bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHAT DOES THE FINDING OF MINIMAL MITRAL REGURGITATION MEAN?
Authors: Paterno Carlos Alberto 
Published: April 2021

Objective:
bjective: Leonardo da Vinci intuited that the cardiac valves were key to the functioning of the heart. Minimal mitral regurgitation in young's is often interpreted as haemodynamically insignificant. Morphological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). The aim is to know the measures of the central haemodynamic parameters (CHPs), brachial blood pressure (BP) values, and the prevalence of headache and AF, in both genders with minimal mitral regurgitation.

Design and method:
Design and Methods: For this cross-sectional retrospective study, data were collected from 323 patients: Female/Male 189/134, from 20 to 89 years old, divided and analyzed in each one of the 7 decades. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The CHPs were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (Diff-AIx) between the normal levels and the observed values was assessed according to normal range by age.

Results:
Results: Average BP was higher than normal: Female- Male 141/83–137/82 mmHg. CHPs and BP values increased in each one of the 7 decades, both genders. Frequently, the patients were symptomatic, among the female/male the headache was found in 61%/25%, with a high prevalence of up to 69 years old in 85%/88% of them. Also, they presented symptoms such as sweating, asthenia, thoracalgia, palpitations. Hypertension would not be silent chronic disease. AF was found in 49 patients (15%), female/male 22/ 27 (12%/20%), increasing the prevalence with age, after 50/60 years old was observed in 68/78%.

Conclusions:
Conclusions: Minimal mitral regurgitation would not be a bystander, it can be the consequence of the higher values of the brachial BP, the central haemodynamic parameters and the Diff-AIx. The appearance of minimal mitral regurgitation principally among younger can indicate that the brachial BP found is higher than normal and the optimal levels should be reassessed.
ASSESSMENT OF PLAQUE VULNERABILITY USING A NOVEL TECHNIQUE: MULTI-SPECTRAL PHOTOACOUSTIC IMAGING (CVENT-PAI)
Authors: Obeid Hasan , Imaizumi Yuki , Bruno Rosa-Maria , Julia Pierre , Calvet David , Boutouyrie Pierre 
Published: April 2021

Objective:
Identification of intraplaque haemorrhage using magnetic resonance imaging (MRI) is expensive, technically demanding and sometimes uncomfortable. Photoacoustic imaging (PAI) is a new non-invasive technique combining multi-wavelength infrared laser light and ultrasound (US) imaging, able to discriminate blood and other components in the tissues. The measurement by the multi-spectral PAI is likely to be more applicable and therefore could be complementary to MRI.
Validate a portable multimodal and multi-wavelength PAI system, for the identification of intraplaque haemorrhage and compare with MRI.

Design and method:
Patients underwent carotid MRI, and US. Photoacoustic (PAI) acquisitions are performed and analysed posteriori blindly of the status of the subjects and results of MRI/US. All patients gave written informed consent. Histology of plaque will be performed as gold standard.

Results:
We included 22 patients (71 ± 5 years old) with carotid stenosis grade of >70% (NASCET). PAI imaging was feasible in all patients. On raw images, only clutter signal can be observed. After adequate post processing, carotid wall with the intima media and plaques were clearly visible with PAI. PAI signal from the lumen can be observed, also strong PAI signals are visible inside the plaque in a reproducible manner. Correspondence between MRI and PAI will be analysed later.

Conclusions:
The use of the PAI technique for carotid plaque assessment is feasible, and PAI signal are observed inside the plaque. Further analyses are needed to assess the reflected PA signal inside the plaque, for haemorrhage detection in the future.
COMPARISON OF PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE GUIDELINES BETWEEN AUSTRALIA, ENGLAND AND THE UNITED STATES
Authors: Chapman Niamh , Breslin Monique , Lay-Flurrie Sarah , Zhou Zhen , Sharman James , Nelson Mark , Mcmanus Richard 
Published: April 2021

Objective:
Background: Cardiovascular disease (CVD) primary prevention guidelines recommend absolute CVD risk estimation to guide lipid and blood pressure lowering therapy recommendations but these are inconsistent despite relying on similar evidence. This study aimed to understand the effect of such inconsistencies on the populations recommended for treatment according to CVD primary prevention guidelines in Australia, England and the United States.

Design and method:
Methods: Data were drawn from Australian(n = 3,942), English(n = 1,899) and United States(n = 2,949) national health surveys in adults aged 40 years or older. Participants were classified as recommended for therapy based on absolute CVD risk stratification and clinical characteristics denoting high risk according to each country's guidelines. Agreement was assessed by Kappa statistic.

Results:
Results: Agreement in therapy recommendation according to CVD primary prevention guidelines was minimal to weak (Kappa = 0.30–0.51). This reflected different populations being targeted due to different risk thresholds (risk calculation agreement Kappa = 0.07–0.45) and different clinical risk criteria (high risk characteristic agreement Kappa = 0.22–0.73).

Conclusions:
Conclusion: Despite a similar evidence base apparently underpinning guidance, there is very little agreement between populations targeted for CVD primary prevention in Australia, England and the United States. This disparity is driven by differences in both absolute CVD risk stratification thresholds and the clinical characteristics considered to denote high risk. Whilst different countries may adopt different policies on the appropriate level of risk to target, given a largely common evidence base, international consensus on how to define population CVD risk would allow optimum targeting of primary prevention.
PRIVATE HEALTH SECTOR PREFERENCES IN TREATMENT OF HYPERTENSION IN INDIA: EVIDENCE FROM HYPERTENSION DRUGS MARKET DATA
Authors: Pathni Anupam Khungar , Sahoo Swagata Kumar , Mahajan Tanushree , Swaroop Kishan , Moran Andrew , Shivashankar Roopa , Sharma Bhawna , Negi Sagri 
Published: April 2021

Objective:
In India, there are an estimated 200 million adults with high blood pressure. National and international guidelines recommend calcium channel blockers (CCB), diuretics, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) for first line treatment of uncomplicated hypertension, while beta-blockers (BB) have been relegated to second-line treatment. As the private sector provides 70% of out-patient care in the country, we assessed private health sector preferences of antihypertensive medications using market data.

Design and method:
Sales of all antihypertensive formulations in India from 2016–2018 were analysed, using a large nationally representative dataset for the private sector pharmaceuticals market. In addition to analysis at the National level, data for five states was analysed to determine any inter-state variations.

Results:
The Indian hypertension drug market grew at a compounded annual growth rate of 6.9% from 2016 to 2018 with a total of 21,066 million tablet or capsule sales in 2018. Two-drug single pill combinations (SPCs) had the highest market share in 2018, with 36% of market volumes, followed by CCBs (18%), BBs (16%), ARBs (14%), diuretics (5%), ACEI (3.6%), and three-or-more-drug SPCs (2.8%). Among two-drug SPCs, amlodipine/atenolol (9.8%) was the most preferred, followed by telmisartan/hydrochlorothiazide (4.1%) and amlodipine/telmisartan (3.8%).
There were inter-state variations in the market share of antihypertensive drugs. In four states, two-drug SPCs accounted for approximately 40% of all antihypertensives sold (range 38%-42%). This was followed by BBs as the second most preferred drug class in two states (range 18%-19%), while CCBs were preferred in the other two states (range 16%-18%). In the fifth state, CCBs (25%) were most preferred, followed closely by BBs (21%). Amlodipine/atenolol was the most preferred molecule in two states, amlodipine in another two states and telmisartan in the fifth state.

Conclusions:
Despite changes in standard hypertension treatment guidelines, evidence from pharmacy sales data indicate variable treatment practices in the private health sector in India, with a preference for beta blockers. This study highlights the need to improve hypertension care quality through private sector engagement strategies including sensitisation, regular training programmes and possibly provider incentives for evidence-based practice.
IS THE CONTROL OF CARDIOVASCULAR RISK FACTORS IS DIFFERENT IN PRIMARY AND SECONDARY PREVENTION? COMPARISON OF 2 COHORTS OF HYPERTENSIVE PATIENTS WITHIN 10 YEARS
Authors: Lopez-Sublet Marilucy , Lequeux Benoit , Gallo Antoine , Dourmap Caroline , Delsart Pascal , Coz Sylvie Regnier Le , Steichen Olivier , Lamirault Guillaume , Boulestreau Romain , Ott Julien , Dimitrov Yves , Sautenet Benedicte , Feit Bertrand , Artifoni Mathieu , Baguet Severine , Irigoin Marc , Mourad Jean Jacques , Le Jeune Sylvain , Sosner Philippe 
Published: April 2021

Objective:
Euroaspire surveys highlighted the insufficiency of control of cardiovascular risk factor (CVRF) in coronary patient in secondary prevention. Patient profiles have changed, making it difficult to analyse these data over time. Our aim was to establish the state of CVRF control in two cohorts of French hypertensive patients in different clinical situations of primary and secondary prevention by following the variables assessed in Euroaspire.

Design and method:
Of each of the 22 participating hypertension specialist consultations, the first 20 patients (followed for at least one year) were included. Theoretical objectives were notified for each patient according to clinical profile. Two cohorts were formed, Cohort 1 (C1) in 2009 (n = 185) and Cohort 2 (C2) in 2019 (n = 260). Patients were classified according to their prevention (P) profile: primary (P1) and secondary (P2).

Results:
Baseline data are summarized in Table 1. The main statistically significant results between C2 vs C1 respectively are: younger people (58.8 vs 63.9 y) and more women in P1 (50% vs 32%); higher systolic blood pressure (BP) in P2 (143.7 vs 134.7 mm Hg), whereas higher diastolic BP in P1 (81.7 vs 76.6 mm Hg); fewer diabetic patients in P1 (19% vs 41%); poorly BP targets met in P1 (43% vs 63%); lower number of antihypertensive drugs in both groups (P1: 2.17 vs 2.66; P2: 2.62 vs 3.16); prescription of statins felt by half in P1 (30% vs 43%) within 10y.

Conclusions:
The high prevalence of unhealthy lifestyles, modifiable CVRF and inadequate use of drug therapies to achieve BP and lipid goals, are documented findings of the Euroaspire surveys in coronary patient, which we confirm in our hypertensive patients. Indeed, the P1 patient is less well managed than 10 years. In P2, there is no difference between the two cohorts, no improvement in BP control, possibly related with a reduction in the number of antihypertensive drugs. Ambition targets allocated for global prevention by combating the clinical inertia in titrating treatments must be a medical priority in clinical practice.
Thanks to patients and Club des Jeunes Hypertensiologues.
EXAGGERATED BLOOD PRESSURE RESPONSE IN EXERCISE IS ASSOCIATED WITH LACK OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN HYPERTENSIVE PATIENTS AFTER 6 YEARS FOLLOW-UP
Authors: Andrikou I. , Tsioufis K. , Dimitriadis K. , Konstantinidis D. , Leontsinis I. , Karaminas N. , Kalos T. , Tolis P. , Anastasiou A. , Andrikou E. , Tousoulis D. 
Published: April 2021

Objective:
Regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. In this study we aimed to investigate the role of exaggerated blood pressure response (EBPR) during exercise in LVH regression in hypertensive subjects over time.

Design and method:
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 (> or = 210 mmHg for men and > 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 < 140/90 mmHg.

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 < 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:
In conclusion, beyond optimal BP control, EBPR is a significant predictor of structural cardiac alterations overtime. These finding strengthens the clinical importance of EBPR during the baseline evaluation of hypertensive subjects.
COMPARISON OF TWO HAEMODYNAMIC MONITORING SYSTEMS IN THE CARDIAC CATHETERIZATION LABORATORY: THE MANIFOLD (MANUAL) VS. AUTOMATED ACIST CVI®
Authors: Mahmud Azra , Balghith Mohammad , Ayoub Kamal , Alanezi Abdulrehman Fahad , Alanezi Abdulrehman , Alhadadi Bandar , Alshammary Hanan , Alshehri Jaber , Alshammary Majed , Alghamdi Ali , Khan Fayaz Mohammad 
Published: April 2021

Objective:
Hemodynamic monitoring is an integral part of any cardiac catheterization procedure and can be potentially prone to many distortions, including damping and resonance. The optimum damping ratio recommended for accurate haemodynamic monitoring ranges between 0.4 to 0.8. The most common systems used include Manifold, the manual system and the automated, ACICT CVi® device, which is claimed to be as accurate as the manual system and easier to use.
The aim of this prospective study was to compare damping ratio, ascending aortic pressure waveform and invasive blood pressures (BP) between manifold and ACIST CVi®, in patients undergoing cardiac catheterization.

Design and method:
This study was conducted at the cardiac catheterization Laboratory at King Abdul-Aziz Cardiac Center, National Guard Health Affairs, Riyadh in adult patients undergoing elective cardiac catheterization procedures. The fast-flush test was performed at the beginning of the procedure using manifold and ACIST in a cross-over fashion. The square wave was analysed to calculate the damping coefficient for each device. Data was analyzed by JMP Pro (SAS for Windows, Version 13) p < 0.05 considered significant. The patients gave informed consent and the study was approved by the Institutional Ethics Committee.

Results:
We compared the two systems in a randomised cross-over fashion in 54 subjects (mean age 58.1 ± 12, 24% females). The mean damping ratio was 0.61 ± 0.11 (range 0.34–0.95) with manifold vs. 0.95 ± 0.27 (range 0.53–2.1) with ACIST, mean difference 0.33, p < 0.0001. The over-damped ACIST yielded lower BP measurements compared with manifold; mean difference 6 mm Hg systolic and 5 mm Hg diastolic with almost 30% of the subjects showing a discrepancy of > 10 mm Hg between the two systems.

Conclusions:
To the best of our knowledge, this is the first study comparing a manual haemdynamic monitoring system to an automated one used widely in cardiac catheterization laboratories. In our study, while the mannifold met the international recommendations for accurate haemodynamic monitoring, ACIST device was overdamped, resulting in significant underestimation of invasive pressures. We recommend using the manifold system for studies involving haemodynamically compromised patients and in patients depending upon accurate haemodynamics for diagnostic purposes.
EVALUATION OF THE CARDIOPROTECTIVE EFFECT OF MANGIFERIN IN AN EXPERIMENTAL MODEL OF ISCHEMIA REPERFUSION INJURY
Authors: Bhatia Jagriti , Suchal Kapil , Bhargava Poorva , Malik Salma , Arya Ds 
Published: April 2021

Objective:
The injurious effects of restoration of coronary blood flow following myocardial infarction is a major concern as reperfusion predisposes to myocardial injury. Mangiferin is a polyphenolic antioxidant present in the bark, fruits, roots and leaves of Mangifera indica Linn (Anacardiaceae). It is known to modulate biological targets in inflammation & oxidative stress. It also possesses anti-oxidant, anti-apoptotic; anti-atherogenic and anti-diabetic actions. Hence, we hypothesized that the anti-oxidative, anti-inflammatory, and anti-apoptotic effects of mangiferin may also be involved in the prevention of IR injury.

Design and method:
Male albino Wistar rats were divided into four groups i.e. sham, IR-control, Mangiferin-40 + IR and Mangiferin 40 per se. Mangiferin was administered at a dose of 40 mg/kg, intraperitoneally for 15 days. On the 15th day, myocardial IR injury was induced by occluding the left anterior descending coronary artery for 45 minutes followed by reperfusion for 60 minutes. At the end of the surgical procedure, the rats were sacrificed, the hearts excised and processed.

Results:
IR-control rats showed significant cardiac dysfunction along with a raised serum cardiac injury markers, and a significant decrease in tissue antioxidants as compared to sham group. Histopathological examination of IR rats showed myocardial necrosis, edema and inflammatory cell infiltration. Pre-treatment with mangiferin significantly suppressed myocardial oxidative damage, maintained membrane integrity, and attenuated the levels of pro-inflammatory cytokines, pro-apoptotic proteins and TGF-beta. Additionally, mangiferin significantly reduced the phosphorylation of p38, and JNK and enhanced phosphorylation of ERK1/2.

Conclusions:
Mangiferin ameliorates myocardial IR injury by alleviating oxidative stress mediated apoptosis and modulating MAPK mediated inflammation.
INVESTIGATION OF BIOACTIVE FLAVONOID SOURCED FROM CITRUS FRUITS ON ITS EFFECT UPON CARDIAC HYPERTROPHY: AN EXPERIMENTAL STUDY
Authors: Bhargava Poorva , Bhatia Jagriti , Arya Ds 
Published: April 2021

Objective:
Cardiac hypertrophy is an adaptive process of the heart. It is a leading cause for heart failure, which in turn has a high mortality rate. Hesperidin (HES) is a bioactive flavanone glycoside with agonistic activity on Peroxisome Proliferator-Activated Receptor gamma (PPAR-gamma), reported to be an inhibitor of cardiac hypertrophy signalling pathways. Therefore, we investigated the cardio-protective effect of this bioactive flavonoid in isoproterenol induced cardiac hypertrophy.

Design and method:
Male albino Wistar rats were divided into 6 groups (n = 6) and administered isoproterenol (3 mg/kg/day s.c.) or hesperidin (200 mg/kg/day, p.o.) and isoproterenol or enalapril (30 mg/kg/day p.o.) and isoproterenol or a combination of hesperidin and enalapril for 28 days. On the 29th day, rats were anaesthetized followed by cannulation of coronary artery to record hemodynamic parameters. Blood sample was collected and heart was excised to evaluate for parameters like biochemical, histopathological, ultrastructural and immunohistochemical studies.

Results:
Hesperidin significantly normalized heart weight/body weight ratio and cardiomyocyte area in the treated rats. Moreover, hesperidin improved cardiac function and attenuated pathological changes as seen in the heart tissue sections. A decline in the levels of cardiac injury markers (CK-MB, LDH) and inflammatory markers TNF-alpha, IL-6) was observed. Additionally, hesperidin suppressed oxidative stress and apoptosis along with an increased PPAR-gamma expression.

Conclusions:
Hesperidin has a good potential for attenuation of cardiac hypertrophy and acts by virtue of its PPAR-gamma agonistic, anti-inflammatory, anti-apoptotic and anti-oxidant properties.
FORWARD WAVE AND ITS IMPACT ON AUGMENTATION INDEX: DO GENDER DIFFERENCES EXIST?
Authors: Kokhan Elizaveta , Kiyakbaev Gayrat , Kobalava Zhanna 
Published: April 2021

Objective:
Some studies have found that women have markedly higher aortic augmentation index (Aix) than men. Traditionally, this difference has been attributed to the early return of the reflected wave because of shorter stature and increased aortic stiffness in women. However, augmentation pressure is also affected by the shape of the forward wave. We aimed to assess the impact of gender on the association between forward aortic wave time, pressure and Aix in hypertensive patients.

Design and method:
30 men and 37 women with hypertension were enrolled. Central hemodynamic was assessed using applanation tonometry method (SphygmoCor-Australia). We estimated central systolic and diastolic pressure, Aix, Aix adjusted by heart rate (Aix@75), pulse wave velocity (PWV), forward wave pressure (FWP), ejection duration (ED), time to peak forward wave (T1), time to peak systolic wave (T2) and reflected wave foot time (Tr).

Results:
Men and women had similar median of age (64 vs 66, p = 0.34), heart rate (77 vs 78, p = 0.40), peripheral systolic (133 vs 130mmHg, p = 0.32) and diastolic (80 vs 77mmHg, p = 0.16) pressure. Despite similar central systolic (119 vs 117mmHg, p = 0.47), diastolic (81 vs 78mmHg, p = 0.19) pressure and PWV (9.9 vs 9.4m/s, p = 0.79), women had higher Aix (33 vs 23%, p < 0.001), and Aix@75 (34 vs 26%; p < 0.001). Men and women had similar T2 and FWP, but Tr was higher in men (134 vs 130ms; p = 0.04), whereas ED (301 vs 314ms) and T1 (105 vs 109ms) – in women (p < 0.05). Tr minus T1 was higher in men (30 vs 22ms; p = 0.014). In a multivariate regression analysis in men Aix@75 was significantly associated with PWV (beta = 0.75, p = 0.005), whereas in women – with T1 (beta = 0.32, p = 0.04) and Tr (beta = 0.42, p = 0.009).

Conclusions:
As according to previous reports, women had higher Aix and Aix@75 and shorter time to backward wave return. However, we also found that men and women had different ejection patterns and women had higher forward wave peak time, that was significantly related to Aix@75 only in them. It may indicate that shape and time of the forward wave may also contribute to higher Aix in women compared to men.