bluuebunny/crossref_metadata_2025_split huggingface dataset:
Independent prognostic value of ventricular premature complexes during exercise and recovery in asymptomatic patients: a meta-analysis of observational studies
Authors: Gupta K , Zahedi S , Kakar T S , Zweig B 
Published: October 2022

Abstract

Introduction
Ventricular premature contractions (VPCs) are a common finding during a cardiac stress test. The independent prognostic value of these findings in asymptomatic participants is not clear.

Purpose
To investigate the cumulative independent prognostic value of VPC for adverse outcomes.

Methods
We conducted a systematic review and meta-analysis of observational studies in the following databases: MEDLINE, Embase®, and Cochrane Central from inception till January 28, 2022. The primary outcome was the cumulative hazard of all-cause mortality with VPCs during exercise or recovery in asymptomatic participants. The secondary outcome was cardiovascular mortality. We stratified results based on VPC during exercise or recovery.
We included studies with participants with no known CV disease and known CV disease. If there was known CV disease at baseline, the study should have adjusted for at least ≥1 known confounder. If a study reported low risk or higher risk VPCs, we included outcomes with higher risk VPCs to make the data comparable across literature. Random effect meta-analyses were used to predict cumulative hazard ratios. The review was registered with PROSPERO (registration number CRD42022297028)

Results
We found 10 studies with 47,497 participants that met our inclusion criteria (8 studies with all-cause and CV mortality, 2 studies with CV mortality only). Three studies included patients with baseline CV disease (proportion 12–33%). Follow-up duration ranged from 5.3 to 20.3 years. Definition of VPCs differed in the individual studies.
Both VPCs during exercise and recovery were associated with a higher hazard of all-cause mortality (HR 1.21, 95% confidence interval [CI] 1.07, 1.34 and 1.32, 95% CI 1.06, 1.58, p&lt;0.001 and low heterogeneity for both, respectively, Figure 1A). There was no small study treatment effect bias.
Similarly, both VPCs during exercise and recovery were associated with a higher hazard of CV mortality (HR 1.63, 95% CI 1.30, 1.96 and 1.68, 95% CI 1.00, 2.35, p&lt;0.001, and low heterogeneity for both, respectively, Figure 1B).
The presence of VPC had a numerically stronger association with CV mortality than all-cause mortality. VPCs during recovery seem to have more prognostic value than VPC during rest.

Conclusion
After adjusting for known confounders, VPCs during exercise and recovery predict a higher risk of all-cause and CV mortality. The risk is higher with VPCs during recovery.

Funding Acknowledgement
Type of funding sources: None.
A phase 2a trial investigating ninerafaxstat – a novel cardiac mitotrope for the treatment of diabetic cardiomyopathy (IMPROVE-DiCE)
Authors: Hundertmark M , Siu A G , Matthews V , Lewis A J , Grist J T , Patel J , Chamberlin P , Sarwar R , Yavari A , Frenneaux M P , Valkovic L , Miller J J J J , Neubauer S , Tyler D J , Rider O J 
Published: October 2022

Abstract

Background
Type 2 diabetes (T2D) is a significant, independent contributor to the development of heart failure (HF), driven by energetic, metabolic, structural and functional myocardial changes. The T2D heart is characterised by over-reliance on fatty acid utilisation, shows reduced glucose oxidation and inhibition of pyruvate dehydrogenase (PDH). This results in a diminished myocardial energy reserve and blunted adenosine triphosphate (ATP) generation as well as cardiac steatosis, contributing to lipotoxicity, and diastolic dysfunction.

Purpose
We assessed the effects of ninerafaxstat – a novel cardiac mitotrope designed to shift myocardial substrate utilisation in favour of glucose and thus, restore myocardial energy homeostasis – on cardiac metabolism & diastolic function in patients with T2D and obesity.

Methods
In this open-label, mechanistic phase 2a trial, we enrolled 21 patients with T2D & obesity (HbA1c median 7.0% (IQR 6.6, 7.8), weight 97kg (90, 102)) and subsequently treated them with 200mg ninerafaxstat twice daily for 4 or 8 weeks; (Fig. 1). Cardiac metabolism and function were assessed pre- & post-treatment using magnetic resonance imaging (MRI), 31P-, 1H- and, in a subset of n=9, hyperpolarized [1-13C]pyruvate MR spectroscopy.

Results
T2D patients at baseline presented with impaired myocardial energetics with a markedly reduced PCr/ATP (1.6 [1.4, 2.1]), myocardial steatosis (myocardial triglycerides 2.2% [1.5, 3.2]) left ventricular (LV) hypertrophy (LV mass 130g [98, 152]), and diastolic dysfunction (peak diastolic strain rate 0.86 1/s [0.82, 1.06]). Ninerafaxstat significantly improved myocardial energetics (PCr/ATP median by 32%, p&lt;0.01), reduced myocardial triglyceride content (by 34%, p=0.03) and improved LV diastolic function (peak circumferential diastolic strain rate by 10%, peak LV filling rate by 11%, both p&lt;0.05) (Fig. 2). PDH flux was increased in 7/9 subjects (mean 45%, p=0.08), consistent with improved glucose utilisation. Left ventricular volumes and mass, heart rate and blood pressure remained unchanged.

Conclusions
Treatment with ninerafaxstat significantly improves myocardial energetics, reduces myocardial steatosis and improves diastolic function in patients with T2D and obesity.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Imbria Pharmaaceuticals
Silent ischemia in exercise test in patients with stable coronary artery disease, what does it mean?
Authors: Virosta Gil E , Tojal Sierra L , Soria Navarro R , Apodaca Arrizabalaga M J , Beltran De Guevera Sainz-Pardo A , Saez De Buruaga Corrales E , Manzabal Gonzalez C , Gomez Corcuera E , Conde Lagartos A I , Fernandez Fernandez De Leceta Z , Cortes Urrutxi A , Para Barbero E , Pasalodos Heras L M , Alonso Gomez A M , Bello Mora M C 
Published: October 2022

Abstract

Introduction
The benefit of cardiac rehabilitation programs (CRP) in ischemic patients is well known and is included as an IA indication in European Cardiology guidelines. At the end of CRP phase II, it is not uncommon to get an isolated electric positive result (silent ischemia) which has an unknown significance as clinical marker. This finding could be more challenging in patients without complete revascularization.

Purpose
To study whether silent ischemia (SI) and incomplete revascularization acted as markers of future events in patients who participated in a CRP after coronary revascularization.

Methods
A retrospective descriptive analysis of consecutive patients who were part of a CRP between January 2019 and March 2020 was performed. We analyzed the relationship between the presence of SI (defined as ST-segment depression &gt; or = 1 mm in two or more contiguous leads in the absence of clinical symptoms) in the routine exercise test at the end of CRP phase II and the occurrence of events within first year (defined as: emergency room visits, cardiac complication without admission, admission for non-cardiac cause, admission for cardiac cause or death). Cardiovascular risks factors and type of revascularization (incomplete vs complete) were analyzed as modifiers of outcomes.

Results
Of the 380 patients analyzed 79 presented some event in the first year. The mean age was 63±10 and 78% were male. The demographic characteristics are shown in Table 1. The presence of SI at the final exercise routine test of phase II CRP was observed more frequently in the group of patients who suffered an event within first year (p 0.030). Although there was a statistically significant correlation between the presence of incomplete revascularization (IR) and the presence of SI (p 0.002), there was no significant relationship between the presence of IR and events (p 0.082). The detailed results are shown in Table 2.

Conclusions
Among our population, exercise tests is useful for detecting patients at an increased risk of events during the first year after coronary revascularization. However, the incomplete revascularization did not appear to be a prognostic factor. The exercise test seems to be useful for detecting patients in whom intensify preventive efforts.

Funding Acknowledgement
Type of funding sources: None.
Cardiopulmonary exercise test and heart failure biomarkers results after comprehensive rehabilitation of LVAD patients
Authors: Chwyczko T , Smolis-Bak E , Zalucka L , Segiet-Swiecicka A , Piotrowicz E , Was J , Niedolistek M , Kowalik I , Sobieszczanska-Malek M , Zielinski T , Szymanski J , Kusmierczyk M , Piotrowicz R , Dabrowski R 
Published: October 2022

Abstract

Background
The novel method of comprehensive rehabilitation after left ventricular assist device (LVAD) implantation was developed in our institution. Cardiopulmonary exercise test was used to program the training and to assess the results of rehabilitation.

Study group
47 consecutive LVAD (32 Heart Mate III, 15 HeartWare) recipients (19–68 years, mean 58.7 years, 43 men) participated in the rehabilitation program. Proposed 4–5 week program included supervised endurance training on cycloergometer (5 times per week), resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). It was followed by individual exercises performed at home. 6-minute walk test (6MWT), cardiopulmonary exercise test (CPET) and prognostic biomarkers of heart failure: NT-proBNP, Galectin-3 and ST2 were investigated at the beginning and at the end of rehabilitation program.

Results
See Table 1. Increase of 6MWT distance, higher maximal workload, peak VO2 and upward shift of anaerobic threshold (AT) in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitation.

Conclusions
Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of functional tests and biomarkers of heart failure.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development
Effects of adding high- vs low-intensity resistance training to endurance training in patients with heart failure: preliminary results of a randomized controlled trial
Authors: Gojevic T , Turri Da Silva N , Gelade K , Jacobs G , Pirlotte R , Tulleneers B , Duchateau A , Mullens W , Hansen D 
Published: October 2022

Abstract

Background
In current ESC/EAPC guidelines, adding resistance training to endurance training is advised for patients with heart failure (HF), but the optimal intensity of the resistance training is unknown (40–80% of 1RM is advised).

Purpose
To investigate the effects of high- vs low-intensity resistance training as an adjunct to endurance training on: aerobic capacity (primary outcome), walking capacity, muscle strength and quality of life in patients with HF.

Methods
Forty patients with HF were consecutively recruited in the cardiac rehabilitation center of the Hospital East-Limburg in Belgium. Patients were block-randomized (by age and sex) by an independent researcher to receive maximally 45 supervised sessions (3x/week) of high-intense (HI: 3 exercises, 3x12 repetitions, 55–70%1RM) or low-intense resistance training (LI: 3 exercises, 3x22 repetitions, 35–40%1RM) as an adjunct to endurance training (30 min/session; 50–75% VO2max). The aerobic capacity (VO2max) was measured by a blinded assessor with a ramp cardiopulmonary cycling test (+5–30W/min). Walking distance was assessed with a 6-minute walk test (6MWT), maximal strength with 1RM (leg-press, pull-down and dip), and quality of life with the Minnesota questionnaire. An unpaired t-test, Mann-Whitney U test or ANCOVA were used for between-group analysis, and paired t-test or Wilcox sign-rank test for the within-group analysis.

Results
Both groups had similar baseline characteristics and training adherence (HI vs LI; 20 vs 20 subjects; Age: 62±9 vs 59±13 years; Sex: 76% vs 79%male; BMI: 27±58 vs 29±4 kg/m2; LVEF: 35±10 vs 38±6%; Adherence: 33±10 vs 36±10 sessions; p&gt;0.05). There were no adverse events. Both groups had significant within-group improvements in aerobic and walking capacity (VO2max: LI (n=20) vs HI (n=19), p≤0.010; 6MWT distance: p≤0.007) (Figure 1), but these improvements did not differ between groups (VO2max: p=0.855; 6MWT distance: p=0.854). The LI group improved significantly more in muscle strength than the HI group (dip and leg-press: p&lt;0.001). Although the LI group significantly improved in the quality of life (Minnesota score reduction: p=0.028), the quality of life did not differ between groups (Minnesota score: p=0.756).

Conclusions
Both low-and high-intense resistance training are similarly beneficial for improving aerobic and walking capacity in patients with HF. Surprisingly, low-intense resistance training seems superior to high-intense training in improving muscle strength.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University
Understanding HCP views about delivering a rehabilitation programme for people living with atrial fibrillation
Authors: Alhotye M , Evans R , Orme M , Ng G A , Singh S J 
Published: October 2022

Abstract

Background
People living with Atrial Fibrillation (AF) can experience symptoms such as palpitation, dyspnea, fatigue and dizziness which lead to reduced physical activity levels and quality of life [1,2]. Current management of AF mainly focus on pharmacological treatments and invasive procedures, while no routine prescription of exercise or rehabilitation programme is offered.

Purpose
To assess the views and opinions of healthcare professionals about delivering a tailored exercise/cardiac rehabilitation programme to people living with AF, and to explore the barriers in referral to this programme.

Methods
A cross-sectional survey was conducted online between April and September 2021 for healthcare professionals who are involved in the care for adults with AF in UK. A range of professions were targeted, including general practitioners, cardiac physicians, physiotherapists and nurses. The survey comprised twelve questions designed to explore healthcare professional views about rehabilitation programmes for adults with AF, factors influencing their decision to recommend rehabilitation and barriers to the referral process.

Results
Overall, n=209 participants responded from a wide range of disciplines (57% female, 43% specialist arrhythmia nurses). The majority of participants agreed that a rehabilitation programme would be beneficial to support patients to perform daily activities (127, 61%), with n=123, 58% agreeing that rehabilitation programme would be beneficial in reducing breathlessness and would reduce other symptoms such as palpitation (108, 52%).
Nearly all the healthcare professional (n=206/99%) suggested that a tailored programme should include information about AF (206, 99%), weight management and symptom management (n=197, 94%) aside from exercise. The factors that strongly influence their decision to refer to a rehabilitation programme included patients with low physical activity levels (n=166, 80%) and low exercise tolerance (n=157, 76%). The main barrier in referring to the programme was transportation problems (n=128, 62%) (Figure 1). The majority reported that home based programme would be the best way to deliver the programme (166, 79%) (Figure 2).

Conclusions
The responses indicate the enthusiasm for a programme targeting people with AF, poor activity levels was the main reason for referral.

Funding Acknowledgement
Type of funding sources: None.
Changes in functional capacity after a cardiac rehabilitation program in Spain: defining the profile of those who improve
Authors: Sestayo Fernandez M , Alonso Vazquez M , Gonzalez Maestro A , Gonzalez Salvado V , Diaz Balboa E , Rabade Castedo C , Neiro Rey M C , Gonzalez Juanatey J R , Pena Gil C 
Published: October 2022

Abstract

Background
Improvement in functional capacity (FC) is one of the most notable benefits patients experience after cardiac rehabilitation (CR) and it is highly important as low levels of FC are associated with a high risk of cardiovascular (CV) disease and all cause mortality.

Purpose
To study the changes in FC after a CR program in Spain and to define the profile of those patients that improve.

Methods
Single-centre observational study from 793 patients with ischaemic heart disease (15.3% women, age 61.79±10.70 years), participating in a CR program from 2015 to 2020 with a stress test performed, both at beginning of CR (conventional stress test, n=436; CPET, n=340; imaging stress test, n=17) and at end of CR (conventional stress test, n=468; CPET, n=322; imaging stress test, n=3). A comparative analysis of patients with “improved FC” and “non-improved FC” at end of CR, was performed. Relevant clinical improvement was defined as a 10% increase of VO2, in accordance with reviewed literature. Additionally, a descriptive analysis of patient exercise capacity parameters was performed at beginning of CR and at end CR, for the complete sample.

Results
A total of 1586 exercise tests were analysed. All exercise capacity parameters analysed showed significant improvement at end of CR, with p values &lt;0.01, (Graph 1). Clinically relevant FC improvement was observed in 54.2% of patients that participated in CR; 45.5% of all women and 55.8% of all men.
Patients that improved FC completed significantly more CR training sessions (p&lt;0.05) than those who did not improve FC (21.39±4.53, 20.37±5.84). Those who improved FC were significantly older (62.74±10.90), presented with significantly more STEMI (n=197, 45.8%), and achieved significantly less METS (7.42±3.01) at baseline, (p&lt;0.05, Table 1).

Conclusions
Our CR rehabilitation program improves patient's functional capacity significantly.
Patients with clinically relevant functional capacity improvement, are significantly older patients with STEMI as diagnosis at CV event, complete significantly more CR training sessions and showed significantly worst physical performance (METS) at baseline.

Funding Acknowledgement
Type of funding sources: None.
Differential associations of emotional and physical domains of the MacNew Heart with changes in 6-minute walking test
Authors: Jellestad L , Meier V G , Bierbauer W , Bermudez T , Auschra B , Gunther M P , Scholz U , Von Kanel R , Hermann M , Euler S 
Published: October 2022

Abstract

Aims
Cardiac rehabilitation (CR), a key component of secondary prevention in cardiac patients, contributes fundamentally to improved cardiovascular health outcomes. Health-related quality of life (HRQOL) represents a widely employed outcome measure in CR, yet, its predictive properties on exercise capacity change during CR are poorly understood. Aim of this study was to examine the association between baseline HRQOL and its subdomains on improvement of exercise capacity during CR.

Methods
Study participants were 13,717 inpatients of six Swiss CR clinics from 2012 to 2018. We measured HRQOL at admission to CR with the MacNew Heart (MNH) questionnaire and exercise capacity at admission and discharge using the six-minutes walking test (6MWT). Following factorial analyses, we performed univariate and multivariate analyses to test the predictive properties of baseline global HRQOL and its domains for improvement in exercise capacity, adjusting for demographic and clinical characteristics.

Results
Mean improvement in 6MWT was 114 meters (SD=90), achieved after 17.4 days (SD=5.5). Lower emotional HRQOL (b=7.85, p≤0.001, 95% CI [−5.67, 10.03]) and higher physical HRQOL (b=−5.23, p&lt;0.001, 95% CI [−6.56, −3.90]) were associated with less improvement in the 6MWT. Global MNH and social HRQOL showed no association with exercise capacity improvement.

Conclusion
Patients entering CR with low emotional and high physical HRQOL are at risk for a lower gain in exercise capacity during CR. Global MNH alone does not provide a reliable assessment of HRQOL; thus a focus on specific domains of HRQOL is needed.

Funding Acknowledgement
Type of funding sources: None.
Sex- and age-related differences of HRQOL change in cardiac rehabilitation
Authors: Jellestad L , Auschra B , Von Kanel R , Euler S , Hermann M 
Published: October 2022

Abstract

Introduction
Health-related quality of life (HRQOL) has emerged as a valid and disease-specific outcome measure in cardiac patients. Cardiac rehabilitation (CR), a core component of secondary prevention, not only improves cardiovascular outcomes, but also HRQOL. Unfortunately, CR is still underutilized, especially among women and older patients. Aim of this study was to highlight age- and sex-specific effects of CR on HRQOL.

Method
A sample of 8286 patients (mean age 69.2±11.47 years; men 67.8±11.29, women 72.2±11.25) was analyzed. Patients were prospectively asessed from 2012 to 2018 in six Swiss CR clinics. HRQOL was measured at CR entry and discharge using the MacNew Heart Disease questionnaire. In multivariate analyses, we estimated sex- and age-specific changes in HRQOL during CR, adjusting for clinical characteristics.

Results
Women scored lower in any subdomain of HRQOL on admission to CR (social M = 5.05 (SD = 1.3); emotional M = 5.06±1.17; physical M = 4.36±1.72), compared to men (social M = 5.2±1.23); emotional M = 5.35±1.1; physical M = 4.43±1.76). Women showed greater improvement of social (F=10.98, p&lt;0.001), emotional (F=17.73, p&lt;0.001) and physical HRQOL (F=9.47, p=0.002). In a subgroup of elderly patients (&gt;76 years) female sex predicted higher changes in emotional (F=10.878, p&lt;0.001), but not in social (F=1.424, p=0.232) and physical HRQOL (F=2.272, p=0.132).

Conclusion
Women report poorer HRQOL in all subdomains at CR entry compared to men, but in turn particularly benefit from CR in this regard. In older patients, this is particularly true for emotional HRQOL. Our results indicate that sex- and age-specific needs of cardiac patients should be considered during CR.

Funding Acknowledgement
Type of funding sources: None.