bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXTERNAL VALIDATION STUDY OF THE EARLY VASCULAR AGING AMBULATORY SCORE (EVAAS)
Authors: Antza Christina , Doundoulakis Ioannis , Akribos Evangelos , Stabouli Stella , Kotsis Vasilios 
Published: April 2021

Objective:
The Early Vascular Aging Ambulatory score (EVVAs) identify hypertensive patients with Early Vascular Aging using ambulatory blood pressure monitoring values and classic cardiovascular risk factors. Our aim was to validate the EVAAs externally in a new population-based cohort study.

Design and method:
This cohort study included all consecutive patients (N = 789, 45.87 ± 23.27, 45.4% men), who referred to the Hypertension-24hour Ambulatory Blood Pressure Monitoring Center of Excellence, at the 3rd Internal Medicine Department of Aristotle University for elevated BP and consented to participate to the study. Carotid-femoral pulse wave velocity (c-f PWV) was measured in all patients. EVA was defined as c-f PWV values higher than the expected for age average values according to European population data. We evaluated the predictive power of the original EVVAs.

Results:
The calculated sensitivity and specificity for EVAAS was 98% and 75% respectively. The EVVAs has a high positive predictive value (PPV) of 95%. The negative predictive value (NPV) was slightly lower at 92%. Receiver operating characteristic curve, including the area under the curve, was 0.951 which indicates a very high accuracy.

Conclusions:
The external validation of the EVVAs yields high sensitivity and PPV in an independent population.
The EVAAs should now be evaluated for its predictive value regarding cardiovascular mortality and morbidity. Finally, the prediction of EVA, assessed by EVAAs, could be used to guide early lifestyle or pharmaceutical interventions in order to prevent future CV events.
ARTERIAL STIFFNESS PREDICTS ATRIAL FIBRILLATION INCIDENCE IN HYPERTENSIVE SUBJECTS
Authors: Andrikou I. , Tsioufis K. , Dimitriadis K. , Konstantinidis D. , Papakonstantinou P. , Tatakis F. , Anastasiou A. , Andrikou E. , Dimitriadou M. , Tousoulis D. 
Published: April 2021

Objective:
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, while hypertension is one of the main factors that influence the development of AF. On the other hand, arterial stiffness is associated with increased blood pressure. The possible relationship between arterial stiffness and AF is not fully elucidated and warrants further investigation. In this setting, we examined the main factors influencing AF development in hypertensive subjects over time.

Design and method:
950 hypertensive subjects, without history of AF (mean age 55.7 ± 11years), 53.3% males, with baseline office blood pressure (BP) 145/92mmHg were followed for a mean period of 6.4 ± 3.3 years. At baseline and last follow-up visit all patients underwent office BP and laboratory evaluation. Electrocardiogram test was performed as well as echocardiographical examination, including determination of left ventricular mass index (LVMI) and left atrial volume index (LAVI). At baseline arterial stiffness was estimated by pulse wave velocity (PWV) measurement. Main outcome variable was new onset AF.

Results:
5.1% of study population (48 subjects) presented new onset AF during follow-up period. Cox-regression analysis, after adjustment for clinical, biochemical and echocardiographic parameters revealed that baseline age >65years (HR = 2.42, 95% CI 1.11–5.25, p = 0.03), baseline PWV (HR = 1.21 95% CI 1.02–1.44, p = 0.01) and baseline LAVI (HR = 1.08, 95% CI 1.03–1.13, p = 0.006) were independent predictors of new-onset AF during follow-up.

Conclusions:
In conclusion, beyond increased left atrial volume, pulse wave velocity is a significant determinant of the development of AF in hypertensive subjects. It seems that arterial stiffness evaluation may help in the prediction of AF episodes in hypertensive patients.
GLP-1 ANALOG LIRAGLUTIDE INDUCED CARDIAC DYSFUNCTION DUE TO ENERGETIC STARVATION IN HEART FAILURE WITH NON-DIABETIC DILATED CARDIOMYOPATHY IN HAMSTERS
Authors: Shiraki Aya , Oyama Jun-Ichi , Node Koichi 
Published: April 2021

Objective:
Glucagon-like peptide-1 analog and DPP4 inhibitors are reported to have cardio-protective properties against atherosclerosis and cardiac function in vitro and in vivo, however, concerns that incretin -related drug can increase the risk of heart failure also have been arisen. Therefore, the purpose of this study was to elucidate the effects and the mechanisms of incretin-related drugs on failing heart in vivo.

Design and method:
We used J2N-k hamsters which develop dilated cardiomyopathy and heart failure. Hamsters were randomized to receive PBS or GLP-1 analog (liraglutide) for 6 weeks using Alzet osmotic pumps. In the complementary experiments, J2N-k hamsters were treated 10% glucose as drinking solution.

Results:
In GLP-1 analog group, energy starvation and increased apoptosis in cardiac tissue were detected by up-regulated LC3 2/1 and cleaved caspase-3. Indirect calorimetry showed increased RQ value in failing heart and this dependency on carbohydrate augmented by administration of GLP-1 analog. In the complementary experiment, glucose was additionally supplied to GLP-1 analog-treated group. As a result, heart failure induced by GLP-1 analog were dramatically ameliorated by adequate glucose supply, exerting improved cardiac function and mortality, and marked the highest RQ value, suggesting heart muscle treated with incretin-related drug need much more carbohydrate as energy substrate to maintain cardiac function.

Conclusions:
Extra higher glucose-demand arose and cardiac function was exacerbated by treatment with incretin-related drug in failing heart, which was caused as the result that energy, especially glucose, could not meet the augmented carbohydrate demand by GLP-1 analog.
Incretin-related treatment with an appropriate glycemic balance as energy regulation should be required when applying GLP-1 analogue to the patients with heart failure.
DIFFERENCES IN BIOMARKERS AMONG HEART FAILURE PATIENTS WITH OR WITHOUT HYPERTENSION
Authors: Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Stavropoulos Konstantinos , Patoulias Dimitrios , Katsimardou Alexandra , Toumpourleka Maria , Bakogiannis Konstantinos , Mitas Christos , Bakaloudi Dimitra , Ziakas Antonios , Papadopoulos Christodoulos , Vassilikos Vassilios , Karagiannis Asterios , Doumas Michael 
Published: April 2021

Objective:
Although hypertension is a well-established risk factor for the development of heart failure (HF) and several biomarkers have a major role in risk stratification of HF patients, it is largely unknown if biomarkers differ among hypertensive and non-hypertensive patients with HF.

Design and method:
HF patients were evaluated in a cross sectional study. Office systolic and diastolic blood pressure (SBP, DBP) were measured, and previous history of hypertension or uncontrolled hypertension were recorded as well. Hemoglobin, serum creatinine, urea, glucose, electrolytes (K+, Na+), NT-proBNP, troponin, SGOT, SGPT, clearance of creatinine (Cockcroft-Gault Equation) and Estimated Glomerular Filtration Rate (eGFR) using MDRD and EPI equations were used.

Results:
306 consecutive patients with HF (men and women) were recruited. Of them, 239 (78.1%) had a history of hypertension and 207 (90.8%) reported adequate blood pressure (BP) control. No statistically significant differences were noticed regarding previous history of hypertension and NT-proBNP, troponin, SGOT, and SGPT levels. Non-hypertensive patients had lower levels of Hb and Hct (p = 0.002 and p = 0.005, respectively), but serum urea and creatinine were higher in hypertensive patients (p = 0.001 and p = 0.005, respectively), and clearance of Creatinine and eGFR values were higher in patients with hypertension as well (p < 0.0001 and p < 0.0001, respectively).

Conclusions:
Our study provides some new insights about the relationship between HF and biomarkers in hypertensive patients. The results might have important implications, regarding the prognostic role of biomarkers in hypertensive patients with HF.
LEFT VENTRICULAR MASS AND SEXUAL FUNCTION IN HYPERTENSIVE PATIENTS WITH HEART FAILURE: SO FAR SO GOOD?
Authors: Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Katsimardou Alexandra , Stavropoulos Konstantinos , Alataki Sofia , Toumpourleka Maria , Bakogiannis Konstantinos , Kerpiniotis Georgios , Lales Georgios , Ziakas Antonios , Papadopoulos Christodoulos , Vassilikos Vassilios , Karagiannis Asterios , Doumas Michael 
Published: April 2021

Objective:
The relation between hypertension and erectile dysfunction (ED) is well established. Moreover, sexual dysfunction, both erectile and female sexual dysfunction (FSD), is highly prevalent in heart failure (HF) patients. On the other hand, hypertension and HF are associated with left ventricular hypertrophy; however the relation between left ventricular mass and sexual function in hypertensive patients with HF has never been investigated sufficiently.

Design and method:
Patients with HF were evaluated in a cross sectional study. ED was evaluated by the International Index of Erectile Function (IIEF) and FSD by the Female Sexual Functioning Index (FSFI). Left ventricular mass (LV mass), relative wall thickness (RWT), interventricular septum (IVS), posterior wall (PW) thickness and LV mass were evaluated by transthoracic echocardiography as well.

Results:
A total of 239 consecutive hypertensive patients (147 men and 92 women) with HF participated in the study. The majority of patients had a normal pattern (39.4%) of LV mass, 15.0% had a concentric remodeling pattern, 13.1% concentric left ventricular hypertrophy (LVH), and 32.4 % eccentric LVH. FSFI had a negative correlation with IVS (r = -0.234, p = 0.032), and IIEF a near to significant negative correlation with PW (r = -0.170, p = 0.053). Patients with or without ED and FSD did not have differences in LV mass.

Conclusions:
Both sexual dysfunction and LV hypertrophy are considered to be hypertension-mediated organ damage. Echocardiographic LV mass is a potent predictor of mortality in hypertensive patients and regression of echocardiographic LVH might lead to a better sexual function and an improved prognosis, although the evidence is limited in HF patients.
CHANGES IN EPICARDIAL FAT THICKNESS IN PATIENTS WITH HYPERTENSION AND PAROXYSMAL FORM OF ATRIAL FIBRILLATION
Authors: Podzolkov Valery , Tarzimanova Aida , Bragina Anna , Osadchiy Konstantin , Gataulin Radik , Oganesyan Karine , Japharova Zarema 
Published: April 2021

Objective:
To evaluate the changes of the epicardial fat thickness in hypertensive patients with paroxysmal form of atrial fibrillation (AF).

Design and method:
The study involved 80 obese patients with hypertension aged from 38 to 77 years. Patients were divided into 2 groups: 40 hypertensive patients with paroxysmal form of AF in sinus rhythm and obesity (Group I) and 40 obese patients with hypertension (Group II). There were no significant differences in body mass index between studied groups. All patients had echocardiography to evaluate the epicardial fat thickness (EFT) around the left atrium. Waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios were assessed to evaluate the visceral adiposity.

Results:
There was a significant increase of anthropometric indicators of visceral adiposity in the group of hypertensive patients with paroxysmal form of AF: the waist-to-hip ratio in I group was 1.37 ± 0.09 and 0.84 ± 0.06 in II group (p = 0.04); the waist-to-height ratio in I group and in II group was 0.8 ± 0.02 and 0.69 ± 0.01 respectively (p = 0.0012); abdominal sagittal diameter in I group and in II group was 37.98 ± 1.26 and 31.85 ± 0.85 respectively (p = 0.03). There was a strong positive correlation between EFT and waist-to-hip ratio in group of patients with hypertension and paroxysmal form of AF (r = 0.583, p = 0.002). Also, there was a positive correlation between EFT and waist-to-height ratio (r = 0.328, p = 0.035) and between abdominal sagittal diameter and EFT (r = 0.673, p = 0.001) in I group.

Conclusions:
Positive correlations between increased EFT and anthropometric indicators confirms the role of visceral obesity in the development of AF.
RELATIONSHIP BETWEEN ATRIAL FIBRILLATION, RHO KINASE ACTIVITY AND CONNEXIN40. STUDY IN END-STAGE RENAL DISEASE PATIENTS ON HAEMODIALYSIS
Authors: Calò Lorenzo , Bertoldi Giovanni , Pagnin Elisa , Rossi Barbara , Fragasso Antonio , Gobbi Laura , Rigato Matteo 
Published: April 2021

Objective:
Evidence on cellular/molecular mechanisms leading to atrial fibrillation (AF) are scanty. Recently, it has been proposed a role for Rho Kinase (ROCK) pathway in terms of increased expression of ROCK, and myosin-phosphatase-target-subunit-1 (MYPT-1), downstream target of ROCK pathway, which correlated with the increased expression of Connexin40 (Cx40), an integral membrane protein of heart gap junctions, fundamental for the rapid cell-cell transfer of action potential. AF is the most frequent arrhythmia in CKD and dialysis patients in which we observed increased MYPT-1 phosphorylation which correlated with their LV mass. Given the ROCK established role in cardiovascular-renal remodelling, induction of impairment of cell-to-cell coupling/potential conduction leading to AF, we evaluated in dialysis patients with AF, the phosphorylation state of MYPT-1, expression of Cx40 and their relationship to support their involvement in AF.

Design and method:
11 AF-dialysis patients (DPAF) under chronic bicarbonate dialysis 3-times/week (8 males, 3 females, 49–91yo), 11 sinus rhythm-dialysis patients (DP) (7 males, 4 females, 53–91yo) and 11 healthy subjects (C) (7 males, 4 females, 26–38yo) were enrolled. Mononuclear cells MYPT-1 phosphorylation state, Cx40 expression and ROCK inhibitor fasudil's effect were determined by Western blot. LV mass and left atrial systolic volume were measured by M-mode echocardiography.

Results:
DPAF's phospho-MYPT-1 was increased vs DP and C (1.57 ± 0.17 du vs 0.69 ± 0.04 vs 0.51 ± 0.05, p < 0.0001). MYPT-1 phosphorylation in DP was also higher vs C, p = 0.009. Cx40 was higher in DPAF (1.23 ± 0.12 vs 0.74 ± 0.03 vs 0.69 ± 0.03, p < 0.0001). DPAF's phospho-MYPT-1 correlated with Cx40 (r = 0.84, p = 0.0014), with cardiac left atrial systolic volume (r = 0.72, p = 0.013) and with LV mass (p = 0.014). Cardiac left atrial systolic volume was increased in DPAF compared with DP (44.45 ± 1,38 vs 35.09 ± 2,62, p = 0.005) and also significantly correlated with LV mass (r = 0.60, p = 0.049). In DPAF Fasudil reduced MYPT-1 phosphorylation (p < 0.01) and Cx40 expression (p = 0.03).

Conclusions:
These data confirm at mechanistic level a significant role of ROCK pathway, MYPT-1 and Cx40 in the mechanisms leading to AF in dialysis patients. The clarification on a mechanistic basis of this relationship/association should contribute to provide mechanistic explanations for AF generation and identify potential pharmacological targets for translations into treatment to AF.
PARTICULARITIES AND CO-MORBIDITIES IN VERY ELDERLY PATIENTS WITH HYPERTENSION AND ATRIAL FIBRILLATION
Authors: Balaceanu Alice , Stirban Raluca Elena , Draganescu Cristiana , Voiculet Cornelia , Zara Octavian Dumitru , Pirvu Diana Maria , Balaceanu Beatrice , Gurau Dorin Cristian , Dina Ion 
Published: April 2021

Objective:
The aim of the study was to assess the particularities of very elderly patients with high blood pressure and atrial fibrillation, which associate other comorbidities.

Design and method:
We performed a retrospective study on a group of 97 very elderly patients over 90 years with hypertension, admitted to an emergency hospital in the last 5 years.

Results:
The average age was 92 years. 67% of the patients were female and 33% male. 40.21% of these patients also had atrial fibrillation. In the subgroup of patients with hypertension and atrial fibrillation, the gender distribution was: 64.10% Female and 35.90% Male. The minimum age was 90 years, the maximum age 98 years. 5.13% Of them came from an old foster care and 41% were immobile. 17.95% Had bed sores. The mean systolic blood pressure that was detected at admission was 135 mmhg and the mean diastolic blood pressure was 75 mmhg. 84.62% of patients were diagnosed with chronic heart failure (33.34% Nyha class ii, 36.36% Nyha class iii and 30.3% Nyha class iv). An echocardiography was performed in 30.77% Of cases and 25% of patients had a preserved ejection fraction. Changes in the electrocardiogram encountered were: right branch block in 12.82% of patients, left branch block in 10.26%, Premature ventricular contractions in 5.13%, And atrial fibrillation with rapid ventricular response in 28.21%. Other co-morbidities: 51.28% Presented with respiratory failure, 15.38% Had copd, 20.51% Required noninvasive ventilation and at the same number of patients an oxygen concentrator was recommended at discharge. 17.95% Of patients had type 2 diabetes mellitus, 20.51% Had a history of stroke and 94.87% Had an altered estimated glomerular filtration rate (based on mdrd formula).

Conclusions:
The management of very elderly patients is a challenge for the clinician. It is necessary to pay greater attention to the interactions between drugs and the type of administration. They are very fragile patients, with many comorbidities that can lead to complications.
A META-ANALYSIS ASSESSING THE EFFECT OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS ON SURROGATE ENDPOINTS IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Toumpourleka Maria , Kalogirou Maria -Styliani , Koutsampasopoulos Konstantinos , Tegou Zoi , Mavridou Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael 
Published: April 2021

Objective:
Heart failure (HF) is a main contributor of cardiovascular morbidity and mortality among patients with type 2 diabetes mellitus (T2DM), while T2DM among patients with HF with reduced ejection fraction (HFrEF) represents an independent risk factor for 1-year all-cause mortality and HF re-admission.

Design and method:
For this meta-analysis, we identified the hallmark cardiovascular outcome trials (CVOTs) and we searched the two major electronic databases, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), for sub-analyses of these trials according to HF status of enrolled participants at baseline.

Results:
Besides the dedicated HFrEF trials (DAPA-HF and EMPEROR-Reduced), only researchers of the DECLARE-TIMI 58 trial provided data regarding the effect of dapagliflozin on “hard” outcomes in patients with HFrEF. Therefore, we pooled data in a total of 9,145 patients with HFrEF. SGLT-2 inhibitor treatment resulted in a significant decrease in the odds for HF hospitalization compared to placebo, equal to 31% [OR = 0.69, 95% confidence interval (CI); 0.61 to 0.78, I2 = 0%]. In addition, SGLT-2 inhibitor treatment decreased the odds for cardiovascular death by 18% (OR = 0.82, 95% CI; 0.68 to 0.99, I2 = 40%). Odds for the composite outcome of cardiovascular death or HF hospitalization was significantly decreased by 28% with SGLT-2 inhibitor treatment (OR = 0.72, 95% CI; 0.65 to 0.80, I2 = 0%). Finally, SGLT-2 inhibitor treatment resulted in marginally non-significant decrease in the odds for all-cause death by 17% (OR = 0.83, 95% CI; 0.68 to 1.00, I2 = 53%).

Conclusions:
SGLT-2 inhibitor treatment provides substantial cardiovascular benefits in patients with HFrEF, decreasing the odds for HF hospitalization and cardiovascular death, while it might reduce the odds for all-cause death, compared to placebo.
THE USE OF ARTIFICIAL INTELLIGENCE TO CAPTURE READINGS ON TRADITIONAL BLOOD PRESSURE DEVICES. A SHOWCASE FROM OFFLINE READINGS TO ONLINE HEALTH MANAGEMENT
Authors: Tsoi Kelvin , Chu Christopher , Yiu Karen , Chow Yuk , Ip Kc 
Published: April 2021

Objective:
Cloud-based blood pressure (BP) monitoring devices can improve the data accuracy for better health management. However, it may not be affordable for those from low income families. Image processing with artificial intelligence on the screen image of BP devices is almost at no cost to save data on the cloud. The aim of this study is to investigate the accuracy of image recognition with deep learning techniques.

Design and method:
A total of 1,000 screen capture images on different BP devices were collected from a group of healthy subjects who regularly marked their BP levels on excel files. Data augmentation technique was used to manipulate a set of 20,000 screen capture images, where noise of image was introduced, such as lighting and contrast adjustment, shift of numerical readings. Deep learning algorithm with ResNet-50 architecture was used to detect numerical readings on the devices on 15,000 images (75%), and the prediction accuracy was verified by another 5,000 images (25%). Clustering algorithm for grouping the numbers into meaningful data, including the readings for systolic and diastolic blood pressure. Each number was estimated with a probability function, and the one with highest probability value was selected. True positive (TP) and false positive (FP) were used to derive the testing precision, i.e. TP/(TP+FP), on the correctness of image recognition.

Results:
A raw image of a screen capture on a BP device was used to demonstrate the performance of deep learning algorithm for image recognition (Figure 1). All numbers were automatically identified in each green box where showed a probability function for the prediction accuracy. Final readings were captured and combined according the numbers with highest accuracy (Table 1). In the validation set of 5,000 images, testing precision was 98.5%.

Conclusions:
The use of artificial intelligence to capture readings on traditional blood pressure devices is a feasible option for those who cannot afford a new cloud-based BP machine. Subjects with detailed BP records on the cloud can, in fact, help physician to make better diagnosis on hypertension.