bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of multimorbidity on cardiac remodelling in the UK Biobank
Authors: Shyam-Sundar V , Nicholls H , Chadalavada S , Vargas J , Slabaugh G , Mohiddin S , Petersen S , Aung N
Published: October 2024

Background/Introduction

Previous work has suggested that multimorbidity is associated with higher all-cause mortality and cardiovascular mortality in the UK Biobank (UKB). The impact of multimorbidity on cardiac remodelling as measured by cardiovascular magnetic resonance (CMR) has not been studied in large cohorts.

Purpose

To determine if CMR biomarkers act as surrogates for adverse cardiovascular outcomes in multimorbidity.

Method

We analysed 44957 UKB participants who had CMR. Self-reported cancer (UKB field ID 20001) and non-cancer illnesses (UKB field ID 20002) were used to calculate comorbidity count with multi-morbidity defined as 2 or more illnesses. The predictive value of comorbidity count (exposure counts measured in quintiles) on CMR traits (outcomes) was evaluated using a univariable and multivariable generalised linear model. Covariates included sex, age, BMI, smoking status, regular alcohol intake, and the Townsend deprivation index, a measure of socioeconomic deprivation. The first model utilised univariable regression without covariates with subsequent iterations including age and sex and then all covariates. An interaction term was included for age and sex and a quadratic term for age in the models. CMR outcome measures were indexed left ventricular mass (LVM), indexed left ventricular end diastolic volume (LVEDV), indexed left ventricular end systolic volume (LVESV), indexed left ventricular stroke volume (LVSV), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and indexed maximal left atrial volume (LA). The absolute value of GLS was used in the regression models. Variance inflation factor testing was used to check for collinearity. Analyses were completed using R v4.1.1.

Results

Median comorbidity count was 2. The burden of long-term conditions in this population of European ancestry with largely healthy individuals is lower than in other large population cohorts. Table 1 summarises multivariable analyses for comorbidity count, LVM and GLS. Due to high collinearity relating to age in the model, we centred age around the mean. LVM was higher with multimorbidity (top quintile Beta 0.63 (95% CI 0.23 to 1.04), P = 2.21x10-03). GLS was lower with multimorbidity (top quintile Beta -0.29 (95%CI -0.42 to 0.16), P = 8.10x10-6). LA volume was lower with multimorbidity (top quintile Beta -0.63(95% CI -1.22 to 0.04), P = 3.53 x 10-2). LVEF and other volume measures were not associated with multimorbidity.

Conclusion

Multimorbidity in this large cohort was associated with adverse cardiac structural and functional remodelling on CMR. These include a lower global longitudinal strain and higher LV mass.
Coronary bypass surgery guided by multislice computed tomography angiography in a low surgical risk population
Authors: Serruys P W , Kageyama S , Pompilio G , Andreini D , Pontone G , Mushtaq S , La Meir M , De Mey J , Tanaka K , Doenst T , Teichgraber U , Schneider U , Puskas J , Narula J , Onuma Y
Published: October 2024

Background

In patients with three-vessel disease and/or left main disease, selecting revascularization strategies based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography(ICA).(1)

Purpose

The FASTTRACK CABG trial aims to assess the feasibility and safety of using CCTA and FFRCT as guidance for planning and performing CABG in patients with 3VD and/or LMCAD.

Methods

In this multicentre study, coronary artery bypass grafts (CABG) were planned and performed based on CCTA without knowledge of ICA. CABG strategy was recommended by a central Core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular events (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals(CI) for feasibility ≥75%.(2)

Results

The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX Score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Three patients did not undergo CABG due to the patient’s preference for percutaneous treatment (n=1) or lack of graft material. Unblinding ICA was required in one case, yielding a feasibility of 99.1% (95%CI: 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Team was 82.9% with a moderate kappa of 0.58 (95%CI:0.50-0.66). The concordance and agreement in revascularization planning between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95%CI:0.53-0.68). The 30-day follow-up CCTA was performed in 102 (91.9%) of the 111 operated patients, which showed an anastomosis patency rate of 92.6%. At 30 days, the incidence of MACCE was 7.2% whereas major bleeding was 2.7%.

Conclusions

CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.
Sex-specific prognosis of right ventricular size measured by 3D echocardiography following isolated tricuspid valve surgery
Authors: Meng F , Wu Y , Liu Y , Yang Y , Kong D , Dong L , Chen H , Chun W , Shu X , Pan C , Ge J
Published: October 2024

Backgrounds

Isolated tricuspid valve surgery (ITVS) is considered a high-risk procedure. Right ventricular (RV) size plays a critical role in the prognosis of ITVS patients. The effect of sex differences in the degree of right ventricular（RV）dilatation in ITVS patients has not been established.

Purpose

The primary objective of this study was to assess in-hospital major adverse events (AEs) following ITVS in women compared with men on the basis of preoperative RV size measured by 3D echocardiography.

Methods

Consecutive patients undergoing ITVS were identified from a prospectively maintained database.Transthoracic echocardiography was performed the day before ITVS. In-hospital AEs were defined as one of the following occurring before discharge: death, shock, acute renal failure requiring dialysis, or prolonged (>72h) mechanical ventilation. 3D RV parameters including end-diastolic volume (EDV), end-systolic volume (ESV), EDVi (indexed by body surface area), ESVi (indexed by body surface area) and ejection fraction (EF) were calculated using commercially available software. Comparison of the adjusted odds ratios (ORs) generated by multivariate logistic regression of in-hospital AEs between women and men on the basis of baseline RV parameters.

Results

59 patients (median age 62 years, 42.37% male, functional tricuspid regurgitation in 62.71%) were finally enrolled. In-hospital AEs were identified in 23 patients (3 death, 5 shock, 5 renal failure, 10 prolonged mechanical ventilation). The risk of AEs was increased from baseline, when the ESV was 69.73 mL for women and 90.66 mL for men. Regarding EDV, the risk for women increased at 130.49 mL compared with 170.36 mL in men. Accordingly, when indexed by body surface area, women had a lower inflection point for both EDVi and ESVi (76.71 mL/m2 vs 91.35 mL/m2, 34.04 mL/m2 vs 52.49 mL/m2). However, there was no inflection point for increased risk with RVEF in either men or women.

Conclusion

Women undergoing ITVS have a higher risk of in-hospital AEs with smaller RV size. These results support the use of sex-specific thresholds for RV size when making surgical decisions in patients with severe tricuspid regurgitation.Figure 1.Adjusted ORs for RV size.
Safety and mid-term outcomes of impella compared to intra-aortic balloon pumping in patients who required mechanical cardiac support
Authors: Makino M , Shishikura D , Kusumoto H , Yamauchi Y , Sakane K , Fujisaka T , Zushi R , Morita H , Kanzaki Y , Hoshiga M
Published: October 2024

Background

Impella (Abiomed USA) is a promising alternative to improve prognosis in patients with cardiogenic shock requiring mechanical cardiac support (MCS). Despite of its advanced hemodynamic profile, its superiority regarding prognosis has not been established yet.

Aims

The aims of this study were to investigate safety and mid-term outcomes of Impella compared to IABP in patients who required MCS.

Methods

In this single-center study, consecutive 205 patients who required IABP or Impella from January 2017 to June 2023 were evaluated retrospectively. The primary outcome was 180-day mortality. Secondary outcomes were the rate of complications including hemolysis, thrombocytopenia, bleeding, limb ischemia, acute kidney impairment and stroke. Major complication was defined as major bleeding (BARC 3-5), limb ischemia and stroke.

Results

Of all patients, 62 (30.2%) received Impella and 143 (69.8%) IABP. The rate of patients required extracorporeal membrane oxygenation (ECMO) support was not significantly different between two groups (31.4 % vs 38.7%; p=0.34. There were no significant differences in 180-day mortality between two groups (36.2% vs 31.1%; p=0.55). Further investigation according to SCAI classification demonstrated that the mortality rate in SCAI C group was significantly lower in Impella than IABP group (34.1% vs 6.7%; p=0.02), whereas there were not significant differences in mortality between two groups in SCAI D and E groups (54.8% vs 61.4%; p=0.71). The rate of major complications was significantly higher in Impella group (54.4% vs 72.1%; p=0.02). The rate of hemolysis (19.6% vs. 58.1%, p<0.01), thrombocytopenia (19.6% vs. 58.1%, p<0.01), limb ischemia (4.3% vs. 17.7%, p<0.01), acute kidney impairment (37.7% vs 64.5%, p<0.01) and initiation of renal replacement therapy (13.8% vs 29%, p=0.02) were significantly higher in Impella group. Multivariate analysis adjusting for Impella use, out of hospital cardiopulmonary arrest (OHCPA), initial lactate ≥60 md/dL and major complication, revealed that age ≥70 (hazard ratio (HR): 3.1, 95%CI: 1.73-5.61) and use of ECMO (HR: 4.3, 95%CI: 2.54-7.31) were independent predictor of mortality. The mortality rate arose up to 83.3% in patients with age ≥70, OHCPA and use of ECMO (HR: 9.7, 95%CI: 4.07-23.02).

Conclusion

The mortality rate did not differ between Impella and IABP, however Impella was associated with improved mortality in patients with SCAI C group. The complications were high likely seen in patients with Impella compared to IABP. Our findings indicate that Impella results in better outcomes with careful selection of patients, defining its indication and appropriate care. A further investigation would be of value to elucidate whether Impella improve prognosis.
Do obese patients undergoing extracorporeal membrane oxygenation have a higher mortality ? a systematic review and meta-analysis
Authors: Picado-Loaiza S , Luiz L , Mesadri Gewehr D , Ferreira R O M , Bittar V , Goebel N , Rylski B , Ayala R
Published: October 2024

Background

While ECMO is a life-saving intervention for patients with severe respiratory or cardiac failure, the impact of obesity on its efficacy and associated risks remains unclear.

Purpose

We aimed to perform a systematic review and meta-analysis comparing whether obese individuals undergoing ECMO face higher mortality and morbidity risks compared to their non-obese counterparts.

Methods

PubMed, Embase, and Cochrane were searched in December 2023 for studies comparing the outcomes between obese versus non-obese patients undergoing extracorporeal membrane oxygenation. We computed mean differences (MD) for continuous outcomes and odds ratios (OR) for binary outcomes, with 95% confidence intervals (95%CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R version 4.2.3.

Results

Twenty-two studies comprising 39,322 participants were included in the meta-analysis. We divided the exposure and the control into 4 pairwise meta-analyses including BMI cut-off values of <25 kg/m², <30 kg/m², <35 kg/m², <40 kg/m². There were no significant differences between groups with a BMI <25, <30, <35 in all-cause mortality (<25: OR 0.96; 95% CI 0.76 - 1.21; p: 0.708 / <30: OR 0.88; 95% CI 0.68 - 1.14; p: 0.340 / <35: 0.97; 95% CI 0.80 - 1.19) p: 0.784) respectively; but with an increasing tendency towards favoring a higher BMI. On the other hand, the higher BMI analysis (<40) demonstrated a significant association between higher BMI and less mortality (OR 0.52; 95% CI 0.29 - 0.95; p: 0.034).

Conclusion

In patients undergoing ECMO, a higher BMI is associated with decreased all-cause mortality.Figure 1.Cut off <25; Cut off <30Figure 2.Cut off <35; Cut off <40
Influence of donor and harvesting protocol on 30 day mortality after heart transplantation
Authors: Monteiro V , Ferraz D , Cunha C , Figueira F , Silva I , Tchaick R , Castro B , Carneiro R , Oliveira Filha M , Lapa A , Lira M , Xavier P , Borba V , Freitas Filho J , Costa C
Published: October 2024

Purpose

Heart transplantation continues to be the gold standard for the treatment of advanced HF, as it promotes increased survival, exercise capacity and quality of life. The choice of the potential donor, as well as the safety of the harvesting process, graft preservation and transportation are fundamental to the success of the procedure. With the territorial extension of Brazil and a large number of donations in other states and regions, evaluating donors remotely, as well as structuring an adequate fundraising plan are fundamental. Therefore, the study of these variables and their influence on the outcome at 30 days was the objective of this study.

Methods

A retrospective cohort was conducted involving patients aged 18 or over, who underwent heart transplantation from July 2012 to July 2022 at our center. Patients who underwent re-transplantation and those who not used the bicaval technique were excluded. Statistical analysis was performed using STATA Software version 18. The Kaplan-Meier method was used to obtain the overall survival curve and, to identify risk factors for death, Cox proportional hazards. The Log test -rank was used for comparisons between groups.

Results

255 cases of heart transplantation were studied, with a 30-day survival rate of 86.6%. The average age of donors was 29 years old and the main cause of death was traumatic brain injury.Regarding the factors that increase the risk of mortality in 30 days, the longest CPB time (HR 1.01; 95% CI 1.002-1.014; p = 0.011) and the donor's age (HR 1.08; 95% CI 1.023-1.139; p = 0.005) were statistically significant. In the univariate analysis, the donor's nutritional status (overweight or obese) was also significant (p = 0.03).The donor's length of hospital stay, use of vasoactive drugs or antimicrobials, serum sodium level or history of previous PCR did not influence the recipient's 30-day survival. Distance organ retrival surgery did not influence the outcome as long as the ischemia time of less than 240 minutes was respected.

Conclusion

The distance harvesting protocol used in our institution proved to be safe and effective. Adequate evaluation of the donor through echocardiography as well as management of vasoactive drugs and electrolytes may have influenced the non-relevance of classic factors that affect the outcomes of patients after heart transplantation.
Right atrial and ventricular function in risk stratification of patients with pulmonary artery hypertension
Authors: Guo J J , Wang J Q , Chen Y C
Published: October 2024

Background

Right atrial (RA) phasic function was proved to be impaired in individuals with pulmonary arterial hypertension (PAH), the awareness of the nonnegligible involvement of RA in the clinical course of PAH was raised. However, evidence for the clinical significance of the RA strain in prognostication and risk stratification for PAH patients was limited.

Method

Participants diagnosed with PAH from June 2013 to December 2022 in West China Hospital were prospectively and continuously recruited. The primary endpoint was all-cause mortality, and the second endpoint was a combination of all-cause mortality and heart failure-related repeat hospitalization. Cox regression analysis and Kaplan Meier survival analysis were performed to identify the association between variables and outcomes. C-index, 1-year mortality, and annual event rate were performed to confirm the value of RA strain in PAH patients’ risk stratification.

Result

A total of 283 participants (mean age, 38 ± 14 years, 84 male) were finally included, following a median follow-up duration of 31.5 months (interquartile range: 15.1-53.9 months). Significant decreases in RA reservoir (p<.001), conduit (p<.001), booster pump function (p<.001), right ventricular global longitudinal strain (RVGLS, p<.001), and free-wall longitudinal strain (RV-FWLS, p<.001) were observed in participants with all-cause mortality than those who survived. Using 16.1% and 23.6% as thresholds for RA reservoir strain, PAH patients could be divided into low-, intermediate, and high-risk groups well, with calculated 1-year mortality of 1.8%, 6.9%, and 21.4%. Moreover, RA reservoir strain presented with better 1-year mortality predictive performance than RV-FWLS (C-index, 0.82 [0.72-0.92] vs 0.72 [0.62-0.82], p<.001). The addition of RA reservoir strain had significantly increased the power of both REVEAL Lite2 and Comparative, Prospective Registry of Newly initiated Therapies for Pulmonary Hypertension (COMPERA) models (both p<.001).

Conclusion

RA reservoir strain was an independent predictor of all-cause mortality in individuals with pulmonary arterial hypertension and could be used to stratify participants into different risk stratification stratum.
Exercise-induced inflammatory and thrombotic acute phase response in hypertensive patients
Authors: Liakos C , Markou M , Dimitroglou I , Koukos M , Patsourakos D , Ververeli C , Savalas D , Zisimos K , Aggeli C , Toutouzas K , Karpanou E , Vyssoulis G , Tsioufis C
Published: October 2024

Background/Introduction

Vigorous physical activity may acutely trigger the onset of an acute coronary syndrome especially in sedentary persons with established cardiovascular risk factors such as arterial hypertension. The rupture of an inflamed coronary plaque and the activation of the coagulation cascade are the main underlying mechanisms.

Purpose

The present study aimed to determine the effect of acute exercise on the inflammatory and thrombotic response in patients with arterial hypertension as compared to normotensive peers.

Methods

After excluding patients with any inflammatory or/and coronary artery disease, a total of 60 non-treated hypertensive patients and 65 normotensive individuals underwent a maximal treadmill exercise testing. Βlood samples were drawn at rest and immediately after peak exercise. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cell (WBC), interleukin-6 (IL-6), and total fibrinogen (TF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured.

Results

All biomarkers increased with exercise, except PAI-1, which decreased (P<0.05 for the change between resting and peak exercise for all biomarkers). The normotensive group had less marked (P<0.05) exercise-induced changes than the hypertensive group in hsCRP (7.7 vs. 8.6%), SAA (5.6 vs. 11.9%), WBC (45.0 vs. 51.7%), and PAI-1 (-17.3 vs. -20.1%) and a similar (P=NS) change in IL-6 (23.8 vs. 23.0%) and TF (8.5 vs. 8.5%) (see also Figure).

Conclusion(s)

In conclusion, the exercise-induced inflammatory and thrombotic acute phase response seems to be more pronounced in non-treated hypertensive patients than in normotensive controls. The effect of blood-pressure lowering treatment on the exercise-induced acute phase response remains to be elucidated.Figure
Impaired systemic microvascular function in patients with resistant arterial hypertension and microalbuminuria: an observational study
Authors: Crahim V , Lorenzo A , Fernandes V , Verri V , Tibirica E
Published: October 2024

Background

Systemic arterial hypertension (SAH) is one of the most prevalent diseases worldwide and is known to be associated with alterations of microvascular function. It is well known that microalbuminuria (MAU) is considered an early marker of renal and cardiac injury in SAH and is an independent risk factor for cardiovascular events in this population. Additionally, it is associated with altered endothelial function, which occurs from the early stages and can be considered an early marker. In some cases, SAH presents as resistant arterial hypertension (RAH), resulting in a worse prognosis compared to individuals with non-resistant hypertension. Moreover, MAU is associated with higher mortality, independent of glomerular filtration rate. Endothelial dysfunction is also a risk marker found in different conditions and can add to MAU in patients with RAH.

Purpose

To investigate systemic microvascular function in patients with RAH, with or without MAU.

Methods

64 patients with RAH, of both genders (50% men), were evaluated, with 32 having MAU and 32 without MAU (defined as a urinary albumin/creatinine ratio between 30 and 300 mg/g in a routine urine sample). Microvascular function assessment was performed using a laser speckle system, allowing analysis of cutaneous microvascular flow. Flow measurements were expressed in arbitrary perfusion units (APU) divided by the mean arterial pressure to obtain cutaneous vascular conductance (CVC). A post-occlusive reactive hyperemia (PORH) test was performed, with brachial artery occlusion using a sphygmomanometer 50 mmHg above systolic pressure for 3 minutes; cutaneous flow was measured after release of the occlusion.

Results

Patients with or without MAU did not differ in terms of age, frequency of diabetes, and chronic kidney disease. The peak CVC values during PORH were 0.64 ± 0.15 and 0.55 ± 0.15 APU/mmHg in RH and RH + MAU patients, respectively (P=0.03). The delta values (peak – baseline) during PORH were 0.31 ± 0.11 and 0.25 ± 0.09 APU/mmHg in RH and RH + MAU patients, respectively (P=0.04)(Figure 1).

Conclusions

PORH-induced vasodilation was found to be reduced in patients with RAH and MAU compared to patients without MAU. This finding shows alteration of endothelium-dependent vasodilation mechanisms in these patients, indicating reduced systemic microvascular endothelial function. Endothelial dysfunction may be associated with glomerular permeability changes, contributing to MAU and further increasing the risk for these patients. This suggests the need for more intensive therapeutic interventions and better risk stratification for these patients, as endothelial dysfunction can be found in the early stages of the disease.Figure 1
Cerebral damage after malignant hypertensive crisis: cerebral MRI follow-up data
Authors: Liegey J , Cremer A , Lucas L , Gosse P , Debeugny S , Dreau H , Rubin S , Doublet J , Sibon I , Boulestreau R
Published: October 2024

Background

Malignant hypertension (MHT) crisis is characterized by acute and diffuse microvascular damages, and the brain is a primary target organ. While a recent MRI study has revealed extensive and frequent cerebral injuries during the acute phase of MHT crisis (1), there is a scarcity of follow-up data.

Purpose

This study aims to investigate the evolution of MRI markers of cerebral injury following the management of the acute phase of MHT.

Methods

In this retrospective analysis, we examined brain MRI data from patients admitted for acute MHT between 2008 and 2022 at our center. Eligible patients had at least one follow-up brain MRI available. A skilled operator conducted a comprehensive analysis of each brain MRI, searching for posterior reversible encephalopathy syndrome (PRES), acute stroke or cerebral hemorrhage and microangiopathy markers, blinded for clinical and demographical data.

Results

Among 149 patients enrolled, 104 had a brain MRI at inclusion, 47 individuals had at least one follow-up brain MRI and were included in the analysis. 72,3% were male, mean age was 48,2 ± 10.8 years and 45,7% presented blood pressure control at the time of the follow-up brain MRI. Median interval between initial and follow-up brain MRI was 228 (84 – 726) days. Five (10,6%) new recent strokes, 2 (4,3 %) cerebral hemorrhage and 0 PRES were recorded during follow-up. On the follow-up brain MRI, more patients presented chronic lacunar infarct and/or microbleeds, in higher numbers. On the contrary, overall Fazekas score was stable in 31 patients (66,0%), improved in 15 patients (31,9 %) and worsened in 1 patients (2,1%). Comparison of subgroups dichotomized according to blood pressure control or follow up duration showed no difference in brain MRI markers.

Conclusion

This study offers valuable insights into the risk of new cerebrovascular events and the evolution of brain MRI markers after managing the acute phase of MHT. Our findings emphasize the dynamic nature of cerebral microvascular burden and the potential for regression of white matter hyperintensities. A better understanding of these phenomena might contribute to improved diagnosis, tailored treatment, and proactive patient care in the context of MHT.
Association between renal function impairment and body roundness index (BRI) in elderly hypertensive patients
Authors: Chen Q , Liu H Y , Li Z Y , Li D , Zhao F , Hao J , Yang C L , Song J S , Gu X Z , Huang R C
Published: October 2024

Objective

The purpose of this study was to explore the associations of renal function impairment and body roundness index (BRI) in elderly hypertensive patients.

Methods

This is a community-based observational and cross-sectional study.A total of 1482 elderly hypertensive patients from our center in 2021 were enrolled. Waist-to-hip ratio(WHR) , Body mass index(BMI) and BRI were calculated with validated formulas. According to tri quantile method of BRI level , the patients were divided into low , medium and high BRI groups. The incidence of renal function impairment in the three groups was compared to explore the associations of renal function impairment and BRI in elderly hypertensive patients.

Result

According to the estimated glomerular filtration rate (eGFR) level, the patients were divided into two groups: impaired renal function group and non impaired renal function group. 133 cases were included in the group with impaired renal function, and 1349 cases were included in the group without impaired renal function. The proportion of patients with impaired renal function was 8%, 497 were in the low BRI group, 491 in the medium BRI group, and 494 in the high BRI group. Comparing the incidence of renal function impairment in patients with different BRI levels, the results showed that the incidence of renal function impairment in patients with high BRI was higher than that in patients with low BRI (7.0%vs.11.5%,p=0.015). The results of binary logistic regression analysis showed that the risk of renal function impairment increased by 19% for each unit of BRI increase (95%CI 1.037-1.122,P=0.024). After adjusting for age, gender, blood lipid, smoking and drinking history, years of hypertension, diabetes, years of diabetes,and random blood glucose levels, the risk of renal function impairment in high BRI group was still significantly higher than low BRI group (OR=1.697,95%CI 1.031-2.794,P=0.038),shows that BRI is an independent risk factor for renal function impairment in elderly hypertension patients. The receiver operating characteristic curve (ROC) results show that the prediction ability of BRI in the whole population is better than that of BMI and waist circumference (WC), and the prediction ability of BRI in elderly female population is the best (AUC=0.569).

Conclusion

Increasing of BRI is correlated with the occurrence of renal function impairment in elderly hypertension patients, and has the best predictive value for renal function impairment in elderly women with hypertension.
Autonomous cortisol secretion in patients with primary aldosteronism is associated with left ventricular hypertrophy and diastolic dysfunction
Authors: Tsai C H , Wu V C , Lin Y H
Published: October 2024

Background and Aims: Autonomous cortisol secretion (ACS) constitutes a significant portion of patients diagnosed with primary aldosteronism (PA) and is potentially linked to adverse cardiovascular outcomes. This study aimed to explore the impact of ACS on cardiac remodeling and diastolic dysfunction in PA patients.

Methods

We prospectively enrolled 567 PA patients from March 2000 to March 2023. ACS was defined as a cortisol level >1.8 μg/dL after a 1 mg dexamethasone suppression test (DST). Clinical, biochemical, and echocardiographic data were collected at baseline and during one-year follow-up after targeted treatments including adrenalectomy and mineralocorticoid receptor antagonist administration.

Results

In this prospective cohort, 21.5% of PA patients had concurrent ACS. PA patients with ACS were older and had a higher prevalence of diabetes. They also exhibited significantly higher left ventricular mass index (LVMI) and worse diastolic function (E/e'). Baseline post-1 mg DST cortisol levels positively correlated with baseline LVMI and E/e' in restricted cubic spline analysis. Multivariable linear regression analysis showed that ACS presence was significantly associated with higher LVMI and worse E/e' after adjusting for significant variables. Among patients who underwent adrenalectomy, both those with and without ACS showed significant improvements in LVMI and E/e'. Patients who received mineralocorticoid receptor antagonist treatment also showed significant improvement in E/e', irrespective of ACS presence. However, significant LVMI improvement was observed only in PA patients without ACS who received mineralocorticoid receptor antagonist treatment.

Conclusions

The presence of ACS in PA patients was associated with worse left ventricular hypertrophy and diastolic dysfunction. Adrenalectomy and mineralocorticoid receptor antagonist treatment partially reversed cardiac remodeling in PA patients with ACS.
Cardiac magnetic resonance (CMR) height-based allometric scaling in Southeast Asians; implications in the diagnosis and prognosis of left ventricular hypertrophy (LVH): the REMODEL study
Authors: Lee C C E , Chan R , Toh D F , Kui M , Lee V , Bryant J A , Boubertakh R , Lee C H , Chai P , Le T T , Chin C W L
Published: October 2024

Background

Left ventricular hypertrophy (LVH) is a strong predictor of adverse cardiovascular outcomes (1). Although normalizing LV mass (LVM) to height exponents has been shown to reduce variability from body size, specific recommendations for height exponents are lacking due to the scarcity of normal cohorts to define appropriate height exponents (2). Cardiac magnetic resonance (CMR) is increasingly used in assessing LVM, and the existing body of research is based primarily on the MESA cohort (3). While the MESA cohort is ethnically diverse, the intrinsic effects of ethnicity may not fully be discerned if certain ethnic groups are under-represented.

Purpose

We aimed to demonstrate the diagnostic and prognostic implications of establishing height exponents specific to sex in a Southeast Asian cohort.

Methods

Non-overweight/obese Southeast Asian healthy volunteers (n=416) were used to establish appropriate height exponents and normal reference ranges of LVM. The impact of these height exponents was examined in a separate cohort of Southeast Asians with hypertension (n=878). All individuals underwent standardized cardiovascular magnetic resonance imaging (CMR). Primary outcome was a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality. Cox regression analysis of various LVH measures were adjusted for 24-hour systolic blood pressure, diabetes, and hyperlipidemia.

Results

The height exponents for healthy females and males were 1.57 and 2.33, respectively. In patients with hypertension, sex-specific height exponents significantly increased the detection of LVH compared with body surface area (BSA) indexing (47% [n=409/878] versus 27% [n= 236/878], p<0.001). Most individuals re-classified to LVH with sex-specific height exponents were overweight (33.1%, n=58/175) or obese (64.6%, n=113/175). There were 37 primary events over 60 [37-73] months of follow-up. Regardless of indexing method, LVH was independently associated with increased adverse events (sex-specific height exponent hazard ratio (HR): 2.8 [1.25-6.29], P=0.013). The prediction ability of LVH diagnosis by sex-specific height exponents was similar to BSA indexing (HR: 5.43 [2.49-11.8], P<0.001).

Conclusions

Reference ranges specific to the ethnicity, sex and imaging modality are necessary to establish appropriate height exponents. Although utilizing sex-specific height exponents to index LVM resulted in significantly more LVH reclassification when compared with BSA indexing, this did not translate to a notable improvement in event prediction. Further research into alternative methods of LVM indexing is warranted.Abstract SummaryPredictive Ability of LVH Measures
Optimal blood pressure values to reduce arterial stiffness, an analysis from UK Biobank
Authors: Shantsila A , Zheng Y Z , Gao Z , Lip G Y H , Shantsila E
Published: October 2024

Introduction

Increased arterial stiffness is a powerful independent risk factor for adverse cardiovascular events. While pulse wave velocity has been used extensively as a biomarker of vascular health reflecting functional and structural arterial changes, its use in clinical practice was limited. The Arterial Stiffness Index (ASI) simplifies the assessment of arterial stiffness using a pulse waveform obtained at the finger with an infrared sensor with BP measured using an automated device. Age and raised blood pressure (BP) are major contributors to increased arterial stiffness, but time trajectories of ASI in the general population and optimal BP values to reduce arterial stiffening are scarcely known.

Purpose

To establish temporal changes of ASI and identify BP values associated with longer-term improvement of arterial stiffness.

Methods

The study analysed data from UK Biobank (baseline n=154,684, median age 54, interquartile range (IQR) [40-72] years; 52% female; 91% white, 28% hypertension). ASI was measured using PulseTrace PCA2 device (CareFusion, USA) at baseline with measurements repeated in 4617 individuals after a median follow up of 3.0, IQR [2.8-3.3] years. BP was measured during the same time points. Multivariable (adjusted for age, sex, diabetes, and use of BP-lowering drugs) linear regression was used to determine the association of BP with baseline and the association of BP and ASI changes during follow up. ROC analysis was used to determine BP values associated with improvement (reduction) of ASI during follow up. Continuous data are presented as median [IQR] and compared using Wilcoxon test. R software packages were used for analyses.

Results

At baseline, ASI (m/sec) was higher in those with systolic BP (SBP) >140 mmHg (9.60 [7.15-11.85] vs. 8.67 [6.77-10.70] for SBP ≤140 mmHg, p<0.001) and in those with diastolic BP (DBP) >90 mmHg (9.90 [7.48-12.16] vs 8.81 [6.78-10.90] for DBP ≤90 mmHg, p<0.001). Both SBP and DBP were independently associated with ASI at baseline (B±SE 0.08±0.02 and 0.79±0,29m, respectively; p<0.001 for both).

During follow up, the population level SBP remained unchanged (change 0 [-8 - 8] mmHg), with some reduction in DBP (-1.0 [-6.0 - 3.5]) mmHg. SBP reduced in 2234 (48%) and DBP in 2517 (55%). ASI increased by 0.56 [-1.46 - 2.78] m/s, with ASI reduction observed in 1935 (42%). An increase in DBP but not in SBP was independently associated with an increase in ASI (B±SE DBP 0.04±0.01, p<0.001; SBP 0.007±0.006, p=0.22; DBP 0.04±0.007, p<0.001). The baseline BP was predictive of the magnitude of changes in ASI: SBP 132 mmHg (AUC 0.53, p=0.001) and DBP 83 mmHg (AUC 0.54, p<0.001).

Conclusions

Increased arterial stiffness is associated with higher BP, particularly with higher DBP. Raised ASI is reversible, providing BP is adequately controlled with optimal BP being <132/83 mmHg.
Sex-related differences in left ventricular geometry patterns in patients with arterial hypertension
Authors: Canciello G , Piccolo R , Izzo R , Bossone E , Pacella D , Lembo M , Manzi M V , Mancusi C , Simonetti F , Borrelli F , Esposito G , Losi M A
Published: October 2024

Background

Sex-specific differences in left ventricular (LV) geometry is key for tailoring management strategies for arterial hypertension.

Purpose

To evaluate sex-related differences in LV geometry patterns at baseline and their evolution over time in hypertension.

Methods

From a prospective registry, we included hypertensive patients with at least 1 year follow-up, without prevalent cardiovascular disease or incident myocardial infarction, with normal LV ejection fraction and no chronic kidney disease of stage III or more. Four LV geometry patterns were assessed: normal geometry, concentric remodeling, eccentric and concentric LV hypertrophy (LVH).

Results

A total of 6427 patients (age 53±11 years, 43% females) were included. At baseline, a normal geometric pattern was less common in female than in male patients (50% vs. 72%, p<0.001). LVH was more prevalent among female than male patients (47% vs. 23%, p<0.001), with a higher prevalence of eccentric LVH (40% vs. 18%, p<0.001). Female sex was independently associated with LV remodeling (odds ratio, 2.36, 95% confidence intervals, 2.12-2.62, p<0.001). At long-term follow-up (mean 6.1 years, IQR 2.8-8.6 years), the proportion of patients with LV remodeling increased in both sexes, although a normal LV geometry remained less frequent in female than male patients (43% vs. 67%, p<0.001), with differences persisting in eccentric (41% vs. 21%, p<0.001) and concentric LVH (11% vs. 5%, p<0.001).

Conclusions

We found relevant sex-related differences in LV geometry among patients with hypertension. Females have a higher risk of LV remodeling at baseline compared with men, with differences persisting at long-term follow-up.
Application of the 2016 ase-eacvi criteria for the assessment of diastolic function in arterial hypertension
Authors: Canciello G , Izzo R , Bossone E , Piccolo R , Pacella D , Ferrara F , Lembo M , Manzi M V , Carbone A , Mancusi C , Simonetti F , Cittadini A , Esposito G , Losi M A
Published: October 2024

Background

No data are available on diagnostic algorithms recommended by guidelines for the assessment of diastolic dysfunction (DD) in patients with arterial hypertension.

Purpose

To fill this gap, we evaluated left ventricular (LV) diastolic function in hypertensive patients matched with healthy subjects.

Methods

Healthy subjects, hypertensive patients without and with LV hypertrophy (LVH) were matched 1:1:1 based on age, sex, and body mass index from two prospective registries. All participants had normal LV ejection fraction (EF). Diastolic function was assessed basing on 2016 ASE-EACVI guidelines, by applying algorithm A, recommended in normal LVEF, and algorithm B recommended in reduced LVEF or normal LVEF and myocardial disease.

Results

A total of 717 participants were enrolled. By applying algorithm A, an indeterminate pattern was found in 0.4% of healthy subjects, in 6.3% of hypertensive patients without LVH (p=0.015 vs. healthy subjects), and in 21% of hypertensive patients with LVH (p=0.001 vs. healthy subjects). DD was absent in healthy individuals, whereas it was found in 2% and 8% of hypertensives without (p=0.06) and with LVH (p=0.001 vs. healthy subjects), respectively. By applying algorithm B, no cases of indeterminate diastolic function were found. DD was observed in 2.9% of healthy subjects, 7% and 10.5% of hypertensives without (p=0.001 vs. healthy subjects) and with LVH (p=0.002 vs. healthy subjects).

Conclusion

When diastolic function is assessed by echocardiography, the use of algorithm A should be limited only to truly normal subjects, whereas algorithm B should be applied to all patients with hypertension irrespective of LVH
The role of IL15 in angiotensin II-mediated cardiac remodelling
Authors: Booth E , Nosalski R , Saju B , Loughrey C , Maffia P , Guzik T J
Published: October 2024

Hypertension (HTN) mediated target organ damage, such as cardiac remodelling, is a major cause of death and disability. Cytokines are important regulators of cardiac function, inflammation, and remodelling in cardiovascular disease. Increased levels of interleukin 15 (IL15) have been noted in HTN, but its role in HTN heart disease remains unknown.

This study investigates the role of the IL15 axis in the pathogenesis of cardiac remodelling in HTN.

Male 12-week-old IL15 receptor α knock-out (IL15RAKO), IL15 knock-out (IL15KO) and matching wild type (WT) mice were administered vehicle or angiotensin II (AngII) (490 ng/min/kg) for 2 weeks by osmotic minipump. Blood pressure was measured by tail cuff (n=5-8). Cardiac function was analysed by echocardiography (n=3-4). Cardiac infiltrating immune cells were analysed by flow cytometry (n=2-3 for IL15RAKO, n=6-10 for IL15KO). Cardiac remodelling was assessed by picrosirius red, WGA staining (n=5-8) and expression of markers of remodelling using RT-qPCR and western blots (n=5-8). Data are presented as mean±SEM and analysed using two-way ANOVA.

AngII infusion caused a significant increase in systolic blood pressure in WT and IL15KO animals. In contrast, in IL15RAKO, the response to AngII was blunted. This was in line with a decrease in ejection fraction, however only WT mice had an increase in global longitudinal strain (-20.3±2.0 vs -10.9±1.2, p=0.0039 in WT and 19.9±0.8 vs -16.0±2.1, p=0.1878 in IL15RAKO). HTN was associated with increased cardiac IL15 protein levels in mice. The heart-to-body ratio, along with cardiomyocyte cross-sectional, were significantly increased in WT, but not in IL15RAKO HTN mice. Furthermore, histological analysis showed significantly higher cardiac collagen accumulation in WT but not IL15RAKO upon AngII infusion (5.8±1.0% in WTvvs. 2.1±0.5% in IL15RAKO, p=0.0021). This was in line with a higher expression of col1a1 in WT but not IL15RAKO HTN hearts (20.0±6.0 vs 4.5±1.7, p=0.0173). Similarly, the FN1 protein level was significantly increased in WT but not IL15RAKO AngII-treated mice. These changes were associated with a higher number of Cd11b+ macrophages accumulated in WT hypertensive hearts only.

In contrast to IL15RAKO, mice lacking IL15 showed similar increases in global longitudinal strain, heart hypertrophy, and cardiomyocyte cross-sectional area as WT mice upon AngII infusion. Similarly, IL15KO hypertensive hearts showed a significant increase of col1a1 and FN1 in comparison to vehicle-treated mice. A similar level of Cd11b+ macrophages was found in hypertensive IL15KO and WT mice's hearts.

In conclusion, IL15RA, but not IL15, plays a critical role in cardiac remodelling mediated by AngII infusion. This suggests that the IL15-IL15RA axis may play an important yet complex role in hypertensive heart disease.
Combining fractional flow reserve and the index of microcirculatory resistance for prognosis prediction in renal artery stenosis interventions: a feasibility sub-study of FAIR-pilot trial
Authors: Liu X , Li Y X , Liu Z H , Zhang Y , Li J P
Published: October 2024

Background

Interventional therapies for renal artery stenosis (RAS) was debatable in previous randomized trials. Fractional flow reserve (FFR), while useful in coronary interventions, does not assess microcirculatory status, which may be critical in RAS. The index of microcirculatory resistance (IMR) provides additional microvascular information, which has not been used in RAS patients.

Purpose

To investigate the feasibility of IMR measurement in RAS patients and the association with the outcome.

Methods

FAIR-pilot study is a multicenter pilot randomized controlled trial exploring the application of FFR to guide the renal artery stenting in patients with renovascular hypertension (NCT05732077). A pressure-temperature sensor guidewire was used to measure the IMR. To derive mean transit time at rest, thermodilution curves were obtained by 3 injections of 4 mL of room temperature saline down the renal artery. Hyperemia was induced using dopamine 50μg/kg bolus to the renal artery. The IMR was calculated as distal arterial pressure (Pd) x mean transit time during hyperemia (TmnH) (Figure 1). Prognostic evaluation was based on improvements in postoperative blood pressure, which was assessed using both ambulatory blood pressure monitor (ABPM) and anti-hypertensive medication number, along with renal function, as determined by the estimated glomerular filtration rate (eGFR).

Results

The IMR was measured among five patients enrolled in FAIR-pilot study. As shown in Table 1 and 2, stent implantation was conducted on five lesions across patients 1 to 4 based on renal FFR < 0.8, with each experiencing varying degrees of improved blood pressure control subsequently. Patient 5 did not receive a stent and was lost to follow-up. At three-month, the recorded decrease in systolic blood pressure ranged from a maximum of 34 mmHg to a minimum decrease of -6 mmHg among the four patients. The antihypertensive medication number showed a maximum reduction of 2 and no change as the minimum. We observed a correlation between baseline IMR and baseline renal function. No significant change in IMR was noted after interventional procedures. Preliminary findings suggest that IMR measurement is feasible in patients with RAS, while the ∆T (temperature change time) was very small, which potentially increasing the measurement bias.

Conclusion

The study suggests measuring IMR in patients with RAS is feasible and can offer information into the renal microvasculature. However, the small ∆T encountered during measurement may introduce increased bias, which should be considered when interpreting results.