bluuebunny/crossref_metadata_2025 huggingface dataset:
24-hour ambulatory blood pressure measurement using a novel non-invasive, cuff-less, wireless device
Authors: Nachman D , Gilan A , Goldstein N , Constantini K , Littman R , Eisenkrafta A , Grossmanc E , Gepnerc Y
Published: October 2021

Background

Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for diagnosis and treatment of hypertension. Technical limitations, low compliance and complex procedures limit their use.

Purpose

The aim of the present study was to test the accuracy of a new technique of 24H ABPM using a photoplethysmography (PPG)-based, wearable device (Wrist-monitor) as compared to the standard cuff-based ABPM device.

Methods

In this prospective observational study, 24H ABPM was performed in parallel for both devices on volunteers aged 18–65 years, while documenting their daily activities. Level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between devices. Receiver Operating Characteristic (ROC) curve analysis was used to assess the capability of the Wrist-monitor to identify abnormal BP values.

Results

The study included 28 subjects (18 men) mean age 41.5±16.2 years. Bland-Altman analysis resulted in 24H bias of −1.1 mmHg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was −1.9 mmHg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mmHg for DBP and SBP respectively). ROC curve analysis on all BP readings (n=2381) yielded a mean area under the curve (AUC) for 24H of 0.965 for both SBP and DBP. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared to the cuff-based device (p<0.001).

Conclusions

The cuff-less device provides comparable measurements to those obtained with the currently used cuff-based ABPM device, with significantly less inconvenience to the subject.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The ABPM devices were given for free by BioBeat LTD. Petach-Tikva, Israel. No other support was given.
Pilot study of comparability of a smartphone blood pressure monitoring algorithm to conventional cuff-based blood pressure measurements
Authors: Vischer A , Rosania J , Socrates T , Blaschke C , Proenca M , Bonnier G , Proust Y.-M , Ferrario D , Eckstein J , Lemay M , Burkard T
Published: October 2021

Background/Introduction

There is a growing market for smartphone applications (apps), offering medical assessments such as blood pressure measurements (BPM). These apps have the potential to improve blood pressure (BP) control by making BPM broadly and easily accessible. Yet, to be suitable for clinical and diagnostic purposes, BPM measured with smartphone apps need to be comparable to conventional BPM.

Purpose

We sought to compare a novel photoplethysmographic BPM algorithm used in a smartphone app to conventional cuff-based BPM.

Methods

We included consecutive patients with an indication for ambulatory BPM. Office blood pressure measurements (OBPM) were taken with an oscillometric cuff-based device (Welch Allyn SureBP). The algorithm of the smartphone app detects the pulse wave in finger capillaries using the phone's camera and estimates BP based on the form of the pulse wave. Before estimating a BP value, the algorithm performs a quality assessment to automatically reject recordings with insufficient quality. On the first day (D1), we took 6 OBPM alternating with 5 smartphone BPM (TestBP). On the second day (D2), 4 OBPM alternating with 3 TestBP were measured. TestBP calibrated based on the first OBPM of D1. Each TestBP was then compared to its RefBP (defined as mean of the previous and following OBPM).

Results

50 patients were included in the study, resulting in 50 TestBP values on D1 and 33 on D2. There was no difference at the 5% significance level between the TestBP and RefBP distributions on both days, and for both systolic and diastolic pressures. The mean ± standard deviation (SD) of the differences between TestBP and RefBP was 0.7±9.4 / 1.0±4.5 mmHg on D1 and 2.6±8.2 / 1.3±4.1 mmHg on D2 for systolic/diastolic values, respectively. The number of TestBP measurements within 5, 10 and 15 mmHg from RefBP are shown in Table 1. Bland-Altman plots depicting the agreement between TestBP and RefBP are shown in Figure 1.

Conclusion

This smartphone algorithm shows comparable values to oscillometric cuff-based especially diastolic values. Its differences between TestBP – RefBP have a good stability 1 day after calibration. Before clinical use, this algorithm needs to undergo formal validation against a reference BP method accepted by international standards (auscultatory or invasive methods).

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Centre Suisse d'Electronique et de Microtechnique Table 1Figure 1
Individualizing the target diastolic blood pressure in patients being treated for hypertension and diabetes
Authors: Sobieraj P , Sinski M , Lewandowski J
Published: October 2021

Background/Introduction

The J-curve hypothesis in hypertension is related to an increased risk of cardiovascular events associated with both too high and too low diastolic blood pressure (DBP) values.

European Society of Cardiology recommended DBP in the range of 70–80 mm Hg as a treatment target for subjects with hypertension, regardless of age, history of cardiovascular disease (CVD) or diabetes mellitus (DM) presence.

Such a recommendation is based on studies performed in subjects with prior CVD. There is no scientific evidence to support a target DBP of 70–80 mmHg in people with DM and without history of CVD.

Purpose

The aim of the study is to determine the relationship between DBP and cardiovascular risk according to age and the presence of CVD in people with DM.

Methods

The ACCORD study dataset (participants with diabetes) available from National Heart, Lung and Blood Institute was used to perform the analysis.

The DBP value during the study was defined as the mean of all DBP measurements obtained during the study individually for each participant.

The composite endpoint (CE) was defined as myocardial infarction, stroke, exacerbation of heart failure or cardiovascular death.

The relationship between the DBP value during the study and the risk of CE was presented using the Cox proportional hazard model and spline curves.

This analysis was performed for 4 sub-populations defined on the basis of 2 criteria: age <65 years and the presence of CVD in the past. Each model was adjusted for other cardiovascular risk factors (age, sex, smoking, systolic blood pressure, chronic kidney disease).

Results

The data of 4,733 participants of the ACCORD BP study were analyzed. The table (Figure 1) presents the baseline characteristics of the 4 sub-populations and CE occurrence.

For each sub-population studied, a Cox model describing the relationship between DBP during the study and CE risk was developed and presented in the Figure 2.

In subjects with CVD the J-curve relationship between DBP and CE risk was observed. Among subjects without prior CVD, no J-curve relationship was observed.

Conclusions

Optimal DBP treatment target in subjects with CVD and DM is slightly lower than the currently recommended range of 70–80 mm Hg.

DBP values in the range of 70–80 mm Hg should not be recommended as the treatment target for subjects with DM and no history of CVD.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial
Authors: Ingabire P M , Ojji D B , Rayner B , Ogola E , Damasceno A , Erika J , Dzudie A , Ogah O , Poulter N , Sani M U , Barasa F , Shedul G , Mukisa J , Mukunya D , Mondo C K ,   CREOLE Study Investigators
Published: October 2021

Background

Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction.

Objectives

To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients.

Methods

This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures.

Results

The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium >140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40).

Conclusion

There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1
Atherosclerosis risk factors may be underestimated in patients with pulmonary hypertension associated with congenital heart disease – results of Polish snapshot registry
Authors: Mamzer A , Kopec G , Kusmierczyk-Droszcz B , Skowron W , Mroczek E , Lewicka E , Kaminski K , Karasek D , Mularek-Kubzdela T , Mizia-Stec K , Kurzyna M , Gasior Z , Ciurzynski M , Plonska-Gosciniak E , Kasprzak J D ,   SKP/PTK study group
Published: October 2021

Introduction

Classic risk factors of atherosclerosis may contribute to cardiovascular (CV) risk in patients (pts) with pulmonary hypertension associated with congenital heart disease (PAH-CHD), but their prevalence is poorly studied.

Purpose

We evaluated a large cohort of Polish PAH-CHD patients (PAHpts) treated with specific therapies with regard to prevalence of classic risk factors for atherosclerosis.

Methods

A multicenter observational snapshot registry was conducted under the auspices of Polish Cardiac Society to study PAH pts, identified in centers treating >5 such pts in years 2008–2018. The analysis included 250 PAH-CHD pts, including non-corrected CHD – predominantly Eisenmenger Syndrome (Gr. 1, 224 pts, mean age 42±2 years, 63% females) and pts after heart disease correction (Gr. 2, 26 pts, mean age 42±6.5 years, 62% females). The incidence of classic CV risk factors was compared in both groups.

Results

The prevalence of risk factors was considerable considering young age of the cohort and statistically similar in both groups (Figure). Hypertension was present in 14% in Gr. 1 and 15% in Gr. 2. The incidence of diabetes was comparable in both groups (3% vs. 4%). Hyperlipidemia was nearly numerically twice as frequent in Gr. 1 (23% vs. 12%, p=0.18). Current smokers (1%) were only present in Gr. 1, while history of smoking was 4% in both groups. Symptomatic atherosclerosis of peripheral arteries was twice as frequent in Gr. 1 (8% vs. 4%, p=0,71). There was no difference regarding prior stroke (3,6% vs 4%, p=0,63). Chronic kidney disease and atrial fibrillation were one and a half more often in Gr. 1 (respectively, 12% vs. 8%, p=0,81; 12% vs. 8%, p=0.75). Mean heart rate was 72±2 bpm in Gr. 1 and 77±7 bpm in Gr. 2. Gastrointestinal bleeding was reported only in Gr. 1 (2.7%). SCORE calculated risks were low due to low age, but high risk was identified in 9.3% of Gr. 1 and 20% of Gr. 2 (p=0.096).

Conclusions

Based on our data from national survey, classic atherosclerosis CV risk factors are not uncommon in the population of relatively young patients with PAH-CHD, parallel to improved longevity. Selected pts from both groups present with elevated risk of death from atherosclerotic complications. This finding may influence the overall mortality risk in PAH-CHD population and reflects new challenges in management despite progress in specific therapies of pulmonary hypertension.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Psychosocial and behavioral characteristics of still smokers at 6 months after acute cerebro or cardiovascular events: preliminary findings from INEV@L, a prospective pilot study
Authors: Zeller M , Sales-Wuillemin E , Guinchard S , Chappe J , Chague F , Ayari H , Maza M , Aboa-Eboule C , Truchot D , Lorgis L , Giroud M , Cottin Y , Bejot Y
Published: October 2021

Introduction

Considering the benefits of smoking cessation, and evolving new tobacco-product consumption, such as e-cigarettes (e-cig), contemporary behavioral and psychosocial factors (PSF) associated with smoking after acute stroke or myocardial infarction (MI) remain to be investigated.

Methods

From INEV@L, a prospective pilot study in 128 workers hospitalized for MI or stroke (MI/stroke: 199/57) <65 y, between 2016 and 2017 in CHU Dijon. Among them, 67 (52%) current smokers were analyzed. PSF (education level (EL), socioeconomic status (SES), perceived disease severity (PDS), anxiety/depression), and health behavior (adhesion to Mediterranean diet (AMD), BMI, physical activity (PA), smoking) were collected at the acute phase and at 6 Months Follow-Up. Patients who quit smoking were compared with non-quitting patients.

Results

Still smokers at 6-M FU were frequent (30 (45%)) and had similar risk factors including age (51±7 y) than quitters. Rate of overweight/obese patients and AMD were similar (52 vs 65%, p=0.281 and 29±6 vs 26±7, p=0.207). SES and EL were slightly higher in still smokers group. The level of anxiety or depression was as high in the 2 groups (63 vs 68%, and 19 vs 20%, p=0.717 and 0.911). Although similar at the acute phase (p=0.867), PDS at 6-M FU, trended to be lower in non-quitters (57 vs 78%, p=0.057). At FU, only few returned to work (57% for both groups). Overweight/obese who reduced their weight were more common in non-quitters (60 vs 38%, p=0.170). Patients who improved AMD or PA level were similar (62 vs 78%, p=0.166, and 67 vs 92%, p=0.317). The vast majority of non-quitters introduced the use of e-cig (80% vs 0%, p<0.001).

Conclusion

Our pilot study in young workers highlights the low rate of smoking cessation, and generalized dual use of electronic+conventional cigarette at mid-term after acute MI or stroke. Our findings further suggest specific PSF pattern of non-quitters, associated with loss of perceived disease severity.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Conseil Régional de Bourgogne Franche Comté et CHU Dijon Bourgogne
Correlations between sympathetic nervous system activity and smoking, as well as unattended blood pressure in essential hypertension
Authors: Manta E , Konstantinidis D , Dimitriadis K , Tatakis F , Drogkaris S , Polyzos D , Ntalakouras I , Leontsinis I , Thomopoulos C , Tsioufis K
Published: October 2021

Background/Introduction

It is a well-known fact that the sympathetic nervous system is involved with the pathophysiology of hypertension. Smoking, which is one of the most significant risk factors for cardiovascular morbidity and mortality, also contributes to the development of hypertension mainly through the stimulation of the sympathetic nervous system. Moreover, measurement of unattended blood pressure (BP) may provide additional information compared to conventionally attended BP.

Purpose

The aim of this study was to demonstrate the impact of smoking on sympathetic nervous system stimulation, and on BP measurement variations with and without medical supervision.

Methods

We studied patients with essential hypertension, who were separated into two groups, depending on their smoking habits (Group I: non-smokers, Group II: smokers). In all participants, sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes of rest) and attended BP measurements were conducted with the same device, on the same day of MSNA recording, in random order. Then, we compared the two BP measurement values of each patient to assess which of the two was higher.

Results

Ninety-two consecutive patients (58±11 years, 50 males) were evaluated. Smokers (n=19) did not differ as regards 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index when compared to non-smokers (n=73). However, higher levels of MSNA were recorded to smokers (73.16±13.42 vs. 61.04±18.10 bursts per 100 heartbeats, p<0.01). Furthermore, higher percentage of smokers recorded to have unattended BP values higher than attended (73.7% vs. 47.9% of them respectively, p=0.045). In particular, in smokers unattended BP was higher than attended by 10.07±6.7 mmHg, while in non-smokers unattended BP was lower than attended by 6.6±7.14 mmHg. No correlation was found between the MSNA and the differences observed in the two values resulting from the two different measurements of BP, maybe due to the small size of the sample.

Conclusions

Cigarette smoking is accompanied with higher sympathetic nervous system activation. Moreover, smokers exhibit higher unattended blood pressure values than normal measurements. The emerging hypothesis is that the stimulation of the sympathetic system causes this difference in measurements. A larger sample of patients is needed to fully determine the clinical significance of the above observation.

Funding Acknowledgement

Type of funding sources: None.
Efficacy and safety of e-cigarette use for smoking cessation: a systematic review and meta-analysis of randomized controlled trials
Authors: Levett J Y , Filion K B , Reynier P , Prell C , Eisenberg M J
Published: October 2021

Background

Quitting smoking substantially reduces the risk of developing cardiovascular disease. Smokers are increasingly turning to electronic cigarettes (e-cigarettes) to help them quit smoking combustible cigarettes. However, the efficacy and safety of e-cigarettes for smoking cessation remain controversial.

Purpose

To examine the efficacy and safety of e-cigarette use for smoking cessation.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing nicotine and non-nicotine e-cigarettes (alone, or in combination with behavioural and/or pharmacological interventions) to conventional smoking cessation therapies (pharmacological, behavioural, or both). We systematically searched MEDLINE, Embase, and the Cochrane Libraries. Inclusion was restricted to RCTs that reported biochemically validated abstinence at six months or greater. The primary comparison was nicotine e-cigarettes versus any (non-e-cigarette) conventional smoking cessation therapy. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and 95% confidence intervals (CIs).

Results

A total of six RCTs (n=3,401) were included, with maximum follow-up durations ranging from six to 12 months. Compared with conventional smoking cessation therapies, point estimates favoured nicotine e-cigarettes for the most rigorous criterion of abstinence, continuous abstinence, and point prevalence abstinence, although findings were inconclusive due to wide 95% CIs (Table 1). Similar trends were observed when comparing non-nicotine e-cigarettes to traditional smoking cessation therapies. Compared with non-nicotine e-cigarettes, nicotine e-cigarettes increased abstinence as defined by the most rigorous criterion. Although there was a signal suggesting a potential increased risk of respiratory adverse events with nicotine e-cigarettes versus traditional therapies, the 95% CI is wide.

Conclusion

E-cigarettes appear to be more efficacious than conventional nicotine pharmacotherapies and behavioural smoking cessation therapies. Although currently available safety data are inconclusive, e-cigarettes may be considered for smoking cessation given the established long-term health consequences of continued smoking.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Mr. Levett is supported by an Ivan Racheff Scholarship, funded through the McGill University Faculty of Medicine and Health Sciences Research Bursary Program. Dr. Filion is supported by a Senior Research Scholar award from the Fonds de recherche du Québec – Santé and a William Dawson Scholar award from McGill University.
Prevalences and incidences of cardiovascular and renal diseases in type 1 compared with type 2 diabetes: a nationwide observational study
Authors: Angoulvant D , Fauchier G , Semaan C , Bisson A , Herbert J , Ducluzeau P H , Fauchier L
Published: October 2021

Background

Type 1 diabetes (T1D) and type 2 diabetes (T2D) increase risks of cardiovascular (CV) and renal disease compared with diabetes-free populations. There are only few studies comparing T1D and T2D for the risk of these clinical events. We examined these issues in a nationwide analysis in France.

Methods

All patients aged ≥18 seen in French hospitals in 2013 with at least 5 years of follow-up were identified and categorized by their diabetes status. A total of 50,623 patients with T1D (age 61.4±18.6, 53% male) and 425,207 patients with T2D (age 68.6±14.3, 55% male) were followed over a mean period of 4.3±2.1 years (median 5.3, interquartile 2.8–5.8 years). Prevalence and event rates of myocardial infarction (MI), heart failure (HF), ischemic stroke, chronic kidney disease (CKD), all-cause death and CV death were assessed with age stratification of 10-year intervals. Cox regression analyses were used to estimate risk with adjustment on sex and age.

Results

The age and sex-adjusted prevalence of CV diseases was higher in T2D for ages above 40 years whereas the adjusted prevalence of CKD was more common in T1D between ages 18 and 69 years and higher in T2D for ages above 80 years.

During 2,033,239 person-years of follow-up, there were 27,497 patients with MIs (yearly rate 1.4%), 24,892 with ischemic strokes (yearly rate 1.2%), 100,769 with incident HF (yearly rate 5.4%), 65,928 with incident CKD (yearly rate 3.4%) and 197,858 deaths (yearly rate 9.7%) including 49,026 CV deaths (yearly rate 2.4%) were recorded. Age and sex-adjusted event rates comparing T1D versus T2D showed that MI risk was increased for ages above 60 (1.2-fold for T1D versus T2D) and HF between ages 18–29 and above 60 years (1.1–1.4-fold). Adjusted risk of ischemic stroke did not markedly differ between T1D and T2D. Risk of incident CKD was 1.1–2.4-fold higher in T1D between ages 18–49 and above 60 years. The all-cause death risk was 1.1-fold higher in T1D at age ≥60 years, the cardiovascular death risk being 1.1-fold higher in T1D between 60 and 69 years.

Conclusions

The adjusted prevalent burden and risk of incident renal disease are greater among patients with T1D compared with T2D patients across most ages. Although the prevalent burden of cardiovascular diseases may be lower in T1D than in T2D, patients with T1D may have a higher risk of incident MI, HF, all-cause death and cardiovascular death at middle-older ages, highlighting their need for improved prevention.

Funding Acknowledgement

Type of funding sources: None.
The association of soluble ACE2 change with metabolic health, body composition and proteome dynamics during a weight loss diet intervention: implications for the COVID-19 pandemic
Authors: Cauwenberghs N , Prunicki M , Sabovcik F , Perelman D , Contrepois K , Li X , Snyder M P , Nadeau K C , Kuznetsova T , Haddad F , Gardner C D
Published: October 2021

Background

Angiotensin-converting enzyme 2 (ACE2) serves protective functions in metabolic, cardiovascular, renal and pulmonary diseases and is linked to COVID-19 pathology. We explored the association between soluble AC2 (sACE2) and metabolic health and proteome dynamics during a weight loss diet intervention.

Methods

We analyzed 457 healthy individuals (mean age 39.8±6.6) with BMI 28–40 kg/m2 who participated in the Diet Intervention Examining the Factors Interacting with Treatment Success (DIETFITS). Biochemical markers of metabolic health and 236 proteins measured by Olink CVD II, CVD III and Inflammation arrays were available at baseline and 6 months following dietary intervention. We determined clinical and routine biochemical correlates of the diet-induced change in sACE2 (ΔsACE2) using stepwise linear regression. We then combined feature selection models and multivariable-adjusted linear regression to identify protein dynamics associated with ΔsACE2.

Results

sACE2 decreased significantly on average at 6-months in the diet intervention. A stronger decline in sACE2 during the diet intervention was independently associated with female sex, lower HOMA-IR and LDL cholesterol at baseline, and a stronger decline in HOMA-IR, triglycerides, HDL-cholesterol and fat mass. In line, participants with decreasing HOMA-IR and triglycerides had significantly higher odds for a decrease in sACE2 during the diet intervention than those who did not (P≤0.0073 for both). Feature selection models linked ΔsACE2 to changes in AMBP, E-selectin, HAOX1, KIM-1, MERTK, PGF, thrombomodulin and TRAIL-R2. ΔsACE2 remained independently associated with these protein changes in multivariable-adjusted linear regression.

Conclusion

Decrease in sACE2 during a weight loss diet intervention was associated with improvements in metabolic health, fat mass and markers of angiotensin peptide metabolism, vascular injury, renal function, chronic inflammation and oxidative stress. Our findings may improve the risk stratification, prevention, and management of cardiometabolic and COVID-19-related complications.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHResearch Foundation Flanders
The significant role of coronary artery calcification score in asymptomatic patients with metabolic syndrome
Authors: Temtem M , Serrao M , Mendonca M I , Santos M , Sousa J A , 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

Background

Metabolic syndrome (MetS) is a clinical condition composed of metabolic and cardiovascular risk factors, such as abdominal obesity, hyperglycemia, dyslipidemia and hypertension. Many patients with MetS suffer major adverse cardiovascular events (MACE) that are not adequately identified by traditional risk assessment, suggesting the need for early detection of subclinical coronary heart disease to identify those at high-risk. Coronary artery calcification (CAC) screening has added utility in categorizing patients with low, intermediate and high cardiovascular risk.

Purpose

Evaluate the prognostic role of CAC score in asymptomatic population patients with metabolic syndrome in cardiovascular events risk prediction.

Methods

A total of 1,122 asymptomatic individuals without known coronary heart disease, enrolled from GENEMACOR study, were followed for a mean of 5.3±3.4 years for the primary endpoint of all-cause of cardiovascular events. All were referred for computed tomography for the CAC scoring assessment. According to the Hoff's nomogram, 3 categories were created: low CAC (0≤CAC<100 or P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). In a subgroup of 507 individuals with MetS and 615 controls, CAC values were compared by T-student and association of CAC severity with events occurrence was evaluated. Finally, a logistic regression model adjusted for CAC severity was performed in patients with MetS.

Results

Among our population, the extent of CAC differs significantly between men and women in the same age group. Patients with Mets (23.2%, n=115) had higher CAC scores than controls (219.0±486.0 vs 115.8±370.8, p<0.0001). In this cohort, with higher CAC scores, 46.7% vs 22.5% had MACEs (p=0.049) during the follow-up. The logistic regression analysis revealed that CAC≥400 is a MACE predictor (OR=4.326, CI 95% 1.241–15.080, p=0.021) in patients with MetS.

Conclusion

Our results point to the importance of the inclusion of CAC screening in patients with MetS to further stratify those patients that, despite tight control of cardiovascular risk factors, may benefit from more intensive therapies. This tool is a useful and straightforward method that could have a significant impact on the prognosis of future cardiovascular disease in patients with MetS.

Funding Acknowledgement

Type of funding sources: None.
Heterogeneity of cardiorespiratory fitness among Brazilian regions and comparison with Norwegian values
Authors: Milani M , Milani J G P O , Cipriano G F B , Cipriano Junior G
Published: October 2021

Introduction

Cardiorespiratory fitness (CRF) is an important component of health-related physical fitness, and its reduction is associated with a higher risk of cardiovascular disease and increased mortality. Maximal oxygen consumption (VO2 max) measured in the Cardiopulmonary Exercise Test (CPET) is the gold standard for CRF evaluation. The measured VO2 max is compared to predicted normal reference values to provide an accurate and individualized evaluation and classification. However, predicted values have gender and age differences, and data from different regions and countries can be heterogenous due to different demographic and biopsychosocial characteristics.

Purpose

To compare reference values of VO2 max in Brazilian and Norwegian population samples do analyze geographical CRF differences.

Method

Brazilian reference values for CRF were compared within each other and with Norwegian values. The included studies evaluated healthy individual with CPET and direct measurement of VO2 max on a treadmill. Mean, standard deviation and sample size were obtained from the published articles in the last decade, and and standard error of mean (SEM) were calculated. The differences on CRF between studies were analyzed using SEM and the 95% confidence interval.

Results

Brazilian reference values for CRF were different between each other, with lower values at Northeast region and higher values at Southeast for all age groups and both genders. Midwest region showed CRF with intermediate values between these two regions. Comparisons also revealed different values from Norway, which presented the highest CRF for all age groups and both genders (Pictures 1 and 2). Observed heterogeneity in CRF may be explained by anthropometric differences, as Northeast individuals had lower height than the other Brazilian samples, and the Norwegians were the tallest. Other demographic and biopsychosocial characteristics may also play a role.

Conclusion

The present study revealed differences on CRF between countries and within Brazilian population, with a negative gradient from southern to northern regions of Brazil. This finding reinforces the appropriateness of adequate use of regional and country specific reference values for VO2 max to ensure a correct CRF evaluation and classification.

Funding Acknowledgement

Type of funding sources: None.
Cardiac rehabilitation do not diminish the socioeconomic and ethnical disparity in patients with coronary heart disease
Authors: Kjesbu I , Prescott E , Rasmusen H K , Osler M , Larsen M L , Gustafsson I , Zwisler A D , Sibilitz K L
Published: October 2021

Aims

Cardiac patients with low socioeconomic status and non-western ethnic background have worse outcomes. The aim of this nationwide study was to determine whether the immediate effect of CR differs between groups defined by socioeconomic status and ethnic background, and whether disparity in the prognosis of cardiac patients is diminished by CR participation.

Methods

We included all patients in Denmark with myocardial infarction and/or coronary revascularization from August 2015 until March 2018. Level of education, as a marker for socioeconomic status, was divided into four groups, and ethnicity into Danish, non-Western and Western. Participation in CR was identified through the Danish Cardiac Rehabilitation Database (DHRD) and the Danish National Patient Register. Primary outcome was achievement of CR quality indicators, including risk factor control and medication, from DHRD, and secondary outcome a composite endpoint of cardiovascular disease hospitalization and all-cause mortality (MACE).

Results

We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR data from DHRD. Higher education was associated with greater improvement in VO2peak and non-western patients were less likely to be screened for depression or receive dietary consulting. No other significant disparity in CR quality indicators, was found across education and ethnicity. There was a strong socioeconomic gradient in MACE irrespective of CR participation, medication and risk factor control (adjusted HR 0.71 (0.58–0.86) for high versus low education). Similarly, non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1–1.4).

Conclusion

We found strong socioeconomic and ethnic disparity in prognosis of CHD patients which were unaffected by CR participation. The results indicate that CR, conventional risk factor control and medical treatment have limited impact on these disparities.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Figure 1Figure 2
Exercise training induces benign right ventricular hypertrophy along with functional improvement and without pathological processes or arrhythmogenicity in a rodent model of athletes heart
Authors: Olah A , Bodi B , Sayour A A , Ruppert M , Barta B A , Virag-Tulassay E , Bottlik O , Papp Z , Merkely B , Radovits T
Published: October 2021

Introduction

Regular sport activity leads to the adaptation of cardiac structure and function, the so-called athlete's heart. Research projects over the last years have focused on exercise-induced adaptation of the right ventricle (RV), because the disproportionate load on the RV - when compared with the left ventricle - might lead to pathological consequences, such as myocardial interstital fibrosis or chamber dilation.

Purpose

We aimed at investigating comprehensively RV alterations induced by regular aerobic exercise training in a rat model of athlete's heart.

Methods

Young, adult rats were divided into control (Co) and exercised (Ex) groups (n=12–12). Exercised rats underwent a 12-week-long swim training program. In vivo electrophysiological study and in vitro cellular force assessments on isolated cardiomyocytes were carried out to investigate electrical and functional RV alterations, respectively. Molecular biological (qRT-PCR, Western-blot) and histological investigations were applied to reveal underlying mechanisms.

Results

Exercise training was associated with increased RV cardiomyocyte diameter (12.5±0.1 μm Co vs. 13.8±0.2 μm Ex, p<0.05), that was associated with hyperphosphorylation of protein kinase B (Akt). RV cardiomyocytes from exercised animals showed improved calcium sensitivity and increased maximal force development, that was associated with hypophosphorylation of troponin I. We found increased length of repolarization as reflected by prolonged QT interval and ventricular effective refracter period (VERP: 44.0±1.6 ms Co vs. 52.8±2.1 ms Ex, p<0.05) along with decreased gene expression of potassium channels (Kcnd2, Kcnj2). We could not induce ventricular arrhythmia by programmed stimulation. Picrosirius staining did not reveal fibrosis, that was associated with unchanged protein expression of connective tissue growth factor (CTGF) and gene expression of profibrotic markers (such as TGF-β). Gene expression of apoptotic markers (Bax, Bcl-2) and fetal gene program (such as β-MHC) did not differ between groups.

Conclusions

According to our data, regular swim training induced RV hypertrophy, that was associated with functional improvement (improved calcium sensitivity and maximal force), hypophosphorylation of troponin I and prolonged repolarization without characteristic pathological alterations or arrhythmogenicity of RV myocardial tissue.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary
Differences in mitral and tricuspid annular geometry in elite athletes with versus without functional mitral regurgitation: a 3D echocardiographic study
Authors: Fabian A , Lakatos B K , Tokodi M , Kiss A , Sydo N , Csulak E , Babity M , Szucs A , Kiss O , Merkely B , Kovacs A
Published: October 2021

Intense exercise exposes the heart to significant hemodynamic demands, resulting in adaptive changes in cardiac morphology and function. Nevertheless, the athletic adaptation of the atrioventricular valves remains to be elucidated. Our study aimed to characterize the geometry of mitral (MA) and tricuspid (TA) annuli in elite athletes using 3D echocardiography.

Thirty-four athletes presented with functional mitral regurgitation (FMR) were retrospectively identified and compared to 34 athletes without MR, and 34 healthy, sedentary volunteers. 3DE datasets were used to quantify MA and TA geometry and leaflet tenting by dedicated softwares.

MA and TA areas, as well as tenting volumes, were higher in athletes compared to controls. MA area was significantly higher in athletes with MR compared to those without (8.2±1.0 vs. 7.2±1.0 cm2/m2, p<0.05, Figure 1). Interestingly, athletes with MR also presented with a significantly higher TA area (7.2±1.1 vs. 6.5±1.1 cm2/m2, p<0.05, Figure 2). Non-planar angle describing the MA's saddle shape was less obtuse in athletes without MR, whereas the values of athletes with MR were comparable to controls (Figure 1). The exercise-induced relative increases in left ventricular (35±25%) and left atrial (40±29%) volumes were similar; however, the increment in the MA area was disproportionately higher (63±23%, overall p<0.001). The relative increase in TA area (40±23%) was also higher compared to the increment in right ventricular volume (34±25%, p<0.05).

Atrioventricular annuli undergo a disproportionate remodeling in response to regular exercise. Athletic adaptation is characterized by both annular enlargement and increased leaflet tenting of both valves. There are differences in MA geometry in athletes presented with versus without FMR.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program). The research was partly financed by the Thematic Excellence Programme (Tématerületi Kiválόsági Program, 2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging programmes of the Semmelweis University. Figure 1Figure 2
Plasma concentration of proneurotensin and prediction of cause-specific mortality in a middle aged cohort during long-term follow-up
Authors: Fawad A , Butt Z , Bergmann A , Schulte J , Nilsson P , Bennet L , Melander M , Melander O
Published: October 2021

Purpose

To examine the prediction of proneurotensin (Pro-NT) on total and cause-specific mortality in a middle-aged cohort.

Methods

In the population-based middle-aged cohort (n=4632 participants, mean age 57 years) of the Malmo Diet and Cancer (MDC) study, Pro-NT was assessed and total- as well as cause-specific mortality were studied. Main cause of death were based on the International Classification of Diseases (ICD). Assessments were done using Cox proportional hazards models adjusted for age and sex.

Results

During a mean follow-up of 20±3 years, 950 men and 956 women died. There was a significantly increased risk of total mortality in subjects belonging to quartile 4 of Pro-NT (Pro-NT ≥149 pmol/L) compared with quartiles 1–3 (Pro-NT <149 pmol/L), hazard ratio (HR) of 1.29 (95% confidence interval [CI] 1.17–1.42; P<0.001) after adjustment for age and sex. No significant interaction was observed between Pro-NT and gender on total mortality. Individuals within quartile 4 vs. quartiles 1–3 had a HR of 1.41 (95% CI 1.18–1.68; P<0.001) for death due to cardiovascular diseases (n=595/4632), 2.53 (95% CI 1.37–4.67; P=0.003) due to digestive tract diseases (n=42/4632), 1.62 (95% CI 1.04–2.52; P=0.032) due to mental and behavioural diseases (n=90/4632), and 1.91 (95% CI 1.15–3.19; P=0.013) due to unspecific causes of death (n=64/4632). No significant relationships between Pro-NT and deaths due to cancer, infections, neurological or other causes were observed. Adjustments for cardiovascular risk factors only marginally changed these results.

Conclusions

Pro-NT is a predictor of total mortality and the increased risk is driven by deaths due to cardiovascular- digestive tract- mental and behavioural diseases, as well as deaths attributed to unspecific causes.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Knut and Alice Wallenberg Foundationthe Swedish Heart and Lung Foundation.
Bleeding risk and selective serotonin reuptake inhibitors treatment after percutaneous coronary intervention: a propensity-matched study
Authors: Gonzalez-Manzanares R , Ruiz-Moreno M , Carmona-Artime L , Rodriguez-Nieto J , Piserra A , Perea-Armijo J , Flores G , Fernandez-Ruiz A , Ojeda S , Hidalgo F J , Suarez De Lezo J , Mazuelos F , Segura J M , Romero M , Pan M
Published: October 2021

Background

Cardiovascular disease and mental disorders frequently coexist. Selective serotonin reuptake inhibitors (SSRIs) are often used to treat depressive and anxiety disorders but have been associated with an increased risk of bleeding due to platelet dysfunction. Up to 10% of patients with coronary artery disease are concomitantly treated with dual antiplatelet therapy (DAPT) and SSRI. Previous studies have assessed the risk of bleeding in patients treated with SSRI and clopidogrel-based DAPT, with contradictory results. However, there is no data regarding the use of SSRI and potent P2Y12 inhibitors (ticagrelor, prasugrel) or triple antithrombotic therapy (TAT).

Purpose

To evaluate the bleeding outcomes in a real-world population of patients undergoing percutaneous coronary intervention (PCI) treated with SSRI and DAPT or TAT after a year follow-up.

Methods

We conducted a retrospective study including all patients undergoing PCI at a high-volume center during 2018. Patients taking SSRI were propensity-score-matched (PSM) 1:1 using nearest neighbor matching with patients not taking SSRI. The primary endpoint was major bleeding as defined by the International Society on Thrombosis and Haemostasis (ISTH) at 1 year. Kaplan-Meier and Cox regression were used to compare outcomes between treatment groups.

Results

Of 1063 patients that underwent PCI during the study period, 1002 met the inclusion criteria and 139 (13.9%) were receiving SSRI. Propensity score distributions, baseline characteristics and standardized mean differences (SMD) of the covariates used for PSM before and after adjustment are shown in Figure 1. In matched survival analysis, there was no significant difference in the primary endpoint at 1 year follow-up: mayor bleeding occurred in 2.9% of patients who received SSRI and in 2.9% of those with no SSRI (HR 1.01; CI 0.25 to 4.03; p=0.991) (Figure 2).

Conclusion

In routine clinical care, patients treated with SSRI and DAPT or TAT after PCI did not have a higher risk of bleeding after a year follow-up.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Baseline characteristicsFigure 2. Survival curves by SSRI treatment
Cardiovascular risk associated with long-term anabolic-androgenic steroid abuse: an observational study from Norway
Authors: Saetereng T , Vanberg P , Steine K , Atar D , Halvorsen S
Published: October 2021

Background

The use of anabolic-androgenic steroids (AAS) has become highly prevalent among recreational weightlifters. Numerous case reports have suggested an association between AAS use and a vast range of different cardiovascular diseases, including sudden cardiac death (SCD) and coronary artery disease (CAD). Few clinical studies have evaluated the risk of SCD and the prevalence of CAD in individuals with long-term AAS use.

Purpose

To evaluate the risk of ventricular arrhythmias and the prevalence of CAD among men with long-term AAS use.

Methods

Strength-trained men with at least three years of cumulative AAS use were recruited from recreational gyms. The control group consisted of strength-trained competing athletes who self-reported never using any performance enhancing drugs (non-users). AAS use was verified by sophisticated blood and urine analyses. Study participants went through a comprehensive cardiovascular evaluation including exercise ECG, 24 h ECG, heart rate variability (HRV) measures, signal averaged ECG (SAECG) and QT dispersion (QTd). Coronary computed tomography angiography (CCTA) was performed in AAS users. Not all participants had all tests.

Results

We included 51 AAS users and 21 non-users. Median age (25th-75th percentile) was 33 (29–37) years in the user group and 33 (29–42) years in the non-user group. Forty-eight (94%) of the users had been using AAS for five years or more. Characteristics are presented in the table. AAS users had significantly lower HDL values compared to non-users (p<0.001). No signs of ischemia or arrhythmias were detected during exercise ECG, however maximal exercise capacity was lower than in the control group and also compared to age-standardized values. A considerable, but statistically non-significant reduction was seen in overall HRV estimated as the standard deviation of the RR intervals for normal sinus beats (SDNN) (p=0.05). No difference was seen regarding left ventricular late potentials or QTd (table). Eight (19%) of the forty-two AAS users undergoing CCTA had at least a mild degree of CAD, and four of them three-vessel disease.

Conclusion

No ECG-findings indicated an increased risk of ventricular arrhythmias among the long-term AAS users. However, their maximal exercise capacity was lower than in controls, and one fifth of the long-term AAS users had verified CAD on CT coronary angiography.

Funding Acknowledgement

Type of funding sources: None. Table 1