contribute to weaken the educational gradient in blood pressure and lipid levels, a stronger emphasis on lifestyle interventions is needed to reduce the educational inequalities in behavioural CVD risk factors.