bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of radiofrequency RDN may be significantly improved if the procedure is guided by impedance drop during the treatment
Authors: Pekarskiy S , Baev A , Tarasov M , Mordovin V , Falkovskaya A , Zubanova I 
Published: November 2020

Abstract

Background
Experimental studies of radiofrequency renal denervation (RDN) have shown a strong relation of the depth of structural lesions and completeness of renal nerve injury to the relative drop in impedance during the treatment caused by the increased permeability of the cell membranes. Thus, the otherwise successful treatments but with low impedance drop may be, in fact, totally ineffective.

Objective
We assessed the relation between impedance drop during single radiofrequency treatments and local structural changes of vascular wall at the electrode positions using optical coherence tomography.

Methods
Optical coherence tomography of the treated segments was performed during radiofrequency RDN in 14 patients with resistant hypertension. The parameters of contrast injection depended on the position of the guiding catheter: for selective branch imaging 15 ml volume was injected at 8 ml/sec speed; otherwise 30 ml of contrast was injected at the speed 15 ml/sec to flush the whole renal artery. Automatic pullback of the sensor was done with the standard speed 20 mm/sec. In total, 423 mm of treated segments in 22 renal vessels (mostly distal branches) had sufficient quality of imaging and were studied for structural changes.

Results
There was almost no local structural changes of the arterial wall after the treatments with low impedance drop &lt;10% reflecting a rather weak heating of even superficial tissue layers. No effect on the deeper tissue layers is expected in this case because these layers are heated almost exclusively by the heat transfer from superficial layer. In contrast, the treatments with the impedance drop 10% or greater were able to significantly affect the arterial structure causing local edema, small dissections, and local thrombi formation as a result of significant resistive heating of the superficial tissue, and, therefore, high potential for heating of the deep layers containing the renal nerves. Only approximately 40% of the point treatments had the impedance drop 10% or greater suggesting adequate lesion depth and sufficient completeness of renal nerve injury. This may indicate a rather low procedural efficacy of the current mode of radiofrequency RDN due to a large proportion of small-depth treatments marked by only a few percent decrease in impedance yet considered fully “successful”. Also, it means a potential for significant increase in the efficacy of radiofrequency RDN through controlling/guiding the treatment by the impedance drop.

Conclusion
Our study shows that variable efficacy of radiofrequency RDN may be explained by a significant proportion of the small-depth point treatments ineffective in terms of renal nerve injury, and, thereby, may be significantly improved if the procedure is guided by the impedance drop during the treatment.

Funding Acknowledgement
Type of funding source: None
Stroke, systemic embolism and bleeding rate in non-valvular atrial fibrillation patients without anticoagulation on the real world data in Japan
Authors: Tanizawa K , Nishimura Y , Okada A , Nishikawa M , Tamaru S , Nagai N 
Published: November 2020

Abstract

Background
Anticoagulant therapy is recommended in patients with non-valvular atrial fibrillation (NVAF) for those with CHADS2 ≥2. However, there have been significant number of subjects with CHADS2 ≥2 who receive no anticoagulation. Most of reported real world data have been collected mainly before wide spread use of DOAC. This study evaluated the clinical outcome of no anticoagulant drug therapy in NVAF.

Methods
This study is a non-interventional, observational, retrospective cohort study of NVAF patients in Mie-LIP Database, which is a regional clinical database joining 1 university hospital and 8 general hospitals in Mie prefecture in Japan. Patient enrolment was conducted from 1st Jan. 2016 to 31st Dec. 2018. The primary outcome events are ischemic stroke, systemic embolism, and bleeding events (bleeding to need a blood transfusion, intracranial bleeding, intraocular bleeding, and gastrointestinal bleeding).

Results
7001 patients were included in the current analysis, 2550 patients, 36.4% were treated without any anticoagulant drug therapy. Table 1 shows patients with no anticoagulant drug therapy, mean age was 75.4 years and 42.2% of patients were female. The most frequent comorbidities included hypertension (50.0%), diabetes mellitus (28.2%), heart failure (14.0%), ischemic stroke (12.7%), vascular disease (14.4%) respectively. The annual incidence of ischemic stroke, systemic embolism per 100 person-years is 3.7, and that in each CHADS2 group is 0: 1.4, 1: 1.4, 2: 3.2, 3–6: 8, respectively in Figure 1. The annual incidence of bleeding events is 1.5, and that in each CHADS2 group is 0: 0.7, 1: 1.0, 2: 1.2, 3–6: 2.9, respectively.

Conclusions
Approximately one-thirds of subjects have not received any anticoagulation in the modern DOAC in daily clinical practice in Japan. The rate of ischemic stroke and systemic embolism increased by CHADS2. Stroke or SEE rate was very low in subjects with CHADS2 ≤1, supporting no indication of anticoagulation in current guidelines. Regarding subjects with CHADS2&gt;2, considering the higher risk of stroke, use of anticoagulant drug therapy is recommended.

Funding Acknowledgement
Type of funding source: None
10 years observation study of low and moderate cardiovascular risk hypertensive patients: the impact of anxiety and depression level in development of cardiovascular complications
Authors: Smirnova M.D , Blankova Z.N , Barinova I.V , Fofanova T.V , Svirida O.N , Ageev F.T 
Published: November 2020

Abstract

Not only “classic” risk factors such as age, sex, smoking status, blood pressure (BP) and cholesterol (HS) levels, but also additional factors, one of which is the psychological status of the patient, need to be considered to improve the prediction of cardiovascular complications. This is especially true for low/moderate risk patients on the SCORE scale, whose risk of cardiovascular complications (CVC) is often underestimated.

Aim
To assess the contribution of psychological status of hypertensive patients and SCORE&lt;5% to increase the risk of development of cardiovascular complications for a period of 10 years of observation.

Materials and methods
In 2009, 142 hypertensive patients with SCORE risk &lt;5% (37 men and 105 women) in addition to the clinical examination, were interviewed on the HADS scale to assess the level of anxiety and depression. In 2019, these patients were interviewed by phone for CVC suffered over the past 10 years: all-cause mortality, cardiovascular death (CVD), fatal and nonfatal myocardial infarction (MI), stroke, revascularization, hospitalization for cardiac events.

Results
At the time of inclusion in the study, the age of the patients was 50, 9±8.2 years. At the first visit systolic BP (SBP) level was 130.0 (128.4; 133.7) mm Hg and diastolic BP (DBP) 80.0 (81.3; 84.5) mm Hg. The HS level was 6.1 (5.9; 6.3) mmol/L, triglycirides 1.4 (1.5:1.8) mmol/L, low dencity lipoproteins 3.8 (3.6; 4.0) mmol/L, high density lipoproteins 1.3 (1.4; 1.5) mmol/L. Level of anxiety (A) was 7.0 (7.0; 8.2) points, depression (D) – 5.7 (5.2; 6.2) points. The patients without the expressed symptom of D (0–7 points) – 76.8% (n=109), A (0–7 points) – 52% (n=74). The patients with clinically significant D (&gt;11 points) – 8.5% (n=12), A (&gt;11 points) – 18.3% (n=26). 2 CVD occurred in the observed group in 10 years (1.4%), 6 MI, 12 percutaneous coronary intervention (8 acute coronary syndrome), 4 strokes, 34 cardiovascular hospitalizations. 14 new onset cases of coronary artery disease (9.6%). Thus 31.7% of observed patients had CVC.
Comparison of the initial data of the group with CVC with the group without CVC revealed a difference only in the level of D: 7.0 (5.6; 7.3) points in patients with CVC vs 5.0 (4.7; 5.8) p=0.04) – Fig. 1. The patients were comparable in sex and age. BP, lipid profile, glucose, heart rate, smoking status, levels of A did not differ significantly. Multi-factor regression analysis has demonstrated that depression levels D is an independent predictor of the development of complications in a model involving age, sex, BP, HS and A (β=0,218, p=0,03).

Conclusion
Level D is an independent risk factor development of CVC in hypertensive patients low/moderate risk on SCORE.

Funding Acknowledgement
Type of funding source: None
Depression and risk of atrial fibrillation: a nationwide population-based study
Authors: Choi J , Lee K.N , Kim Y.G , Jeong J.H , Choi H.Y , Choi Y.Y , Shim J , Na J.O , Choi C.U , Han K.D , Kim Y.H 
Published: November 2020

Abstract

Background
Although treatments of atrial fibrillation (AF) based on the biological mechanisms for initiation and maintenance of AF improve cardiovascular outcomes, psychosocial factors have been also implicated in the etiology and progression of cardiovascular disease.

Objective
We aimed to evaluate the association between depression and incident AF using nationwide database from the National Health Insurance Service in South Korea.

Methods
A total of 9,075,224 participants with data of national health checkup in 2009 were included, and participants who were diagnosed with AF before the examination were excluded. Exposure to depression is determined by the precedence of depression diagnosed within 2 years.

Results
Depression was diagnosed in 1.37% (124,709) of participants at baseline. Compared to the non-depression group, depression group was likely to be female and had higher comorbidities. After adjusting covariates, depression group had a higher risk of incident AF compared with non-depression group (hazard ratio, 1.30; 95% confidence interval, 1.26–1.34). Repeated exposure to depression increased a risk of incident AF (Figure 1).

Conclusion
Depression was associated with an increased risk of new-onset AF. This association was stronger for patients who had more burden of depression. Future studies should investigate whether early treatment of depression can prevent incident AF.
Figure 1

Funding Acknowledgement
Type of funding source: None
The effect of physical activity enlargement on anthropometric parameters and blood lipids depending on genetic polymorphisms of beta-2 and beta-3 adrenoreceptors
Authors: Isayeva G.S , Shalimova A , Vovchenko M , Buriakovska O , Galchinska V 
Published: November 2020

Abstract

Background
Assessment of genetic factors, which determine the effect of physical exercise, allows to identify individuals that are not susceptible to positive effects of enlargement of physical activity.
The aim of the study was to assess the effect of enlargement of physical activity on anthropometric parameters and blood lipids in individuals without cardiovascular diseases.

Methods
One hundred ten persons, mean age 41.1±8.1 y.o. were included in the study. Blood pressure, body mass index, fat to muscular ratio (bioimpedance method), blood lipids and glucose levels, eating habits were assessed before and after 6 month of physical activity enlargement. Patients were instructed how to increase physical activity and their activity was monitored monthly with the pedometer and with “International Questionnaire on Physical Activity”. Genotyping of polymorphic sites of ADRB2 (C531G, rs1042714 and A46G, rs1042713) and ADRB3 (T190C, rs4994) genes was done with real-time polymerase chain reaction. Statistical analysis was performed in SPSS 17 (IBM).

Results
It was found out that carries of AA+AG genotypes of A46G polymorphism of ADRB2 gene and TT genotype of T190C polymorphism of ADRB3 gene had significant reduction of fat tissue and rise of muscular tissue proportion as well as a rise of muscular strength. Higher level of physical activity was associated with reduction of low-density cholesterol in carries of TT genotype of T190C polymorphism of ADRB3 gene and carries of AA+AG genotypes of A46G polymorphism of ADRB2 gene (Table 1).

Conclusion
Carrying of AA+AG genotypes of A46G polymorphism of ADRB2 gene and TT genotype of T190C polymorphism of ADRB3 gene is associated with significant decline of proportion of fat tissue and decrease of low-density cholesterol after physical activity enlargement.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): L.T. Mala National Institute of Therapy
Serum copeptin is a new biomarker of continuous-positive-airway-pressure treatment in severe obstructive sleep apnea
Authors: Sekiguchi H , Ishida I , Suzuki M , Hagiwara M 
Published: November 2020

Abstract

Introduction
Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker which has been reported to be increased in cardiovascular and cerebrovascular diseases, thus playing a role in predicting their prognosis. Patients with obstructive sleep apnea syndrome (OSA) have been demonstrated to have a high risk for developing these vascular diseases. However, there have been no authentic reports concerning the effect of continuous positive airway pressure (CPAP) on serum copeptin levels in OSA patients.

Purpose
We hypothesis that CPAP treatment substantially modifies copeptin levels in OSA patients.

Methods
A total of 60 OSA patients confirmed by polysomnographic examinations was divided into two groups: a mild-moderate OSA (apnea-hypopnea index: AHI &lt;30/h) group and a severe OSA (AHI ≥30/h) group. Blood samples were collected early in the morning after overnight fasting, and serum copeptin and ADH levels were measured with an enzyme immunoassay method. In patients initiated with CPAP, hormone levels were measured before and after CPAP treatment.

Results
Twenty-one patients (age: 54.7±12.4 y, male: 17, NT-proBNP: 45.3±44.2 pg/mL) were diagnosed as having mild-moderate OSA (AHI: 16.5±8.4/h), while 39 patients (age: 57.8±11.4y, male: 29, NT-proBNP: 73.7±87.3 pg/mL) were diagnosed as severe OSA (AHI: 49.5±21.1/h). As a whole, there were no significant differences in copeptin and ADH levels between mild-moderate OSA and severe OSA groups (copeptin: 2.1±1.4 pmol/L vs. 1.9±1.4, ADH: 2.3±2.6 pg/dL vs. 2.0±0.7). In 26 severe OSA patients (age: 55.9±12.9y, male: 23, NT-proBNP: 63.3±85.2 pg/mL), these hormones were again evaluated after CPAP initiation. AHI was significantly improved after CPAP treatment (45.5±20.8/h vs. 5.0±5.0, P&lt;0.01). Although the ADH level was changed from 1.85±0.77 pg/dL to 1.68±0.99, the difference did not reach the statistical significance. The copeptin level was certainly decreased after CPAP by 26% (2.29±2.63 pmol/L vs. 1.69±1.68, P&lt;0.01) (Figure 1).

Conclusions
Serum copeptin levels decreased after CPAP treatment in patients with severe OSA. Copeptin, but not ADH, can be considered as a new biomarker for predicting cardio/cerebrovascular events in severe OSA patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
Validation and comparison of six risk scores for post acute myocardial infarction infection
Authors: Liu Y.H , Wang L.T , Dai Y.N , Zeng L.H , Fan H.L , Duan C.Y , Tan N , Chen J.Y , He P.C 
Published: November 2020

Abstract

Background
Various risk scores have been proven to predict outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, few of them were validated and compared the difference of the prediction of infection during hospitalization in such patients.

Aim
We aimed to validate and compare the discriminatory value of different risk scores for predicting infection.

Methods
Patients who were diagnosed with STEMI treated with PCI were enrolled from January 2010 to May 2018. The six risk scores included the Age, Serum Creatinine (SCr), or Glomerular Filtration Rate, and Ejection Fraction (ACEF or AGEF) score, Canada Acute Coronary Syndrome Risk Score (CACS score), CHADS2 score, Global Registry for Acute Coronary Events (GRACE) score and Mehran score. The primary end point was infection during hospitalization. The secondary endpoint was major adverse clinical events including all cause death, stroke and any bleeding. The prognostic accuracy of the six scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration.

Results
A total of 2260 eligible patients were enrolled (62.32±12.36 year, 81.3% of males). A significant gradient of risk with respect to infection and in hospital major adverse clinical events (MACE) was observed with increasing all six risk scores. Other than the CHADS2 score (AUC: 0.682; 95% CI, 0.652–0.712), other five risk scores showed the good discrimination for predicting infection, with the GRACE score being the best (AUC: 0.791; 95% CI, 0.765–0.817). In addition, all risk scores showed best calibration for infection, but good calibration for CACS risk score (calibration slope: 0.77, 95% CI: 0.18–1.35) (Figure 1). Furthermore, each score showed a best discrimination for in hospital MACE, with AUCs ranging from 0.761 to 0.786, other than CACS risk score and CHADS2 risk score with AUC of 0.700 and 0.696, respectively. All risk scores showed best calibration for in hospital MACE.

Conclusions
In patients with STEMI undergoing PCI, these risk scores (ACEF, AGEF, CACS, GRACE and Mehran) showed good discrimination and calibration to predict infection and MACE. The CACS score was recommended for clinical use as its clinical variables were simple and practical.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Science Foundation for Young Scientists of China
Evaluating the sensitivity of the ACC/AHA pooled cohort risk calculator to predict atherosclerotic cardiovascular events within 10 years: how many events are we failing to predict?
Authors: Medina-Inojosa J , Somers V.K , Hayes S , Mankad R , Lopez-Jimenez F 
Published: November 2020

Abstract

Background
The ACC/AHA Pooled Cohort Equation (PCE) for atherosclerotic cardiovascular disease (ASCVD) has been recommended as the initial step in cardiovascular risk assessment. The sensitivity of this tool to detect those who will develop ASCVD within 10-years, while considering age and sex groups, has not been extensively studied.

Methods
Using the Rochester Epidemiology Project (REP) we evaluated a community-based cohort of consecutive patients that sought primary care in Olmsted County, MN, between the years 1998–2000 and were followed up through March 1st 2016. Inclusion criteria were ages 40–79 and complete data to calculate the PCE. We excluded those with known ASCVD, atrial fibrillation or heart failure. Criteria were similar to those used to derive the PCE. Events were validated in duplicate and included fatal and non-fatal myocardial infarction and ischemic stroke. Patient information was ascertained using the record linkage system of the REP. Follow-up was truncated at 10 years. We assessed the ASCVD predicted risk (categorized as low &lt;5%, intermediate 5–9.9%, high 10–19.9%, and very high ≥20% risk) at baseline, in subjects having an ASCVD event within 10-years in the community across age (&lt;65 years) and sex categories. We also categorized ideal cardiovascular health as ≥4 metrics [non-smoker, body mass index &lt;25 kg/m2, and not having of elevated blood pressure (≥130/80 mmHg), LDL cholesterol (&gt;100 mg/dL), or fasting blood glucose (&gt;100 mg/dL), in the absence of a medical diagnosis or treatment].

Results
We included 30,042 adults, mean ± SD age 48.5±12.2 years, 54% women, with a median follow-up of 16.5±5.3 years. There were 1,555 ASCVD events (5.2%) at 10 years of follow-up. The performance of the PCE was similar to what was described in the original report (0.78 vs 0.79). Overall, among those who suffered an ASCVD, 54% of women and 41% of men were not high risk as predicted by PCE (Figure 1A). Most women (73%) &lt;65 years of age would had been considered low risk within 10-years before the event, and only 10% would have been considered to be high risks (Figure 1B). Nonetheless, women &lt;65 years who had an ASCVD event and low 10-year predicted ASCVD risk by PCE were less likely to have ideal cardiovascular health [55 (0.40%) vs 3884 (28.39%), p-value&lt;0.0001], when compared to women in the low risk category without an event.

Conclusion
The PCE fails to identify most women who will develop an ASCVD event, particularly women &lt;65 years of age. These results underscore the importance of using additional information when estimating ASCVD risk among women and the need for better cardiovascular risk prediction tools.
Figure 1

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Mayo Clinic
Utilization of Guidelines-recommended secondary cardiovascular preventive medications in a decade or more survivors after coronary revascularization in the Middle East; analysis form the DECADE PLUS S
Authors: Hammoudeh A , Qabbaa L , Alhaddad I.A , Izraiq M , Jarrah M , Shami D , Hattar M , Dahabreh Z , Al-Jarrah M , Othman A , Al-Kouz M , Shahwan Y , Alfawara M 
Published: November 2020

Abstract

Background
There is scarcity of studies from the Middle East had address the use of guideline-recommended secondary cardiovascular prevention medications among individuals who survived at least one decade after coronary revascularization (CR) by percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG).

Purpose
An objective of the DECADE-PLUS study was to evaluate the use of antiplatelet agents (APA), statins, beta blockers (BB) and renin-angiotensin system inhibitors (RASI) in such patients.

Methods
We enrolled consecutive patients seen at ambulatory or in-patient settings with the following inclusion criteria: patient had PCI or CABG &gt;10 years ago, age &gt;18 years at the time of the index CR, and availability of data of currently used medications.

Results
Of 892 patients enrolled, 600 (67.3%) had PCI and 292 (32.7%) had CABG. Patients had CR &gt;20 years ago (100; 11.2%), 11–19 years ago (536; 60.1%) or 10 years ago (256; 28.7%). Women comprised 13.8% of the whole cohort, and mean age at index CR was 53.4+9.4 years. Hypertension, diabetes mellitus, and dyslipidemia were present in 398 (44.6%), 351 (39.3%) and 290 (32.5%), respectively at the time of CR. Overall, aspirin was used in 745 (83.5%), and a second APA in 329 (36.9%). Statins, BB and RASI were used in 83.7%, 71.7% and 54.3%, respectively. Univariate analysis of predictors of lower rates of use of these medications showed that survival time (10 years vs. &gt;20 years), and revascularization type (PCI vs. CABG) had no impact on use of these medications. However, nondiabetics were less often prescribed second APA (odds ratio (OR) 0.78, p=0.005) and RASI (OR 0.85, p=0.007) compared with diabetics. Furthermore, compared with men, women were less often prescribed aspirin (OR 0.66, p&lt;0.0001), statin (OR 0.67, p&lt;0.0001), BB (OR 0.71, p=0.005), and RASI (OR 0.79, p=0.005).

Conclusion
Middle East patients surviving at least one decade after coronary revascularization have a high rate of utilization of secondary cardiovascular medications compared with western data. However, women and non-diabetic individuals have lower rate of use of these medications compared with diabetics and men, respectively. Larger studies are warranted to explore the reasons behind these discrepancies and thus represent potential targets for positive intervention.

Funding Acknowledgement
Type of funding source: None