bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective reflection distance and its association with pressure augmentation index under a variety of acute hemodynamic perturbation
Authors: Uemura K , Nishikawa T , Kawada T , Sugimachi M 
Published: November 2020

Abstract

Effective reflection distance (ERD), a conceptual distance to a major reflection site from the aortic root, is associated with aging and pressure augmentation index (AIx) in clinical population. However, it is poorly understood how ERD varies and associates with AIx within a subject when the hemodynamic condition is changed extensively by acute pharmacological interventions.

Methods
In 13 anesthetized dogs, we measured aortic pressure (AP) and flow (AF) and femoral arterial flow (FF). Using AP, AF and FF, ERD based on an arterial model comprising a tube with frequency-dependent load (ERD_TL) was determined as a physiologically valid reference. ERD was also determined by wave separation (ERD_WSA) and pressure-only analyses (ERD_AW). Hemodynamic condition was changed by administrating zatebradine (bradycardic agent), nitroprusside, noradrenaline, dobutamine, and dextran.

Results
ERD_TL shortened significantly in response to infusion of nitroprusside or dobutamine. ERD_TL was significantly and negatively associated with AIx in multivariate analysis (Figure/Table). Changes in ERD_WSA or ERD_AW, and their association with AIx were not necessarily concordant with those observed in ERD_TL.

Conclusion
For the first time, we demonstrated that under diverse hemodynamic conditions, ERD_TL can change sensitively, and associates with AIx physiologically. This substantiates importance of tight attention to medication at clinical analysis of wave reflection phenomena. ERD_WSA or ERD_AW may not be a surrogate of ERD_TL.
Responses of ERD to drugs

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science (JSPS)
Effectiveness of personalized selection of antihypertensive therapy based on genetic polymorphism
Authors: Shlyk S.V , Drobotya N.V , Khaisheva L.A , Arytyunyan L.V , Pirozhenko A.A 
Published: November 2020

Abstract

Recent data indicate that it is important to develop the problem of genetic polymorphism in patients with arterial hypertension (AH) for the long-term possibility of using it as a justification for choosing the optimal treatment strategy. Currently, despite the availability of effective antihypertensive agents, the percentage of patients who have reached the target blood pressure level remains still not enough. A rational basis for choosing a particular class of drugs and / or their combinations in a concrete patient with AH can be the detection of genetic markers that determine the degree of sensitivity to therapy, since the relationship of its effectiveness with the genetic features is not in doubt today.

Material and methods
The work is based on the results of a clinical, instrumental, laboratory and genetic examination of 41 patients with AH with insufficient effectiveness of previous antihypertensive therapy. The median age and duration of the disease were 54 (32; 70) years and 7 (1; 20) years, respectively. Taking into account the identified gene polymorphism, a fixed combination of an ACE inhibitor (perindopril 10 mg) and a thiazide-like diuretic (indapamide 2.5 mg) was assigned. The comparative dynamics of blood pressure daily monitoring, left ventricle echocardiographic parameters, as well as indicators of vascular wall stiffness were analyzed before therapy and 3 months later.

Results
The study established a relationship between the clinical and morpho-functional features of AH in the examined patients with polymorphism of the AGT, AGTR2, CYP11B2, GNB3, NOS3 genes:-786 of their heterozygotes and “mutant” homozygotes, of which 3 polymorphic genes (AGT, AGTR2, CYP11B2) encode the activity of ACE.
The obtained results allowed to establish that positive dynamics of the studied indicators was revealed in all patients. Though patients, carriers of the mutant allele C of polymorphic marker T704C AGT gene, had statistically significant more expressed benefit changes in blood pressure daily profile, echocardiographic parameters (such as left ventricular mass index, indicators of left ventricular diastolic function) and all parameters of arterial wall stiffness compared with patients who do not carry the “mutant” allele.

Conclusion
Thus, the selected treatment regimen demonstrated maximum antihypertensive, cardio - and vasoprotective effectiveness in the group of AH patients with the presence of the allele 704C of the polymorphic marker T704C of the AGT gene, which indicates the perspectivity of using genetic approaches to develop personalized tactics of AH patients drug treatment.

Funding Acknowledgement
Type of funding source: None
Effect of blood pressure lowering treatment on the risk of atrial fibrillation: an individual-participant data meta-analysis
Authors: Pinho-Gomes A.C , Azevedo L , Copland E , Canoy D , Nazarzadeh M , Remakrishnan R , Berge E , Sundstrom J , Kotecha D , Woodward M , Rahimi K 
Published: November 2020

Abstract

Background
Although observational studies have suggested an association between elevated blood pressure (BP) and increased risk of atrial fibrillation (AF), randomised evidence on the effects of pharmacological blood pressure lowering on the risk of new-onset AF remains limited.

Purpose
To investigate the effects of pharmacological BP lowering on the risk of AF overall and stratified by baseline risk of AF and by drug class.

Methods
We extracted individual participant data from trials with over 1,000 person-years of follow-up that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs vs placebo, or to more vs less intensive BP-lowering regimens. We investigated the effects of BP lowering on the risk of new-onset AF using fixed-effect one-stage individual participant data meta-analyses based on Cox proportional hazards models stratified by trial.

Results
Twenty-one trials were included with a total of 194,041 patients, in whom 6,357 new-onset and 516 recurrent AF events were recorded. The hazard ratio for new-onset AF was 1.01, 95% CI [0.95–1.07] per each 5-mmHg reduction in systolic BP, and meta-regression suggested that treatment effects were similar irrespective of the intensity of systolic BP reduction. Patients were overall at low risk of AF at baseline (median 2.3%, IQR [1.2–3.4%] at 5 years), and there was no evidence of heterogeneity in treatment effects across thirds of risk and 10-mmHg strata of baseline systolic BP (Figure). There was also no clear evidence that treatment effects differed between drug classes when renin-angiotensin-aldosterone system inhibitors and calcium channel blockers were compared with placebo and/or standard treatment.

Conclusion
In a low-risk population, pharmacological BP lowering did not reduce the risk of new-onset AF. Further research is needed to understand whether the effects would be different in high-risk individuals, and to better clarify the existence of class-specific effects.
Figure 1. Forest plot

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Angiotensin receptor blockers and mineralocorticoid receptor antagonists therapy reaches better central haemodynamic parameters and avoid the episodes of atrial fibrillation
Authors: Paterno Marchioli C.A 
Published: November 2020

Abstract

Introduction
The goal of antihypertensive therapy is to prevent complications. The harmful effects of aldosterone are innumerable: induced cardiac/renal fibrosis, sodium and water retention, inflammation, oxidative stress, among others, that are involved in arterial/myocardium stiffness, remodelling, heart failure and new-onset atrial fibrillation (AF). Thiazide diuretics can activate the neurohormonal system, impair glucose metabolism, increase new-onset diabetes, and are potentially arrhythmogenic. Protective effect of Angiotensin Receptor Blockers (ARB) on major cardiovascular events might be partly independent of the degree of blood pressure reduction. Mineralocorticoid Receptor Antagonists (MRA) therapy reduce arterial stiffness, plasma volume, collagen/elastin ratio and vascular/myocardial fibrosis.

Purpose
The objective was to assess the levels reached in central haemodynamic parameters (CHP) and the presence of episodes of AF during ARB+hydrochlorothiazide (Hct) versus ARB+MRA therapy in hypertensive patients with normal kidney function.

Methods
For this cross-sectional retrospective study, data were entered from 108 hypertensive patients, female 62 (ARBs+MRA/ARB+Hctz average age 67/71), male 46 (average age ARB+MRA/ARB+Hctz 67/71), both p=ns). The average doses of Hct among female/male were 16/19 mg and the duration of the ARB+Hctz therapy were 37/47 months, while the ARB+MRA therapy were 36/49 months. 24-hours Holter monitoring was used in all patients. The group ARB+MRA before therapy had a history of AF episodes. The CHP (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure, Augmentation Index) were registered by the SphygmoCor System PVX (AtCor-Medical, Australia), according system's standard methods. Also was measured the difference between the normal levels, and the observed values of Augmentation Index (Diff-AIx) according age.

Results
The results of CHP, Diff-AIx, systolic and diastolic blood pressure during association of ARB+MRA therapy compared to ARB+Hct, both genders, showed the lowest values with a highly statistically significant difference. The episodes of AF during 24-hours Holter monitoring in the group ARB+Hct therapy in female/male were 55%/71%; instead, in the ARB+MRA treated they were not found.

Conclusions
These findings suggest that the dual block with ARB+MRA therapy giving better CHP, reducing the stress to arterial-ventricular coupling, it could be helpful to prevent, the harmful effects of angiotensin-aldosterone system such as the development of heart failure and atrial fibrillation.

Funding Acknowledgement
Type of funding source: None
Electrophysiology-based assessment of the procedural success of radiofrequency renal denervation
Authors: Pekarskiy S , Baev A , Mordovin V , Falkovskaya A , Zubanova I , Sitkova E 
Published: November 2020

Abstract

Objective
To assess whether electrode temperature and impedance change that are typically monitored during radiofrequency renal denervation (RDN) for safety reason may also be used as measures of the procedural success of the intervention.

Methods
We conducted a prospective clinical study of the radiofrequency RDN in patients meeting criteria of true resistant hypertension. The RDN treatment included the trunk and major branches of the renal artery. To obtain simple easy-to-use electrophysiology measures of the procedural success of RDN we averaged the maximal values of the temperature and change of impedance across all single treatments with a full duration. Then we assessed the relation of the average change in impedance and average maximal electrode temperature during RDN to blood pressure (BP) lowering 6 month post-procedure using a linear regression analysis. Also, we compared the groups with “successful” and “unsuccessful” procedures according to whether the impedance decreased, on average, ≥10% during RDN, and, alternatively, on whether the average maximal temperature of the electrode was ≥50 C.

Results
Of 65 treated patients 52 with quality recordings of the electrophysiology parameters during RDN completed 6-month follow-up. The mean 24-h systolic BP decreased significantly after RDN by −14.3 mmHg [95% CI: −8.7; −19.9]. The BP lowering was positively and significantly related to the decrease in impedance during RDN, r=0.35, p=0.013 and to less extent to the maximal electrode temperature, r=0.29, p=0.044. The 10% average drop in impedance predicted -9.9 mmHg decrease in 24-h mean systolic BP. According to group analysis the decrease of mean 24-h systolic BP was powerful in those with average decrease in impedance ≥10% during RDN (“successful” procedure), but almost zero otherwise: −19.9 [95% CI: −13.7; −24.5] vs −0.5 [95% CI: −11.9; 12.9] mmHg, respectively (raw estimates), p=0.003. The difference in BP lowering was less pronounced and non-significant when the procedural “success” was defined according to the average maximal electrode temperature.

Conclusions
The impedance decrease during radiofrequency RDN treatment may be an effective criterion of the procedural success of the intervention. Guiding radiofrequency RDN by the impedance drop 10% or greater may significantly improve the efficacy of the procedure.

Funding Acknowledgement
Type of funding source: None
Effect of short-term exposure to indoor particulate matter on noctunal blood pressure dipping among hypertensive adults in ibadan: a pilot study
Authors: Adeoye A.M , Fakunle A , Aderonmu O , Tayo B 
Published: November 2020

Abstract

Introduction
While blunted nocturnal blood pressure is a major risk factor for cardiovascular events, limited information exist on the association between indoor particulate and circadian blood pressure variation. We report the association of short-time exposure to PM2.5 and PM10 with blunted nocturnal blood pressure among hypertensive adults in Ibadan.

Purpose
This study was to determine the association between short time exposure to air particulates and blunted nocturnal blood pressure among people of African descent.

Methods
We conducted a cross-sectional study among fifty hypertensive cases attending our University College Hospital. A 24-hours blood pressure (BP) monitoring was carried out at the same time as indoor particulate matter monitoring in their homes. Exposure to indoor fine particles (PM2.5) and thoracic particles (PM10) was estimated using a real-time particle counter and compared to the World Health Organization (WHO) 24-hours threshold of 25 μg/m3 and 50 μg/m3 for PM2.5 and PM10 respectively. All monitoring was carried out over a 24-hours period during the wet season. Linear regression model was fitted to determine predictors of non-dipping hypertension.

Results
Of the 50 hypertensive patients studied, 5 (10.0%), 39 (78.0%), 6 (12.0%) were reverse dippers, non-dippers and dippers respectively. The mean indoor PM2.5 (44.17±19.18 μg/m3) and PM10 (60.10±27.13 μg/m3) among the non-dippers were significantly higher than values obtained among dippers (PM2.5 = 22.97±10.19 μg/m3; PM10 = 29.51±12.74 μg/m3); p&lt;0.0001, and the WHO threshold limit. More non-dippers than dippers (54.5% vs 37.8%) used unimproved fuel such as firewood for cooking. PM10 was an independent predictors of non-dipping status in our regression analysis.

Conclusion
Short-term exposure to indoor PM air pollution was associated with blunted nocturnal blood pressure. Therefore air pollution reduction strategies through improved cooking pattern is advocated in order to prevent future cardiovascular events.

Funding Acknowledgement
Type of funding source: None
Clinical genetics involved in monogenic forms of hypertension in Chinese patients with early-onset hypertension and hypokalemia
Authors: Fan P , Zhang D , Yang K.Q , Zhang Y , Lu Y.T , Luo F , Tian T , Liu Y.X , Zhou X.L 
Published: November 2020

Abstract

Background
Monogenic forms of hypertension are regarded as a group of conditions characterized by early-onset and resistant hypertension, electrolyte imbalance. These alterations stem from single mutations that lead to maladaptive excretion of potassium, and consequent hypokalemia.

Purpose
This study aimed to analyze genes involved in monogenic forms of hypertension and clinical features in Chinese patients with early-onset hypertension and hypokalemia.

Methods
A total of 129 unrelated Chinese patients (89 male and 40 females; average onset age of hypertension 25±5 years) with early-onset hypertension and hypokalemia. Patients with hypertension secondary to common causes, including renal disease and renovascular disease, aortic diseases, and obstructive sleep apnea were excluded. Genomic DNA were extracted from peripheral blood leucocytes of each subject. Using next-generation sequencing, we targeted and sequenced 42 genes related to monogenic forms of hypertension. All rare variants were confirmed by Sanger sequencing.

Results
We detected 63 rare variants in 23 genes in 52 patients (40.3%). The variants in genes associated with pseudohypoaldosteronism, familial aldosteronism, pheochromocytoma or paraganglioma, and pseudohyperaldosteronism accounted for 22.2%, 23.8%, 20.6% and 11.1% respectively. Patients with rare variants had a significantly lower serum potassium (2.94±0.21 vs. 3.30±0.24 mmol/L, P&lt;0.001) and family history of hypertension (67.3% vs. 31.2%, P&lt;0.001). During 24±7.9 months of follow-up, several complication occurred, including stroke in 22 patients, coronary heart disease in 10, and chronic renal failure in 10. Factors associated with stroke were carrying rare variants (HR=4.371, 95% CI: 1.709–11.181, P=0.002), systolic blood pressure (HR=1.015, 95% CI: 1.004–1.037, P=0.015).

Conclusions
This study revealed a wide genetic spectrum in Chinese patients with early-onset hypertension and hypokalemia. Genetic testing helps to differentiate the diagnosis of monogenic forms of hypertension in patients with hypertension and hypokalemia, and evaluates prognosis. Those patients carrying rare variants presented with a high risk of severe complications, stroke and needed close follow-up.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): CAMS Innovation Fund for Medical Sciences; the National Key Research and Development Program of China
Prediction of 10-year and lifetime risk of cancer in individual patients with established cardiovascular disease, results from UCC-SMART and CANTOS
Authors: Van 't Klooster C.C , Ridker P.M , Cook N.R , Aerts J.G.J.V , Westerink J , Asselbergs F.W , Van Der Graaf Y , Visseren F.L.J 
Published: November 2020

Abstract

Background
As treatment for cardiovascular disease (CVD) has improved substantially over the last decades, more patients survive acute CVD manifestations and are at risk for developing cancer as well as recurrent CVD. Due to similar risk factors, including smoking and obesity, patients with established CVD are at higher risk for cancer.

Objectives
The aim of this study was to develop and externally validate prediction models for the estimation of 10-year and lifetime risk for total, colorectal, and lung cancer in patients with established CVD.

Methods
Data from patients with established CVD from the UCC-SMART prospective cohort study (N=7,280) were used for model development, and data from the CANTOS trial (N=9,322) were used for model validation. Predictors were selected based on previously published cancer risk prediction models or cancer risk factors, easy clinical availability, and availability in the derivation dataset (UCC-SMART cohort). A Fine and Gray competing risk-adjusted lifetime model was developed for total, colorectal, and lung cancer.

Results
Selected predictors were age, sex, smoking status, weight, height, alcohol use, antiplatelet use, diabetes mellitus, and C-reactive protein. External calibration for 4-year risks of the total cancer, colorectal cancer, and lung cancer models was good (Figure 1), and C-statistics were 0.63–0.74 in the CANTOS trial population. Median predicted lifetime risks in CANTOS were 26% (range 1%-52%) for total cancer, 4% (range 0%-13%) for colorectal cancer, and 5% (range 0%-37%) for lung cancer.

Conclusions
Lifetime and 10-year risk of cancer can be estimated with easy to measure variables in patients with established CVD, showing a wide distribution of predicted lifetime risks for total cancer and lung cancer. Using these lifetime models in clinical practice could increase understanding of cancer risk and aid in emphasizing healthy lifestyle changes.
Figure 1. Calibration plots of cancer models

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University Medical Center; Additional funding: CANTOS trial was funded by Novartis Pharmaceuticals.
Malaria and cardiovascular disease: a systematic review
Authors: Holm A , Gomes L.C , Biering-Soerensen T , Silvestre O , Brainin P 
Published: November 2020

Abstract

Background
Myocardial tissue appears to be a favored site for the malaria parasite, and several studies have suggested that malaria may lead to myocardial dysfunction. Therefore, we conducted a systematic review of clinical studies reporting on malaria and cardiac disease.

Methods
We searched PubMed and Embase through January 2020. We applied strict inclusion criteria (Figure 1A) and assessed studies reporting on verified cardiac disease by paraclinical tests, ECG, cardiac biomarkers and echocardiographic findings. Two reviewers independently screened articles, extracted data and assessed the PRISMA guidelines.

Results
Twenty-eight articles were identified (published 1954–2020; n=19 case-reports, n=5 cohort studies, n=4 cross-sectional studies; Figure 1B), of which most were conducted in India (n=11) and Germany (n=4). The studies included a total of 2,221 malaria cases (mean age 42 years; 67% men; 41% complicated infection) and the distribution of species were: Plasmodium falciparum (n=15), vivax (n=12) and knowlesi (n=1). The most commonly reported cardiac diagnoses in case-reports were myocarditis (n=9), pericarditis (n=3) and acute myocardial infarction (n=4). Although the cohort and cross-sectional studies reported on different cardiac parameters (Figure 1C), a majority showed that malaria cases more often had elevated levels of cardiac biomarkers, ECG alterations and reduced left ventricular ejection fraction when compared to controls (P&lt;0.05 for all).

Conclusion
Studies reporting on malaria and cardiovascular disease display considerable heterogeneity in terms of study design, severity and outcome measurements. Despite this, the included studies demonstrate a potential link between malaria and cardiac disease. This should be explored in future and larger hypothesis generating clinical studies.
Figure 1

Funding Acknowledgement
Type of funding source: None