bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluid responsiveness in patients under mechanical ventilation and low tidal volume ventilation through the pulse pressure variation after tidal volume challenge in the post-operative cardiac surgery
Authors: Azevedo D F C , Viera De Melo R M , Cunha A C , Brito L G S , Viana T , Figueiredo C S , Gomes B C S , Bezerra C G , Tamazato A O , Santos Junior R P , Rangel R A , Oliveira F C , Nascimento Junior O R , Da Silva D N V , Passos L C S 
Published: October 2021

Abstract

Background
It is known that in the immediate postoperative period of cardiac surgery, strict control of hemodynamic variables and blood volume is necessary, since there is an imbalance between oxygen supply and consumption. Thus, the present study seeks to validate methods previously used in different clinical situations to predict fluid responsiveness, in the current scenario of the immediate postoperative period of cardiac surgery.

Purpose
To evaluate the influence of “tidal volume challenge” from 6 ml / kg to 8 ml / kg of the predicted body weight (PBW) in conjunction with the end expiratory occlusion test (EEOT) in the variation of pulse pressure to predict fluid responsiveness in the immediate postoperative period of cardiac surgery.

Methodology
This prospective study included 30 patients after cardiac surgery. Hemodynamic and ventilatory parameters were initially recorded in mechanical ventilation at 6 ml/kg and after tidial volume challenge and with the EEOT at 8 ml/kg of predicted body weight (PBW). After recorded the intervention data, there was a return to ventilation at 6 ml/kg and a saline infusion of 500 ml was performed for 15 minutes. Fluid responsiveness was defined for patients who had an increase of 10% or more in velocity time integral (VTI) by echocardiogram after volume expansion compared to baseline value. Multivariate analysis was used to identify independent predictors of fluid response status. Sensitivity and specificity analyzes were performed to determine the predictive precision of each parameter.

Results
The main result of our study is that, when the tidal volume is increased from 6 to 8 ml/kg of PBW, the relative increase in pulse pressure variation (%ΔPPV6–8) predicts with excellent accuracy responsiveness to fluids with cut-off values of 18.3%, with sensitivity of 92.9% and specificity of 84% (P=0.019). Although changing PPV6, EEOT6 and EEOT8 are not reliable in predicting fluid responsiveness, they still require additional calculations. PPV8 also discriminates between responders and non-responders; however, with sensitivity (78.6%) and specificity (66.6%) when the value found in the PPV8 is up 8.5, but without statistical significance (figure).

Conclusion
The challenge of tidal volume and its influence on the ΔPP variation has excellent accuracy to predict fluid responsiveness in the immediate postoperative period of cardiac surgery. EEOT did not present good accuracy to predict fluid responsiveness in patients in the immediate postoperative period of cardiac surgery.

Funding Acknowledgement
Type of funding sources: None.
Off-pump versus on-pump coronary artery bypass grafting: a propensity score-matching analysis of safety and long-term results
Authors: Saraiva F A , Cerqueira R J , Ferreira A F , Moreira R , Amorim M J , Barros A S , Pinho P , Lourenco A P , Leite-Moreira A F 
Published: October 2021

Abstract

Background
The role and the indications for using off-pump coronary artery bypass surgery (OPCAB), instead of the traditional on-pump (ONCAB), is still to be addressed.

Aim
To describe our centre experience and to compare 15-years survival and early safety outcomes between OPCAB and ONCAB.

Methods
Single-centre retrospective cohort including 9-years of isolated first CABG (2005–2013). Multi-vessel disease with at least 2 surgical grafts patients were considered and the first 50 surgeries of each surgeon with each technique were excluded to account for the learning curve effect. Emergent surgeries and on-pump beating heart procedures were also excluded. A propensity-score matching (PSM) analysis was performed to balance groups and both survival and early outcomes comparison was done within the matched cohort using Kaplan-Meier or Cox stratified and paired tests, respectively. The median follow-up was 9 years, maximum 15 years.

Results
From 3012 multi-vessel patients with at least 2 surgical grafts, 2503 were included at the main analysis: 1487 ONCAB and 1016 OPCAB. ONCAB patients presented more frequently 3-vessels disease and left ventricular dysfunction, but received similar number of grafts than OPCAB, who in turn, received more frequently multiple arterial grafts. The surgical completeness of revascularization (CR) was similar, but hybrid procedures were more frequent in OPCAB raising CR rate in this group. After PSM (646 pairs), both groups were similar regarding pre and peri-operative characteristics. The long-term survival was similar (HR stratified by pair: 1.02 (0.81–1.30), but OPCAB evidenced benefits at early term results including bleeding, postoperative atrial fibrillation and stroke incidence.

Conclusion
At our centre, OPCAB performed by experienced surgeons provides rates of complete revascularization and long-term survival similar to ONCAB. In-hospital results favoured OPCAB.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP; Social European Fund; FCT-Fundação para a Ciência e a Tecnologia
Higher levels of serum phosphorus are associated with coronary calcification post heart transplantation
Authors: Ozcan I , Toya T , Corban M T , Ahmad A , Nardi V , Lerman L O , Kushwaha S S , Lerman A 
Published: October 2021

Abstract

Background
A higher serum phosphorus level, although within the normal range has been linked to coronary artery and aortic calcification in the non-transplant population. Coronary calcification is mostly associated with donor-derived lesions, and is uncommon within the first years after heart transplantation.

Purpose
We aimed to investigate the association of phosphorus levels with plaque calcification after heart transplantation.

Methods
A total of 156 patients who underwent virtual histology intravascular ultrasound (VH-IVUS) studies for cardiac allograft vasculopathy (CAV) surveillance and had fasting serum phosphorus levels &lt;4.5 mg/dL, were included in the analyses. IVUS analyses were performed in the proximal left anterior descending artery, and plaque composition of dense calcium (DC) was evaluated using VH-IVUS, and presented as percent DC of total plaque volume. The patients were separated into 3 groups according to tertiles of serum phosphorus levels.

Results
Mean recipient and donor ages were 54±13 and 31±14 years, respectively. Mean serum phosphorus in recipients was 3.5±0.6 mg/dL, with median time after transplantation at the IVUS studies of 6 (3,10) years. There were no significant differences in %DC between phosphorus tertiles in patients who underwent IVUS within 6 years after transplantation (p=0.11, Fig. 1A). However, beyond 6 years after transplantation, we observed an incremental association between phosphorus levels and the extent of calcification (p=0.02, Fig. 1B). In this group, serum phosphorus levels significantly correlated with %DC (standardized β=0.29, P=0.008), and this correlation remained significant after adjustment for donor age, recipient age, and eGFR (standardized β=0.26, P=0.001).

Conclusion
Higher serum phosphorus levels were associated with a level-dependent increase in calcified coronary artery plaque in patients starting 6 years post heart transplant. Long-term exposure to higher serum phosphorus, even within the normal range, might promote plaque calcification after heart transplantation.

Funding Acknowledgement
Type of funding sources: None.
Associations between plasma metabolite profiles and blood pressure: the HELIUS study
Authors: Verhaar B , Mosterd C M , Collard D , Galenkamp H , Van Den Born B J H , Muller M , Nieuwdorp M , Van Raalte D H 
Published: October 2021

Abstract

Background
Blood pressure (BP) is regulated by plasma metabolites from different neurohumoral and cardiometabolic systems. Since there are established differences in hypertension pathogenesis and treatment response between ethnicities, we hypothesized that plasma metabolites may be differently associated with BP across ethnic groups.

Purpose
To investigate associations between plasma metabolite profiles and BP in a multi-ethnic population-based cohort.

Methods
From the Healthy Living In an Urban Setting (HELIUS) study, 369 subjects (mean age 52±11 years, 51%F) of African and non-African descent were included. Office systolic (136±21 mmHg) and diastolic (83±12 mmHg) BP levels were recorded. Plasma metabolites were measured semi-quantitively with LC-MS (Metabolon) from fasting plasma samples. Associations between metabolite profiles and BP were assessed with machine learning prediction models using the XGBoost algorithm with nested cross-validation. Associations between the resulting best predictors and BP were assessed with linear regression models while adjusting for age, sex, estimated glomerular filtration rate and diabetes.

Results
Plasma metabolite profiles explained 14.1% of systolic BP variance and 10.6% of diastolic BP variance. These were attenuated to 3.1% and 1.4% respectively, when using residuals of BP after adjusting for age and sex. Top predictors for both systolic and diastolic BP included N-formylmethionine, several acylcarnitines and polyunsaturated fatty acids such as hexadecadienoate. These metabolites were significantly associated with higher systolic BP with estimates ranging from 3.0 to 4.5 mmHg per 1 SD increase in the adjusted models. Associations with hexadecadienoate, dihomolinoleate and catecholamine metabolites, including vanillactate had significant interactions (p&lt;0.05) with ethnicity, and were only significant in subjects of non-African descent.

Conclusions
Plasma metabolome composition explained a large proportion of BP variance, but this association was attenuated when adjusting for confounders. Polyunsaturated fatty acids and catecholamine metabolites were only associated with BP in the non-African descent subjects. N-formylmethionine was the most consistent predictor for systolic BP across all subgroups. Future studies could focus on translating these findings in vitro in order to decipher the role of N-formylmethionine in BP regulation.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Dutch Heart Foundation, the Netherlands Organization for Health Research and Development, the European Integration Fund and the European Union (Seventh Framework Programme) Explained variances of machine learningLinear regression models
Blood pressure response during treadmill exercise testing and the risk for future cardiovascular events and new-onset hypertension
Authors: Zafrir B , Asaf Y , Aker A , Saliba W 
Published: October 2021

Abstract

Background
Although there is a diminishing role of exercise stress testing (EST) in the diagnostic assessment of coronary heart disease, the physiologic response to exercise may provide valuable prognostic information. We aimed to investigate the association of repeated blood pressure (BP) measurements during EST with long-term risk of myocardial infarction, stroke or death (MACE), as well as the development of new-onset hypertension.

Methods
Retrospective analysis of EST performed between the years 2005–2019 in a single center according to Bruce protocol. Included were patients aged 35–75 years without a history of cardiovascular disease (n=14,792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 minutes). Association of BP measures with study outcomes during a median follow-up of 78 months was investigated.

Results
An increment of 10-mmHg in rest, submaximal, peak and recovery systolic BP was each associated with a significant increase in the hazard ratio (HR) and 95% confidence interval (CI) for MACE: 1.09 (1.04–1.14), 1.06 (1.01–1.10), 1.04 (1.01–1.08), and 1.06 (1.02–1.10), respectively, after adjustment including exercise capacity, medications and resting BP. The association between SBP at submaximal exercise and recovery with MACE had a J-shaped appearance (Figure). Among non-hypertensive patients without BP lowering medications (n=8,529), 13% were diagnosed with new-onset hypertension during follow-up. Excessive systolic BP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of future hypertension [HR (95% CI)]: 1.87 (1.41–2.48), as were systolic BPs during submaximal exercise [&gt;160 vs. ≤130 mmHg: 2.44 (1.97–3.03)] and recovery [≥140 vs. ≤120 mmHg: 1.65 (1.37–1.98)], showing gradual, incremental association with the risk for developing hypertension.

Conclusions
BP measurement during exercise and recovery phases of treadmill testing provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing future hypertension.

Funding Acknowledgement
Type of funding sources: None.
Tobacco cigarette smoking accelerates impairment of aortic elastic properties in middle-aged patients with high normal blood pressure
Authors: Ioakeimidis N , Dima I , Terentes-Printzios D , Georgakopoulos C , Gardikioti V , Aznaouridis C , Lazaros G , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Background
The impact of smoking on atherosclerosis progression is greater in patients with arterial hypertension. High blood pressure (BP) is a major determinant of increased aortic stiffness which is an independent predictor of cardiovascular events. Aim of this study was to examine whether there are differences between office BP categorization and aortic stiffness on the basis of smoking status.

Methods
We measured carotid-femoral pulse wave (PWV) in 185 men (mean age: 55±10 years) who were not receiving antihypertensive medications and they had no history of diabetes and cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP &lt;130 and DBP &lt;85 mmHg, n=79), high normal (130≤SBP&lt;140 or DBP 85≤DBP&lt;90mmHg, n=42), and hypertension (SBP≥140 or DBP≥90mmHg, n=64).

Results
The three groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). PWV progressively increased from normotensive to high normal BP, and to hypertensive patients (7.8±1.4 vs 8.2±1.4 vs 8.6±1.6 m/s, respectively, overall P&lt;0.01). Then we subdivided the three office BP groups into subgroups according to smoking status. Figure shows PWV of the three groups stratified by smoking status. The three subgroups of smokers had similar tobacco exposure (40 pack-years). There were not statistically significant differences between smokers and non smokers in each office BP category with regard to age and metabolic parameters. In separate analysis, among individuals with either normal BP the association of smoking status with PWV level was not significant. However, in hypertensive patients but also in patients with high normal BP, smoking status was significantly correlated with PWV (all P&lt;0.01). Furthermore, the differences in mean PWV between smokers with high normal BP and patients with hypertension were not statistically significant reflecting a detrimental effect of smoking on aortic stiffness among males with high normal BP.

Conclusion
Smoking has an unfavorable effect on aortic elastic properties in men with high normal BP. The smokers with high normal BP have PWV comparable to that of hypertensive patients. This finding imply that smoking cessation should be a premising non pharmacological intervention in men with high-normal BP and increased aortic stiffness who are considered to be at a higher cardiovascular risk.

Funding Acknowledgement
Type of funding sources: None. Smoking, BP categories and PWV
Effectiveness of bisoprolol versus selective beta-1 blockers in the management of hypertension: a systematic review and meta-analysis of randomized cross-over trials
Authors: Jadhav U , Ray S , Bansal S , Nair T 
Published: October 2021

Abstract

Background
Cross-over trials carry a higher weightage in choosing a therapeutic agent in clinical practice. A meta-analysis of cross-over trials involving the use of bisoprolol in hypertension (HT) would bring about clarity in positioning this drug.

Purpose
The present study aimed to clarify the underlying benefits of bisoprolol in the reduction of blood pressure (BP) in HT patients when compared to selective beta-1 blockers (s-BBs - Atenolol, Betaxolol hydrochloride, Esmolol, Acebutolol hydrochloride, Metoprolol succinate, Nebivolol) by performing a meta-analysis of “cross-over” trials published in literature.

Methods
Systematic search was undertaken in PubMed, Embase, Cochrane Library, Clinicaltrials.gov registry, Surveillance, Epidemiology and End Results Program and 12 pharmacovigilance databases. Randomized, cross-over studies published up to October 2019 which compared bisoprolol with other s-BBs in HT patients were evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was performed using random effects model in terms of mean difference (MD) and 95% confidence intervals (95% CI) for BP, heart rate (HR) and lipid profile.

Results
Nine randomized cross-over studies which compared bisoprolol with other s-BBs (atenolol and nebivolol) were included in this meta-analysis. Bisoprolol reported significant reduction of sitting BP [MD: −3.35, 95% CI: −6.75, 0.05; P=0.05] and reduction of diastolic BP [MD: −2.00; 95% CI: −8.04, 4.04; P=0.52, non-significant] among patients with HT when compared to other s-BBs. Heart rate (HR) decreased significantly among HT patients in bisoprolol group treated for 2 w [MD: −6.00; 95% CI: −11.30, −0.70; P=0.03] when compared to those treated with other s-BBs. Analysis of lipid profile showed non-significant reduction of serum cholesterol [MD: −7.74; 95% CI: −17.18, 1.70; P=0.11] and triglyceride [MD: −26.57; 95% CI: −64.34, 11.20; P=0.17] levels in the bisoprolol group compared to other s-BBs. Bisoprolol treatment for 8 w resulted in a slight but statistically significant change in potassium levels [MD: −0.10; 95% CI: −0.16, −0.04; P&lt;0.01] among HT patients.

Conclusion
The results of this meta-analysis reported significant efficacy of bisoprolol on BP and HR in comparison to other s-BBs in a meta-analysis of cross-over trials. Our findings show that use of bisoprolol as a therapeutic option is efficacious and safe compared to other s-BBs in this patient population.

Funding Acknowledgement
Type of funding sources: None.
Prevalence of metabolic syndrome in the United States National Health and Nutrition Examination Survey (nhanes) 2011–2018
Authors: Liang X P , Or C Y , Tsoi M F , Cheung C L , Cheung B M Y ,   Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Hong Kong
Published: October 2021

Abstract

Background
Metabolic syndrome (MetS) is a cluster of risk factors presaging the development of cardiovascular disease and diabetes. It is a risk factor for severe coronavirus disease 2019 (COVID-19).

Purpose
To estimate the prevalence of MetS in the US National Health and Nutrition Examination Survey (NHANES) 2011–2018.

Methods
This cohort study included 22370 eligible participants aged ≥20 years from the NHANES 2011–2018. MetS was defined as the presence of at least three of these components: central obesity, reduced high-density lipoprotein, elevated triglycerides, elevated blood pressure and elevated fasting blood glucose. The prevalence of MetS was estimated taking into account the complex sampling. The time trend was evaluated using logistic regression. Annual percentage changes (APC) were measured trend in MetS prevalence.

Results
The prevalence of MetS was 36.2% (95% CI, 32.3–40.3), 34.8% (95% CI, 32.3–37.4), 39.9% (95% CI, 36.6–43.2) and 38.3% (95% CI, 35.3–41.3) in 2011–2, 2013–4, 2015–6, 2017–8, respectively (P for trend = 0.08). Among the MetS components, the prevalence of elevated glucose increased from 48.7% (95% CI, 45.9–51.5) in 2011–2 to 64.3% (95% CI, 61.0–67.4) in 2017–8 [P for trend &lt;0.001; APC=11.7, (95% CI, 3.5–21.0)]. The prevalence of MetS in non-Hispanic Asian increased from 21.8% (95% CI, 16.7–28.0) in 2011–2 to 31.2% (95% CI, 27.4–35.3) in 2017–8 [P for trend &lt;0.001; APC=14.6, (95% CI, 2.5–34.8)].

Conclusions
The prevalence of MetS remained stable during 2011 to 2018. Lifestyle modification is needed, especially among non-Hispanic Asians to prevent the metabolic syndrome and the associated risks of diabetes and cardiovascular disease.

Funding Acknowledgement
Type of funding sources: None.
Evaluation of basic nutritional parameters in older adults treated with percutaneous coronary intervention
Authors: Marti Sanchez D , Duarte Torres J , Marschall A , Biscotti Rodil B , Delgado Calva F , Dejuan Bitria C , Del Castillo Carnevali H , Morales Gallardo M J , Lopez Soberon E , Alvarez Anton S 
Published: October 2021

Abstract

Background
Aging patients are characterized by their variability in terms of biological status and outcomes after invasive procedures. Recently, concepts of comorbidity, frailty, and nutrition have been incorporated into clinical decision-making. Of these, nutrition is the least studied component.

Purpose
To analyze the prevalence and impact of different baseline nutritional disorders on the clinical course in the first year after PCI.

Methods
We conducted a prospective observational study of consecutive patients aged ≥75 years treated by PCI in a tertiary hospital between 2014 and 2017. We evaluated the patients with baseline information on the nutritional parameters of the validated Controlling Nutritional Status (CONUT) score variables: serum albumin, total cholesterol and lymphocyte count. We analyze the prevalence of nutritional disorders, CONUT values (ranging from 0–12, with higher values indicating more severe malnutrition), and their relationship with the 12-months cumulative events rates.

Results
The study population comprised 209 patients (mean age 82±5 years, 40% women). The averaged laboratory values were as follows: serum albumin 3.8±0.5 g/dL, total cholesterol 141±35 mg/dL, lymphocytes 1723±913 per mL, CONUT score 2.8±2.2 points. The table shows the prevalence of each nutritional disorder, and its impact on the incidence of ischemic or hemorrhagic events. Hypoalbuminemia was significantly associated with bleeding and mortality. Notably, low cholesterol was associated with a higher incidence of vascular events in this population, and low LDLc levels did not have a protective effect.

Conclusions
The analysis of simple nutritional parameters is relevant in the prognostic prediction after PCI in the older adult. In particular, hypoalbuminemia and low cholesterol levels were associated with a higher incidence of adverse events. Future studies should assess the role of dietary strategies and supplements in this context.

Funding Acknowledgement
Type of funding sources: None. Nutrition disorders and clinical events