bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of thrombus burden by cangrelor in ticagrelor-loaded st-elevation myocardial infarction patients with high residual platelet reactivity: the imaging sub-study of the ERMIT randomized trial
Authors: Beygui F , Peron C , Lacote C , Stettler R , Guillemot V , Blanchart K , Bignon M , Lemaitre A , Schwob L , Roule V
Published: October 2024

Background

Residual high platelet reactivity (HPR) at the time of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with higher residual thrombus burden and the subsequent suboptimal reperfusion.

Purpose

We sought to determine the impact of intravenous Cangrelor on the residual post-PCI thrombus burden in patients with HPR admitted for primary PCI in a prespecified intracoronary optical coherence tomography (OCT) sub-study of the ERMIT randomized trial.

Methods

In the ERMIT trial patients pre-treated with ticagrelor and aspirin with residual HPR (baseline platelet reactivity unit >208) were randomly assigned in a 1:1 ratio to receive cangrelor on top of standard therapy or standard therapy alone prior to PCI. The primary endpoint of the sub-study was the relative thrombus volume quantified on OCT. Other OCT quantified parameters were predefined as secondary endpoints.

Results

After screening of 128 patients, a total of 60 patients with HPR were enrolled and randomized. The OCT sub-study included 53 patients, 29 in the cangrelor and 24 in the control group.

As reported in the table, baseline characteristics were similar between the groups. The post-PCI PRU was dramatically lower in the cangrelor as compared to the standard group (p<0.001). The primary endpoint was 4.5% [3.4;7.2] versus 6.9% [5.2;8.5], (p=0.03) in the cangrelor and control groups respectively. All other imaging parameters confirmed the significantly lower thrombus burden in patients receiving cangrelor (Table).

Conclusion

The imaging sub-study of the randomized ERMIT trial shows that cangrelor use is associated with a more effective platelet inhibition and lower post-PCI residual thrombus burden in ticagrelor-loaded STEMI patients with residual HPR. The clinical implications of such finding warrant larger size trials.Table
Comparison of different calcium modification strategies for coronary calcified nodules: insights from optical coherence tomography
Authors: Yasumura K , Koshy A , Vengrenyuk Y , Minatoguchi S , Krishnamoorthy P , Hooda A , Sharma R , Kapur V , Sweeny J , Sharma S , Kini A
Published: October 2024

Background

The optimal treatment strategy for coronary calcified nodules (CN) remains uncertain.

Purpose

We sought to compare the safety and efficacy of different calcium modification strategies for managing CN using optical coherence tomography (OCT).

Methods

In this single-center retrospective cohort study, consecutive patients undergoing OCT-guided percutaneous coronary intervention (PCI) for severely calcified lesions using rotational atherectomy (RA), orbital atherectomy (OA), or intravascular lithotripsy (IVL) between January 2017 and December 2022 were included. OCT analysis was performed through our institutional core-laboratory to identify CN, assess plaque characteristics, and evaluate post-stent optimization. Primary outcomes were minimum stent area (MSA) and MSA at CN site post-PCI. One-year target vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target vessel revascularization, was also recorded.

Results

Among a total of 154 patients with 158 lesions, CN was identified in 54 lesions (34.2%) and managed with RA (39%, n=21), OA (33%, n=18), or IVL (28%, n=15). The IVL group exhibited a larger minimal lumen diameter, maximum calcium arc, and maximum calcium thickness at baseline. Post-PCI OCT demonstrated comparable MSA (RA: 5.91 ± 0.33mm², OA: 5.94 ± 0.38mm², IVL: 6.46 ± 0.45mm²; p=0.61) and MSA at CN site (6.77 ± 0.49mm², 6.71 ± 0.51mm², 7.13 ± 0.59mm², respectively; p=0.87) after adjusting for procedural and morphologic factors among the groups. The incidence of TVF at one year was similar among the groups.

Conclusions

In patients undergoing PCI for severely calcified lesions with CN, comparable procedural and clinical outcomes can be achieved using RA, OA, or IVL. The equivalence across these techniques underscores a role for individualized decision-making integrating patient- and lesion-specific characteristics, as well as center expertise when selecting a treatment strategy for CN.OCT findings and clinical outcomes
Retrograde coronary chronic total occlusion intervention (JR-CTO) score: from the Japanese CTO-PCI expert registry
Authors: Tanaka H , Tsuchikane E , Kishi K , Okada H , Oikawa Y , Ito Y , Muramatsu T , Yoshikawa R , Kawasaki T , Okamura A , Sumitsuji S , Muto M , Katoh O
Published: October 2024

Background

Despite the effectiveness of the retrograde approach for chronic total occlusion (CTO) lesions, there are no standardized tools to predict the success of retrograde percutaneous coronary intervention (PCI).

Purpose

The objective of this study was to develop a prediction tool to identify CTO lesions that will achieve successful retrograde PCI.

Methods

This study evaluated data from 2,374 patients who underwent primary retrograde CTO-PCI and were enrolled in the Japanese CTO-PCI Expert Registry between January 2016 and December 2022. All observations were randomly assigned to the derivation and validation cohorts at a 2:1 ratio. The prediction score for guidewire failure in retrograde CTO-PCI was determined by assigning one point for each factor and summing all accrued points.

Results

The JR-CTO score (moderate–severe calcification, tortuosity, Werner collateral connection grade ≤ 1, and non-septal collateral channel) demonstrated a c statistic for guidewire failure of 0.72 (95% confidence interval: 0.67–0.76) and 0.71 (95% confidence interval: 0.64–0.77) in the derivation and validation cohorts, respectively. Patients with lower scores had higher guidewire and technical success rates and decreased guidewire crossing time and procedural time (P < 0.01).

Conclusions

The JR-CTO score, a simple four-item score that predicts successful guidewire crossing in patients undergoing retrograde CTO-PCI, has the potential to support clinical decision-making for the retrograde approach.
Flow adjusted predicted prosthesis patient mismatch in patients undergoing transcatheter aortic valve implantation
Authors: Tomii D , Heg D K , Nakase M N , Samim D S , Lanz J L , Praz F P , Stortecky S S , Reineke D R , Windecker S W , Pilgrim T P
Published: October 2024

Background

Effective orifice area (EOA) is flow dependent. However, established methods for the assessment of prosthesis-patient mismatch (PPM) do not consider flow status, and therefore may underestimate the rate and impact of PPM in patients with abnormal flow status.

Objectives

To investigate the clinical impact of flow-adjusted predicted PPM in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods

Patients undergoing TAVI in a prospective TAVI registry were stratified by the presence of moderate or severe PPM (EOA index to body surface area [EOAi]: 0.65-0.85 or ≤0.65 and 0.55-0.70 or ≤0.55 cm2/m2 if obese). PPM was defined according to echocardiographically measured EOAi (measured PPM) or unadjusted or flow-adjusted predicted EOAi. Predicted EOAs were based on reference values of EOA for each valve generation and size (predicted PPMTHV) or native aortic annulus dimension (predicted PPMCT).

Results

Among 1,510 patients included (August 2007-June 2022), rates of moderate or severe PPM differed according to method of assessment; 27.0% and 8.7% according to measured PPM, 11.3% and 1.2% according to predicted PPMTHV, 12.0% and 0.1% according to PPMCT, 21.6% and 0.2% according to flow-adjusted predicted PPMTHV, and 25.1% and 0.4% according to flow-adjusted predicted PPMCT. Five-year mortality was comparable in patients with and without flow-adjusted predicted PPM defined by either method. These results were consistent when patients were stratified by flow status.

Conclusions

Rates of PPM differ considerably when flow status is considered. There was no consistent signal of increased risk of adverse events up to 5 years in patients with flow-adjusted predicted PPM.Frequency of PPM afteer TAVICumulative event curves for death
Transcatheter versus surgical aortic valve replacement in aortic stenosis patients requiring mechanical circulation support: a nationwide Japanese study
Authors: Mitsui K , Takagi K , Kataoka Y , Nakao K , Otsuka F , Asaumi Y , Kawamoto N , Fukushima S , Kanzaki H , Sumita Y , Kanaoka K , Miyamoto Y , Yamamoto K , Tsujita K , Noguchi T
Published: October 2024

Introduction

Transcatheter aortic valve replacement (TAVR) has demonstrated comparable clinical outcomes to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS). However, previous trials excluded patients who had required mechanical circulatory support (MCS) for cardiogenic shock. Thus, the clinical feature of aortic valve replacement requiring MCS and the efficacy of TAVR compared to SAVR has not been fully exhibited in AS patients.

Purpose

This study investigated the demography and clinical outcomes comparing TAVR and SAVR for AS demanding MCS.

Methods

The current study was an observational retrospective study using Japanese nationwide data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). Between April 1, 2012, and March 31, 2022, AS patients undergoing TAVR or SAVR who required MCS were evaluated. The primary outcome was 30-day mortality. In addition, we assessed ischemic stroke, hemorrhagic stroke during hospitalization.

Result

During the period, 80,752 patients (TAVR=36,546 and SAVR=44,206) were identified. The frequency of MCS (intra-aortic balloon pumping and/or extracorporeal membrane oxygenation) was 3.0% (1,097 patients) of the TAVR group and 4.8% (2,133 patients) of the SAVR group. In the TAVR group, 78% of patients were implanted balloon-expandable valve and 7.1% of patients were transapical apical approach. TAVR was performed in older (median age: 85 years vs. 76 years, p<0.001), lower body mass index (BMI) (median BMI: 21.5 kg/m2 vs. 22.7 kg/m2, p<0.001), and more female patients (42% vs. 27%, p<0.001) than SAVR. The 30-day mortality was lower in TAVR than SAVR (12% in TAVR and 19% in SAVR, p<0.001) (Figure). After adjusting age, gender, TAVR was significantly associated with decreased 30-day mortality compared to SAVR (adjusted HR 0.52 (0.41–0.67), p<0.001). In contrast, the incidence of ischemic stroke and hemorrhagic stroke were comparable in 2 groups (ischemic stroke; 4.2% in TAVR vs. 4.1% in SAVR, p=0.93 and hemorrhagic stroke; 0.3% vs. 0.3%, respectively).

Conclusion

According to nationwide real-world clinical data on aortic valve replacement for AS, the frequency of patients requiring MCS due to cardiogenic shock was 3.0% in the TAVR group and 4.8% in the SAVR group. Our findings demonstrated short-term outcomes following TAVR for patients requiring MCS for cardiogenic shock was better than those following SAVR.
Safety and quality of life assessment at 6 months follow-up of the valvosoft pivotal study
Authors: Van Wely M , Van Belle E , Puymirat E , Iung B , Van Gameren M , Eltchaninoff H , Amoroso G , Faroux L , Kim W K , Schewel D , Lepage L , Messas E
Published: October 2024

Background

Calcific Aortic stenosis (CAS) is currently the most common heart valve disease. Patients suffering from severe CAS are treated with invasive surgeries based on valve replacement. Symptoms heavily impact quality of life, including chest pain, shortness of breath, dizziness, fatigue, and major risks as heart failure or sudden death, and daily activities might also be strongly impacted.

Purpose

A prospective, multi-centre, single-arm, pivotal study (NCT05235568) was initiated in 2021 to treat severe CAS patients with Valvosoft, a medical device based on Non-Invasive Ultrasound Therapy (NIUT) intended to treat CAS in patients not eligible for immediate aortic valve replacement (SAVR/TAVR) or refusing such a treatment, to confirm safety and performance at 1-, 3-, 6- and 12 months. We present here the safety and quality of life results at 6M follow-up.

Methods

Valvosoft NIUT procedure is based on a trans-thoracic delivery of focused, high intensity short therapeutic ultrasound pulses, to precisely generate a cavitation bubble cloud on the aortic valve. Echocardiographic imaging enables to monitor the valve in real-time while cavitation causes both non-thermal tissue softening and calcification fractionation of the diseased valve.

60 planned subjects, suffering from severe calcific aortic stenosis, not recommended for aortic valve replacement or refusing such a procedure, were enrolled in 11 centres in Europe. Patients were awake or lightly sedated, NIUT was delivered during up to 70 minutes per patient per procedure.

DSMB and CEC were installed to monitor safety, performance and effectiveness of Valvosoft device, and safety related to participation in the clinical investigation.

Results

Sixty high-risk patients advanced in age (85.2 ± 9.1) with multiple severe comorbidities were included. Primary safety endpoint (less than 25% MACE) was met at 30D (p=0.002). Furthermore patients experienced an overall quality of life improved. 6 minutes’ walk test increases from baseline towards 6 months with 10 %.

At 6M follow-up, no stroke was reported, an average KCCQ score improvement of 17% was noticed, and NYHA class improved or stabilized for 78% of patients. The calcium score or volume on the aortic did not change pre- and post-procedure.

Conclusion

Valvosoft NIUT safety and quality of life improvement are proven at 6MFU, and the technology is presented as potentially disruptive, in the treatment of severe calcific aortic stenosis.
Venous thrombo-embolic events as the probable cause of arterial ischemic event in patients with patent foramen ovale
Authors: Chevrot G , Montalescot G , Larbi-Messaoud S , Zeitouni M , Devos P , Procopi N , Charpentier E , Hammoudi N , Wallet T , Toledano D , Boussouar S , Silvain J , Redheuil A , Guedeney P
Published: October 2024

Introduction

The origin of the emboli involved in patent foramen ovale (PFO)-related embolic events remains mostly unknown.

Purpose

To evaluate the venous thrombo-embolic (VTE) origin of patients with PFO-related embolic event.

Methods

Patients planned for PFO closure for secondary prevention of PFO-related arterial embolic event had a systematic venous thrombo-embolic (VTE) risk evaluation that included : an extensive questionnaire on past history of VTE events, clinical situations at high risk of VTE including complicated hemorrhoids, prior saphenectomy or venous sclerosis, varicocele, intrapelvic tumor, pregnancy, surgery or prolonged travel or presence of hyperthrombotic state (i.e., thrombophilia, active cancer or covid) and an abdominopelvic magnetic resonance venography (MRV) evaluation to identify any intrapelvic venous disease.

Results

From July 2020 to May 2023, 366 consecutive patients (Median age 51 [42-58] years, 42.9% female) were prospectively included. A past medical VTE events, a high risk VTE situation, a hyperthrombotic state and a pelvic venous abnormality on MRV were present in 8.5% (95%CI 6.0-11.8), 22.7% (95%CI 18.7-27.2), 7.1% (95%CI 4.9-10.2), and 36.3% (95%CI 31.6-41.4), respectively, and 58.5% (95%CI 53.4-63.4) of the patients presented at least one of the previous conditions. MRV identified various undiagnosed pelvic venous abnormalities with 20.0% of pelvic varices, 9.8% of May-Thurner-Cockett and 7.4% of Nutcracker phenomenons (Figure 1). Imaging abnormalities were more frequent among younger patients (aOR 1.02 95%CI:1.00-1.04) and women (aOR 1.94 ; 95%CI:1.25-3.02).

Conclusion

A majority of patients undergoing PFO closure for secondary prevention have a potential VTE source of paradoxical emboli suggesting that VTE events is the probable cause of arterial ischemic event in these patients.
Feasibility and early outcomes of atrial septal defect prostheses use for percutaneous closure of widely open patent foramen ovale
Authors: Dupuy M , Guedeney P , Silvain J , Zeitouni M , Devos P , Wallet T , Bouziri N , Procopi N , Hammoudi N , Montalescot G
Published: October 2024

Background

The efficient closure of patent foramen ovale (PFO) with short canal length and large width, usually associated with atrial septal aneurysm (ASA), remains challenging. These cases frequently require the use of larger PFO devices to avoid the risk of device embolism at the cost of a higher rate of residual shunting, mostly due to interdisk spacing. The use of atrial septal defect (ASD) prosthesis could be useful in these patients.

Purpose

To describe feasibility and early outcomes of the use of ASD device for percutaneous closure of widely open PFO representing an "ASD-like anatomy".

Methods

Since January 2022 in a high volume French university center, we started to use ASD device for percutaneous closure of selected cases of PFO with complex anatomy as mainly defined by a sheathed width of PFO ≥ 5 mm and sheathed canal length ≤ 10 mm (Figure 1) facing major per-operative residual shunt with PFO prostheses in some patients. In addition to the descriptive results, we compared this ASD device subgroup with a cohort of patients with similar anatomy but previously treated in our center with PFO device. All available transesophageal echocardiography (TEE) examinations were reviewed. The main objective was to describe the feasibility of the procedure (success and safety), the secondary endpoint was immediate post-procedural moderate to severe residual right-to-left shunt (RLS), defined as ≥ 10 bubbles in the left atrium within 3 cardiac cycles after transfemoral agitated saline injection.

Results

A total of 65 patients was treated with ASD devices, procedural success was achieved in all patients with a low rate (4,2%) of intrahospital complications (two supraventricular arrythmia, one anaphylactic shock and one minor laryngeal injury) and without device embolism. As compared with a cohort of 127 patients of similar anatomy treated with PFO device, patients in the ASD device group had more complex characteristics especially higher mean sheathed PFO width and shorter mean sheathed PFO canal length. Immediate post-procedural residual moderate to severe RLS did not differ significatively between groups (Table 1). No or minimal shunting was observed in 91% and 92% of cases (p=NS) but the three patients with severe RLS were all in the PFO device group.

Conclusion

Percutaneous closure of "ASD-like" PFO with ASD prostheses is feasible and safe. Larger studies and longer follow-ups are now required to confirm the expected improved sealing effect with this strategy.
In-hospital bowel ischemia and mortality trends of left ventricular assist device placement in the USA from 2017 to 2020
Authors: Perry J , Sinclair S , Kibwey Peterkin K P , Adarsh Balaji A B , Allen Mcnamara A M , Akinti O A , Khan A
Published: October 2024

Background

Left ventricular assist devices (LVADs) are critical for treating advanced heart failure patients. Yet, insights into clinical outcomes, particularly concerning bowel ischemia and mortality, remain scarce.

Purpose

We aimed to examine temporal trends of in-hospital mortality and bowel ischemia among heart failure patients with LVAD between 2017 and 2020.

Methods

The National Inpatient Sample was queried from 2017 to 2020 to identify all adults with congestive heart failure who underwent LVAD implantation using the International Classification of Diseases 10th Revision codes. The Cochran-Armitage test was used to assess the linear trend of in-hospital bowel ischemia with LVAD. Multivariable regression analysis was conducted to evaluate the association of LVAD placement with in-hospital mortality and bowel ischemia. The Elixhauser comorbidity index was used to adjust for confounders. Linear logistic results are represented as adjusted odds ratios (ORs) with their respective 95% Confidence Intervals (CIs).

Results

Of a total of 19,410 LVAD placements, 189 (0.97%) patients developed bowel ischemia of any type. The mean age of these patients was 58 years, with a predominance of males (68%). A trend analysis revealed an increasing occurrence of bowel ischemia following LVAD placement over the years (trend: 1%, p < 0.001). Specifically, the proportion of LVAD patients with bowel ischemia was 0.8% in 2017 (OR = 6, 95% CI 3.6-13, p < 0.001), increased slightly to 0.9% in 2018 (OR = 6.2, 95% CI 3.4-11.7, p < 0.001), followed by a decrease to 0.73% in 2019 (OR = 4.2, 95% CI 2.4-7.5, p = 0.02), and then a rise to 1.53% in 2020 (OR = 7.2, 95% CI 4-12.9, p < 0.001), as illustrated in Figure 1. Across all years, LVAD placement was associated with a significant risk for developing bowel ischemia (OR= 6.9, 95% CI 5-9.6, p < 0.001).The mortality rate among patients who developed bowel ischemia post-LVAD insertion was significant, with a rate of 50% in 2017 (OR = 5.3, 95% CI 1.3-20, p = 0.01), escalating to 67% in 2018 (OR = 10, 95% CI 2.4-43, p < 0.002), and stabilizing at 57% for both 2019 (OR = 8, 95% CI 1.8-37.3, p < 0.006) and 2020 (OR = 6.7, 95% CI 2.3-19.1, p < 0.001), as detailed in Table 1. The overall in-hospital mortality for patients with LVAD and bowel ischemia was 58% (OR = 7, 95% CI 4-14, p < 0.001).

Conclusions

The study indicates rising trends in-hospital bowel ischemia and fluctuations in mortality rates in LVAD patients from 2017 to 2020. Despite its rarity, LVAD placement carries a notable risk of bowel ischemia, which significantly affects mortality. This underscores the need for vigilant monitoring and management.Figure 1Table 1
Comparative analysis of muscle sympathetic nerve activity in patients afflicted with orthostatic hypertension versus conventional hypertension
Authors: Hirai T , Ikeda T , Murai H , Sugimoto H , Mukai Y , Tokuhisa H , Kobayashi D , Takata S , Sakata K , Usui S , Takamura M
Published: October 2024

Introduction

Standing places a significant hemodynamic burden on the cardiovascular system. In healthy individuals, neurohumoral reflex mechanisms, particularly the arterial baroreflex, maintain blood pressure during standing. However, in some cases, the counterregulatory response can be excessive, resulting in a condition known as orthostatic hypertension (OrthoHT), which appears to be linked to an increased cardiovascular risk. Epidemiologically, orthostatic hypertension has been reported in 5-30% of hypertensive patients. Furthermore, in recent years, it has garnered attention as a responder group in renal denervation therapy.

Purpose

In hypertensive patients, sympathetic hyperactivity is expected to exacerbate cardiovascular risk. However, the relationship between OrthoHT and sympathetic nerve activity remains poorly understood. This study aims to assess the differences in sympathetic nerve activity between OrthoHT and conventional hypertensive patients using muscle sympathetic nerve activity (MSNA) measurements.

Methods

We conducted an examination of hypertensive patients undergoing drug treatment at our clinic between April 1, 2023, and June 30, 2023, to identify cases of OrthoHT. Only patients with essential HT were included in the HT group; patients diagnosed with secondary HT were excluded. HT patients with other active CV diseases (i.e., symptomatic cerebral/coronary artery diseases or heart failure) and/or severe renal dysfunction (estimated glomerular filtration rate <30 mL/min/1.73 m2) were also excluded. OrthoHT was defined as a sustained increase in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg within 3 minutes of standing. MSNA was recorded from the left peroneal nerve using a tungsten microelectrode at supine position. We measured MSNA in the cases for which consent was obtained. Statistical analyses were performed using SPSS software.

Results

Among the 183 cases, 31 were diagnosed with OrthoHT, and 7 of them consented to MSNA measurement. Of the 11 cases of hypertensive patients who consented, two groups were well age-matched. We assessed body mass index, resting systolic blood pressure, diastolic blood pressure, heart rate, blood glucose level, creatinine, cholesterol, brain natriuretic hormone, and ejection fraction measured by echocardiography, but found no significant differences between the two groups.

OrthoHT patients exhibited elevated MSNA burst frequency (28.3 +/- 5.7 vs. 38.4 +/- 12.2 bursts/min, P < 0.05) and burst incidence (44.6 +/- 11.1 vs. 61.1 +/- 21.3 bursts/100 heartbeats, P < 0.05) at rest.

Conclusions

OrthoHT is associated with sympathetic hyperactivity compared to normal hypertensive patients, contributing to an increased cardiovascular risk.
The influence of the daily salt-intake on the antihypertensive action and atrial natriuretic peptide level in patietns with angiotensin receptor neprilysin inhibition
Authors: Sato T , Watanabe S , Aizawa Y
Published: October 2024

Background

The angiotensin receptor–neprilysin inhibitor (ARNI) is a drug which acts through angiotensin receptor blocking effect and the increase in atrail natriuretic peptide (ANP) through neprilysin inhibitor in hypertension (HT). These combined effects result in a reduced risk of hospitalization for heart failure or death from cardiovascular causes. ANP is also known for its various cardioprotective effects including vasodilator and natriuretic action. Acording to Guyton's pressure-natriuresis curve, the efficacy of angiotensin receptor blocker drugs is diminished in HT cases with high daily salt inatke. However, whether the effect of ARNI on HT is attenuated in patients with high daily salt intake remains unclear.

Purpose

The present study investigated the influence of a daily salt intake on the antihypertensive action and ANP level in patients with ARNI.

Methods

Fourty-four consecutive essential HT patients on ARNI were enrolled. Blood pressure and ANP level were measured at baseline (before taking ARNI) and 3 weeks later. ARNI (200mg) was prescribed and maintained during the study. In addtion, the daily salt intake was calculated using creatinine and natrium levels in urine, age, and body weight according to Japanese hypertensive guideline at baseline and 3 weeks later.

Results

The average age was 70±8 years old. About 50% (N=23) was male. The mean sytolic and diastolic blood pressure was 148±14mmHg and 89±10mmHg, respectively. The mean daily salt intake was 9.5±2.2 g/day at baseline. The mean ANP level was 529±300pg/ml.

At follow up (3 weeks later), the mean systolic and diastolic blood pressure significanly went down to 132± 18 mmHg and 70± 9 mmHg, respectively (p=0.03). ANP level also increased from 529±300pg/ml to 793±580pg/ml. However, the mean daily salt intake was almost same as the baseline at 9.4±3.2 g/day.

The patients were divided into 2 groups; high daily salt intake (N=20 with mean daily salt intake 10.5±1.7g/day)) and low daily salt intake (N=24 with 8.4±3.1g/day) groups compared to the baseline. The absolute and percentage changes in systolic blood pressure were almost same in the high and low daily salt intake groups (-12.7±15.8mmHg vs -13.7±14.2mmHg, p=0.75; -5.8±6.5% vs.-7.0±9.6%, p=0.58, respectively). However, the change rate in ANP level was significantly higer in the high daily salt intake group than in the low daily salt intake group (155±63 vs. 12±16%, p=0.01).

Conclusion

ARNI demonstrates effectiveness in lowering the blood pressure even in patients with higher salt intake, unlike angiotensin receptor blocker. In cases with high salt intake, the notable increase in ANP levels may contribute to decreasing blood pressure through vasodilator and natriuretic action.
Manganese-enhanced magnetic resonance imaging in diabetic cardiomyopathy
Authors: Joshi S , Singh T , Loganath K , Spath N , Kershaw L , Dattani A , Singh A , Semple S , Williams M , Van-Beek E , Gulsin G , Mccann G , Dweck M , Newby D E
Published: October 2024

Aim

To investigate myocardial calcium handling using manganese-enhanced magnetic resonance imaging in patients with type 2 diabetes in the presence and absence of heart failure with reduced ejection fraction.

Methods

In a prospective case-control study, 14 healthy volunteers, 24 patients with type 2 diabetes with normal left ventricular function (early stages of diabetic cardiomyopathy), 20 patients with heart failure with reduced ejection fraction, and 20 patients with both heart failure with reduced ejection fraction and type 2 diabetes (late stages of diabetic cardiomyopathy) underwent cardiac manganese-enhanced magnetic resonance imaging.

Results

Mean myocardial manganese uptake was 8.3±1.3 mL/100 g of tissue/min in healthy volunteers, falling to 6.5±0.9 mL/100g of tissue/min in patients with type 2 diabetes and lowest in patients with heart failure (4.5±1.0 mL/100g of tissue/min). Patients in late stages of diabetic cardiomyopathy had lower myocardial manganese uptake compared to patients in early stages of diabetic cardiomyopathy (4.9±0.7 versus 6.5±0.9, p<0.001). Furthermore, patients with both type 2 diabetes and heart failure had suppressed myocardial manganese uptake compared to patients with heart failure without type 2 diabetes (4.9±0.8 versus 5.7±1.1 mL/100g of tissue/min, p=0.01). On multivariable analysis, type 2 diabetes and left ventricular ejection fraction were the independent predictors of myocardial manganese uptake in patients with heart failure, after adjusting for age, sex, ischaemic heart disease, hypertension, and hyperlipidaemia.

Conclusions

Patients with either heart failure or type 2 diabetes have impaired myocardial calcium handling, and these effects appear to be additive. Type 2 diabetes and impaired left ventricular systolic dysfunction are independent predictors for abnormal myocardial calcium handling, and this may play an important role in the pathogenesis of diabetic cardiomyopathy.
Ten-year major clinical outcomes between first- and second-generation drug-eluting stents in hypertensive patients underwent percutaneous coronary intervention
Authors: Rha S , Choi S Y , Choi B G , Cha J , Hyun S , Kang J , Chu W , Park S , Choi C U , Park C G
Published: October 2024

Background

There are very limited long-term clinical outcome data comparing first-generation (1G) versus second-generation (2G) drug-eluting stents (DES) in patients with hypertension. The authors sought to compare the efficacy and safety 2G-DES with 1G-DES in hypertension patients who underwent percutaneous coronary intervention (PCI) during ten-year clinical follow-up periods.

Methods

Finally, a total of 1,631 eligible hypertensive patients who underwent PCI with 1G-DES (paclitaxel-, sirolimus-eluting stent, n = 715) or 2G-DES (zotarolimus [endeavor, endeavor resolute]- or everolimus-eluting stent [promus element, xience], n = 916) were enrolled. The study endpoints were individual and composite clinical outcomes up to ten-year.

Results

After PSM, two propensity-matched (PSM) groups (452 pairs) were generated. During the ten-year follow-up period, the 2G-DES group had a lower incidence of target lesion revascularization (TLR; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.35 – 0.82; p = 0.004), target vessel revascularization (TVR; HR, 0.66; 95% CI, 0.46 – 0.94; p = 0.022), any revascularization (HR, 0.65; 95% CI, 0.48 – 0.88; p = 0.006), total major adverse cardiac events (MACE; HR, 0.70; 95% CI, 0.55 – 0.90; p = 0.005), TLR MACE (HR, 0.69; 95% CI, 0.49 – 0.98; p = 0.037), and MACCE (HR, 0.69; 95% CI, 0.54 – 0.88; p = 0.002, table).

Conclusion

In our single-center, all-comer registry, 2G-DES had better efficacy especially repeat revascularization and MACE as compared with 1G-DES in hypertensive patients during 10-year follow-up periods.
Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019
Authors: Janssen-Telders C , Schlaich M , Schutte A E , Stergiou G , Poulter N R , Beaney T
Published: October 2024

Background

Cardiometabolic multimorbidity (CMM), defined as the presence of two or more cardiometabolic conditions, presents a significant global challenge due to aging populations and a growing prevalence of cardiometabolic diseases. However, evidence regarding the risk factors for CMM is scarce, particularly in low- and middle-income countries. May Measurement Month (MMM) is the largest annual global campaign collecting data on blood pressure (BP) and cardiometabolic diseases.

Purpose

To determine the proportion of hypertension in people with CMM and risk factors associated with CMM, from the three MMM campaigns in 2017-2019.

Methods

A total of 3 397 746 participants (≥18 years) were included, arising from 103 countries. CMM was defined as having two or more of three cardiometabolic diseases: myocardial infarction, stroke, and diabetes. Hypertension was defined as a systolic BP≥140mmHg and/or diastolic BP≥90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. A multivariable logistic mixed effects regression model was used to examine associations between CMM and potential risk factors, including age, sex, BMI category, smoking status, and alcohol consumption in the model, with random effects for country.

Results

Amongst all participants, 316 940 (9.3%), 62 731 (1.8%), and 28 491 (0.8%) had one, two or three cardiometabolic conditions, respectively, and 91 222 (2.7%) had CMM. The proportion with hypertension increased with an increasing number of cardiometabolic conditions: 29.6% in those with none, and 63.0%, 68.6% and 71.2% in those with one, two, or three conditions, respectively. In a fully adjusted model, females had 16% (OR = 1.16, 95% CI: 1.12-1.20, p-value <0.001) higher odds of having CMM than males (Figure). Increasing age was associated with higher odds of having CMM, the highest risk being found in participants ≥70 years. Participants who were underweight, overweight, or obese, were more likely to have CMM than those with a healthy weight. Of the risk factors studied, current smoking was associated with the highest odds for CMM, (OR = 12.8, 95% CI: 12.62-13.04, p-value<0.001) compared with not smoking. Participants consuming alcohol at least once per week had 74% lower odds (OR = 0.26, 95% CI: 0.25-0.27, p-value <0.001) of having CMM compared with those who never or rarely consumed alcohol (Figure 1).

Conclusions

The risk of CMM increases with female sex, older age, abnormal weight, and smoking. Additionally, CMM is associated with a higher likelihood of having hypertension. Efforts targeting high-risk populations with modifiable CMM related-risk factors are crucial for prevention of CMM.Figure 1.Risk factors for CMM
Increasing trends in hypertension-related mortality in European Union 27 countries from 2011 to 2019
Authors: Zuin M , Rigatelli G , Mazza A
Published: October 2024

Background

Arterial Hypertension (HT) is one of the most common chronic cardiovascular disease in adults and a leading cause of disability and mortality worldwide. However, update data regarding the HT-related mortality trends in Europe are lacking. Therefore, we assess the age- and sex- specific trends in HT-related mortality in the 27 European Union Member States (EU-27) between years 2011 and 2029.

Methods

Data were retrieved from the free publicly available EUROSTAT death certificate database to examine age-adjusted HT-related mortality rates (AAMR) (per 100.000 people) and relative average annual percentage change (AAPC) across all European Union 27 countries (EU27) from 2011 to 2019 using the International Classification of diseases, Tenth Revision (ICD-10) codes I10-I13 and I15. To calculate annual trends in HT-related mortality, we assessed the average annual percent change (AAPC) and relative 95% confidence intervals (CIs) using Joinpoint regression analysis.

Results

Over the study period, 254.540 HT-related deaths (157,081 males) were listed in EU27. Age-adjusted HT-related death increased from 9.12 to 10.7 per 100,000 people [AAPC: +1.5% (95% CI: 0.8-2.0), p<0.001]. Specifically, the HT-related mortality increased in males [AAPC: +1.8 (95% CI: 0.9-2.6) while decreased in women [AAPC: -1.1 (95% CI: -2.0 to 0.2), p=0.001]. Additionally, the HT-related mortality rates increased in northern [+1.5 (95% CI: 0.7 to 2.3), p<0.001] and eastern [AAPC: +3.9 (95% CI: 2.3 to 5.4), p<0.001] EU-27 states. Conversely, the AAMR plateaued in southern [AAPC: -0.1 (95% ci: 0.6 to 0.7), p=0.96)] and western EU-27 countries [AAPC: 1.0 (95% CI: -0.1 to 2.1, p=0.07] over the same period.

Conclusions

In EU27, HT-related mortality increased from 2011 to 2019, especially in men. However, significant disparities in HT-related mortality rates still exist between different European regions.
Adherence to treatment in patients with arterial hypertension at the wartime conditions in Ukrainian population
Authors: Tseluyko V
Published: October 2024

Background

Adherence to therapy significantly affects the course and prognosis of the disease. However, the impact of military operations and related factors on adherence to therapy has not been studied.

Purpose

The aim of the study was to evaluate additional factors influencing adherence to antihypertensive treatment in wartime.

Materials and Methods

A total of 1299 patients with arterial hypertension from different regions of Ukraine included into the study. All regions were divided into 3 zones: active hostilities; regions with moderate intensity; relatively calm regions. Besides traditional factors (age, education, concomitant pathology, type of therapy), the individual patients’ status was included to analysis as being a resident of a given region, an immigrant from an occupied territory or from a region of hostilities, or a person temporarily displaced. Analysis was performed in 4 treatment groups: 1 – fixed three-component combination olmesartan medoxomil/ amlodipine/ hydrochlorothiazide, 2 – fixed two-component combination olmesartan/ hydrochlorothiazide, 3 – fixed two-component therapy with olmesartan/ amlodipine, 4 - other antihypertensive therapy. Adherence was assessed at 1, 2 and 3 treatment months. Uni- and multivariate statistical analyses was performed to identify factors independently associated with treatment adherence.

Results

In total, 50 patients stopped the drug during the first month (3.8%), 9.8% stopped medication after 2 months, and 19.1% after 3 months. When analyzing patients' adherence depending on whether or not the doctor arrived from another region, we found that the percentage of patients who stopped treatment was almost twice higher if the doctor was displaced (32%), compared to doctors who remained in the places (18%). Based on results of comparative analysis, adherence to therapy was influenced by several factors: age, presence of concomitant coronary artery disease, staying in a high-risk region, number of pills, and prescribed drug. After 3 months adherence was 89% in patients who received 1 tablet per day, 84% - 2 tablets, 82% - 3-5 tablets, and 52% - more than 5 pills. The highest adherence was observed with the three-component pill and with combination of olmesartan and amlodipine. These combinations showed higher adherence compared to other types of therapy. Patient's level of education had no effect on adherence to therapy. Multivariate regression analysis showed, that age over 55 years (p=0.01) and patient’s being in dangerous area (p<0.0001) had significant independent negative influence on adherence. The use of two-component combination olmesartan/amlodipine or three-component therapy significantly increased adherence (p<0.0001).

Conclusion

In the wartime adherence to antihypertensive treatment depends both on previously known and specific factors - activity of hostilities in the region, as well as relocation of both patients and prescribing physicians to another region.
Antihypertensive treatment during pregnancy and maternal and fetal outcomes
Authors: Vaclavik J , Ramik Z , Jarkovsky J , Zouharova A , Pohlova R , Jirova J
Published: October 2024

Introduction

Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. The study aimed to analyse the outcomes of pregnancy in women treated for arterial hypertension in pregnancy in the Czech Republic.

Methodology

Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy induced hypertension. Hypoxia in the new-born was defined as pH <7.1 or Apgar score <8 present after delivery. For all factors, univariate logistic regression was used to calculate the odds ratios (OR) of adverse outcomes.

Results

There were total of 1,154,648 deliveries in the 11-year period. 95,215 women had hypertension in pregnancy, out of these 21,094 (22.2%) were treated with antihypertensive drugs. Odds ratios for caesarean section, pre-term delivery, low birth weight, new-born hypoxia and pre-eclampsia in women using different antihypertensive classes and drugs are shown in the Table. Risk of maternal and fetal complications was found to be higher with calcium channel blockers (mainly amlodipine) compared to methyldopa and beta blockers. Among beta blockers, bisoprolol had the most favourable safety profile. Although used in limited numbers, diuretics, verapamil, ACE-inhibitors and angiotensin receptor blockers (ARBs) appeared to be comparably safe to methyldopa. Combination of multiple antihypertensive drugs was associated with higher risk of adverse outcomes.

Conclusion

Bisoprolol, verapamil and diuretics seem to have the risk of adverse maternal and fetal outcomes comparable to methyldopa. Amlodipine and multiple antihypertensive drug combinations are associated with increased risk.Table
Influence of orthostatic blood pressure changes on the effects of intensive blood pressure control in patients with type 2 diabetes
Authors: Zhao M L , Jiang C , Li M X , Wang Z Y , Wang Y F , Gao M Y , He L , Tang R B , Long D Y , Sang C H , Du X , Dong J Z , Ma C S
Published: October 2024

Background

Intensive blood pressure (BP) control has been proven to reduce the risks of major cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM) (1). Excessive orthostatic BP changes should be fully addressed, given its high prevalence and associations with adverse events among T2DM patients (2-5). However, the benefits of intensive BP control among T2DM patients with significant orthostatic BP changes have been equivocal.

Purpose

To examine whether orthostatic BP changes modify the efficacy of intensive BP control on CVD outcomes in patients with T2DM.

Methods

The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) is a 2×2 factorial designed trial that aimed to evaluate the effects of intensive glycemia and BP control on major CVD events among T2DM patients (6). We enrolled participants with at least one record of orthostatic BP values for analysis. The composite CVD outcome in this study comprised cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalized congestive heart failure. Associations between orthostatic BP changes and the composite CVD outcome and all-cause death, respectively, were presented by restricted cubic spline curves based on multivariable Cox models. We examined if the effects of intensive BP control varied across the orthostatic BP change for the composite CVD outcome and all-cause death.

Results

Among 4330 participants, 877 (20.3%) experienced episodes of orthostatic hypotension (OH) at baseline or during follow-up. There was no significant difference in the proportions of OH participants between the intensive and standard BP arms. U-shaped associations were observed between orthostatic systolic BP changes and the composite CVD outcome, as well as all-cause mortality (Figure 1). In the standard glycemia arm, intensive BP control was significantly associated with a lower risk of composite CVD outcome (HR 0.76, 95%CI 0.59-0.97). There was a beneficial association of intensive BP control with all-cause mortality without statistical significance (HR 0.85, 95%CI 0.56-1.30). The favorable effect of intensive BP control was not influenced by orthostatic BP changes (P for interaction 0.51 for the composite CVD outcome and 0.97 for all-cause mortality) (Figure 2). Beneficial effects of intensive BP control were not observed for participants in the intensive glycemia arm on the composite CVD outcome (HR 0.99, 95%CI 0.76-1.28) and all-cause mortality (HR 1.19, 0.79-1.80).

Conclusion

Orthostatic BP changes should not be a barrier to intensive BP control for T2DM patients treated with guideline-recommended standard glycemia control.
Semaglutide for the treatment of resistant hypertension
Authors: Kennedy C , Hayes P , Cicero A F G , Dobner S , Le Roux C , Mc Evoy J W , Zgaga L , Hennessy M
Published: October 2024

Background

Treatment options for resistant hypertension (RH) are often limited by medication intolerance and adverse effects. Novel approaches to treatment are required. The disease of obesity affects 70% of patients with RH.

Purpose

To determine if a weight centric approach using semaglutide improved BP control in patients with RH.

Methods

Individual participant data from three randomised placebo-controlled trials (STEP 1, 3 and 4) examining the effect of semaglutide 2.4mg on body weight over 68 weeks were included. Participants on >4 anti-hypertensive medications or those with systolic BP (SBP) >130mmHg at baseline and 3 anti-hypertensive medications including a diuretic were considered to have RH. Firstly, the change in SBP comparing those on semaglutide to placebo was analysed with baseline systolic BP as a covariate in an ANCOVA model. Then, the RH group was subdivided into those with SBP above or below 130mmHg at baseline and BP response to semaglutide assessed. Analyses were performed using R Software version 4.0.3.

Results

In the pooled analysis of 3136 trial participants, 111 met the criteria for RH. Compared to placebo, participants on semaglutide had a SBP reduction of -4.93mmHg, adjusted for SBP baseline to -3.16mmHg (95%CI -8.69 to 2.37). For those with RH and a baseline SBP > 130mmHg on semaglutide, the SBP change was -10.94mmHg. This change was 4.54mmHg for those with a SBP < 130mmHg. The diastolic BP changes were -3.62 and 2.79mmHg respectively (Figure 1). At trial completion, 36% of those on semaglutide did not meet the criteria for RH.

Conclusions

The effect of semaglutide on BP for patients with RH is modest. A greater BP reduction is evident for those with a higher baseline SBP. Targeting excess body weight with semaglutide is a viable treatment option for patients with RH and uncontrolled BP.