A 30-month worksite-based lifestyle program to promote cardiovascular health in middle-aged bank employees: Design of the TANSNIP-PESA randomized controlled trial

Cardiovascular disease (CVD) is the leading cause of death worldwide. With atherosclerosis as the underlying cause for many CVD events, prevention or reduction of subclinical atherosclerotic plaque burden (SAPB) through a healthier lifestyle may have substantial public health benefits. The objective was to describe the protocol of a randomized controlled trial investigating the effectiveness of a 30-month worksite-based lifestyle program aimed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with standard care. We will conduct a randomized controlled trial including middle-aged bank employees from the Progression of Early Subclinical Atherosclerosis cohort, stratified by SAPB (high SAPB n = 260, low SAPB n = 590). Within each stratum, participants will be randomized 1:1 to receive a lifestyle program or standard care. The program consists of 3 elements: (a) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30-month period, (b) a wrist-worn physical activity tracker, and (c) a sit-stand workstation. Primary outcome measure is a composite score of blood pressure, physical activity, sedentary time, body weight, diet, and smoking (ie, adapted Fuster-BEWAT score) measured at baseline and at 1-, 2-, and 3-year follow-up. The study will provide insights into the effectiveness of a 30-month worksite-based lifestyle program to promote cardiovascular health compared with standard care in participants with a high or low degree of SAPB.

Arritmias ventriculares en superrespondedores a la terapia de resincronización cardiaca

La terapia de resincronización cardiaca se asocia a mejora de la calidad de vida y reducción de la morbimortalidad de los pacientes con disfunción ventricular grave y QRS ancho. Sobre su papel en la reducción de arritmias ventriculares, hay más discusión. Se comparó la incidencia de arritmias ventriculares en pacientes portadores de desfibrilador automático implantable con función de resincronización cardiaca, según el grado de respuesta ecocardiográfica a la resincronización. Se clasificó a los pacientes en tres subgrupos: superrespondedores, respondedores y no respondedores. Se incluyó a 196 pacientes seguidos durante una mediana de 30,1 [intervalo intercuartílico, 18,0-55,1] meses. Se documentó presencia de arritmias ventriculares en 37 pacientes (18,8%); 3 pacientes (5,9%) del grupo de superrespondedores presentaron arritmias ventriculares, en comparación con 14 (22,2%) del grupo de respondedores y 20 (24,4%) del grupo de no respondedores (p = 0,025). En el análisis multivariable, el implante del dispositivo en prevención secundaria (odds ratio = 4,04; intervalo de confianza del 95%, 1,52-10,75; p = 0,005), la ausencia de superrespuesta ecocardiográfica (odds ratio = 3,81; intervalo de confianza del 95%, 1,04-13,93; p = 0,043), un QRS > 160 ms (odds ratio = 2,39; intervalo de confianza del 95%, 1,00-1,35; p = 0,049) y el tratamiento con amiodarona (odds ratio = 2,47; intervalo de confianza del 95%, 1,03-5,91; p = 0,041) fueron los únicos predictores independientes de aparición de arritmias ventriculares. Los pacientes superrespondedores a la terapia de resincronización cardiaca presentan una disminución significativa en la incidencia de arritmias ventriculares respecto a los demás pacientes. Pese a ello, los episodios arrítmicos no llegan a desaparecer por completo en este subgrupo.

Association of myocardial T1-mapping CMR with hemodynamics and RV performance in pulmonary hypertension

Early detection of right ventricular (RV) involvement in chronic pulmonary hypertension (PH) is essential due to prognostic implications. T1 mapping by cardiac magnetic resonance (CMR) has emerged as a noninvasive technique for extracellular volume fraction (ECV) quantification. We assessed the association of myocardial native T1 time and equilibrium contrast ECV (Eq-ECV) at the RV insertion points with pulmonary hemodynamics and RV performance in an experimental model of chronic PH. Right heart catheterization followed by immediate CMR was performed on 38 pigs with chronic PH (generated by surgical pulmonary vein banding) and 6 sham-operated controls. Native T1 and Eq-ECV values at the RV insertion points were both significantly higher in banded animals than in controls and showed significant correlation with pulmonary hemodynamics, RV arterial coupling, and RV performance. Eq-ECV values also increased before overt RV systolic dysfunction, offering potential for the early detection of myocardial involvement in chronic PH.

Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial

We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)–administered intravenous metoprolol in anterior ST-segment elevation myocardial infarction patients undergoing eventual primary angioplasty. This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprolol by EMS and compared them with others treated by EMS but not receiving intravenous metoprolol. Outcomes included infarct size and left ventricular ejection fraction on cardiac magnetic resonance imaging at 1 week, and safety by measuring the incidence of the predefined combined endpoint (composite of death, malignant ventricular arrhythmias, advanced atrioventricular block, cardiogenic shock, or reinfarction) within the first 24 hours. From the total population of the trial (N=270), 147 patients (54%) were recruited during out-of-hospital assistance and transferred to the primary angioplasty center (74 intravenous metoprolol and 73 controls). Infarct size was smaller in patients receiving intravenous metoprolol compared with controls (23.4 [SD 15.0] versus 34.0 [SD 23.7] g; adjusted difference –11.4; 95% confidence interval [CI] –18.6 to –4.3). Left ventricular ejection fraction was higher in the intravenous metoprolol group (48.1% [SD 8.4%] versus 43.1% [SD 10.2%]; adjusted difference 5.0; 95% CI 1.6 to 8.4). Metoprolol administration did not increase the incidence of the prespecified safety combined endpoint: 6.8% versus 17.8% in controls (risk difference –11.1; 95% CI –21.5 to –0.6). Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours.