bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulatory blood pressure variability measures in hypertensive patients according to non-alcoholic fatty liver disease state
Authors: Kakouri N , Konstantinidis D , Siafi E , Tatakis F , Polyzos D , Drogkaris S , Koskinas J , Thomopoulos C , Tsioufis K 
Published: October 2021

Abstract

Background
Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events.

Purpose
To compare different BPV measures in hypertensive patients with and without NAFLD.

Methods
Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge.

Results
Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p&lt;0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment.

Conclusions
Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension.

Funding Acknowledgement
Type of funding sources: None.
Cumulative prognostic effect of diabetes and myocardial injury in patients attended in the emergency room
Authors: Del Moral Ronda V , Sanchez Gimenez R , Lal-Trehan Estrada N , Bonet Pineda G , Carrasquer Cucarella A , Peiro Ibanez O M , Fort Gallifa I , Bardaji Ruiz A 
Published: October 2021

Abstract

Background
Diabetes and myocardial injury are clinical conditions associated with cardiovascular events and increased mortality during follow-up. It is not known to what extent both conditions enhance their prognostic effect in patients seen in the emergency room with cardiac troponin determination.

Purpose
This study aims to evaluate the prognostic implication of diabetes and myocardial injury in patients attended in the emergency room with cardiac troponin determination.

Methods
Retrospective observational cohorts study, in which all the patients attended the emergency room from January 2012 and December 2013 with a troponin determination. The sample was categorized according to the diabetes mellitus condition and myocardial injury (troponin below 99 th), studying four groups: non-diabetic without myocardial injury (G1), diabetic without myocardial injury (G2), non-diabetic with myocardial injury (G3), and diabetic with myocardial injury (G4). Baseline clinic characteristics and prognostic data were studied with a four years follow-up.

Results
A total of 3622 patients were studied; 924 (25'55%) diabetics. Three hundred seventy-one diabetic patients (40% of all diabetic patients) had an elevated troponin determination, while six hundred seventy-eights non-diabetic patients had elevated troponin (25'13% from all non-diabetics). Diabetic patients were significantly older (mean age 74 vs. 67 years). They had more frequently history of hypertension (81'9% vs 53'2%), acute myocardial infarction (31'6% vs 15'8%), heart failure (11'1% vs 5'7%), peripheral vascular disease (11'1% vs 5'2%), cerebrovascular disease (11'4% vs 6'6%), chronic pulmonary disease (23'3% vs 16'2%) and renal impairment (16'8% vs 5'2%). At four years of follow-up, G2, G3 and G4 had higher mortality than G1 (HR (95IC): 1,352 (1,080–1,693), 2,896 (2,896–3,477), and 3,441 (2,809–4,216), respectively). A multivariate competing risk model was used to obtain the HRs for readmission for myocardial infarction and heart failure between G2, G3 and G4 in relation to G1 (HR (IC 95%) 2,511 (1,592–3,96), 2,682 (1,739–4,138) and 5,036 (3,221–7,876), respectively for myocardial infarction, and 2,663 (1,825–3,886), 2,562 (1,753–3,744) and 4,292 (2,936–6,274) respectively for heart failure).

Conclusions
Both conditions, myocardial injury, and diabetes have a prognostic impact at a long-term follow-up with a cumulative effect, being the troponin elevation, a better prognostic marker of death risk, and similar to diabetes history for the risk of myocardial infarction and heart failure.

Funding Acknowledgement
Type of funding sources: None. ICC hospitalization cumulativeincidenceIAM cumulative incidence
Sex differences in the effect of family stress on risk of myocardial infarction and stroke in population 25–64 years: WHO program MONICA-psychosocial
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A 
Published: October 2021

Abstract

Purpose
To determine the influence of family stress on the risk of cardiovascular diseases (myocardial infarction and stroke) in an open population aged 25–64 years in Russia / Siberia.

Methods
Within the framework of the III screening of WHO's MONICA-psychosocial program, a random representative sample of the population of both sexes of 25–64 years of Novosibirsk in 1994 (men n=657, mean age 44,3±0,4y, response 82.1%; women: n=689, mean age 45,4±0,4y, response 72.5%) was examined. The screening included: socio-demographic data, the definition of the family stress. New-onset cases of MI and stroke in women - 15 and 35 cases and in men - 30 and 22 cases, respectively detected in the cohort over follow-up period in frame of budgetary theme # AAAA-A17–117112850280–2.

Results
In the open population aged of 25–64 years the prevalence of high family stress was higher in men (31.5%) than women (20.9%). The risk of myocardial infarction in men and women experiencing stressful situations in the family was 5.9 and 5.58-fold higher, respectively over 16-year period. The most significant risk factors for the development of myocardial infarction were divorce (HR = 3.9) and widowhood (HR = 6.3). The risk of developing a stroke was 3.45-fold higher in men and 3.52-fold higher in women with family stress. The risk of developing stroke was higher among those with high school and elementary education levels, both in men (HR = 3.9 and HR = 6.3) and women (HR = 2.87 and HR = 3.33).

Conclusion
Stress in the family is more common in men within the working-age population. Family stress increases the risk of developing both myocardial infarction and stroke among men and women.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This survey was performed within the framework of the budgetary theme NIITPM - branch of the ICG SB RAS Reg. No. AAAA-A17-117112850280-2, Gov.Task No. 0324-2018-0001.
Patient reported health status and cardiovascular risk factors in a remote area of South America: a cross-sectional study
Authors: Holm A E , Gomes L , Lima K O , Matos L O , Wegener A , Vieira I V M , Souza R M , Marinho C R F , Biering-Soerensen T , Silvestre O M , Brainin P 
Published: October 2021

Abstract

Background
Several studies have indicated that self-perception of health is related to cardiovascular disease. Despite cardiovascular disease is the leading cause of mortality in South America, the relationship between patient reported health and cardiovascular risk is sparsely explored, specifically in indigenous areas.

Purpose
We assessed if self-rated health is associated with cardiovascular risk factors in a remote area in South America.

Methods
We included participants by cluster-randomization of community health care clinics from June to December 2020. Sociodemographic variables and information on cardiovascular risk factors were collected by questionnaires and physical examination. All participants rated their present health status according to the validated EQ5D-VAS instrument, ranging from 0 (worst) to 100 (best).

Results
A total of 492 participants (mean age 41±15 years; 38% men) were included. The mean value of self-rated health was 80 (range 0 to 100) and the prevalence of cardiovascular risk factors were: Hypertension (19%), hypercholesterolemia (15%), smoking (37%), low intake of vegetables (defined as &lt;3 times per week; 54%), no sport activity (62%), diabetes (6%) and obesity (24%). In logistic regression models adjusted for sex, age and socioeconomic status, higher self-rated health was significantly associated with lower risk of hypertension, hypercholesterolemia, smoking, obesity and greater vegetable intake (P&lt;0.05; Figure 1). No association was found with sport activity or diabetes. The total number of cardiovascular risk factors increased with lower self-rated health (beta = 0.100 [0.04 to 0.15], P&lt;0.001 per 10 decrease in self-reported health).

Conclusion
Self-rated health was significantly associated with a greater burden of cardiovascular risk factors and may influence ideal cardiovascular health. Future studies should assess if patient reported health status constitutes an independent risk factor for heart disease in this specific population, and studies elucidating gaps on self-perception of cardiovascular health are encouraged.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark
Long-term benefits of cardiac rehabilitation after incomplete percutaneous revascularization
Authors: Otte Alba C , Romero Reyes M J , Padilla Escamez A , Rufian Andujar S , Molano Casimiro F J 
Published: October 2021

Abstract

Background
Incomplete revascularization versus complete revascularization in patients undergoing percutaneous coronary intervention (PCI) is associated with higher risk of mortality and major adverse cardiac events. Cardiac rehabilitation (CR) is one of the most important evidence-based interventions for secondary prevention after ischemic heart disease. However, it has been less studied in patients with incomplete PCI.

Purpose
The aim of our study was to evaluate the effects of CR on long-term clinical outcomes after incomplete PCI.

Methods
Unicentric, descriptive and analitical study. We included 285 patients who underwent incomplete PCI at our hospital from 2004 to 2011. We compared those who participated in a CR program with those who refused to. We analyzed events occurring during a median follow-up of 11 years.

Results
This study included 285 patients, 121 (42.5%) participated in the CR program. Attending to baseline characteristics, there were significant differences in prevalence of male gender (88.4% vs 67.7%, p=0.000) and DM (69.4% vs 51.8%, p=0.003), which were more prevalent in CR group; they were also significantly younger (58.81 vs 66.34 years, p=0.000). Acute myocardial infarction (AMI) was the most common indication for PCI in those who attended CR, whereas in the other group it was unstable angina.
Using univariate logistic analysis, CR participation was found to be associated with significantly reduced heart failure readmissions (14.2% vs 31.7%; OR 0.356; IC95% 0.193- 0.656; p=0.001), all-cause mortality (21.5% vs 56.7%; OR 0.209; IC95% 0.123- 0.356; p=0.000) and cardiovascular mortality (5.8% vs 26.8%; OR 0.167; IC95% 0.072- 0.387; p 0.000). No significant differences were observed in re-AMI (20.8% vs 26.4%, p=0.280) nor incidence of stroke (5.8% vs 9.8%, p=0.226) during the follow-up.
The multivariate regression showed as well that CR was associated with a lower rate of all-cause and cardiovascular mortality and heart failure readmissions. Other predictors of clinical outcomes were NYHA stage, age &gt;65 years and LVEF &lt;40%.

Conclusion
CR is an excellent strategy for reducing hospital readmissions and mortality during long-term follow-up in patients with incomplete PCI.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario de Valme, Sevilla, Spain Baseline characteristics
Characterisation of ventricular premature beats during exercise testing in masters athletes
Authors: Duncan E , Fyyaz S , Papatheodorou S , Merghani A , Papadakis M , Sharma S 
Published: October 2021

Abstract

Background
Exercise induced ventricular premature beats (VPBs) are associated with an adverse outcome in patients with cardiac disease and the general population. The incidence and significance of exercise induced VPBs in masters athletes remains unknown.

Methods
237 masters athletes (54.6±8 years of age, 42% male) and 50 controls of similar age and sex were assessed with a 12-lead ECG, echocardiogram, cardiopulmonary exercise test, 24-hour holter, cardiovascular magnetic resonance imaging and a CT coronary angiogram. Athletes had participated in endurance exercise for a meanof 32±12 years.

Results
Athletes achieved a higher VO2 max (43.2 ml/min/kg vs 28 ml/min/kg) compared with controls and on average weighed 12kg less (63kg vs 75kg).
VPBs were common in master athletes during exercise but are no more common than in age matched sedentary controls (39.3% vs 33.3% &gt;1 VPB, and 8.9% vs 5.9% complex or frequent VPBs). There were no sex differences in terms of VPB number (40% vs 39%) or complex morphology (10% vs 8%) between male and female athletes.
Athletes demonstrating complex ectopy during ETT had similar age (54.8±9 and 54.6±8), years of competition (34±9 and 32±12), VO2 max (40±6 and 43±7ml/min/kg), left ventricular mass (142±36g and 148±35g), end diastolic volume (160±35ml and 157±32ml) and incidence of late gadolinium enhancement (14% and 10%) compared with athletes who did not reveal complex VPBs.

Conclusion
VPBs are common during exercise testing in both masters athletes and sedentary age matched controls. Exercise-induced complex ectopy in an asymptomatic, low risk masters athlete represents a poor marker of significant structural heart disease.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Cardiac Risk in the Young
Benefits from optimised antihypertensive and statin treatment in high risk people
Authors: Wu R , Rison S , Raisi-Estabragh Z , Dostal I , Carvalho C , Robson J , Mihaylova B 
Published: October 2021

Abstract

Background
Hypertension and hypercholesterolaemia are major modifiable risk factors for cardiovascular diseases (CVD) with available effective and low-cost treatments. However, their suboptimal treatment remains widespread. We characterise treatment gaps in a large urban population and quantify the potential long-term health and economic impact with optimised use.

Methods
We studied 1 million UK urban residents served by 123 primary care practices in 2019. We categorised antihypertensive treatment in adults with diagnosed hypertension, and statin treatment in adults with diagnosed CVD, into optimal, suboptimal and not treated following UK clinical guidelines. A long-term CVD model was used to project cardiovascular events avoided, years of life and quality-adjusted life years (QALYs) gained, and healthcare costs saved with optimised treatments for individual patients accounting for their socio-demographic characteristics and risk factors.

Results
21,954 (24%, mean age 59 years; 49% female) of the 91,828 adults with hypertension were either suboptimally treated (20%) or untreated (4%) and 9,062 (38%, mean age 69 years; 43% female) of the 23,723 adults with CVD were either suboptimally treated (24%) or untreated (14%). Per 1000 patients (95% CI) optimised over lifespan, hypertension treatment would prevent 154 (72–230) major vascular events (MVEs, including heart attack, stroke or arterial revascularisation) and 69 (28–103) vascular deaths, and gain 769 (436–1038) QALYs for those sub-optimally treated, and prevent 138 (68–201) MVEs and 50 (21–76) vascular deaths, and gain 674 (386–920) QALYs for those not treated; statin treatment would prevent 68 (46–88) MVEs and 17 (12–21) vascular deaths, and gain 145 (113–178) QALYs for those sub-optimally treated, and prevent 260 (190–319) MVEs and 55 (40–68) vascular deaths, and gain 535 (412–651) QALYs for those not treated (Figure). Hospital cost savings net of medication costs were about £1100 per person over their remaining lifespan.

Conclusion
Optimising preventive cardiovascular treatments in UK primary care is likely to cost-effectively reduce cardiovascular risk and improve life expectancy, while reducing population inequalities.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Barts Charity, British Heart Foundation, and Health Data Research UK Predicted benefits from optimisation
Effect of body mass index on cardiac injury/cardiovascular outcomes in coronavirus disease 2019: a systematic review and meta-analysis
Authors: Ashraf M , Zlochiver V , Rawala M S , Dahar M , Robinson J , Jan M F 
Published: October 2021

Abstract

Coronavirus disease 2019 has affected millions of people worldwide. Its clinical spectrum ranges from completely asymptomatic to significant respiratory and non-respiratory symptoms leading to critical illness, including death. We aimed to study the effects of body mass index (BMI) on cardiovascular and other critical illness outcomes in these patients in the USA. We conducted a systematic search of three databases for the period of November 2019 to August 2020 and selected 37 studies for analysis. One study showed a non-significant difference in cardiac injury among BMI groups, but there is a paucity of data on cardiovascular outcomes among different BMI groups; hence, meta-analysis was not done for cardiovascular outcomes. Both high BMI and cardiac injury are independent predictors of poor outcomes in these patients. Pooled analysis showed obesity as a significant risk factor for intensive care unit admission (OR=1.547, CI=1.208–1.981, P=0.001) and intubation /mechanical ventilation (OR=1.744, CI=1.363–2.231 P=0.000). Therefore, BMI should be considered an important part of risk stratification, and vaccination should be prioritized for obese patients when it becomes widely available.

Funding Acknowledgement
Type of funding sources: None. Risk of intubation
CHLD score, a new score based on traditional risk factor evaluation and long-term cardiovascular outcomes in patients with systemic sclerosis
Authors: Wybraniec M , Gieszczyk-Strozik K , Widuchowska M , Kotyla P , Brzezinska-Wcislo L , Kucharz E , Mizia-Stec K 
Published: October 2021

Abstract

Purpose
The aim of the study was to assess the predictors of major adverse cardiovascular events (MACE) in patients with systemic sclerosis (SSc) without pulmonary arterial hypertension.

Methods
The study comprised 68 patients with SSc who were followed up for the median time of 97 (74.5; 105) months. The main exclusion criteria involved tricuspid regurgitation maximal velocity &gt;2.8 m/s and structural heart disease. At baseline the patients underwent clinical assessment of cardiovascular risk factors, 6-minute walk test, transthoracic echocardiography and biomarker testing for fetuin-A, growth differentiation factor 15 (GDF-15) and N-terminal pro-B-type natriuretic peptide. The primary composite endpoint was onset of MACE defined as death, myocardial infarction, myocardial revascularization and hospitalization for heart failure. The follow-up consisted of outpatient visits at 1 year intervals and telephone interview every 6 months.

Results
The baseline analysis revealed that chronic kidney disease (HR 28.13, 95% CI: 4.84–163.38), lung fibrosis on high resolution computed tomography (HR 4.36, 95% CI: 1.04–18.26) and GDF-15 concentration (unit HR 1.0006, 95% CI: 1.0002–1.0010) were independent predictors of MACE occurrence. CHLD score was formulated which assigned 1 point for the presence of arterial hypertension, hyperlipidaemia, diabetes mellitus and chronic kidney disease. After inclusion of CHLD score in Cox proportional model, it remained the only independent predictor of MACE onset (unit HR per 1 point 3.46; 95% CI: 2.06–5.82, p&lt;0.0001). Receiver operating curve (ROC) analysis (Figure 1) showed that CHLD score accurately predicted MACE (AUC 0.839; 95% CI: 0.745–0.932, p&lt;0.0001) and death (AUC 0.914, 95% CI: 0.849–0.978, p&lt;0.0001) on follow-up.

Conclusion
Joint assessment of traditional risk factors in the form of CHLD score may serve as a reliable predictor of long-term outcome in patients with SSc without pulmonary arterial hypertension.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland Figure 1
Clinical phenotypes of cardiac sarcoidosis by latent class analysis
Authors: Dai Q , Bose B , Li P , Liu B , Jin L , Laidlaw D 
Published: October 2021

Abstract

Background
Sarcoidosis is a systemic granulomatous disease with cardiac involvement reported in 20–27% of patients [1]. Cardiac sarcoidosis (CS) can lead to atrial or ventricular arrhythmias, various conduction system disorders, heart failure or sudden cardiac death, depending on the location of myocardial involvement [2]. Previous studies have investigated the possible types of CS based on the distribution of myocardial involvement on imaging as well as the role of genetic factors [3,4]. However, there are no studies describing the clinical heterogeneity of CS patients.

Purpose
In order to determine if clinical clusters exist in CS, we carried out a latent class analysis (LCA) to explore potential phenotypes in a large sample of CS patients from the National Inpatient Sample (NIS).

Methods
We identified 848 patients with a diagnosis of CS from the NIS in 2016–2018. A LCA was performed based on comorbidities. Utilizing the Bayesian information criterion and Akaike's information criterion we divided our study population into 3 cohorts. We subsequently applied the LCA model for our study population to fit each patient into one of the 3 cohorts. Finally, we compared the clinical outcomes among the 3 groups.

Results
Following LCA, patients in cohort 3 were strongly associated with a cardiometabolic syndrome profile with the highest prevalence of congestive heart failure (CHF, 95.1%), chronic kidney disease (CKD, 69.7%), diabetes mellitus (68.9%), hyperlipidemia (52.5%) and obesity (45.1%). Patients in cohort 2 had an intermediate prevalence of cardiometabolic syndrome with a universal diagnosis of hypertension (100%) but with the lowest number of CHF (32.5%) patients and none with CKD. Finally, patients in cohort 1 had the least comorbidities in comparison to the other groups but there was a higher prevalence of CHF (71.7%). There was no significant difference in mortality among the 3 groups, but acute respiratory failure was the highest in cohort 3. However, ventricular arrhythmias were more prevalent in cohort 1 patients (Table).

Conclusion
We identified 3 different types of CS based on their clinical phenotype. The clinical outcomes varied among the cohorts with ventricular arrhythmias being the most prevalent in patients with the least cardiometabolic comorbidities.

Funding Acknowledgement
Type of funding sources: None.