bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in diastolic blood pressure changes with age using 24-hour ABPM in 30,513 patients
Authors: Matangi M , Armstrong D , Cases M , Zhu T , Brouillard D 
Published: November 2020

Abstract

Background
We have previously shown, using 24-hour ABPM monitoring, that diastolic blood pressure (DBP) in a large referral population, containing both males and females, increases until age 42 years, following which DBP falls progressively. This occurs in the hypertensive population some 13 years sooner than previous general population studies. There is conflicting emerging data on sex differences in the lifelong trajectory of both systolic and diastolic blood pressure.

Purpose
To examine sex-specific patterns of diastolic blood pressure throughout the lifespan of patients referred for 24-hour ABPMs.

Methods
Our database was searched for all 24-hour ABPMs. We used the average 24-hour SBP and DBP for this analysis. Scatter grams were produced for age versus systolic BP (SBP) and DBP for both males and females. Second order polynomial regression was performed on the DBP scatter grams for both genders and their inflection points calculated. The inflection point is the age at which the DBP on the polynomial curve where the slope changes from positive to negative. This, inflection point, corresponds to the age at which DBP begins to decrease. The DBP polynomial curves for males and females were then superimposed to show any gender differences.

Results
There were 30,513 24-hour analysable ABPMs over 24 years, representing 97% of all ABPMs. There were 15,913 females aged 60.8±14.6 years (range 15–97 years) and 14,600 males aged 58.8±14.2 years (range 15–100 years). As can be seen from the charts below, in females DBP begins to fall at a very early age of 22.3 years, whereas in males the diastolic BP begins to fall at 46.5 years.

Conclusions
There are significant sex differences in the changes in DBP with increasing age. For the first 35 years DBP is higher in women, thereafter DBP is lower in females and only intersects again much later in life at 95 years. The significance of this sex difference is unclear but may explain the increased prevalence of systolic hypertension in elderly females.
Figure 1

Funding Acknowledgement
Type of funding source: None
Effect of weight loss, exercise and risk factor control in microvascular angina. A randomized controlled pilot trial
Authors: Bove K.B , Nilsson M , Pedersen L.R , Mikkelsen N , Suhrs H.E , Astrup A , Prescott E 
Published: November 2020

Abstract

Background
Coronary microvascular dysfunction (CMD) is a common cause of angina in women and associated with adverse cardiovascular prognosis. Currently, no evidence-based treatment for CMD exists.

Purpose
To examine whether an intervention targeting cardiovascular risk factors is feasible and improves angina symptoms and microvascular function in women with CMD and no obstructive coronary artery disease.

Methods
We randomized 62 women aged 40–75, with body mass index &gt;25 kg/m2, angina symptoms monthly or more and coronary flow velocity reserve (CFVR) &lt;2.5 to a 24-week intervention comprising low energy diet, exercise training, and optimized medical treatment of hypertension, dyslipidemia and diabetes or to usual care. Patients were assessed before randomization and after 24 weeks. The primary outcomes were CFVR assessed by transthoracic Doppler stress-echocardiography and angina burden measured by the Seattle Angina Questionnaire (SAQ). Secondary endpoints were exercise capacity (VO2max), body composition and glycemic control, anxiety and depression symptoms measured by the Hospital Anxiety and Depression Scale (HADS).

Results
Fifty-six participants (90%) completed the study. Median age was 65 years. The intervention group obtained a mean weight loss of 10 kg, mainly (9 kg) from fat tissue (all p&lt;0.0001), increased work load (p&lt;0.01), decreased triglycerides, low density lipoprotein and low plasma cholesterol (all p&lt;0.006). HbA1c in non-diabetes participants also decreased (p&lt;0.05).
There was a clinically relevant improvement in all angina symptoms (9–21-point increase on all SAQ scales (all p&lt;0.01)) as well as in depression score (p=0.008). There was no effect on CFVR or other secondary outcomes.

Conclusion
A major weight loss and intensified risk factor control resulted in significant improvement in angina burden but no improvement of coronary microvascular function among women with microvascular angina.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Unlimited research funding sources from the Capital region of Denmark and Bispebjerg-Frederiksberg Hospital internal funding sources.
Specific sex and gender factors of pericarditis in women
Authors: Cepas Guillen P.L , Martinez-Nadal G , Izquierdo M , Aldea A , Matas A , Lopez-Sobrino T , Lopez-Barbeito B , Andrea R , Miro O 
Published: November 2020

Abstract

Introduction
Pericarditis is relatively common in clinical practice and may present as an isolated disease or as a manifestation of a systemic disease. There is an important sex-gap in the evidence on cardiovascular diseases, whereas it is unclear if there are sex-specific differences in the features of patients with acute pericarditis (AP).

Objective
The aim of this study was to evaluate the presence of specific sex and gender factors of pericarditis in women.

Material and methods
We retrospectively included all consecutive patients admitted with acute pericarditis (AP) in an emergency department (ED) of a tertiary care center between 2008 and 2018. Patients without acute pericarditis diagnosis criteria were excluded. We collected patients' baseline characteristics and management data. Recurrence and complicated related to AP at 30-days and 1-year follow-up were assessed.

Results
A total of 729 patients (mean age 42±17.2 years, 33% females) were analyzed. Women were older than men (47.5 yo vs 40 yo, P&lt;0.001). Univariate analysis showed that women presented more prevalence of obesity (11% vs 5%, P&lt;0.01) and chronic kidney disease (6% vs 3%, P&lt;0.05) with previous autoimmune disease (15% vs 3%, P&lt;0.001), and previous immunosuppressive treatment more frequent (15% vs 7%, P&lt;0.01). Women presented more delayed time between beginnings of symptoms until first medical attendance (70 min vs 41 min, P&lt;0.01). No difference was found either echocardiography findings or blood test values. Autoimmune AP was more prevalent in women than men (9% vs 1%, P&lt;0.001). Hence, corticosteroids treatment was more used in women (12% vs 4,5%, P&lt;0.001). In multivariate analysis, six factors were found as specific gender factors of pericarditis in women: Age (OR: 1.02, 95% CI: 1.01–13.2, P&lt;0.01), obesity (OR: 2.27, 95% CI: 1.15–4.49; P&lt;0,05), smoker (OR: 0.39, 95% CI: 0.25–0.59, P&lt;0.001), previous autoimmune disease (OR: 4,29, 95% CI: 1,77–13,21; P&lt;0,01); electrocardiogram diagnosis criteria (OR: 0,18, 95% CI: 0,6–0,52; P&lt;0,001); Autoimmune etiology (adjusted OR: 11,78, 95% CI: 1,99–69,64; P&lt;0,01). No difference was found in recurrence of AP in 30-days and 1-year follow-up (12% vs 13%, P&gt;0.05; 14% vs 13%. P&gt;0.05; respectively).

Conclusion
In our cohort, women with AP attended ED later than men and were less likely to present with typical AP changes in the electrocardiogram. Moreover, women are more commonly affected by specific forms of pericarditis related to autoimmune disease. However, follow-up did not show differences related to gender.

Funding Acknowledgement
Type of funding source: None
Persistent chest pain at 1-year predicts long-term angina hospitalization in women with and without obstructive coronary artery disease: results from Women's Ischemia Syndrome Evaluation (WISE)
Authors: Quesada O , Wei J , Suppogu N , Cook-Wiens G , Kelsey S.F , Bittner V , Reis S.E , Reichek N , Shaw L.J , Sopko G , Handberg E , Pepine C.J , Baireymerz C.N 
Published: November 2020

Abstract

Background
There is growing evidence that women with ischemia and no obstructive coronary artery disease (INOCA) have an increased risk of major adverse cardiovascular events (MACE). Half of these women continue to experience persistent chest pain (PChP); however longer-term outcomes are unknown.

Purpose
To investigate the relationships between PChP at 1-year with obstructive and nonobstructive coronary artery disease (CAD) and longer-term all-cause mortality, MACE and angina hospitalization in women with suspected myocardial ischemia.

Methods
We studied 673 women with chest pain undergoing coronary angiography for suspected myocardial ischemia in the National Heart, Lung, and Blood Institute Women's Ischemia Syndrome Evaluation (WISE) study. PChP was defined as self-reported continuing chest pain at 1-year, obstructive CAD as &gt;50 stenosis in any coronary artery and non-obstructive CAD was further divided as &lt;20% stenosis and 20–50% stenosis in any coronary artery. The Kaplan-Meier method was used to estimate cumulative incidence rates of all-cause mortality, MACE, and angina hospitalization. Proportional hazards regression estimated adjusted hazard ratios of mortality, MACE and angina hospitalization in relation to PChP at 1-year in obstructive and nonobstructive CAD.

Results
The median age was 58 years, 45% had PChP, and 39% had obstructive CAD with a median follow-up time of 9 years (range 1 to 11) for mortality and 5 years (range 0 to 9) for MACE and anginal hospitalization. There was no difference in mortality or MACE in women with PChP compared to women without PChP in any of the 3 groups (&lt;20%, 20–50%, or &gt;50% CAD), however differences were noted in long-term angina hospitalization (Figure 1). Notably,angina hospitalization rates in women with PChP and nonobstructive CAD were 2.2 times those of women without PChP, and comparable to those of women with obstructive CAD and no PChP (p&lt;0.0001).

Conclusions
Among women undergoing coronary angiography for suspected myocardial ischemia, women with nonobstructive CAD and PChP have rates of angina hospitalization comparable to patients with obstructive CAD without PChP. Thus, PChP increases the hazard of long term anginal hospitalization regardless of the presence or absence of obstructive CAD. Given the economic burden of angina hospitalization, further studies are needed to determine whether aggressive treatment in women with PChP without obstructive CAD changes outcomes and impact on the health care system.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH)
The prevalence of Wolff-Parkinson-White syndrome in newborns – results from a large general population study
Authors: Paerregaard M , Kock J , Pihl C , Pietersen A , Iversen K.K , Bundgaard H , Christensen A.H 
Published: November 2020

Abstract

Background
The accessory electrical pathway in Wolff-Parkinson-White (WPW) syndrome predisposes to tachycardia and may increase risk of sudden cardiac death. Studies investigating the prevalence of this condition in newborns are few.

Purpose
To describe the prevalence of WPW syndrome and assess the localization of the accessory pathway and associated structural heart disease in newborns from a large general population study.

Methods
Electrocardiograms (ECG's) and echocardiograms of 17.489 newborns (aged 0–30 days) from a large, prospective general population study were included. WPW cases were identified through manual evaluation of outliers in measurements of PR-interval, QRS-duration, QTcB interval and QRS axis. Newborns suspected for WPW syndrome were offered a secondary echocardiogram and ECG recording. Localization of the accessory pathway was assessed based on a QRS polarity algorithm. The control group consisted of 5,000 randomly selected newborns with a normal echocardiogram.

Results
Among the 17,489 ECG's we manually analyzed 5,166 and found 15 newborns (80% boys) with WPW syndrome (secondary confirmatory ECG's will be available at ESC 2020) consistent with prevalence of WPW syndrome of 0.1%. The median values of the PR-interval, QRS-duration and QTcB in cases and controls were 80 vs 98 ms, 74 vs 56 ms, and 449 vs 420 ms, respectively (all p&lt;0.0001). The accessory electrical pathway was left-sided in 13 (87%) of the newborns. One newborn had moderate mitral regurgitation while all other newborns had structurally normal hearts and no cases of Ebstein's anomaly.

Conclusion
The prevalence of WPW syndrome in our cohort was 0.1%. The syndrome was more frequent in boys, and the accessory pathways were mainly left-sided. All but one of the affected newborns had structurally normal hearts.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.
The value of coronary artery calcium scores based on non-gated chest CT in predicting perioperative cardiovascular risk in patients with lower-risk lung cancer surgery
Authors: He B , Yang X , Xie M , Shen L 
Published: November 2020

Abstract

Objectives
This study evaluated whether coronary artery calcium scores (CACS) that were measured with non-gated chest CT predicted perioperative cardiovascular events in patients who were undergoing lower-risk lung cancer surgery.

Method
In this retrospective single center study, we evaluated 3112 consecutive lung cancer patients with non-gated chest CT before low-medium risk surgeries in 2017. We measured CACS and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores and predictable surgery factors. Perioperative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, atrial and ventricular arrhythmia with hemodynamic compromise, and complete heart block during hospitalization.

Result
83 patients (2.7%) had perioperative cardiac events, 71 (85.5%) of them were atrial fibrillation. Coronary calcification CT findings were seen in 761 (24.5%) patients. CACS were associated with incidence of cardiac events (p&lt;0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 1 (sensitivity, 0.60; specificity, 0.75; area under the curve, 0.680). In the multivariate analysis, CACS &gt;1 (OR=1.75, 95% CI: 1.08–2.84, p=0.023), age (OR=1.06, 95% CI: 1.03–1.10, p&lt;0.001), pulmonary function classification (p&lt;0.001) and thoracotomy (OR=3.06, 95% CI: 1.78–5.26, p&lt;0.001) were predictive of cardiovascular complications.

Conclusion
Predicative value of CACS based on non-gated chest CT is high for perioperative cardiovascular risk in lung cancer patients with lower-risk lung surgery. It may be considered as a valuable tool for preoperative risk assessment in these patients without additional testing.

Funding Acknowledgement
Type of funding source: None
Primary percutaneous coronary intervention in the oldest-old age: clinical outcomes and predictors of in-hospital mortality in nonagenarians patients with ST-segment elevation myocardial infarction
Authors: Pinton F.A , Prado G.F , Bezerra C.G , Mariani Junior J , Campos C.M , Almeida B.O , Caixeta A.M , Franken M , Lemos P.A 
Published: November 2020

Abstract

Introduction
Owing to the ageing of the population, nonagenarian patients are increasingly present in catheterization laboratories, part of them with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in patients with STEMI, provided it can be performed promptly. However, elderly patients are usually excluded from clinical trials and few data are available about nonagenarians referred for primary PCI.

Purpose
The aim of the present study was to evaluate clinical characteristics and in-hospital outcomes of nonagenarians STEMI patients undergoing primary PCI.

Methods
We retrospectively analyzed clinical, angiographic and in-hospital outcomes of death, re-infarction and stroke of primary PCI in nonagenarian STEMI patients, included in the Brazilian PCI Registry (CENIC) between June 2006 and March 2016. Predictors of in-hospital mortality of this population were determined through multivariate analysis.

Results
Over a period of 10 years, 847 nonagenarians were enrolled in the CENIC Registry, and 252 presented with STEMI and underwent a primary PCI. The population was predominantly female (55.2%), with a median age of 92 years (interquartile range 4 years, maximum of 105 years) and 63.9% in Killip class I at admission. Median door-to-balloon time was 90±60 minutes. Double or triple-vessel disease was found in 63%. It was used 1.3 stent per patient, 8.9% drug-eluting stents. The femoral access route was preferred in 82.1% of patients and glycoprotein IIb/IIIa inhibitors was given to 9.9%. In-hospital mortality in the period was 10.7% and re-infarction occurred in 0.5%. No cases of stroke have been reported. The only predictor of hospital mortality was Killip class (OR 7.1, 95% CI 2.7–18.5, p&lt;0.001).

Conclusion
In a real-world setting, primary PCI in nonagenarian STEMI patients can be performed with good clinical outcomes and acceptable in-hospital mortality rate and must be recommended even in oldest-old age patients. Killip class was the only predictor of in-hospital mortality in this population.

Funding Acknowledgement
Type of funding source: None
Echocardiography for the 10-year prediction of cardiomyopathy in long-term survivors of childhood cancer
Authors: Leerink J.M , Van Der Pal H.J.H , Feijen E.A.M , Meregalli P.G , Pourier M.S , Merkx R , Bellersen L , Van Dalen E.C , Loonen J , Pinto Y.M , Kapusta L , Kremer L.C.M , Mavinkurve-Groothuis A.M.C , Kok W.E.M 
Published: November 2020

Abstract

Background
Childhood cancer survivors (CCS) treated with anthracyclines and/or chest-directed radiotherapy receive life-long echocardiographic surveillance to detect cardiomyopathy early. Current risk stratification and surveillance frequency recommendations are based on anthracycline- and chest-directed radiotherapy dose. We assessed the added prognostic value of an initial left ventricular ejection fraction (EF) measurement at &gt;5 years after cancer diagnosis.

Patients and methods
Echocardiographic follow-up was performed in asymptomatic CCS from the Emma Children's Hospital (derivation; n=299; median time after diagnosis, 16.7 years [inter quartile range (IQR) 11.8–23.15]) and from the Radboud University Medical Center (validation; n=218, median time after diagnosis, 17.0 years [IQR 13.0–21.7]) in the Netherlands. CCS with cardiomyopathy at baseline were excluded (n=16). The endpoint was cardiomyopathy, defined as a clinically significant decreased EF (EF&lt;40%). The predictive value of the initial EF at &gt;5 years after cancer diagnosis was analyzed with multivariable Cox regression models in the derivation cohort and the model was validated in the validation cohort.

Results
The median follow-up after the initial EF was 10.9 years and 8.9 years in the derivation and validation cohort, respectively, with cardiomyopathy developing in 11/299 (3.7%) and 7/218 (3.2%), respectively. Addition of the initial EF on top of anthracycline and chest radiotherapy dose increased the C-index from 0.75 to 0.85 in the derivation cohort and from 0.71 to 0.92 in the validation cohort (p&lt;0.01). The model was well calibrated at 10-year predicted probabilities up to 5%. An initial EF between 40–49% was associated with a hazard ratio of 6.8 (95% CI 1.8–25) for development of cardiomyopathy during follow-up. For those with a predicted 10-year cardiomyopathy probability &lt;3% (76.9% of the derivation cohort and 74.3% of validation cohort) the negative predictive value was &gt;99% in both cohorts.

Conclusion
The addition of the initial EF &gt;5 years after cancer diagnosis to anthracycline- and chest-directed radiotherapy dose improves the 10-year cardiomyopathy prediction in CCS. Our validated prediction model identifies low-risk survivors in whom the surveillance frequency may be reduced to every 10 years.
Calibration in both cohorts

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation
The histone deacetylase SIRT1 mediates the proper DNA repair response by targeting histone H2AX to protect against doxorubicin-induced cardiotoxicity
Authors: Kuno A , Hosoda R , Horio Y 
Published: November 2020

Abstract

Background
Failure of DNA repair and accumulation of damaged DNA have been implicated in the pathogenesis of doxorubicin-induced cardiotoxicity. SIRT1, an NAD+-dependent histone deacetylase, is known to positively regulate DNA repair. One of the earliest events in DNA damage response (DDR) is phosphorylation of histone H2AX on Ser139 catalyzed by kinases including ATM (mutated in ataxia-telangiectasia). However, it remains unknown whether SIRT1 protects the heart from doxorubicin-induced cardiotoxicity by regulating histone H2AX.

Purpose
In this study, we investigated whether SIRT1 plays a role against doxorubicin-induced cardiotoxicity by regulating histone H2AX and therefore DDR.

Methods and results
We used tamoxifen-inducible cardiomyocyte-specific SIRT1 knockout (SIRT1-cKO) mice. Knockout was induced at 2 month of age, and mice without Cre recombinase served as wild type (WT). Mice were treated with vehicle (Veh) or doxorubicin (4 IP injections of 5 mg/kg/week) starting at 3 month of age. Echocardiography showed that fractional shortening (FS) before doxorubicin was similar in WT (34%) and SIRT1-cKO (34%). However, FS at 1 week after final doxorubicin was lower in SIRT1-cKO than WT (26% vs. 30%, P&lt;0.05). Myocardial ANP mRNA level was 2.4-fold higher in SIRT1-cKO than WT after doxorubicin. Apoptotic cells analyzed by TUNEL-positive nuclei were similar in Veh-treated SIRT1-cKO and WT (0.125 vs. 0.073%) but were more increased by doxorubicin in SIRT1-cKO than WT (0.384 vs 0.194%, P&lt;0.05). Immunoblotting showed that doxorubicin significantly increased myocardial levels of phospho-Ser139-histone H2AX (p-H2AX) and phospho-Ser1981-ATM (p-ATM) in WT. However, the doxorubicin-induced increase in p-H2AX level was significantly attenuated in SIRT1-cKO despite similar p-ATM levels after doxorubicin between WT and SIRT1-cKO.
In H9c2 cardiomyocytes, doxorubicin treatment (10 μM) increased both p-ATM and p-H2AX levels, but siRNA-mediated knockdown (KD) of SIRT1 attenuated doxorubicin-induced phosphorylation of H2AX without changing p-ATM level. Cell death after doxorubicin was enhanced in SIRT1-KD cells compared to control cells (13.2% vs 8.6%, P&lt;0.05). Immunostaining showed that SIRT1 colocalized with histone H2AX in the nucleus. Treatment with a SIRT1 inhibitor Ex527 increased level of acetylated H2AX at 5th lysine residue, suggesting that SIRT1 regulates histone H2AX via deacetylation.

Conclusion
These data suggest that SIRT1 plays a protective role against doxorubicin-induced cardiotoxicity via regulation of H2AX phosphorylation to mediates proper DDR.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science