bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6293Assessment of testosterone/estradiol ratio, DHEA-S level and correlation with coronary inflammatory markers IL-1 & 6, TNF-1 and hsCRP predict 5 years risk of cardiovascular disease in men
Authors: Sen N , Tanwar S , Jain A , Sharma J , Gokhroo R K , Mehta A , Kalra B 
Published: October 2019

Abstract

Background
Previous data showed the adrenal sex hormone dehydroepiandrosterone (DHEA) which is present in serum mainly as the sulfate DHEA-S is the most abundant steroid hormone and another hormones like testosterone, estradiol are related to cardiovascular risk in men. Literatures revealed vascular and metabolic actions of DHEA/-S, evidence for an association between DHEA/-S levels and cardiovascular events is controversy.

Objectives
Our aim is to review and clear the contradictory point regarding cardiovascular risk and correlation of testeosterone/ estradiol ratio, DHEA-S level with coronary inflammatory markers in men.

Methods
Large population based cohort study done at multi centre of cardiology from 2013- 2018 in India. We enrolled total 23631 normal healthy male population age between 40 to 60 years and divided into two groups based on testosterone/estradiol ratio (Group A (n=2450) lower value of T/E ratio and Group B (n=21181) normal or higher T/E ratio. We did cohort analysis for 5 years and evaluated DHEA-S level and correlated it with coronary inflammatory markers and cardiovascular risk.

Results
In group A (low T/E ratio) we found low level of DHEA-S (98% of individual) and higher value of interleukins IL-1 (68%),IL-6 (74%) and tumor necrosis factor TNF-1 (71%) and high sensitive C-reactive protein (hsCRP) (73% of individual). Data revealed two fold increase of high blood pressure and LDL cholesterol level as compared to group B (normal or high T/E ratio and normal or high value of DHEA-S). 2.5 fold higher rate of coronary heart disease (CHD) found in group A versus in group B. We did not found as much significant difference in stroke, carotid and peripheral artery disease. T/E ratio and DHEA-S levels were inversely associated with the age-adjusted risk of a CHD event; the hazard ratios and 95% confidence intervals per standard deviation (SD) increase were 0.76 (0.66 to 0.91) and 0.82 (0.72 to 0.93), respectively.

Conclusions
Decrease ratio of testosterone/estradiol levels correlate decreased levels of DHEA-S which may increase the risk of CHD in men. For future aspect, correction of T/E ratio, DHEA-S and increase its awareness should be at mass level for prevention of CHD.
P6295Methotrexate reduces cardiac remodeling and improves left ventricle function in rats with Takotsubo cardiomyopathy
Authors: Guido M C , Lopes N M , Tavares E R , Bispo D L , Tavares De Melo M D , Salemi V M C , Maranhao R C 
Published: October 2019

Abstract

Introduction
Takotsubo cardiomyopathy (TC) is characterized by cardiac disfunction and left ventricle (LV) remodeling caused, mainly, by physical or emotional stress. Previously, we have shown in atherosclerotic rabbits that methotrexate (MTX), an anti-inflammatory chemotherapeutic agent, is capable of reducing the inflammatory process and atherosclerotic lesions.

Purpose
To investigate the effect of MTX treatment in rats with TC.

Methods
TC was induced in Wistar rats with 2 injections of isoproterenol (85mg/kg) with a 24h interval. Animals were allocated in 3 experimental groups: CT: animals induced and treated with saline; TK: animal induced with isoproterenol and treated with saline; TK-MTX: animals induced with isoproterenol and treated with MTX (1mg/kg). Animals were treated every week for 4 weeks. After the treatment, echocardiography, morphometry and molecular analysis (Western blot) of the LV were performed.

Results
TK and TK-MTX groups did not show cardiac dilation or LV intraventricular septum and posterior wall thickening. However, compared to TK, the treatment with MTX improved both LV systolic and diastolic function. In addition, the treatment diminished myocytes diameter and subendocardial and interstitial fibrosis of the LV. Protein expression of pro-apoptotic factors (caspase 3 and BAX), pro-inflammatory cytokine TNF-α, metalloproteinase 2, transforming growth factor beta, collagen I and III and hypoxia-inducible factor 2 alfa were all decreased. Vascular endothelial growth factor (VEGF) and adenosine A1 receptor showed increased protein expression in TK-MTX group when compared to CT and TK. There was correlation of myocardial fibrosis (r2=-0.57), myocytes diameter (r2=-0.78) and VEGF expression (r2=0.58) with LV systolic disfunction. Also, myocardial fibrosis (r2=0.57) and VEGF expression (r2=-0.68) correlated with diastolic disfunction in the LV. Animals treated with MTX did not present any toxicity.

Conclusion
Treatment with MTX diminished apoptosis, the expression of TNF-α and metalloproteinases, cardiac hypertrophy and myocardial fibrosis. Besides that, the treatment increased angiogenesis and strongly improved cardiac function of the LV. MTX, possibly through an increase in the production of intracellular adenosine, could be considered as a feasible treatment for TC.

Acknowledgement/Funding
FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo)
P6329123-Iodine Metaiodobenzylguanitidine imaging: a useful prognostic marker of cardiovascular death in heart failure patients
Authors: Birtolo L I , Scarparo P , Salvi N , Frantellizzi V , Cimino S , Severino P , Maestrini V , Mancone M , De Vincentis G , Fedele F 
Published: October 2019

Abstract

Background
According to guidelines, implantable cardioverter defibrillator (ICD) is recommended in prevention of sudden cardiac death (SCD) in heart failure (HF) patients (pts). Guidelines have several limitations because ICD indication is based mainly on left ventricular ejection fraction (LVEF). Recently, 123-iodine metaiodobenzylguanidine imaging (123-I MIBG) seems to identify, independently from LVEF, pts at high risk of SCD: heart/mediastinum (H/M) ratio<1.6 and summed score (SS)>26.

Purpose
The aim is to assess the role of 123-I MIBG to predict malignant ventricular arrhythmias (VA) in HF pts

Methods
We enrolled 208 pts, admitted to our hospital with diagnosis of HF and LVEF≤35%, NYHA class II and III, who underwent 123-I MIBG imaging. H/M ratio of 1.6 was used as a cut-off to identify high risk (G1) versus low risk pts (G2). All pts underwent ICD implantation. Follow-up was performed at 24 months.

Results
138 patients were included in G1 and 70 patients in G2. All baseline characteristics were similar in the two groups (table 1). At 24 months follow-up VA events were recorded greater in G1 compared to G2 (21% vs 10%, p=0.04).
Table 1 G1 G2 P value H/M ≤1.6 (N=138) H/M >1.6 (N=70) Age (years) 65±12 63±14 0.28 Male, N (%) 108 (78) 64 (91) 0.02 Diabetes mellitus type II, N (%) 54 (39) 14 (20) 0.01 Dyslipidemia, N (%) 58 (42) 30 (42) 0.64 LVEF (%) 30±5 31±4 0.14 Ischaemic CM, N (%) 85 (62) 30 (42) 0.012 Malignant VA, N (%) 30 (21) 7 (10) 0.04 SS 38±9 16±7 0.0001 H/M: heart mediastinum ratio; LVEF: left ventricular ejection fraction; CM: cardiomyopathy; VA: ventricular arrhythmias; SS: summed score.

Conclusion
Our results seem to confirm that 123-I MIBG uptake is associated with the occurrence of life-threatening VA in HF pts independently from LVEF. The use of 123-I MIBG could be a useful tool in the future to increase the specificity of the pts selection for ICD therapy.
P6349Inflammation mitigation improves post-infarction functional recovery of the heart
Authors: Ivanov M , Tacu L , Todiras M , Moraru I , Cobet V , Popovici M 
Published: October 2019

Abstract

Aim
The in vitro evaluation of the cardiac functional effects of TNF-α antagonist administration in rats after isoproterenol induced myocardial infarction.

Material and methods
Myocardial infarction was reproduced using a proven model based on isoproterenol i/p administration in rats in 2 consecutive days in a similar dose, 150 mg/kg. In another group the animals after isoproterenol induced myocardial infarction (series IMI) have received daily TNF-α antagonist, a specific monoclonal antibody (ma-TNF-α) i/p in dose of 50 mg/kg during 8 days (series IMI+ma-TNF-α). In both series the animals were sacrificed after 10 days from the 1st injection and their isolated hearts ware perfused with Krebs solution according to Langendorff and Neely-Rovetto models.

Results
The most remarkable traits of left ventricle dysfunction in IMI in comparison to control were following: (1) diminution of cardiac output (CO), systolic pressure (SP) and +dP/dT max by respectively 28,7 and 34,7 and 23,3%; (2) negative inotropic effect to action of endothelin-1 manifested by decrease of SP and aortic jet during stimulation up to 13,9%; (3) increased cardiac arrhythmogenic activity in response to calcium overload; (4) increasing by 45,2% of ischemia induced contracture as well as decreasing by 37,5% of SP during reperfusion. The ma-TNF-α administration in post-infarction period led to noticeable benefits such as: significant enhancement of SP and CO respectively by 17,3 and 18,6% as well as positive inotropic effect developing to ET-1 action as well as significant increase of time regarding the appearance of ventricular extrasystole and ventricular tachyarrhythmia by respectively 12,9 and 11,7% as well as perceptible improvement of ischemia-reperfusion syndrome.

Conclusion
A sustained inflammation inhibition by ma-TNF-α administration in post-infarction period improves tangibly the cardiac functioning that proves the role of inflammatory response in myocardial infarction induced functional and structural myocardial remodeling and underlines the inflammation as a therapeutic target.
P6356Comparisons of clinical outcomes in patients with heart failure with preserved ejection fraction with and without atrial fibrillation: results from a multicenter PURSUIT-HFpEF registry
Authors: Masuda M , Kanda T , Asai M , Mano T , Yamada T , Yasumura Y , Uematsu M , Hikoso S , Nakatani D , Tamaki S , Higuchi Y , Nakagawa Y , Fuji H , Abe H , Sakata Y 
Published: October 2019

Abstract

Background
The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction.

Objective
This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF).

Methods
PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded.

Results
Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups.

Conclusion
In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without.

Acknowledgement/Funding
None
P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?
Authors: Vidal-Perez R , Agra-Bermejo R , Pascual-Figal D , Gude Sampedro F , Abou Jokh C , Delgado Jimenez J , Varela-Roman A , Gomez Otero I , Ferrero-Gregori A , Alvarez-Garcia J , Worner Diz F , Segovia J , Cinca J , Fernandez-Aviles F , Gonzalez-Juanatey J R 
Published: October 2019

Abstract

Background
The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients.

Purpose
The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes.

Methods
We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission.

Results
The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1)
Effect of post-discharge heart rate

Conclusions
In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients

Acknowledgement/Funding
Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de
P6363Achieved blood pressure and cardiovascular outcomes in hypertensives
Authors: Park H.-Y , Lim N.-K , Kim W.-H , Lee J.-W , Cho M.-C 
Published: October 2019

Abstract

Background/Introduction
Lowering blood pressure is very beneficial in reducing the risk of cardiovascular morbidity and mortality. But, the extent of optimal target blood pressure in hypertensive patients is still controversial.

Purpose
The objectives of this study were to assess the level of proper systolic and diastolic blood pressure to prevent cardiovascular events in older and younger patients.

Methods
We used the National Sample Cohort from the National Health Insurance Service of 2007 to 2013 in Korea and analyzed data from 44,462 hypertensive patients aged from 20 to 84, treated with one or more antihypertensive agents and participated at least one general health examination. Achieved systolic and diastolic blood pressure (SBP/DBP) were categorized by exclusive average achieved SBP (<120, <130, <140, <150, and ≥150 mmHg) and DBP (<70, <80, <90, <100, and ≥100 mmHg) categories using the blood pressure measurements of one or more available health examinations. The primary outcome was defined as composite, which was the first occurred event among admissions of myocardial infarction, stroke, and heart failure or cardiovascular death. Secondary outcomes were individual components of composite outcome and all-cause death.

Results
Of 44,462 patients, 5,478 (12.3%), 13,410 (30.2%), 15,021 (33.8%), 7,051 (15.9%), and 3,502 (7.9%) patients achieved SBP <120 mm Hg, 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and ≥150 mm Hg, respectively. During the median follow-up of 6.8 years, 2,151 (4.8%) died by all-cause of death, and 2,463 (5.5%) met the criteria of composite outcome. In elderly patients, compared with achieved SBP 120–129 (reference), there was no significant increase in risk at SBP 130–139 mm Hg and 140–149 mm Hg, but SBP 150 mm Hg or more was positively associated with significant risk of composite outcome and all-cause death, with HR of 1.29 (95% CI, 1.11–1.51) and 1.66 (95% CI, 1.43–1.92), respectively (Figure). On the other hand, in younger patients, the risk for incidence of composite outcome was significantly increased both at SBP 140–149 mm Hg (HR, 1.39; 95% CI, 1.11–1.73) and 150 mm Hg or more (HR, 2.00; 95% CI, 1.53–2.62) In addition, an achieved SBP 130 mm Hg and more was also significantly associated with all-cause death with HR of 1.27 (95% CI, 1.00–1.62). Compared with 120–129 mm Hg, elderly patients who had achieved SBP less than 120 mm Hg were more likely to have increased risk for composite outcome (HR, 1.29; 95% CI, 1.10–1.52), but not in younger patients (HR, 1.01; 95% CI, 0.78–1.30).

Conclusion
In conclusion, an intensive lowering of blood pressure is more likely to increase the risk rather than to prevent major cardiovascular events and all-cause death, particularly in older than younger. Therefore, an intensive blood pressure lowering of SBP/DBP below 120/70 mm Hg in the elderly should be avoided.

Acknowledgement/Funding
The Korea National Institute of Health research grant 2017-NI63001-00
P6367Predictors and covariables of incident hypertension in midlife: the Hordaland Health Study
Authors: Kringeland E A , Tell G S , Midtbo H B , Haugsgjerd T , Gerdts E 
Published: October 2019

Abstract

Background
Different blood pressure (BP) development in midlife have been described in women and men. Less is known about factors associated with incident hypertension in this age group.

Purpose
To identify predictors and covariables of incident hypertension in women and men in their forties.

Methods
2936 women (60%) and men born 1950–51 who participated in the community-based Hordaland Health Study both in 1992–93 (baseline, mean age 42±0.7 years) and in 1997–99 and were normotensive at baseline were included. Hypertension was defined as use of antihypertensive medication and/or systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg. High-normal BP was defined as systolic BP 130–139 mmHg and/or diastolic BP 85–89 mmHg following European guidelines. Predictors and covariables of incident hypertension were identified in logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI).

Results
348 (12%) subjects developed hypertension during an average of 5.9 years follow-up. Incident hypertension was more common among men than women (14% vs. 10%, p=0.005). In univariate analyses, incident hypertension was positively associated with high normal BP and higher body mass index (BMI), serum total cholesterol and serum triglycerides at baseline, as well as with larger increase in BMI and serum triglycerides during follow-up (all p<0.05). In multivariable analysis, incident hypertension was associated with high-normal BP and higher serum triglycerides at baseline, and larger increase in BMI during follow-up, while the association with sex became non-significant (Table).
Variable Multivariable analysis OR (95% CI) P-value High-normal BP 4.87 (3.82–6.20) <0.001 ΔBMI at follow up (kg/m2) 1.33 (1.24–1.42) <0.001 Ln serum triglycerides (mmol/L) 1.41 (1.14–1.75) 0.002

Conclusion
In the community-based Hordaland Health Study, a larger proportion of men than women developed hypertension in midlife. However, this sex difference in incidence was explained by differences in prevalence of high-normal BP at baseline and metabolic factors.
P6388Effects of Interleukin-1 blockade with anakinra in patients with ST-segment elevation acute myocardial infarction on recurrent ischemic events: results from the VCUART3 study
Authors: Van Tassell B , Lipinski M J , Appleton D , Trankle C R , Kadariya D , Abouzaki N A , Canada J M , Carbone S , Buckley L F , Melchior R , Thomas C , Garnett J , Puckett L , Kontos M C , Abbate A 
Published: October 2019

Abstract

Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of recurrent ischemic events. Prior studies of IL-1 blockade have shown conflicting results regarding the risk of future events.

Methods
We enrolled patients with STEMI within 12 hours of presentation at 3 sites in the United States of America. After revascularization, patients were randomly assigned to receive anakinra 100 mg twice daily, anakinra 100 mg once daily (standard dose) alternated with placebo once daily every 12 hours, or placebo every 12 hours for 14 days in 1:1:1 ratio. Prespecified exploratory endpoints for recurrent ischemic events, adjudicated by an independent committee, evaluated the composite risk of subsequent acute myocardial infarction (AMI, World Health Organization classification Type 1), unstable angina, or urgent revascularization. Data are expressed as median and interquartile range or number and percentage. Cox regression analysis was used to generate unadjusted hazard ratios and confidence intervals. (ClinicalTrials.gov number, NCT01950299)

Results
Of 311 patients screened, 99 subjects (81% males, 58% Caucasians, 55 [49–62] years of age) were randomly assigned to anakinra twice daily (N=31), anakinra once daily (N=33) or placebo (N=35). The cohort included patients with hypertension (57%), tobacco use (55%), diabetes mellitus (30%), and prior diagnosis of coronary artery disease (21%) without statistically significant imbalances in the demographic characteristics between groups (all P>0.05). Discharge medications for the index STEMI admission, in addition to the study medication, included aspirin (100%), statins (100%), P2Y12 inhibitors (100%), beta-blockers (90%), and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84%), without statistically significant imbalances between the 3 groups. Over the 1-year follow-up, recurrent ischemic events occurred in 5/35 (14.3%) patients treated with placebo and 6/64 (9.1%) patients treated with anakinra (hazard ratio = 0.68 [0.20–2.24], P=0.53). No differences were observed between high- and low-dose anakinra treatment groups.

Conclusions
A two week treatment with IL-1 receptor antagonist, anakinra, did not significantly decrease or increase recurrent ischemic events over the course of a 1-year follow-up in patients with STEMI.

Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply by Swedish Orphan Biovitrum