bluuebunny/crossref_metadata_2025_split huggingface dataset:
INCREASED PREVALENCE AND HIGHER 1-YEAR MORTALITY OF PATIENT HOSPITALIZED FOR AORTIC STENOSIS WITH COMORBID CHRONIC KIDNEY DISEASE IN THE PROVINCE OF QUEBEC, CANADA
Authors: Khelifi Nada , Hamel Denis , Jean Sonia , Blais Claudia , Mac-Way Fabrice 
Published: April 2021

Abstract

Objective:
Development of aortic stenosis is associated with valvular calcifications which are highly prevalent in chronic kidney disease (CKD). The objective of this study was to evaluate the temporal trends in the prevalence and 1-year mortality of patients hospitalized for aortic stenosis according to comorbid CKD status in the province of Quebec, between 2000–2017.

Design and method:
Using the Quebec Integrated Chronic Disease Surveillance System, we identified patients aged 20 years and older with incident aortic stenosis using International Classification of Diseases diagnostic codes versions 9 and 10, in the hospital discharge database. We subsequently combined hospital discharges and physician billing claims databases to identify patients with comorbid CKD in the two years prior to aortic stenosis’ diagnosis. Three subgroups of CKD were considered: 1) non-CKD, 2) pre-dialysis and 3) dialysis. The distribution of the 2016–2017 aortic stenosis population was used for age-standardization of prevalence, 1-year all-cause and cardiovascular mortality.

Results:
We included 108 780 patients with incident aortic stenosis (females: 51.8%; mean age (±SD): 76.4 ± 11.7; comorbid CKD status: 80 768 non-CKD; 26 809 pre-dialysis; 1 203 dialysis). During the study period, the age-standardized prevalence of non-CKD patients decreased by 14% (80.72% [95% CI 77.56–83.99] to 69.56% [95% CI 67.23–71.94]; Figure 1). Inversely, the age-standardized prevalence of pre-dialysis and dialysis patients increased by 58% (18.52% [95% CI 16.93–20.21] to 29.33% [95% CI 27.82–30.91]) and 46% (0.76% [95% CI 0.51–1.11] to 1.11% [95% CI 0.84–1.44]), respectively. Age-standardized 1-year all-cause and cardiovascular mortality decreased over time but remained higher in patients with comorbid CKD. In 2015–2016, age-standardized relative risk of 1-year all-cause mortality was significantly higher in pre-dialysis (RR = 1.56 [95% CI 1.44, 1.69]) and dialysis (RR = 2.04 [95% CI 1.62–2.61]) than in non-CKD patients. Age-standardized relative risk of 1-year cardiovascular mortality was also significantly higher in pre-dialysis (RR = 1.83 [95% CI 1.66–2.03]) and dialysis (RR = 2.28 [95% CI 1.68–3.09]) than in non-CKD patients.

Conclusions:
Prevalence of patients with incident aortic stenosis and comorbid CKD increased between 2000–2017. 1-year all-cause and cardiovascular mortality improved over time but remain higher in aortic stenosis patients with comorbid CKD.
CAN HYPERTENSION EXPLAIN THE DIFFERENT SEASONAL EVOLUTION OF STEMI PATIENTS?
Authors: Vintila Vlad Damian , Stuparu Cosmin , Bratu Vladimir , Andreescu Adriana , Mitrut Radu , Cotoban Alexandru George , Vintila Ana -Maria , Vinereanu Dragos 
Published: April 2021

Abstract

Objective:
To determine the impact of hypertension on evolution of a STEMI population studied during winter and summer months.

Design and method:
We reviewed the local STEMI registry data. Data were recorded from the in-hospital medical charts and from a phone follow-up with patients/family. Hospitalization inform consent stipulates the possibility of follow-up for research purposes.

Results:
We reviewed the 2018 data from a local STEMI registry We analyzed 470 patients admitted with STEMI in a primary PCI hospital from a temperate region.
We reviewed 247 (52.6%) patients admitted during 3 winter months and 223 (47.4%) during 3 summer months and we interviewed 32.6% (153) patients for follow-up.
In-hospital death-rate was 7.9% (37 patients), with death-rate at follow-up to 13.2% (62 patients). A higher in-hospital mortality was noted for winter (10,5% vs. 4,9%, X2 = 5,05, p = 0,025), while at follow-up a similar evolution was noted (16,7% vs. 9.5%, x2 = 5,35, p = 0,021).
A higher median blood pressure was recorded for the alive STEMI patients at discharge (132,09 ± 23,64 mmHg vs. 107,15 ± 38,84 mmHg; t (463) = 5,524; p = 0,000) and at follow-up (131,94 ± 23,56 mmHg vs. 118,60 ± 36,3 mmHg; t (460) = 3,73; p = 0,000).
During wintertime, the maximum in-hospital Killip class was higher (x2 = 9,28, p = 0,026); Killip class was higher in dead persons, initialy and after discharge.
At follow-up, patients were asked to self-report their exercise capacity. A lower BP level was noted for higher exercise tolerance - NYHA I, 140,92 ± 20,66 mmHg, p = 0.04), NYHA II (141,25 ± 17,24 mmHg, p = 0.06), both compared with lower exercise tolerance - NYHA III-IV (162.33 ± 29,45 mmHg, p = 0.04); differences were significant (ANOVA test (F (3) = 4.53, P = 0.005).
Limitations. The phone interview was performed at different time interval after discharge, 17,11 ± 5,48 months for winter group, and 16,23 ± 0.89 months for summer (T (468) = 2,37, p = 0.018) with a low rate of answers. Evaluation of larger cohorts is needed for further validation of the results.

Conclusions:
The course of a STEMI patient is critical. It's valuable to predict evolution upon the level of cardiovascular risk factors. A good high blood pressure control migth further improve outcome.
RECOVERY OF PHYSICAL ABILITY OF PATIENTS AFTER ACUTE Q-MYOCARDIAL INFARCTION WITH ARTERIAL HYPERTENSION
Authors: Tereshchenko Nataliia , Malynovska Irina , Shumakov Valentin , Tereshkevych Lesya , Voloshyna Oxana 
Published: April 2021

Abstract

Objective:
To establish the physical recovery of patients who have suffered Q-MI with AH during 1 year follow-up.

Design and method:
91 patients (pts) were divided into 2 groups: 1 group (63 pts) in which Q-MI was preceded by AH and 2 group (28 pts) with Q-MI without AH. Physical exercise test (PET) on a bicycle ergometer before inclusion in the study and was performed in the dynamics while 1 year after MI.

Results:
Diabetes mellitus (DM) was diagnosed in 13 (20.6%) and in 2 (7.1%) pts respectively. On the results of the 1st PET on the BE in the1st group, the PET level was (75,0; 75–100) W, and the cost of work was (2.13; 1.68 - 2.53) units. In the 2nd group, these variables were (75.0; 75.0 - 100.0) W and (1.85; 1.47 - 2.03) units. One year after MI in the 1st group the PET level increased to (125.0; 100.0 – 125.0) W (p = 0,01) and the cost of work remained at the previous level (1.43; 1.39 – 1.52) units (p = 0.09), in the 2nd group the PET level remained at the previous survey (125.0; 125.0 - 140.0) W (p = 0.12) and the cost of the work became more economical (1.12; 0.89 - 1.36) (p = 0.04). It is advisable to emphasize that in the 1st group the level of blood pressure (BP) raised up to153 mm Hg at the top of the1st PET, to 161 mm Hg at the 2nd and to 176 mm Hg at the 3rd test; in the 2nd group these variables were respectively 146, 161 and 164 mm Hg. The target BP levels were reached at all stages of follow-up.

Conclusions:
Pts with Q-MI and AH are (a) older; b) have more frequent development of DM; c) less economical execution PET; d) have higher levels of BP at the top of the PET at all stages of follow-up and e) regular outpatient monitoring of BP made it possible to individualize the therapy and reach the target of levels in all pts.
ASSOCIATION BETWEEN THE PRESENCE OF CORONARY ARTERY DISEASE AND INTENSIVE LOWERING BLOOD PRESSURE AT THE TIME OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY
Authors: Suematsu Yasunori , Tsukihashi Yohei , Shiga Yuhei , Miura Shin-Ichiro 
Published: April 2021

Abstract

Objective:
Blood pressure (BP) lowering treatment should be an intensive BP control according to JSH2019 guideline. Coronary computed tomography angiography (CCTA) has become more widely available in many general hospitals and enables the accurate non-invasive assessment of coronary artery stenosis for screening. The presence or severity of coronary artery disease (CAD) in patients with intensive BP control at the time of CCTA were compared with those in patients without hypertension (HTN).

Design and method:
One thousand one hundred consecutive subjects (65 yrs., males 53%) who were clinically suspected of having CAD or who had at least one cardiac risk factor underwent CCTA. The patients were divided into 4 groups: the patients without HTN (non-HTN group), hypertensive patients with intensive BP lowering (Intensive group, < 130/80 mmHg), standard BP lowering (Standard group, 130–139/80–89 mmHg) and uncontrolled BP (Uncontrolled group, 140/90 mmHg<) groups.

Results:
% CAD in patients with HTN was significantly higher than that in patients without HTN. Interestingly, % CAD in the intensive group was also significantly higher than that in patients without HTN. The intensive group showed older, higher body mass index and the number of significantly stenosed coronary vessels, lower levels of high-density lipoprotein cholesterol in blood, higher rates of dyslipidemia, diabetes, anti-dyslipidemia and anti-diabetic medications.

Conclusions:
The hypertensive patients with intensive BP lowering showed older, higher rate of CAD and more severe coronary stenosis. Thus, it was suggested that the patients also need more rigorous management of other coronary risk factors, as well as intensive BP lowering, and the patients need to perform CCTA much earlier than we think.
CLINICAL EFFECTS OF BETA-BLOCKERS IN HYPERTENSIVE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER ONE YEAR
Authors: Joo Seungjae , Beom Jong -Wook , Lee Jae -Geun , Choi Joon -Hyouk , Kim Song -Yi , Kim Ki -Seok , Jeong Myung -Ho 
Published: April 2021

Objective:
Although the oral beta-blocker therapy is recommended at least 3 years after acute myocardial infarction (AMI), especially in hypertensive patients to control blood pressure, the evidence to support its clinical benefit is very poor. This study aimed to investigate the long-term clinical effects of beta-blockers in hypertensive patients with AMI who had no major adverse cardiac events (MACE) until 1 year after the initial attack.

Design and method:
Among 13,624 patients who were enrolled in nationwide AMI database of South Korea, the KAMIR-NIH Registry, 4,610 hypertensive patients, who underwent echocardiographic study and had no MACE (a composite of cardiac death, MI, revascularization or readmission due to heart failure) until 1 year, were selected in this study.

Results:
Beta-blockers were prescribed in 4,237 hypertensive patients (92%) at 1 year after AMI. On multivariable Cox-proportional hazard analysis, beta-blockers further reduced 1-year cardiac death (1.4 vs. 7.5/100 person-year; HR 0.23; 95% CI 0.14–0.38; p < 0.001), MI (1.1 vs. 3.1/100 person-year; HR 0.33; 95% CI 0.16–0.68; p = 0.002), and MACE (5.8 vs. 11.1/100 person-year; HR 0.54; 95% CI 0.37–0.79; p = 0.001). However, clinical outcomes showed a significant interaction with left ventricular ejection fraction (LVEF). Beta-blockers decreased 1-year MACE of patients with LVEF =<40% (11.3 vs. 24.5/100 person-year; HR 0.40; 95% CI 0.19–0.84; p = 0.015) and 40% <LVEF <50% (6.3 vs. 18.9/100 person-year; HR 0.43; 95% CI 0.22–0.85; p = 0.015, but not those with LVEF >=50% (4.7 vs. 5.8/100 person-year; HR 0.77; 95% CI 0.42–1.43; p = 0.411). ∗HR; hazard ratio, CI; confidence interval.

Conclusions:
Beta-blockers improved the clinical outcomes in hypertensive patients with mid-range as well as reduced LVEF until 2 years after AMI. However, its benefit in hypertensive patients with preserved LVEF was questionable.
LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN ACROSS THE SPECTRUM OF COMPLEXITY OF STABLE CORONARY ARTERY DISEASE
Authors: Caunite Laima , Kamzola Ginta , Knoka Evija , Mazule Mairita , Pelcberga Renate , Trusinskis Karlis 
Published: April 2021

Objective:
In patients with stable coronary artery disease left ventricular ejection fraction may remain within normal range. Myocardial strain is a precise tool for evaluation of early subclinical systolic function changes in a number of cardiac pathologies. Our aim was to determine if there is correlation between left ventricular global longitudinal strain (GLS) and complexity of coronary artery disease.

Design and method:
Study included stable coronary artery disease (SCAD) patients undergoing elective percutaneous coronary intervention (PCI). Patients with PCI in previous 3 months or target vessel, history of previous MI or atrial fibrillation at the time of study were excluded. No patients with medium or pronounced left ventricular hypertrophy, significant valvular pathology, hypo- or akinetic segments visually, or decreased ejection fraction were included. Complexity of coronary artery disease was calculated by SYNTAX score. Transthoracic echocardiography was performed on Philips iE33 the day before revascularization. Myocardial strain was determined by 2D speckle tracking on TOMTEC ARENA using 16-segment model and results were analysed by SPSS 22.

Results:
Study included 90 patients, mean age 64,6 years. Mean SYNTAX score was 12.63 (± 5.88). 76 patients had low SYNTAX score (< 18 points), 10 had medium SYNTAX score (18–27 points), 4 had high SYNTAX score. GLS was decreased in 75 (83.33 %) patients (mean GLS was -15.84 ± 5.19). Overall correlation between the SYNTAX score and GLS was weak: Spearman's rank correlation r = 0.30 (p = 0.002). In patients with decreased GLS correlation r was 0.41; p < 0.001. In patients with preserved GLS correlation was r = 0.336, p = 0.11. There was no significant difference between mean SYNTAX score when comparing groups with normal/decreased GLS.

Conclusions:
In this study left ventricular systolic function assessed by global longitudinal strain had a statistically significant weak correlation with complexity of coronary artery disease.
EFFECTIVENESS OF THE COMBINATION OF TRIMETAZIDINE AND BISOPROLOL IN PATIENTS WITH ANGINA PECTORIS: A POST-HOC ANALYSIS OF CHOICE-2 STUDY
Authors: Glezer Maria , Logunova Natalya 
Published: April 2021

Objective:
Objectives. To evaluate the effectiveness of the combination of trimetazidine (TMZ) and bisoprolol in angina patients in real-world clinical practice.

Design and method:
Methods. This is a post-hoc analysis of CHOICE II, a Russian, multicenter, 6-month, open-label, prospective observational study that assessed the effect of adding TMZ modified release 35 mg bid to antianginal treatment. 896 patients with persistent symptomatic stable angina were included in CHOICE-II, of whom 221 receiving TMZ -bisoprolol were included in the post-hoc analysis. Patients took TMZ 35 mg bid for the entire study duration. There was no optimization of other antianginal drugs.

Results:
Results. The mean age of patients was 64.8 ± 8.9 years. 52.0% were female. 91.9% had hypertension. Mean heart rate was 71.9 ± 9.6 beats per minute. At baseline patients had stable angina, mostly with CCS Class II (65.6%) or Class III (30.8%). Both angina frequency and short-acting nitrate (SAN) use decreased significantly on TMZ-bisoprolol from baseline to month 6 from 6.2 ± 5.3 to 1.5 ± 1.9 attacks/week and from 5.5 ± 4.4 to 1.0 ± 1.4 SAN/week, respectively (P < 0.001 for both). Exercise capacity also improved: angina-free walking distance significantly increased (from 308 ± 207 to 497 ± 253 meters, P < 0.001), as well as the number of flight of stairs until angina (from 2.9 ± 2.0 to 4.5 ± 2.3, P < 0.001). At 6 months, the number of patients presenting dyspnea decreased from 169 (76.5%) to 87 (39.4%). % of patients with CCS Class I angina increased more than 10-fold during the treatment period (from 2.3% to 27.6%) while % of patients with CCS Class III angina decreased 3-fold (from 30.8% to 10.0%). After 6 months of treatment, mean systolic and diastolic blood pressure decreased by 13.4 ± 13.1 and 6.7 ± 9.4 mm Hg staying within normal ranges, respectively. 3 patients (1.4%) prematurely discontinued the study treatment combination.

Conclusions:
Conclusion. This analysis supported the antianginal effectiveness of TMZ-bisoprolol in real-life clinical practice.
LIPID CONTROL AFTER AN ACUTE MYOCARDIAL INFARCTION REGARDING THE ANTIHYPERTENSIVE REGIME
Authors: Carrera Jon Ortiz , Fernández Pascual Císcar , Escrig Ana Isabel Renau , López Cristina Campo , Aldea Carmen Morata , García Fernando Martínez 
Published: April 2021

Objective:
-Lipid control is essential after an acute myocardial infarction (AMI).
-The information regarding the grade of lipid control in hypertensive patients after an AMI is scarce.
-Our objective was to assess the grade of lipid control according to their antihypertensive treatment.

Design and method:
-The sample includes 130 patients admitted during the year 2017 in the Cardiology department with a diagnosis of AMI (ICD 9 410) and with, at least, one ambulatory lipid determination during the follow-up. The threshold to considerer an appropriate lipid control was 55 mg/dL but we also analyzed according to the previously threshold of 70 mg/dL.
-Differences regarding the percentage of lipid control were evaluated using the Chi-square test. This analysis was adjusted by the intensity of lipid treatment and by the type and number of antihypertensive drugs used.
-Mean differences in lipid levels were assessed using ANOVA. This analysis was adjusted by age, sex and the intensity of lipid treatment.
-The relationship between lipid levels and the time elapsed since the infarction was assessed by means of Pearson's correlation coefficient.
-Every statistical analysis was performed using Stata IC 14.

Results:
-Globally, the level of control was 31% considering 55 mg/dL and an additional 29% if 70 mg/dL was the desired LDLc threshold. Although the percentage of controlled patients increased according to the number of antihypertensive medications, these differences were not statistically significant.
-The same occurs for the LDLc levels, which were similar among groups: 0–1; 2–3 or more than 3 antihypertensive drugs (figure 1). The only significant differences were found in those having diuretics who have higher LDL levels (77,2 vs 64,4 mg/dL, respectively, p-value=0.04) in the unadjusted but not after adjustment and without any differences in the percentage of control.
-A positive correlation was found between the LDLc and the elapsed time since the AMI.

Conclusions:
-The percentage of lipid control after an AMI is low and it seems to get worse along time.
-We did not find an association between the complexity of antihypertensive treatment and the LDL levels. Diuretics could impact negatively the grade of lipid control.
SPONTANEOUS CORONARY ARTERY DISSECTION IN A PATIENT WITH CUSHING DISEASE
Authors: Vieira Joana Tender , Besteiro Bruno , Cunha Ana , Lemos Luís , Faceira Ana , Marques Pedro , Almeida Jorge 
Published: April 2021

Objective:
Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction, caused by a non-traumatic and non-iatrogenic separation of the coronary arterial wall, especially amongst young women with no conventional cardiovascular risk factors. The most common factors associated with SCAD are fibromuscular dysplasia (FMD), postpartum, multiparity, connective tissue disorders, systemic inflammatory conditions and hormonal therapy. After extensive diagnostic workup some cases are labeled as idiopathic. In the literature reported cases of aortic, cervical and carotid arterial dissections, but not SCAD, were associated with Cushing syndrome.

Design and method:
We describe a 46-year-old woman with a past medical history of Cushing disease (ACTH-producing pituitary tumor) treated surgically in 2009 that presented with SCAD.

Results:
A nulliparous, hypertensive, obese and non-smoker 46-year-old woman with a surgically treated Cushing disease in 2009, presented to the emergency department with a retrosternal chest pain with radiation to the left arm lasting for 30 minutes, nausea and diaphoresis. No ischemic changes were seen in the electrocardiogram but serum high sensitive troponin I test rose to a pic level of, 96.3 ng/L (normal range <16 ng/L). Cardiac catheterization revealed diffuse distal stenosis of the anterior descending coronary artery, compatible with spontaneous dissection type 2, with Thrombolysis in Myocardial Infarction (TIMI) II flow. The patient was treated conservatively, with anticoagulation during hospitalization and single anti-aggregation without reported complications. Further investigations were performed to explore possible etiologies or associations for SCAD. Serum inflammatory, auto-immune and immunologic workups were negative. Angio-CT scan of the abdomen and supra-aortic trunks showed no signs of FMD or inflammatory changes.

Conclusions:
Cushing Syndrome is not considered a traditional risk factor for SCAD. As there are reported cases of arterial dissections in the literature associated with this entity and common causes of SCAD were excluded we hypothesized that the patient past medical history may have contributed to SCAD. In fact, high cortisol levels may increase blood vessel fragility, making vessel walls more vulnerable. To the best of our knowledge there are no other reported cases in the literature of Cushing syndrome associated SCAD.
ASSOCIATION OF ARTERIAL STIFFNESS WITH ALL-CAUSE MORTALITY AMONG HOSPITALIZED COVID-19 PATIENTS
Authors: Rodilla Enrique , Belda Alberto , Canales Sergio , Quilis Maria , Saez Maria Carmen , Roldan Alicia , Cortes Xavi , Aguilar Marta , Albert Amparo , Garijo Marta , Malek Tamara , Palop Marta , Pinel Jorge , Salvador Inmaculada , Sanchez Vanesa , Vicente Julio , Saura Alberto , Jimenez Iratxe , Mendizabal Andrea , Lloris Amparo , Ridaura Bianca , Karroud Zinneb , Nicolas Angela , Morro Santiago , Fernandez Monica , Beltran Noemi , Reino Sandra , Carmena Amparo , Gag Angela , Pascual Jose Maria 
Published: April 2021

Objective:
Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in COVID-19 patients. Hypertension (HT) and age are the two principal determinants of arterial stiffness (AS). The objective of this study is to estimate AS in COVID-19 patients requiring hospital admission and analyze its association with all-cause mortality.

Design and method:
This cross-sectional, observational, retrospective multicenter study includes 122170 patients who required hospital admission in 150 Spanish centers, included in the nationwide SEMI-COVID-19 Network. We compared estimated AS as pulse pressure > 60 mmHg and compared clinical characteristics between survivors and nonsurvivors.

Results:
Mean age was 67.5 ± 16.1 years, 42.5% were women. Most patients were white (90.0%). Globally, 2606 (21.4%) subjects died. Blood pressure (BP) < 120 mmHg and BP > 140 at admission predicted higher all-cause mortality (23.5% and 22.8%, respectively, p < 0.001), compared to BP between 120–140 mmHg (18.6%). 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that even adjusting for gender (males, OR: 1.6, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), Charlson-Index (second and third tertiles, OR: 4.8 and 8.6, p = 0.0001), heart failure, previous and in-hospital antihypertensive treatment, AS and BP < 120 mmHg significantly and independently predicted all-cause mortality (OR: 1.27, p = 0.0001 and OR: 1.48, p = 0.0001, respectively).

Conclusions:
Our data show that arterial stiffness, defined as pulse pressure above 60 mmHg at hospital admission, and BP at admission < 120 mmHg were important determinants with independent prognostic value for all-cause mortality in COVID-19 patients requiring hospitalization.