bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between short-term pulse pressure variability and cardiovascular death among normotensive adults
Authors: Visaria A D , Kostis J B , Kostis W J 
Published: October 2021

Abstract

Background
Short-term systolic and diastolic blood pressure variability have been associated with adverse cardiovascular (CVD) outcomes, especially in conjunction with traditional CVD risk factors. However, there are limited data on the relationship between short-term pulse pressure (systolic minus diastolic blood pressure) variability (PPV) and mortality.

Purpose
We examined the association between PPV and death due to cardiovascular causes.

Methods
Data from the United States National Health and Nutrition Examination Surveys (NHANES-III, 1988–1994) were linked to death certificates from the National Death Index until December 31, 2015. A total of 6,340 adults (2,981 men and 3,359 non-pregnant women) aged ≥20 years who were normotensive (BP&lt;140/90, without history of hypertension and not taking antihypertensive medication) were followed for an average of 22.3 years. Individuals with any self-reported history of CVD (heart failure, myocardial infarction, stroke) were excluded. PPV was calculated as the standard deviation of six pulse pressure measurements across two visits less than two weeks apart. PPV was categorized into quartiles: Q1: ≤4, Q2: 4.1–6, Q3: 6.1–8, Q4: &gt;8 mmHg. The primary outcome was CVD mortality. Cox proportional hazards models were used to determine hazard ratios, adjusting for demographics & sociobehavioral factors (age, race, ethnicity, poverty-income ratio, smoking status), cardiometabolic factors (waist circumference, HDL, triglycerides, microalbuminuria, diabetes status), BP-related factors (mean pulse pressure, between-visit variability), and accounting for the complex survey design.

Results
Whereas the proportion of CVD death among men was similar across quartiles, women in Q4 had significantly higher proportion of CVD death (Figure 1; p=0.0055). Women in Q4 of PPV had significantly higher risk of CVD mortality (unadjusted HR 3.63, 95% CI 1.66, 7.90) compared to Q1, even after 1) adjustment for demographics & sociobehavioral factors (HR 2.80, CI 1.40, 5.60), 2) additional adjustment for cardiometabolic factors (HR 2.59, CI 1.33, 5.05), and 3) additional adjustment for mean pulse pressure and between visit variability (HR 2.71, CI 1.42, 5.17). Men in Q4 also had increased, but insignificant, risk of CVD mortality (adjusted HR 1.06, CI 0.38, 2.96). Gender significantly modified the effect of PPV on CVD mortality (p=0.036 for interaction term). When looking at the first visit alone, every 1 mmHg increase in PPV was associated with a 11% significant increase in risk of cardiovascular mortality in females (1.11 [1.03, 1.19]), but only a 1% insignificant increase in males (1.01 [0.91, 1.12]).

Conclusions
These NHANES data with an average 22.3 years of follow-up indicate that two visit pulse pressure variability is associated with cardiovascular death and that this effect is more pronounced in women.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Pulse Pressure Variability and Mortality
Geriatric depression and quality of life in atrial fibrillation: the geriatric population analysis
Authors: Senoo K , Yukawa A , Okura T , Iwakoshi H , Nishimura T , Matoba S 
Published: October 2021

Abstract

Background and purpose
Arrhythmias such as atrial fibrillation (AF) is often associated with depression, with vague anxiety about symptom and the risk of serious complication such as stroke or heart failure. In the geriatric population, geriatric depression often occurs with an increase of physical illness and has substantial costly and quality of life implications for functionality and life satisfaction. However, few studies have investigated relationship between geriatric depression and Quality of Life (QoL), and arrhythmia symptoms (palpitation, dyspnea and chest discomfort).

Method
Between November 2019 and October 2020, elderly people (≥65 years) who participated in the AF awareness symposium were enrolled in this study. They were divided into 4 groups according to the presence or absence of chest symptom and AF, and were examined geriatric depression by Geriatric depression scale (GDS)-15 and Quality of Life (QoL) by the 12-item Short- Form Health Survey (SF-12) including physical and mental health status.

Results
Of the 1511 subjects, 1364 were analyzed after excluding 147 with missing values. Among them, 911 were in the non-AF group without symptom (Group A), 43 in the AF group without symptom (group B), 323 in the non-AF group with symptom (group C), and 87 in the AF group with symptom (group D).
Geriatric depression rates (defined as GDS-15 ≥10) were 2.7% in non-symptomatic group (2.7% in A [n=25] and 2.3% in B [n=1]) and 7.8% in symptomatic group (7.4% in C [n=24] and 9.2% in D [n=8]). (P&lt;0.05) In multivariate regression analysis, an increased risk of geriatric depression was observed in groups C and D (group C: odds ratio [OR]=2.54, CI: 1.40, 4.61, P&lt;0.01 and group D: OR=3.13 CI: 1.16, 7.57, P=0.02).
The mean values of physical and mental health status in SF-12 were 48.5 (±7.9) and 56.7 (±6.8) in A, 44.6 (±10.7) and 57.3 (±7.3) in B, 45.0 (±9.9) and 53.8 (±7.7) in C, and 43.4 (±10.8) and 54.8 (±8.6) in D, respectively. Physical health status in SF-12 was associated with group C (C vs A: estimate −2.95 [CI: −4.03, −1.87], p&lt;0.01) and D (D vs A: estimate −2.93 [CI: −4.88, −0.97], p&lt;0.01), other than heart failure, older age and female. Mental health status in SF-12 was associated with group C (C vs A: estimated −2.34 [CI: −3.72, −1.42], p&lt;0.01), heart failure, hypertension, older age, female and group D (D vs A: estimate −1.63 [CI: −3.31, 0.05], p=0.06), but not statistically significant. Individuals with arrhythmia symptom (group C and D) had lower physical and mental health status than those without (group A and B) (P&lt;0.05).

Conclusion
Older adults with arrhythmia symptoms were more likely to have geriatric depression and low QoL, especially those with symptomatic AF, with a geriatric depressive complication rate of 9.2%. Further studies are needed to investigate whether improving physical health status can improve QoL and geriatric depression.

Funding Acknowledgement
Type of funding sources: None.
Residual risk after acute coronary syndrome: the PRATO-ACS Registry
Authors: Toso A , Leoncini M , Maioli M , Villani S , Bellandi F ,   PRATO-ACS
Published: October 2021

Abstract

Background
Despite administration of current evidence-based therapies, substantial residual risk for cardiovascular events persists, particularly after acute coronary syndrome (ACS). It is well known that different inflammatory, metabolic, renal factors concur in defining the residual risk, beyond lipids, platelets and coagulation.

Purpose
The purpose of this study is to analyze the prevalence of various residual risk factors in patients at 1 month after ACS and their association with all-cause death within 3 years.

Methods
Of the 1585 patients admitted to our center for ACS and included in the PRATO-ACS Registry we selected the 1099 patients (69±12 yrs; 30% female; 26.7% with diabetes; 73% NSTE-ACS and 27% STEMI) who underwent laboratory analyses 1 month after the index event. All patients had undergone early invasive strategy and received high intensity statins during hospitalization and at discharge. The frequency of 5 specific risk factors was evaluated: LDL cholesterol ≥70 mg/dl; high sensitivity C reactive protein (hs-CRP) ≥2 mg/l; triglycerides ≥135 mg/dl; high glycosylated hemoglobin (HbA1c) ≥6.5% in diabetic and ≥5.7% in non-diabetic patients; decrease in estimated glomerular filtration rate (eGFR) ≥25% compared to baseline. Patients were followed up for three years. The association between the individual risk factors and all-cause death within 3 years was evaluated with Cox proportional analysis expressed by hazard ratio (HR) and 95% confidence intervals (CI).

Results
The Table lists the prevalence of the five residual risk factors at 1 month and the mortality HR (95% CI) within 3 years for each risk factor.

Conclusions
After ACS, despite the secondary prevention therapy (high intensity statins), residual risk factors, all measured at 1 month, are persistently elevated in the majority of patients. Their association with all-cause death at 3 years is significantly high for inflammatory and metabolic parameters as well as renal function deterioration. These findings should prod us to develop new strategies that target all residual risk factors, not only lipid profile.

Funding Acknowledgement
Type of funding sources: None.
Remnant cholesterol is an independent determinant of the presence and extent of subclinical carotid atherosclerosis in statin-naive individuals
Authors: Delialis D , Aivalioti E , Mavraganis G , Dimopoulou A M , Sianis A , Angelidakis L , Patras R , Petropoulos I , Ioannou S , Syrigou R , Kanakakis J , Georgiopoulos G , Stellos K , Stamatelopoulos K 
Published: October 2021

Abstract

Background
Despite continuous improvements of diagnostic and therapeutic algorithms for cardiovascular disease (CVD), mortality from CVD remains high suggesting unaddressed residual risk. Remnant cholesterol (RC) consists the cholesterol content of triglyceride-rich lipoproteins, which along with LDL cholesterol infiltrate the arterial wall, accumulate and cause atherosclerosis. Increased remnant cholesterol (RC) levels have been previously associated with future adverse cardiac events despite hypolipidemic therapy. However, a mechanistic association of RC levels with human atherosclerosis in vivo has not been proven in a clinical setting.

Purpose
To evaluate the association of RC levels with the presence and extend of subclinical carotid atherosclerosis.

Methods
In this retrospective cohort study, 438 subjects from the Athens Vascular Registry without clinically overt CVD or treatment with statin were recruited. Atherosclerotic burden was assessed by B-mode carotid ultrasonography using: 1. Maximal carotid wall thickness [maxWT, the highest intima-media thickness (IMT) or highest atherosclerotic plaque thickness (PLQ) if present derived from all carotid sites], 2. Total thickness (sumWT, sum of maximal wall thickness), 3) high plaque burden (PLQ ≥2) and 4) average carotid IMT (avgIMT). RC was calculated using the formula RC=total cholesterol-LDL-C-HDL-C.

Results
Mean (SD) age was 54.8±12.4 years old with 41% being males. Subjects with RC&gt;median (=18mg/dl) had higher sumWT (6.12±0.7 vs 5.57±1.7, p=0.002), maxWT (1.61±0.7 vs 1.43±0.7, p=0.008) and avgIMT (0.88±0.16 vs 0.83±0.16, p=0.003) vs RC&lt;median.&gt;median was associated with higher odds for increased sumWT (highest tertile, OR: 2.15 95% CI 1.26–3.66, p=0.006) and maxWT (OR: 2.15 95% CI: 1.38–3.33, p=0.001), and a higher plaque burden (≥2 plaques, OR: 2.1 95% CI 1.93–3.1, p&lt;0.001) after adjustment for age, gender and systolic blood pressure, glomerular filtration rate, smoking, diabetes mellitus, body mass index and LDL-C

Conclusion
In a statin-naive population without clinically overt CVD, increased RC levels were associated with the presence and extend of subclinical carotid atherosclerosis. These findings provide novel mechanistic insight into mechanisms associated with increased CVD risk in individuals with high RC levels.

Funding Acknowledgement
Type of funding sources: None.
MicroRNA profile analysis in pericoronary adipose tissue of diabetic patients with significant coronary artery disease
Authors: Marketou M , Plevritaki A , Kontaraki J , Kalogerakos P , Kochiadakis G , Anastasiou I , Paradaki S , Zervakis S , Maragkoudakis S , Parthenakis F , Lazopoulos G 
Published: October 2021

Abstract

Background
Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner,and plays a role in the pathogenesis of atherosclerosis. PCAT may be a source of microRNAs (miRs) that target other tissues and act as messengers for intercellular communication. In this study, we investigated whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific miRs expression patterns in patients with diabetes type 2 compared to non-diabetic patients.

Methods
We enrolled 43 patients (29 men, aged 63±12 years old) with 3-vessel coronary artery disease who underwent elective coronary bypass surgery with and without diabetes type 2. The PCAT samples were received from all participants. miR-133a, miR-21, miR-26b, miR-9 and miR-143 expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results
Twenty-one patients with diabetic type 2 (14 men, 64±10 years old) and twenty=two non-diabetic patients (15 men, 62±15 years old) were included in the study. PCAT analysis showed a significant upregulation of miR-21 levels in diabetic compared to non-diabetic patients (181±76 versus 21±15, p=0.04). Diabetic patients also revealed a significant increase of miR-26b and miR-143 expression in PCAT samples compared to on-diabetics (33±22 versus 16±13, p=0.02, 93±42 versus 16±23, p=0.01). No significant differences between the two sites were observed in PCAT expression of miR-133a and miR-9 (73±12 versus 130±143, 56±44 versus 34±33, respectively, p =NS for both).

Conclusions
miRs expression in PCAT from diabetic patients with significant coronary disease show a distinct expression profile. Our study opens new perspectives in the pathophysiologic role of PCAT in atherosclerotic complications of diabetes and should be further investigated.

Funding Acknowledgement
Type of funding sources: None.
Association of adipose tissue insulin resistance and serum free fatty acid levels with the incidence of type 2 diabetes: a retrospective cohort study
Authors: Sasaki N , Maeda R , Ozono R , Nakano Y , Higashi Y 
Published: October 2021

Abstract

Background
Insulin resistance in adipose tissue attenuates the suppression of lipolysis, leading to increased free fatty acid (FFA) release. The excess FFA may be involved in the development of type 2 diabetes.

Purpose
In this study, we investigated the association of adipose tissue insulin resistance and serum free fatty acid levels with the incidence of type 2 diabetes.

Methods
This is an observational study involving 6800 participants (3451 women, mean age 69.2 years) without diabetes who underwent 75-g oral glucose tolerance test (OGTT) at baseline. The participants were divided into the obesity and nonobesity groups on the basis of body mass index of ≥25 and &lt;25 kg/m2, respectively. Serum FFA levels were assessed before and 30, 60, and 120 min after glucose ingestion, and the total area under the FFA curve (AUCFFA) was calculated. Adipose tissue insulin resistance was assessed using adipose insulin resistance index (adipo-IR) calculated based on fasting FFA and insulin concentrations. The homeostasis model assessment of insulin resistance (HOMA-IR), and the Matsuda index were evaluated as measures of insulin resistance in the liver and whole-body, respectively. High adipo-IR, high fasting FFA, great AUCFFA high HOMA-IR, and low Matsuda index were determined based on the optimal cutoff values from ROC curve analysis.

Results
Over a mean 5.3-year follow-up period, 485 participants developed type 2 diabetes. Multivariate logistic regression analyses showed that high adipo-IR was a significant predicator for incident type 2 diabetes in the obesity group, but not in nonobesity group. AUCFFA, HOMA-IR, and Matsuda index were significantly associated with incident type 2 diabetes in both the two groups (Table).

Conclusion
Serum FFA levels after glucose loading predict the incidence of type 2 diabetes. Adipose tissue insulin resistance was associated with the risk of type 2 diabetes in individuals with obesity, but not in individuals without obesity.

Funding Acknowledgement
Type of funding sources: None.
Impact of a cardio-oncology rehabilitation program in patients with breast cancer undergoing cardiotoxic treatment
Authors: Oliveira C C , Matos M , Azevedo R , Flores R , Medeiros P , Pires C , Mane F , Silva R , Braga C , Pereira V H 
Published: October 2021

Abstract

Background
Cancer treatment–related cardiotoxicity (CTrCD) is commonly associated with anthracyclines and anti-HER2 agents which are widely used for the treatment of breast cancer. In order to mitgate CTrCD, exercise-based cardio-oncology rehabilitation (COR) involving a structured exercise program has been proposed.

Objectives
To evaluate the impact of a cardiac-rehabilitation program in breast cancer patients submitted to chemotherapy with known cardiotoxicity.

Methods
A systematic review was performed. Two databases were searched, PubMed and SCOPUS. All randomized or controlled trials and other prospective studies published between 2000 and March 2020 which evaluate the impact of an aerobic exercise program on cardiorespiratory fitness (CRF), health-related quality of life (QOL), vascular/endothelial function as well as cardiac assessment namely through the evaluation of left ventricular function and cardiac biomarkers in patients undergoing anthracycline and/or anti-HER2 treatments were included.

Main results
Fourteen studies were included enrolling 578 breast cancer patients with a mean age of 48.80 years. Regarding the impact of exercise in CRF, 5 studies (n=176) reported a significant improvement of VO2 max. and 4 studies of VO2max./kg (n=137). The peak power output was also improved in 4 studies (n=95) in the exercise-group. Considering the assessment of QOL, 3 studies (n=180) revealed significant differences favoring the exercise-group. The results regarding the evaluation of the LVEF were not clear: 2 studies (n=48) reported a significant decrease on LVEF when compared to baseline at the end of the intervention in both groups, despite the exercise program. However, 2 studies (n=97) showed a significant increase on LVEF in the exercise-group. Three studies (n=82) did not found significant differences in global longitudinal strain between groups. Limited evidence was found in vascular and endothelial functon. In 2 studies (n=50), endothelial function measured by brachial artery flow-mediated dilatation significantly improved in the exercise-group. Two studies (n=98) reported no significant impact of exercise on atenuating the increase of cTnI and BNP levels in the course of chemotherapy. On the other hand, when considering NT-proBNP, an increase in its levels was attenuated in the exercise-group.

Conclusions
This study confirms that exercise-based COR seems to be an effective approach to improve several cardiovascular outcomes and quality of life in breast cancer patients.

Funding Acknowledgement
Type of funding sources: None.
Very long-term benefits of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention
Authors: Padilla Escamez A , Romero Reyes M J , Otte Alba C , Rufian Andujar S , Molano Casimiro F J 
Published: October 2021

Abstract

Background
Short and medium-term benefits of cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) have been well studied. However, studies on long-term benefits of such programs after percutaneous coronary intervention (PCI) are scarce.

Purpose
The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) on very long-term mortality and morbidity after PCI.

Methods
We conducted a retrospective cohort study of 701 patients who underwent PCI at our hospital between 2004 and 2011. Patients were classified into two cohorts based on whether or not they participated in a CR program phase II. A follow-up was performed in May 2020. We collected the events occurring during a median follow-up of 11 years.

Results
701 patients were included in our study: 291 (41.5%) participated in the CR program, whereas 410 (58.4%) refused to do it. AMI was the most frequent indication for PCI (51.9%), followed by unstable angina (42.8%). The characteristics of the cohort based on participation in the CR program are shown in the table below. Patients who participated in the CR program were younger and mostly male. However, those who refused to do it had a higher cardiovascular risk due to a higher percentage of multivessel disease, diabetes mellitus, kidney failure and history of cerebrovascular accident.
Using multivariate logistic regression, CR participation was found to be associated with significantly reduced all-cause mortality (19.5 vs 48.4%; OR 0.455; IC95% 0.295–0.701; p&lt;0.001) and cardiac mortality (4.5% vs 18.0%; OR 0.361; IC95% 0.181–0.721; p 0.004). CR is also associated with a substantial decrease in heart failure hospitalization (10.0% vs 24.8%; OR 0.557; IC95% 0.331–0.937; p 0.027) and incidence of stroke (5.5% vs 10.6%; OR 0.491; IC95% 0.271–0.890; p&lt;0.017) during the follow-up. No significant differences were observed in re-AMI (20.6% vs 24.1%, p=NS).

Conclusion
CR participation after PCI is associated with lower all-cause mortality, cardiac mortality, heart failure hospitalization rates and morbidity during long-term follow-up.

Funding Acknowledgement
Type of funding sources: None.
Echocardiography and ECG monitoring not very beneficial in COVID-19 follow-up even in long haulers
Authors: Radvan M , Kamenik M , Koc L , Bartecku E , Sykorova L , Kala P ,   COSUBR
Published: October 2021

Abstract

Objective
To evaluate the need for cardiac evaluation of unselected patients recovered from COVID-19.

Methods
Prospective observational cohort study, which included 105 patients recently recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The diagnosis was established by reverse transcription polymerase chain reaction on swab test of the upper respiratory tract.
Demographic parameters, patient history, clinical evaluation, cardiac blood markers, ambulatory 7-day ECG monitoring and echocardiography have been performed to determine possible cardiac injury.

Results
The study group (n=105) included 58% women, mean age was 46 years (range 18–77 years). Mean time interval between the onset of the infection and the follow-up visit was 107 days. One quarter of the patients required hospitalisation during the acute phase of the disease, the rest recovered at home. 74% suffered from mild form, 3.8% moderate, 18.3% severe and 2.9% of critical form of the disease.
At the time of evaluation 63.5% of the patients were referring the ongoing symptoms, fulfilling the criteria of postcovid syndrome, while more than half of the whole group mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue).
One patient was diagnosed with paroxysmal atrial fibrillation (woman, 73 years old, dilated left atrium), one patient with atrioventricular block with indication for implantation of the pacemaker (man, 71 years, cardiac MRI didn't found any signs of myocardial inflammation); in one subject (man, 69 years) was diagnosed coronary artery disease due to atherosclerosis with the necessity of revascularization by percutaneous coronary intervention; one woman was prescribed beta-blocker for inadequate sinus tachycardia and palpitations. All these findings are not suspected to be the result of SARS-CoV-2 infection. In three patients mild pericardial effusion was found with no intervention necessary. There was not found any left or right ventricle dysfunction on echocardiography. Only three findings on ECG monitoring mentioned above need a therapeutic intervention.

Conclusion
Despite the significant proportion of the patients with ongoing symptoms beyond the 12 weeks after the onset of the infection SARS-CoV-2, confirmed cardiac impairment is quite rare and distributed mostly among older patients and those with other risk factors.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Supported MEYS, RI CZECRIN and by Avast Global Employees Matching Collection.