bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi-omics approach to post-CABG renal impairment
Authors: Boerschel C , Geelhoed B , Conradi L , Girdauskas E , Mueller C , Reichenspurner H , Blankenberg S , Zeller T , Schnabel R.B 
Published: November 2020

Abstract

Background
Renal impairment is a common complication after CABG (coronary artery bypass graft) surgery associated with an adverse outcome.

Purpose
To further characterize the molecular framework of the disease through omics analyses.

Methods
In N=165 CABG patients we performed multi-omics-analyses in preoperatively collected blood and tissue samples as well as 991 creatinine measurements. We used multivariable mixed-model regression analyses to analyse post-operative creatinine increase and to find common genetic polymorphisms, transcripts, metabolites and/or proteins associated with changes in postoperative creatinine increase. Multiple testing was accounted for by setting a 5%-limit on the false discovery rate (FDR) using the Benjamini-Hochberg procedure.

Results
Post-operative increase of log transformed creatinine was 0.035 (8%); 95% confidence interval (CI) 0.025, 0.045; P&lt;0.001. We identified 55 gene expressions and two proteins associated with post-CABG renal impairment. On the metabolomic and single nucleotide point mutation (SNP) level, no relevant targets were found. The three most important identified gene expressions were MIR3202.1 (beta of log transformed creatinine increase per standard deviation gene expression increase −0.034; 95% CI: −0.048, 0.020; P&lt;0.001), LOC105374386 (−0.032; 95% CI: −0.046, 0.019; P&lt;0.001) and maternal embryonic leucine zipper kinase (MELK) (−0.022; 95% CI: −0.032, 0.013; P&lt;0.001). Expression of all three was associated with a lower risk of post-CABG renal impairment. The same applies to the identified protein CAPRIN2 (−0.042; 95% CI: −0.062, 0.022; P&lt;0.001), while expression of the protein TUBB6 was associated with a higher risk (0.033; 95% CI: 0.017, 0.048; P&lt;0.001).

Conclusions
In an integrated approach we identified omics-biomarkers for the prediction of renal impairment after CABG surgery. The underlying pathophysiological associations of these genes and proteins are not fully understood. MELK might be an interesting target for further investigations, as it plays a prominent role in cell cycle control, cell proliferation, apoptosis, cell migration and cell renewal. Our results may help to better identify individuals at risk and lay the methodological groundwork for further omics analyses.

Funding Acknowledgement
Type of funding source: None
Identification of trajectories of cardiac allograft vasculopathy after heart transplantation: a nationwide comparison
Authors: Bonnet G , Coutance G , Van Keer J , Raynaud M , Aubert O , Bories M.C , Bruneval P , Varnous S , Leprince P , Empana J.P , Naesens M , Patel J.K , Loupy A , Kobashigawa J , Jouven X 
Published: November 2020

Abstract

Background
Cardiac allograft vasculopathy (CAV) is a major contributor of heart transplant recipient's mortality. However, little is known about CAV trajectories at a population level.

Purpose
We aimed to identify the different profiles of CAV trajectories.

Methods
Heart transplant recipients receiving care at 4 academic centers (2004 to 2016) were included. Patients underwent prospective, protocol-based monitoring consisting of repeated coronary angiographies together with systematic assessment of clinical, functional, histological and immunological parameters. The mainoutcome was the CAV trajectories, identified with unsupervised latent class mixed models.

Results
Overall, 1,301 patients were included (609 in France, 206 in Belgium and 486 in the US). The median follow-up post-transplant was 6.6 years (IQR=4.7) with 4,710 coronary angiographies analyzed (3.6±1.6 CAV assessments per patient). In the French development cohort, we identified 4 distinct profiles of CAV trajectories over 10 years that were characterized by i) Patients without CAV at baseline and non-progression (n=317, 52.1%), ii) patients without CAV at baseline and late onset CAV progression (n=52, 8.5%), iii) patients with mild baseline CAV and mild progression (n=151, 24.8%), iv) patients with mild baseline CAV and accelerated CAV progression (n=89, 14.6%, discrimination 0.92). The 4 CAV trajectories were independently validated in the external validation cohorts from Belgium (discrimination=0.92) and the US (discrimination=0.97).

Conclusion
In a large multicentric and highly phenotyped prospective cohort of heart transplant recipients, we identified and validated 4 distinct CAV trajectories corresponding to specific initial CAV grades and subsequent evolutions. Our results provide the basis for a trajectory-based assessment for risk stratification at early-stage post heart transplantation.
Figure 1. Cardiac allograft vasculopathy trajectories in France (n=609), in Belgium (n=206), in USA (n=486). Thick lines represent latent class trajectory; thin lines represent CAV individual patient trajectory.

Funding Acknowledgement
Type of funding source: None
Clinical comparison of the two invasive treatments of hypertrophic obstructive cardiomyopathy: a systematic review and meta-analysis
Authors: Bytyci I , Bajraktari G , Henein M.Y 
Published: November 2020

Abstract

Background
The two available interventional treatment of patients with hypertrophic obstructive cardiomyopathy aresurgical myectomy (SM) and Alcohol septal ablation (ASA). The aim of this meta-analysis was to assess the efficacity of these two invasive strategies in relieving symptoms and left ventricular outflow tract obstruction (LVOTO).

Methods
We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until February 2020 for RCTs and cohorts comparing clinical outcomes with alcohol septal ablation (ASA) vs surgical myectomy (SM) in patients with HCM. The endpoints were relieving symptoms, reduced left ventricular outflow tract obstruction (LVOTO) and the need for reintervention.

Results
We included 20 studies (n=4547; 3 RCTs and 17 cohorts) comparing ASA vs MS for a mean follow-up 5.2±2.1 year. Baseline mean LVOT gradient was not different between the ASA and the MS patient groups with weighted mean difference (WMD) = 1.50 [−3.47 to 6.46, p=0.56]. During follow-up, SM patients showed greater reduction in the LVOT gradient compared to ASA WMD = −9.61 [CI, 4.71 to 14.50, p=0.0001]. In addition, SM group had greater resolution of clinical symptoms compared to ASA (NYHA class III/IV, 17% vs. 6.2% R: 2.76, CI, 1.64 to 4.64, p&lt;0.001, angina 46% vs. 15.7%, RR: 2.79 [CI, 1.14 to 6.82, p=0.02) and lower reinterventions (10.1% vs. 0.02%; RR=15.1, 95% CI: 6.10 to 37.1 p&lt;0.001).

Conclusion
Compared with alcohol septal ablation, septal myectomy treatment of hypertrophic obstructive cardiomyopathy is associated with greater resolution of clinical symptoms and less need for reintervention.

Funding Acknowledgement
Type of funding source: None
The Gly460Trp polymorphism and the overnight sodium potassium excretion in hypertensives
Authors: Delgado C , Delgado-Lelievre M , Lelievre D , Delgado-Almeida A 
Published: November 2020

Abstract

Introduction
The Gly460Trp polymorphism is associated to hypertension and renal sodium (Na) potassium (K) exchange. This study explores the relationship between blood pressure (BP) and urinary overnight Na/K ratio (UONaK) in patients genotyped for Gly460Trp polymorphism, from a cohort of hypertensive (HT) and normotensive (NT) subjects from National Heart, Lung and Blood Institute funded, Family Blood Pressure Program (FBPP).

Hypothesis
Abnormal renal K and Na excretion is associated to the Trp allele of Gly460Trp polymorphism.

Methods
3,545 subjects genotyped for Gly460Trp polymorphism were analyzed from FBPP. Subjects with diastolic BP (DBP) ≥80 or systolic BP (SBP) ≥130 mmHg were classified HTN; subjects with SBP &lt;130 and DBP &lt;80 mmHg were classified as NT. UONAK was calculated by dividing overnight Na by K concentration. Correlation analysis done with partial variables (body mass index, waist hip ratio, overnight urine creatinine).

Results
In HTN group (n=1,464), 75% had Gly/Gly, 22% Gly/Trp and 3% Trp/Trp. HTN with Gly/Gly showed strong associations between UONaK and DBP (r=0.191 p&lt;0.0001) and SBP (r=0.06, p=0.04); HTN with Gly/Trp showed strong association for DBP (r=0.123 p=0.025) but not for SBP (r=0.07, p=0.188); while HTN with Trp/Trp there was strong inverse association with SBP (r=−0.399, p=0.010; Fig. 1) and none with DBP (r=0.215 p=0.18). In NT group (n=2,081), 69% had Gly/Gly, 28% Gly/Trp and 3% Trp/Trp; NT with Gly/Gly showed strong associations between UONaK and DBP (r=0.104 p&lt;0.0001) and SBP (r=0.09, p=0.0002); NT with Gly/Trp showed strong association for DBP (r=0.146, p=0.0004) but not for SBP (r=0.05, p=0.18); while NT with Trp/Trp showed no association with DBP (r=−0.003 p=97), or SBP (r=0.06, p=0.61).

Conclusions
Hypertensives with Trp/Trp showed strong correlation between systolic blood pressure and UONaK, indicating abnormal K excretion in hypertensives, and possible subgroup targeted to potassium sparing drugs.

Funding Acknowledgement
Type of funding source: None
Arterial stiffness is associated with elastin fragmentation and medial collagen content in the human aorta
Authors: Mahmud A , McNulty M , McGovern E , Spiers J.P , Kavanagh P , Tolan M , Young V , Feely J , Silke B 
Published: November 2020

Abstract

Background
Age-related changes in arterial stiffness are ascribed to collagen and elastin content in the aorta (Ao) which is modulated by the matrix metalloprotienases (MMPs). However, no study has directly compared arterial stiffness and arterial structure in man.

Methods
Aortic and internal mammary artery (IMA) tissue were obtained from 10 patients (62±1 years, 2 female) undergoing coronary artery bypass grafting (CABG). Aortic pulse wave velocity (PWV) was measured prior to CABG. Collagen content was assessed in tissue sections using Sirius Red staining and elastin by ACCUSTAIN. Elastin fragmentation in the Ao media was graded; increasing in severity from 1 to 4. MMP-2 and MMP-9 activity was quantified in the Ao using gelatine zymography. Results are expressed as mean±SEM, p&lt;0.05 considered significant.

Results
The collagen concentration was 50% (intima), 42% (media)and 76% (adventitia) in the Ao but was lower in the IMA. PWV was significantly associated with Ao medial (r=0.79, p=0.03) but not intimal or adventitial collagen concentrations. Aortic intimal thickness was related significantly with age (r=0.70, p&lt;0.05) but not PWV. There was no relationship between age and Ao collagen concentration. There was a significant association (p&lt;0.001) between increasing elastin fragmentation in the aortic media and PWV but not age. There was no relationship between collagen concentration in the IMA and either PWV or age. Neither latent nor active MMP-2 activity was related with PWV or age. Latent MMP-9 expression was significantly associated with PWV (r=0.66, p&lt;0.05) but not age.

Conclusions
Our proof-of-concept study is the first one to show that elastin fragmentation in the aorta may underlie arterial stiffening in man. In contrast, the internal mammary artery does not age, unlike the aorta, which makes it the reassuring choice for coronary artery bypass grafting.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Health Research Board, Ireland
Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients
Authors: Andrikou E , Dimitriadis K , Andrikou I , Kasiakogias A , Tatakis F , Dimitriadi M , Anastasiou A , Kintis K , Kalos T , Iliakis P , Tousoulis D , Tsioufis C 
Published: November 2020

Abstract

Background/Introduction
Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome.

Purpose
In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time.

Methods
1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&gt; or =210 mmHg for men and &gt; or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &lt;140/90mmHg.

Results
46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p&lt;0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up.

Conclusions
Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects.

Funding Acknowledgement
Type of funding source: None
Cardiovascular risk and outcome in patients with hypertensive emergencies and urgencies in an emergency department. an italian greek collaboration
Authors: Muiesan M.L , Salvetti M , Fragoulis C , Paini A , Bertacchini F , Stassaldi D , Dimitriadis K , Konstantinidis D , Kasiakogias A , Andrikou I , Siafi E , Leontsinis I , Iliakis P , Tousoulis K , Tsoufis K 
Published: November 2020

Abstract

Background
At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies.

Methods
Medical records of patients aged &gt;18 yrs, admitted to the ED with blood pressure values ≥180 mmHg (SBP) and/or ≥120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76% as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70±13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5±7 months years.

Results
During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22%) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7%, chi-square p=0.0001 and 5.8 vs 1.2% chisquare p&lt;0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events.

Conclusions
Admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.

Funding Acknowledgement
Type of funding source: None
Screening and health education in barbershop centers for hypertension (SALOON-HTN)
Authors: Addad F , Bahri F , Zaghib H , Abdellatif N , Bennour E , Bouzouita M , Ben Jemaa N , Ladhib W , Abid L , Abdesslem S , Kachboura S 
Published: November 2020

Abstract

Background
Hypertension is a major concern of public health policy in Tunisia. However hypertension is both highly prevalent (almost 35% of the Tunisian population) and insufficiently treated and controlled, which is partly due to unawareness. Historically, barbershops previously have been used for blood pressure screening and to improve hypertension controlled rate

Objective
This study aimed to screen hypertension in barbershops.

Study design
SALOON-HTN is a cross-sectional, descriptive, non-interventional, multicenter survey aiming to screen hypertension by measuring blood pressure in barbershops, located in Metline Township (limited contact with the healthcare system). Twenty-seven barbershops hairdressers were trained by a medical staff to measure the blood pressure by an ambulatory device. All subjects willing to participate in the survey were asked to measure their blood pressure after at least 5 minutes rest. Three measures were performed by the Hairdressers, with an interval of 1 minute between each measure. The mean of the last two measures was considered. If the mean blood pressure level exceeded 135 and/or 85 mmHg the subject was referred to physician.

Patients
Adults aged more than 18 years were included.

Results
A total of 1 536 patients were included in the study. The mean age was 40.7±15 years; 57% were men. Among them, 54.2% had never measured their blood pressure; 439 (28.5%) participants had hypertension, only 136 (8.9%) of those with hypertension were aware of their condition, 95 participants (69.9% of those who were aware of their condition) were receiving treatment, and hypertension was controlled in 43.2% participants of those being treated. Overall control was worst in our study (8.9%).

Conclusion
Saloon-htn confirmed the poor control and unawareness of hypertension. There is an obvious need for programs to increase access to primary care physicians.

Funding Acknowledgement
Type of funding source: None
Hemodynamic and metabolic disorders in obese patients with resistant hypertension
Authors: Shalimova A , Psarova V , Kochuieva M , Kolesnikova O , Isaieva A , Prosolenko K 
Published: November 2020

Abstract

Resistant hypertension (RH) is an important cause of cardiovascular morbidity and mortality. Both true and pseudo-resistant arterial hypertension (AH) represent a big problem not only in blood pressure (BP) control, but also in those possible adverse cardiovascular events, the development of which is associated with failure to achieve target BP levels.
The aim of the study was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant AH.

Material and methods
The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target BP levels after 3 months on dual therapy were additionally assigned a third antihypertensive drug. Of the 98 patients who were assigned triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy.

Results
After 6 months of therapy, patients with RH had higher body mass index (BMI) and higher BP levels compared to patients without this condition. Patients with RH also had more pronounced cardiovascular remodeling, higher levels of triglycerides, insulin, HbA1c, more pronounced insulin resistant (IR), which was confirmed by greater HOMA-IR, greater imbalance of adipokines, proinflamation activity and higher activity of the renin-angiotensin-aldosterone system (RAAS). A comparative assessment of pseudo-resistance and true resistance showed that patients with true resistance differed from pseudo-resistant patients with significantly lower BMI (p=0.02). In addition, in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone (p=0.04), higher activity of oxidative stress (malonic dialdehyde, p=0.01 and diene conjugates, p=0.03), a lower level of total antioxidant protection (p=0.00), a higher level of adiponectin (p=0.00), and a lower level of leptin (p=0.00), compared with pseudo-resistant patients.

Conclusions
Patients with resistant hypertension differed from hypertensive obese patients without resistance with higher BMI and BP, higher levels of triglycerides, insulin, HbA1c, more pronounced IR, cardiovascular remodeling, imbalance of oxidative stress - antioxidant protection system, higher proinflammatory and RAAS activity. Patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress - antioxidant protection and less pronounced adipokines imbalance.

Funding Acknowledgement
Type of funding source: None
A new odissey for the clinical cardiologist: the difficult application of arterial hypertension guidelines in patients with chronic coronary syndrome
Authors: Cosmi D , Mariottoni B , Cosmi F 
Published: November 2020

Abstract

Introduction
In hypertensive patients with chronic coronary syndrome (CCS), the 2018 European Society of Cardiology (ESC) arterial hypertension guidelines recommend target pressure ranges that can be difficult to apply, leading to possible medico-legal and other not insignificant problems.

Methods
In 2019 we evaluated blood pressure values measured according to the ESC 2018 recommendations in 2,456 patients. We focused on 505 asymptomatic patients with CCS, already undergoing antihypertensive drug treatment.
Patients with secondary hypertension, heart failure, atrial fibrillation, malignancies or life expectancy &lt;1 year were excluded. We analyzed the incidence of high systolic pressure coexisting with diastolic pressure lower than the indicated target and the incidence of blood pressure below the targets indicated in asymptomatic patients in the various age groups considered.

Results
In 24% of patients aged ≥80 years we found an office systolic blood pressure ≥140 mmHg together with a diastolic &lt;70 mmHg, confirmed at the 2- and 4-week control. These values were also recorded in 18% of patients aged 65–79 years and in 5% of those aged 18–65 years.
In asymptomatic patients aged 18–65 years old we found a systolic blood pressure &lt;120 mmHg (considered not safe in the guidelines) in 4% of cases; SBP was &lt;130 mmHg in 14% of patients aged 65–79 years and in 7% of those aged ≥80 years (considered not safe in the guidelines in these age group) (See table 1).

Conclusions
The daily application of the ESC 2018 guidelines is challenging, due to contradictory suggestions (is it necessary to reduce a high systolic pressure ≥140 mmHg in the presence of a diastolic below the level considered dangerous &lt;70 mmHg?; in an asymptomatic patient should therapy be reduced or suspended if blood pressure levels are not within the range considered optimal and safe?). This problem does not occur in American and NICE guidelines. We think that this topic should be largely reconsidered; guidelines writers should ask themselves these questions in order not to make hypertension treatment difficult or arbitrary.

Funding Acknowledgement
Type of funding source: None