bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incomplete functional reverse remodelling of the left ventricle one year after bariatric surgery. Insights from the prospective FatWest study
Authors: Grymyr L M D , Nadirpour S , Gerdts E , Nedreboe B G , Hjertaas J J , Matre K , Cramariuc D 
Published: October 2021

Abstract

Background
Patients with severe obesity are predisposed to development of left ventricular (LV) hypertrophy with subsequent increased myocardial oxygen demand and impaired myocardial function. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile.

Purpose
To assess whether LV systolic function, wall mechanics, and cardiac power improve 1 year after bariatric surgery.

Methods
91 severely obese patients (43±10 years, 70% women, body mass index [BMI] 41.7±4.9 kg/m2, 55% with hypertension, 17% with diabetes mellitus) underwent echocardiography before, 6 and 14 months after Roux-en-Y gastric bypass surgery in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV systolic function by biplane ejection fraction (EF), LV wall mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), and cardiac power normalized for LV mass by 0.222 x cardiac output x mean blood pressure (BP)/LV mass.

Results
Surgery induced a significant reduction in BMI, heart rate, systolic BP, and LV mass (Figure 1). Prevalence of LV hypertrophy fell from 34 to 20% 14 months after surgery (p&lt;0.001), while that of concentric geometry remained stable: 8 vs 10% (p=0.36). GLS improved by 28%, however LV EF and MWS did not change (Figure 2). LV power at rest decreased postoperatively, reflecting the lower BP and heart rate, but was unaltered when normalized for LV mass (Figure 2). In backward stepwise multivariate regression analyses, 1 year improvement in GLS was predicted by the systolic BP reduction (p&lt;0.05) (R2 0.73, p&lt;0.001), while low 1-year MWS was independently associated with female gender, concentric geometry and higher myocardial oxygen demand (all p&lt;0.01) (Nagelkerke R2 0.44, p&lt;0.001), and lower 1-year LV power-mass with female gender and LV hypertrophy (p&lt;0.01) (R2 0.24, p&lt;0.001).

Conclusion
In severely obese patients, LV longitudinal function normalizes 1 year after bariatric surgery, mainly due to the BP reduction. LV midwall mechanics and power do not improve, especially in women and patients with persistent LV geometric abnormalities.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
HF and CKD present a dire prognosis in young Type 2 Diabetic patients
Authors: Seabra Carvalho D , Gavina C , Valente F , Bernardo F , Santos Araujo C , Taveira Gomes T 
Published: October 2021

Abstract

Introduction
Type-2 diabetes (T2D) is one of the most relevant risk factors for both heart failure (HF) and chronic kidney disease (CKD). Target organ damage causes significant morbi-mortality, especially when these two conditions are combined with diabetes.
Understanding the natural history of the combination of these conditions is paramount to implement tailored preventive measures.

Purpose
To estimate the risk of all-cause death, cardiovascular (CV) death and non-fatal major CV events (MACE) in T2D patients younger than 65 years, either: i) without HF or CKD, ii) with HF (T2D-HF), or iii) with CKD (T2D-CKD) in a real-world clinical setting.

Methods
Retrospective cohort study performed in a healthcare centre that provides primary and secondary care. It included adults with T2D aged between 40 and 65 years of age stratified into three groups: i) T2D with HF defined as either: Ejection Fraction (EF) ≤40% and NT-proBNP ≥200pg/mL (≥600pg/mL if atrial fibrillation (AF)) or BNP ≥100pg/mL (≥125pg/mL if AF); EF &gt;40% in the presence of structural cardiac abnormalities), ii) T2D with CKD (eGFR ≤60mL/min using EPI-CKD formula) and T2D without HF or CKD. We modelled 1-year risk for CV death, all-cause mortality and non-fatal MACE using multivariate weighted cox regression models clustered by patient. Models were adjusted for age (using penalized splines), sex, age-sex interaction, prior history of hypertension, myocardial infarction, stroke, and peripheral arterial disease. We reported hazard ratios (versus T2D without HF or CKD) with 95% confidence intervals.

Results
We identified 14986 patients with T2D without HF or CKD, 1101 with T2D with HF and 3114 with T2D with CKD. Patients were in general 55–58 years old, with a slight predominance of the male gender across the groups. Event rate was 14% in T2D with HF, 15% in T2D with CKD and 5% in TD2 without these conditions.
One-year all-cause death risk was 2.77 (2.26–3.40) for T2D-HF and 3.09 (2.77–3.45) for T2D-CKD. CV death risk was 2.59 (1.72–3.91) for T2D-HF and 2.75 (2.19–3.46) for T2D-CKD. Non-fatal MACE risk was 2.82 (2.34–3.41) for T2D-HF and 1.90 (1.66–2.17) for T2D-CKD. Regarding MACE, the event rate was 32% in T2D-HF, 13% in T2D-CKD but only 6% in T2D. T2D-HF was associated with the highest risks of myocardial infarction (3.25 [2.60–4.06]) and end-stage kidney disease (9.9 [7.3–13.43]) when compared to T2D-CKD.

Conclusions
Young patients with T2D combined with HF or CKD have an increased risk of early adverse CV and renal events. HF was linked with highest risk of myocardial infarction and end-stage kidney disease.
These findings highlight the importance of an early identification and management of HF and CKD in T2D patients.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZeneca Produtos Farmacêuticos Lda Figure 1. Outcomes for HF and CKD groups
Fibroblast growth factor 21 and adipose tissue distribution in young adult with abdominal obesity
Authors: Zheleznova E , Zhernakova Y U , Blinova N , Azimova M , Shariya M , Sharf T , Masenko V , Chazova I 
Published: October 2021

Abstract

Introduction
Fibroblast growth factor 21 (FGF-21) is a hormone-like protein that is involved in the regulation of glucose and lipid homeostasis. Several studies have reported the association of FGF21 with visceral fat, epicardial fat, and pericardial fat. However, there is limited information about distribution of FGF21 levels in young adults with different metabolic status and its relationship to different body fat.

Objective
The main aim of study was to investigate the association between subcutaneous (SF), visceral (VF), periaortic (PF), epicardial (EF), perirenal (PRF), renal sinus (RSF) fat and fibroblast growth factor 21 (FGF21) in young adult with abdominal obesity (AO), or with metabolic syndrome (MS).

Purpose
To assess the level of FGF21 in blood serum in young people with AO and compare it with the distribution of adipose tissue.

Methods
There were 132 adult 18–45 y.o. in the study. We formed 3 groups: health (n=16, M - 43,8%, av.age 32 [27; 35]); AO plus 1 or less sing of MS (AO) (n=46, men (M) – 37,0%, av.age 40 [34; 43]), and MS (n=70, M – 81,4%, av.age 40 [35; 44]). Height, weight, BMI, waist circumference, blood tests (fast glucose (FG) and glucose tolerance (GT), lipid profile, insulin, adiponectin (ELISA, Mediagnost), leptin (ELISA, DBC), FGF21 (ELISA KIT, BCM Diagnostics) were measured. MS was defined as AO (cut-off of &gt;80cm in women (W) and &gt;94cm in M) plus &gt;1 sign: HDL&lt;1,30(w)/1,04(m)mmol/l; triglycerides&gt;1,7mmol/l; FG&gt;5,6mmol/l; violation GT; BP&gt;140/90mmHg. SF, VF, PF, EF, PRF, RSF (range: −150 to −30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). 24-hour blood pressure monitoring was performed.

Results
The clinical characteristics of the groups are presented in table 1. We didn't find any difference of level FGF 21 between groups AO (294,4 pg / ml [110,0; 583,5]) and MS (245,7 pg/ml [129,2; 474,8]). But in health group (110,2 pg/ml [62,2; 221,9] it was significant lower (p=0,05). We found significant week relationship FGF 21 with VF (r=0,02, p&lt;0,05) and SF (r=0,02, p&lt;0,05), and insignificant association with PF (r=0,11 p&gt;0,05), EF (r=0,04 p&gt;0,05), PRF (r=−0,17 p&gt;0,05), RSF (r=−0,02 p&gt;0,05). Also, we checked association with other parameters (insulin (r=0,15 p&gt;0,05), adiponectin (r=0,00 p&gt;0,05), glucose (r=0,12 p&gt;0,05)) and found a statistically significant association FGF21 with leptin (r=0,24, p&lt;0,01).

Conclusions
Young adults with abdominal obesity had elevated level of FGF21. And it was associated with visceral, subcutaneous fat depots and leptin.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of Russian Federation Table 1. Clinical characteristics of the groups
Prognostic value of the hemodynamic gain index in different groups of patients undergoing cardiopulmonary exercise stress testing
Authors: Chaikijurajai T , Wu Y , Grodin J L , Harb S , Jaber W , Tang W H W 
Published: October 2021

Abstract

Background
A novel hemodynamic parameter obtained from the cardiopulmonary exercise testing (CPET), the hemodynamic gain index (HGI), was developed and shown to be a strong independent predictor of all-cause mortality in a large male cohort. The HGI also strongly correlates with exercise parameters such as peak oxygen consumption and metabolic equivalents (METs). However, prognostic implications of the HGI have not been externally validated with subgroup analyses based on sex, heart failure (HF), coronary artery disease (CAD) and the use of beta-blockers.

Purpose
We aimed to validate the prognostic value of the HGI in men, women, and patients with and without HF, CAD, and beta-blocker use.

Methods
We identified 126,356 consecutive patients undergoing treadmill exercise testing for symptom evaluation between 1/1/1991–02/27/2015. HGI was calculated using the formula, [(SBPpeak x HRpeak) − (SBPrest x HRrest)] / (SBPrest x HRrest). Univariable and multivariable cox regression models were used to determine the associations between the HGI stratified by quartiles and all-cause mortality at 10 years with adjustment for cardiovascular risk factors (age, sex, diabetes, hypertension, dyslipidemia, chronic kidney disease, smoking status and body mass index) and exercise testing parameters (chronotropic reserve index, METs, abnormal heart rate recovery, and total exercise time).

Results
In our study cohort, mean age was 53.5±12.6 years. There were 74,724 (59.1%) male, 5,940 (4.7%) HF, 21,123 (16.7%) CAD, and 30,568 (24.2%) beta-blocker-using patients. During the mean follow up of 8.7 years, 9,929 (7.9%) died. Mean HGI was 2.0±1.2 bpm/mmHg. Lower HGI was associated with all-cause mortality in the entire cohort (Figure 1A, log rank p&lt;0.001). After adjustment for the covariates, the lowest quartile of the HGI was independently associated with all-cause mortality in subgroups of men, women, and patients with and without HF, CAD, and beta-blocker use (Figure 1B, all p≤0.001) compared with the highest quartile of the HGI.

Conclusions
HGI is an independent predictor of long-term mortality after adjusted for traditional cardiovascular risk factors, and exercise performance across patient subgroups.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier curve and Cox regression
Characteristics of warfarin underprescription in older adults with atrial fibrillation
Authors: Rashid S , Tysarowski M , Naranjo J , Dhole A , Petrovic L , Aziz E F 
Published: October 2021

Abstract

Objectives
The prevalence of atrial fibrillation (AF) and atrial flutter (AFl) increases with age. Prior research suggests that underprescription of anticoagulants, such as warfarin, in older adults can lead to increased morbidity and mortality. We analyzed rates and patterns of warfarin prescription in older adults.

Methods
In this prospective observational study, we enrolled 2179 consecutive patients with admission diagnosis of AF or AFl. Those placed on a non-warfarin anticoagulation (189 patients) were excluded. Patients were then divided into “older cohort” (≥75 years of age) and “younger cohort” (&lt;75 years of age). Within the older cohort, prescription patterns of warfarin were analyzed. Serial prospective follow-up was 3.1±2.06 years.

Results
Of the 1990 patients, 46.9% were ≥75 years older, of which 51.1% were prescribed warfarin. There was no difference between mean CHA2DS2-VASc score and warfarin prescription (OR=1.06 (95% CI 0.93–1.21), p=0.388) in the older cohort. After adjusting for hypertension, glomerular filtration rate, and Black race, appropriate warfarin prescription in older adults was independently associated with lower aspirin prescription rates (OR=0.57 (95% CI 0.43–0.75), p&lt;0.001), lower body mass index (OR=1.03 (95% CI 1.01–10.6), p=0.018), and lower hemoglobin levels (OR=1.11 (95% CI 1.04–1.19), p=0.002).

Conclusions
In our study, adults 75 years and older with AF and AFl tended to have lower rates of warfarin prescription despite higher CHA2DS2-VASc score and higher risk of thromboembolic events. Anemia, lower weight, and aspirin use were characteristics associated with warfarin underprescription. These patterns can shed light on clinicians' perceived hesitancy to anticoagulate certain older adults.

Funding Acknowledgement
Type of funding sources: None.
Right ventricle strain changes in patients with breast cancer during anthracycline therapy
Authors: Laufer-Perl M , Gvili M , Sirota Dorfman S , Baruch G , Rothschild E , Beer G , Arbel Y , Rozenbaum Z , Topilsky Y , Kapusta L 
Published: October 2021

Abstract

Background
Cardiotoxicity has become a significant adverse effect of cancer therapy, with Anthracyclines (ANT) in particular. There is a crucial need for the early subclinical detection of cardiotoxic effect. We aimed to evaluate Right ventricle (RV) two-dimensional speckle tracking echocardiography (2D-STE) changes during ANT therapy and to assess the correlation between RV 2D-STE and the routine echocardiographic RV parameters.

Methods
Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). All female patients with breast cancer, planned for ANT therapy were included. All patients underwent serial echocardiography exams including baseline RV 2D-STE (before chemotherapy, T1) and shortly after the completion of ANT therapy (T3). RV 2D-STE was evaluated using the apical 4 chamber (4C) RV-focused view, assessing both the combined RV free wall and inter-ventricular septum (RV GLS) and solely the RV free wall strain (RV FWLS). Significant reduction in both RV GLS and RV FWLS was determined by either a relative reduction of &gt;10% or an absolute value of &gt;−25% for RV GLS and &gt;−29% for RV FWLS.

Results
From September 2016 to June 2019, 40 patients were evaluated with a mean Doxorubicin (type of ANT) dose of 238.5±9.4 mg/m2. RV FWLS showed significant correlation to Tricuspid annular plane systolic excursion. At T3, significant reduction in both RV GLS and RV FWLS was observed among 77% and 62% of the patients with a mean RV GLS and RV FWLS reduction from −26.8 (±4.7) % to −21.5 (±4.4) % and −28.9 (±5.1) % to −25.6 (±5.9) % (p&lt;0.001, p=0.002), respectively. Left ventricle (LV) ejection fraction and LV GLS were within the normal range.

Conclusions
RV GLS and RV FWLS reduction are frequent and occur early in the course of ANT therapy, preceding LV dysfunction, which may imply for the role of RV 2D-STE in the detection of early cardiotoxicity.

Funding Acknowledgement
Type of funding sources: None.
The effects of dapagliflozin on kidney and cardiovascular outcomes in patients with chronic kidney disease with and without heart failure
Authors: Heerspink J L , Wheeler D C , Vart P , Jongs N , Hou F F , Langkilde A M , Correa-Rotter R , Rossing P , Sjostrom C D , Toto R D , Chertow G M , Stefansson B V , McMurray J J V ,   DAPA-CKD
Published: October 2021

Abstract

Background
Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and the severity of kidney impairment increases risk of HF, highlighting the deleterious interplay between the conditions. The DAPA-CKD trial showed that dapagliflozin reduced the risk of kidney failure and HF hospitalization in patients with CKD.

Purpose
This prespecified analysis of DAPA-CKD aimed to determine the effects of dapagliflozin on kidney, cardiovascular and mortality outcomes according to presence or absence of HF.

Methods
DAPA-CKD (NCT03036150) was a randomized, double blind, controlled trial, which enrolled 4,304 participants with CKD. Participants were randomized to dapagliflozin 10 mg/day or placebo, as adjunct to standard care, and were followed for a median 2.4 years. The primary endpoint was a composite of sustained decline in eGFR ≥50%, end-stage kidney disease, or renal or cardiovascular death. Key secondary endpoints included a composite of cardiovascular death or HF hospitalization and all-cause mortality.

Results
Overall, 468 (11%) participants had a HF diagnosis at baseline. Participants with HF were older (65.3 vs 61.4 years) and more frequently diagnosed with type 2 diabetes (77% vs 66%) compared with those without HF; mean eGFR was similar (43.2 vs 43.1 mL/min/1.73m2) in the two groups. The primary outcome occurred more frequently in those with versus without HF (8.8 vs 5.7 events per 100 patient-years, respectively). The effect of dapagliflozin on the primary outcome was consistent among those with (hazard ratio [HR] 0.58; 95% CI 0.37, 0.91) or without HF (HR 0.62; 95% CI 0.51, 0.75; p-interaction 0.59). The composite of cardiovascular death or HF hospitalization (HR 0.68; 95% CI 0.44, 1.05 vs 0.70; 95% CI 0.51, 0.97; p-interaction 0.90), and the relative risk reduction for mortality (HR 0.56; 95% CI 0.34, 0.93; vs 0.73; 95% CI 0.54, 0.97; p-interaction 0.39) were also consistent in those with or without HF.

Conclusion
Patients with co-existing CKD and HF are at high risk of kidney and cardiovascular events and premature mortality. Dapagliflozin consistently reduced the proportional risk of these events, regardless of the presence or absence of HF.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
Telmisartan for treatment of Covid-19 patients: an open randomized clinical trial
Authors: Duarte M , Pelorosso F , Nicolosi L N , Salgado V , Vetulli H M , Arquieri A , Azzato F , Coyle J , Davolos I , Fernandez Criado I , Gregori R , Rubio M C , Sarquis S M , Whalmann F , Rothlin R P 
Published: October 2021

Abstract

Background
The imbalance of the Renin Angiotensin System in favor of the angiotensin II has been described in Covid-19-patients. Angiotensin II regulates life processes, such as cell growth and division and can promote apoptosis initiating an inflammatory process with release of proinflammatory cytokines. Angiotensin receptor blockers (ARBs) block the AT1 receptor and could have a beneficial effect reducing Covid-19 inflammation.

Purpose
To assess whether Telmisartan is effective in reducing C-reactive protein (CRP) plasma levels in hospitalized patients with Covid-19, and improves clinical outcomes and length of stay and morbimortality.

Trial design
This is a parallel-group, randomized, two-arm, open-label, multicenter superiority trial with 1:1 allocation ratio.

Methods
Inclusion criteria: patients aged more than 18 years with less than 5 days of symptoms onset and after informed consent was obtained.
Exclusion criteria: Patients admitted to intensive care unit (ICU) or using mechanical ventilatory support or ongoing ARBs / angiotensin-converting enzyme inhibitors treatment at the time of randomization. Control arm received standard care alone and treatment arm Telmisartan 80 mg bid 14 days added to standard care. Primary outcome were CRP plasma levels at day 5 and 8 after randomization. Secondary outcomes included time to discharge at 15 days, admission to ICU and death at 15 and 30 days.

Results
158 patients were included in the analysis, 80 in the control and 78 in the telmisartan group. Day 5 control-group CRP levels were 6.06±6.95 mg/dL (n=66) while telmisartan group were 3.83±5.08 mg/dL (mean±SD; n=66, p&lt;0.05). Day 8 CRP levels were 6.30±8.19 mg/dL (n=44) and 2.37±3.47 mg/dl (mean±SD; n=43, p&lt;0.05) in the control and telmisartan groups, respectively. Kaplan-Meier analysis showed that Telmisartan-treated patients had lower median time to discharge (control=15 days; telmisartan=9 days). Death by day 30 was reduced by 81% in the telmisartan-treated group (control 22.54%, 16/71; telmisartan 4.29%, 3/70 participants; p=0.0023). Composite ICU, mechanical ventilation or death was reduced by telmisartan treatment at days 15 and 30. No telmisartan-related adverse events were reported.

Conclusions
Telmisartan, an inexpensive safe drug, in high doses, demonstrated anti-inflammatory effects and reduced morbimortality in Covid-19-hospitalized patients.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s):Hospital Escuela José de San Martín, ArgentinaHospital Español de Buenos Aires, Argentina Probability of discharge up to
Prognostic impact of treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the acute phase and medium-term on COVID-19 infected patients
Authors: Broco-Fernandez C , Varela-Lopez A , Diaz-Argueso L , Cacho-Antonio C E , Antunez-Muinos P J , Otero-Garcia O , Jimenez-Ramons V , Gonzalez-Ferreiro T , Perez-Poza M , Bastos-Fernandez M , Garcia-Campos A , Lopez-Pais J , Lopez-Otero D , Gonzalez-Juanatey J R ,   CARDIOVID
Published: October 2021

Abstract

Introduction
The first case of COVID-19 infection was described in Wuhan, China, in December 20191. Shortly after, cases of limited human-to-human transmission were reported in other countries, which made the WHO declare the outbreak a Public Health Emergency of International Concern (ESPII) on January 30, 20202.
Recent studies suggest that treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARAB) during acute COVID-19 infection has no effect on mortality3, but it is no evidence regarding the medium-term clinical implication of previous treatment with ACEI/ARAB on the prognosis of patients with COVID-19 infection.

Purpose
The aim of this study is to evaluate the clinical implication of the use of ACEI/ARB in the acute moment and in medium-term follow-up in patients after COVID-19.

Methods
It is a single-centre, retrospective, analytical observational study of cohorts based on all consecutive patients diagnosed with COVID-19 who were admitted during the first wave (March 10th until May 31st), of the pandemic in our health area. Survival analysis of main outcomes (mortality, heart failure, and major acute cardiovascular events [a composite of cardiovascular mortality, myocardial infarction and stroke]) were adjusted by multivariate logistic regression.

Results
Of the total population studied, 447,979 inhabitants, 1,030 (0.23%) were diagnosed with COVID-19 infection, of which 196 (19%) were under treatment with ACEI/ARB at the time of diagnosis. The main results showed that ACEI/ARB treatment (combined and individually) had no effect on mortality (Hazard Ratio [HR]: 1.64, 95% Confidence Interval [CI] 0.98 2.76, p=0.062), heart failure (HR: 0.98, 95% CI 0.53 1.79, p=0.942), thrombotic events (HR: 1.02, 95% CI 0.22 4.83, p=0.98) and major acute cardiovascular events (HR: 0.88, 95% CI 0.48 1.60, p=0.665).

Conclusions
In conclusion, previous treatment with ACEI/ARB in patients with COVID-19 had no effect on the 6-month prognosis, defined as mortality, heart failure, or major acute cardiovascular events.
Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies.

Funding Acknowledgement
Type of funding sources: None.