bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHRONIC KIDNEY DISEASE AND SURVIVAL AFTER FIRST ISCHEMIC STROKE. CROATIAN COHORT OF THE ESH STROKE SURVEY
Authors: Jelakovic Ana , Malojcic Branko , Stevanovic Ranko , Kos Jelena , Premuzic Vedran , Dika Zivka , Vrkic Tajana Zeljkovic , Karanovic Sandra , Wohlfahrt Peter , Krajcoviechova Alena , Cifkova Renata , Jelakovic Bojan 
Published: April 2021

Abstract

Objective:
Aim of this study was to analyze the association of chronic kidney disease (CKD) with survival of patients after first ischemic stroke in the Croatian cohort of the ESH Stroke Survey.

Design and method:
Consecutive sample of 292 patients (171 m, average age 64 y) who were admitted to UHC Zagreb and diagnosed with ischemic stroke between 2011- 2014 were included in this analyses. Patients were followed-up for 2350 days. Mortality data were obtained from Croatian National Public Health archive. CKD was defined as eGFR < 60 ml/min/1,73m2 (CKD-Epi).

Results:
Previously we reported that hypertension, smoking, diabetes, dyslipidemia and atrial fibrillation were diagnosed in 75%, 27.3%, 24.5%, 17.4%, and 11.7% of patients, respectively. CKD was diagnosed in 51.7%. CKD stages 1, 2, 3a, 3b, 4, 5 were confrimed in 6.8%, 41%, 31.8%, 14.7%, 3.4% and 1.7% of patients, respectively. During the follow-up period 91 patients (31.1%) died from stroke, CV diseases, cancer and other causes (60.4%, 9.8%, 14.2% and 15.3%, respectively). We also reported that stroke deaths and CV composite deaths were more frequently present in CKD than in non-CKD patients p < 0.001). Here we are reporting that patients with CKD (both gender) lived significantly shorter than non-CKD patients (2290 days vs. 2546 days, p < 0.001). Even patients in CKD stages 3a/3b survived significantly shorter than patients in CKD stages 1 and 2.

Conclusions:
High prevalence of CKD was observed in our cohort of patients who survived first ischemic stroke. We confirmed previous results that CKD is significantly associated with survival after stroke and found that even CKD stage 3a is associated with shorter survival than non-CKD patients indicating that CKD should be considered as an independent prognostic factor in patients with ischemic stroke.
CARDIOVASCULAR SCREENING IN ASYMPTOMATIC TYPE 1 DIABETES PATIENTS: PRELIMINARY RESULTS AND MODEL PROPOSAL FOR A COST-EFFECTIVENESS ANALYSIS
Authors: Helleputte Simon , Lapauw Bruno , Calders Patrick , De Backer Tine 
Published: April 2021

Abstract

Objective:
Background: Type 1 diabetes (T1DM) is an independent risk factor for cardiovascular disease (CVD), with patients being considered as a high or even very high risk group. However, routine screening for CVD in an asymptomatic T1DM population is currently not recommended. Moreover, the cost-effectiveness of such screening programs has been subject of debate.

Objectives:
Discuss results and perform a cost-effectiveness (CEA) and cost-utility (CUA) analysis of a CVD screening program (2013–2019) in a Belgian cohort of asymptomatic T1DM patients.

Setting:
Ghent University Hospital (Flanders, Belgium).

Methods:
Adult T1DM patients with a minimum disease duration (DD) of 10 years and without known macrovascular disease were enrolled in a CVD screening program, including: coronary artery calcium (CAC) scoring, cyclo-ergometry, transthoracic echocardiography, 24-hour Holter monitoring, and carotid ultrasound. A decision-analytic Markov model is applied to compare estimated costs and health outcomes (i.e. CVD events and quality-adjusted life years or QALYs) of the screening program vs. usual care (i.e. no screening). After screening, patients were categorised in five possible Markov states: (1) “No additionally increased risk” in case of no significant abnormalities being detected; (2) “Soft attention” in case of mild to moderate alterations or doubtful findings; (3) “Hard attention” if CAC > P90 or absolute > 400 Agatston score, i.e. subclinical high atherosclerotic burden; (4) “Unequivocally documented CVD on imaging” if presence of significant carotid plaque; and (5) “Documented clinical CVD” if patients were referred for coronary revascularization. The Markov model further includes stroke, myocardial infarction (MI) and death. Time horizon of the model is 10 years and a healthcare payer perspective will be applied. Results of the CEA will be expressed in incremental costs per event avoided (stroke and MI), and the CUA in incremental costs per QALY gained. Both one-way and probabilistic sensitivity analyses will be performed. To report on CUA, a willingness-to-pay threshold of €40 000 per QALY will be applied.

Preliminary results:
97 patients (M/F: 61/36; age: 45 ± 10.0 years; DD: 24 ± 10.1 years; HbAc1: 7.7 ± 0.75%, BMI: 25 ± 3.0 kg/m2) were included. The CVD screening program yielded the following results: (1) “No additionally increased risk after screening”: n = 68/97 (70.1%); (2) “Soft attention”: n = 16/97 (16.5%); (3) “Hard attention”: n = 8/97 (8.2%); (4) “Unequivocally documented CVD on imaging”: n = 2/97 (2.1%); and (5) “Documented clinical CVD”: n = 3/97 (3.1%). Up to now, one event (MI) has occurred during follow-up (being a patient from group 1).
DISTURBED LEFT ATRIAL CONDUIT FUNCTION IN HYPERTENSIVE PATIENTS
Authors: Georgieva Neli , Borizanova-Petkova Angelina , Krastev Bozhidar , Poroyliev Nikolay , Kinova Elena , Goudev Assen 
Published: April 2021

Abstract

Objective:
Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between left atrial remodeling and arterial stiffness in middle – aged hypertensive patients.

AIM:
To investigate the early changes in left atrial (LA) mechanical function and parameters of arterial stiffness in a population of asymptomatic hypertensive individuals.

Design and method:
A total 95 patients (57 ± 14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees))and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo – arterial coupling (VAC). All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for LA – reservoir (LARs), conduit (LAScd) and contractile (LASct) strain. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24 h) and central pulse pressure (cPP24 h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA.

Results:
RESULTS: Statistically significant differences in parameters of vascular stiffness were found in patients with normal VAC in comparison with disturbed EA/Ees: cSys24 h (107.64 ± 9.19 vs. 116.64 ± 16.7 mm Hg, p = 0.02), cPP24 h (40.23 ± 11.84 vs. 48.08 ± 10.51 mm Hg, p = 0.04). There were statistically significant differences in echocardiography parameters between patients with disturbed VAC in comparison to other group: LAScd (16.86 ± 1.94 vs. 19.49 ± 1.35 %, p < 0.001), LASr (30.22 ± 3.26 vs. 31.81 ± 5.32 %, p = 0.007) and LAVI (30.95 ± 9.22 vs. 36.65 ± 8.83 ml/m2, p = 0.007). There was positive correlation between LAScd with EA/Ees (r = 0.272, p < 0.008) and negative E/Em (r = -0.264, p < 0.01). LAVI correlated moderate positively with E/Em ratio (r = 0.407, p < 0.0001) and negatively with LAScd (r = - 0.410, p < 0.0001).

Conclusions:
LA mechanical deformation is dependent to arterial stiffness. Reduced LAScd could play a key role in early stages of atrial remodeling. These findings could be used for the prediction of cardiovascular events in this population.
HIGH WATTAGE VAPING SHIFTS URINE METABOLOME TOWARD A HEALTHIER PROFILE: A RANDOMIZED CROSSOVER STUDY
Authors: Chaumont Martin , Communi David , Tagliatti Vanessa , Colet Jean-Marie , Van de Borne Philippe 
Published: April 2021

Abstract

Objective:
We previously demonstrated in young and healthy occasional tobacco smokers that acute exposure to high wattage vaping with and without nicotine decreases transiently transcutaneous oxygen tension and arterial oxyen tension. Propylene glycol and glycerol are e-cigarette constituents that facilitate liquid vaporization and nicotine transport. As these small hydrophilic molecules have a short serum/urine half-live, we hypothesized that short-term cessation of vaping in regular users would change urine metabolic signatures.

Design and method:
Thirty regular e-cigarette users were enrolled in this randomized, investigator-blinded, three-period crossover-study. The periods consisted of nicotine-vaping (nicotine-session), nicotine-free vaping (nicotine-free-session), and complete cessation of vaping (stop-session), all maintained for five days before the session began. Multiparametric metabolomic analyses on urine and serum were used to verify subjects’ protocol compliance. Metabolomic analysis was performed on urine samples by proton nuclear magnetic resonance.

Results:
Partial least squares discriminant analysis (PLS-DA) performed on baseline serum metabolome did not allow to split up any of the three experimental session. PLS-DA performed on baseline urine metabolome allowed to split up the nicotine and the stop sessions (Figure 1.C), the nicotine-free and the stop-sessions (Figure 1.D) but not the nicotine from the nicotine-free session (Figure 1.B) as well as all three sessions (Figure 1.A). Heatmap outlines the main metabolites with variables of importance values > 1 of both session as well as those identified by the PLS-DA. Baseline urine propylene glycol was lower in the stop-session compared to the nicotine-and nicotine-free sessions (all-p < 0.0001). Baseline urine 3-hydroxyisovalerate and urine-pyruvate were higher in the nicotine-session vs. the nicotine-free and the stop-sessions (all-p < 0.05). Compared to the stop-session, baseline urine trimethylamine-oxide and hippurate were lower in the nicotine-session (all-p < 0.05). Finally, baseline N-Phenylacetyl-glycine was lower in the nicotine-session when compared to the stop-session (p < 0.05).

Conclusions:
In conclusion, our study reveals that short-term e-cigarette cessation in regular users modified the urine metabolomic signature in a way signature in a way that suggests several modulations in hypoxia related pathways. This will need further researches focusing on cellular and molecular alterations (i.e., hypoxia-inducible Factors-1, nuclear factor-kappa B), in cell and animal models.
A NEW VISION OF NON-ALCOHOLIC FATTY LIVER DISEASE: A “CARDIAC” DISEASE PER SE AND A “VASCULAR” DISEASE ONLY WITH HYPERTENSION
Authors: Cattazzo Filippo , Dalbeni Andrea , Mantovani Anna , Bevilacqua Michele , Dell’atti Davide , Zoncapè Mirko , Paon Veronica , Ieluzzi Donatella , Prat Laura Iogna , Roccarina Davide , Sacerdoti David , Tsochatzis Emmanouil , Fava Cristiano 
Published: April 2021

Abstract

Objective:
Non-alcoholic fatty liver disease (NAFLD) is associated with an increased cardiovascular (CV) risk. However, it is still not clear whether NAFLD contributes independently to the development and progression of CV disease. This study aimed to assess the differences between NAFLD patients with or without hypertension (HT) and patients with HT but no NAFLD through markers of subclinical and clinical atherosclerosis, cardiac function and morphology and liver fibrosis.

Design and method:
Eighty-seven participants (51,9 ± 9y; males = 83,7%) were divided according to the presence of NAFLD and essential HT in three groups: only-NAFLD, only-HT and NAFLD + HT. Patients with BMI > 35 and type II diabetes were excluded. Blood pressure (BP) measurement, carotid ultrasonography, echocardiography and transient elastography were performed. Carotid intima–media thickness (cIMT), Carotid Distensibility (CD) and Carotid-femoral pulse wave velocity (cf-PWV) were measured as markers of subclinical atherosclerosis and arterial stiffness.

Results:
The prevalence of atherosclerotic plaques was significantly higher in NAFLD + HT group compared with only-NAFLD group (40% vs 5,7%; p < 0,001). Belonging to NAFLD + HT group, rather than other clinical variables, was independently associated with atherosclerotic plaques in stepwise multiple logistic regression analysis (beta ± SEM = 2.083 ± 0.958; p = 0,01). No differences in cIMT, CD, cf-PWV, echocardiographic parameters and liver stiffness were found among the three groups; nevertheless, a significant prevalence of concentric cardiac remodeling (RWT > 0,42) was detected in all groups (only-HT, NAFLD + HT and only-NAFLD group at 40,9%, 35,7% and 33,3%, respectively; p = not significant).

Conclusions:
Overt atherosclerosis, rather than subclinical atherosclerosis and arterial stiffness, was more evident in NAFLD + HT patients. A surprising finding was the high prevalence of concentric cardiac remodelling in all groups, including in the only-NAFLD one, suggesting a possible direct involvement of NAFLD in cardiac structural changes. Therefore, the impact of NAFLD on vascular and cardiac structure could be different and partially dependent on the presence of HT.
CARDIOVASCULAR PROFILE OF CROATIAN MILITARY VETERANS WITH HISTORY OF PTSD
Authors: Cuti Edina Catic , Kovacevic Idriz , Kolaric Ivan , Jelakovic Bojan 
Published: April 2021

Abstract

Objective:
The purpose of this analysis was to evaluate cardiovascular profile of military veterans with confirmed diagnosis of PTSD

Design and method:
We evaluated cardiovascular risk of military veterans in relation to their history of combat exposure and targeted a specific group of veterans with confirmed diagnosis of PTSD. All subjects underwent physical examination which included measurement of vital signs. Blood pressure was measured using Omron M6 device, central BP and PWV were determined by MobiloGraph. CV risk was calculated using Heart Score chart for high-risk countries.

Results:
Mean age was 53,40 ± 6,95. 90,0% were active or former tobacco users, while 20,0% drank alcohol. Mean cholesterol level was 5,89 ± 1,36; mean levels of LDL and triglycerides were 3,65 ± 1,35 and 1,81 ± 0,75 respectively. Body mass index mean was 28,25 ± 4,02. 10,0% of all subjects had left ventricular hypertrophy. Mean value for Pulse Wave Velocity was 8,90 ± 1,03. Average value measured in estimated glomerular filtration rate (eGFR) was 98,20 ± 11,73. 30,0% had diabetes; 10,0% had coronary heart disease; 10,0% had previous myocardial infarction.
Analysis showed 40,0% of PTSD veterans had hypertension, 20,0% had well controlled hypertension with pharmacotherapy while10% had uncontrolled but treated hypertension.
60,0% of PTSD military veterans had resting heart rate below 80/min, 10,0% had heart rate between 80 and 84/min and 30,0% had heart rate equal or higher than 85/min.

Conclusions:
There is limited data regarding cardiovascular risk in veterans with history of PTSD. A possible explanation for insufficient data is veterans’ avoidance of Croatian healthcare system due to social stigma associated with PTSD. Veterans prefer to obtain support and assistance through various veterans’ associations and religious organizations. Eliminating stigma around PTSD, its’ early detection and appropriate treatment could improve registration of veterans with Croatian healthcare system and allow better understanding of their cardiovascular profile while ensuring optimal management of their cardiovascular risks.
PREDICTORS OF THE SUPERNOVA (SUPERNORMAL VASCULAR AGING) PHENOMENON IN POPULATION-BASED SAMPLE
Authors: Boyarinova Maria , Rotar Oxana , Tolkunova Kristina , Alieva Asiiat , Moguchaya Ekaterina , Solntsev Vladislav , Vasilieva Elena , Baranova Elena , Konradi Alexandra 
Published: April 2021

Objective:
It is known that chronological age can be different from biological age. Supernormal vascular aging (SUPERNOVA) - can be diagnosed in subjects who present an exceptionally low arterial stiffness for their age. The aim of our study was to identify the factors associated with the SUPERNOVA in subjects from population-based Saint Petersburg sample.

Design and method:
As a part of all-Russian epidemiology survey ESSE-RF random sampling of 1600 Saint-Petersburg inhabitants stratified by age and sex was recruited. Anthropometry, blood pressure measurement and fasting blood-tests: glucose, lipids, C-reactive protein, insulin was performed according to standard protocols. HOMA IR was used as a marker of insulin resistance. Carotid–femoral pulse wave velocity (PWV) was performed by SphygmoCor (AtCor). SUPERNOVA phenomenon was detected in case of equal or less than 10 percentile of PWV for healthy individuals in each age group [European Heart Journal. 2010. Vol. 31. P. 2338–2350].

Results:
PWV was performed in 524 individuals, SUPERNOVA was revealed in 55 (10.5%). Cardiovascular (CV) risk predictors were compared in different age groups. In the group of people 25–39 years old, there were no significant differences in CV risk factors between subjects with the SUPERNOVA and other persons. In the group of 40–49 years old, individuals with SUPERNOVA had significantly lower SBP (p = 0.036), BMI (p = 0.042), HDL (p = 0.021) comparing with others. In the 50–59 years old, among SUPERNOVA subjects there were more often females (p = 0.029), significantly lower were: SBP (p = 0.032), BMI (p = 0.009), HDL (p = 0.002), HOMA IR (p = 0.039) and higher adiponectin (p = 0.045). In the oldest age group: 60–69 years old, those with SUPERNOVA also had significantly lower SBP (p = 0.006) and DBP (p = 0.005), total cholesterol (p = 0.009), LDL (p = 0.016), triglycerides (p = 0.025) and significantly higher adiponectin (p = 0.014).

Conclusions:
It seems that at young age the presence of the SUPERNOVA phenomenon is not determined by the presence of traditional CV risk factors. Starting from middle age (> = 40 years old) such factors as female gender, SBP, BMI, HDL and adiponectin is associated with supernormal vascular aging. In the oldest group the levels of both SBP and DBP, lipids acquire the greatest importance for the presence of SUPERNOVA.
ANNOYANCE DUE TO NOISE TRIGGERS VASCULAR CHANGES IN THE RENAL HEMODYNAMIC
Authors: Bosch Agnes , Kannenkeril Dennis , Ott Christian , Harazny Joanna M. , Striepe Kristina , Karg Marina V. , Jung Susanne , Kolwelter Julie , Schmieder Roland E. 
Published: April 2021

Objective:
There is evidence from epidemiological and animal studies that noise exposure is associated with an increased incidence of arterial hypertension and cardiovascular disease. We recently investigated the influence of annoyance due to noise on the renal hemodynamic and found a lower renal plasma flow in patients subjectively annoyed in every-day life compared to not-annoyed patients. We now further explored the pathophysiological mechanisms of this finding.

Design and method:
We analysed the influence of annoyance due to noise on the renal and systemic hemodynamic in 110 subjects, who were either healthy or presented with drug-naive hypertension (HT) without evidence of end-organ damage. Renal hemodynamic was measured using steady state input clearance with infusion of paraaminohippuric acid and inulin, respectively. Intraglomerular pressure and resistances of the afferent (RA) and efferent (RE) arterioles were calculated according to the Gomez equation. The systemic hemodynamic was recorded by the SphygmoCor System (AtCor Medical). All subjects ranked subjective annoyance due to noise in everyday life on a 7 grade likert scale. The median of all rankings was used as cut off point to divide the group into annoyed and non-annoyed subjects.

Results:
Annoyed subjects (n = 55) showed lower renal plasma flow (596 ± 108 vs 646 ± 130 ml/min, p = 0.030), higher filtraction fraction (22.9 ± 3.3 vs 21.6 ± 3.2, p = 0.036), higher renal vascular resistance (93.4 ± 27.5 vs 81.0 ± 25.7 mmHg/(ml/min), p = 0.021), higher RA (4565 ± 1744 vs 3792 ± 1676, p = 0.024) and a trend to higher RE (2442 ± 480 vs 2288 ± 411, p = 0.076) compared to not-annoyed subjects (n = 55). There was no difference in glomerular filtration rate (133 ± 12 vs 136 ± 15 ml/min, p = 0.307) and intraglomerular pressure (37.1 ± 2.5 vs 37.6 ± 3.1 mmHg, p = 0.325) between annoyed and not-annoyed subjects.
There was also no difference in office blood pressure (133 ± 13/79 ± 10 vs 131 ± 13/78 ± 11 mmHg, p = 0.429/p = 0.527), central blood pressure (115 ± 13/79 ± 11 vs 112 ± 12.8/75 ± 12 mmHg, p = 0.317/p = 0.092), central pulse pressure (36.3 ± 6.9 vs 37.6 ± 6.3 mmHg, p = 0.304) and heart rate (66 ± 8.4 vs 65 ± 10 bpm, p = 0.680) between annoyed and not-annoyed subjects.

Conclusions:
Annoyance due to noise in everyday life was associated with a vasoconstrictive response in the renal hemodynamic. Our data suggest the hypothesis that annoyance due to noise may trigger early renal vascular changes potentially leading to hypertension.
PSYCHOLOGICAL DISTRESS, PSYCHOSOMATIC SYNDROMES AND PSYCHOLOGICAL WELL-BEING IN MASKED HYPERTENSION
Authors: Bernardini Francesco , Gostoli Sara , Rafanelli Chiara , Roncuzzi Renzo , Veronesi Maddalena , Borghi Claudio 
Published: April 2021

Objective:
In patients affected by masked hypertension psychological variables have been poorly investigated so far. Some authors found an association of masked hypertension with hypochondria and/or depression. Studies on the relationship between masked hypertension and stress focused on stressors at work ignoring chronic/acute stressful life events related to other contexts. This research aims to understand psychological, psychosomatic and well-being characteristics among patients with masked hypertension.

Design and method:
10 patients with masked hypertension, enrolled at the Division of Internal Medicine, were assessed. They were administered both observer- (interviews on clinical psychological distress and psychosomatic syndromes) and self-rated (questionnaires on subclinical distress and well-being) measures.

Results:
40% of patients reported at least one depressive disorder (30% past major depressive episode and 20% persistent depressive disorder) and 40% at least one anxiety disorder (30% generalized anxiety, 10% panic and 10% social anxiety). 50% showed illness behaviour, 20% psychological manifestations and 20% personality syndrome. Only 30% of patients did not report a diagnosis of either Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or Diagnostic Criteria for Psychosomatic Research (DCPR). 20% of the sample reported only one psychosomatic syndrome (somatization and conversion syndromes). The mean levels of psychological well-being were significantly lower in masked hypertension patients than those of the general population: autonomy (29.9 ± 6.87 versus 37.14 ± 6.96), environmental mastery (26.70 ± 2.75 versus 38.15 ± 7.41), personal growth (32.10 ± 3.93 versus 38.40 ± 6.93), positive relations (31.20 ± 4.92 versus 40.57 ± 6.96), purpose in life (26.72 ± 5.32 versus 38.40 ± 6.98) and self-acceptance (25.80 ± 5.37 versus 38.12 ± 8.20). The mean scores Psychosocial Index subscales were significantly higher than those reported by the general population: psychological distress (13 ± 6.43 versus 5.54 ± 3.60), abnormal illness behavior (1.10 ± 1.20 versus 0.50 ± 0.82) and stress (4.40 ± 1.51 versus 2.30 ± 1.81). On the contrary, the mean scores of well-being dimension were significantly lower (6 ± 1.33 versus 7.42 ± 1.64).

Conclusions:
A high percentage of patients with masked hypertension showed high levels of psychological and psychosomatic distress. A psychosomatic assessment including both distress and psychological well-being impairments should be implemented in patients with masked hypertension in order to recognize potential vulnerability factors for both medical and psychiatric syndromes.