bluuebunny/crossref_metadata_2025_split huggingface dataset:
sST2 is a promising biomarker in hypertensive patients undergoing renal denervation
Authors: Topf A , Paar V , Grueninger J , Wernly B , Weber T , Mahfoud F , Lichtenauer M , Hoppe U , Brandt M , Motloch L.J 
Published: November 2020

Abstract

Introduction
Therapy resistant arterial hypertension (raHTN) is a major clinical burden. While therapeutic alternatives are still missing, novel interventional procedures like renal denervation (RD) are still evolving. Indeed, despite discoursing results of the Simplicity HTN-3 trial, new promising results resulted in a revival of this procedure. Therefore, predictors for the success of future interventions would be of great clinical benefit. The novel biomarker sST2 shows promising results for risk stratification of cardiovascular patient. While, sST2 belongs to the IL-1 receptor family, it has an influence on immunologic processes with consequent cardioprotective effects including prevention of myocardial hypertrophy and fibrosis indicating predictive potential in hypertensive heart disease. Nevertheless, clinical implementation of this promising biomarker was not investigated in patients with raHTN undergoing RD.

Purpose
To investigate a potential clinical relevance of sST2 in patients with raHTN undergoing RD.

Methods
We evaluated 58 patients with raHTN (age: 63±11 years, systolic blood pressure at baseline: 178±24mmHg) undergoing bilateral RD. If available, serum levels of sST2 were analyzed at baseline as well as at follow-up at one and/or three month.

Results
While RD was able to decrease blood pressure levels after one month (systolic blood pressure at one month: 158±21mmHg, p&lt;0.01), on echocardiography a reduction of left ventricular mass (LVM) was observed at one month with a further significant reduction at three month (LVM at baseline: 233±68g, LVM at one month: 218±59g and LVM at three month: 181±59, p&lt;0.01). This observation was accompanied by a significant decrease of sST2 levels at three month (sST2 baseline: 6322±3578pg/ml vs. sST2 three month: 4704±1586pg/ml, p=0.02). Furthermore, baseline sST2 was positively correlated with systolic blood pressure at one month, measured either at office (r=0.57, p&lt;0.01) or invasively in the aorta (r=0.49, p=0.03) indicating a potential predictive value of this biomarker.

Conclusion
In patients with raHTN, RD is associated with a significant decrease of sST2 levels, indicating sST2 to be involved in remodeling processes after RD. Furthermore, sST2 levels at baseline might be a potential predictor of intervention success of RD. Further, studies need to investigate the association of sST2 levels and RD.

Funding Acknowledgement
Type of funding source: None
When to expect cognitive disorders in hypertension
Authors: Khomazyuk T , Krotova V.U 
Published: November 2020

Abstract

In large-scale clinical studies, age, arterial hypertension (AH), multi-focal atherosclerosis, and cognitive disorders (CD) are interrelated, affecting the level of disability, quality of life, and social adaptation of patients with cardiovascular diseases.

Aim of the study
To determine the prognostic criteria for cognitive disorders in patients with hypertension.

Methods
To achieve the aim of the study, the examinations were performed in 182 outpatients with AH II stage, 34–68 years, in 164 of them were CD according to neuropsychological tests of MMSE and MoCA, mostly of mild and moderate degree. The relationship between clinical data, cognitive function characteristics and daily monitoring data of hypertension were evaluated. The data obtained were analyzed using medical methods statistics.

Results
Among factors such as age (&gt;60 years), gender (male / female), disease duration (&gt;10 years), waist circumference, overweight or obesity, hypercholesterolemia, no influence on the development of CD was detected (p&gt;0.05)). Risk factors for the development of CD in hypertension were an burdensome history of CD in closest relatives (2.79 (95% CI 1.15–6.77) relative to practically healthy individuals and 2.41 (1.01–5.88)), high vegetative index (rs +0,15; p&lt;0,05).
The correlation between CD and high rates of blood pressure variability according to daily monitoring of blood pressure in patients with hypertension, even under conditions of blood pressure control, is confirmed by the results of correlation and one-factor logit analysis. Thus, elevated levels of systolic blood pressure variability in the day and at night increased the chances of developing CD in patients with hypertension by 2.11 times, (rs = +0.57 and rs = +0.61; p&lt;0.001). It was found that the likelihood of developing cognitive impairment exceeds 50% (high risk) if the level of systolic blood pressure variability is above 12 mm Hg in the day (area under ROC curve AUC = 0.891; 95% CI 0.883–0.940. (AUC = 0.891; 95% CI 0.883–0.940; ST = 82.5% and SP = 92.9%) and at night over 10 mm Hg (AUC = 0.922; 95% CI 0.861–0.963; ST = 82.5% and SP = 85.7%) according to daily blood pressure monitoring.

Conclusion
The prognosis for the development of cognitive impairment in arterial hypertension is influenced by: evidence of family CD history, autonomic nervous system index and variability of day and night blood pressure characteristics, according to ambulatory daily monitoring data.

Funding Acknowledgement
Type of funding source: None
Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study
Authors: Ogawa H , Sekiguchi H , Jujo K , Kawada-Watanabe E , Arashi H , Yamaguchi J , Hagiwara N 
Published: November 2020

Abstract

Background
There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial.

Methods
HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of &lt;130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up.

Results
During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP.

Conclusions
The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD.
Figure 1

Funding Acknowledgement
Type of funding source: None
Non-psychotic mental disorders in adolescent men and risk of myocardial infarction: a national cohort study
Authors: Bergh C , Oasti Z , Montgomery S 
Published: November 2020

Abstract

Background/Purpose
Recent studies show that early life stress is associated with later risk of cardiovascular disease (CVD) and stress may also increase the risk of psychiatric disease. We investigated the association between non-psychotic mental disorders in adolescence and subsequent myocardial infarction, and the role of stress resilience and physical fitness in this association.

Method
This is a register-based cohort study with 238 013 males born between 1952 and 1956 followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semi-structured interview with a psychologist. Physical fitness was measured at conscription examination with a cycle ergometer test. A total of 34 503 men were diagnosed with a non-psychotic mental disorder at conscription. Using Cox regression, we estimated the association of mental disorders with myocardial infarction after adjustment for other established CVD risk factors in adolescence. Stress resilience and physical fitness were included in the adjusted model in a second set of analyses.

Results
A total of 5891 diagnoses of first myocardial infarction were identified. Non-psychotic mental disorders were associated with an increased risk of myocardial infarction, with a hazard ratio (HR) and confidence interval (CI) of 1.51 (1.41–1.62). The association remained statistically significant after adjustment for other important potential confounders in adolescence such as systolic and diastolic blood pressure, body mass index, inflammation, cognitive function, parental socioeconomic index and a summary disease score (HR 1.24 (CI 1.13–1.35)). The association was further explained by stress resilience and lifestyle factors assessed with a cardiovascular fitness test in adolescence, as the association attenuated but remained statistically significant when further adjusting for stress resilience and physical fitness (HR 1.18 (CI 1.08–1.29)).

Conclusion
A non-psychotic mental disorder in adolescences may increase the risk of developing myocardial infarction later in life. This association was partly but not completely explained by poorer stress resilience and physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress in early life.

Funding Acknowledgement
Type of funding source: None
Phenotypic difference of sarcopenia in the prediction of mortality for elderly patients with heart failure: from CURE-HF registry
Authors: Kanai M , Motoki H , Okano T , Kimura K , Minamisawa M , Yoshie K , Kato T , Saigusa T , Ebisawa S , Okada A , Kuwahara K 
Published: November 2020

Abstract

Background
Sarcopenia and malnutrition are associated with mortality in elderly patients with heart failure (HF). However, impact of phenotypic difference of sarcopenia on mortality is not well investigated. We hypothesized that evaluation using both body mass index (BMI) and free-fat mass index (FFMI) enabled distinction of phenotypic difference of sarcopenia and risk stratification for mortality in elderly patients with heart failure.

Methods
In 800 patients who discharged after treatment for HF were prospectively enrolled from 13 medical centers. Body mass index and FFMI was evaluated. Free-fat mass index was calculated dividing the square of the patients' heights in meters into lean body mass. All-cause mortality was followed-up. Patients were divided into 3 subgroups according to BMI and FFMI values, and compared incidence of mortality among them.

Results
In our study cohort (median age, 78 [range 72–87]), BMI was 21.1 [18.9, 23.8] and FFMI was 16.7 [15.2, 18.0]. 211 patients were experienced all-cause mortality during 631 [266, 983] days follow-up. In Kaplan-Meier analysis, lower BMI and lower FFMI was associated with all-cause mortality (Log-rank p&lt;0.001, p&lt;0.001, respectively). Furthermore, FFMI was an independent predictor of adverse events after adjustment for age, gender, albumin, hemoglobin, creatinine, brain natriuretic peptide, and left ventricular ejection fraction (HR 95% CI: 0.841 (0.745–0.944), p=0.004). In subgroup analysis, comparing with low-BMI and low-FFMI subgroup, better prognosis was observed in the other 2 subgroups (Log-rank p&lt;0.001, p=0.022, Figure 1).

Conclusions
Phenotypic difference was evident in elderly patients with HF. A combination of BMI and FFMI would be useful for risk stratification of mortality in those patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
A U-shape trend between total and red meat consumption and depressive symptomatology in apparently healthy women: highlights from the ATTICA prospective (2002–2012) study
Authors: Kouvari M , Panagiotakos D.B , Chrysohoou C , Yannakoulia M , Georgousopoulou E.N , Pitsavos C , Tousoulis D 
Published: November 2020

Abstract

Background/Introduction
Increasing amount of evidence currently suggests that in the context of vegetarianism, where meat is completely excluded from daily diet, the risk to develop depression-related symptoms is impressively high.

Purpose
The aim of the present work was to evaluate the association of meat consumption with prevalent depressive symptomatology in apparently healthy individuals.

Methods
ATTICA study was conducted during 2001–2012 including n=1,514 men and n=1,528 women (aged &gt;18 years old) from the greater of our region in Greece. At baseline, depressive symptomatology through Zung Self-Rating Depression Scale (range 20–80) and meat consumption (total meat, red, white and processed meat) through validated semi-quantitative food frequency questionnaire were assessed. Follow-up (2011–2012) was achieved in n=2,020 participants (n=317 cases); n=845 participants with complete psychological metrics were used for the primary analysis.

Results
Ranking from 1st to 3rd total meat consumption (low to high) tertiles, participants assigned in 2nd tertile had the lowest depressive-symptomatology scoring (p&lt;0.001). This trend was retained in multi-adjusted logistic regression analysis; participants reporting moderate total and red meat consumption had ∼20% lower likelihood to be depressed (i.e. Zung scale&lt;45) compared with their 1st tertile counterparts (Odds Ratio (OR)total meat 0.82, 95% Confidence Interval (95% CI) (0.60, 0.97) and ORred meat 0.79 95% CI (0.45, 0.96)). Non-linear associations were revealed; 2–3 serving/week total meat and 1–2 servings/week red meat presented the lowest odds of depressive symptomatology (all ps&lt;0.05). All aforementioned associations were more evident in women (all ps for sex-related interaction&lt;0.05).

Conclusions
The present findings generate the hypothesis that moderate total meat consumption and impressively, red meat may be more beneficial to prevent depressed mood and probably in turn hard CVD endpoints.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].
Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients
Authors: Ehara M , Yamada S , Shibata K , Kameshima M , Fujiyama H , Matsui Y , Higashida Y , Shimada A , Ito T , Sano T , Okumura H , Masaoka K , Okawa Y 
Published: November 2020

Abstract

Background
Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear.

Purpose
We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis.

Methods
This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories.

Results
The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p&lt;0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p&lt;0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p&lt;0.001).

Conclusion
Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome.

Funding Acknowledgement
Type of funding source: None
Artificial neural networks to compare the contribution of basic clinical factors, ESC SCORE, and multidimensional risk factors for cardiovascular event prediction performance: an observational study
Authors: Kim K , Park S.M 
Published: November 2020

Abstract

Background/Introduction
Despite the recent increase in the availability of different data sources that can be used for prediction models for cardiovascular disease (CVD), it remains unclear to what extent such data could contribute to improving performance of the models in data-driven cardiovascular research.

Purpose
To compare the contribution of different data types in basic clinical factors, the European Society of Cardiology Systematic Coronary Risk Evaluation (ESC SCORE), and multidimensional risk factors for CVD prediction performance of artificial neural networks (ANN) using the relevant input features derived from a large-scale medical claims database.

Methods
We abstracted data through the National Health Insurance Sharing Service and collected information on 258,896 middle-aged individuals free of CVD at baseline (2009–2010) who were followed up for incident CVD until 2013. Multidimensional risk factors identifiable from the database were chosen from a systematic review of published articles. Input features in ANN were classified as follows: basic clinical factors (age, sex, and body mass index), ESC SCORE (age, sex, total cholesterol, systolic blood pressure, and cigarette smoking), and multidimensional risk factors (sociodemographic, lifestyle behavior, underlying medical conditions, dental health, medication use, etc). The data were partitioned into the training and test sets with 7:3 ratio and the performance of each ANN model was evaluated with area under the curve (AUC).

Results
The ANN model with multidimensional risk factors had higher prediction performance (AUC: 0.692) compared to the models with basic clinical factors (AUC: 0.671) and ESC SCORE (AUC: 0.684). Within the multidimensional risk factors, atrial fibrillation, family history, chronic kidney disease, retinal vein occlusion, dental caries, antipsychotics, and corticosteroid use were some of the strong predictors. However, adding multidimensional risk factors only showed marginal improvement (increase in 1.17% of AUC) compared with the ESC SCORE model.

Conclusions
Adding multidimensional risk factors as input features in the ANN only showed marginal improvement in the CVD prediction performance. When assessing cardiovascular risk from the large-scale healthcare data, variables included in the ESC SCORE should primarily be considered in the model.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Kyuwoong Kim received a scholarship from the BK21-plus education program provided by the National Research Foundation of the Republic of Korea. This work is a part of Kyuwoong Kim's PhD dissertation.
Validation of the ESC/EASD cardiovascular risk stratification model in diabetic patients
Authors: Prausmueller S , Resl M , Arfsten H , Spinka G , Wurm R , Neuhold S , Bartko P , Goliasch G , Strunk G , Pavo N , Clodi M , Huelsmann M 
Published: November 2020

Abstract

Background
Recently, the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) introduced a new cardiovascular (CV) risk stratification model to aid further treatment decisions in individuals with diabetes. Our study aimed to validate the ESC/EASD CV risk assessment in type 2 diabetes mellitus (T2DM) patients for the first time and to compare the prognostic significance of NT-proBNP with the ESC/EASD CV risk stratification model.

Methods and results
We prospectively included 2186 T2DM patients with a follow-up of 60 months. Patients were stratified according to ESC/EASD CV risk criteria, 33 (1.5%) were classified as moderate, 321 (14.9%) high and 1453 (67.6%) very high risk. Both, the ESC/EASD risk stratification model and NT-proBNP were associated with CV outcome (CV events: adj. HR: 1.47 [1.09–1.98], p=0.011 and adj. HR per IQR: 2.61 [2.27–3.01], p&lt;0.0005; cardiac events: adj. HR: 1.57 [1.09–2.25], p=0.016 and adj. HR per IQR: 2.94 [2.50–3.47], p&lt;0.0005; respectively) but only NT-proBNP proved to independently predict all-cause mortality (adj. HR per IQR: 2.32 [1.93–2.80], p&lt;0.0005). NT-proBNP outperformed the ESC/EASD CV risk stratification model as determined by C-statistic (CV events: 0.74 vs 0.55, p&lt;0.001; cardiac events: 0.76 vs 0.54, p&lt;0.001; all-cause mortality: 0.73 vs 0.52, p&lt;0.001; Figure 1) and net reclassification improvement of 69% for CV events, 73% for cardiac events and 67% for all-cause death (p&lt;0.001 for all).

Conclusion
NT-proBNP measurement provides a valid tool to identify T2DM patients at risk and shows superiority in terms of risk prediction and discriminatory power compared to the ESC/EASD CV assessment.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant from the Austrian Science Fund