bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1684Elevated serum uric acid associated with hypertension in healthy individuals
Authors: Liu C W , Wu Y W , Hwang J J 
Published: October 2019

Abstract

Background
Elevated serum uric acid (SUA) induces endothelial dysfunction and is associated with hypertension according to the traditional definition of hypertension. The impact of a divergent definition of hypertension between contemporary guidelines is unclear.

Purpose
We conducted the present study to investigate the association between SUA and new-onset hypertension according to contemporary blood pressure guidelines.

Methods
We enrolled 10,537 healthy individuals aged more than 30 years, who routinely underwent an annual health exam with office blood pressure records at our hospital in 2016; of them, 7,349 individuals repeated the exam in 2017. The individuals with hypertension at baseline were excluded, and the rest of the study population were divided into the European Society of Cardiology (ESC) cohort and the American College of Cardiology (ACC) cohort. According to the ESC guideline, hypertension was defined as office BP ≥140/90 mm Hg, whereas ACC guidelines defined hypertension as blood pressure ≥130/80 mm Hg. Hyperuricemia (HUA) is defined as an SUA level of ≥7 mg/dl in men and ≥6 mg/dl in women.

Results
The study population consisted of 6,378 individuals in the ESC cohort and 4,330 individuals in the ACC cohort. The HUA group was predominantly male and older than the normouricemic group and had a greater ratio of alcohol intake and histories of gout, and greater values of laboratory cardiometabolic biomarker values. The incidence of hypertension was 5.8% in the ESC cohort and 19% in the ACC cohort. Incident hypertension was significantly greater in the HUA vs. normouricemic group (8.6% vs. 4.7%, P<0.001 for ESC and 25.5% vs. 16.9%, P<0.001 for ACC). In multivariate logistic regression analyses, each increment of SUA was associated with increased risks of incident hypertension after age, gender, body mass index, blood pressure at baseline, fasting glucose were adjusted (OR: 1.160, 95% CI: 1.056–1.274, P=0.002 for ESC and OR: 1.120, 95% CI: 1.040–1.207, P=0.031 for ACC).
Incidence of hypertension

Conclusion
Elevated SUA was associated with incident hypertension in healthy individuals from Taiwan regarding various contemporary blood pressure guidelines. Future studies might investigate the effect of urate-lowering therapy on lowering blood pressure.

Acknowledgement/Funding
TSGH 108-14
P1688Behavior of indices of sympathetic activity in relation to sleep time duration in untreated hypertensives
Authors: Seravalle G , Quarti Trevano F , Dell'oro R , Bertoli G , Mancia G , Grassi G 
Published: October 2019

Abstract

Background
Short sleep duration and poor sleep quality has been reported to be associated with increased cardiovascular risk and increased incidence of cardiovascular events.

Purpose
Whether and what extent the pathophysiology of this association includes sympathetic abnormalities has never been examined via microneurography.

Methods
In 28 untreated mild-to moderate essential hypertensives aged 66.4±3.1 (mean±SEM) without other cardiovascular or non-cardiovascular disease (including obstructive sleep apnea) recruited from the outpatient clinic and referred for short sleep duration, we directly assessed at patients home via actigraphy (actiwatch spectrum activity monitor, Phillips) time sleep duration and efficiency. Measurements, performed during a day preceding or following the 7 day actigraphy evaluation, included microneurographic recording of efferent postganglionic sympathetic nerve traffic (MSNA), venous plasma norepinephrine (HPLC), clinic, 24 hour and beat to beat blood pressure and heart rate values. Sleep diary and a sleep questionnaire were also administered.

Results
Nine patients slept less than 6 hours per night (LSD), while the remaining ones between 6 to 7 (MSD, n=8) or more than 7 hours (GSD,N=11). The 3 groups showed similar age and gender distribution and a body mass index amounting to 28.1±0.8, 28.6±0.5 and 27.3±0.5 kg/m2 (P=NS). For similar mean blood pressure values LSD showed MSNA values significantly greater than GSD (53.4±4.9 vs 40.1±3.8bs/100hb, P<0.03), this being the case also for MSD (49.7±4.4, P<0.05 vs GSD but not SLD). HR was significantly elevated only in LSD group when compared to GSD, while no significant difference was found in plasma NE between the 3 groups.

Conclusions
The present study provides the first microneurographic direct evidence that short sleep duration is linked to a marked sympathetic activation, which may participate at the high cardiovascular risk of these subjects. The sympathetic overdrive affects both the cardiac and peripheral district but is not reflected by NE, which thus does not represent in this condition a valuable adrenergic marker.
P1689Nighttime blood pressure and dipping patterns relate to sodium sensitivity of blood pressure
Authors: Xing X , Liu F , Yang X , Huang J 
Published: October 2019

Abstract

Background
Attenuated nighttime blood pressure (BP) fall during a high-sodium diet is associated with higher sodium sensitivity of BP. However, the prognostic value for sodium sensitivity of nighttime BP profile during a habitual diet is not fully understood.

Purpose
To elucidate the usefulness of nighttime BP and dipping patterns under a habitual diet in assessing sodium sensitivity.

Methods
We conducted a dietary intervention study among 250 resident aged 18–60 years with high-normal or stage I hypertension in rural areas of northern China. The 24-hour ambulatory BP monitoring and baseline survey were performed for each participant under a habitual diet during the first 3 days. Then participants underwent a 7-day low-sodium intervention (51.3mmol sodium per day), followed by a 7-day high-sodium intervention (307.8mmol sodium per day). Three clinic BP measurements were obtained in every morning of the 3-day baseline observation and days 5, 6, and 7 of each intervention period.

Results
Among 250 participants, 86 (34.4%) had daytime hypertension (DH) and 149 (59.6%) had nighttime hypertension (NH). The systolic BP (SBP) responses to low-sodium and high-sodium intervention were significantly higher in those with NH than those without irrespective of DH status [−8.1 (−9.3, −7.0) vs. −5.5 (−7.0, −4.1) mmHg, P=0.001; and 13.0 (11.6, 14.3) vs. 11.0 (9.3, 12.7) mmHg, P=0.038, respectively]. Compared with dippers, extreme dippers had significantly higher SBP responses to low-sodium and high sodium intervention independently of 24-hour SBP. Moreover, the quadratic curve between nighttime SBP fall and SBP responses to low-sodium (β=−105.5 for quadratic term, P=0.015) and high-sodium (β=108.9 for quadratic term, P=0.035) intervention suggested both non-dipping and extreme dipping might indicate higher sodium sensitivity.

Conclusions
NH as well as non-dipping and extreme dipping determined during a habitual diet might indicate higher sodium sensitivity, which highlights the potential usefulness of nighttime BP profile in assessing sodium sensitivity.

Acknowledgement/Funding
This study is supported by the National Natural Science Foundation of China (grant no. 81570386)
P1691Impact of dose and duration of dietary salt reduction on blood pressure levels: systematic review and meta-analysis of randomised trials
Authors: Huang L , Trieu K , Yoshimura S , Woodward M , Campbell N , Lackland D , Leung A , Anderson C A M , MacGregor G , Neal B , He F 
Published: October 2019

Abstract

Background
Authoritative medical and public health agencies in most countries advise to reduce population dietary salt intake to under 5–6 g/day as a strategy for preventing high blood pressure and cardiovascular disease. However, there is still dispute about whether salt reduction should be adopted by all populations. In addition, the effect of duration of dietary salt reduction has not been sufficiently investigated.

Purpose
To understand the effect of dietary salt reduction on blood pressure and the impact of intervention duration.

Methods
A systematic review and meta-analysis was conducted. Randomized controlled trials that allocated participants to low and high salt intake, without confounding from unequal concomitant interventions, were included. We excluded studies done in individuals younger than 18 years, pregnant women, individuals with renal disease or heart failure, and studies with sodium excretion estimated from spot urine. Random effect meta-analysis was used to generate pooled estimates of the effect on 24-hour urinary sodium excretion, systolic and diastolic blood pressure. Multivariate meta-regression was used to quantify the dose response effect of dietary salt on blood pressure change and to understand the impact of the intervention duration.

Results
125 studies were included with 162 data points extracted. Ninety-nine data points (61%) had interventions under 4 weeks. Overall, 24-hour urinary sodium excretion changed by −141 mmol (95% CI: −156; −126), systolic blood pressure changed by −4.4 mm Hg (95% CI: −5.2; −3.7) and diastolic blood pressure changed by −2.4 mm Hg (95% CI: −2.9; −1.9). Sodium reduction resulted in a significant decrease of systolic blood pressure in all subgroups except in participants with low baseline sodium intake (<109 mmol) (Figure 1). Each 100 mmol reduction of sodium was associated with 2.7 mm Hg (95% CI: 1.0; 4.4; p=0.002) reduction of systolic blood pressure and 1.2 mm Hg (95% CI: 0.0; 2.4; p=0.046) reduction of diastolic blood pressure after adjusting for intervention duration, age, sex, race, baseline blood pressure, baseline sodium intake and interaction between age and baseline blood pressure. For the same amount of salt reduction, a 10 mm Hg higher baseline systolic blood pressure would result in 2.5 mm Hg greater reduction of systolic blood pressure. There is not enough evidence to show the impact of intervention duration.
Figure 1

Conclusions
Our meta-analysis showed that sodium reduction could reduce blood pressure in all adult populations regardless of age, sex and race. The effect of salt reduction on systolic blood pressure increases with higher baseline blood pressure. Further studies, designed to investigate the impact of intervention duration, are needed to understand the significance of the duration.

Acknowledgement/Funding
None
P1697Determinants and prognostic value of cardiac magnetic resonance imaging derived infarct characteristics in Non-ST-Elevation Myocardial Infarction
Authors: Feistritzer H.-J , Eitel I , Jobs A , De Waha-Thiele S , Meyer-Saraei R , Freund A , Stiermaier T , Abdel-Wahab M , Lurz P , Reinstadler S J , Reindl M , Klug G , Metzler B , Desch S , Thiele H 
Published: October 2019

Abstract

Background
The prognostic significance of cardiac magnetic resonance (CMR) derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients.

Purpose
To investigate determinants and the long-term prognostic impact of CMR imaging derived infarct characteristics in patients with NSTEMI.

Methods
Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) were assessed using CMR imaging in 311 consecutive NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centers. CMR imaging was performed 3 [interquartile range (IQR) 2–4] days after admission. The clinical endpoint was defined as major adverse cardiac events (MACE) during a median follow-up of 4.4 (IQR 3.6–4.9) years.

Results
Median IS was 7.0% (IQR 2.3–13.5) of LV myocardial mass (%LV) and MSI was 65.2 (IQR 36.7–82.9). Age (p=0.003), heart rate (p=0.002) and TIMI flow grade before PCI (p<0.001) were independent predictors of IS. Independent predictors of the MSI were age (p=0.001), heart rate (p=0.01), the number of diseased coronary arteries (p=0.001) and the TIMI flow grade before PCI (p<0.001). MACE occurred in 75 (24.1%) patients. CMR-derived infarct characteristics had no additional prognostic value over and above LV ejection fraction in multivariable analysis.

Conclusions
In this prospective, multicenter NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics above and beyond traditional risk markers.
P1703Impact of prehospital epinephrine administration and quality of cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest patients with non-shockable rhythm
Authors: Funada A , Goto Y , Okada H , Maeda T , Takamura M 
Published: October 2019

Abstract

Background
The effects of prehospital epinephrine administration in combination with the quality of cardiopulmonary resuscitation (CPR) on neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm remains unclear.

Purpose
This study aimed to elucidate the effects of prehospital epinephrine administration in combination with the quality of CPR on neurologically intact survival in OHCA patients with non-shockable rhythm.

Methods
We analysed 118,732 adult OHCA patients with non-shockable rhythm from the All-Japan OHCA registry between 2011 and 2016 (29,989 emergency medical service [EMS]-witnessed arrests with EMS-initiated CPR [high-quality CPR] and 88,743 bystander-witnessed arrests with bystander-initiated CPR continued by EMS providers [low-quality CPR]). Patients who achieved prehospital return of spontaneous circulation without prehospital epinephrine administration were excluded. The primary outcome measure was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1–2). Time from collapse to prehospital epinephrine administration for patients with prehospital epinephrine administration, or to hospital arrival for patients without prehospital epinephrine administration was calculated and adjusted collectively in multivariate logistic regression analysis for 1-month CPC 1–2.

Results
Multivariate logistic regression analysis revealed that the time from collapse to prehospital epinephrine administration or to hospital arrival was negatively associated with 1-month CPC 1–2 (adjusted odds ratio [OR] 0.95 per 1-minute increment, 95% confidence interval [CI] 0.94–0.96). Compared with bystander-witnessed arrests without prehospital epinephrine administration, EMS-witnessed arrests with or without prehospital epinephrine administration were significantly associated with increased chances of 1-month CPC 1–2 (adjusted OR 2.04, 95% CI 1.50–2.75 and adjusted OR 1.97, 95% CI 1.57–2.48, respectively). Prehospital epinephrine administration was significantly associated with an increased chance of 1-month CPC 1–2 among bystander-witnessed arrests (adjusted OR 1.57, 95% CI 1.24–1.98), but not among EMS-witnessed arrests. EMS-witnessed arrests without prehospital epinephrine administration were significantly associated with an increased chance of 1-month CPC 1–2 compared with bystander-witnessed arrests with prehospital epinephrine administration (adjusted OR 1.26, 95% CI 1.01–1.56).

Conclusions
High-quality CPR is crucial for increasing neurologically intact survival in OHCA patients with non-shockable rhythm. The additional beneficial effects of prehospital epinephrine administration were observed only among OHCA patients with low-quality CPR.
P1705The association between pre-shock ventricular fibrillation duration and shock success during out-of-hospital cardiac arrest
Authors: Nas J , Thannhauser J , Van Grunsven P M , Meinsma G , Van Royen N , De Boer M J , Bonnes J L , Brouwer M A 
Published: October 2019

Abstract

Background
After the first shock, most ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) patients require subsequent shocks before organized rhythm is restored. Currently, all those shocks are given after a fixed 2 or 3-minute chest compression interval, resulting in many unsuccessful shocks. However, recently new defibrillators have been developed that can recognize VF during chest compressions, and enable earlier shocks immediately upon detection of VF. This prompts the question whether VF of shorter duration is associated with higher shock success.

Purpose
To study the association between pre-shock VF-duration and shock success in all subsequent shocks during OHCA.

Methods
Detailed VF-study on a subset of our prospective, real-world cardiac arrest-registry, focusing on patients with ≥2 shocks for VF and available ECG-tracings. These were scrutinized to determine VF-duration (time from VF-onset until shock) and shock success (return of organized rhythm within 1 min. after the shock). All first shocks were excluded.

Results
We studied 397 shocks from 101 patients. Of these, 77% were male and median age was 64 (interquartile range [IQR] 54–76) years. Overall shock success was 51% and survival to discharge was 19%. Overall median pre-shock VF-duration was 221s (IQR 125–433). The median pre-shock VF-duration was shorter before a successful (171s [IQR 75–295]) than before an unsuccessful shock (334s [IQR 174–740]), p<0.001. Shock success decreased from 75% in the quartile with the shortest to 21% in the quartile with the longest pre-shock VF-duration, p for trend<0.001 (Figure 1).
Figure 1

Conclusion
In shocks following the first defibrillation attempt, VF of shorter duration is associated with higher proportions of shock success. In an era of defibrillators that are able to recognize VF during chest compressions, our findings prompt the question whether shock upon detection of VF may improve the dismal outcomes of VF cardiac arrest.

Acknowledgement/Funding
None
P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography
Authors: Akin M , Garcheva V , Sieweke J T , Tongers J , Napp L C , Flierl U , Bauersachs J , Schaefer A 
Published: October 2019

Abstract

Purpose
To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts.

Methods
Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA.

Results
Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l.

Conclusion
Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.
P1711The association of multidisciplinary team approach with clinical outcomes in patients with acute myocardial infarction underwent veno-arterial extracorporeal membrane oxygenation
Authors: Hong D , Choi K H , Youn T , Lee S Y , Bak M , M K M , Cho Y H , Yang J H 
Published: October 2019

Abstract

Background
Multidisciplinary team approach is necessary for the management of critically-ill patients. However, limited data are available on the impact of specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock.

Objectives
This study aimed to identify whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients underwent venoarterial ECMO.

Methods
A total of 255 AMI patients underwent venoarterial ECMO from May 2004 to July 2018 were enrolled. In January 2014, multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into pre-ECMO team group (n=131) and post-ECMO team group (n=124). The primary outcome was in-hospital mortality.

Results
In-hospital mortality (54.2% vs. 33.9%, p=0.002) and cardiac intensive care unit mortality (45.0% vs. 25.0%, p=0.001) were significantly lower after the implantation of multidisciplinary ECMO team (pre ECMO team vs. post-ECMO team). On binary logistic regression model, the multidisciplinary ECMO team approach was associated with lower risk of in-hospital mortality (odds ratio 0.36, 95% confidence interval 0.19–0.67, p=0.001). Incidence of all-cause mortality (58.3% vs. 35.2%, p<0.001) and rehospitalization due to heart failure (28.2% vs. 6.4%, p=0.001) at 6-months follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group.
Clinical outcomes Variables Total (N=255) Pre-ECMO team (N=131) Post-ECMO team (N=124) P value In-hospital mortality 113 (44.3) 71 (54.2) 42 (33.9) 0.002 Cardiovascular death 90 (35.3) 59 (45.0) 31 (25.0) 0.001 Noncardiovascular death 23 (9.0) 12 (9.2) 11 (8.9) >0.99 Cardiac intensive care unit mortality 106 (41.6) 68 (51.9) 38 (30.6) 0.001 Successful weaning of ECMO 169 (66.3) 75 (57.3) 94 (75.8) 0.002 Data are presented as n (%). Abbreviations: ECMO, extracorporeal membrane oxygenation.
Incidence of death, readmission for HF

Conclusions
The multidisciplinary ECMO team approach was associated with improved clinical outcomes in AMI patients complicated by cardiogenic shock. Our data support that specialized ECMO team is indispensable to improve outcomes in patients with AMI with refractory cardiogenic shock.