bluuebunny/crossref_metadata_2025_split huggingface dataset:
P776Use of sacubitril-valsartan in an extensive long term follow up cohort in real life
Authors: Galvan Ruiz M , Singh M , Fernandez De Sanmamed M , Groba Marco M , Perez Nogales E , Medina Gil J M , Martin Lorenzo P , Quevedo Nelson V , Mendoza Lemes H , Pena Ortega P , Rua-Figueroa Erausquin D , Medina Suarez J M , Caballero Dorta E , Garcia Quintana A 
Published: October 2019

Abstract

Background
Most clinical data regarding the use of sacubitril-valsartan (SV) in patients with heart failure with reduce EF (HFrEF) come from clinical trials, while observational studies in real life are scarce.

Purpose
To analyse the efficacy, safety and tolerability of SV in patients with HFrEF in real life.

Methods
An analysis of the SAVE-RLife (SV Evidence in Real Life) study was performed. This is an observational and ambispective study that included all patients with HFrEF who started SV between SEP2016 and DEC2018.

Results
A total of 291 patients were included in the study with a median follow-up of 326 (169; 523). Mean age 66.16±11.8, 71 were women (24.4%), 209 patients started treatment at office (71.8%) and 82 during the admission (28.2%). The main aetiologies were ischemic heart disease (51.5%) and idiopathic dilated cardiomyopathy (35.4%). Comorbidities included: 71.5% hypertensive, 55.3% dyslipidemic, 37.1% AF and 44% T2DM. Baseline treatment included 85.9% beta-blockers, 87.2% ACEI or ARA-II, 65.6% MRA and 17.5% iSGLT2. After treatment start with SV, baseline and follow-up analytical parameters such as GFR, K+ levels and NT-BNP, and echo parameters of LV reverse remodeling were evaluated (Table 1).
Improvement of the functional NYHA class (Figure 1) and reduction in the incidence of hospital admission or visits to emergency room (ER) were observed. Side effects were 16.2% acute renal failure, 9.3% symptomatic hypotension, 9.7% asymptomatic hypotension and 15.9% hyperkalemia. In 31 patients (11%) the drug was discontinued, one patient due to angioedema. 7.9% of patients died during follow-up, 7 of them due to HF (2.4%).
Table 1 Before SV After SV P value Analytical data GFR (ml/min) 70.25±24.95 68.27±24.62 0.008 Serum K+(mEq/L) 4.53±0.50 4.71±0.456 <0.001 NT-proBNP (pg/ml) 2201 (846; 4664) 1146 (436; 2564) <0.001 Echocardiographic data LVEF (%) (n=84) 30.60±7.16 38.30±12.22 <0.001 LVED (mm) (n=72) 65.22±7.82 60.81±8.37 <0.001 PAPs (mmHg) (n=48) 44.48±13.03 37.52±12.25 0.002 MR (grade 1–4) (n=71) 1.83±0.91 1.38±0.90 <0.001 Clinical outcomes HF Hospital/ER Admission the year before (mean± SD) 0.79±1.09 0.41±0.963 <0.001
Predictors of clinical improvement

Conclusions
SV has shown to improve morbidity and mortality in patients with HFrEF by improving functional class, decreasing NT-proBNP levels and reducing admissions due to HF, without significant side effects. In our study SV improved LVEF and reverse remodeling echocardiographic parameters too.
P778Valsartan reduces level of soluble ST2 and left ventricle remodeling in patients with dual chamber pacemaker
Authors: Radzik E , Pigon K T , Banasik G B , Tomasik A T , Jachec W J , Romuk E R , Birkner E B , Kawecki D K , Wojciechowska C W , Kalarus Z K , Gasior M G , Kozielska E K 
Published: October 2019

Abstract

Introduction
Permanent right ventricle pacing leads to left ventricle remodeling, its systolic dysfunction and symptomatic heart failure in the long run. Valsartan is well known for its preventive anti-remodeling function in the post infarction heart remodeling.

Objectives
To assess the effect of valsartan on left ventricle remodeling in patients with second and third degree atrioventricular block with first-time implantation of dual chamber pacemaker.

Methods
This was a randomized, double-blind, placebo controlled single center study. One hundred eligible patients were assigned in a 1:1:1 fashion to receive placebo, valsartan 80mg or 160mg once daily, respectively. Echocardiographic assessment of left ventricle geometry, its systolic and diastolic function was performed at baseline and at twelve months. One patient from placebo group suffered stroke. We present the baseline date for 100 enrolled patients and follow-up data for 88 patients who have completed the study. Data in valsartan arms are pooled in one group. Concentration of soluble ST2 was measured in duplicates with Aspect Reader (Critical Diagnostics).

Results
Results are presented in table. Data are presented as mean and standard deviation.
Table 1 Placebo (n=28) Valsartan (n=60) ANOVA Baseline 12 mths Baseline 12 mths sST2, ng/mL 36.0±16.0 39.4±15.3 35.1±15.2 19.9±6.5 0.01 LVEF, % 60±8 55±9 60±8 58±8 0.01 LVEDD, mm 48±5 50±4 48±6 49±5 NS LVESD, mm 29±4 32±5 29±5 31±4 NS LVEDV, mL 79±12 84±13 80±12 81±13 NS LVESV, mL 32±5 38±7 31±5 34±6 0.01 E/A 0.94±0.12 0.92±0.13 0.94±0.15 0.95±0.15 NS DecT, ms 211±38 226±43 223±45 218±37 0.01 IVRT, ms 98±14 108±17 101±17 99±18 0.01

Conclusion
Valsartan has protective effect of left ventricle remodeling and function. It may be useful in prevention of pacing induced heart failure. Decrease in soluble ST2 concentration may help explain the alternative mechanism for protective role of valsartan. (NCT01805804)
P780Superiority of long-acting to short-acting loop diuretics in the treatment of heart failure with preserved ejection fraction: a sub-analysis of the CURE-HF Registry
Authors: Suzuki S , Motoki H , Kanzaki Y , Maruyama T , Hashizume N , Kozuka A , Yahikozawa K , Kuwahara K 
Published: October 2019

Abstract

Introduction
Long-acting loop diuretics have a possibility of better prognosis compared to short-acting loop diuretics in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose
To investigate the effect of long- and short-acting loop diuretics in patients with HFpEF.

Methods
From the Clue of Risk Stratification in Patients With Heart Failure Registry (CURE-HF Registry), we enrolled 301 consecutive patients with HFpEF (median age, 84 years; 55% female). Long-acting loop diuretics (azosemide) were administrated in 127 patients, and short-acting loop diuretics (furosemide) in 174 patients. We constructed Cox models for MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure [HF] hospitalization).

Results
During a median follow-up of 317 [174–734] days, the primary endpoint occurred in 129 patients (42.8%). On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, patients treated with long-acting loop diuretics had a significantly lower incidence of adverse events than those treated with short-acting loop diuretics (hazard ratio [HR], 0.39; 95% confidence interval [CI] 0.23–0.67; P=0.001). Furthermore, on multivariate IPTW Cox modeling for the secondary endpoints, all-cause mortality (HR, 0.50; 95% CI, 0.20–0.80; P=0.01) and unplanned hospitalization for decompensated HF (HR, 0.50; 95% CI, 0.28–0.89; P=0.018) were also reduced in patients treated with long-acting loop diuretics.

Conclusions
Long-acting loop diuretics reduced the risk of MACE compared to short-acting diuretics in patients with HFpEF.
P781Resveratrol improves cardiac function and exerts an anti-inflammatory effect in systolic heart failure patients
Authors: Halmosi R , Gal R , Deres L , Horvath O , Marton Z S , Sumegi B , Toth K , Habon T 
Published: October 2019

Abstract

Introduction
The positive effects of resveratrol on heart failure have already been evaluated in several experimental animal models, however, in a human clinical trial it was not yet confirmed. The aim of our study was to assess the effect of resveratrol supplementation on left ventricular structure and function in patients with heart failure with reduced ejection fraction (HFrEF).

Methods and materials
60 HFrEF patients (age: 66.7±11.04 years, 17 women and 43 men) were enrolled into our study. They were randomized into two groups, in the first group (n=30) daily 2x50 mg resveratrol was administered orally and placebo was given in the other group (n=30). 56% of the enrolled patients had ischemic HFrEF. During the whole study period, patients were taken the optimal medical therapy of HFrEF (ACEI/ARB, BB, MRA) in the same dose as before the randomization. On the day of randomization and 3 months later echocardiography, six minutes walking test (6MWT) and quality of life questionnaire (QoL) test were performed. Besides the routine lab tests, the levels of biomarkers (NT-proBNP, galectin-3) and inflammatory cytokines (IL-1, IL-6) were also measured.

Results
After the 3-month-long follow-up period left ventricular ejection fraction improved significantly in the resveratrol group comparing to the placebo group (p<0.001). The function of the right ventricle (RV) improved (p<0.05), moreover the RV dimensions, as well as atrial volumes decreased significantly in the resveratrol group (p<0.05). In the case of 6MWT (p<0.05) and QoL test (p<0.05) a significant improvement could be observed in the resveratrol group versus the placebo group (p<0.05). Lab test analysis showed that resveratrol supplementation reduced significantly the total cholesterol level (p<0,05) and LDL-C level (p<0,05) and had no overt effect on other metabolic parameters. NT-proBNP level increased significantly in the placebo group (p<0.05) by the end of the trial, however, in the resveratrol group we could see a slight improving tendency (NS). In the case of Galectin-3, no significant changes could be seen.

Conclusions
Our results revealed that resveratrol supplementation in systolic heart failure patients adding to the standard medical therapy resulted in an improvement of echocardiographic parameters, functional status and decreased the level of inflammatory cytokines.

Acknowledgement/Funding
GINOP-2.3.2-15-2016-00048
P795Long-term prognostic value of the combination of plasma volume status and pulmonary-systemic pressure ratio in patients admitted with acute decompensated heart failure
Authors: Yamada T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Kawai T , Seo M , Nakamura J , Abe M , Yamamoto K , Kayama K , Kawahira M , Tanabe K , Fukunami M 
Published: October 2019

Abstract

Background
Plasma volume (PV) expansion plays an essential role in heart failure and PV status provides prognostic information in patients (pts) with acute decompensated heart failure (ADHF). On the other hand, concomitant presence of pulmonary hypertension in heart failure is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency. It has recently been shown that an increased mean pulmonary artery pressure to mean systemic arterial pressure ratio (MPS ratio), a marker of interventricular coupling and efficiency, is associated with worse clinical outcomes in patients with advanced heart failure. However, there is no information available on the long-term prognostic value of the combination of PV status and MPS ratio in pts admitted for ADHF.

Methods
We studied 248 pts admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. PV status and MPS ratio were obtained at the admission. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). The study endpoint was cardiovascular death (CVD).

Results
During a mean follow-up period of 5.2±4.4 yrs, 62 pts had CVD. PV status (10.0±16.2 vs 5.0±15.3%, p=0.03) and MPS ratio (0.408±0.114 vs 0.347±0.102, p=0.0001) were significantly greater in patients with than without CVD. At multivariate Cox regression analysis, PV status and MPS ratio were significantly associated with CVD, independently of prior heart failure hospitalization, eGFR, and serum sodium level and anemia. Patients with greater PV status (> median value = 4.6%) and MPS ratio (> median value = 0.346) had a significantly higher CVD risk than those with either and none of them (44% vs 22% vs 14%, p<0.0001, respectively).

Conclusions
The combination of PV status and MPS ratio might be useful for stratifying patients at risk for CVD in patients with ADHF.
P798Automated blood pressure measurements: optimal diastolic blood pressure range in treated hypertensives at high cardiovascular risk
Authors: Sobieraj P , Lewandowski J , Sinski M 
Published: October 2019

Abstract

Background/Introduction
Automated office blood pressure measurements (AOBPM) is recommended for the diagnosis of arterial hypertension. Nevertheless, use of automated office blood pressure in monitoring of treated patients with hypertension is limited by the discrepancies between AOBPM, auscultatory and research grade measurements of blood pressure. The treatment targets using AOBPM are not well-determined.

Purpose
This post-hoc analysis is aimed to establish the optimal range for on-treatment diastolic blood pressure (DBP) measured with AOBPM in hypertensive patients without cardiovascular disease but at high risk, who achieved systolic blood pressure treatment goal (SBP).

Methods
Data of 3715 subjects without prior cardiovascular disease treated to achieve SBP goal <120 mm Hg were selected from SPRINT trial database obtained from National Heart, Lung and Blood Institute. Clinical endpoint was defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes.
On-treatment blood pressure was computed as mean of AOBPM readings in a period from 6th month until to end of the study, which was considered as with a stable blood pressure.
Optimal on-treatment DBP range was established on the basis of hazard ratio plot for clinical endpoint after adjustment for age, sex, SBP, smoking habits and history of chronic kidney disease. The target DBP range was set to be 10 mm Hg wide, what is line with current ESC/ESH guidelines. To evaluate nonlinear relationship between continuous variables and outcome cubic spline methods were used.

Results
Data of 3715 (38.3% female and 61.7% male) subjects aged 67.3±9.2 mm Hg were analysed. Mean on-treatment SBP and DBP were 120.8±8.5 mm Hg and 68.2±8.1 mm Hg, respectively. Lowest hazard risk of primary endpoint was found in on-treatment DBP range 62.8–72.8 mm Hg with a minimum at 67.8 mm Hg (Figure 1). Hazard risk increased linearly toward lower and higher values than selected optimal DBP range.
Figure 1

Conclusion(s)
In treated hypertensives at high cardiovascular risk, but without prior cardiovascular disease who achieved SBP treatment goal, on treatment DBP 62.8–72.8 mm Hg range should be considered when treatment is monitored using AOBPM.
P802Interrelationships of sympathetic nervous system activity with attended and unattended blood pressure levels in essential hypertensive patients
Authors: Manta E , Tsioufis C , Dimitriadis K , Kouremeti M , Kakouri N , Kasiakogias A , Leontsinis I , Vogiatzakis N , Konstantinidis D , Andrikou I , Liatakis I , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
Measurement of unattended blood pressure (BP) may provide additional information over conventionally attended BP. Moreover, hypertension is related to sympathetic drive while there are scarce data on the diverse links of attended and unattended BP with muscle sympathetic nerve activity (MSNA) in hypertensive patients.

Purpose
The aim of this study was to assess the relation of BP levels in the attended and unattended setting with MSNA in patients with essential hypertension.

Methods
We studied 38 patients with essential hypertension (age: 59±11 years, 20 males, office BP: 142/86±19/11 mmHg, 24-hour BP: 137/80±14/12 mmHg). In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended BP (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes) and attended BP were measured with the same device, on the same day of MSNA recording, in random order. Patients were divided into the combined attended and unattended hypertensive group when BP≥140/90 mmHg in both attended and unattended BP estimations and to the attended hypertensive group when only attended BP≥140/90 mmHg.

Results
Patients with combined attended and unattended hypertension (n=18) compared to those with attended hypertension (n=20) were older (61±11 vs 57±11 years, p=0.03), whereas did not differ regarding 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index (p=NS for all). Moreover, patients with combined attended and unattended hypertension compared to those with attended hypertension were characterized by greater levels of MSNA (41.2±11.6 vs 32.2±10.1 bursts per minute, p=0.031). In all participants, sympathetic nerve traffic as assessed by resting MSNA was related to attended systolic BP (r=0.459, p=0.004), attended diastolic BP (r=0.503, p=0.001), unattended systolic BP (r=0.433, p=0.007) and unattended diastolic BP (r=0.423, p=0.008).

Conclusions
The phenotype of combined attended and unattended hypertension compared to attended hypertension is accompanied by higher sympathetic nervous system activation. Moreover, the close association of MSNA with attended and unattended BP levels in essential hypertension, further supports the key role of sympathetic drive in modulating BP.
P805Changes in arterial stiffness independently predict stroke in patients with essential hypertension: Data from a 8-year-follow-up study
Authors: Iliakis P , Tsioufis C , Dimitriadis K , Konstantinidis D , Kasiakogias A , Liatakis I , Asimaki E , Leontsinis I , Kouremeti M , Vogiatzakis N , Karaminas N , Thomopoulos K , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
Although arterial stiffening is related to atherosclerosis progression, the prognostic role of its alterations in cerebrovascular events in hypertension is not fully elucidated.

Purpose
The aim of the present study was to assess the predictive role of changes inarterial stiffness for the incidence of stroke in a cohort of essential hypertensive patients.

Methods
We followed up 1082 essential hypertensives (mean age 55.9 years, 562 males, office blood pressure (BP)=145/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit and underwent blood sampling for assessment of metabolic profile, whilearterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method at the initial and last visit. The distribution of baseline PWV was split by the median (8.2 m/sec) and accordingly subjects were classified into those with high (n=546) and low values (n=536). Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by computed tomography and magnetic resonance angiography and/or cerebrovascular angiography findings.

Results
The incidence of stroke over the follow-up period was 2.2%. Hypertensives who had stroke (n=24) compared to those without stroke at follow-up (n=1058) were older at baseline (65±9 vs 56±12 years, p=0.032), had higher office BP levels (155±13 vs 145±15mmHg, p=0.014) and prevalence of high PWV levels (67% vs 40%, p=0.021). No difference was observed between hypertensives with stroke and those without stroke with respect to baseline renal function and lipid levels (p=NS for all). By univariate Cox regression analysis it was revealed that changes in PWV levels between baseline and last visit predicted stroke (hazard ratio=1.352, p=0.004). Moreover, in multivariate Cox regression model, baseline age (hazard ratio=1.087, p=0.03), changes in PWV (hazard ratio=1.115, p=0.024) but not changes in office BP levels turned out to be independent predictors of stroke.

Conclusions
In essential hypertensive patients, changes in PWV predict future development of stroke, independently of established confounders, including BP. These findings support that PWV constitutes a potent prognosticator of cerebrovascular events and its estimation is essential in order to improve risk stratification in hypertension.
P807Short-term versus visit-to-visit blood pressure variability as predictor of early adverse cardiovascular outcome in hypertension
Authors: Mos L , Mos L , Saladini F , Mazzer A , Vriz O , Azzini V , Palatini P 
Published: October 2019

Abstract

Background
Blood pressure variability (BPV) has emerged as an important predictor of future cardiovascular events among hypertensive patients. However, it is not known whether BPV measured with ambulatory monitoring (short-term BPV) or computed from office visits (visit-to-visit BPV) are related to each other and carry similar prognostic significance.

Purpose
To investigate the association of short-term BPV and visit-to-visit BPVs with cardiovascular and renal events in a young hypertensive cohort untreated at baseline.

Methods
Short-term BPV was measured from 24-hour blood pressure (BP) monitoring at baseline in 1167 participants with stage 1 hypertension from the HARVEST study, aged 33.1±8.5 years. Visit-to-visit BPV was calculated from office BP measured in triplicate at each visit. Visits were made two weeks apart at baseline, and then after 1 month, 2 months, 3 months, 6 months, and 1 year. Only untreated subjects were taken into account for the analysis. Hazard ratios for short-term (weighted 24-hour BP Standard Deviation) and visit-to-visit Standard Deviation were computed, adjusting for the corresponding average BP, age, sex, body mass index, 24h heart rate, smoking, alcohol and coffee consumption, physical activity, parental cardiovascular disease, glucose, total cholesterol, HDL-cholesterol, and nocturnal BP dipping.

Results
Short-term systolic BPV showed a weak correlation with visit-to-visit BPV (p=0.018). No correlation was found for diastolic BPVs. Independent predictors of short-term BPV were average 24h BP, smoking, and nocturnal dipping. Predictors of visit-to-visit BPV were average office BP, parental cardiovascular disease, female gender, and nocturnal dipping. During a 15.4-year follow-up, 95 end-points were observed. In a parsimonious multivariable Cox model, short-term systolic BPV (p=0.03) was an independent predictor of the endpoints with a 7% increase in risk for each 1 mmHg increment in systolic BPV. The hazard ratio for a short-term systolic BPV ≥12.8 mmHg was 2.03 (95% CI, 1.34–3.05, p=0.0007). This threshold value was identified by ROC curve analysis. The association was particularly strong for coronary events (N=41) with a hazard ratio of 3.45 (95% CI, 1.73–6.89, p=0.0004). No independent association with outcome was found for visit-to-visit systolic or diastolic BPV (p>0.66). Similar results were obtained when average real variability was used instead of standard deviation as a metric of visit-to-visit BPV (p>0.15).

Conclusions
These data show that in untreated young hypertensive people short-term BPV and visit-to-visit BPV have a weak relationship and a different clinical significance. Only short-term BPV measured with ambulatory monitoring improved traditional risk prediction models in this setting.

Acknowledgement/Funding
Associazione 18 maggio 1370