Elevated Heart Research Articles

Interactions between antidiabetes medications and heart-brain axis.

The heart-brain axis (HBA) is the physiological interactions between the cardiovascular and nervous systems through autonomic nerves, hormones, and cytokines. Patients diagnosed with diabetes mellitus have an increased risk of the cardiovascular and neurological diseases. However, recent evidence demonstrated that different antidiabetic drugs may delay cognitive impairment and improve cardiovascular outcomes. This review examines the impact of antidiabetic drugs on the HBA in patients with diabetes. Metformin improves the cardiovascular and cognitive outcomes through adenosine 5'-monophosphate-activated protein kinase activation. Sodium-glucose cotransporter-2 inhibitors reduce inflammation, oxidative stress by inhibiting the NLRP3 inflammasome thereby reducing the incidence of heart failure and formation of beta-amyloid and neurofibrillary tangles in the brain. Dipeptidyl peptidase-4 inhibitors exhibit neuroprotective effects in Alzheimer's disease by reducing amyloid-beta and tau pathology and inflammation but may exacerbate heart failure risk due to increased sympathetic activity and prolonged β-adrenergic stimulation. Glucagon-like peptide-1 receptor agonists exhibit neuroprotective effects in Alzheimer's and Parkinson's diseases by reducing neuroinflammation, but may increase sympathetic activity, potentially elevating heart rate and blood pressure, despite their cardioprotective benefits. Antidiabetes medications have the potential to improve cardiovascular and cognitive outcomes; however, additional studies are required to substantiate these effects.

Biologging in a free-ranging mammal reveals apparent energetic trade-offs among physiological and behavioural components of the acute-phase response.

The acute-phase response (APR) is an adaptive emergency life-history stage, wherein vertebrates exhibit fever and anorexia to survive an infection. However, induced immune responses are energetically costly, and sick animals may reduce physical activity to compensate. Tests of this predicted energetic trade-off in free-ranging animals are rare due to difficulties in measuring individual physiology and behaviour under immune challenge in natural settings. However, recent advances in biologging technology now make such studies possible. We surgically implanted heart rate/temperature loggers in free-ranging adult male Arctic ground squirrels, fitted the squirrels with collar-mounted accelerometers and light/temperature loggers, and injected animals with lipopolysaccharide (LPS) to simulate an immune challenge. LPS-injected squirrels exhibited approximately 1°C overnight fevers accompanied by slightly elevated (10 bpm) heart rates; LPS-injected squirrels also spent 19% less of their time aboveground the following day and reduced overall movement by 40% compared with saline-injected controls. Thus, we found support for an energetic trade-off between functional immune responses (fever and anorexia) and lethargic sickness behaviour within the APR of a free-ranging mammal. Moreover, our results suggest animal-borne devices can play an important role in future studies of vertebrate immunity and disease dynamics.

Impact of oral health on COVID-19 outcomes in patients with pre-existing cardiovascular conditions: a questionnaire-based analysis of disease severity, recovery time, and C-reactive protein

Aim: This study aimed to assess oral health’s influence on COVID-19 outcomes in recovered individuals with pre-existing cardiovascular conditions. Methods: In the main study employing a cross-sectional design based on a questionnaire survey, 464 Egyptian patients who had recovered from COVID-19 were enrolled, with 86 individuals who had pre-existing cardiovascular conditions included in a subgroup analysis. Oral health was classified as poor and good based on scores from an 18-question survey with higher scores indicating better health. Severe COVID-19 was defined by criteria that included elevated respiratory and heart rates, severe dyspnea low oxygen saturation, high fever, and need for hospitalization or ICU care. Participants’ recovery duration was classified into three groups: fast (≤ 2 weeks), intermediate (4 weeks), and delayed (6 weeks), characterized by symptom-free status. Moreover, C-reactive protein (CRP) levels (> 18 mg/L) were considered elevated. Results: Our results revealed that cardiac patients with poor oral health showed a significant association with severe COVID-19 cases, elevated CRP levels (> 18 mg/L), and a prolonged recovery period (6 weeks) (p < 0.001). In contrast, participants demonstrating good oral health were associated with milder COVID-19 cases, lower CRP levels, and faster recovery (p < 0.001). Conclusions: Our findings indicate a significant link between the condition of oral health and the experienced severity of COVID-19 in cardiac patients. Poor oral health was associated with elevated CRP levels, delayed recovery, and more severe symptoms. These results highlight the importance of good oral hygiene as a modifiable factor in reducing infection severity, especially in vulnerable cardiac populations.

Prosopis africana extract inhibits critical enzymes associated with hypertension in vitro and in cyclosporine-induced hypertensive rats

ObjectiveThis study evaluated the antihypertensive properties of leaf extracts of Prosopis africana (PA) in vitro and in hypertensive rats. MethodsEthanol (ELPA) and differential solvent fractions [ethyl-acetate (EAPA), butanol (BLPA), and aqueous (ALPA)] were prepared using standard protocols. Hypertension was induced in female albino Wistar rats intraperitoneally using cyclosporine (25 mg/kg/day) while extracts were administered via oral route. Forty female rats were grouped into 5 (n = 8). Group 1 received 2 ml distilled water, Group 2: (cyclosporine + 2 ml distilled water); Group 3: cyclosporine + captopril (10 mg/kg/day); Group 4: cyclosporine + 1000 mg/kg ELPA and Group 5: cyclosporine + 1500 mg/kg ELPA. The blood pressure of anesthetized rats was measured using LabScribe coupled to a Lab-Trax-4/24T, and the activities of angiotensin-converting enzyme (ACE), arginase, phosphodiesterase-5 (PDE-5), acetylcholinesterase (AChE) and adenosine deaminase (ADA) were evaluated using standard methods. ResultsAll the fractions exerted significantly (p < 0.05) higher ACE inhibitory effect (ELPA = 64.36 ± 0.50%; EAPA = 86.31 ± 0.60%; BLPA= 85.28 ± 2.30 % ; ALPA= 82.27 ± 2.10 % ) than the reference, lisinopril (40.22±0.50 % ); while the butanol fraction (67.05±0.40 % ) showed higher PDE-5 inhibition than the reference, sildenafil (23.06±0.70 % ). Administration of cyclosporine caused notable (p < 0.05) elevation of systolic/diastolic blood (131.00 ± 1.22/93.25 ± 1.49 mmHg) pressure plus elevated heart rate when in comparison with the normotensive rats (106.25 ± 1.65/85.25 ± 1.18 mmHg). Treatment of hypertensive rats with ELPA significantly reduced elevated activities of ACE, PDE-5, AChE, and arginase to values that are not significantly (p < 0.05) different from those of the rats treated with the reference drug. ConclusionThis result could validate the use of P. africana as an antihypertensive agent in folklore.

Correlation of the triglyceride-glucose index and heart rate with 28-day all-cause mortality in severely ill patients: analysis of the MIMIC-IV database

BackgroundResearch has identified a link between the triglyceride-glucose index (TyG-i) and the risk of mortality in severely ill patients. However, it remains uncertain if the TyG-i affects mortality by influencing heart rate (HR).MethodsThis study enrolled 3,509 severely ill participants from the Medical Information Mart for Intensive Care (MIMIC-IV) database who had triglyceride, glucose, and HR data upon entering the ICU. Cox regression models were applied to estimate the effect of the TyG-i and HR on 28-day all-cause mortality (ACM) and 28-day in-hospital mortality (IHM). Additionally, Kaplan-Meier (K-M) survival analysis was employed to explore outcome variations among different patient groups. The association of the TyG-i with HR, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS) II was explored through linear regression analysis. Subgroup analysis explored potential interactions among patient characteristics, while sensitivity analysis gauged the robustness of the findings. Additionally, mediation analysis was conducted to assess whether elevated HR acts as an intermediary factor linking the TyG-i to both 28-day ACM and 28-day IHM.ResultsDuring the 28-day follow-up, 586 cases (16.7%) died from all causes, and 439 cases (12.5%) died during hospitalisation. Cox results showed that individuals with a heightened TyG-i and elevated HR had the highest 28-day ACM (Hazard Ratio 1.70, P-value below 0.001) and 28-day IHM (Hazard Ratio 1.72, P-value below 0.001) compared to those with a reduced TyG-i and HR. The K-M curves showed that individuals with low TyG-i and low HR had the lowest incidence of 28-day ACM and 28-day IHM. The linear analysis results evidenced that the TyG-i was independently connected to HR (beta = 3.05, P-value below 0.001), and the TyG-i was also independently associated with SOFA score (beta = 0.39, P-value below 0.001) and SAPS II (beta = 1.79, P-value below 0.001). Subgroup analysis revealed a significant association in participants without hypertension, the interaction of an elevated TyG-i and HR strongly correlated with a higher 28-day death risk (interaction P-value below 0.05). Furthermore, HR mediated 29.5% of the connection between the TyG-i and 28-day ACM (P-value = 0.002), as well as 20.4% of the connection between the TyG-i and 28-day IHM (P-value = 0.002).ConclusionFor severely ill patients, the TyG-i is distinctly correlated with HR, and elevated levels of both are strongly connected to greater 28-day ACM and 28-day IHM risks, especially in patients without hypertension. Furthermore, elevated HR mediates the connection between the TyG-i and 28-day mortality.

Astrocytic inhibition of lateral septal neurons promotes diverse stress responses

Inhibitory neuronal circuits within the lateral septum (LS) play a key role in regulating mood and stress responses. Even though glial cells can modulate these circuits, the impact of astrocytes on LS neural circuits and their functional interactions remains largely unexplored. Here, we demonstrate that astrocytes exhibit increased intracellular Ca²⁺ levels in response to aversive sensory and social stimuli in both male and female mice. This astrocytic Ca²⁺ elevation inhibits neighboring LS neurons by reducing excitatory synaptic transmissions through A1R-mediated signaling in both the dorsal (LSd) and intermediate LS (LSi) and enhancing inhibitory synaptic transmission via A2AR-mediated signaling in the LSi. At the same time, astrocytes reduce inhibitory tone on distant LS neurons. In the LSd, astrocytes promote social avoidance and anxiety, as well as increased heart rate in socially stressed male mice. In contrast, astrocytes in the LSi contribute to elevated heart rate and heightened blood corticosterone levels in unstressed male mice. These results suggest that the dynamic interactions between astrocytes and neurons within the LS modulate physiological and behavioral responses to stressful experiences.

Development and Validation of a Measure of the Resolution Phase of the Sexual Response Cycle: The Sexual Resolution Scale (SRS)

ABSTRACT We developed and validated a measure of the depth of the resolution experience – the Sexual Resolution Scale (SRS). Portuguese-speaking participants responded to an online survey including the SRS whose eight items were derived from the literature on post-sex states: 1) deeply relaxed, 2) with elevated heart rate, 3) with intensified emotions, 4) more aware of body, 5) in a profound peace, 6) more imaginative, 7) more predisposed to talk about emotionally charged topics, 8) more predisposed to listen to emotionally charged topics. They also reported the intensity of satisfaction, desire, arousal, and orgasm, during the last sexual activity, and completed the Perceived Relationship Quality Components Inventory, and the Female Sexual Function Index or the International Index of Erectile Function. Principal Component Analysis and Confirmatory Factor Analysis revealed two dimensions: Internal Experience (items 1 to 6) and Openness to Communication (items 7 and 8). The two dimensions had good reliability. Invariance was confirmed between women and men. Nomological validity evidence was demonstrated: the two dimensions correlated with better sexual function during the last sexual activity and over the past 4 weeks. The SRS appears to be usable to measure the enjoyable aspects of the resolution phase of sexual intercourse.

Investigating heart rate responses of children to active travel: a mixed effects modeling analysis

BackgroundThe active travel concept has gained recognition as an effective method to enhance physical activity in children’s everyday mobility. Yet, there is a notable gap of quantitative evidence on its direct impacts, especially regarding physiological outcomes that can concretely demonstrate its influences on physical intensity and overall health of children.MethodsThis study investigates the effects of active travel on children, focusing on trip-level physiological responses, specifically heart rate. Through a mixed survey design, we obtained a repeated-measures dataset from a cohort of 73 children (average age 13) across three Austrian secondary schools, each observed for 7 days. By applying mixed effects modelling approach, both fixed and random effects to children’s heart rates were explored.ResultsAccording to results from developed mixed linear models (maximum R2 = 0.22), it revealed a significant positive association between active travel mode(s) engagement and heightened physiological responses (Low, Medium and High active level of trip compare to None: β = 1.81, 5.01 and 8.34, t-value = 4.70, 10.29 and 21.34), indicating that increased usage of active travel modes led to elevated heart rate values. Additionally, subjective perceptions also played an important role in influencing children’s physiological responses. Feelings of exhausted, anxiety, and stress contributing to a higher heart rate (β = 14.79, 16.69 and 1.99, t-value = 20.42, 5.67 and 3.0), while unhappiness was associated with a lower heart rate (β = -5.96, t-value = -14.62). Effects of social interactions were also found during the trip. The presence of adults was associated with a calming effect (β = -1.92, t-value = -5.72), whereas solo travel resulted in lower heart rate compared to travel with peers (β = -1.95, t-value = -6.59).ConclusionOur article innovatively employs mixed survey methods and heart rate data to quantitatively demonstrate the positive association between engagement in active travel modes and heightened physiological responses in children, elucidating the intricate interplay of subjective perceptions and social interactions during trips, thus offering valuable insights into the health implications of active travel at a trip level. Future research will keep on leveraging survey and experimental methods.

The effect of social anxiety on social attention in naturalistic situations

ABSTRACT Background and Objectives This multimodal two-phase study investigated the impact of trait social anxiety on exploration, social attention, and autonomic responses in a naturalistic setting. We expected higher avoidance of potentially crowded spaces, reduced visual attention on other people, and heightened physiological arousal in social situations for participants with higher social anxiety levels. Design and Methods Eighty-seven participants, pre-screened for high variance in trait social anxiety, first completed a half-hour walk on a freely chosen route and subsequently had a staged social interaction with a confederate consisting of a non-interactive waiting phase and a short conversation. Results While social anxiety did not modulate the choice of route during the walk phase, socially anxious participants avoided gazing at other individuals in non-interactive situations, i.e., during the walk and the waiting phase. In contrast, during actual interaction, they showed increased visual attention towards the confederate’s face. Across all experimental phases, highly socially anxious individuals showed elevated heart rates, but this effect was independent of the social context. Conclusions This study showed that social anxiety affects social exploration behavior not in a way of general avoidance, but rather in nuanced adaptations depending on the concrete situation, likelihood of interaction and associated socio-evaluative threat.

Multimodal examination of daily stress rhythms in chronic Cannabis users.

Chronic cannabis users frequently report stress relief as their primary reason for use. The endocannabinoid system is involved in the neuroendocrine stress response, and diurnal cortisol rhythms may be disrupted in chronic cannabis users. The objectives were to determine whether cannabis users demonstrate disruptions in diurnal stress rhythms and examine the acute effects of cannabis on stress-related outcomes in cannabis users' natural environments. Eighty-two participants (39 cannabis users, 43 non-users) collected saliva samples to quantify cortisol concentrations and provided subjective stress ratings at 8 time points throughout the day. They wore a medical-grade wearable device for 24h that recorded physiological indicators of stress (heart rate variability, electrodermal activity). Cannabis users collected additional saliva samples before and after cannabis use to examine acute effects of cannabis use. Cannabis users exhibited significant dysregulations in diurnal cortisol rhythms, including a blunted cortisol awakening response, flattened diurnal cortisol slope, and elevated afternoon cortisol concentrations. There were no differences in diurnal heart rate variability or electrodermal activity except for elevated evening heart rate in cannabis users. Finally, there were significant decreases in cortisol, subjective stress, and electrodermal activity following acute cannabis use in cannabis users' natural environment. These results provide evidence of dysregulated diurnal cortisol rhythms in cannabis users that were related to later waking times and acute stress-relieving properties of cannabis use in naturalistic environments. Future research should examine the direction of the relationship between cannabis use and diurnal cortisol rhythms and potential implications for other psychological disorders.

Cardiac Structure and Function of Elite Australian Jockeys Compared to the General Population: An Observational Cross-Sectional Study.

Research highlights the intense physiological demands of thoroughbred racing on jockeys, with elevated heart rates and substantial oxygen uptake, confirming the rigorous physical nature of the sport, however, the cardiovascular changes resulting from the physical demands of thoroughbred racing remain unexplored in Australian jockeys. Therefore, the objective of this study was to compare measures of cardiac structure and function of professional Australian jockeys to that of the general population and to determine if there are differences in heart structure and function detected using echocardiography. Forty-six jockeys and thirty-three participants from the general population underwent two-dimensional echocardiography, which included all standard views and measurements. Each measurement was compared between groups using a Mann-Whitney U test. Groups were matched for age (jockeys (35 ± 12 years) and controls (36 ± 13 years)). Jockeys were shorter (1.64 ± 0.07m vs. 1.75 ± 0.09m, p < 0.001), lighter (56.5 ± 6.0kg vs. 74.2 ± 12.9kg, p < 0.001) and had a lower body surface area (BSA) (1.55 ± 0.17m2 vs.1.9 ± 0.2m2, p < 0.001). Jockeys had a larger absolute left ventricular (LV) end diastolic volume than the control group (120 ± 18.2ml vs.109.3 ± 29.0ml, p = 0.05) which had a larger variation when indexed for BSA (78.0 ± 12.2 ml/m2 vs. 57.5 ± 13.3 ml/m2, p < 0.001). Jockeys demonstrated a higher LV mass index (79.4 ± 18.1g/m2 vs. 64.2 ± 15.4g/m2, p < 0.001). Left atrial volume index was larger in jockeys (33.4 ± 6.5mL/m2 vs. 26.3 ± 7.0mL/m2, p < 0.001). There were no differences in global longitudinal strain (GLS) for either group overall (-19.3 ± 3.0% vs. -19.8 ± 1.6%, p = 0.52), but 17% of the jockey group demonstrated an abnormal GLS. Jockeys have adaptations to their cardiac structure and function compared to the general population. Differences could be attributed to chronic physiological demands of racing and should be considered in future research involving jockeys.

Improving Image Quality and Diagnostic Performance of CCTA in Patients with Challenging Heart Rate Conditions using a Deep Learning-based Motion Correction Algorithm

Challenging HR conditions, such as elevated Heart Rate (HR) and Heart Rate Variability (HRV), are major contributors to motion artifacts in Coronary Computed Tomography Angiography (CCTA). This study aims to assess the impact of a deep learning-based motion correction algorithm (MCA) on motion artifacts in patients with challenging HR conditions, focusing on image quality and diagnostic performance of CCTA. This retrospective study included 240 patients (mean HR: 88.1 ± 14.5 bpm; mean HRV: 32.6 ± 45.5 bpm) who underwent CCTA between June, 2020 and December, 2020. CCTA images were reconstructed with and without the MCA. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured to assess objective image quality. Subjective image quality was evaluated by two radiologists using a 5-point scale regarding vessel visualization, diagnostic confidence, and overall image quality. Moreover, all vessels with scores ≥ 3 were considered clinically interpretable. The diagnostic performance of CCTA with and without MCA for detecting significant stenosis (≥ 50%) was assessed in 34 patients at both per-vessel and per-patient levels, using invasive coronary angiography as the reference standard. The MCA significantly improved subjective image quality, increasing the vessel interpretability from 89.9% (CI: 0.88-0.92) to 98.8% (CI: 0.98-0.99) (p < 0.001). The use of MCA resulted in significantly higher diagnostic performance in both patient-based (AUC: 0.83 vs. 0.58, p = 0.04) and vessel-based (AUC: 0.92 vs. 0.81, p < 0.001) analyses, with the vessel-based accuracy notably increased from 79.4% (CI: 0.72-0.86) to 91.2% (CI: 0.85-0.95) (p = 0.01). There were no significant differences in objective image quality between the two reconstructions. The mean effective dose in this study was 2.8 ± 1.1 mSv. The use of MCA allows for obtaining high-quality CCTA images and superior diagnostic performance with low radiation exposure in patients with elevated HR and HRV.

Edaravone Ameliorate Inflammation in Vitamin D3 and High Fat Diet Induced Atherosclerosis in Rat via Alteration of Inflammatory Pathway and Gut Microbiota.

Cardiovascular disease refers to a group of conditions that affect the heart and blood vessels, including coronary artery disease, heart failure, and stroke, among others. Edaravone (ED) inhibits oxidative stress and free radical damage, which are thought to contribute to the progression of various diseases. Thus, the purpose of the study is to examine the cardioprotective effect of ED against vitamin D3 and high fat-induced atherosclerosis in rats. In this study, Sprague Dawley (SD) rats were utilized. The rats were separated into several groups and fed a high-fat diet along with vitamin D3 to induce atherosclerosis. Various doses of ED were orally administered to the animals for 30 days. The administration of Edaravone effectively reduced the elevated body weight, as well as the excessive water and food consumption. The treated groups exhibited a decrease in glucose level, leptin, and apolipoprotein-B. Administration of ED also modified the cholesterol parameters, coronary artery index, atherogenic index, and antioxidant parameters. It also reduced the elevated heart rate, systolic blood pressure (BP), mean BP, and diastolic BP. The group treated with ED exhibited a decrease in the level of inflammatory cytokines. The ED significantly (p < 0.001) reduced the levels of MMP-2, MMP-3, and MMP-9. Furthermore, it induced significant (p < 0.001) adjustments in the abundance of Firmicutes, Bacteroidetes, Proteobacteria, Verrucomicrobia, and F/B ratio. Edaravone exhibited the cardio protection against HFD induced atherosclerosis in rats via alteration of gut microbiota.

Accuracy of Patient-Collected Vital Signs.

Introduction: Telehealth has emerged as an important clinical setting for managing acute respiratory tract infections (ARIs), potentially reducing emergency department and urgent care overcrowding, and reducing nosocomial transmission. Many current algorithms for ARI management incorporate information on patient vital signs. However, the accuracy of vital signs collected by patients using readily available home devices and techniques has not been studied. Methods: A cross-sectional sample of patients seen for urgent conditions at a hospital emergency and urgent care center were given instructions and low-cost, readily available devices to collect their vital signs. A trained research coordinator collected a parallel set of vital signs using standard hospital equipment, serving as the gold standard. We analyzed the performance of patient-collected vital signs compared with vital signs collected by a trained research coordinator. Results: A total of 300 patients completed the study. Patient-collected vital signs were highly specific for traditional levels of abnormalities (HR >100 beats per min, RR >24 breaths per min, temperature >100.4 degrees Fahrenheit, oxygen saturation <94 percent); however, sensitivity was poor for elevated heart rate by pulse estimation (25%) and elevated respiratory rate (60%). Heart rate and oxygen saturation by pulse oximeter and oral temperature had higher sensitivity. Conclusions: Vital signs measured and provided by patients are not uniformly accurate, particularly when using manual techniques rather than automated devices. Telehealth algorithms that rely on these values could provide incorrect triage and management advice.

Predicting atrial fibrillation from ECG characteristics

Abstract Background/Introduction Atrial fibrillation (AF) is the most common cardiac arrythmia, and demographic shifts in age continues to increase the prevalence of atrial fibrillation on a global scale. With manifestations of short and intermittent duration, identifying and diagnosing AF often proves to be a challenge. As a consequence, patients who develop AF are at risk of experiencing stroke and other cardiac diseases such as heart failure (HF) before appropriate treatment is initialized. Despite the potential benefits of early AF detection, risk profiling based on electrocardiographic (ECG) findings is currently lacking. Several smaller studies have identified ECG characteristics associated with increased risk of AF, but these characteristics have not been individually evaluated in large-scale nationwide cohorts, and no evidence exists on the additive effect of these ECG characteristics. Purpose We aimed to evaluate the risk of new-onset AF, HF, and stroke according to five ECG characteristics previously linked to AF, in order to identify potential predictors of AF. Methods We used national registers and the Danish Nationwide ECG Cohort to include patients with ECG measurements taken between 2010 and 2022. Patients were grouped according to how many of the following ECG characteristics were present in their baseline ECG: Elevated heart rate (&amp;gt;80), prolonged PR-interval (≥196 ms for women and ≥204 ms for men), biphasic P-waves (positive and negative amplitude within same p-wave), abnormal P terminal force (≥ 6000 mV×ms), and prolonged P-wave duration(≥120 ms). Patients were followed for 2 years to evaluate the risk of atrial fibrillation, heart failure (HF), and stroke, according to baseline ECG characteristics. Results We included 1,505,474 patients of whom 594,702 had exactly one ECG characteristic, 197,367 had two characteristics, 44,983 had three characteristics, 6,390 had four characteristics, and 451 had all five characteristics on their baseline ECG. The risk of developing AF or HF increased with the number of ECG characteristics present on the baseline ECG. Patients with two ECG characteristics had a 2-fold increased risk of AF or HF compared to patients with no ECG characteristics (HR: 2.11 95%CI: 2.05-2.16). Patients with two or more ECG characteristics present on their baseline ECG exceeded a 5% 2-year absolute risk of developing either AF or HF. Among patients with only one ECG characteristic on their baseline ECG, elevated heart rate and prolonged PR interval were the factors most associated with an increased risk of AF compared to patients with none of the ECG characteristics on their baseline ECG. Conclusions The absolute and relative risk of atrial fibrillation, heart failure, and stroke increased with the number of ECG characteristics present on the baseline ECG. We suggest that the ECG characteristics evaluated in this study could be used in screening scenarios for atrial fibrillation to identify high risk patients.Absolute and relative 2-year risksRisk acc. to specific ECG characteristic

Arrhythmogenic effects of DEHP exposure: insights into cardiac electrophysiology and myocardial cells

Abstract Introduction Hemodialysis patients, who are exposed to plasticizers through the hemodialysis circuit, face a high risk of cardiovascular disease (CVD). Plasticizers, such as the endocrine-disrupting compound Di(2-ethylhexyl) phthalate (DEHP), have emerged as potential contributors to CVD. This study explores the impact of DEHP on cardiac electrophysiology and myocardial cells, providing insights into its cardiotoxic effects. Methods We employed optical mapping techniques to assess cardiac electrophysiology in Langendorff-perfused rat hearts exposed to DEHP, comparing them to a control group. Additionally, we evaluated the effect of DEHP on cardiac muscle cells using H9C2 rat cardiomyoblasts. Results Prolonged DEHP exposure resulted in elevated heart rate, increased electrocardiographic variability, and higher low-frequency values, indicative of sympathetic nervous system overactivity. Action potential duration at APD80 increased, leading to greater action potential triangulation. Electrical alternans observed in the DEHP-treated group heightened the risk of arrhythmias. Single-cell analysis revealed severe mitochondrial damage, myocardial cell apoptosis, and disrupted calcium ion balance. Conclusion This study highlights DEHP's cardiotoxicity, suggesting its potential role in arrhythmogenesis and cardiac dysfunction. Environmental pollutants like DEHP warrant consideration as contributors to cardiovascular diseases, emphasizing the need for further research on preventive strategies.

Heart rate and prognosis of heart failure with reduced ejection fraction in women and men in sinus rhythm

Abstract Background Resting heart rate (HR) is a well-established therapeutic target for treating heart failure (HF). Beta-blockers are the primary drugs to reduce HR. Elevated HR is associated with higher mortality in heart failure with reduced ejection fraction (HFrEF). However, the influence of HR on mortality and predictors of death in women with HFrEF in sinus rhythm is not well understood. Purpose to analyse mortality for HR ≤60&amp;gt;bpm and ≤70&amp;gt;bpm in women and men. Methods From February 2017 to January 2022, we analysed the influence of resting HR (≤60&amp;gt; and ≤70&amp;gt;bpm) on mortality and predictors of death in women and men with HFrEF in sinus rhythm. Baseline data included clinical characteristics and echocardiographic findings. The HR used in the analysis was obtained at the closest outpatient visit to the death event. We used the adjustment for multiple comparisons for the log-rank test of Kaplan-Meier (K-M) and Cox proportional hazards methods to analyse mortality rates and search for death predictors for women and men. Results We analysed 2,984 patients, with a mean age of 61 ± 13.8 years, 1,922 (64.4%) men. Age, body mass index, myocardial infarction, diabetes, chronic kidney disease, stroke, carvedilol dosage, hospitalization, and initial left ventricular ejection fraction (LVEF) were similar in both genders. Over the follow-up period of 3.7±1.6 years, we observed an increase in LVEF in men (29.5%±6.7% vs. 36.7%±12.9%; p&amp;lt;0.001) and women (29.9%±6.4 vs. 38.0%±13.4%; p&amp;lt;0.001), and HR reduced in men (73.1±13.0 to 72.1±11.8 bpm; p=0.007) and women (72.8±12.7 to 71.8±11.3 bpm; p=0.026). Death incidence was higher in men (43.7% vs. 36.7%; p&amp;lt;0.001). The cumulative incidence of death was higher in men with HR&amp;gt;60bpm (K-M: log-rank p&amp;lt;0.001) and &amp;gt;70bpm (K-M: log-rank p=0.011) compared to women. Cox regression for death, adjusted for covariates with p&amp;lt;0.25, showed age (HR=1.01;95%CL:1.008-1.017; p&amp;lt;0.001), men (HR=0.80;95%CL:0.71-0.90; p&amp;lt;0.001), LVEF (HR=0.986;95%CL:0.98-0.99; p=0.001), and HR (HR=1.005;95%CL:1.00-1.01; p=0.025) as independent death variables. For men, the independent variables were age (HR=1.01;95%CL:1.01-1.02; p=0.002), LVEF (HR=0.98;95%CL:0.97-0.99; p=0.001), and HR (HR=1.008;95%CL:1.00-1.01; p=0.008), and for women, only the age (HR=1.02;95%CL:1.01-1.02; p&amp;lt;0.001). Conclusion Increased HR was an independent variable of death in men but not in women. Future studies are needed to determine the best reference HR for a chronotropic drug intervention to reduce mortality in women with HFrEF in sinus rhythm.

Vital Predictive and Prognostic Roles of Triglyceride-Glucose Index in Women With Acute Myocardial Infarction: A Retrospective Cohort Study.

As a biomarker of insulin resistance (IR) in patients with acute myocardial infarction (AMI), the triglyceride-glucose index (TyG index) has received significant attention. However, most research on AMI has focused on male patients, as it is traditionally believed to primarily affect males. Therefore, this study was conducted on a female population with AMI to investigate the potential correlation between the TyG index and their outcomes. A total of 320 women who were admitted to Fujian Provincial Hospital for AMI between January 2017 and December 2019 were included in this study. The TyG index was calculated using the following formula: ln [fasting triglycerides (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2]. The primary endpoint of the study was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which included all-cause mortality, myocardial infarction, repeat revascularization, rehospitalization for heart failure and stroke. The association between the TyG index and unfavorable outcomes in female patients was investigated using the Cox proportional hazards regression model. It was ultimately estimated that 111 patients developed MACCEs. Females with high TyG indices had a higher prevalence of diabetes, elevated heart rates, and hemoglobin A1c, as well as a higher likelihood of undergoing thrombus aspiration and stent placement. The TyG index was found to be positively correlated with the prevalence of hypertension, diabetes, low-density lipoprotein cholesterol, hemoglobin A1c, and damaged vessels. However, this correlation was modest, yet statistically significant. Furthermore, after adjusting for conventional risk factors, the TyG index (HR: 4.292, 95% CI: 2.784-6.616, p < 0.001) was independently associated with MACCEs. As an independent risk predictor, the TyG index has the potential to enhance clinical outcomes for women with AMI.

Beyond smoking: Risk assessment of nicotine in pouches

Orally consumed nicotine pouches that contain no tobacco are marketed as a less harmful alternative to tobacco products. This study aims to assess nicotine in pouches and potential risks for health damage. 31 samples of nicotine pouches were collected and analyzed. The median nicotine uptake from single pouches was calculated to be 65 µg/kg bw. Consumption of more than one pouch per day would lead to a strikingly higher nicotine dose over the day. Health effects after nicotine exposure are, among others, cardiovascular effects. An acute reference dose (ARfD) of 0.8 µg/kg bw was proposed for risk assessment purposes based on an observed increased heart rate in a human study after acute nicotine uptake. The ARfD was exceeded by at least 20-fold, even when considering the consumption of a single pouch with the lowest detected nicotine level. With higher nicotine contents in pouches or with an increasing number of pouches per day, vast ARfD exceedances are possible. Therefore, a clinically relevant elevation of heart rate is very likely to occur in consumers after acute consumption of nicotine pouches.

Cardiovascular handgrip responses during treadmill exercise: randomized pilot trial.

The isometric exercise performed using the handgrip (HG) acutely promotes elevation of systolic blood pressure (SBP) and diastolic blood pressure (DBP), and in a non-consensual manner among articles elevation or maintenance of heart rate (HR). Currently, although there is a vast literature on the hemodynamic effects of interval training and isometric exercise with HG alone, there is still no consistent evidence of such adjustments occurring in the association between the two. Therefore, the objective of this study was to describe the acute hemodynamic responses found only during interval training and when combined with isometric contraction with HG. This is a pilot study of a crossover clinical trial. Seven male volunteers, aged 24±3.9 years, underwent three protocols on an ergometric treadmill, with a 3-minute warm-up at 30% of heart rate reserve (HRR), four sprints 2 minutes at 50% HRR and active intervals at the same speed as the warm-up. Randomization was carried out in a simple random manner. The protocols were classified according to the use of HG during sprints, as follows: PI = without HG; PII = HG 30% of handgrip strength (HGS) and PIII = 60% of HGS). Variations (Δ) in HR, double product (DP), SBP and DBP were evaluated. The presence of HG did not change HR behavior, but it increased DP (PI: 10,472±2,539 vs. PII: 12,217±1,933 vs. PIII: 13,369±3,089) through SBP, which in PI had a plateau behavior of 15±22.2 mmHg, while PII varied with an average of 41±12.2 mmHg and PIII 47±11.1 mmHg, in the 4th sprint. DBP fell in PI with 12±13.2 mmHg, while PII and PIII showed an drop of 0±19.6 and 6±13.0 mmHg in the last sprint, respectively. The use of HG during interval training directly modulates hemodynamic variables, promoting an increase in SBP elevation, attenuation of the drop in DBP and an increase in DP, without an increase in HR. RBR-78fhyrf. Available in https://ensaiosclinicos.gov.br/rg/RBR-78fhyrf.