bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real world radiation exposure in left atrial appendage occlusion device implantation performed in a high volume center
Authors: Aslam S , O'Grady R , Casey A , Kennedy M , Hussein H 
Published: October 2021

Abstract

Left atrial appendage occlusion (LAAO) is an established and effective treatment to reduce the risk of thromboembolic stroke derived from the LAA in patient with non valvular atrial fibrillation. Per-cutaneous closure of the LAA is typically guided by fluoroscopic and echocardiographic guidance.
The purpose of our study is to ascertain real world radiation exposure during the LAAO performed in our institution and the interplay of different variables and patient characteristics.
Our study retrospectively analyzed all consecutive LAAO procedures performed at our Tertiary level Teaching Hospital. Data was collected using Hospital electronic records and cardiac catherization laboratory records.
A total of 261 patients who underwent LAAO were identified, 28% were female. Average age at the time of procedure was 77 years (range 54–93 years). Mean fluoroscopy time was 10.2 minutes (±7.0), average Radiation dose was 67 gy/cm2 (±73). Interestingly, gy/cm2 per minute of fluoroscopy averaged at 6.69 (±5.0).
Subgroup analysis focused on the effect of Body mass index (BMI) on radiation dose. Since the recent introduction of a partial electronic health record system, BMI data was only available on 161 patients. The cohort with BMI &lt;30 had a mean radiation dose of 57±62 gy/cm2, whereas for BMI &gt;30 mean dose was 96.8±68, p=0.0025 (95% CI (65 to 14)).
Analysis by the four different device types (Watchman, Watchman Flx, Wavecrest and ACP) were used for LAAO, with highest number been watchman (n=189). Upon comparing the radiation exposure in our study cohort watchman device had the least Dose adjusted Product (DAP) at 62gy/cm2 but the newer watchman flx (n=25) had slightly lower gy/cm2 per minute of fluoroscopy time 6.58±3.41 versus 6.83±5.56.
In addition, operator volume between our two implanters was assessed. Our highest volume operator implanted the majority of devices (n=235) whilst the Watchman Flx was predominantly implanted by our newer implanter (n=26). Despite the relatively modest numbers of the Watchman Flx, there was minimal difference in exposure time in favor of the more senior interventionist.
In conclusion, LAAO in our center has encouraging radiation safety data, which is comparable to previously published data in internationally recognized high volume centers. Normal BMI patients had the least radiation exposure, with the dose increasing with rising BMI.

Funding Acknowledgement
Type of funding sources: None. Bar Graph, radiation dose vs BMIScatter Plot, radiation dose vs BMI
Two-year incidence of PPMI post SAVR, modified SAVR and TAVR
Authors: Kawkabani N , Boustros O , Darwish R , Abi Ghanem M , Farah R , Abou Khalil B 
Published: October 2021

Abstract

Background
Moderate and high risk patients presenting with aortic stenosis are offered surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) as therapeutic options. However, both techniques are associated with postoperative conduction abnormalities necessitating permanent pace maker implantation (PPMI).
Many factors have been implicated in increasing the risk of atrioventricular (AV) block and subsequent PPMI. The stress on the conduction system seems to be a major cause of this complication.

Methods
We conducted a study to compare the incidence of PPMI between two groups of patients. In group A, 62 patients underwent the classic SAVR and in group B, 92 patients underwent a simple modified SAVR technique (3–4 pledgeted ethibond sutures were placed above the annulus, at the commissure between the right and non coronary sinuses) that aims to decrease the mechanical trauma to the conduction system.

Results
The results revealed a significant lower PPMI rate in group B as compared to group A,at thirty days (2.17% versus 14.5%) as well as at two years (2.17% versus 17.7%) postoperatively. The statistical analysis showed that the operative technique was a strong predictor of the need for PPMI. The odds of needing pace maker implantation was significantly lower in the group of patients who underwent the simple modified SAVR technique. Of note is that the reported incidence of PPMI in the literature, at thirty days and two- years post classic SAVR were 6.1% and 11%. In addition, the rate observed in group B, was lower than the post-TAVR incidence of PPMI (9.3% at thirty days and 13% at two years post procedure), as reported by numerous studies, whether self expandable or balloon expandable valves were used.

Conclusion
This reproducible and reliable simple technique should be recommended whenever SAVR is performed.On the other hand,the low incidence of PPMI (2.17%) observed after a modified SAVR technique should be adopted as a benchmark whenever TAVR is offered as a therapeutic option. Moreover, this less traumatic procedure may be taken into consideration whenever stent design modifications for TAVR are considered.

Funding Acknowledgement
Type of funding sources: None.
Type 1 and 2 matrix metalloproteinases, tissue inhibitor of metalloproteinases and left ventricular diastolic dysfunction in hypertensive patients
Authors: Lareva N , Kalinkina T , Govorin A 
Published: October 2021

Abstract

The purpose of the study. To assess the level of matrix metalloproteinases of types 1 and 2 (MMP1, MMP2), as well as tissue inhibitor of metalloproteinases (TIMP) in relation to indicators of left ventricular myocardial deformation in patients with essential hypertension, depending on the presence of left ventricular (LV) diastolic dysfunction (DD).

Materials and methods
114 hypertensive patients (40 women and 74 men) were involved in the study. The average age of the patients was 42±8.3 years. The diagnosis was confirmed by a thorough clinical and instrumental examination. Patients had no CVD or renal disease. LV diastolic filling parameters were assessed according to ASE/EACVI criteria (2016). The indicators of myocardial deformation were studied as well. The level of MMP1, MMP2 and TIMP was assessed by the method of enzyme-linked immunosorbent assay. Statistical methods such as Cruskell-Walles criteria and Spearman's correlation coefficient were used.

Results
1st group consisted of 66 patients with normal LV filling parameters, 2nd group was represented by 48 patients with LV DD, control group consisted of 35 healthy men and women, matching by age.
The level of MMP1 in group 2 was increased by 112% compared with group 1 and by 117% compared with the control group (101.1±10.4, 47.7±13.2 ng/ml and 46.6±26.1 ng/ml, respectively, p&lt;0.01). In group 2 patients, there was an increased level of MMP2 by 107% compared with patients in group 1 and by 112% compared with the control group (2519.0±233.9 ng/ml, 1216.1±189.8 ng/ml and 1186, 9±64.0 ng/ml, respectively, p&lt;0.01). The TIMP level was higher in hypertensive patients with LV DD: 2.3 times higher than in the group of patients without diastole disturbance, and 2.4 times higher than in the control group (158±24 ng/ml, 68.2±18.8 ng/ml and 66.3±14.0 ng/ml, respectively, p&lt;0.05). Differences between groups 1 and controls were not found for any of the studied parameters.
The study of global longitudinal myocardial deformation (Avg) depending on the presence of LV DD showed that in the 2nd group patients this indicator was 22.8% lower than in 1st group patients (p&lt;0.05). Compared with healthy people in groups 1 and 2, there was a decrease in Avg by 23.3% and 40.7%, respectively (p&lt;0.05). The analysis revealed a moderate negative correlation between the global longitudinal LV deformity and the level of MMP2 (r=−0.64, p&lt;0.05).

Conclusion
Thus, in hypertensive patients with LV DD, an increase in the level of MMP1, MMP2, and TIMP interrelated with global myocardial deformation was revealed, which suggests the participation of these markers in the formation of impaired LV diastolic filling in hypertension.

Funding Acknowledgement
Type of funding sources: None.
Renal biomarkers reflect overall hypertensive organ damage: “one organ to rule them all”
Authors: Terentes-Printzios D , Aznaouridis K , Ioakeimidis N , Gardikioti V , Xaplanteris P , Georgakopoulos C , Dima I , Oikonomou D , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Background/Introduction
Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Albumin to creatinine ratio (ACR) in urine has been recognized as an independent risk factor for cardiovascular events.

Purpose
We hypothesized that there is a relationship between ACR and markers of TOD in never-treated hypertensives.

Methods
We enrolled 924 consecutive essential hypertensives (mean age 53±12 years, 486 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure.

Results
ACR exhibited significant association with LVMI (r=0.277, p&lt;0.001, Figure), PWV (r=0.277, p&lt;0.001) ABI (r=−0.078, p=0.018) and eGFR (r=−0.100, p=0.002). In further analysis, ACR was associated with TOD as suggested by the 2018 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI&gt;115 g/m2 in men and &gt;95 g/m2 in women), increased PWV (PWV&gt;10m/s), decreased ABI (ABI&lt;0.9) and decreased renal function (eGFR&lt;60ml/min)]. Specifically, ACR exhibited significant association with the number of TOD and this association was independent of age and gender (p&lt;0.05).

Conclusions
Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive ability of ACR for TOD.

Funding Acknowledgement
Type of funding sources: None. Association between LVMI and ACR
Factors of adherence to lifestyle modification in older patients with cardiovascular comorbidity
Authors: Efremova E , Shutov A M , Skorodumova E G 
Published: October 2021

Abstract

Lifestyle modification is one of the leading strategies for successful therapy. Older patients are characterized by comorbidity and gerontological syndromes that result in low adherence to lifestyle modifications. The aim of this study was to investigate the factors of adherence to lifestyle modification in older patients with cardiovascular comorbidity.

Materials and methods
344 older patients with cardiovascular disease (171 females, mean age 69,5±7,6 years) were examined. Arterial hypertension had 330 (95,9%) patients, coronary heart disease - 298 (86,6%), chronic heart failure - 240 (69,8%), diabetes mellitus – 100 (29%). Arterial hypertension was defined according to ESC Guidelines for the diagnosis and treatment of arterial hypertension, 2018. An integral indicator of adherence to a healthy lifestyle was assessed, including smoking status, physical activity, consumption of fruits and vegetables, and salt restriction. The level of education, income, personal profile (MMPI scale), cognitive status (MMSE scale) were estimated.

Results
145 (42.2%) older patients with cardiovascular comorbidity had high and satisfactory adherence to lifestyle modification. Women more often had a high and satisfactory adherence to adherence to lifestyle modification compared to men: 85 (49.7%) and 60 (34.6%), resp., χ2=7.96; p=0.005. The presence of diabetes mellitus was associated with high and satisfactory adherence to lifestyle modification (OR 2.39; 95% CI 1.29–4.42; p=0.005). Older patients with high adherence to lifestyle recommendations had a higher MMSE score (26.9±2.7 and 24.7±3.7 scores, resp., p=0.01) and lower personality profile indices on the depression scale (MMPI) (52.2±9.8 and 60.6±11.1 T-scores, resp., p=0.01) compared to patients with low adherence. There were no differences from education, income, and marital status (p&gt;0.05). When constructing classification trees in older patients with cardiovascular comorbidity diabetes mellitus was an independent factor for satisfactory and high adherence to lifestyle modification, in the absence - female sex (sensitivity - 84.8%; specificity - 37.5% (AUC = 0.64); p=0.001 for model; χ2=20.2, p=0.0002).

Conclusions
More than half of older patients with cardiovascular comorbidity are characterized by low adherence to lifestyle modification. Diabetes mellitus is the most significant predictor of a high degree of adherence to lifestyle modification in older patients with cardiovascular comorbidity.

Funding Acknowledgement
Type of funding sources: None.
Antihypertensive medication and outcome in patients with COVID-19 compared to non-COVID respiratory infections
Authors: Blum S , Lampart M , Zhou Q , Mueller C , Osswald S , Kuster G M , Twerenbold R 
Published: October 2021

Abstract

Background
Recent reports suggested no adverse effects of antihypertensive medication including inhibitors of the renin-angiotensin system on outcome of patients with coronavirus disease 19 (COVID-19). However, most of these studies lack adequate control groups, and regional and socio-economic differences may additionally affect clinical course and outcome of COVID-19.

Methods
In the prospective observational cohort COrona VIrus surviVAl (COVIVA) study at our university hospital, we consecutively enrolled patients presenting to the emergency department with symptoms suggestive of COVID-19 between March and June 2020. Patients tested positive for COVID-19 (cases) were compared with patients tested negative, who had a respiratory infection (respiratory control). Primary outcome measure was the composite of ICU admission, 3'-day mortality or rehospitalization for respiratory symptoms.

Results
The final analysis consisted of 191 patients with COVID-19 and 323 respiratory controls. Sixty cases (31.4%) and 87 (26.9%) respiratory control patients were on ACE inhibitors (ACE-I) or angiotensin II receptor blockers (ARB). In unadjusted models the hazard ratio [95% CI] for the composite outcome for patients on ACE-I/ARBs was 2.36 [1.34; 4.16], p=0.003 and 2.05 [1.03; 4.09], p=0.04 among patients with COVID-19 and respiratory controls, respectively. The corresponding multivariable adjusted HRs were 1.32 [0.68; 2.55], p=0.41 and 1.20 [0.58; 2.48], p=0.62. Furthermore, we did not observe an increased risk for the outcome when assessing ACE-Is and ARBs separately or other antihypertensive agents, both in COVID-19 patients and respiratory controls (Table).

Conclusions
In a Swiss cohort of patients with COVID-19 or non-COVID respiratory controls treatment with ACE-I/ARBs or other antihypertensive medication was not associated with adverse events after accounting for comorbidities and risk factors.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Foundation for Cardiovascular Research Basel (FCVR Basel)Swiss Heart Foundation
Clinical and radiological testing for subclinical atherosclerosis in first-degree relatives of patients with premature coronary artery disease: feasibility and diagnostic yield
Authors: Vikulova D , Bevanda L , Pimstone S N , Brunham L R 
Published: October 2021

Abstract

Background
Premature atherosclerotic cardiovascular disease (ASCVD) is highly heritable. The screening of first-degree relatives (FDR) of patients with premature ASCVD is recommended but not routinely performed, and the diagnostic yield of different approaches to such screening is unknown.

Purpose
To determine the feasibility and diagnostic yield of clinical and radiological screening of FDRs of patients with premature coronary artery disease (CAD) in clinical setting.

Method
We recruited FDRs of patients with angiographically-proven CAD with stenosis of ≥50% who presented at the age of ≤50 years for males and ≤55 years for females. After clinical and laboratory assessment, patients with no personal history of cardiovascular disease underwent either coronary computed tomography angiography (CCTA), coronary calcium scoring assessment (CAC), or carotid ultrasound (CUS). Subclinical atherosclerosis was defined as 1) CAC score &gt;100 Agatston units or &gt;75% percentile for age and sex; 2) Stenosis &gt;50% in at least one coronary artery or segment involvement scores &gt;50th percentile in males and &gt;75th in females; or, 3) Carotid plaque on ultrasonography.

Results
We enrolled 220 FDRs between 2017 and 2020, 129 completed clinical assessment (Figure 1). Of them, 28 (21.7%) had a personal history of ASCVD and 101 were tested for subclinical atherosclerosis. The characteristics of these patients are shown in Table 1. The most prevalent cardiovascular risk factors were dyslipidemia (40.6%), hypertension (22.8%), and obesity (21.8%). When assessed with the Framingham risk score calculator without adjustment for family history, only 5.1% and 28.6%, of patients had high or moderate cardiovascular risk, respectively. After adjusting for family history and the presence of statin-indicated conditions, 39.6% and 14.9% of patients were placed in high and moderate risk groups, respectively. Subclinical atherosclerosis was found in 43.6% of all patients (Figure 1) and 57.7% of patients over 40 years of age. The diagnostic yield of procedures was 29.6% for CUS, 37.8% for CCTA and 61.1% for CAC scoring. After the radiological assessment, 13.9% of patients were reclassified to a higher risk group (Table 1).

Conclusion
Non-invasive cardiovascular imaging detected subclinical atherosclerosis in 43.6% of healthy patients with a family history of premature ASCVD, moving 1 in 7 patients to a higher risk group and suggesting that this screening approach may improve risk prediction in this population.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research.St. Paul's Hospital Foundation and the Vancouver General Hospital Foundation. Figure 1Table 1
Mild renal dysfunction is associated with increased risk of ischemic heart disease disease among healthy adults
Authors: Tiosano S , Fardman A , Kaplan A , Kalstein M , Moshkovits Y , Segev S , Beckerman P , Segev A , Grossman E , Maor E 
Published: October 2021

Abstract

Introduction
The relationship between ischemic heart disease (IHD) and advanced chronic kidney disease is well established. However, there is a paucity of data regarding the long-term association in between renal function and incidence of IHD.

Purpose
To study the remote association between point renal function and future incidence of ischemic heart disease among healthy adults.

Methods
We evaluated asymptomatic self-referred adults who participated in a medical screening program. All subjects were free of IHD at baseline. Glomerular Filtration Rate (GFR) was calculated by CKD-EPI and divided into quartiles (Q1 represents the lowest quartile). Study endpoint was the development of IHD which was externally adjudicated by a physician. Mortality data were available for all subjects from national registry. Cox regression models were applied while adjusting for confounders.

Results
The final study population included 27,647 subjects (68% men) with a mean age of 47 years. At baseline (first screening visit), median GFR by CKD-EPI was 84 [IQR 74; 95] and 86 [IQR 74.; 101] mL/min per 1.73m2 for men women, respectively. During median follow up of 6 years [IQR 2; 12], 2,286 (8%) of subjects developed IHD, of whom 1,912 (10%) were men and 374 (4%) were women. Incident IHD was in 964 (13.98%), 705 (10.22%), 437 (6.34%) and 171 (2.48%) subjects from GFR Q1-Q4, respectively. Kaplan Meier survival analysis demonstrated a graded increased risk of IHD with decreasing eGFR quartiles (p Log rank &lt;.001; Figure 1). Multivariate cox regression analysis revealed hazard ratio of 1.26 (95% CI 1.06, 1.51), 1.43 (95% CI 1.20, 1.70), and 1.25 (1.05, 1.50) for IHD incidence for Q1-Q3, respectively (using Q4 as reference). While considering GFR as a continuous variable, each 10 units increase in GFR was significantly associated with 4% less risk for developing IHD - HR 0.96 (95% CI 0.93–1.00, p=0.04).

Conclusion
Mild renal dysfunction even within the normal range is independently associated with remote risk of IHD among young apparently healthy adults. Cardiovascular screening should be considered among young patients with reduced renal function, even within normal reference range.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Association of nephronophthisis 4 genetic variation with cardiorenal syndrome and cardiovascular events in Japanese general population: the Yamagata (Takahata) study
Authors: Otaki Y , Watanabe T W , Goto J G , Saito Y S , Aono T A , Kobayashi Y K , Sato J S , Watanabe M W 
Published: October 2021

Abstract

Background
Nephronophthisis (NPHP) 4 gene encoding nephrocystin-4, which contributes to end-stage renal disease in children and young adults, is involved in the development of the heart and kidneys. Cardiorenal syndrome (CRS), which consists of bidirectional dysfunction of the heart and kidneys, is a risk factor for cardiovascular events. Single nucleotide polymorphisms (SNPs) within the NPHP4 gene are reportedly associated with kidney function, even in adults. However, the association of NPHP4 gene variability with CRS and cardiovascular events remains unknown.

Purpose
To examine whether NPHP4 gene variability is related to CRS and cardiovascular events in general population.

Methods and results
This prospective cohort study included 2,946 subjects who participated in a community-based health study with a 16-year follow-up period. We genotyped 11 SNPs within the NPHP4 gene whose minor allele frequency was greater than 0.1 in the Japanese population. The SNP rs12058375 was significantly associated with CRS and cardiovascular events. Multivariate logistic analysis demonstrated a significant association between the homozygous A-allele of rs12058375 with the presence of CRS. Haplotype analysis identified the haplotype with the A-allele of rs12058375 as an increased susceptibility factor for CRS. Kaplan-Meier analysis demonstrated that homozygous A-allele carriers of rs12058375 had the greatest risk of developing cardiovascular events among the NPHP4 variants. Multivariate Cox proportional hazard regression analysis revealed that the homozygous A-allele and heterozygous carriers of rs12058375 were associated with cardiovascular events after adjusting for confounding factors. The net reclassification index and integrated discrimination index were significantly improved by the addition of rs12058375 as a cardiovascular risk factor.

Conclusion
Genetic variations in the NPHP4 gene were associated with CRS and cardiovascular events in the general population, suggesting that it may facilitate the early identification of high-risk subjects with CRS and cardiovascular events.

Funding Acknowledgement
Type of funding sources: None.