bluuebunny/crossref_metadata_2025 huggingface dataset:
Leukocyte telomerase concentration is inversely associated with central wave reflection in patients with hypertension
Authors: Pavlova O S , Denisevich T L , Belskaya M I , Shafranovskaya E V , Ogurtsova S E , Mrochek A G
Published: October 2021

Introduction

Telomere length and telomerase are biomarkers of aging and cardiovascular diseases. Arterial stiffness is associated with vascular age and higher risk of cardiovascular diseases. Decreased reparative cell's potential may cause vascular ageing and predispose to the progression of hypertension.

Objective

To determine association leukocyte telomerase concentration (TC) and relative telomere length (RTL) with arterial stiffness in hypertensive patients.

Material and methods

The study included 120 people (70 patients with uncomplicated arterial hypertension (AH) and 50 normotensive individuals). Mean age of hypertensives was 54.8±9.3 and of normotensives was 50.2±9.73 years. Dietary habits, smoking, level of physical activity, body mass index, waist circumference, presence of obesity, blood pressure (BP) level, family history of cardiovascular deseases, depressive episodes and psychological stress according the international questionnaires, glucose; cholesterol, angiotensin II, renin and aldosteron in blood were assessed in the participants. Aortic BP, aortic pulse pressure, augmentation index (AIx), AIx adjusted for heart rate 75 beats per minute (Aix@HR75), pulse wave velocity (PWV) were determined by the applanation tonometry. RTL of peripheral blood leukocytes was performed by real-time PCR. The leukocyte TC was measured using the enzyme immunoassay.

Results

There were no differences between patients with AH and normotensives in both leukocyte TC (4.9 (4.0; 8.0) versus 6.2 (4.1; 9.4), p=0.281) and RTL (0.94 (0.86; 1.0) versus 0.96 (0.83; 1.0), p=0.978). In hypertensive and normotensive groups the mean systolic aortic BP were 130.6±17,7 and 109.9±11.7 mmHg (p<0.001), aortic pulse pressure – 41.5±9,7 and 33.6±10,4 mmHg (p<0.001), Aix@HR75 – 16.0 (7.0; 28.0) and 27.0 (13.0; 35.0)% (p=0.004), PWV –7.9±1.4 and 8.1±1,7 m/s (p=0.409) respectively. In patients with AH the mean leukocyte TC was lower with an increased Aix@75 (>25%) in contrast to the group of patients with normal Aix@75 (4.45 (3.9; 7.8) versus 7.97 (4.6; 10.0) ng/ml; p=0.043). Based on the multivariate logistic regression analysis independent factors influencing on the Aix@75 were leukocyte TC <5 ng/ml with the family history of AH (OR=1.9, 95% CI: 1.1–3.4; p=0.036), the degree of AH combined with decreased salt sensitivity (OR=3.1; 95% CI: 1.3–7.5; p=0.010) and age (OR=1.2; 95% CI: 1.1–1.2; p=0.001).

Conclusions

Decrease of the leukocyte telomerase concentration associated with the raise of augmentation index in patient with uncomplicated AH. As a parameter of central wave reflection the augmentation index may considered as an early sign of biological and vascular aging in hypertension.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The state program of scientific research “Fundamental and applied sciences for medicine”
Exploring the cross-talk between liver and vessels through increased morning blood pressure in hypertension
Authors: Kakouri N , Konstantinidis D , Siafi E , Tatakis F , Drogkaris S , Polyzos D , Thomopoulos C , Koullias M , Tsioufis K
Published: October 2021

Background

Nonalcoholic fatty liver disease (NAFLD) is associated with hypertension and predicts future cardiovascular events.

Purpose

To compare blood pressure (BP) morning surge assessed by ambulatory blood pressure monitoring (ABPM) in hypertensive patients with and without NAFLD.

Methods

Sixty-five consecutive patients with newly diagnosed essential hypertension (age 57±10 years, office BP 139/87±16/9 mmHg) were studied. In all patients a routine biochemical blood examination was undertaken while BP morning surge was automatically calculated by a Spacelabs 90207 device. NAFLD was confirmed by a liver ultrasound. Accordingly, patients were divided in those with and without NAFLD (control group).

Results

Patients with NAFLD (n=44) in comparison with controls (n=21) had similar 24h systolic (141.6±9.9 vs 143.2±10.4 mmHg) and diastolic BP (83.6±10.23 vs 84.7±9.53 mmHg) while office BP was also not different between groups (p=NS). However, those with NAFLD were younger (55±10 vs 61±9 years, respectively, p=0.046), had higher body mass index (32.5±4.5 vs 26.3±3.8 kg/m2, p<0.001), glomerular filtration rate (93.8±17 vs 82.6±9.2 ml/min/1.73m2, p=0.013), and higher levels of morning BP surge (14.29±8.5 vs 5.92±9.01mmHg, p=0.034), compared to the non-NAFLD group. Standard deviation of BP, average real variability, coefficient of variation and dipping status were not different between groups.

Conclusions

At the same levels of clinic and ambulatory BP, hypertensive patients with NAFLD compared to their non-NAFLD counterparts demonstrated increased morning surge BP levels. Our finding suggests that NAFLD may demonstrate a detrimental effect to early-morning at variance to the whole-day hemodynamics.

Funding Acknowledgement

Type of funding sources: None.
Effect of the Mediterranean diet on blood pressure in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials
Authors: Filippou C , Thomopoulos C , Kouremeti M , Sotiropoulou L , Nihoyannopoulos P , Tousoulis D , Tsioufis K
Published: October 2021

Background

It is unclear whether the Mediterranean diet (MedDiet) has a favorable effect on blood pressure (BP) levels because among randomized controlled trials (RCTs) investigating the MedDiet-mediated BP reduction there are significant methodological and clinical differences.

Purpose

The purpose of this study was to comprehensively assess the MedDiet BP-effect compared to the usual diet or another dietary intervention (e.g. low-fat diet) in adults with and without hypertension, accounting for different confounders.

Methods

We systematically searched Medline and the Cochrane Collaboration Library databases and identified 35 RCTs (13,943 participants). Random-effects model was used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted.

Results

Compared to the usual diet and all other active intervention diets the MedDiet reduced SBP and DBP (difference in means: −1.5 mm Hg; 95% CI: −2.8, −0.1; P=0.035, and −0.9 mm Hg; 95% CI: −1.5, −0.3; P=0.002, respectively). Compared only to the usual diet the MedDiet reduced SBP and DBP, while compared to all other active intervention diets or only to the low-fat diet the MedDiet did not reduce SBP and DBP. The MedDiet reduced DBP levels to a higher extent in trials with a mean baseline SBP ≥130 mm Hg, while both SBP and DBP were reduced more in trials with a mean follow-up period ≥16 weeks. The quality of evidence was rated as moderate for both outcomes according to the grading of recommendations, assessment, development and evaluation (GRADE) approach.

Conclusions

The adoption of the MedDiet was accompanied by a relatively small, but yet significant BP reduction, while higher baseline SBP levels and longer follow-up duration enhanced the BP-lowering effect of the intervention

Funding Acknowledgement

Type of funding sources: None.
Structure and predictors of repolarization disorders in patients with severe COVID-19 infection
Authors: Danilevych T D , Mostovoy Y M , Rasputina L V
Published: October 2021

Background

COVID-19 infection can adversely affect the function of cardiac ion channels, leading to changes of the properties of conductivity and repolarization, which increases arrhythmogenesis.

Purpose

To determine the features of the structure and predictors of repolarization disorders in the patients with severe COVID-infection.

Methods

133 patients with severe COVID-19 infection were examined, who were in the intensive care unit of the clinical hospital No. 1 in our city in the period from April to December 2020 and as a result of treatment with improved health were discharged from the hospital.

Among them there were 65 (48.9%) men and 68 (51.1%) women (X2=0.068, p=0.79). The age of patients ranged from 24 to 90 years, averaging 61.38±12.96 years. Middle-aged and elderly patients were dominated at age structure (p=0.001). The total duration of staying in the hospital was 18.9±9.12 days. The duration of staying in the intensive care unit was 8.32±6.91 days. Statistical processing of the obtained data was performed using the statistical software package SPSS 12.0 for Windows.

Results

ECG analysis showed that most of the patients had various ischemic changes and/or myocardial repolarization disorders – in 119 (89.5%) patients. Thus, inversion of the T wave was registered – in 91 (68.4%), signs of early ventricular repolarization – in 14 (10.5%), elevation of ST segment – in 6 (4.5%), depression of ST segment – in 54 (40.6%), pathological Q wave – in 9 (6.8%). In turn, signs of an overload of a left ventricle (LV) – in 27 (20,3%), signs of an overload of a right ventricle (RV) – in 8 (6,0%), a sign of SIQIIITIII – in 7 (5,3%), prolongation of QT interval – in 6 (4.5%) patients, respectively. Also signs of LV hypertrophy – in 45 (33.8%), signs of RV hypertrophy – in 12 (9.0%), the presence of p-pulmonale – in 6 (4.5%), p-mitrale – in 7 (5.3%) patients, respectively.

Predictors of ischemic changes and/or repolarization disorders in the patients with severe COVID infection are: a decrease of glomerular filtration rate (GFR) <60 ml/min/1.73 m2 – r=0.580, p=0.006; time of hospitalization r=−0,204, p=0,02; elderly patients – r=0,184; p=0.02.

Conclusions

The prevalence of ischemic changes and/or myocardial repolarization disorders according to ECG data is 89.5%. Presence of inversion of T wave (68.4%) and depression of ST segment (40.6%) were dominated in the structure of ischemic changes and/or myocardial repolarization disorders. Their predictors are: decrease of GFR <60 ml/min/1.73 m2; time of hospitalization; elderly patients.

Funding Acknowledgement

Type of funding sources: None.
Association of food intake with cardiometabolic diseases among filipino adults
Authors: Lusica P , Jimeno C
Published: October 2021

Background

The prevalence of Metabolic Syndrome among Filipino adults was found to be 12–15% in 2003. Diet has been one of the identified modifiable risk factors targeted to prevent cardiovascular disease or its complications, however the association of each macronutrient component with metabolic syndrome remains unclear. There is no Philippine data on macronutrient intake and cardiometabolic diseases, thus, the primary objective of this study is to determine the association of food intake with cardiometabolic diseases among Filipino adults.

Methodology

This study utilized a cross-sectional analytic design. Data was taken from the results of the 8th NNHeS in 2013–2015 by the Food and Nutrition Research Institute. Filipino adults from different regions of the Philippines who consented to participate in the interview, anthropometrics, blood collection for clinical data, and other measurements were included in this study.

Results

There were 8,056 adults included in the NNHeS 2013. The prevalence of Metabolic Syndrome was 33%. Median total calorie intake in one day was 1,524.1 kcal (range: 148.3 to 7349.5) while median total carbohydrates, protein and fat intake in one day were 273.3 grams (range: 33.8 to 1309.2), 49.4 grams (range: 2.8 to 273.3) and 19.8 g (range: 0.2 to 334.9). Multivariate analysis showed that the following were associated with an increased risk for MetS: increased total protein intake OR 1.391 (1.150–1.684), increased daily consumption of meat and poultry OR 1.397 (1.163–1.677), and decreased vegetable intake OR 1.3 (1.080–1.565)

Conclusion

Increased age, higher socioeconomic status, female sex, increased total protein intake and daily consumption of meat and poultry, and decreased vegetable intake are associated with an increased risk for metabolic syndrome.

Funding Acknowledgement

Type of funding sources: None.
Epicardial adipose tissue (EAT) volume is related to subclinical atherosclerosis and major adverse cardiovascular events (MACE) in asymptomatic subjects
Authors: Sousa A , Mendonca M I , Santos M , Temtem M , Mendonca F , Sousa A C , Rodrigues M , Freitas S , Henriques E , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Introduction

Epicardial adipose tissue (EAT) is an emerging cardiovascular risk marker. It has been suggested to be an inflammatory mediator with a role in subclinical atherosclerosis and coronary artery disease. However, its prognostic relevance in hard clinical outcomes remains thoroughly unexplored in the literature.

Purpose

Evaluate the prognostic relevance of EAT, regarding the occurrence of major adverse cardiovascular events (MACE) in an asymptomatic population.

Methods

895 asymptomatic volunteers were prospectively enrolled in a single Portuguese center (mean age 51.9±7.7, 78.5% male) and underwent a median follow-up time of 3.7 years (IQR 5.0). EAT volume was measured by Cardiac Computed Tomography (CCT) using a modified simplified method. Participants were distributed into two groups, above and below the EAT-volume median. We compared both groups regarding the occurrence of MACE through univariate analysis, Kaplan-Meier Survival curves and log-rank test. Association to subclinical atherosclerosis was addressed using correlation between EAT volume and calcium score (Agatson).

Results

There is a strong correlation between EAT volume and calcium score (r=0.205, p<0.0001), sustaining that it may play an important role in mediating coronary artery disease and subclinical atherosclerosis. Patients with higher EAT volume, were exposed to higher occurrence of MACE on follow-up [70.4% (19 of 27) vs 49.4% (429 of 868), p=0.032] with a clearer separation of the curves after 5.7 years.

Conclusion

In an asymptomatic population, EAT volume seems to be related to subclinical atherosclerosis and to the occurrence of adverse cardiovascular events on long-term follow-up. Our study addresses some unanswered questions, such as the prognostic relevance of EAT as an emerging cardiovascular risk marker.

Funding Acknowledgement

Type of funding sources: None.
Gender differences low-density lipoprotein cholesterol reduction with PCSK9 inhibitors in real world patients
Authors: Cordero A , Fernandez Del Olmo M R , Cortez Quiroga G A , Romero C , Facila L , Fornovi A , Rondan J , Bello Mora M C , Valle A , Sandin A.L.B.E.R.T , Freixa R , Sanchez-Alvare S , Blanch P , Clemente Lorente M , Gonzalez-Juanatey J R ,   LIPID-REAL study
Published: October 2021

Background

Monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 55%, regardless of baseline treatments, and are supposed to have a homogenous effect. We tested possible gender differences in a large multicenter registry of real-world patients treated with PCSK9 inhibitors.

Methods

Multicentre and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals from Spain. Before and on-treatment LDLc cholesterol was recorded as well as medical treatments, clinical indication and clinical features.

Results

A total of 562 patients were analysed, mean age 60.2 (9.6) years and 79.2% males. Most frequent indication for PCSK9 inhibitor treatment was established cardiovascular disease (CVD) with LDLc >100 mg/dl (58.1%) followed by familial hypercholesterolemia (23.4%) and statin intolerance (18.5%). Indications other than CVD were more frequent in women (53.3% vs. 39.1%; p=0.03). Women were more frequently ezetimibe (67.5% vs. 50.6%; p=0.001) before PCSK9 treatment; although no gender differences in statin use was observed (78.6% vs. 83.6%; p=0.93) in the whole cohort it was significantly lower in patients with coronary heart disease (91.4% vs. 98.9%; p=0.005). Before treatment LDLc was 148.7 (50.1) mg/dl and it was higher women vs. men (160.3 (59.3) vs. 145.6 (47.0); p=0.005). Evolocumab was initiated in 318 (56.6%) patients; 229 (40.7%) alirocumab 75 mg and 15 (2.7%) alirocumab 150 mg. No gender differences in PCSK9 inhibitors drug or dose were observed.

Median time to second blood determination were 187.5 (IQR 101–242) days. Mean on-treatment LDLc was 66.7 (46.4) mg/dl and it was also higher in women vs. men (84.4 (58.6) vs. 61.9 (41.3); p<0.001). Mean LDLc reduction was 54.7% but it was higher in men as compared to women (57.0% vs. 46.1%; p=0.0003). Higher LDLc reductions were also observed in patients with CVD as compared to the other 2 indications (57.1% vs. 47.3%; p=0.002). Moreover, LDLc reduction with PCSK9 inhibitors treatment was also higher in men vs women among patients with CVD (58.9% vs. 48.0%; p=0.04)

Conclusions

This multicentre and retrospective registry of real-world patients treated with PCSK9 inhibitors highlights significant gender differences in LDLc reduction.

Funding Acknowledgement

Type of funding sources: None.
Metabolically healthy obesity in a young population assisted by the Family Health Strategy in Brazil. LapARC study
Authors: Vasconcellos C A M , Boghossian R B , Machado M K , Muguet C M C , Cervasio A R B , Flumignan V S M , Barbalho D G , Wandermurem D C R , Marinho B D , Botelho E G , Tostes F R C , Barradas F C , Bica R B S , Kendler D B , Muxfeldt E S ,   LapARC study
Published: October 2021

Background

Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective

To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil.

Methods

A cross-sectional population study for CV risk assessment in adults aged 20–50 years old from a FHC unit in Brazil. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥200 mg/dL, HDL<40 mg/dL (men) and 50 mg/dL (women), triglycerides>150 mg/dL and increased waist circumference.

Results

A total of 632 individuals were evaluated (60% female; mean age 37±9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO.

Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p=0.03), hypertension (44% vs 19%, p<0.001), dyslipidemia (50% vs 36%, p=0.002) and diabetes (7% vs 2%, p=0.001) with higher systolic OBP.

MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p=0.02) and abdominal circumference (102 vs 110 cm, p=0.03), with lower diastolic BP.

Conclusion

MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention

Funding Acknowledgement

Type of funding sources: None.
Effects of canagliflozin on hyperkalaemia and serum potassium in people with diabetes and chronic kidney disease: insights from the CREDENCE trial
Authors: Neuen B L , Oshima M , Perkovic V , Arnott C , Bakris G , Cannon C P , Charytan D M , Jardine M , Levin A , Neal B , Pollock C , Wheeler D C , Mahaffey K W , Heerspink H J L
Published: October 2021

Background

Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin aldosterone system (RAAS), particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain.

Purpose

We sought to assess the effect of canagliflozin on hyperkalaemia and other potassium-related outcomes in people with T2DM and CKD by conducting a post-hoc analysis of the CREDENCE trial.

Methods

The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post-hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and <3.5 mmol/L, respectively) and change in serum potassium.

Results

At baseline the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin angiotensin system blockade. Canagliflozin reduced the risk of investigator-reported hyperkalaemia or initiation of potassium binders (HR 0.78, 95% CI 0.64–0.95, p=0.014; Figure 1). The incidence of laboratory-determined hyperkalaemia was similarly reduced (HR 0.77, 95% CI 0.61–0.98, p=0.031; Figure 2); the risk of hypokalaemia (HR 0.92, 95% CI 0.71–1.20, p=0.53) was not increased. Mean serum potassium over time with canagliflozin was similar to that of placebo.

Conclusion

Among patients treated with RAAS inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Associations between kidney function and outcomes following cardiac rehabilitation in patients with heart failure
Authors: Hamazaki N , Kamiya K , Nozaki K , Ichikawa T , Yamashita M , Uchida S , Noda T , Maekawa E , Meguro K , Yamaoka-Tojo M , Matsunaga A , Ako J
Published: October 2021

Background

Kidney dysfunction is considered one of the most prevalent comorbidities in patients with heart failure (HF). A combination of HF and kidney dysfunction is associated with peripheral muscle impairment, exercise intolerance, and poor prognosis. Conversely, cardiac rehabilitation (CR) for HF patients has been recognized to improve their clinical outcomes. However, the impact of kidney function on responses to CR in patients with HF is still unclear.

Purpose

This study aimed to investigate the associations between baseline kidney function and outcomes following CR including changes in physical function and prognosis in HF patients.

Methods

We reviewed a total of 3,727 patients who were admitted for HF treatment and underwent comprehensive CR during hospitalization. In addition to clinical characteristics, we assessed the kidney function using estimated glomerular filtration rate (eGFR) based on serum creatinine level at hospital discharge as baseline. The quadriceps strength (QS) and 6-minute walk distance (6MWD) were measured as muscle strength and functional capacity, respectively, at baseline. We also remeasured these parameter 5 months after hospital discharge in patients who participated in outpatient CR. The association between participation in outpatient CR and composite outcome of all-cause death and/or unplanned readmission were assessed using the multivariate Cox proportional hazard models in a subgroup of baseline eGFR. We also compared the changes in QS and 6MWD (ΔQS and Δ6MWD) between the eGFR stages.

Results

During the median follow-up period of 1.9 years, all-cause death/readmission occurred in 1604 (43.0%) patients, and their rate of incidence was 20.9/100 person-years. Out of studied patients, 1,585 (42.5%) patients participated in outpatient CR that was significantly associated with lower incidences of all-cause clinical events in patients with both eGFR ≥60 (adjusted hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.60–0.89, P=0.002) and eGFR <60 (adjusted HR: 0.88, 95% CI: 0.78–0.99, P=0.045), but those with an eGFR <60 showed significant interaction between CR participation and adverse clinical events (interaction P<0.035, Figure 1). Among the outpatient CR participants, QS and 6MWD were significantly higher after 5-month CR than those at baseline (P<0.001, respectively), but the low baseline eGFR correlated with low ΔQS and Δ6MWD (trend P<0.001, respectively) even after adjustment for clinical confounding factors (Figure 2).

Conclusions

Although the outcomes following CR is affected by baseline kidney function, outpatient CR is significantly associated with the positive change in physical function and better prognosis in HF patients with low kidney function.

Funding Acknowledgement

Type of funding sources: None.
Abdominal hemodynamics in patients with visceroptosis
Authors: Ljaljukov A , Loginova E , Nechaeva G , Druk I , Semenkin A , Shupina M , Tereschenko Y , Nadey E , Vershinina M , Korennova O , Kondrateva N , Konovalova G , Rjapolova E , Semenova E
Published: October 2021

Background

Abdominal circulation plays the important physiological role for structure and function of the digestive system, maintenance of nutrient homeostasis.

Purpose

To study the features of abdominal hemodynamics in patients with visceroptosis.

Methods

We studied 69 patients (mean age 22.28±3.7 years) with splanchnoptosis (visceroptosis) and 52 age- and sex- matched patients without splanchnoptosis (controls). Exclusion criteria: a history of digestive system surgery of taking blood circulation activating drugs. Doppler ultrasonography of the common hepatic artery, splenic artery, superior mesenteric artery, portal vein was performed on an empty stomach and 30 minutes after a food sample (standardized for proteins (14 g), fats (10 g) and carbohydrates (45 g)) using the Sonoace-8000 ultrasound scanner (Medison, South Korea). The data were analyzed using the Statistica-6 packages.

Results

There were no differences in hemodynamic parameters of fasting abdominal blood flow (ABF). After a food testing, in the postprandial period the ABF in all vessels in patients with splanchnoptosis was lower than in controls: the portal vein blood flow (BF) 1124,0 [1030,0–1419,0] ml/min vs 1373,0 [1136,0–1567,5] ml/min respectively (U=433,5; Z=−2,1; p=0,0342); the common hepatic artery BF 341,0 [295,0–394,0] ml/min vs 412,0 [331,0–521,0] ml/min respectively (U=335,0; Z=−2,3; p=0,0218); the splenic artery BF 396,0 [292,0–538,0] ml/min vs 502,0 [394,0–594,0] ml/min respectively (U=328,0; Z=−2,1; p=0,0399); the superior mesenteric artery BF 988,0 [837,0–1272,0] ml/min vs 1136,5 [992,0–1465,0] ml/min respectively (U=1625,5; Z=−2,2; p=0,0314). Changes in ABF were correlated with splanchnoptosis: the portal vein BF with any ptosis (rs=−0,21; p<0.05), the common hepatic artery BF with gastroptosis (rs=−0,38; p<0.05), the superior mesenteric artery BF with colonoptosis (rs=−0,86; p<0.05). The peripheral vascular resistance was correlated with the common hepatic artery BF (rs=−0,46; p<0.05), with the splenic artery BF (rs=−0,33; p<0.05) and with the superior mesenteric artery BF (rs=−0.79; p<0.05).

Conclusions

Patients with splanchnoptosis in the postprandial period have low volumetric BF in abdominal aorta vessels. This can be associated with the length of the mesenteric vessels, which undergoes the greatest changes in splanchnoptosis. Food testing reveals latent BF deficit in patients with splanchnoptosis.

Funding Acknowledgement

Type of funding sources: None.
Bisphosphonates and atrial fibrillation risk: a final word
Authors: Sousa J , Lourenco R , Lopes J , Saleiro C , De Campos D , Lourenco C , Goncalves L
Published: October 2021

Background

Bisphosphonates (BPs) are widely prescribed drugs that decrease bone fracture risk in osteoporosis patients. Nevertheless, the class has been associated with a plethora of adverse effects, including incidental atrial fibrillation (AF). This epidemiologic link has, however, been met with skepticism by some authors.

Purpose

To perform a meta-analysis aimed at ascertaining the extent to which BPs might increase the odds of AF.

Methods

We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to the first of March, 2021, for randomized controlled trials comparing oral or intravenous BPs with placebo or a no-treatment control, in what concerns AF risk. In order to be included in the quantitative analysis, studies were required to feature a minimum patient follow-up of 6 months. De novo AF diagnoses served as the primary endpoint. Data related to individual BPs were further investigated separately, with respect to this outcome. Study-specific Mantel-Haenszel odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model.

Results

42 RCTs, encompassing 52.436 patients (32.071 randomized to BPs), were regarded as eligible for quantitative synthesis. Of note, 2 pooled analyses, one of 4 trials with ibandronate and the other of 6 trials with risedronate, were included. Individual BP representation may be depicted as follows: Alendronate, 23 trials, with 14.599 patients; Risedronate, 7 trials, with 15.350 patients; Zoledronic acid, 7 trials, with 13.059 patients; Ibandronate, 4 trials, with 8.754 patients; and Minedronate, 1 trial, with 674 patients. 748 de novo AF diagnoses were reported, in total. In the main analysis, BPs were not found to be significantly associated with an increase in AF odds (OR 1.10, 95% CI 0.95–1.28, P 0.21, i2 0%). As for individual BPs, Alendronate (OR 1.09, 95% CI 0.82–1.45, P 0.55, i2 0%), Risedronate (OR 0.81, 95% CI 0.35–1.86, P 0.61, i2 31%), Ibandronate (OR 0.89, 95% CI 0.52–1.52, P 0.67) and Minedronate (0 AF events reported, both in the active and in the control group) were also not shown to meaningfully enhance AF risk. On the contrary, Zoledronic acid utilization was associated with a significant, though small, increase in new AF cases (OR 1.29, 95% CI 1.01–1.64, P 0.04, i2 0%).

Conclusion

The professed BP-driven increase in AF odds is not apparent in a fairly populated randomized setting. In fact, a barely significant increment in AF risk seems only to occur with the most potent BP (Zoledronic acid). Therefore, AF development concerns should not refrain doctors from prescribing this highly effective pharmacological class.

Funding Acknowledgement

Type of funding sources: None.
Women with atrial fibrillation in the Middle East: utilization of oral anticoagulant agents in a population with bad baseline clinical profiles and risk scores
Authors: Hammoudeh A , Ibdah R , Rawashdeh S , Ababneh A , Al-Kasasbeh A , Shawar H ,   The Jordan Atrial Fibrillation (JoFib) Study Investigators
Published: October 2021

Background

Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide and in the Middle East. Several studies have shown that women with AF are undertreated despite worse baseline clinical and risk profiles compared with men. It is largely unknown if this also applies to Middle Eastern AF patients.

Purpose

To evaluate baseline clinical features and utilization of guideline-recommended oral anticoagulant medications (OACs) in Middle Eastern women with AF.

Methods

The Jordan AF prospective multicenter study enrolled 2160 patients with AF, including 1164 (53.9%) women, in 20 hospital and outpatient clinics (May 2019 through January 2021).

Results

Nonvalvular AF was present in 1038 (91.0%) of women and 935 (94.6%) of men. Compared with men, women were older (mean age 69.2±11.5 years vs. 66.1±14.9 years, p<0.001), and had higher prevalence of hypertension (79.1% vs. 69.5%, p<0.001), diabetes (46.1% vs. 41.7%, p=0.04) and obesity (60.5% vs. 34.6%, p<0.001). Women, however, had lower prevalence of two comorbidities; heart failure (21.5% vs. 28.6, p=0.001) and coronary artery disease (7.7% vs. 15.4%, p<0.001) compared with men. Rate of utilization of oral anticoagulant agents (OACs) was higher in women than men with high and intermediate CHA2DS2 VASc scores (Table). Direct OACs were used in 64.0% of women and 63.3% of men with high risk score (p=NS). Multivariate analysis did not show sex to be an independent predictor of use of OACs.

Conclusions

Middle Eastern women with AF have worse baseline clinical and risk score profiles compared with men. In disagreement with other regional studies, the majority of these women received guideline-recommended OACs.

Funding Acknowledgement

Type of funding sources: None.
Sex-specific differences in management and treatment in ST-elevation myocardial infarction – a German nationwide real-life analysis
Authors: Kuehnemund L , Koeppe J , Fischer A J , Feld J , Illner J , Makowski L , Engelbertz C , Gerss J , Droege P , Guenster C , Reinecke H , Freisinger E ,   GenderVasc
Published: October 2021

Background/Introduction

Acute myocardial infarction (AMI) continues to be the leading cause of death in men and women worldwide. The outcome of patients with AMI improved during the last years but the impact of sex is under current debate since female sex has repeatedly to be associated with an unfavourable outcome in AMI.

Purpose

This retrospective routine-data-based analysis sought to examine sex differences of recent trends in in-patient healthcare and outcome of ST-elevation myocardial infarction (STEMI).

Methods

The dataset of the Federal Association of the Local Health Insurance Funds was used to identify patients who were hospitalized for STEMI in Germany between January 2010 and December 2017. Further, data on concomitant diseases, risk constellations, selected cardiovascular procedures, as well as in-hospital and 30-days mortality were assessed and further analyzed with regard to sex differences.

Results

In total, we identified 175,187 STEMI patients over the 8-year period, thereof about 35% female patients. Women with STEMI were older (median (interquartile range (IQR)): 76 (19) vs. 64 (20) years in men) and had more comorbidities including diabetes (44.9% vs. 35.5%), hypertension (90.9% vs. 82.8%), congestive heart failure (54.7% vs. 43.8%) and chronic kidney disease (33.5% vs. 22.3%); all p<0.001). Further, female STEMI patients underwent less often percutaneous coronary intervention during hospitalization (PCI; 75.5% vs. 85.2%; p<0.001). Complications such as shock (14.8% vs. 13.0%) and bleeding (9.3% vs. 6.6%; both p<0.001) could be observed more frequently in women.

Female sex was independently associated with a higher adjusted 30-day mortality (Odds Ratio 1.08; CI 1.05–1.12; p<0.001).

Conclusion

In a contemporary unselected cohort, one-third of STEMI patients are female. Women with STEMI are older with higher cardiovascular risk, and continue to receive less likely interventional revascularization therapy compared to male STEMI patients. Moreover, female STEMI patients were observed higher complications and death during index hospitalization and 30 days thereafter. Further analyses are urgently needed to identify causes of under-treatment and impaired outcome in women with STEMI.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): joint federal committee, Germany.
Heart rate variability as a predictor factor of the development of preeclampsia: systematic review of the literature
Authors: Rueda-Ochoa O L , Cordero Agon L S , Quiroz Vargas K J , Pico Camacho A J ,   Electrocardiography Research Group, Industrial University of Santander
Published: October 2021

Introduction

Preeclampsia corresponds to one of the main causes of maternal and fetal morbidity and mortality worldwide. There are several studies in the literature that refer to heart rate variability (HRV) as a potential predictor factor for preeclampsia. However, a large number of these evidence shows wide heterogeneity in the results of the evaluated domains, which raises the need to develop new studies to demonstrate their predictive value and applicability.

Purpose

To determine if HRV is a predictor factor for the development of preeclampsia.

Methods

The electronic databases PUBMED, Google Scholar and EBSCO host, were searched for observational studies that measured the HRV in pregnant women, comparing the evolution towards the development or not of preeclampsia. Two independent reviewers extracted the data using a predesigned data collection form for their respective analysis in the statistical program STATA v.14.

In each of the studies, clinical and statistical heterogeneity was assessed using the I2 test. Additionally, an overall effect measure was calculated based on the standardized mean difference. The Forest-plot graph was used to summarize the results of the study.

Results

The search identified 1661 articles of which 15 were included in this review. The variables that were associated with the development of preeclampsia from the standardized mean difference (SMD) with an I2 of 0.0% were High frequency (HF) in normalized units with a SMD of −0.45 (95% CI: −0.68, −0.22); Low frequency (LF) in ms2 with a SMD of 0.36 (95% CI: 0.04, 0.68) and SDNN in ms2 with a SMD of −0.43 (95% CI: −0.67, −0.18).

Other variables that showed a significant standardized mean difference but with a higher heterogeneity were LF in normalized units with an I2 of 57.3%, a SMD of 0.45 (95% CI: 0.22, 0.68), and the Low frequency/High frequency (LF/HF) ratio with an I2 of 41.9% and a SMD of 0.41 (95% CI: 0.18, 0.64).

Conclusion

The findings of this review indicate that preeclamptic women present decreased vagal tone, evidenced in low HF and SDNN SMD values, and an increased sympathetic activity, shown in high LF and LF/HF ratio SMD values, compared to the healthy pregnant women. These findings open the discussion about if autonomic disturbances are a consequence or could be a cause associated with the develop of preeclampsia.

Funding Acknowledgement

Type of funding sources: None.
ST-segment elevation myocardial infarction: are women being discriminated?
Authors: Oliveira C C , Vilela F , Flores R , Medeiros P , Pires C , Mane F , Braga C , Marques J , Costa J
Published: October 2021

Background

Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI) have improved, a gender disparity exists, with women showing higher mortality.

Objectives

To assess gender differences in presentation, management and in-hospital, at 30-days, 6-months and 1-year after STEMI mortality.

Methods

We collected data from 809 consecutive patients treated with primary PCI and compared the females versus males.

Results

Women were older than man (69,1±14,6 vs. 58,5±12,7 years; p<0.001) with higher prevalence of age over 75 years (36.7% vs. 11.7%; p<0.001), diabetes (30,6% vs. 18,5%; p=0.001), hypertension (60.5% vs. 45.9%; p=0.001), chronic kidney disease (3.4% vs. 0.6%; p=0.010) and acute ischemic stroke (6.8% vs. 3.0%; p=0.021). At presentation, women had more atypical symptoms, less chest pain (90.3% vs. 95.6%; p=0.014) and greater clinical severity (cardiogenic shock (10.7% vs. 5.4%; p=0.011). There were no differences in the symptom-first medical contact me (95.0 min vs. 80.5 min; p=0.215); however, women had longer time until reperfusion (264.0 min vs. 212.5 min; p=0.001) and were less likely to receive optimal medical therapy (aspirin-93.1% vs. 99.2%; p<0.001; P2Y12 inhibitors 91.9% vs. 98.2%; p<0.001; beta-blockers-90.8% vs. 95.1%; p=0.032; ACEIs- 88.1% vs. 94.8%; p=0.003). In-hospital mortality (9.6% vs. 3.5%; p=0.001), at 30-days (11.3% vs. 4.0%; p<0.001), 6-months (14.1% vs. 4.7%; p<0.001) and 1-year (16.4% vs. 6.3%; p<0.001) was significantly higher in women. The multivariate analysis identified age over 75 years (HR=4.25; 95% CI [1.67–10.77]; p=0.002), Killip class II (HR=8.80; 95% CI [2.72–28.41]; p<0.001), III (HR=5.88; 95% CI [0.99–34.80]; p=0.051) and IV (HR=9.60; 95% CI [1.86–48.59]; p=0.007), acute kidney injury (HR=2.47; 95% CI [1.00–6.13]; p=0.051) and days of hospitalization (HR=1.04; 95% CI [1.01–1.08]; p=0.030) but not female gender (HR=0.83; 95% CI [0.33–2.10]; p=0.690) as independent prognostic factors of mortality.

Conclusions

Compared to men, women with STEMI undergoing primary PCI have higher mortality rates. Our results suggest that this is not due to the gender itself, but due to the women worse risk profile, the higher reperfusion time related with system delays and the minor probability of receiving the recommended therapy. Efforts should be made to reduce these gender differences.

Funding Acknowledgement

Type of funding sources: None.
In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention
Authors: Angelini F , Franchin L , Bocchino P P , De Filippo O , Morici N , Wanha W , Savonitto S , Trabattoni D , Cerrato E , Barbieri L , De Luca L , Fortuni F , Capodanno D , D'Ascenzo F , De Ferrari G M ,   SENEX group
Published: October 2021

Objective

The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).

Methods

Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.

Results

A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). [Figure 1] After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI 1.03–1.11, p-value <0.001), lower SBP (OR 0.98 per mmHg reduction, 95% CI 1.01–1.03, p-value 0.001) and being not independent at home (OR 2.56, 95% CI 1.25–5.26, p-value 0.01) resulted independent predictors of in-hospital mortality. [Figure 2] A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.

Conclusion

Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation
Authors: Carbone A , Santelli F , Bottino R , Attena E , Mazzone C , Parisi V , D'Andrea A , Golino P , Nigro G , Russo V
Published: October 2021

Aims

Older age was associated to inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.

Methods and results

Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥ 80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR=3,15 (95% IC 1.45–6.83); p<0,01], coronary artery disease [OR= 3,6 (95% IC 1.41–9.1); p<0,01] and body mass index [OR=1,27 (1.14–1.41); p<0,01]. Overdosage was independently associated with diabetes mellitus [OR= 18 (3.36–96); p<0,01]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p<0,001).

Conclusion

In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs' overdosage (diabetes mellitus type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage resulted in less survival.

Funding Acknowledgement

Type of funding sources: None.
Pacemaker therapy in the elderly and very elderly: comorbidity-burden vs age, as prognostic factors for excess of length of in-hospital stay, complications and mortality
Authors: Marschall A , Del Castillo Carnevali H , Goncalves Sanchez F , Torres Lopez M , Delgado Calva F A , Dejuan Bitria C , Biscotti Rodil B , Duarte Torres J , Basabe Velasco E , Gomez Sanchez I , Rubio Alonso M , Alvarez Anton S , Marti Sanchez D
Published: October 2021

Background

The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Recent studies suggest that comorbidity burden may have an equal, if not greater, effect on length of in-hospital stay (LOS), complications and mortality, as age in a variety of clinical scenarios.

Objective

The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate the impact of comorbidities, as compared to age, on excess of length of in-hospital stay and mortality.

Methods

This is a retrospective observational study of a single centre. Patients that underwent (both elective and non-elective) PM implantation between June 2016 and December 2018 in our centre, were included for chart review. Elderly patients were defined as those with age 80–89 years, whereas very elderly patients were defined as those with ≥90 years of age. Excess in LOS was defined as an in-hospital stay >3 days.

Results

A total of 507 patients were included in the study with a mean age of 80.6 (±8.5) years. 255 elderly and 60 very elderly patients were included. Median follow-up time was 24 months. Baseline clinical characteristics are presented in Table 1. The mortality rate for elderly patients was 18.8% for the elderly and 36.7% for the very elderly (p=0.002). The presence of ≥2 comorbidities (defined in Table 1) resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 7.1 (4.4–11.4), p<0.001); HR: 1.01 (0.9–1.1), p=0.56, respectively). Neither age, nor comorbidity burden predicted the appearance of device related complications. Both comorbidites and age predicted mortality. However, the association was stronger for the presence of comorbidites, than for age (HR: 1.9 (1.1–3.1), p=0.002 vs HR: 1.1 (1.1–1.2), p<0.001, respectively). Elderly patients with low comorbidity burden (<2 comorbidities) showed no significant differences with regards to LOS and mortality when compared to younger patients (2 (2–4) vs 3 (2–5) days, p=0.529 and 18.3% vs 17.4%, p=0.702; respectively).

Conclusions

Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation.

Funding Acknowledgement

Type of funding sources: None.