bluuebunny/crossref_metadata_2025_split huggingface dataset:
IIMAGING OF PRIMARY ALDOSTERONISM IN YOUNG PATIENTS FROM A LARGE INTERNATIONAL STUDY (AVIS-2-YOUNG)
Authors: Rossi Gian Paolo , Crimi’ Filippo 
Published: April 2021

Objective:
Purpose The Endocrine Society guidelines suggested skipping adrenal vein sampling (AVS) when referring for surgery young PA patients with a unilateral adrenal nodule and a contralateral normally appearing gland at imaging, but this was based on a limited set of cases. Hence, we sought to determining if imaging provided an accurate identification of unilateral PA.

Materials and Methods:
We examined the large cohort of patients ?45 years-old recruited in the AVIS-2-Young study. Biochemical cure of PA after unilateral adrenalectomy was used as the final diagnosis to assess imaging diagnostic accuracy.

Results:
Among the 1625 AVIS-2 patients those ?45, 40 and 35 years-old were 29.0%, 15.5% and 6.1%, respectively. In the same age cohorts, a unilateral adrenal nodule was found in 53.2%, 57.3% and 47.3%; 42.6%, 38.5% and 50.9%, respectively, showed no nodules and 4.2%, 4.2% and 1.8% bilateral nodules. In those with a unilateral nodule, the culprit adrenal was identified in 81.4%, 84.1%, and 92.3% of the patients. Youden index analysis identified ? 38 years as the best cut-off for unilateral PA identification; by restricting the analysis to those with a nodule size to > 10 mm, the overall concordance was 94.0%. However, bilateral or no nodules were detected at imaging in > 37% of the patients with a final diagnosis of unilateral PA in all age cohorts.

Conclusion:
Referring PA patients ?45, 40 and 35 years-old based on a unilateral nodule at imaging carried a likelihood of wrong/inappropriate surgery in 18.6%, 15.8% and 7.7%, respectively. This error rate can be minimized to 6.0% by selecting patients ?38 years with a nodule > 10 mm. However, in these age cohorts up to 1/3 of the patients, who had unilateral surgically curable PA were not detected with imaging.
ATRIAL SEPTAL ANEURYSM IN ADULTS – IS IT A DEGENERATIVE HEART DISEASE?
Authors: Ejim Emmanuel , Ubani-Ukoma Chidi , Ugwu Collins , Njoku Paschal 
Published: April 2021

Objective:
Atrial septal aneurysm (ASA) is a localised “saccular” deformity of the interatrial septum, generally at the level of the fossa ovalis, which protrudes to the right or the left atrium or on both sides. It is a well recognised cardiac abnormality that was previously diagnosed on autopsy only, but it is now frequently picked up on routine echocardiography or during evaluation of ischemic stroke. There is a dearth of data on atrial septal aneurysm in our environment, and the authors set out to find the common cardiac abnormalities associated with atrial septal aneurysm in adults who had transthoracic echocardiographic examination in Enugu, South-East Nigeria

Design and method:
Conquest Medical Imaging is a private medical diagnostic centre in Enugu, South-East Nigeria. The centre offers radiologic and ultrasonography diagnostic services. The echocardiographic records of 1390 patients done over a 4-year period were retrospectively reviewed. The examinations were done with a Logic 500MD Echocardiographic machine made by General Electric. Data obtained from the echocardiography register included presence of atrial septal aneurysm, age, gender, other cardiac abnormalities present.

Results:
A total of 1174 adults had echocardiographic examination during the period under review, and consisted of 667 males and 507 females. The mean age of the males was 43.1 ± 6.2 years, while the mean age of the females was 45.9 ± 7.1 years.
Atrial septal aneurysm was present in 28 patients representing 0.2% of the total adult population, and made up of 11 males and 17 females. 25 patients had one or more additional cardiac abnormalities, representing 89.3% of all patients with atrial septal aneurysm. Degenerative aortic valve disease, degenerative mitral valve disease, and left ventricular diastolic dysfunction were the cardiac abnormalities noted in addition.

Conclusions:
The frequent association of degenerative valvular heart diseases with atrial septal aneurysm in adults may suggest that atrial septal aneurysm has a degenerative aetiology in adults.
OBESITY PARADOX AND HYPERTENSION: NEW INSIGHTS IN HEART FAILURE PATIENTS
Authors: Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Stavropoulos Konstantinos , Katsimardou Alexandra , Patoulias Dimitrios , Toumpourleka Maria , Bakogiannis Konstantinos , Bouloukou Sofia , Manafis Alexandros , Ziakas Antonios , Papadopoulos Christodoulos , Vassilikos Vassilios , Karagiannis Asterios , Doumas Michael 
Published: April 2021

Objective:
Heart failure (HF) is more prevalent among obese and overweight individuals than among normal weight people, although there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients, the so-called obesity paradox in HF. On the other hand, obesity increases the risk of hypertension and the relationship between HF and hypertension is well-established; however, the prognostic role of obesity has not been investigated sufficiently in hypertensive HF patients.

Design and method:
Patients with HF were evaluated in a cross sectional study. Office blood pressure (BP), both systolic (SBP) and diastolic (DBP), the duration in years from the first diagnosis of hypertension and body mass index (BMI) were recorded as well. The prognostic role of obesity was evaluated according to the number of hospitalizations for HF in the last six months and in the last year.

Results:
A total of 306 consecutive male patients with HF participated in the study. Overweight were 45,8%, obese 37,2% and normal weight 16,9% of patients according to BMI. Both SBP and DBP had a negative correlation with the number of hospitalizations for HF in the last six months and in the last year (r = -0.174, p = 0.008, r = -0.190, p = 0.004 for systolic, and r = -0,130, p = 0.049, r = -0.155 and p = 0.018 for diastolic, respectively). Overweight, obese and lean participants did not differ in BP, both SBP and DBP, and in their HF morbidity according to hospitalizations (p = 0.075, p = 0.271, and p = 0.407, respectively). Patients with hypertension had higher values of BMI (p = 0.032), but office SBP and DBP did not have any correlation with BMI. Also, BMI did not differ among patients with or without hypertension, and although BMI had a negative correlation with the number of hospitalization for HF, that was not significant (r = -0.062, p = 0.346).

Conclusions:
Our study provides some new insights regarding to the relationship between obesity and office BP in HF patients. Obese is highly prevalent in HF patients with or without hypertension, but the association between BMI and morbidity according to the number of hospitalizations has not been found to be significant in hypertensive patients.
META-ANALYSIS EVALUATING THE RISK OF ATRIAL FIBRILLATION WITH NEWER ANTIDIABETICS ACROSS THE CARDIOVASCULAR AND RENAL OUTCOME TRIALS
Authors: Patoulias Dimitrios , Toumpourleka Maria , Katsimardou Alexandra , Imprialos Konstantinos , Stavropoulos Konstantinos , Koutsampasopoulos Konstantinos , Mavridou Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael 
Published: April 2021

Objective:
Patients with type 2 diabetes mellitus (T2DM) experience a significantly increased risk for atrial fibrillation (AF) compared to unaffected subjects. The latter confers to increased risk for heart failure, all-cause and cardiovascular mortality. Notably, even patients with sufficient glycemic control feature an increased risk for AF. Thus, it seems to be of interest whether antidiabetic treatment can affect the risk for AF among patients with T2DM.

Design and method:
We searched PubMed from its inception to 2 October 2020. We sought to determine the risk of AF with the use of newer antidiabetics, namely dipeptidyl-peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, extracting corresponding data from the published cardiovascular and renal outcome trials. We assessed the risk for AF with each drug class separately.

Results:
We pooled data from 4 trials with DPP-4 inhibitors versus placebo or active comparator in a total of 34,884 patients, from 7 trials with GLP-1RAs versus placebo in a total of 55,943 patients and from 7 trials with SGLT-2 inhibitors versus placebo in a total of 55,966 patients. Risk of bias is considered as low across all selected studies. DPP-4 inhibitor treatment resulted in a non-significant decrease in the risk for AF, equal to 7% (RR = 0.93, 95% CI; 0.75 to 1.16, I2 = 1%). Similarly, GLP-1RA treatment produced a non-significant decrease in the risk for AF, equal to 12% (RR = 0.88, 95% CI; 0.76 to 1.03, I2 = 29%). Notably, SGLT-2 inhibitor treatment significantly decreased the risk for AF 19% (RR = 0.81, 95% CI; 0.69 to 0.95, I2 = 0%).

Conclusions:
Collectively, newer antidiabetics do not confer an increased risk for AF among patients with T2DM, while, SGLT-2 inhibitors seem to be protective, providing an additional cardiovascular benefit, besides the well-established ones.
PREDICTION OF LEFT VENTRICULAR REMODELING IN PATIENTS WITHOUT CARDIOVASCULAR DISEASE THROUGH MACHINE LEARNING: AN ECG-BASED APPROACH
Authors: Angelaki Eleni , Marketou Maria , Barbaris George , Patrianakos Alexandros , Parthenakis Fragiskos , Tsironis George 
Published: April 2021

Objective:
Cardiac remodeling -even at early stages-is considered an important aspect of cardiovascular disease progression and is therefore emerging as a significant therapeutic target. We used machine learning (ML) techniques and investigated several ML classifiers built on basic clinical parameters and ECG features for detecting left ventricular remodeling (LVR), even at the early stages before the onset of LVH in a population without cardiovascular disease

Design and method:
We enrolled 475 subjects with and without essential hypertension and no other indications of cardiovascular disease. Based on left ventricular mass index (LVMi) and relative wall thickness (RWT), calculated using echocardiography, the subjects were classified into 3 groups; those with normal geometry, concentric remodelling, concentric and eccentric left ventricular hypertrophy (LVH). We trained a Random Forest, i.e. a nonlinear predictive ML model suitable for panel data, to classify subjects either in the normal group, or in the other three combined (LVH and both types of left ventricular hypertrophy-LVH). We also perform feature importance and feature interaction analysis by calculating SHAP values, a game theoretic tool that helps in interpreting the model's predictions.

Results:
Hypertension, age, and body mass index (BMI) were the most significant features, as expected. Additionally, a combination of BMI and Sokolow criteria as well as the areas under the QRS complex and the QTc duration, among others, were also important. The age of 65 marked a sharp change in the risk of being classified with LV remodelling and LVH. The random forest model was able to distinguish normal subjects from the ones with LVR and LVH with accuracy 80%, specificity 65% and sensitivity 91%.

Conclusions:
We found promising clinical and ECG features in the direction of machine based assistance in the detection of LVR even at early stages before the onset of LVH. Strategic and innovative solutions are needed to improve hypertension management, especially in primary care settings and our data indicate that ML may improve risk stratification of hypertensive population with simple clinical approaches.
UROCORTIN 2 LEVEL AND BLOOD PRESSURE VALUES IN PATIENTS WITH NEWLY DIAGNOSED HYPERTENSION
Authors: Walczewska Jolanta , Dzieza-Grudnik Anna , Siga Olga , Wizner Barbara , Wolkow Pawel , Gryglewska Barbara , Grodzicki Tomasz 
Published: April 2021

Objective:
Urocortin 2 (Ucn2)is a peptide hormone having favorable hemodynamic actions. Lowering in blood pressure and in peripheral vascular resistance as well as vasodilating effect of ucn2 are considered to be important and interesting.
The aim of the study was to assess serum concentration of Ucn2 in patients with newly detected hypertension without pharmacotherapy.

Design and method:
We examined 71 participants (group I – healthy, group II newly diagnosed hypertension without treatment). All patients underwent 24-hour ambulatory blood pressure monitoring (SpaceLabs90207), anthropometric measurements, biochemical test, ucn2 blood level assessment.

Results:

Conclusions:
Subjects with higher level of UCN 2 have lower values of night DBP in ABPM, however other parameters of ABPM monitoring were not associated with levels of serum Ucn2.
Higher Ucn2 level may play a role in lowering blood pressure in patients with essential hypertension.
Not showing such a relation to daily BP values may suggest the disturbing effect of many environmental and life style factors on daily BP values.
ALPHA-GST AS A TUBULAR BIOMARKER IN EARLY DIAGNOSIS OF ACUTE KIDNEY INJURY IN CARDIAC SURGERY
Authors: Santos Ana Carolina Casinhas Dos , Matos Andreia , Raimundo Mário , Madureira Ana Isabel , Malcato Ester , Côrte-Real Hugo , Gameiro Joana , Nobre Ângelo , Bicho Manuel , Almeida Edgar 
Published: April 2021

Objective:
Acute Kidney Injury(AKI) is a frequent complication in cardiac surgery, leading to an increase in morbility/mortality. The monitorization of the creatinine after the procedure is recommended, however, new tubular biomarkers may allow earlier diagnosis of AKI(a few hours after the procedure, against the 24/48 hours standard). Glutathione S-transferase(GST), cytoplasmic enzymes involved in detoxification of free radicals, are presented in the proximal contoured tube. The aim of this study is to evaluate the use of a single alpha-GST determination at 3 h after surgery, to early diagnosis of AKI.

Design and method:
Cohort, prospective and observational study, with adults submitted to elective cardiac surgery (valvular/coronary), without chronic kidney disease. Blood and urine samples were collected simultaneously before(T0) and within 3 hours after surgery(T1). The levels of alpha-GST were determined in the urine samples by ELISA and normalized to urinary creatinine(UCr). The variation of alpha-GST was calculated using the difference between T1 and T0(T1-T0). Demographic, clinical and surgical-related data was collected. For statistical analysis, Chi-square and Mann-Whitney test were used. The ROC curve was generated in order to evaluate the discriminative power of the biomarker. P < 0.05 was statistically significant.

Results:
This study included 17 patients(11 male and 6 female), with 88.2% submitted to valvular surgery, with a mean age of 63.4 ± 14.3 years. Before the procedure, 82.4% of the patients had hypertension. After 48 hours surgery, using as gold standard the KDIGO classification, 6 patients presented AKI stage 1(75%) and 2(25%) stage 2. The mean arterial blood pressure was higher before surgery(T0: 90.0[74.5–103.3] vs T1: 64.5[57.2–80.7], p = 0.05). The increase of alpha-GST levels were associated to presence of AKI(p = 0.05). This increase remains when associated with the variation of alpha-GST(T1-T0) without and with AKI (- 0,002[-0.02–0.004]vs -0.02[0.009–0.04], respectively, p = 0.003). In the ROC curve, this variation had a AUC = 0.958(p = 0.05) and AUC = 0.854(p = 0.028) for the cut-off of the alpha-GST variation. These biomarkers present 78%-specificity and 75%-sensibility.

Conclusions:
alpha-GST is a promising biomarker to the early diagnosis of AKI after cardiac surgery with only one determination, contributing to this diagnosis before an increase of serum creatinine. Preventing costs and therapeutic options.
URINARY UROMODULIN DIRECTLY AND INDIRECTLY CONTRIBUTE TO LEFT VENTRICULAR HYPERTROPHY IN MIDDLE-AGED PREHYPERTENSIVES
Authors: Josipovic Josipa , Simicevic Livija , Milicic Borna , Domislovic Viktor , Vrsalovic Mislav , Jelakovic Bojan 
Published: April 2021

Objective:
Recent GWAS studies found uromodulin gene polymorphisms to be associated with hypertension and atrial remodeling. This study analysed urinary uromodulin (UM), sodium excretion, blood pressure (BP) and echocardiogram in a group of middle-aged non-treated subjects.

Design and method:
We included 326 apparently healthy subjects (mean age 37). According to JNC-7 optimal BP (OBP), prehypertension (PHT) and hypertension (HT) were diagnosed in 103 subjects (72% m), 143 subjects (43% m), and 80 subjects (38% m), respectively. Fasting blood and urine samples were obtained and office and ambulatory BP were measured in all subjects. Sodium excretion was determined from the 24h-urine specimens in a subgroup of 175 subjects. All echocardiograms were performed by the same co-author. UM an alpha1 microglobulin (A1 M) from the morning spot urine sample were determined by ELISA (Cobas Roche, BioVendor) and Siemens Dade Behring BN II Nephelometer (Siemens, Germany), and were corrected to urine creatinine, respectively.

Results:
Nonsignificant trend to higher nonindexed UM (nUM, mg/ml) were found in HT/PHT compared to OBP, and opposite trend was observed for indexed UM (iUM, mg/g creatinine). nUM and iUM correlated positively with ABPM parameters in OBP group, but negatively in HT. In OBP and PHT groups iUM correlated positively with fractional sodium excretion (FENa) (Rho 0.272; P = 0.01) and FENa (Rho 0.208; P = 0.02), respectively, as well as with A1mCR (Rho 0.317; P < 0.001) and (Rho 0.347; P < 0.001), respectively. There were significant differences in interventricular septum diameter (IVSd) between first and second/ third terciles of nUM in the OBP group (P = 0.02) and first and third terciles in the PHT group (P = 0.04). nUM correlated positively with left ventricule mass (LVM) (Rho 0.221; P = 0.01) and IVSd (Rho 0.191; P = 0.03) in the whole group. In the PHT group nUM correlated positively with IVSd (Rho 0.399; P < 0.001).

Conclusions:
Positive association of UM with LVM suggests effect of uromodulin on left ventricule remodeling in middle-aged non-treated subjects.
EFFECT OF CUFF-INFLATION ON BLOOD PRESSURE, SLEEP EFFICIENCY AND AROUSAL: A SUBANALYSIS OF THE VAST STUDY
Authors: Socrates Thenral , Krisai Philipp , Meienberg Andrea , Mayr Michael , Burkard Thilo , Vischer Annina 
Published: April 2021

Objective:
Standard cuff-based devices (RefBP) are the gold standard for 24 hour blood pressure (BP) measurement, however the repeated inflations may be distressing for patients especially at night. A cuffless blood pressure measurement device (TestBP) using pulse transit time for beat-to-beat calculation of BP is in clinical use. We investigated the effect of RefBP cuff-inflations on asleep measurements taken simultaneously with the TestBP including BP, sleep efficiency and arousal.

Design and method:
Cuffless and standard cuff-based 24 h BP measurements were simultaneously performed on both arms. TestBP was calibrated with the initial cuff-based measurement. A subgroup analysis was carried out on 21 participants who 1–4 days later had measurements repeated only with the TestBP device. Comparisons were made between the asleep simultaneous measurements RefBP/TestBP and the TestBP alone for systolic and diastolic asleep BP, sleep efficiency, total arousals during sleep and arousal during sleep per hour. Asleep was defined as time in bed as protocolled by the participant. According to current guidelines, asleep hypertension was defined as >=120/70 mmHg.

Results:
21 individuals were prospectively enrolled. Mean (±standard deviation (SD)) age was 49(±15) years and 57% were female. Mean (± SD) systolic asleep BP for the RefBP/TestBP and TestBP were 131(±21.7) and 131.2(±26) respectively. Mean diastolic asleep BP values for RefBP/TestBP and Test BP were 80(±14) and 83.7(±14.2). Wilcoxon signed rank test showed no significant difference when comparing mean systolic or diastolic asleep BP of RefBP/TestBP and TestBP (p = 0.86, p = 0.11 respectively). However when classifying the two groups into hypertensive or normotensive, there were significantly more systolic hypertensive classifications with RefBP/TestBP simultaneous measurements than with TestBP alone (p = 0.025, Fig1). There was no significant difference seen in sleep efficiency between the two groups (p = 0.117). There were significantly less total arousals with the TestBP alone (p = 0.040).

Conclusions:
We showed that simultaneous measurements with RefBP/TestBP may lead to more patients being labelled as having nocturnal systolic hypertension, potentially caused by more arousals from the cuff inflations of the RefBP. However, further studies are needed to identify the effects of cuff inflations on arousals and nocturnal hypertension.
PROGNOSTIC VALUE OF MASKED UNCONTROLLED HYPERTENSION DEFINED BY DIFFERENT AMBULATORY BLOOD PRESSURE CRITERIA
Authors: Coccina Francesca , Pierdomenico Anna Maria , Cuccurullo Chiara , Vitulli Piergiusto , Pizzicannella Jacopo , Madonna Rosalinda , Trubiani Oriana , Cipollone Francesco , Pierdomenico Sante Donato 
Published: April 2021

Objective:
Masked uncontrolled hypertension (MUCH), that is, normal clinic but high out-of-office blood pressure (BP) in treated hypertensive patients is at increased cardiovascular risk than controlled hypertension (CH), that is, normal clinic and out-of-office BP. Based on ambulatory BP, MUCH can be defined as daytime and/or nighttime and/or 24-hour BP above threshold values. It is unclear whether different definitions of MUCH show similar prognostic information. This study assessed the prognostic value of MUCH defined by different ambulatory BP criteria.

Design and method:
The occurrence of a composite end-point was evaluated in 738 treated hypertensive patients with normal clinic BP (<140/90 mmHg) who were selected from 2264 treated subjects. Participants were classified as having daytime MUCH (BP >135/85 mmHg) regardless of nighttime BP (Group 1), nighttime MUCH (BP >120/70 mmHg) regardless of daytime BP (Group 2), 24-hour MUCH (BP >130/80 mmHg) regardless of daytime or nighttime BP (Group 3), daytime MUCH only (Group 4), nighttime MUCH only (Group 5) and daytime + nighttime MUCH (Group 6).

Results:
There were 215, 357, 275, 42,184 and 173 patients with MUCH from Group 1 to 6, respectively. During the follow-up (10 ± 5 years), 148 events occurred in patients with CH and MUCH. Results of univariate and multivariate Cox regression analyses are reported in the Table.

Conclusions:
The prognostic impact of MUCH defined according to various ambulatory BP definitions may be different.