bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of cusp-overlap view for TAVR with self-expandable valves on 30-day conduction disturbances
Authors: Mendiz O , Noc M , Fava C M , Gutierrez Jaikel L A , Sztejfman M , Pleskovic A , Lev G , Gada H , Tang G H L 
Published: October 2021

Abstract

Background and aim
Conduction disturbances leading to permanent pacemaker implantation (PPMI) remains a common complication for TAVR procedures, particularly when self-expanding valves are used. We compared the 30-day incidence of new onset Left Bundle Branch Block (LBBB) and permanent pacemaker implantation (PPMI) rate between two consecutive groups using either conventional 3-cusp coplanar view (CON) and right/left cusp-overlap view (COVL) for implantation.

Methods and results
We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n=101) or COVL (n=156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new onset LBBB (12.9% vs 5.8%; p=0.05) and PPMI rate (17.8% vs 6.4%; p=0.004) were significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%) and the need for surgical aortic valve replacement (0% for both groups).

Conclusion
Using the COVL view for implantation we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.

Funding Acknowledgement
Type of funding sources: None.
Impact of pacing-related differences on clinical and echocardiographic outcomes after TAVR with SAPIEN-3 valve
Authors: Lak H , Sammour Y , Chawla S , Gajulapalli R D , Kumar A , Parikh P , Svensson L G , Harb S , Tarakji K , Wazni O , Reed G W , Puri R , Krishnaswamy A , Kapadia S 
Published: October 2021

Abstract

Background
Data regarding the impact of pacing on outcomes after transcatheter aortic valve replacement (TAVR) is evolving especially with regards to pre-existing PPM. We examined the impact of new and prior PPM on clinical and hemodynamic outcomes after SAPIEN-3 (S3) TAVR.

Methods
Consecutive patients who underwent transfemoral-TAVR using S3 valve between April 2015 and December 2018 at our Clinic were included.

Results
Among 1028 patients, 10.2% required new PPM within 30 days, while 14% had pre-existing PPM. The presence of either prior or new PPM had no impact on 3-year mortality (log-rank p=0.6), or 1-year major adverse cardiac and cerebrovascular event (MACCE) (log-rank p=0.65). New PPM was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (54.4±11.3% vs. 58.4±10.1%; p=0.001), and 1 year (54.2±12% vs. 59.1±9.9%; p=0.009) compared to no PPM. Similarly, prior PPM was associated with worse LVEF at 30 days (53.6±12.3%; p&lt;0.001) and 1 year (55.5±12.1%; p=0.006) compared to no PPM. Interestingly, new PPM was associated with lower 1-year mean gradient (11.4±3.8 vs. 12.6±5.6 mmHg; p=0.04), and peak gradient (21.3±6.5 vs. 24.1±10.4 mmHg; p=0.01) despite no baseline differences. Prior PPM was also associated with lower 1-year mean gradient (10.3±4.4 mmHg; p=0.001), and peak gradient (19.4±8 mmHg; p&lt;0.001), and higher doppler velocity index (0.51±0.12 vs. 0.47±0.13; p=0.039). Moreover, 1-year LV end-systolic volume (LVESVi) was higher with new (23.2±16.1 vs. 20±10.8 ml/m2; p=0.038), and prior PPM (24.5±19.7; p=0.038) compared to no PPM. Prior PPM was associated with higher moderate-to-severe tricuspid regurgitation (35.3% vs. 17.7%; p&lt;0.001). There were no differences with regards to the rest of the studied echocardiographic outcomes at 1 year.

Conclusion
In this S3 cohort, new and prior PPM did not affect 3-year mortality or 1-year MACCE, however they were associated with worse LVEF, higher LVESVi and lower mean and peak gradients on follow-up compared to no PPM.

Funding Acknowledgement
Type of funding sources: None. Figure 1. All-cause Survival
Cerebrovascular accidents in patients supported with veno-arterial extra-corporeal membrane oxygenation- is duration of support important?
Authors: Hussain S , Zero N , Al-Saadi T , Asghar M , Glowacki N , Andrade A , Sciamanna C , Joshi A , Dia M , Macaluso G , Tatooles A , Pappas P , Cotts W , Pauwaa S 
Published: October 2021

Abstract

Purpose of study
Veno-Arterial Extra-corporeal Membrane Oxygenation (VA-ECMO) is indicated for refractory cardiac and/or respiratory failure. Adverse events remain considerable despite best practices. We specifically aimed to understand risk factors associated with cerebrovascular accidents (CVA) in patients who underwent VA-ECMO support.

Methods
We retrospectively assessed all VA-ECMO patients from 2007 to 2019 at our institution. We identified those who experienced a CVA while supported by VA-ECMO. Patients with the primary event (CVA) were matched to controls (no CVA) based on age and sex. Comparisons were made between groups using McNemar's, Mantel-Haenszel, and Wilcoxon Signed-Rank tests where appropriate.

Results
Of the 278 VA-ECMO patients in the registry, 32 patients who experienced a CVA were identified; 24 (8.6%) ischemic and 8 (2.9%) hemorrhagic. Median age was 59.5 years (inter-quartile range: 49–65 years) and 75% of patients were males. Hypertension, diabetes, CAD and CHF were common co-morbidities (Table 1). Cardiogenic shock was the most common indication for VA-ECMO support in both cohorts, 75% in cases and 71.9% in controls. Cannulation strategies were identified as central or peripheral. There was a significant association of duration of VA-ECMO support with incidence of CVA, with a p-value of 0.03. Regression analysis showed a trend of increased risk of CVA by 4% for each additional day on VA-ECMO, however, this was not statistically significant (Odds ratio: 1.04; confidence interval 1.00–1.08). Most common outcome was death followed by decannulation to recovery and bridge to LVAD.

Conclusion
Ischemic and hemorrhagic CVAs are not uncommon during VA-ECMO support. Our case control study shows an association of duration of VA-ECMO support with incidence of CVA. This underscores the importance of timely assessment and weaning or bridging of VA-ECMO patients to their next management step.

Funding Acknowledgement
Type of funding sources: None.
Protective effects of renal denervation based on MRI assessment of the brain in patients with resistant hypertension
Authors: Sukhareva A E , Falkovskaya A Y U , Baev A E , Ussov V Y U 
Published: October 2021

Abstract

Purpose
The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension based on MRI assessments and their changes one year after renal denervation.

Material and methods
The study comprised 58 patients with resistant hypertension (RH), aged 52.1±9.1 years, who underwent renal denervation (RDN) according to the good clinical practice guidelines. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring (BPM), and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, in particular the linear measurements of the cerebral lateral ventricles, the linear measurements of the external subarachnoid spaces in 6 regions (in the right and left frontal, parietal, and occipital lobes), sizes of the 3rd and 4th ventricles (length and width), dimensions of intracerebral cisterns (quadrigeminal, prepontine, and chiasmatic), the presence of periventricular leukoaraiosis and focal changes in the brain white matter were evaluated.

Results
Initially, patients with RH had a high incidence of the structural brain alterations: 75% with fine focal brain lesions, 75% with impaired CSF dynamics, 23% with sulcal widening, and 90% with periventricular oedema. After RDN, a significant hypotensive effect was noted. According to brain MRI, the number of patients without impaired CSF dynamics did not change significantly: 25% initially, and 20% a year later (χ2=0.63 p=0.43, and χ2=0.72 p=0.40). The number of patients with grade I impaired CSF dynamics after 6 months significantly increased after 12 months from 50% to 64% (χ2=4.00, p=0.046) due to lowering the number of patients without impaired CSF dynamics and patients with grade II impaired CSF dynamics (χ2=1.56, p=0.21). The number of patients with sulcal widening significantly decreased: from 23% to 8% one year following RDN (χ2=40.21 p=0.000). The incidence of periventricular cerebral oedema did not significantly change one year after the procedure; however, the incidence of fine focal brain lesions significantly decreased (from 75 to 60%, p=0.02).

Conclusion
Thus, it has been revealed that patients with RH are characterised by a high incidence of structural brain alterations based on MRI assessments. A year after bilateral renal denervation, there are significant improvement in intracranial hypertension signs and decrease in the incidence of fine focal brain lesions, without a significant change in the CSF dynamics parameters (Table 1). Figure 1 shows a clinical example of a decrease in the number of fine focal brain lesions after the intervention.

Funding Acknowledgement
Type of funding sources: None.
Association between isolated diastolic hypertension and cardiovascular events: a systematic review and meta-analysis of prospective cohorts
Authors: Huang M , Tang T , Cheng X 
Published: October 2021

Abstract

Background
Isolated diastolic hypertension (IDH) is a subtype of hypertension, which is defined as systolic blood pressure (SBP) &lt;140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg by 2018 European Society of Cardiology (ESC) guideline and 2019 National Institute for Health and Care Excellent (NICE). Whereas some previous studies have demonstrated the significant association between IDH and cardiovascular (CV) events, some have not.

Purpose
To assess the association between IDH and the risk of CV events, CV mortality, and all-cause mortality.

Methods
We conducted a systematic search for publications using Medline, Embase, and the Cochrane Library from inception through March 2021 for prospective cohort studies exploring the association between IDH and CV events, CV mortality, and all-cause mortality. Relative risks (RR) or hazard ratios were extracted from the selected studies. Random effect models with inverse variance weighting were used to calculate the pooled RR and 95% confidence interval (CI). The primary outcome was a composite of total CV events including CV mortality. The secondary outcomes were CV mortality and all-cause mortality. We defined the IDH as SBP &lt;140 mmHg and DBP ≥90 mmHg, reference group as BP less than 140/90mmHg.

Results
Overall, 15 studies were identified including 1049587 participants (5.5% IDH). For the primary outcome, IDH was significantly associated with risk of CV events (RR, 1.40 [95% CI, 1.18–1.66], p&lt;0.001). The increased risk of CV events was also observed in subgroup analyses based on age (less or more than 50) and sex. However, in further stratified analysis based on geographical region, only the Asia population showed a significant association with increased risk of CV events, whereas results were null in Europe and North America populations. For the secondary outcomes, IDH was significantly associated with increased CV mortality (RR [95% CI], 1.41 [1.12–1.78], p&lt;0.001) but not with all-cause mortality (RR [95% CI], 1.13 [0.86–1.48], p=0.378). The sensitivity analysis showed the overall results did not vary significantly after exclusion of any one study.

Conclusions
IDH is associated with increased risk of CV events and CV mortality. Further, more large-scale prospective epidemiological cohorts are needed to confirm our conclusion.

Funding Acknowledgement
Type of funding sources: None. Primary outcomeSecondary outcomes
Cardiovascular multimorbidity and associated factors: the first Brazilian Registry of patients with hypertension
Authors: Batista S R , Vitorino P V O , Silva R R , Sousa A L L , Barroso W K S , Coca A 
Published: October 2021

Abstract

Background
Cardiometabolic multimorbidity (CM-MM) defined by the occurrence of at least two of morbidities (diabetes mellitus, stroke, acute myocardial infarction) is a important issue for health systems and it was associated with several health negative outcomes, especially decreasing of the life expectancy.

Purpose
To analyze the occurrence of CM-MM and associated factors among Brazilian patients with hypertension.

Methods
Cross-sectional study with participants of The First Brazilian Registry of Patients with Hypertension (BRH) from 45 sites in all regions of Brazil (n=2,646). For this study we select the individuals with ≥65 years (n=1,033) and CM-MM was defined with the presence of ≥2 of the following: diabetes mellitus, stroke, acute myocardial infarction evaluated by self related. CM-MM was analyzed according to sex, age, race, presence of others morbidities (dyslipidemia, myocardial revascularization, heart failure and chronic kidney disease), control of blood pressure, obesity, physical activity, actual smoking and alcohol consumption. The numerical variables were presented by median and interquartile range, the categorical variables by absolute and relative frequency. To verify the variables associated with the outcome, simple logistic regression was performed.

Results
CM-MM was present in 8.9% of participants. The median age was 71.6 (IQ: 67.9–76.8), female (59.7%), 65–70 years of age (39.6%), and 59.8% were white. Obesity was present in 55.8% and 48.4% of individuals have no blood pressure controlled. The occurrence of diabetes mellitus, stroke, and acute myocardial infarction was, respectively, 32.7%, 14.7% and 6.7%. A higher occurrence of CM-MM was observed in males, aged between 70 and 75 years old and with 75 years old or more, the presence of dyslipidemia; myocardial revascularization (MR); heart failure (HF) and kidney disease. The intersection size among diseases is represented in Figure 1. After multiple analysis, the following variables were associated with the presence of cardiovascular multimorbidity: male gender; age equal to or greater than 75 years and report of dyslipidemia, MR and HF.

Conclusions
The prevalence of CM-MM was high and an approach based on the clusters of cardiometabolic diseases can be a potent care strategy.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Intersection size among diseases CM-MM
A novel natural-derived pentameric peptide protects from angiotensin-evoked high blood pressure
Authors: Carrizzo A , Basilicata M G , Pepe G , Ciccarelli M , Di Pietro P , Campiglia P , Vecchione C 
Published: October 2021

Abstract

Background
Arterial hypertension is the most important risk factor for cardiovascular diseases, myocardial infarction, heart failure, renal failure and peripheral vascular disease. In the last decade, milk-derived bioactive peptides have attracted attention for their beneficial cardiovascular properties.

Methods
Here we combined in-vitro chemical assay such as LC-MS/MS analysis of buffalo ice cream, ex-vivo vascular studies evaluating endothelial and smooth muscle responses using pressure myograph, and translational assay testing in-vivo the vascular actions of PG1 administration in murine models.

Results
We demonstrate that a novel buffalo ice-cream-derived pentapeptide “QKEPM”, namely PG1, is a stable peptide that can be obtained at higher concentration after gastro-intestinal digestions (GID) of buffalo ice-cream (BIC). It owns potent vascular effect in counteract the effects of angiotensin II-evoked vasoconstriction and high blood pressure levels. Its effects are mediated by the inhibitory effect on AT1 receptor leading to a downregulation of p-ERK½/Rac1-GTP and consequent inactivation of NADPH oxidase activity.

Conclusions
These results strongly candidate PG1, as a novel bioactive peptide for the prevention and management of hypertension, thus expanding the armamentarium of preventive strategies aimed at reducing the incidence and progression of hypertension and its related cardiovascular complications.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): University
Association of residential distance to coast with myocardial infarction: a prospective cohort study
Authors: Zhuang Z X D , Liao X X , Zhang S Z 
Published: October 2021

Abstract

Background
Little is known about whether the residential distance to coast is associated with incident myocardial infarction (MI), as well as which mechanisms may explain the association. We aim to explore this association using data from a prospective, population-based cohort with unprecedented sample size and broad geographical coverage.

Methods
377,340 participants from the prospective, population-based UK Biobank cohort were included. Residential distance to the coast was defined as participant's residence location to coast.

Results
4,059 MI occurred during median 8.0 years follow-up. Using group (&lt;1 km) as reference, group (20–50 km) was associated with lower risk of MI (hazard ratio, HR 0.79, 95% CI 0.64–0.98) and a U-shaped relation between distance to coast and MI was shown with the low risk interval between 32 km and 64 km (Pnonlinear = 0.0012). Using participants of intermediate region (32–64 km) as reference, participants of offshore region (&lt;32 km) and inland region (&gt;64 km) were both associated with a higher risk of incident MI (HR 1.12, 95% CI 1.04–1.21 and HR 1.09, 95% CI 1.01–1.18, respectively). HR for offshore region (&lt;32 km) was larger in subgroup with low total physical activity (&lt;24 hours/week) (HR 1.24, 95% CI 1.09–1.42, Pinteraction = 0.043), whereas HR for inland region (&gt;64 km) was larger in subgroup in urban area (HR 1.12, 95% CI 1.03–1.22, Pinteraction = 0.065) and in subgroup of high nitrogen dioxide air pollution (HR 1.29, 95% CI 1.11–1.50, Pinteraction = 0.021).

Conclusions
Our findings highlight the complex and diverse associations between residential distance to the coast and incident MI.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Emotional and cardiovascular health: the impact of depression on cardiac autonomic activity
Authors: Theofilis P , Oikonomou E , Lazaros G , Vogiatzi G , Tsalamandris S , Chasikidis C , Fountoulakis P , Anastasiou M , Goliopoulou A , Mystakidi V X , Papakonstantinou M , Christoforatou E , Siasos G , Tousoulis D 
Published: October 2021

Abstract

Background
The coexistence of depression and cardiovascular diseases is frequently accompanied by an increased risk of adverse outcomes. QTc, an indicator of ventricular depolarization and cardiac autonomic activity, has been proposed as a biomarker of this interplay.

Purpose
We aimed to investigate the possible association of depression with QTc interval.

Methods
Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung self-rating depression scale in those younger than 65 years of age (Group 1) and with the geriatric depression scale in elderly individuals (&gt;65 years, Group 2). Moreover, electrocardiogram was performed and measurement of the QT interval was derived after correction for heart rate (QTc) using the Bazett's formula. Abnormal QTc was present when QTc duration exceeded 440 ms.

Results
Group 1 individuals classified as having depression had longer QTc duration (No depression: 389.3±27.0 ms vs. Depression: 401.1±32.9 ms, p&lt;0.001) and percentage of abnormal QTc (No depression: 2.0% vs. Depression: 10.8%, p=0.001) (Figure 1, Panels A and B). Elderly individuals had similar values of QTc (No depression: 409.9±29.6 ms vs. Depression: 405.2±46.4 ms, p=0.37) and percentage of abnormal QTc (No depression: 13.2% vs. Depression: 12.3%, p=0.78) irrespective of depression status (Figure 1, Panels C and D). The presence of depression in Group 1 subjects was associated with an increased QTc- by 10.8 ms and with an approximately 7-fold higher prevalence of abnormal QTc duration, even after adjustment for confounders (). Such finding was not detected in elderly individuals (Figure 1, Panel F).

Conclusion
Depression might adversely affect ventricular repolarization especially in middle-aged subjects. These findings highlight the interrelationship between emotional and cardiovascular health and the role of depression as a cardiovascular risk factor.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Cardiovascular risk profile in Portugal: evidence from a large population-based cohort
Authors: Gavina C , Araujo F , Pardal M , Grangeia D , Moreira F , Leitao A , Taveira-Gomes T 
Published: October 2021

Abstract

Background
The rising prevalence of CVD in Portugal translates into more than 35 thousand annual deaths (1,2), with stroke and ischemic heart disease as the leading causes of death (3). Reducing the incidence of ASCVD is a public health priority, for which LDL-C lowering is paramount to halt atherosclerotic plaque progression (4,5). Real-world data is lacking regarding patient characterization, lipid-lowering therapy, and LDL-C levels by CV risk profile.

Purpose
To assess the proportion of patients with low, intermediate, high, and very high CV risk in a population with a complete spectrum of care, and describe their clinical characteristics, cardiovascular medications, and degree of LDL-C control.

Methods
This non-interventional, cross-sectional study included adult patients between 40 and 80 years old followed for primary or secondary CV risk prevention at a major healthcare institution that provides both primary and hospital care. Patient data spanned the period from 1/1/2008 to 31/12/2019. The index date for patient identification and characterization was 31/12/2019. CVD risk assessment was computed according to the 2019 ESC/EAS Guidelines for the management of dyslipidemias (6). Every criterion for risk assessment (excluding imaging and family history) was reconstructed using the most granular available records of clinical observations, measurements, episodes, lab orders, diagnosis and medications recorded at all primary and secondary care sites of the institution. We described patient demographic and clinical characteristics for each CV risk level, lipid-lowering treatment (LLT), and LDL-C levels.

Results
We identified 111.394 patients eligible for analysis. Sufficient records for CV risk assessment were available for 82.271 patients. According to 2019 ESC/EAS Guidelines CV risk categories, 25.7%, 21.4%, 12.2% and 40.7% of patients had low, intermediate, high and very high CV risk. High/very high CV risk patients had a mean (SD) age of 65.6 (10.1) years. Type 2 diabetes was present in 13.1% of high CV risk and 40% of very high CV risk groups. Although approximately 70% of patients with high/very high CV risk were treated with a LLT, only 5.1% of high CV risk and 3.6% of very high CV risk had LDL-C levels within the recommended targets. There was a very low use of high intensity statins or combination therapies in high/very high CV risk categories (table 1). Patients with atherosclerotic CV disease accounted for 34.6% of those at very high CV risk and only 4.8% attained desired goals (table 2).

Conclusions
There is a pressing need for better control of LDL-C levels at every stage of CV risk, with a particular focus on high and very high CV risk patients. Effective strategies for LCL-C control are thus needed.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by Novartis Farma, Produtos Farmacêuticos S.A.