bluuebunny/crossref_metadata_2025 huggingface dataset:
Opthalmic artery doppler measurements and cardiovascular assessment in pregnancies with placental dysfunction
Authors: Di Fabrizio C , Giorgione V , Murdoch C , Khalil A
Published: October 2021

Women affected by hypertensive disorders of pregnancy and fetal growth restriction frequently present alterations in the cardiovascular system, even before the clinical onset of the pathology. The objective of this study is to assess the relationship between peripheral vascular system (ophthalmic and uterine arteries), cardiac output and adverse fetomaternal outcomes.

Methods

Women with singleton pregnancies from mid second trimester until delivery were prospectively included in this observational study performed at our Hospital, between December 2020 and July 2021. The inclusion criteria included women with evidence of placental dysfunction (preeclampsia and fetal growth restriction) and normotensive controls.

Vascular systemic resistance (VSR), arterial stiffness and cardiac output were measured by ultrasound (uterine and ophthalmic arteries), plethysmography and continuous Doppler. Study variables were compared using t-test and Chi-squared test according to whether they were normally distributed or not.

Results

The analysis included 32% women with hypertensive disorders of pregnancy and 67% normal pregnancies.

Statistically significant difference was observed in the Second to First Peak Systolic Velocity Ratio (2PSVR) of the ophthalmic artery (p=0.011), heart Rate (p=0.03), stroke volume (p=0.004) and cardiac output (0.094) between the two groups. There were significant correlation between parameters of the central haemodynamics and those of the uteroplacental circulation, as well as ophthalmic artery Doppler.

Conclusion

Ophthalmic artery 2PSVR is a simple and potentially promising measurement to assess women with hypertensive disorders of pregnancy. However, this parameter must be validated against the well described Uterine artery Doppler. A bigger cohort is needed to clarify and determine its effectiveness.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): iPlacenta
Aortic systolic blood pressure predicts periprocedural myocardial injury after transcatheter aortic valve implantation
Authors: Terentes-Printzios D , Gardikioti V , Latsios G , Drakopoulou M , Siasos G , Oikonomou E , Mpei E , Xanthopoulou M , Christoforatou E , Toutouzas K , Vavuranakis M , Tsioufis K , Vlachopoulos C
Published: October 2021

Background/Introduction

Periprocedural myocardial injury (PPMI) is a complication of transcatheter aortic valve implantation (TAVI) associated with worse outcome. Central (aortic) systolic blood pressure (SBP) is an independent predictor of cardiovascular events.

Purpose

We sought to investigate the effect of TAVI on peripheral and central hemodynamics, as well as the predictive ability of brachial and aortic SBP for PPMI.

Methods

We enrolled 70 patients (mean age 79.9±8.7 years, 50% males) with severe symptomatic aortic valve stenosis (AVS) undergoing TAVI. Brachial pressures were measured with an oscillometric device and central pressures were assessed by arterial tonometry at baseline and after the procedure at discharge. PPMI was identified based on Valve Academic Research Consortium (VARC-2) criteria. Biomarkers for MI (cardiac troponin and creatinine kinase MB) were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records. Stepwise multivariable regression analysis was performed for the prediction of PPMI.

Results

According to VARC-2 definition, 38 (54%) patients had PPMI. In stepwise multivariable regression analysis, brachial SBP at baseline was not predictive of PPMI (p=0.07) after adjusting for age, sex and history of coronary artery disease. On the contrary, aortic SBP predicted PPMI even after adjustment for the abovementioned confounders (Odds ratio [OR]=1.032, 95% Confidence Interval [CI] 1.004–1.061, p=0.026). Interestingly, both SBP and aortic SBP were higher at discharge in patients with PPMI compared to patients without PPMI after adjustment (p=0.021 and p=0.006, respectively). On the contrary, the periprocedural changes of aortic SBP and SBP were not different between patients with PPMI and without PPMI.

Conclusions

Aortic SBP, as assessed by tonometry, is an independent predictor stronger than brachial SBP for PPMI in AVS patients treated with TAVI. This finding suggests the possible clinical role of aortic pressures as a risk stratification tool for PPMI prior to TAVI, as well as, warrants further investigation on their role as therapeutic targets to decrease the incidence of PPMI.

Funding Acknowledgement

Type of funding sources: None.
Causal and observational evidence on the role of early menopause in hypertension
Authors: Roa Diaz Z M , Asllanaj E , Amin H A , Rojas L Z , Nano J , Ikram M A , Drenos F , Franco O H , Pazoki R , Marques-Vidal P , Voortman T , Muka T
Published: October 2021

Introduction

Blood pressure has been suggested as potential factor contributing to the increased risk of cardiovascular disease observed in women experiencing early menopause (<45 years). However, whether the association between early menopause and hypertension is causal remains unclear (1,2).

Purpose

To evaluate the observational and causal association between age at natural menopause (ANM) and blood pressure (BP) traits in Caucasian women.

Methods

Cross-sectional and one-sample Mendelian randomization (MR) study was conducted in 4451 postmenopausal women from two different cohort studies. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg, and/or diastolic BP (DBP) ≥90 mmHg, and/or the use of antihypertensive medication. Multivariable linear and logistic regressions were implemented in the observational analysis. We calculated a weighted genetic risk score with 54 variants associated with ANM (GRS-ANM) (3). The genetic variants were previously identified in a genome wide association study (4), after that we implemented two-stage least squares in the one-sample MR. Estimates from all cohorts were pooled through meta-analysis

Results

The pooled analysis across cohorts showed early menopause, compared to menopause between 50–54 years, to be associated with lower DBP (β=−1.31 mmHg, 95% CI: −2.43; −0.18), while no association was found between other ANM categories and DBP. Similarly, the pooled analysis of both cohorts did not show an association of ANM with SBP, neither as a continuous variable nor by category. One year of later onset of menopause was associated with higher odds of developing hypertension (Odds ratio (OR): 1.02, 95% CI: 1:00; 1.04) while no association was found for the ANM categories and hypertension (Table 1). Results of the evaluation of MR assumption, supported their compliance, the GRS-ANM was associated with observed ANM and explained between 1.4% and 3.4% of the ANM variance in the included cohorts, F statistic values were among 11.15 and 40.63 (Figure 1). We found no association between GRS-ANM and SBP, DBP or hypertension (Table 1).

Conclusion

The present study does not support the hypothesis that early onset of menopause is associated with higher BP.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The CoLaus study was and is supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (grants 33CSCO-122661, 33CS30-139468 and 33CS30-148401).Zayne M. Roa-Díaz has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076, through the SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health.
Blood pressure control in the general and high risk populations, longitudinal trends
Authors: Bruthans J , Mayer O , Cifkova R
Published: October 2021

Introduction

Despite better control of high blood pressure (BP) in the general as well as high cardiovascular (CV) risk populations as a factor contributing to the decrease in CV mortality since 1990, the targets set by the guidelines may not have been reached.

Purpose

We analysed longitudinal trends in BP control in the general and high risk populations, to assess implementation of guidelines and to identify subpopulations with still unsatisfactory BP control.

Methods

Analysis of seven independent surveys of the general population (Czech MONICA and post-MONICA studies, 1985–2017) and five independent surveys of patients with stable manifest coronary heart disease (CHD) 1995–2017 (Czech samples of the EUROASPIRE I-V surveys).

Results

A total of 15 000 persons (Czech MONICA) and 2 098 patients (Czech EUROASPIRE) were investigated. In the 1985–2017 period, mean systolic BP decreased in the general population (MONICA) from 134 to 128 mmHg (p<0.001) and diastolic BP from 84 to 82.5 mmHg (p<0.01), hypertensive levels of BP (>140/90mmHg) were found in 45% in 1995 but only in 27.5% in 2017, and the prevalence of uncontrolled severe hypertension (BP>180/110 mmHg) decreased from 3 to 1%. The proportion of properly controlled hypertension increased from 13.2 to 53% (p<0.0001). In the 1995–2017 surveys of the high-risk population (EUROASPIRE) systolic BP decreased from 144.1 to 135.5 mmHg (p<0.001), diastolic BP from 87.5to 83.5mmHg (p<0.01), higher than recommended BP (>140/90mmHg, >140/85mmHg in diabetics) was found in 66.2% in 1995, still present as much as in 54.4% in 2017. Proportion of patients with very high BP (BP>180/110 mmHg) decreased from 18.4 to 1% only. Drugs with a potentially antihypertensive effect were used in 79.9 and 95.3% of patients in 1995 and 2017, respectively (p<0.0001). Population BP levels ceased to decline since 2000/01 survey, in the CHD population since the 2012/13 survey. This is obviously due to considerable increase in prevalence of obesity, and an increasing prevalence of diabetes, both in the general and high-risk populations. The more intensive medical high BP treatment seems to have a beneficial effect on hypertension control, even more in the general than in the high risk population.

Conclusions

The recent trend in BP levels, both in the general and high-risk populations, are far from satisfactory, with the main causative factor suggested to be the increasing prevalence of obesity and diabetes. While there has been progress in hypertension control, more in the general nad limited in high-risk population, truly effective BP control may be illusory without comprehensive CV risk factor control.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic
Renal denervation in truly resistant hypertensive patients: six-year follow-up results of a single-center study
Authors: Ionov M , Emelyanov I V , Yudina Y S , Panarina S A , Zverev D A , Avdonina N G , Zvartau N E , Konradi A O
Published: October 2021

Background

Renal sympathetic denervation (RDN) is one of the invasive treatment options for the patients with hypertension (HTN) who are resistant to antihypertensive therapy (AHT). The short-term efficacy of RDN has been proven in a number of randomized clinical trials, but remains controversial, the data on its long-term efficacy are limited.

Purpose

To evaluate the natural course of HTN, to assess long-term major adverse cardiovascular events (MACEs) and other clinically significant outcomes, as well as AHT efficacy and its features in patients with truly resistant HTN after bilateral RDN during extended prospective follow-up.

Methods

We included 22 patients with truly resistant HTN (median 57 y.o., 9 males), in whom RDN was performed during 2012–2015 in the clinical center of excellence. We assessed initial and further (after 1 year and after ≥5 years) office and 24-hour BP values, as well as AHT history in detail. Long-term MACEs and other cancer-related outcomes were recorded. The baseline quality of life (QoL) and its dynamics were assessed with the use of EQ-5D-5L questionnaire at all timepoints. Multiple linear regression was used to find possible predictors of the efficacy of RDN.

Results

The median follow-up after the RDN was 6 (from 5 to 8) years. A significant decrease in office and 24-hour systolic (S) and diastolic BPs was observed at 12 months after RDN compared to initial values (Δ −24 and −12 mm Hg, p<0.005; Δ −10 and −7 mm Hg, p<0.05, respectively). There were 7 patients with office SBP on-target (<140 mm Hg), and 12 patients were considered responders (SBP decrease more than 10 mm Hg from the baseline). These numbers increased to 10 and 14 patients after 6 years after RDN, respectively. A causal relationship between changes in office SBP was found only for SBP baseline values (β −0.6, p=0.02). No differences in the number of medications were noted during follow-up (4.4 versus 4.1 versus 4.1 drugs, p=0.41). We have recorded 10 MACEs and 5 cancer cases with various types with no fatal outcomes. The QoL significantly improved at 12 months after RDN (+9.7 points, p=0.01), however a negative trend was observed in the next 6 years (−13,8 points, p=0,02) with return to the reference. No association was observed between BP and QoL changes in two timepoints (p=0,65).

Conclusions

The RDN shows a pronounced clinical effect in patients with resistant HTN up to 6 years, and is not accompanied by an AHT intensification, and also is not associated with QoL changes. The initial positive trend for QoL completely harked back after 5 years which may be associated with the development of MACEs. The only predictor of RDN positive effect seems to be baseline office SBP levels.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Russian Science Foundation Study flow-chartChanges in BPs during follow-up
Is the minimal mitral regurgitation a marker of high blood pressure, and can predispose to the appearance of atrial fibrillation?
Authors: Paterno Marchioli C A
Published: October 2021

Background

Leonardo da Vinci intuited that the cardiac valves were the key to the functioning of the heart. Minimal mitral regurgitation (MMR) in young's is often interpreted as haemodynamically insignificant, it is attributed that it starts from birth or named para-physiologic effect. Pathophysiological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF).

Purpose

The aim of this study is to know if the presence of MMR is a consequence of the High Blood Pressure (BP), and whether in the own evolution can contribute to the appearance of the AF.

Methods

For this cross-sectional retrospective study, data were collected from 436 patients. Female-Male: 249–187 from the 20 to the 89 years old, mean age (±SD) 59.6 (16.5) – 59.7 (16.1), divided and analyzed in each one of them all 7 decades. All patients had MMR. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The measures of BP were registered in mmHg. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The Central Haemodynamic Parameters (CHP) were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (between the normal levels and the observed values) was assessed according to the normal range by age.

Results

In all patients female - male, the mean (±SD) of SBP/DBP 142.7 (24.5)/83.7 (13.6) – 137.7 (20.2)/82.4 (11.3) was higher than normal levels of BP accepted by ESC/ESH. All measures of CHP and SBP/DBP increased with age in each decade, in female from the 20s 120.3 (18.9)/76.7 (14.1) to the 80s 160.4 (21.1)/86.0 (25), and in male from the 20s 133.7 (16.7)/78.9 (6.4) to the 70s 142.8 (23.5)/78.8 (12.4), but slightly decreased in the 80s 138.4 (20.4)/76.6 (8.0). The difference of Augmentation index (surrogate value of arterial stiffness) in all decades was higher too, for both genders. In the adult total sample, in female - male the AF reached 26.5% - 27.8%, beginning after 33 years old, and strongly increased its prevalence after the 60s to a top of 50.0% - 43.8% at 80s.

Conclusions

MMR can be an early marker of high BP levels, the prevalence increasing with age, and it would be a predisposing condition to evolving to AF. The appearance of MMR principally among younger can indicate that the brachial BP found is higher than “normal”, needing any time to modify the original ventricular geometry toward myocardial remodelling, Therefore, it should be reassessed the optimal levels of BP to avoid its complication.

Funding Acknowledgement

Type of funding sources: None.
Sex-specific associations of evening blood pressure burden and cardiac load with nocturia severity in the Japanese at high-risk of cardiovascular disease
Authors: Nagai M , Hoshide S , Kario K
Published: October 2021

Background

Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established. We hypothesized that blood pressure (BP) burden, the classes of antihypertensive agents and cardiac load were associated with severity of nocturia, and that these associations might be moderated by gender.

Purpose

To investigate the relationships of home BP (HBP) level, the class of antihypertensive agent, brain natriuretic peptide (BNP) with nocturia severity, and to investigate these associations stratified by gender in the Japanese at high-risk of cardiovascular disease.

Methods

In the Japan Morning Surge-Home Blood Pressure Study, measurements of HBP at evening (mean 11.2 days) as well as BNP were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used.

Results

According to the number of nocturia (no void: n=2382; one void: n=847; >2 voids per night: n=1082), significant associations of systolic BP (SBP) at evening (130 vs 130 vs 132 mmHg, p<0.0001) and logBNP (1.20 vs 1.30 vs 1.42, p<0.0001) were observed with nocturia severity. In the multinomial logistic regression analysis adjustment for confounders including age, smoking, total cholesterol, fasting blood glucose, HbA1c and clinic SBP, the use of diuretics (OR: 1.26, 95% CI: 1.06–1.52, p<0.05) was significantly associated with one nocturnal void, while evening SBP (OR: 1.009, 95% CI: 1.003–1.014, p<0.01) and logBNP (1.43, 95% CI: 1.19–1.73, p<0.001) were significantly associated with multiple nocturnal voids. While no significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in the total population, a significant interaction was found between evening SBP and logBNP for multiple nocturnal voids in females (p<0.05).

Conclusions

In this study, the use of diuretics was a significant indicator of single nocturnal void, while evening SBP and BNP were those of multiple nocturnal voids in the high-risk Japanese population. Specifically, in the females, treatment to reduce BP burden as well as cardiac overload might be important to improve sleep disturbance caused by nocturia.

Funding Acknowledgement

Type of funding sources: None.
Myocardial work in overweight and obesity: impact of sex and central haemodynamics
Authors: Lindseth K T , Gerdts E , Midtboe H , Pristaj N , Cramariuc D , Einarsen E
Published: October 2021

Background

Women with increased body mass index (BMI) have better left ventricular (LV) global longitudinal strain (GLS) than men. LV global myocardial work index (GWI) is a novel measure of myocardial function that adjusts for afterload and offers the opportunity to differentiate between early systolic dysfunction and elevated myocardial workload.

Purpose

To investigate sex differences in myocardial work in women and men with increased BMI.

Methods

Clinical and echocardiographic data from 467 participants (61% women, average age 47±9 years) with a BMI above 27 kg/m2 and without cardiac disease was analysed. Central pulse wave analysis was assessed by applanation tonometry. GWI was calculated by GLS and post-echocardiography blood pressure (BP). Covariables of GWI were identified by linear regression analysis with collinearity tools.

Results

Women had higher BMI (31.4 vs. 31.0 kg/m2) and higher aortic augmentation pressure (12±7 vs. 8±6 mmHg), but lower clinic systolic BP (127±17 vs. 134±14 mmHg) compared to men (all P<0.05). Women also had higher LV GLS (20.0±2.8 vs. 18.8±2.8%) and GWI (2126±385 vs. 2047±389 mmHg%) (both P<0.05). In univariable regression analyses, higher GWI was significantly associated with higher age, clinic systolic BP, wall stress, ejection fraction, aortic augmentation pressure, left atrial size, and LV ejection time, and with lower waist circumference (all P<0.05), but not with BMI. In multivariable linear regression analyses, adjusting for these correlates, female sex was independently associated with higher GWI (Table 1, model 1). After additional adjustment for aortic augmentation pressure, the association between GWI and sex became non-significant (Table 1, model 2).

Conclusions

Women with increased BMI have higher GWI compared to men, despite lower BP. Higher GWI in women is mainly explained by elevated workload due to higher central aortic stiffness.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Western Norwegian Regional Health Authorities
Parameters of treadmill exercise test and sympathetic activation are linked to the development of hypertension in subjects with high normal blood pressure
Authors: Kalos T , Dimitriadis K , Konstantinidis D , Tatakis F , Drogkaris S , Manta E , Dri E , Thomopoulos C , Tousoulis D , Tsioufis K
Published: October 2021

Background/Introduction

The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension.

Purpose

The aim of this study was to assess parameters related to the development of hypertension in a 3 year follow in subjects with high normal BP.

Methods

One hundred consecutive subjects with high normal office BP (54±8 years, 42 males, baseline office BP: 132/82 mmHg, 24-hour BP: 122/76 mmHg) at baseline underwent a negative for ischemia treadmill exercise test. Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values and sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) based on established methodology. SBP/MET-slope defined as: peak systolic BP–resting SBP)/(peak MET-1) was assessed. Follow up was scheduled every 6 months for 3 consecutive years, where BP was measured both in the office and with ambulatory blood pressure monitoring. End point was the development of hypertension diagnosed from office blood pressure measurements and confirmed from ambulatory blood pressure monitoring.

Results

Patients who developed hypertension (n=35) compared to those who remained normotensives (n=65) had at baseline higher prevalence of HRE (75% vs. 13%, p=0.026), higher levels of carotid to femoral PWV (8.35 vs. 7.5 m/sec, p=0.043) and MSNA (37 vs. 31 bursts per minute, p=0.04), while their metabolic profile did not differ at the follow up (p=NS for all). In those who developed hypertension, SBP/MET-slope was higher in all Bruce protocol stages till peak exercise (stage 1: 6.25 vs. 4.25, stage 2: 7.6 vs. 5.3, peak exercise: 7.22 vs. 5.1; p<0.05 for all). Additionally, those who remained normotensives compared to those who developed hypertension exhibited a higher exercise capacity (10 vs. 11.5 METs, p<0.05) and maximal heart rate at peak exercise (154 vs. 164, p=0.001).

Conclusion

In subjects with high normal BP, those who develop hypertension during follow-up are characterized by more frequent HRE accompanied with lower exercise capacity, arterial stiffening and sympathetic overactivation. These results suggest that exercise BP response, along with PWV and MSNA estimation could contribute to identify high normal BP subjects who are more prone to become hypertensives.

Funding Acknowledgement

Type of funding sources: None.
Daily calorie intake and efficacy of 24-hours blood pressure control in hypertensive patients with obesity on stable antihypertensive therapy
Authors: Isayeva A , Matyashova L
Published: October 2021

Although it has been established that excessive daily calorie intake contributes to the development of hypertension, the relation between daily energy consumption and blood pressure in patients on stable antihypertensive therapy is not yet known.

The aim of the study was to evaluate the relation between daily calorie intake and 24 hours blood pressure control in patients on stable antihypertensive therapy.

Materials and methods

Cross-sectional study included 141 hypertensive patients with age median 56.5 (45.00 ÷ 63.70) years old. All hypertensive patients had been on the stable antihypertensive therapy during three months and had target office blood pressure at the moment of inclusion to the study. Ambulatory blood pressure monitoring (ABPM) was done to all patients with Heaco ABPM50 monitoring. Physical activity was assessed using International Physical Activity Questionnaire (kcal/week). Patients full in daily dietary diaries and mean daily calorie intake for three days was calculated with standardized soft “Test of Rational Nutrition” (TRP-D02, Ukraine). Fasting glucose, HbA1c, blood lipids, uric acids, creatinine, C-reactive protein were assessed in all patients. Data were analyzed with SPSS IBM 19.0.

Results

Mean office systolic blood pressure (SBP) was 128.5±11.3 mmHg and diastolic blood pressure (DBP) was 78.5±9.1 mmHg; mean body mass index (BMI) was 34.7±6.2 kg/m2. All patients were divided into three groups according to daily calorie intake: in the 1st group (n=21) patients daily intook less than 1372.2 kcal per day, in the 2nd group (n=58) daily calorie intake was between 1373.2 and 2976.3 kcal per day and in the 3rd (n=62) group subjects intook more than 2977.5 kcal per day. Body mass index in groups 1, 2 and 3 corresponds to 30.34±5.1, 35.1±8.9 and 34.3±6.9 kg/m2, ANOVA test F=2.3, p=0.10. The physical activity level was low in all three groups and did not differs significantly between groups. Results of ambulatory blood pressure monitoring are presented in the table 1. It was observed that high daily calorie intake contributes to non-satisfactory blood pressure control according to ABPM. The odd ratio of day SBP higher than target level in the 2nd group was 1.21 (95% CI, 0.42–4.51) and in the 3rd group 2.67 (95% CI, 0.67–11.70). The odd ratio of day DBP higher than target level was in the 2nd group was 1.19 (95% CI, 0.33–3.50) and in the 3rd group 2.12 (95% CI, 0.61–7.79). The odd ratio of night SBP higher than target level was 2.81 (95% CI, 0.33–10.51) and for DBP 2.88 (95% CI, 0.37–9.43).

Conclusion

In hypertensive patients with obesity on stable antihypertensive therapy with target office blood pressure high calorie intake contributes to non-satisfactory day and night blood pressure control.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Academy of Medical Science of Ukraine
Efficacy of folic acid therapy for the association between high serum vitamin B12 level with all cause mortality among hypertensive population: the CSPPT randomized clinical trial post-hoc analysis
Authors: Cao T , Huang X , Huang X , Wang B Y , Wang B Y , Wu H Y , Wu H Y , Spence D , Spence D , Yong H Y , Yong H , Cheng X S , Cheng X S , Liu L S , Liu L S , Xu X P , Xu X P
Published: October 2021

Background

While higher vitamin B12 level was found to be co-related with mortality in various population, the effectiveness of folic acid therapy for this association remained unknown.

Purpose

1: Explore the association between high B12 level and all cause mortality in hypertensive population. 2: To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing all cause mortality than enalapril alone among targeted population.

Methods

Current study used post hoc analysis to examin data from the china stroke primary prevention trial (CSPPT), a randomized, double-blind, multi-center clinical trial. After excluded those lack of vitamin B12 data and with extreme B12 value, 20,204 participants (mean age 60 [SD. 8.54]; 59.16% male gender; total mean serum vitamin B12 level 410.51 [SD. 124.85] pg/ml) were included in present study.10,093 participants were treated with enalpril alone and 10,111 patients took the combine use of enalapril and folic acid. The primary outcome was all cause mortality, which collected based on hospital issued death certificate and investigation during follow up period.

Results

Over the medium follow-up time of 4.5 years, 308 death occurred in enalapril group and 295 death happened in enalapril-folic acid group. Differences were observed regarding sex, center, smoking & drinking status at baseline. In enalapril group, high vitamin B12 level presented positive linear association with all cause mortality and was found to be significantly differences (P=0.018). Whereas no association between high vitamin B12 level and all cause mortality were observed in enalapril and folic acid group. (P=0.448). KM curves and tertile analysis of vitamin B12 level also showed same finding. Sensitivity analysis were processed to ensure the accuracy of the study result.

Conclusion

The present study not only explored that higher vitamin B12 level will increase all cause mortality in hypertensive population, but also found that high vitamin B12 level loses its co-relationship with all cause mortality after folic acid therapy, which potentially reflected the benefits of long-term, low-dose folic acid supplementation.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Key R&D Projects, Jiangxi National Key Research and Development Program Smoothing curveKM curve
Burden of arrhythmias in patients with obstructive sleep apnea and its impact on mortality: a descriptive study from the National Inpatient Sample
Authors: Gopalakrishnan A , Dhulipala V , Grillo M , Ayala-Rodriguez C , Garyali S , Reddy S
Published: October 2021

Background

Obstructive sleep apnea (OSA) accounts for significant mortality and morbidity worldwide. A limited but emerging literature has revealed increased risk of sudden cardiac death in patients with OSA. There is paucity of data on arrhythmia burden in patients with OSA, particularly in hospitalized patients.

Purpose

Therefore, we sought to study the prevalence of atrial and ventricular arrhythmias among hospitalized patients with OSA and examine its impact on sudden cardiac death and in-hospital mortality.

Methods

All patients over 18 years of age with OSA were extracted from the National Inpatient Sample (NIS) from 2009–10 using 9th revision of International Classification of Diseases (ICD-9) code 327.23. Demographic data, hospital characteristics, comorbid conditions, and arrhythmia burden including different types of arrhythmia were identified. Clinical outcomes were in-hospital mortality, length of stay and sudden cardiac death. Logistic regression analysis was performed to determine the impact of arrhythmia on in-hospital mortality in patients with OSA. Hospital level discharge weights provided by NIS were used to obtain national estimates of OSA hospitalizations.

Results

OSA was prevalent in 2.8% (n=1,114,297) of all hospitalizations among which 20.1% had any arrhythmia (n=223,974). Patients with arrhythmia were older, more likely to be males, and had higher prevalence of risk factors and comorbid conditions except for chronic liver disease, and smoking (p<0.0001 for all). Arrhythmia burden analysis revealed increase prevalence of both atrial and ventricular arrhythmia in patients with OSA compared to general population. In-hospital mortality (3.48% vs 1.27%; p<0.0001), length of hospital stay (6.4±0.1 vs 5±0.1; p<0.001) and sudden cardiac death (1.34% vs 0.4%; p<0.0001) were higher in OSA patients with arrhythmia compared to OSA patients without arrhythmia. Presence of arrhythmia in OSA patients was associated with increased in-hospital mortality in both unadjusted [OR 2.79 (2.62–2.98); p<0.001] and multivariable model adjusted for all risk factors and comorbid conditions [OR 1.83 (1.69–1.98); p<0.001].

Conclusion

Arrhythmia burden was higher in patients with OSA compared to the general population. Presence of arrhythmia among OSA patients was independently associated with increased in-hospital mortality and longer hospital stays. Routine evaluation to assess arrhythmia burden in patients in OSA could be a potential target to decrease sudden cardiac death in this high risk population.

Funding Acknowledgement

Type of funding sources: None.
Cardiovascular morbidity and mortality related to non-alcoholic fatty liver disease: a systematic review and meta-analysis of prospective studies
Authors: Bisaccia G , Ricci F , Melchiorre E , Tana C , Renda G , Khanji M Y , Fedorowski A , De Caterina R , Gallina S
Published: October 2021

Background

Whether non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiovascular (CV) events is still debated. Currently available evidence derives from non-homogeneous studies yielding conflicting results.

Purpose

We set out to assess the relationship between NAFLD and CV morbidity and mortality by pooling results of previous studies.

Methods

We performed a systematic review and meta-analysis of prospective observational studies published from 1966 through 2021 reporting summary-level outcome data in subjects with and without NAFLD. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for all-cause mortality, CV mortality, myocardial infarction (MI), stroke, major adverse cerebrocardiovascular events (MACCE) and atrial fibrillation (AF) were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. We performed post-hoc subgroup analysis stratified by geographical region and univariate mixed-effect model meta-regression analysis to address statistical heterogeneity.

Results

We identified a total of 29 studies pooling an overall population of 5,626,573 middle-aged individuals (mean age 56±8; male sex 53%; NAFLD 5.8%, n=326,389). Mean follow-up was 10±6 years. Compared with control population, presence of NAFLD was associated with similar risk of all-cause death (RR 1.17; 95% CI 0.89–1.52) and CV death (RR 0.84; 95% CI 0.64–1.10). When analysed by geographic location, pooled estimates of RR (95% CI) for all-cause death were 1.57 (1.00–2.48) for Western countries, and 0.81 (0.52–1.1.26) for Eastern countries (test for subgroup difference, P=0.04). Meta-regression analysis showed a stronger relationship between NAFLD and all-cause mortality proportional to increasing body mass index (P=0.048). NAFLD was associated with increased risk of myocardial infarction (RR 1.35; 95% CI 1.09–1.68), stroke (RR 1.20; 95% CI 1.06–1.35), MACCE (RR 2.09; 95% CI 1.57–2.78) and atrial fibrillation (RR 1.37; 95% CI 1.05–1.78).

Conclusion

NAFLD portends excess all-cause mortality but only in Western countries. CV mortality was similar in NAFLD and non-NAFLD groups. NAFLD is associated with increased risk of incident MI, stroke, MACCE and AF.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
A 10-year follow-up study of the cardiovascular risk factors in children aged 6–16 years
Authors: Triantafyllidi H , Dretsiou E , Benas D , Trivilou P , Pavlidis G , Ikonomidis I , Iliodromitis E
Published: October 2021

Background

Obesity and arterial hypertension in children represent well recognized risk factors for future cardiovascular (CV) events during early adult life. We aimed to investigate any changes regarding several parameters affecting the CV status of children aged 6–16 years after a 10-year follow-up period.

Methods

A cohort of 143 children 6–16 years old (79/64 boys/girls, mean age 9±2 years) was evaluated regarding food habits (fish/chicken/vegetables/fruit per week), obesity (BMI), office blood pressure (SBP/DBP), aortic stiffness (PWV), lipid profile (HDL, LDL) and sports activity (hours of exercise/week). After a 10-years follow-up period, we managed to re-evaluate 62/143 (43%) young adults (33/31 boys/girls, mean age 20±2 years) for the same parameters plus endothelial function estimated by endothelial glycocalyx integrity (PBR5–25).

Results

We found that after 10 years, young adults compared to themselves had increased BMI, SBP/DBP and PWV (p<0.001), decreased HDL and LDL (p<0.001 and p=0.004, respectively), increased consumption of chicken and vegetables (p<0.001 and p=0.05, respectively) and decreased consumption of fish and fruits (p=0.004 and p=0.001, respectively) per week and finally increased weekly hours of sports activity (p=0.005). Mean PBR5–25 was 1.9±0.2 μm. Regarding obesity, the majority of children were overweight (20%) or obese (41%) while the majority of young adults were normoweight (60%) and only 11% obese. Regarding arterial hypertension (mean value of a triple office BP measurement), we measured BP >95th percentile in 7% of the children (50% of children had finally white coat hypertension) while just one young adult (2%) had BP >140 mmHg).

Conclusions

After 10 years, children became young adults with an improved status regarding obesity, normal BP levels, favorable lipid profile as for LDL levels, almost healthy food habits who also spend more hours in sport activities. However, HDL was decreased, aortic stiffness was increased while there are no comparable data regarding endothelial glycocalyx integrity. Overall, the profile of young adults seems protective against future CV events.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Relationship between morphometric parameters of epicardial adipose tissue and adipocytokine profile in patients with myocardial infarction
Authors: Belik E , Gruzdeva O V , Dyleva Y U A , Brel N K , Borodkina D A , Barbarash O L
Published: October 2021

Aims

To reveal the relationship between the thickness of epicardial adipose tissue (EAT) and the levels of adiponectin, leptin, interleukins (IL) IL-6, IL-10, IL-12, IL-33 in the blood serum of patients with myocardial infarction.

Materials and methods

A total of 119 patients with ST-segment elevation myocardial infarction (MI) who signed voluntary informed consent were examined. The thickness of the epicardial adipose tissue of the left and right ventricles (LV EAT and RV EAT, respectively) was assessed using magnetic resonance imaging on an Exelart Atlas 1.5 MR tomograph (Toshiba, Japan). The concentration of the studied parameters was determined in the blood serum of patients by the ELISA method on the 1st and 12th days of hospitalization: adiponectin and leptin (BioVendor, USA), IL-6, IL-10, IL-12, IL-33 (eBiosciens, USA). Statistical analysis was performed using Statistica 9.0.

Results

The thickness of the LV EAT was 6.3 (4.7; 9.5) mm, the thickness of the EAT RV was 6.8 (4.9; 0.6) mm. The concentrations of the studied parameters in the blood serum of patients on the 1st day of hospitalization: adiponectin 7.72 (6.5; 13.0) μg/ml, leptin 7.48 (5.98; 12.5) ng/ml, IL-6 14.5 (11.6; 21.8) pg/ml, IL-10 1.9 (0.7; 2.5) pg/ml, IL-12 128.7 (66.4; 182.0) pg/ml, IL-33 5.6 (3.4; 7.2) ng/ml. On the 12th day, there was an increase in the level of adiponectin and IL-33 by 1.5 times, IL-10 by 2 times, a decrease in leptin by 1.6 times, IL-6 by 1.4 times and IL-12 by 1.3 times. Correlation analysis revealed a relationship between the thickness of LV EAT and the following parameters in serum: adiponectin level 1st (r=−0.29; p=0.01), IL-10 12st (r=0.36; p=0.03), IL-6 1st (r=−0.64; p=0.046), IL-33 12st (r=0.24; p=0.04). The thickness of the RV EAT correlated with the concentration of IL-12 in the blood serum of patients 12st (r=−0.59; p=0.01).

Conclusions

The data obtained indicate the presence of a relationship between the morphometric characteristics of EAT and the serum parameters of the adipocytokine profile in patients with MI. Based on this, we can conclude about the ability of the markers under study to reflect the thickness of the EAT and their potential use for the development of methods for correcting pathological activation of adipose tissue in MI.

Funding Acknowledgement

Type of funding sources: None.
BNP/ NT-pro BNP thresholds for the assessment of the prognosis in patients without heart failure
Authors: Hendricks S , Mahabadi A A , Vogel L , Al-Rashid F , Luedike P , Totzeck M , Rassaf T , Dykun I
Published: October 2021

Background

Natriuretic peptides (BNP/NT-proBNP) are predominantly used for risk stratification, diagnosis and therapeutic monitoring in heart failure patients. A potential value of BNP/NT-proBNP serum levels for the prediction of prognosis in the general population and for non-heart failure patient cohorts is suggested in the literature. However, for non-heart failure patients, no thresholds are established. We aimed to determine cut-off levels that allow prediction of long-term survival in patients without known heart failure.

Methods

The present analysis is based on a registry of patients undergoing coronary angiography between 2004 and 2019. Patients with existing diagnosis of heart failure or elevated natriuretic peptides (BNP >100pg/nl, NT-proBNP >400pg/nl), with missing follow-up information or without BNP/NT-proBNP levels at admission were excluded. As either BNP or NT-proBNP was available for singular patients and to adjust for the skewed distribution, BNP/NT-proBNP levels ranked based on gender specific percentile from 0 to 99. The cohort was then divided into a derivation and a validation cohort using random sampling. Incidence of death of any cause during follow-up was recorded. In the derivation cohort, cox regression analysis was used to determine the association of natriuretic peptides with incident mortality per 1 standard deviation increase in BNP/NT-proBNP rank. Multivariable models controlled for age, sex, LDL-cholesterol, systolic blood pressure, smoking status, and family history of premature cardiovascular disease. Receiver operating characteristics curve analysis was performed, with corresponding area under the curve, along with Youden's J index assessment, to establish a threshold for prediction of survival. The association of this threshold with incident mortality was tested in the validation cohort.

Results

Overall, 3,687 patients (age 62.9±12.5 years, 71% male) were included. During a mean follow-up of 2.6±3.4 years, 169 deaths occurred. In the derivation cohort, BNP/NT-proBNP was significantly associated with mortality (Hazard ratio [95% confidence interval]: 1.25 [1.01–1.54], p=0.04). Based on Youden's J index, BNP-thresholds of 9.6 and 29pg/ml and NT-proBNP thresholds of 65 and 77pg/ml for men and women, respectively, were determined. In the derivation cohort, BNP/NT-proBNP levels above these thresholds were significantly associated with increased mortality (2.44 [1.32–4.53], p=0.005). The predictive value of the determined thresholds was confirmed in the validation cohort (2.78 [1.26–6.14], p=0.01).

Conclusion

We here describe gender-specific BNP/NT-proBNP thresholds that allow prediction of impaired survival in patients without heart failure. Utilization of these thresholds in clinical routine may qualify for risk prediction in non-heart failure cohorts, independent of traditional cardiovascular risk factors.

Funding Acknowledgement

Type of funding sources: None.
The prognostic impact of fibroblast growth factor-23 on cardiovascular death after cardiac surgery
Authors: Hofer F , Kluger F , Kazem N , Hammer A , Koller L , Laufer G , Andreas M , Steinlechner B , Hengstenberg C , Sulzgruber P , Niessner A
Published: October 2021

Background

Fibroblast growth factor 23 (FGF-23) participates in phosphate and vitamin D metabolism and proved to be associated with an increased risk for fatal events in individuals presenting with cardiovascular disease. In the era of personalized medicine and individualized prognostication, the identification of novel risk markers seems of major importance in terms of state-of-the-art patient care. Since data on the prognostic potential of FGF-23 in individuals undergoing cardiac valve and/or coronary artery bypass graft (CABG) surgery remain scarce, we aimed to investigate the impact of FGF-23 on cardiovascular (CV) death in an unselected patient population after cardiac surgery.

Methods

Within the present investigation, patients undergoing elective cardiac valve and/or CABG surgery were prospectively enrolled at the Department of Cardiac Surgery of our Medical University. Preoperative blood values were assessed immediately before the surgical intervention. FGF-23 concentrations were measured via FGF Quantikine ELISA Kit (R&D Systems, Minneapolis, USA). Patients were followed prospectively until the primary study endpoint (CV death) was reached. Cox regression models were calculated and adjusted for age, sex, diabetes, heart failure, body mass index, prior myocardial infarction, hypertension and coronary artery disease.

Results

In total, 462 patients were included in the present analysis and followed over a median of 3.9 years. During follow-up 67 (14.5%) patients died. The patients' median age was 70 years (interquartile range [IQR] 60 to 75) and 133 (28.8%) were female. The median FGF level in the entire study population was 1.9 pmol/L (IQR 1.2 to 3.5). After stratification into tertiles (T) of FGF-23 (median FGF-23 T1: 0.95 pmol/L [IQR 0.65 to 1.19], T2: 1.93 pmol/L [IQR 1.64 to 2.28] T3: 4.80 pmol/L [IQR 3.54 to 8.09]), patients in the highest FGF-23 tertile had highest rates of CV death (T1: 4.8%, T2: 6.8%, T3: 19.1%; P-logrank <0.001; Figure A). Moreover, there was a strong association between FGF-23 and CV death (Adj. hazard ratio for 1-unit increase in standardized log-transformed biomarker 1.44, 95% CI: 1.19 to 1.75; P-value <0.001). The risk of CV death increased within higher tertiles of FGF-23 (T3: adj. HR 3.59 [95% CI 1.48–8.71], P-value= 0.005) (T1 was chosen as reference). FGF23 also showed good discriminatory performance (area under the curve [AUC] 0.69, 95% CI 0.61–0.77).

Conclusion

FGF-23 proved to be a strong and independent predictor for CV death in individuals undergoing elective cardiac valve and/or CABG surgery. This biomarker may provide improved risk assessment and fosters individualized patient care in this highly vulnerable patient population in the era of personalized medicine.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Kaplan Meier curves