bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic role of right ventricular geometry and function in patients undergoing double valve surgery
Authors: Tse Y K , Yu Y J , Li H L , Wu M Z , Ren Q W , Chen Y , Yu S Y , Tse H F , Yiu K H 
Published: October 2021

Abstract

Introduction
Multiple valvular heart disease, a combination of stenotic and regurgitant lesions occurring on two or more valves, is a highly prevalent condition. For these patients, surgical correction is the only definitive treatment to improve prognosis, yet concomitant aortic and mitral (double) valve surgery is associated with poor post-operative outcomes. While current guidelines outline left ventricular dimensions and function as surgical triggers, little is known regarding the importance of right ventricular (RV) remodelling in these patients.

Purpose
We sought to evaluate the prognostic value of RV remodelling in patients undergoing double valve surgery.

Methods
RV remodelling was characterised by transthoracic echocardiography in 152 patients undergoing concomitant aortic and mitral valve replacement (n=118) or aortic valve replacement and mitral valve repair (n=34). Four patterns of RV remodelling were defined according to the presence of RV dilation (tricuspid annulus diameter&gt;35mm) and RV systolic dysfunction (percentage RV fractional area change &lt;35%): normal RV size and systolic function (pattern 1); dilated RV with normal systolic function (pattern 2); RV systolic dysfunction with normal RV size (pattern 3); and dilated RV with systolic dysfunction (pattern 4). Adverse events were defined as the composite of all-cause mortality and hospitalisation for heart failure.

Results
Overall, 62 (41%), 31 (20%), 35 (23%), and 24 (16%) patients were classified as RV remodelling patterns 1, 2, 3, and 4, respectively. Patients with advanced RV remodelling patterns were more frequently male, had worse renal function, and a higher EuroSCORE II. During a median follow-up of 43 months, 41 adverse events (22 heart failure hospitalisation and 19 deaths) occurred. Patients with patterns 3 and 4 RV remodelling had an increased risk of adverse events compared to pattern 1 (log-rank χ2 27.42; p&lt;0.001; Figure 1). After adjustments for EuroSCORE II and significant tricuspid regurgitation, RV remodelling patterns 3 (Hazard Ratio [HR] 3.24, 95% Confidence Interval [CI] 1.27–8.24, p=0.014) and 4 (HR 6.18, 95% CI 2.49–15.32, p&lt;0.001) were independently associated with poor post-operative outcomes. Importantly, RV remodelling patterns provided incremental prognostic value to EuroSCORE II (χ2 increased from 18 to 38, p&lt;0.001).

Conclusion
In patients with concomitant aortic and mitral valve disease, RV remodelling is frequent and associated with poorer outcomes. Our study highlights the involvement of the RV in left-sided valvular heart disease and underlines the importance of preoperative assessment of RV geometry and function in patients undergoing double valve surgery.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Artificial intelligence derived age algorithm after heart transplantation
Authors: Ozcan I , Toya T , Cohen-Shelly M , Ahmad A , Corban M T , Noseworthy P A , Kapa S , Lerman L O , Attia Z I , Friedman P A , Kushwaha S S , Lerman A 
Published: October 2021

Abstract

Background
An artificial intelligence (AI) algorithm detecting age from 12-lead ECG has been suggested to signal “physiological age” of the individual. Importantly, increased physiological age gauged by an increased difference between ECG-age and chronological age has been associated with higher risk of cardiac events in non-transplant population.

Purpose
We sought to investigate the validity of the AI-derived ECG-age algorithm in patients who underwent heart transplantation and its relationship to major adverse cardiovascular events (MACE).

Methods
A total of 489 consecutive patients who had undergone heart transplantation in our institution between 1994 and 2018 were studied. AI-ECG age was calculated by a previously-trained artificial intelligence (AI) algorithm using a 12-lead ECG per patient. ECGs used in the training process of the algorithm were excluded. The average of the ECG-ages within one year before and one year after heart transplantation was used to represent pre- and post-transplant ECG-ages. MACE was defined as any incidence of revascularization, re-transplantation, and death.

Results
Pre-transplant ECG-age (mean 63±10 years) correlated significantly with recipient chronological age (mean 50±13 years, r=0.57, p&lt;0.0001), but this correlation between recipient and ECG-ages was weakened after transplantation (mean post-transplant ECG age of 55±10 years, r=0.34, p&lt;0.0001). Interestingly, post-transplant ECG-age correlated significantly with donor age (mean ECG age of 55±10 years vs. mean donor age of 32±13 years, r=0.42, p&lt;0.0001). During a median (IQR) follow-up of 9 (5, 14) years, 251 patients had MACE. Mean change in ECG age after transplantation compared to before was −8.8±12.7 years. Patients who had an increase in ECG-age after compared to before transplantation showed increased risk of MACE (HR: 1.53 [1.16, 2.01], p=0.002), independent of recipient and donor ages (adjusted HR: 1.68 [1.26, 2.25], p=0.001); whereas there were no significant differences in risk of MACE in patients who were transplanted with an older donor heart (HR: 1.07 [0.77, 1.50], p=0.66). In a Kaplan Meier survival analysis, those with increased ECG-age after transplantation had significantly lower MACE-free survival compared to those with decreased ECG-age. (Log-rank P=0.002; Wilcoxon P=0.001) (Figure)

Conclusion
Post-transplant ECG-age correlates more faithfully with the donor's than the recipient's chronological age, suggesting that ECG-age more closely reflects cardiac age than the patient age. Furthermore, ECG-age derived cardiac aging after transplantation is associated with higher risk of MACE.

Funding Acknowledgement
Type of funding sources: None.
Association between blood pressure classification using the 2017 American College of Cardiology/American Heart Association blood pressure guideline and hypertensive retinopathy
Authors: Seki H , Kaneko H , Matsuoka S , Itoh H , Yano Y , Morita K , Kiriyama H , Kamon T , Fujiu K , Michihaka N , Jo T , Takeda N , Morita H , Yasunaga H , Komuro I 
Published: October 2021

Abstract

Purpose
We aimed to explore the association of blood pressure (BP) classification using the 2017 American College of Cardiology/ American Heart Association Guideline and the prevalence of hypertensive retinopathy using a nationwide epidemiological database.

Methods
This study is a retrospective observational cross-sectional analysis using the health claims database of the JMDC between 2005 and 2020. We analyzed 280,599 participants who did not take anti-hypertensive medications. Each participant was categorized as having normal BP (systolic BP [SBP] &lt;120 mm Hg and diastolic BP [DBP] &lt;80 mm Hg; n=159,524); elevated BP (SBP 120–129 mm Hg and DBP &lt;80 mm Hg; n=35,603); stage 1 hypertension (SBP 130–139 mm Hg or DBP 80–89 mm Hg; n=54,795); or stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg; n=30,677). Retinal photography at health check-up was classified as normal, grade 1, grade 2, grade 3, or grade 4 according to the Keith-Wagener-Barker system.

Results
Median (interquartile range) age was 46 (40–53) years, and 50.4% were men. Hypertensive retinopathy which was defined as ≥ Keith-Wagener-Barker system grade 1, was observed in 16,836 participants (6.0%). Multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23–1.38), stage 1 hypertension (OR 1.71, 95% CI 1.64–1.79), and stage 2 hypertension (OR 4.10, 95% CI 3.93–4.28) were associated with higher prevalence of hypertensive retinopathy. Even among 92,121 participants without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol drinking, multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio 1.34, 95% CI 1.19–1.51), stage 1 hypertension (OR 1.79, 95% CI 1.61–1.98), and stage 2 hypertension (OR 4.42, 95% CI 4.00–4.92) were associated with higher prevalence of hypertensive retinopathy. The association between BP category and hypertensive retinopathy was observed in all subgroups stratified by age or sex.

Conclusion
Our investigation showed that the prevalence of hypertensive retinopathy increased with the blood pressure category, suggesting that atherosclerotic change could start even in elevated BP and stage 1 hypertension.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
Arterial stiffness and the risk of heart failure formation in rotational shift workers in the arctic
Authors: Shurkevich N , Vetoshkin A , Gapon L , Dyachkov S , Simonyan A 
Published: October 2021

Abstract

Aim
To investigate factors associated with arterial hypertension (AH) development, evaluate arterial stiffness (AS) and the risk of heart failure formation in rotational shift workers in the Arctic.

Methods
Within 6 days of September 2019, in the polar settlement of Yamburg (68 N), on the basis of Yamburggazdobycha LLC medical unit, 183 individuals (48.7±8.3 years), working rotating shifts (16.9±8.7 years) were enrolled via medical examination. Patients were divided into 2 groups according to the level of blood pressure (BP): Group 1 (Gr. 1) included 86 individuals with AH of 1,2 stages; Group 2 (Gr. 2) comprised 97 individuals with BP &lt;140/90 mm Hg. Ultrasound examination of carotid arteries (CA) was performed, Peterson's elastic modulus (Ep), β-stiffness index, cardio-ankle vascular index (CAVI), pulse wave velocity (PWV) were determined; ABPM was performed; EchoCG was conducted using calculation of probability for heart failure with preserved ejection fraction (HFpEF) by the H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); blood lipid spectrum, inflammatory markers, brain natriuretic peptide were determined.

Results
In Gr.1 vs Gr.2, elevated levels of left CAVI (7.9 vs 7.4) (p=0.022) and right CAVI (7.9 vs 7.5) (p=0.045) were registered; PWV: 13.8 m/s vs 12.6 m/s (right), (p&lt;0.001) and 13.9 m/s vs 12.6 m/s (left), (p&lt;0.001); triglycerides, (p=0.03); very low density lipoprotein cholesterol, (p=0.054); homocysteine, (p=0.025). Probability of HFpEF by the H2FPEF score was higher in Gr.1 than Gr.2 (p&lt;0.001). According to logistic regression analysis, data of odds ratio (OR) determined the risk of AH developing with increasing of PWV (OR=1.444); 24-hour diastolic blood pressure variability (DBPV24) (OR = 1.164); probability of HFpEF by the H2FPEF score (OR = 1.677). Relationships of Peterson's elastic modulus (Ep) of common carotid artery (CCA) with left ventricular myocardial mass (LVMM) (r=0.39), (p&lt;0.01), LVMMI (r=0.39), (p&lt;0.01), probability HFpEF by H2EPEF score (r=0.27), (p&lt;0.01); β-stiffness index of CCA with LVMM (r=0.25), (p&lt;0.01) were found.

Conclusion
Interrelation of AH with PWV (OR=1.444), DBPV24 (OR=1.677), probability of HFpEF by the H2FPEF score (OR = 1.677) should be considered for prognostication of the risk of AH with HFpEF formation in rotational shift workers in the Arctic. Associations of AS with LVMM and LVMMI, HFpEF signs may indicate processes of simultaneous interconnected formation of arterial and cardiac stiffness.

Funding Acknowledgement
Type of funding sources: None.
Age differences in the association between arterial velocity pulse index and muscle sympathetic nerve activity in hypertensive patients
Authors: Sugimoto H , Murai H , Hirai T , Hamaoka T , Mukai Y , Tokuhisa H , Usui S , Sakata K , Kawajiri M , Takamura M 
Published: October 2021

Abstract

Background
Increased arterial stiffness characterize by aging. It is reported that age-related increases in muscle sympathetic nerve activity (MSNA) may be one of contributing factor for arterial stiffness. Arterial reflected wave was composed of SNA and aging. Increased arterial reflected wave partly plays an important role in blood pressure. Recently, we reported that arterial velocity pulse index (AVI), a novel index of arterial reflected waves, was associated with MSNA in hypertensive patients. It is still uncertain the effect of age on the association between AVI and SNA in hypertensive patients.

Method
Patients with essential HT and matched non-hypertensive control subjects were included in this study. HT was diagnosed as systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg. AVI was measured from left upper arm by NAS-1000. SNA was evaluated by direct recording of muscle sympathetic nerve activity (MSNA) from peroneal nerves.

Results
45 HT patients and 46 control subjects were included. Age, SBP and DBP were significantly increased in HT group compared to control (Age 63±14 vs 42±16 years, p&lt;0.001; SBP 144±16 vs 115±9 mmHg, p&lt;0.001; DBP 80±14 vs 67±9 mmHg, p&lt;0.001). MSNA and AVI were significantly increased in HT group compared to control (MSNA 34±10 vs 25±8 bursts/min, p&lt;0.05; AVI 28±9 vs 17±5, p&lt;0.05). AVI was significantly correlated with MSNA, age, and SBP in HT group. HT group was divided into two groups according to their age (group 1, age ≤63 N=21, group 2, age ≥64 N=26). AVI in group 1 showed correlation with MSNA (r=0.59, p&lt;0.05), but no correlation was seen in group 2. However excluded SBP&gt;160 mmHg subjects in group 2, significant correlation was clarified between AVI and MSNA (r=0.62, p&lt;0.05).

Conclusion
The relationship between AVI and MSNA in HT patients is preserved regardless of aging, however, high blood pressure over 160mmHg might obscure its correlation. These results indicate that AVI is useful to estimate sympathetic nerve activity in high aging HT patient treated &lt;160 blood pressure.

Funding Acknowledgement
Type of funding sources: None.
Strain analysis by two-dimensional speckle tracking echocardiography for evaluating left ventricular systolic function in women with pre-eclampsia
Authors: Giorgione V , O'Driscoll J , Di Fabrizio C , Frick A , Cauldwell M , Khalil A , Thilaganathan B 
Published: October 2021

Abstract

Background
Previous echocardiographic studies have shown that most women affected by pre-eclampsia present with mild-to moderate diastolic dysfunction and left ventricle remodelling with a preserved systolic function. These alterations appear more severe when pre-eclampsia develops before 34 weeks of gestation.

Purpose
The aim of this study is to compare left ventricular systolic (LV) function by using 2-D speckle tracking echocardiography in women with early-onset and late-onset pre-eclampsia.

Methods
In this single-centre prospective longitudinal study, 119 women with a diagnosis of pre-eclampsia underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. LV function was assessed using two-dimensional speckle-tracking strain imaging on 4-chamber views with a frame rate of 60–90 frames/second. Strain analysis quantification was performed using a commercial software.

Results
Pre-eclampsia was diagnosed before and after 34 weeks in 37.3% (44/119) and 62.7% (74/119) of the patients, respectively. Maternal characteristics, such as maternal age, body mass index, pre-existing hypertension and nulliparity, did not show any significant difference between the two groups. Although LV remodelling/hypertrophy and diastolic dysfunction occurred more often in early-onset pre-eclampsia compared to late-onset (65.9% vs 60.8% and 59.1% vs 51.4%, respectively), this difference was not statistically significant (p=0.580 and p=0.414, respectively). Similarly, LV mass index was 80.1±16.3 in pre-eclampsia &lt;34 and 79.1±15 &gt;34 (p=0.715) and E/e' was 7.8±1.9 and 7.6±1.7 (p=0.424). However, global longitudinal strain (GLS) was significantly lower (−16.4±2.4 vs −17.6±2.4, p=0.030) and apical rotation was higher (11.1±5.9 vs 8.7±4.7, p=0.019) in early-onset pre-eclampsia. A positive weak correlation has been found between GLS and difference in days from pre-eclampsia diagnosis to delivery (r=0.2, p=0.002).

Conclusions
Lower GLS in women affected by early-onset pre-eclampsia compared to late-onset pre-eclampsia might be useful to detect sub-clinical LV systolic impairment. Although further studies are needed, this sensitive marker may have a role in identifying women at risk of preterm delivery and/or severe maternal morbidity in the peripartum period.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).
Opthalmic artery doppler measurements and cardiovascular assessment in pregnancies with placental dysfunction
Authors: Di Fabrizio C , Giorgione V , Murdoch C , Khalil A 
Published: October 2021

Abstract

Women affected by hypertensive disorders of pregnancy and fetal growth restriction frequently present alterations in the cardiovascular system, even before the clinical onset of the pathology. The objective of this study is to assess the relationship between peripheral vascular system (ophthalmic and uterine arteries), cardiac output and adverse fetomaternal outcomes.

Methods
Women with singleton pregnancies from mid second trimester until delivery were prospectively included in this observational study performed at our Hospital, between December 2020 and July 2021. The inclusion criteria included women with evidence of placental dysfunction (preeclampsia and fetal growth restriction) and normotensive controls.
Vascular systemic resistance (VSR), arterial stiffness and cardiac output were measured by ultrasound (uterine and ophthalmic arteries), plethysmography and continuous Doppler. Study variables were compared using t-test and Chi-squared test according to whether they were normally distributed or not.

Results
The analysis included 32% women with hypertensive disorders of pregnancy and 67% normal pregnancies.
Statistically significant difference was observed in the Second to First Peak Systolic Velocity Ratio (2PSVR) of the ophthalmic artery (p=0.011), heart Rate (p=0.03), stroke volume (p=0.004) and cardiac output (0.094) between the two groups. There were significant correlation between parameters of the central haemodynamics and those of the uteroplacental circulation, as well as ophthalmic artery Doppler.

Conclusion
Ophthalmic artery 2PSVR is a simple and potentially promising measurement to assess women with hypertensive disorders of pregnancy. However, this parameter must be validated against the well described Uterine artery Doppler. A bigger cohort is needed to clarify and determine its effectiveness.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): iPlacenta
Aortic systolic blood pressure predicts periprocedural myocardial injury after transcatheter aortic valve implantation
Authors: Terentes-Printzios D , Gardikioti V , Latsios G , Drakopoulou M , Siasos G , Oikonomou E , Mpei E , Xanthopoulou M , Christoforatou E , Toutouzas K , Vavuranakis M , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Background/Introduction
Periprocedural myocardial injury (PPMI) is a complication of transcatheter aortic valve implantation (TAVI) associated with worse outcome. Central (aortic) systolic blood pressure (SBP) is an independent predictor of cardiovascular events.

Purpose
We sought to investigate the effect of TAVI on peripheral and central hemodynamics, as well as the predictive ability of brachial and aortic SBP for PPMI.

Methods
We enrolled 70 patients (mean age 79.9±8.7 years, 50% males) with severe symptomatic aortic valve stenosis (AVS) undergoing TAVI. Brachial pressures were measured with an oscillometric device and central pressures were assessed by arterial tonometry at baseline and after the procedure at discharge. PPMI was identified based on Valve Academic Research Consortium (VARC-2) criteria. Biomarkers for MI (cardiac troponin and creatinine kinase MB) were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records. Stepwise multivariable regression analysis was performed for the prediction of PPMI.

Results
According to VARC-2 definition, 38 (54%) patients had PPMI. In stepwise multivariable regression analysis, brachial SBP at baseline was not predictive of PPMI (p=0.07) after adjusting for age, sex and history of coronary artery disease. On the contrary, aortic SBP predicted PPMI even after adjustment for the abovementioned confounders (Odds ratio [OR]=1.032, 95% Confidence Interval [CI] 1.004–1.061, p=0.026). Interestingly, both SBP and aortic SBP were higher at discharge in patients with PPMI compared to patients without PPMI after adjustment (p=0.021 and p=0.006, respectively). On the contrary, the periprocedural changes of aortic SBP and SBP were not different between patients with PPMI and without PPMI.

Conclusions
Aortic SBP, as assessed by tonometry, is an independent predictor stronger than brachial SBP for PPMI in AVS patients treated with TAVI. This finding suggests the possible clinical role of aortic pressures as a risk stratification tool for PPMI prior to TAVI, as well as, warrants further investigation on their role as therapeutic targets to decrease the incidence of PPMI.

Funding Acknowledgement
Type of funding sources: None.