bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex-specific prognosis of right ventricular size measured by 3D echocardiography following isolated tricuspid valve surgery
Authors: Meng F , Wu Y , Liu Y , Yang Y , Kong D , Dong L , Chen H , Chun W , Shu X , Pan C , Ge J 
Published: October 2024

Abstract

Backgrounds
Isolated tricuspid valve surgery (ITVS) is considered a high-risk procedure. Right ventricular (RV) size plays a critical role in the prognosis of ITVS patients. The effect of sex differences in the degree of right ventricular（RV）dilatation in ITVS patients has not been established.

Purpose
The primary objective of this study was to assess in-hospital major adverse events (AEs) following ITVS in women compared with men on the basis of preoperative RV size measured by 3D echocardiography.

Methods
Consecutive patients undergoing ITVS were identified from a prospectively maintained database.Transthoracic echocardiography was performed the day before ITVS. In-hospital AEs were defined as one of the following occurring before discharge: death, shock, acute renal failure requiring dialysis, or prolonged (&gt;72h) mechanical ventilation. 3D RV parameters including end-diastolic volume (EDV), end-systolic volume (ESV), EDVi (indexed by body surface area), ESVi (indexed by body surface area) and ejection fraction (EF) were calculated using commercially available software. Comparison of the adjusted odds ratios (ORs) generated by multivariate logistic regression of in-hospital AEs between women and men on the basis of baseline RV parameters.

Results
59 patients (median age 62 years, 42.37% male, functional tricuspid regurgitation in 62.71%) were finally enrolled. In-hospital AEs were identified in 23 patients (3 death, 5 shock, 5 renal failure, 10 prolonged mechanical ventilation). The risk of AEs was increased from baseline, when the ESV was 69.73 mL for women and 90.66 mL for men. Regarding EDV, the risk for women increased at 130.49 mL compared with 170.36 mL in men. Accordingly, when indexed by body surface area, women had a lower inflection point for both EDVi and ESVi (76.71 mL/m2 vs 91.35 mL/m2, 34.04 mL/m2 vs 52.49 mL/m2). However, there was no inflection point for increased risk with RVEF in either men or women.

Conclusion
Women undergoing ITVS have a higher risk of in-hospital AEs with smaller RV size. These results support the use of sex-specific thresholds for RV size when making surgical decisions in patients with severe tricuspid regurgitation.Figure 1.Adjusted ORs for RV size.
Safety and mid-term outcomes of impella compared to intra-aortic balloon pumping in patients who required mechanical cardiac support
Authors: Makino M , Shishikura D , Kusumoto H , Yamauchi Y , Sakane K , Fujisaka T , Zushi R , Morita H , Kanzaki Y , Hoshiga M 
Published: October 2024

Abstract

Background
Impella (Abiomed USA) is a promising alternative to improve prognosis in patients with cardiogenic shock requiring mechanical cardiac support (MCS). Despite of its advanced hemodynamic profile, its superiority regarding prognosis has not been established yet.

Aims
The aims of this study were to investigate safety and mid-term outcomes of Impella compared to IABP in patients who required MCS.

Methods
In this single-center study, consecutive 205 patients who required IABP or Impella from January 2017 to June 2023 were evaluated retrospectively. The primary outcome was 180-day mortality. Secondary outcomes were the rate of complications including hemolysis, thrombocytopenia, bleeding, limb ischemia, acute kidney impairment and stroke. Major complication was defined as major bleeding (BARC 3-5), limb ischemia and stroke.

Results
Of all patients, 62 (30.2%) received Impella and 143 (69.8%) IABP. The rate of patients required extracorporeal membrane oxygenation (ECMO) support was not significantly different between two groups (31.4 % vs 38.7%; p=0.34. There were no significant differences in 180-day mortality between two groups (36.2% vs 31.1%; p=0.55). Further investigation according to SCAI classification demonstrated that the mortality rate in SCAI C group was significantly lower in Impella than IABP group (34.1% vs 6.7%; p=0.02), whereas there were not significant differences in mortality between two groups in SCAI D and E groups (54.8% vs 61.4%; p=0.71). The rate of major complications was significantly higher in Impella group (54.4% vs 72.1%; p=0.02). The rate of hemolysis (19.6% vs. 58.1%, p&lt;0.01), thrombocytopenia (19.6% vs. 58.1%, p&lt;0.01), limb ischemia (4.3% vs. 17.7%, p&lt;0.01), acute kidney impairment (37.7% vs 64.5%, p&lt;0.01) and initiation of renal replacement therapy (13.8% vs 29%, p=0.02) were significantly higher in Impella group. Multivariate analysis adjusting for Impella use, out of hospital cardiopulmonary arrest (OHCPA), initial lactate ≥60 md/dL and major complication, revealed that age ≥70 (hazard ratio (HR): 3.1, 95%CI: 1.73-5.61) and use of ECMO (HR: 4.3, 95%CI: 2.54-7.31) were independent predictor of mortality. The mortality rate arose up to 83.3% in patients with age ≥70, OHCPA and use of ECMO (HR: 9.7, 95%CI: 4.07-23.02).

Conclusion
The mortality rate did not differ between Impella and IABP, however Impella was associated with improved mortality in patients with SCAI C group. The complications were high likely seen in patients with Impella compared to IABP. Our findings indicate that Impella results in better outcomes with careful selection of patients, defining its indication and appropriate care. A further investigation would be of value to elucidate whether Impella improve prognosis.
Do obese patients undergoing extracorporeal membrane oxygenation have a higher mortality ? a systematic review and meta-analysis
Authors: Picado-Loaiza S , Luiz L , Mesadri Gewehr D , Ferreira R O M , Bittar V , Goebel N , Rylski B , Ayala R 
Published: October 2024

Abstract

Background
While ECMO is a life-saving intervention for patients with severe respiratory or cardiac failure, the impact of obesity on its efficacy and associated risks remains unclear.

Purpose
We aimed to perform a systematic review and meta-analysis comparing whether obese individuals undergoing ECMO face higher mortality and morbidity risks compared to their non-obese counterparts.

Methods
PubMed, Embase, and Cochrane were searched in December 2023 for studies comparing the outcomes between obese versus non-obese patients undergoing extracorporeal membrane oxygenation. We computed mean differences (MD) for continuous outcomes and odds ratios (OR) for binary outcomes, with 95% confidence intervals (95%CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R version 4.2.3.

Results
Twenty-two studies comprising 39,322 participants were included in the meta-analysis. We divided the exposure and the control into 4 pairwise meta-analyses including BMI cut-off values of &lt;25 kg/m², &lt;30 kg/m², &lt;35 kg/m², &lt;40 kg/m². There were no significant differences between groups with a BMI &lt;25, &lt;30, &lt;35 in all-cause mortality (&lt;25: OR 0.96; 95% CI 0.76 - 1.21; p: 0.708 / &lt;30: OR 0.88; 95% CI 0.68 - 1.14; p: 0.340 / &lt;35: 0.97; 95% CI 0.80 - 1.19) p: 0.784) respectively; but with an increasing tendency towards favoring a higher BMI. On the other hand, the higher BMI analysis (&lt;40) demonstrated a significant association between higher BMI and less mortality (OR 0.52; 95% CI 0.29 - 0.95; p: 0.034).

Conclusion
In patients undergoing ECMO, a higher BMI is associated with decreased all-cause mortality.Figure 1.Cut off &lt;25; Cut off &lt;30Figure 2.Cut off &lt;35; Cut off &lt;40
Influence of donor and harvesting protocol on 30 day mortality after heart transplantation
Authors: Monteiro V , Ferraz D , Cunha C , Figueira F , Silva I , Tchaick R , Castro B , Carneiro R , Oliveira Filha M , Lapa A , Lira M , Xavier P , Borba V , Freitas Filho J , Costa C 
Published: October 2024

Abstract

Purpose
Heart transplantation continues to be the gold standard for the treatment of advanced HF, as it promotes increased survival, exercise capacity and quality of life. The choice of the potential donor, as well as the safety of the harvesting process, graft preservation and transportation are fundamental to the success of the procedure. With the territorial extension of Brazil and a large number of donations in other states and regions, evaluating donors remotely, as well as structuring an adequate fundraising plan are fundamental. Therefore, the study of these variables and their influence on the outcome at 30 days was the objective of this study.

Methods
A retrospective cohort was conducted involving patients aged 18 or over, who underwent heart transplantation from July 2012 to July 2022 at our center. Patients who underwent re-transplantation and those who not used the bicaval technique were excluded. Statistical analysis was performed using STATA Software version 18. The Kaplan-Meier method was used to obtain the overall survival curve and, to identify risk factors for death, Cox proportional hazards. The Log test -rank was used for comparisons between groups.

Results
255 cases of heart transplantation were studied, with a 30-day survival rate of 86.6%. The average age of donors was 29 years old and the main cause of death was traumatic brain injury.Regarding the factors that increase the risk of mortality in 30 days, the longest CPB time (HR 1.01; 95% CI 1.002-1.014; p = 0.011) and the donor's age (HR 1.08; 95% CI 1.023-1.139; p = 0.005) were statistically significant. In the univariate analysis, the donor's nutritional status (overweight or obese) was also significant (p = 0.03).The donor's length of hospital stay, use of vasoactive drugs or antimicrobials, serum sodium level or history of previous PCR did not influence the recipient's 30-day survival. Distance organ retrival surgery did not influence the outcome as long as the ischemia time of less than 240 minutes was respected.

Conclusion
The distance harvesting protocol used in our institution proved to be safe and effective. Adequate evaluation of the donor through echocardiography as well as management of vasoactive drugs and electrolytes may have influenced the non-relevance of classic factors that affect the outcomes of patients after heart transplantation.
Right atrial and ventricular function in risk stratification of patients with pulmonary artery hypertension
Authors: Guo J J , Wang J Q , Chen Y C 
Published: October 2024

Abstract

Background
Right atrial (RA) phasic function was proved to be impaired in individuals with pulmonary arterial hypertension (PAH), the awareness of the nonnegligible involvement of RA in the clinical course of PAH was raised. However, evidence for the clinical significance of the RA strain in prognostication and risk stratification for PAH patients was limited.

Method
Participants diagnosed with PAH from June 2013 to December 2022 in West China Hospital were prospectively and continuously recruited. The primary endpoint was all-cause mortality, and the second endpoint was a combination of all-cause mortality and heart failure-related repeat hospitalization. Cox regression analysis and Kaplan Meier survival analysis were performed to identify the association between variables and outcomes. C-index, 1-year mortality, and annual event rate were performed to confirm the value of RA strain in PAH patients’ risk stratification.

Result
A total of 283 participants (mean age, 38 ± 14 years, 84 male) were finally included, following a median follow-up duration of 31.5 months (interquartile range: 15.1-53.9 months). Significant decreases in RA reservoir (p&lt;.001), conduit (p&lt;.001), booster pump function (p&lt;.001), right ventricular global longitudinal strain (RVGLS, p&lt;.001), and free-wall longitudinal strain (RV-FWLS, p&lt;.001) were observed in participants with all-cause mortality than those who survived. Using 16.1% and 23.6% as thresholds for RA reservoir strain, PAH patients could be divided into low-, intermediate, and high-risk groups well, with calculated 1-year mortality of 1.8%, 6.9%, and 21.4%. Moreover, RA reservoir strain presented with better 1-year mortality predictive performance than RV-FWLS (C-index, 0.82 [0.72-0.92] vs 0.72 [0.62-0.82], p&lt;.001). The addition of RA reservoir strain had significantly increased the power of both REVEAL Lite2 and Comparative, Prospective Registry of Newly initiated Therapies for Pulmonary Hypertension (COMPERA) models (both p&lt;.001).

Conclusion
RA reservoir strain was an independent predictor of all-cause mortality in individuals with pulmonary arterial hypertension and could be used to stratify participants into different risk stratification stratum.
Exercise-induced inflammatory and thrombotic acute phase response in hypertensive patients
Authors: Liakos C , Markou M , Dimitroglou I , Koukos M , Patsourakos D , Ververeli C , Savalas D , Zisimos K , Aggeli C , Toutouzas K , Karpanou E , Vyssoulis G , Tsioufis C 
Published: October 2024

Abstract

Background/Introduction
Vigorous physical activity may acutely trigger the onset of an acute coronary syndrome especially in sedentary persons with established cardiovascular risk factors such as arterial hypertension. The rupture of an inflamed coronary plaque and the activation of the coagulation cascade are the main underlying mechanisms.

Purpose
The present study aimed to determine the effect of acute exercise on the inflammatory and thrombotic response in patients with arterial hypertension as compared to normotensive peers.

Methods
After excluding patients with any inflammatory or/and coronary artery disease, a total of 60 non-treated hypertensive patients and 65 normotensive individuals underwent a maximal treadmill exercise testing. Βlood samples were drawn at rest and immediately after peak exercise. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cell (WBC), interleukin-6 (IL-6), and total fibrinogen (TF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured.

Results
All biomarkers increased with exercise, except PAI-1, which decreased (P&lt;0.05 for the change between resting and peak exercise for all biomarkers). The normotensive group had less marked (P&lt;0.05) exercise-induced changes than the hypertensive group in hsCRP (7.7 vs. 8.6%), SAA (5.6 vs. 11.9%), WBC (45.0 vs. 51.7%), and PAI-1 (-17.3 vs. -20.1%) and a similar (P=NS) change in IL-6 (23.8 vs. 23.0%) and TF (8.5 vs. 8.5%) (see also Figure).

Conclusion(s)
In conclusion, the exercise-induced inflammatory and thrombotic acute phase response seems to be more pronounced in non-treated hypertensive patients than in normotensive controls. The effect of blood-pressure lowering treatment on the exercise-induced acute phase response remains to be elucidated.Figure
Impaired systemic microvascular function in patients with resistant arterial hypertension and microalbuminuria: an observational study
Authors: Crahim V , Lorenzo A , Fernandes V , Verri V , Tibirica E 
Published: October 2024

Abstract

Background
Systemic arterial hypertension (SAH) is one of the most prevalent diseases worldwide and is known to be associated with alterations of microvascular function. It is well known that microalbuminuria (MAU) is considered an early marker of renal and cardiac injury in SAH and is an independent risk factor for cardiovascular events in this population. Additionally, it is associated with altered endothelial function, which occurs from the early stages and can be considered an early marker. In some cases, SAH presents as resistant arterial hypertension (RAH), resulting in a worse prognosis compared to individuals with non-resistant hypertension. Moreover, MAU is associated with higher mortality, independent of glomerular filtration rate. Endothelial dysfunction is also a risk marker found in different conditions and can add to MAU in patients with RAH.

Purpose
To investigate systemic microvascular function in patients with RAH, with or without MAU.

Methods
64 patients with RAH, of both genders (50% men), were evaluated, with 32 having MAU and 32 without MAU (defined as a urinary albumin/creatinine ratio between 30 and 300 mg/g in a routine urine sample). Microvascular function assessment was performed using a laser speckle system, allowing analysis of cutaneous microvascular flow. Flow measurements were expressed in arbitrary perfusion units (APU) divided by the mean arterial pressure to obtain cutaneous vascular conductance (CVC). A post-occlusive reactive hyperemia (PORH) test was performed, with brachial artery occlusion using a sphygmomanometer 50 mmHg above systolic pressure for 3 minutes; cutaneous flow was measured after release of the occlusion.

Results
Patients with or without MAU did not differ in terms of age, frequency of diabetes, and chronic kidney disease. The peak CVC values during PORH were 0.64 ± 0.15 and 0.55 ± 0.15 APU/mmHg in RH and RH + MAU patients, respectively (P=0.03). The delta values (peak – baseline) during PORH were 0.31 ± 0.11 and 0.25 ± 0.09 APU/mmHg in RH and RH + MAU patients, respectively (P=0.04)(Figure 1).

Conclusions
PORH-induced vasodilation was found to be reduced in patients with RAH and MAU compared to patients without MAU. This finding shows alteration of endothelium-dependent vasodilation mechanisms in these patients, indicating reduced systemic microvascular endothelial function. Endothelial dysfunction may be associated with glomerular permeability changes, contributing to MAU and further increasing the risk for these patients. This suggests the need for more intensive therapeutic interventions and better risk stratification for these patients, as endothelial dysfunction can be found in the early stages of the disease.Figure 1
Cerebral damage after malignant hypertensive crisis: cerebral MRI follow-up data
Authors: Liegey J , Cremer A , Lucas L , Gosse P , Debeugny S , Dreau H , Rubin S , Doublet J , Sibon I , Boulestreau R 
Published: October 2024

Abstract

Background
Malignant hypertension (MHT) crisis is characterized by acute and diffuse microvascular damages, and the brain is a primary target organ. While a recent MRI study has revealed extensive and frequent cerebral injuries during the acute phase of MHT crisis (1), there is a scarcity of follow-up data.

Purpose
This study aims to investigate the evolution of MRI markers of cerebral injury following the management of the acute phase of MHT.

Methods
In this retrospective analysis, we examined brain MRI data from patients admitted for acute MHT between 2008 and 2022 at our center. Eligible patients had at least one follow-up brain MRI available. A skilled operator conducted a comprehensive analysis of each brain MRI, searching for posterior reversible encephalopathy syndrome (PRES), acute stroke or cerebral hemorrhage and microangiopathy markers, blinded for clinical and demographical data.

Results
Among 149 patients enrolled, 104 had a brain MRI at inclusion, 47 individuals had at least one follow-up brain MRI and were included in the analysis. 72,3% were male, mean age was 48,2 ± 10.8 years and 45,7% presented blood pressure control at the time of the follow-up brain MRI. Median interval between initial and follow-up brain MRI was 228 (84 – 726) days. Five (10,6%) new recent strokes, 2 (4,3 %) cerebral hemorrhage and 0 PRES were recorded during follow-up. On the follow-up brain MRI, more patients presented chronic lacunar infarct and/or microbleeds, in higher numbers. On the contrary, overall Fazekas score was stable in 31 patients (66,0%), improved in 15 patients (31,9 %) and worsened in 1 patients (2,1%). Comparison of subgroups dichotomized according to blood pressure control or follow up duration showed no difference in brain MRI markers.

Conclusion
This study offers valuable insights into the risk of new cerebrovascular events and the evolution of brain MRI markers after managing the acute phase of MHT. Our findings emphasize the dynamic nature of cerebral microvascular burden and the potential for regression of white matter hyperintensities. A better understanding of these phenomena might contribute to improved diagnosis, tailored treatment, and proactive patient care in the context of MHT.
Association between renal function impairment and body roundness index (BRI) in elderly hypertensive patients
Authors: Chen Q , Liu H Y , Li Z Y , Li D , Zhao F , Hao J , Yang C L , Song J S , Gu X Z , Huang R C 
Published: October 2024

Abstract

Objective
The purpose of this study was to explore the associations of renal function impairment and body roundness index (BRI) in elderly hypertensive patients.

Methods
This is a community-based observational and cross-sectional study.A total of 1482 elderly hypertensive patients from our center in 2021 were enrolled. Waist-to-hip ratio(WHR) , Body mass index(BMI) and BRI were calculated with validated formulas. According to tri quantile method of BRI level , the patients were divided into low , medium and high BRI groups. The incidence of renal function impairment in the three groups was compared to explore the associations of renal function impairment and BRI in elderly hypertensive patients.

Result
According to the estimated glomerular filtration rate (eGFR) level, the patients were divided into two groups: impaired renal function group and non impaired renal function group. 133 cases were included in the group with impaired renal function, and 1349 cases were included in the group without impaired renal function. The proportion of patients with impaired renal function was 8%, 497 were in the low BRI group, 491 in the medium BRI group, and 494 in the high BRI group. Comparing the incidence of renal function impairment in patients with different BRI levels, the results showed that the incidence of renal function impairment in patients with high BRI was higher than that in patients with low BRI (7.0%vs.11.5%,p=0.015). The results of binary logistic regression analysis showed that the risk of renal function impairment increased by 19% for each unit of BRI increase (95%CI 1.037-1.122,P=0.024). After adjusting for age, gender, blood lipid, smoking and drinking history, years of hypertension, diabetes, years of diabetes,and random blood glucose levels, the risk of renal function impairment in high BRI group was still significantly higher than low BRI group (OR=1.697,95%CI 1.031-2.794,P=0.038),shows that BRI is an independent risk factor for renal function impairment in elderly hypertension patients. The receiver operating characteristic curve (ROC) results show that the prediction ability of BRI in the whole population is better than that of BMI and waist circumference (WC), and the prediction ability of BRI in elderly female population is the best (AUC=0.569).

Conclusion
Increasing of BRI is correlated with the occurrence of renal function impairment in elderly hypertension patients, and has the best predictive value for renal function impairment in elderly women with hypertension.