Journal: Prog Cardiovasc Dis

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Abstract

Exercising immune cells: The immunomodulatory role of exercise on atrial fibrillation.

Miguel-Dos-Santos R, Moreira JBN, Loennechen JP, Wisløff U, Mesquita T
Exercise training is generally beneficial for cardiovascular health, improving stroke volume, cardiac output, and aerobic capacity. Despite these benefits, some evidence indicates that endurance training may increase the risk of atrial fibrillation (AF), particularly in highly trained individuals. Among multiple mechanisms, autonomic tone changes and atrial remodeling have been proposed as main contributors for exercise-induced AF. However, the contribution of local and systemic immunity is poorly understood in the development of atrial arrhythmogenic substrates. Here we aim to update the field of immunomodulation in the context of exercise and AF by compiling and reconciling the most recent evidence from preclinical and human studies and rationalize the applicability of \"lone\" AF terminology in athletes.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 14 Jul 2021; epub ahead of print
Miguel-Dos-Santos R, Moreira JBN, Loennechen JP, Wisløff U, Mesquita T
Prog Cardiovasc Dis: 14 Jul 2021; epub ahead of print | PMID: 34274371
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Abstract

Role of non-coding RNAs as biomarkers of deleterious cardiovascular effects in sepsis.

Beltrán-García J, Osca-Verdegal R, Nácher-Sendra E, Cardona-Monzonís A, ... Lavie CJ, García-Giménez JL
The mechanisms occurring during sepsis that produce an increased risk of cardiovascular (CV) disease (CVD) are poorly understood. Even less information exists regarding CV dysfunction as a complication of sepsis, particularly for sepsis-induced cardiomyopathy. However, recent research has demonstrated that non-coding RNAs, including microRNAs, long non-coding RNAs, and circular RNAs, play a crucial role in genetic reprogramming, gene regulation, and inflammation during the development of CVD. Here we describe experimental findings showing the importance of non-coding RNAs mediating relevant mechanisms underlying CV dysfunction after sepsis, so contributing to sepsis-induced cardiomyopathy. Importantly, non-coding RNAs are critical novel regulators of CVD risk factors. Thus, they are potential candidates to improve diagnostics and prognosis of sepsis-induced cardiomyopathy and other CVD events occurring after sepsis and set the basis to design novel therapeutic strategies.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 12 Jul 2021; epub ahead of print
Beltrán-García J, Osca-Verdegal R, Nácher-Sendra E, Cardona-Monzonís A, ... Lavie CJ, García-Giménez JL
Prog Cardiovasc Dis: 12 Jul 2021; epub ahead of print | PMID: 34265333
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Abstract

Effects of cardiac rehabilitation in low-and middle-income countries: A systematic review and meta-analysis of randomised controlled trials.

Mamataz T, Uddin J, Ibn Alam S, Taylor RS, ... Grace SL, ACROSS collaboration
Objectives
To assess the effectiveness of cardiac rehabilitation (CR) in low- and middle-income countries (LMICs), given previous reviews have included scant trials from these settings and the great need there.
Methods
Six electronic databases (PubMed, Medline, Embase, CINAHL, Cochrane Library, and APA PsycINFO) were searched from inception-May 2020. Randomised controlled CR (i.e., at least initial assessment and structured exercise; any setting; some Phase II) trials with any clinical outcomes (e.g., mortality and morbidity, functional capacity, risk factor control and psychosocial well-being) or cost, with usual care (UC) control or active comparison (AC), in acute coronary syndrome with or without revascularization or heart failure patients in LMICs were included. With regard to data extraction and data synthesis, two reviewers independently vetted identified citations and extracted data from included trials; Risk of bias was assessed using Cochrane\'s tool. Certainty of evidence was ascertained based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A random-effects model was used to calculate weighted mean differences and 95% confidence intervals (CI).
Results
Twenty-six trials (6380 participants; 16.9% female; median follow-up = 3 months) were included. CR meaningfully improved functional capacity (VO2peak vs UC: 5 trials; mean difference [MD] = 3.13 ml/kg/min, 95% CI = 2.61 to 3.65; I2 = 9.0%); moderate-quality evidence), systolic blood pressure (vs UC: MD = -5.29 mmHg, 95% CI = -8.12 to -2.46; I2 = 45%; low-quality evidence), low-density lipoprotein cholesterol (vs UC: MD = -16.55 mg/dl, 95% CI = -29.97 to -3.14; I2 = 74%; very low-quality evidence), body mass index (vs AC: MD = -0.84 kg/m2, 95% CI = -1.61 to -0.07; moderate-quality evidence; I2 = 0%), and quality of life (QoL; vs UC; SF-12/36 physical: MD = 6.05, 95% CI = 1.77 to 10.34; I2 = 93%, low-quality evidence; mental: MD = 5.38, 95% CI = 1.13 to 9.63; I2 = 84%; low-quality evidence), among others. There were no evidence of effects on mortality or morbidity. Qualitative analyses revealed CR was associated with lower percutaneous coronary intervention, myocardial infarction, better cardiovascular function, and biomarkers, as well as return to life roles; there were other non-significant effects. Two studies reported low cost of home-based CR.
Conclusions
Low to moderate-certainty evidence establishes CR as delivered in LMICs improves functional capacity, risk factor control and QoL. While more high-quality research is needed, we must augment access to CR in these settings.
Systematic review registration
PROSPERO (CRD42020185296).

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 12 Jul 2021; epub ahead of print
Mamataz T, Uddin J, Ibn Alam S, Taylor RS, ... Grace SL, ACROSS collaboration
Prog Cardiovasc Dis: 12 Jul 2021; epub ahead of print | PMID: 34271035
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Abstract

Hypertrabeculation; a phenotype with heterogenous etiology.

Adabifirouzjaei F, Sachiyo I, DeMaria AN
Left ventricular hypertrabeculation (LVHT) is a phenotype with multiple etiologies and variable clinical presentation and significance. It is characterized by a 2-layer myocardium with an enlarged trabecular layer and a thinner compacted layer. The prevalence has been increasing due to advances in cardiac imaging. Initial attention was focused on the congenital noncompaction syndrome, and the presence of LVHT was always attributed to this etiology. However, due to the lack of consensus diagnostic criteria, LVHT has now been reported in a broad spectrum of cardiomyopathies, congenital heart diseases, monogenetic disorders, neuromuscular diseases, and even healthy individuals. LVHT is often associated with systolic dysfunction, arrhythmias, and thromboembolic events. Given the etiologic heterogeneity, the prognosis and outcomes are primarily determined by comorbidities, and treatment is dictated by known guidelines. We present hypertrabeculation (HT) as a phenotype and discuss the varied landscape in the classification, etiology, diagnosis, and management of the condition.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 11 Jul 2021; epub ahead of print
Adabifirouzjaei F, Sachiyo I, DeMaria AN
Prog Cardiovasc Dis: 11 Jul 2021; epub ahead of print | PMID: 34265334
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Abstract

Contemporary technologies to modify calcified plaque in coronary artery disease.

Rozenbaum Z, Takahashi T, Kobayashi Y, Bliagos D, ... Colombo A, Latib A
With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 08 Jul 2021; epub ahead of print
Rozenbaum Z, Takahashi T, Kobayashi Y, Bliagos D, ... Colombo A, Latib A
Prog Cardiovasc Dis: 08 Jul 2021; epub ahead of print | PMID: 34252411
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Abstract

Peak oxygen pulse and mortality risk in healthy women and men: The Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST).

Peterman JE, Harber MP, Chaudhry S, Arena R, Kaminsky LA
Peak oxygen pulse (O2 pulsepeak) may have predictive utility for health outcomes yet, presently, has only been examined in men and only using a single baseline measure.
Purpose
The primary aim of this investigation was to evaluate the relationship between O2 pulsepeak and all-cause mortality in apparently healthy women and men. A secondary aim was to explore the relationship between longitudinal changes to O2 pulsepeak and mortality.
Methods
The sample included 3877 participants (43% women) for the primary aim and 759 participants (32% women) who performed two cardiopulmonary exercise tests ≥1 year apart for the secondary aim. Cox proportional hazard models were performed to determine the relationship between O2 pulsepeak and mortality. Prognostic peak oxygen consumption (VO2peak) and O2 pulsepeak models were compared using the concordance index and Akaike information criterion (AIC).
Results
In the assessment from baseline, there were 730 deaths over a 24.7 ± 11.8 year follow-up period. For men, a single measure of O2 pulsepeak was inversely associated with risk for mortality (P < 0.05). However, the concordance index and AIC indicated lower discrimination compared to VO2peak models and O2 pulsepeak did not provide complementary benefit to VO2peak models. For women, O2 pulsepeak was not associated with mortality risk. In the longitudinal analysis, there were 168 deaths over a follow-up of 20.1 ± 11.4 years. Changes to O2 pulsepeak were not significantly related to mortality in either sex.
Conclusions
Within an apparently healthy cohort, a single assessment of O2 pulsepeak is related to all-cause mortality in men but not women. Further, longitudinal changes to O2 pulsepeak are not predictive of mortality in either sex. These findings suggest O2 pulsepeak may have limited prognostic utility in healthy individuals, particularly within healthy women.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 06 Jul 2021; epub ahead of print
Peterman JE, Harber MP, Chaudhry S, Arena R, Kaminsky LA
Prog Cardiovasc Dis: 06 Jul 2021; epub ahead of print | PMID: 34242652
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Abstract

The effects of high-intensity interval training, Nordic walking and moderate-to-vigorous intensity continuous training on functional capacity, depression and quality of life in patients with coronary artery disease enrolled in cardiac rehabilitation: A randomized controlled trial (CRX study).

Reed JL, Terada T, Cotie LM, Tulloch HE, ... Reid RD, Pipe AL
Background
Coronary artery disease (CAD) patients undergoing revascularization procedures often experience ongoing, diminished functional capacity, high rates of depression and markedly low quality of life (QoL). In CAD patients, studies have demonstrated that high-intensity interval training (HIIT) is superior to traditional moderate-to-vigorous intensity continuous training (MICT) for improving functional capacity, whereas no differences between Nordic walking (NW) and MICT have been observed. Mental health is equally as important as physical health, yet few studies have examined the impact of HIIT and NW on depression and QoL. The purpose of this randomized controlled trial (RCT) was to compare the effects of 12 weeks of HIIT, NW and MICT on functional capacity in CAD patients. The effects on depression severity, brain-derived neurotrophic factor (BDNF) and QoL were also examined.
Methods
CAD patients who underwent coronary revascularization procedures were randomly assigned to: (1) HIIT (4 × 4-min of high-intensity work periods at 85%-95% peak heart rate [HR]), (2) NW (resting HR [RHR] + 20-40 bpm), or (3) MICT (RHR + 20-40 bpm) twice weekly for 12 weeks. Functional capacity (six-min walk test [6MWT]), depression (Beck Depression Inventory-II [BDI-II]), BDNF (from a blood sample), and general (Short-Form 36 [SF-36]) and disease-specific (HeartQoL) QoL were measured at baseline and follow-up. Linear mixed-effects models for repeated measures were used to test the effects of time, group and time × group interactions.
Results
N = 135 CAD patients (aged 61 ± 7 years; male: 85%) participated. A significant time × group interaction (p = 0.042) showed greater increases in 6MWT distance (m) for NW (77.2 ± 60.9) than HIIT (51.4 ± 47.8) and MICT (48.3 ± 47.3). BDI-II significantly improved (HIIT: -1.4 ± 3.7, NW: -1.6 ± 4.0, MICT: -2.3 ± 6.0 points, main effect of time: p < 0.001) whereas BDNF concentrations did not change (HIIT: -2.5 ± 9.6, NW: -0.4 ± 7.7, MICT: -1.2 ± 6.4 ng/mL, main effect of time: p > 0.05). Significant improvements in SF-36 and HeartQoL values were observed (main effects of time: p < 0.05). HIIT, NW and MICT participants attended 17.7 ± 7.5, 18.3 ± 8.0 and 16.1 ± 7.3 of the 24 exercise sessions, respectively (p = 0.387).
Conclusions
All exercise programmes (HIIT, NW, MICT) were well attended, safe and beneficial in improving physical and mental health for CAD patients. NW was, however, statistically and clinically superior in increasing functional capacity, a predictor of future cardiovascular events.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 06 Jul 2021; epub ahead of print
Reed JL, Terada T, Cotie LM, Tulloch HE, ... Reid RD, Pipe AL
Prog Cardiovasc Dis: 06 Jul 2021; epub ahead of print | PMID: 34245777
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Abstract

Impact of nutraceuticals on markers of systemic inflammation: Potential relevance to cardiovascular diseases - A position paper from the International Lipid Expert Panel (ILEP).

Ruscica M, Penson PE, Ferri N, Sirtori CR, ... Banach M, International Lipid Expert Panel (ILEP) and International Lipid Expert Panel Experts (alphabetically)
Inflammation is a marker of arterial disease stemming from cholesterol-dependent to -independent molecular mechanisms. In recent years, the role of inflammation in atherogenesis has been underpinned by pharmacological approaches targeting systemic inflammation that have led to a significant reduction in cardiovascular disease (CVD) risk. Although the use of nutraceuticals to prevent CVD has largely focused on lipid-lowering (e.g, red-yeast rice and omega-3 fatty acids), there is growing interest and need, especially now in the time of coronavirus pandemic, in the use of nutraceuticals to reduce inflammatory markers, and potentially the inflammatory CVD burden, however, there is still not enough evidence to confirm this. Indeed, diet is an important lifestyle determinant of health and can influence both systemic and vascular inflammation, to varying extents, according to the individual nutraceutical constituents. Thus, the aim of this Position Paper is to provide the first attempt at recommendations on the use of nutraceuticals with effective anti-inflammatory properties.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 26 Jun 2021; epub ahead of print
Ruscica M, Penson PE, Ferri N, Sirtori CR, ... Banach M, International Lipid Expert Panel (ILEP) and International Lipid Expert Panel Experts (alphabetically)
Prog Cardiovasc Dis: 26 Jun 2021; epub ahead of print | PMID: 34186099
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Abstract

Shelter from the cytokine storm: Healthy living is a vital preventative strategy in the COVID-19 era.

Arena R, Bond S, Calvo IR, Lebowicz L, ... Carbone S, HL-PIVOT Network
Coronavirus disease 2019 (COVID-19) continues to have a devastating effect on a global scale. COVID-19 variants continue to arise and counteract vaccination efficacy. As such, preventative health measures, such as social distancing and stay at home mandates, will continue for the foreseeable future. Evidence on those at greatest risk for poor outcomes if infected with COVID-19 has rapidly come to light. It has become clear that those with unhealthy lifestyle characteristics, chronic disease risk factors and/or a confirmed diagnosis of one or more chronic conditions are at greatest risk for hospitalization, intensive care unit admission, mechanical ventilation, and death if infected with COVID-19. The cytokine storm is a phenomenon that has been posited as a pathophysiologic response to COVID-19 infection that leads to poor outcomes. The current graphical review illustrates the association between unhealthy lifestyle characteristics and increased vulnerability to the cytokine storm as well as the physiologic mechanisms healthy living behaviors elicit and decrease risk for the cytokine storm. Through this graphical review, we will demonstrate unhealthy lifestyle characteristics, chronic disease risk factors and diagnoses, and COVID-19 outcomes are intricately linked, creating a new global syndemic. It is also clear that a primary way to uncouple this syndemic is through increasing healthy living behaviors, as illustrated in this graphical review. Moving forward, healthy living medicine should be practiced with renewed vigor to improve human resiliency to health threats posed by both chronic disease and viral infections.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 17 Jun 2021; epub ahead of print
Arena R, Bond S, Calvo IR, Lebowicz L, ... Carbone S, HL-PIVOT Network
Prog Cardiovasc Dis: 17 Jun 2021; epub ahead of print | PMID: 34153291
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Abstract

The obesity wars and the education of a researcher: A personal account.

Flegal KM
A naïve researcher published a scientific article in a respectable journal. She thought her article was straightforward and defensible. It used only publicly available data, and her findings were consistent with much of the literature on the topic. Her coauthors included two distinguished statisticians. To her surprise her publication was met with unusual attacks from some unexpected sources within the research community. These attacks were by and large not pursued through normal channels of scientific discussion. Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer. The goal appeared to be to undermine and discredit her work. The controversy was something deliberately manufactured, and the attacks primarily consisted of repeated assertions of preconceived opinions. She learned first-hand the antagonism that could be provoked by inconvenient scientific findings. Guidelines and recommendations should be based on objective and unbiased data. Development of public health policy and clinical recommendations is complex and needs to be evidence-based rather than belief-based. This can be challenging when a hot-button topic is involved.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 14 Jun 2021; epub ahead of print
Flegal KM
Prog Cardiovasc Dis: 14 Jun 2021; epub ahead of print | PMID: 34139265
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Abstract

Beyond cardioversion, ablation and pharmacotherapies: Risk factors, lifestyle change and behavioral counseling strategies in the prevention and treatment of atrial fibrillation.

Mehta NK, Strickling J, Mark E, Swineheart S, ... Haines DE, Franklin BA
Importance
It has been suggested that atrial fibrillation (AF) is the new cardiovascular disease epidemic of the 21st century. Clinical cardiology has largely focused on AF treatment and associated stroke prevention rather than preventing AF itself. To reduce the global consequences and associated costs of AF, it is critical to now embrace prevention as a priority. Proactively addressing the risk factors for AF and the underlying unhealthy lifestyle habits that contribute to them, using research-based counseling approaches, represents a complementary and adjunctive alternative in combatting this disease burden.
Observations
Encouraging and sustaining patient involvement to reduce AF incidence and improve outcomes begins with screening to identify risk factors, unhealthy lifestyle habits, and characteristics associated with failed attempts at favorably modifying these causalities. Modulators of and common barriers to achieving risk reduction and lifestyle change include self-efficacy, social support, age, sex, marital and socioeconomic status, education, employment, and psychosocial factors such as depression, isolation, anxiety and chronic life stress. Focused behavioral counseling approaches, including assessing the patient\'s readiness to change, motivational interviewing and using the 5 A\'s (assess, advise, agree, assist, arrange), along with employing initial downscaled goals to overcome inertia, are proven methodologies to overcome these common barriers to favorably modifying risk factors and unhealthy lifestyle habits.

Conclusions:
and relevance
To complement and enhance the current armamentarium for the medical management of cardiac arrhythmias, there is an urgent need to proactively address the causative factors triggering new-onset, recurrent and persistent AF. Beyond the counseling skills of highly trained professionals (eg, psychiatrists, psychologists), this narrative review highlights the need for and potential impact on lifestyle modification that non-behavioral scientists, including internal medicine, cardiology, and allied health professionals, can have on the patients they serve.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 19 May 2021; epub ahead of print
Mehta NK, Strickling J, Mark E, Swineheart S, ... Haines DE, Franklin BA
Prog Cardiovasc Dis: 19 May 2021; epub ahead of print | PMID: 34023354
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Abstract

Cardiopulmonary exercise testing during the COVID-19 pandemic.

Mihalick VL, Canada JM, Arena R, Abbate A, Kirkman DL
The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has presented a global public health emergency. Although predominantly a pandemic of acute respiratory disease, corona virus infectious disease-19 (COVID-19) results in multi-organ damage that impairs cardiopulmonary (CP) function and reduces cardiorespiratory fitness. Superimposed on the CP consequences of COVID-19 is a marked reduction in physical activity that exacerbates CP disease (CPD) risk. CP exercise testing (CPET) is routinely used in clinical practice to diagnose CPD and assess prognosis; assess cardiovascular safety for rehabilitation; and delineate the physiological contributors to exercise intolerance and exertional fatigue. As such, CPET plays an important role in clinical assessments of convalescent COVID-19 patients as well as research aimed at understanding the long-term health effects of SARS-CoV-2 infection. However, due to the ventilatory expired gas analysis involved with CPET, the procedure is considered an aerosol generating procedure. Therefore, extra precautions should be taken by health care providers and exercise physiologists performing these tests. This paper provides recommendations for CPET testing during the COVID-19 pandemic. These recommendations include indications for CPET; pre-screening assessments; precautions required for testing; and suggested decontamination protocols. These safety recommendations are aimed at preventing SARS-CoV-2 transmission during CPET.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 05 May 2021; epub ahead of print
Mihalick VL, Canada JM, Arena R, Abbate A, Kirkman DL
Prog Cardiovasc Dis: 05 May 2021; epub ahead of print | PMID: 33964290
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Impact:

This program is still in alpha version.