bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microvascular complications, coronary artery disease and the risk of cardiovascular disease in diabetes patients undergoing coronary angiography: a cohort study from the Western Denmark Heart Registry
Authors: Olesen K , Gyldenkerne C , Thrane P G , Maeng M 
Published: October 2022

Abstract

Background
Diabetes is associated with an increased risk of both microvascular macrovascular complications. The association between microvascular disease and cardiovascular risk, however, is less explored.

Aims
We aimed to estimate the cardiovascular risk associated with microvascular disease in diabetes patients with and without coronary artery disease.

Methods
We included every patient who underwent coronary angiography in Western Denmark between 2003–2016. Patients were stratified by microvascular disease (defined as diagnosis retinopathy, nephropathy, or peripheral neuropathy) and coronary artery disease by angiography. Outcomes included major adverse cardiovascular events (myocardial infarction, ischemic stroke, and cardiac death) as a combined outcome and as separate outcomes. Patients were followed for a maximum of 10 years. We estimated 10-year cumulative incidence of each outcome. Incidence rate ratios (IRR) were estimated by a modified Poisson regression model using diabetes patients with neither microvascular disease nor coronary artery disease as reference.

Results
We included 19,295 patients with diabetes, of whom 1,268 (6.6%) had microvascular disease, 10,161 (52.7%) had coronary artery disease, 3,113 (16.3%) had both microvascular disease and coronary artery disease, and 4,753 (24.6%) had neither microvascular nor coronary artery disease. Median follow-up was 5.9 years (interquartile range 3.3–9.0) Patients with microvascular disease had an increased risk of major adverse cardiovascular events compared to diabetes patients with neither microvascular disease nor coronary artery disease (13.6% versus 10.0%, adjusted IRR 1.45, 95% CI 1.19–1.77, Figure 1). This increased risk was driven by a 3.9% higher risk of ischemic stroke (adjusted IRR 1.53, 95% CI 1.14–2.05, Figure 2), while microvascular disease was not associated with an increased risk of myocardial infarction (adjusted IRR 1.08, 95% CI 0.72–1.62) or cardiac death (adjusted IRR 0.99, 95% CI 0.63–1.56). Patients with both microvascular disease and coronary artery disease had the highest risk of major adverse cardiovascular events (29.3%, adjusted IRR 3.06, 95% CI 2.67–3.50).

Conclusion
Microvascular disease in diabetes patients without angiographic coronary artery disease is associated with an increased cardiovascular risk. However, this was driven by a higher risk of ischemic stroke than by higher rates of myocardial infarction or cardiac death. In fact, diabetes patients with microvascular disease but no coronary artery disease had the same risk of ischemic stroke as those with combined microvascular disease and coronary artery disease.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Aarhus University Hospital
Therapeutic value of tafamidis in patients with wild-type transthyretin amyloidosis (ATTRwt) with cardiomyopathy based on cardiovascular magnetic resonance (CMR) imaging
Authors: Chamling B , Bietenbeck M , Korthals D , Drakos S , Vehof V , Stalling P , Weil M , Meier C , Yilmaz A 
Published: October 2022

Abstract

Background
Tafamidis was approved in Europe for the treatment of cardiomyopathy (CM) in patients with transthyretin amyloidosis (ATTR) in April 2020. So far, real-world data addressing the therapeutic value of tafamidis for the treatment of ATTR-CM are scarce. The purpose of this study was to carefully analyse the therapeutic benefit of tafamidis in patients with wild-type ATTR (ATTRwt) and CM (ATTRwt-CM) after one year of therapy based on serial multi-parametric cardiovascular magnetic resonance (CMR) imaging.

Purpose
The purpose of this study was to carefully analyse the therapeutic benefit of tafamidis in patients with wild-type transthyretin amyloidosis (ATTRwt) and cardiomyopathy (ATTRwt-CM) after one year of therapy based on serial multi-parametric cardiovascular magnetic resonance (CMR) imaging.

Methods
The present study comprised N=40 patients with ATTRwt-CM who underwent two serial multi-parametric CMR studies within a follow-up period of 12±3 months. Baseline (BL) clinical parameters, serum biomarkers and CMR findings were compared to follow-up (FU) values in patients with treated “with” tafamidis 61mg daily (n=20, group A) and those “without” tafamidis therapy (n=16, group B). CMR studies were performed on a 1.5-T system and comprised (amongst others) cine-imaging for assessment of cardiac anatomy and function including 3D longitudinal strain assessment. In addition, a modified Look-Locker inversion recovery (MOLLI) T1-mapping sequence was performed for measurement of pre- and post-contrast myocardial T1-values with additional calculation of extracellular volume fraction (ECV)-values.

Results
While left ventricular ejection fraction (LV-EF), left ventricular mass index (LVMi), left ventricular wall thickness (LVWT), native T1- and ECV-values remained unchanged in the tafamidis group A, a slight reduction in LV-EF (p=0.003) as well as a subtle increase in LVMi (p=0.034), in LVWT (p=0.001), in native T1- (p=0.038) and ECV-values (p=0.017) were observed in the untreated group B. Serum NT-proBNP levels showed an overall increase in both groups, however, with the untreated group B showing a relatively higher increase compared to the treated group A. Assessment of NYHA class did not result in significant intra-group differences when BL were compared with FU, but a trend to improvement in the treated group A compared to a worsening trend in the untreated group B (Δp=0.005).

Conclusion
Tafamidis does not improve cardiac phenotype in patients with ATTRwt-CM after one year of therapy. However, tafamidis seems to slow down cardiac disease progression in patients with ATTRwt-CM compared to those without tafamidis therapy based on multi-parametric CMR data already after one year of therapy.

Funding Acknowledgement
Type of funding sources: None.
Influence of long-term sodium-glucose cotransporter 2 inhibition on cardiac remodeling in rats with type 1 diabetes mellitus
Authors: Rodrigues E A , Rosa C M , Campos D H S , Murata G M , Damatto F C , Souza L M , Rego A B G C , Oliveira L R S , Borim P A , Gatto M , Okoshi K , Okoshi M P 
Published: October 2022

Abstract

Background
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have beneficial effects on the cardiovascular system in diabetes mellitus (DM) patients. However, as most clinical trials were performed in type 2 DM, the effects of SGLT2 inhibitors in patients with type 1 DM still need further clarification. In this study, we evaluated the effects of long-term treatment with the SGLT2 inhibitor dapagliflozin on cardiac remodeling, myocardial function, and energy metabolism in rats with type 1 DM.

Methods
Male Wistar rats were divided into three groups: control (C, n=15); DM (n=15); and DM treated with dapagliflozin (DM+DAPA, n=15) for 30 weeks. DM was induced by streptozotocin; DAPA was added to the rat chow (5 mg/kg/day). Cardiac performance was evaluated by echocardiogram and myocardial function in isolated left ventricular (LV) papillary muscle preparations. Myocardial energy metabolism enzyme activities were evaluated by spectrophotometry. Statistical analyzes: ANOVA and Tukey or Kruskal-Wallis and Dunn.

Results
DM+DAPA had lower glycemia than DM [C 112 (108–116); DM 531 (522–535)*; DM+DAPA 267 (179–339) mg/dL; p&lt;0.05 vs C and DM+DAPA]. Echocardiogram showed that DM and DM+DAPA had left atrium and left ventricle dilatation with systolic and diastolic dysfunction; in DM+DAPA, the changes were attenuated in relation to DM. Developed tension and +dT/dt were higher in DM+DAPA than DM in basal condition. After inotropic stimulation with post-pause contraction, extracellular calcium concentration elevation, and isoproterenol addition to the nutrient solution, +dT/dt and –dT/dt were higher in DM+DAPA than DM. Hexokinase, phosphofructokinase, and pyruvate kinase activity was lower in DM than the C. Phosphofructokinase and pyruvate kinase activity was higher in DM+DAPA than DM.

Conclusion
Long-term dapagliflozin treatment attenuates cardiac remodeling and myocardial dysfunction and preserves hexokinase, phosphofructokinase and pyruvate kinase activity in rats with type 1 diabetes mellitus.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CNPq - National Council for Scientific and Technological Developmentdoctor
Excess mortality in Aspirin and Dipyrone (Metamizole) co-medicated in patients with cardiovascular disease: a nationwide study
Authors: Polzin A , Dannenberg L , Helten C , Metzen D , Duecker C , Marschall U , L Hoest H , Hennig B , Petzold T , Jung C , Levkau B , Zeus T , Schroer K , Hohlfeld T , Kelm M 
Published: October 2022

Abstract

Background
Pain is a serious issue in our aging society. Metamizole is one of the most commonly used analgesics. In addition, metamizole has been shown to attenuate the pharmacodynamics response to aspirin as measured by platelet function tests. However, the extent to which this laboratory effect translates to clinical outcome in patients is unknown.

Methods
We conducted a nationwide analysis based on health insurance database including 9.2 million patients in Germany. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting (IPTW) analysis was performed to examine mortality rates between patients on aspirin-metamizole co-medication and aspirin medication alone. Myocardial infarction (MI) and stroke/transient ischemic attack (TIA) events were also documented.

Results
26,200 patients received continuous aspirin medication alone and 5,946 received co-medication with aspirin and metamizole. In the IPTW analysis, significantly increased mortality was observed in the co-medication group (15.6% vs. 24.4%, hazard ratio (HR)=1.66, 95% confidence interval (CI) 1.56–1.76; p&lt;0.0001). MI and stroke/TIA were also increased (MI: 1,370 [5.2%] vs. 355 [5.9%]; HR=1.18, 95% CI 1.05–1.32; p=0.0066, relative risk (RR) 1.14, absolute risk increase (ARI) 0.71%, number needed to harm (NNH) 140. Stroke/TIA: 1,901 [7.3%] vs. 506 [8.5%]; HR=1.22, 95% CI 1.11–1.35; p&lt;0.0001, RR 1.17, ARI 1.21%, NNH 82).

Conclusion
In this nationwide observational study, aspirin-metamizole co-medication was associated with excess mortality. This was partly due to ischemic events (MI and stroke/TIA), which were also more frequent in the co-medication patients. Therefore, metamizole should be used with caution in aspirin-treated patients for secondary prevention

Funding Acknowledgement
Type of funding sources: None.
Impact of mental disease on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study
Authors: Bae N , Lee S , Choi E , Ahn H , Ahn H , Kwon S , Han K , Oh S , Lip G 
Published: October 2022

Abstract

Background
Diabetes mellitus (DM) is known to increase the risk of mental disorders, which increases the health care burden in these patients. Also, DM is one of the risk factors leading to atrial fibrillation (AF), and the presence of concomitant AF and DM adds to the increased risks of stroke and death. It is uncertain whether mental disease is an independent risk factor of incident AF in patients with DM.

Purpose
To investigate whether diabetic patients with mental disease have an increased risk of AF.

Methods
Using the Korea National Health Insurance Service database, we enrolled 2,512,690 patients diagnosed with DM without AF between 2009 and 2021. Newly diagnosed AF was identified during the follow-up period. We compared the risk of AF between patients with mental disease and those without.

Results
Among the total population, 828,929 (32.99%; mean age 61.58±11.28; 56.71% female) patients were diagnosed with mental diseases (Figure 1). Anxiety (564,786 patients, 68.13%) was the most common mental disease, while depression was the second most common (313,773 patients, 37.85%). Diabetic patients with mental diseases had a higher percentage of women, hypertension, dyslipidemia, chronic kidney failure, congestive heart failure, obstructive sleep apnea, and thyroid disease. During a median 7.0 years (IQR 5.93–8.07) follow-up, 34,523 were diagnosed new-onset AF (4.66 per 1,000 person-year). In multivariate analysis, diabetic patients with mental disorders showed a higher risk of new-onset AF (HR 1.19; 95% CI 1.17–1.21; p-value &lt;0.0001) (Figure 2). Among mental diseases, depression, insomnia, and anxiety were associated with increased risks of new-onset AF (HR 1.15; 95% CI 1.12–1.17; HR 1.15; 95% CI 1.13–1.18; and HR 1.19; 95% CI, 1.67–1.21; all p-value &lt;0.0001, respectively), whereas bipolar disorder and schizophrenia showed non-statistically significant trends (due to small numbers). Subgroup analyses showed that younger age had significant interactions with depression, insomnia, and anxiety.

Conclusion
Mental diseases, especially depression, insomnia, and anxiety, showed an increased risk of AF in patients with DM. Awareness and prompt diagnosis and management of AF would be necessary for these high-risk populations at risk of incident AF.

Funding Acknowledgement
Type of funding sources: None.
Anxiety and depression among ambulatory and hospitalized patients with cardiovascular long-COVID-19 presentation referred to cardiology consultation after COVID-19 infection
Authors: Rasmus P , Kasprzak J D , Chudzik M , Lipert A 
Published: October 2022

Abstract

Introduction
COVID-19 is connected with varying degrees of emotional stress. Patients (pts) who are hospitalized with severe COVID-19 (C19) are located in single rooms without a permanent attendant to prevent contamination. All personnel serving these pts come into contact with patients with personal full-body protective garment. Ambulatory C19 pts, usually with less severe presentation, are treated in more comfortable conditions.

Purpose
To evaluate the impact of the psychosocial changing conditions on individuals' psyche and to analyse the differences in terms of experienced anxiety and depression among the ambulatory and hospital patients referred to post-C19 cardiology consultation.

Methods
The study involved 388 pts with persistent cardiovascular symptoms, including 198 ambulatory patients (130 females and 68 males) and 190 hospital patients (128 females and 62 males) referred to the cardiology consultation (mean age 4.9±12.9 and 50.5±14.4 years, respectively). The data were collected using the specially designed questionnaire related to descriptive characteristics of the patients and to standardized questionnaires: the State-Trait Anxiety Inventory (STAI) and Beck's Depression Inventory (BDI).

Results
Abnormal psychological metrics was common in the study pts. Indicators of anxiety were lower in the ambulatory than in hospitalized pts (p&lt;0.001). Depression level was also lower in the ambulatory pts (p&lt;0.001). The same differences were statistically significant in both female and male pts subsets. However, anxiety and depression were more pronounced among female than male pts. Very strong positive correlation was observed between anxiety - state and depression among ambulatory patients, both females and males (p&lt;0.05).

Conclusions
C19 convalescents with persistent symptoms of presumed cardiovascular origin present with abnormal psychological traits including increased anxiety and depression especially in individuals requiring hospital treatment. For this reason, it is necessary to plan the interventions particularly in hospitalized pts to reduce their anxiety and depression levels and to create psychological support programs.

Funding Acknowledgement
Type of funding sources: None.
Brief, intensive group-based cognitive therapy integrated in cardiac rehabilitation reduces psychological distress in cardiac patients with anxiety and depression a randomized controlled
Authors: Holdgaard A , Eklo Kjesbu I , Funch Lassen C , Eckhardt-Hansen C , Prescott E , Kruuse Rasmussen H 
Published: October 2022

Abstract

Background/Introduction
Patients with coronary artery disease (CAD) and valvular heart disease (VHD) often suffer from psychological distress, which in turn leads to impaired quality of life, delayed return to work, and increased morbidity and mortality. European guidelines emphasize recognition and intervention, but evidence-based treatment options are limited and perceived as costly. Manageable interventions addressing psychological distress in cardiac patients are needed.

Purpose
To develop an efficient and cost-effective model for cardiac patients to reduce psychological distress.

Methods
A multi-center randomized clinical trial in patients with newly diagnosed CAD and/or surgically treated VHD, part of the workforce and concomitant psychological distress (defined as Hospital Anxiety and Depression scale (HADS) Anxiety ≥8 or Depression ≥8). The patients were randomized to five sessions of group-based cognitive-behavioral therapy plus cardiac rehabilitation (Intervention, I) or cardiac rehabilitation alone (Control, C). Furthermore, 41 cardiac patients (male gender 85.4%, age 57±6.4 years) without psychological distress (background, B) participated as reference group to follow the natural course. The primary outcome was a total HADS score at three months. Secondary outcomes were return to work, adherence to CR (participation in &gt;80% of planned training sessions), adherence to lifestyle interventions for CVD risk factor goals, HeartQoL (is a disease-specific questionnaire that measures cardiac quality of life), and cardiovascular readmissions after 12 months.

Results
148 patients were included, 67% men, mean age 54±7.5 years and median HADS score at baseline 15 (IQR 10–19) (Table 1). At 3 months HADS score improved significantly more in the intervention group (p&lt;0.001) and this difference persisted at 6 months (p&lt;0.001, Figure). Similar results were seen for HADS anxiety and HADS depression (Figure 1). HeartQol also improved more in the intervention group. 78% had returned to work at 6 months in the intervention group versus 67% in the control (p=0.11). There were no differences in other secondary outcomes

Conclusion
Brief cognitive-behavioral therapy provided by cardiac nurses to patients with CAD/VHD and a high HADS score significantly reduced psychological distress and quality of life. The program is simple and can be integrated with existing CR programs at low costs. Larger trials are needed to confirm the effect of the program on retaining cardiac patients in the workforce.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The trial is fonded by TrygFonden
Selenium concentration and cardiovascular disease risk: Mendelian randomization study
Authors: Yuan S , Mason A M , Bruzelius M , Akesson A , Burgess S , Larsson S C 
Published: October 2022

Abstract

Background/Introduction
Selenium has been associated with cardiovascular disease (CVD) risk in observational studies; however, the causality of the association remains unestablished.

Purpose
To examine the associations of selenium concentrations with 15 CVDs using Mendelian randomization analysis.

Methods
Genetic variants significantly associated with concentrations of toenail and blood (TAB) and blood selenium in mild linkage disequilibrium (r2 &lt;0.3) were used as instrumental variables. Summary-level data for 15 CVDs were obtained from the UK Biobank study (n=367,561), FinnGen study (n=218,792), and six international consortia. The inverse variance weighted method accounting for linkage disequilibrium was used to estimate the associations. Results for one outcome from different sources were combined using the fixed effect meta-analysis method. Bonferroni correction was used to account for multiple testing, and associations with P value ≤0.003 (0.05 / 15 outcomes) were described as significant. Associations with P value between ≤0.05 and &gt;0.003 were regarded as suggestive associations.

Results
Genetically predicted concentrations of TAB selenium were not significantly associated with the risk of the 15 CVDs. However, there were suggestive associations of genetically predicted higher concentrations of TAB selenium with increased risk of atrial fibrillation and peripheral artery disease. The odds ratio per one-unit increase in log-transformed concentrations of TAB selenium was 1.07 (95% confidence interval, 1.01–1.12; P=0.019) for atrial fibrillation and 1.20 (95% confidence interval, 1.05–1.38; P=0.008) for peripheral artery disease. We observed no associations between genetically predicted blood selenium concentrations and risk of the 15 CVDs.

Conclusions
Genetically predicted higher concentrations of TAB or blood selenium were not associated with a lower risk of CVD, which suggests that high selenium status may not prevent CVD development. The suggestive positive associations of TAB selenium with atrial fibrillation and peripheral artery disease warrants verification.

Funding Acknowledgement
Type of funding sources: None.