bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autonomous cortisol secretion in patients with primary aldosteronism is associated with left ventricular hypertrophy and diastolic dysfunction
Authors: Tsai C H , Wu V C , Lin Y H 
Published: October 2024

Abstract
Background and Aims: Autonomous cortisol secretion (ACS) constitutes a significant portion of patients diagnosed with primary aldosteronism (PA) and is potentially linked to adverse cardiovascular outcomes. This study aimed to explore the impact of ACS on cardiac remodeling and diastolic dysfunction in PA patients.

Methods
We prospectively enrolled 567 PA patients from March 2000 to March 2023. ACS was defined as a cortisol level &gt;1.8 μg/dL after a 1 mg dexamethasone suppression test (DST). Clinical, biochemical, and echocardiographic data were collected at baseline and during one-year follow-up after targeted treatments including adrenalectomy and mineralocorticoid receptor antagonist administration.

Results
In this prospective cohort, 21.5% of PA patients had concurrent ACS. PA patients with ACS were older and had a higher prevalence of diabetes. They also exhibited significantly higher left ventricular mass index (LVMI) and worse diastolic function (E/e'). Baseline post-1 mg DST cortisol levels positively correlated with baseline LVMI and E/e' in restricted cubic spline analysis. Multivariable linear regression analysis showed that ACS presence was significantly associated with higher LVMI and worse E/e' after adjusting for significant variables. Among patients who underwent adrenalectomy, both those with and without ACS showed significant improvements in LVMI and E/e'. Patients who received mineralocorticoid receptor antagonist treatment also showed significant improvement in E/e', irrespective of ACS presence. However, significant LVMI improvement was observed only in PA patients without ACS who received mineralocorticoid receptor antagonist treatment.

Conclusions
The presence of ACS in PA patients was associated with worse left ventricular hypertrophy and diastolic dysfunction. Adrenalectomy and mineralocorticoid receptor antagonist treatment partially reversed cardiac remodeling in PA patients with ACS.
Cardiac magnetic resonance (CMR) height-based allometric scaling in Southeast Asians; implications in the diagnosis and prognosis of left ventricular hypertrophy (LVH): the REMODEL study
Authors: Lee C C E , Chan R , Toh D F , Kui M , Lee V , Bryant J A , Boubertakh R , Lee C H , Chai P , Le T T , Chin C W L 
Published: October 2024

Abstract

Background
Left ventricular hypertrophy (LVH) is a strong predictor of adverse cardiovascular outcomes (1). Although normalizing LV mass (LVM) to height exponents has been shown to reduce variability from body size, specific recommendations for height exponents are lacking due to the scarcity of normal cohorts to define appropriate height exponents (2). Cardiac magnetic resonance (CMR) is increasingly used in assessing LVM, and the existing body of research is based primarily on the MESA cohort (3). While the MESA cohort is ethnically diverse, the intrinsic effects of ethnicity may not fully be discerned if certain ethnic groups are under-represented.

Purpose
We aimed to demonstrate the diagnostic and prognostic implications of establishing height exponents specific to sex in a Southeast Asian cohort.

Methods
Non-overweight/obese Southeast Asian healthy volunteers (n=416) were used to establish appropriate height exponents and normal reference ranges of LVM. The impact of these height exponents was examined in a separate cohort of Southeast Asians with hypertension (n=878). All individuals underwent standardized cardiovascular magnetic resonance imaging (CMR). Primary outcome was a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality. Cox regression analysis of various LVH measures were adjusted for 24-hour systolic blood pressure, diabetes, and hyperlipidemia.

Results
The height exponents for healthy females and males were 1.57 and 2.33, respectively. In patients with hypertension, sex-specific height exponents significantly increased the detection of LVH compared with body surface area (BSA) indexing (47% [n=409/878] versus 27% [n= 236/878], p&lt;0.001). Most individuals re-classified to LVH with sex-specific height exponents were overweight (33.1%, n=58/175) or obese (64.6%, n=113/175). There were 37 primary events over 60 [37-73] months of follow-up. Regardless of indexing method, LVH was independently associated with increased adverse events (sex-specific height exponent hazard ratio (HR): 2.8 [1.25-6.29], P=0.013). The prediction ability of LVH diagnosis by sex-specific height exponents was similar to BSA indexing (HR: 5.43 [2.49-11.8], P&lt;0.001).

Conclusions
Reference ranges specific to the ethnicity, sex and imaging modality are necessary to establish appropriate height exponents. Although utilizing sex-specific height exponents to index LVM resulted in significantly more LVH reclassification when compared with BSA indexing, this did not translate to a notable improvement in event prediction. Further research into alternative methods of LVM indexing is warranted.Abstract SummaryPredictive Ability of LVH Measures
Optimal blood pressure values to reduce arterial stiffness, an analysis from UK Biobank
Authors: Shantsila A , Zheng Y Z , Gao Z , Lip G Y H , Shantsila E 
Published: October 2024

Abstract

Introduction
Increased arterial stiffness is a powerful independent risk factor for adverse cardiovascular events. While pulse wave velocity has been used extensively as a biomarker of vascular health reflecting functional and structural arterial changes, its use in clinical practice was limited. The Arterial Stiffness Index (ASI) simplifies the assessment of arterial stiffness using a pulse waveform obtained at the finger with an infrared sensor with BP measured using an automated device. Age and raised blood pressure (BP) are major contributors to increased arterial stiffness, but time trajectories of ASI in the general population and optimal BP values to reduce arterial stiffening are scarcely known.

Purpose
To establish temporal changes of ASI and identify BP values associated with longer-term improvement of arterial stiffness.

Methods
The study analysed data from UK Biobank (baseline n=154,684, median age 54, interquartile range (IQR) [40-72] years; 52% female; 91% white, 28% hypertension). ASI was measured using PulseTrace PCA2 device (CareFusion, USA) at baseline with measurements repeated in 4617 individuals after a median follow up of 3.0, IQR [2.8-3.3] years. BP was measured during the same time points. Multivariable (adjusted for age, sex, diabetes, and use of BP-lowering drugs) linear regression was used to determine the association of BP with baseline and the association of BP and ASI changes during follow up. ROC analysis was used to determine BP values associated with improvement (reduction) of ASI during follow up. Continuous data are presented as median [IQR] and compared using Wilcoxon test. R software packages were used for analyses.

Results
At baseline, ASI (m/sec) was higher in those with systolic BP (SBP) &gt;140 mmHg (9.60 [7.15-11.85] vs. 8.67 [6.77-10.70] for SBP ≤140 mmHg, p&lt;0.001) and in those with diastolic BP (DBP) &gt;90 mmHg (9.90 [7.48-12.16] vs 8.81 [6.78-10.90] for DBP ≤90 mmHg, p&lt;0.001). Both SBP and DBP were independently associated with ASI at baseline (B±SE 0.08±0.02 and 0.79±0,29m, respectively; p&lt;0.001 for both).
During follow up, the population level SBP remained unchanged (change 0 [-8 - 8] mmHg), with some reduction in DBP (-1.0 [-6.0 - 3.5]) mmHg. SBP reduced in 2234 (48%) and DBP in 2517 (55%). ASI increased by 0.56 [-1.46 - 2.78] m/s, with ASI reduction observed in 1935 (42%). An increase in DBP but not in SBP was independently associated with an increase in ASI (B±SE DBP 0.04±0.01, p&lt;0.001; SBP 0.007±0.006, p=0.22; DBP 0.04±0.007, p&lt;0.001). The baseline BP was predictive of the magnitude of changes in ASI: SBP 132 mmHg (AUC 0.53, p=0.001) and DBP 83 mmHg (AUC 0.54, p&lt;0.001).

Conclusions
Increased arterial stiffness is associated with higher BP, particularly with higher DBP. Raised ASI is reversible, providing BP is adequately controlled with optimal BP being &lt;132/83 mmHg.
Sex-related differences in left ventricular geometry patterns in patients with arterial hypertension
Authors: Canciello G , Piccolo R , Izzo R , Bossone E , Pacella D , Lembo M , Manzi M V , Mancusi C , Simonetti F , Borrelli F , Esposito G , Losi M A 
Published: October 2024

Abstract

Background
Sex-specific differences in left ventricular (LV) geometry is key for tailoring management strategies for arterial hypertension.

Purpose
To evaluate sex-related differences in LV geometry patterns at baseline and their evolution over time in hypertension.

Methods
From a prospective registry, we included hypertensive patients with at least 1 year follow-up, without prevalent cardiovascular disease or incident myocardial infarction, with normal LV ejection fraction and no chronic kidney disease of stage III or more. Four LV geometry patterns were assessed: normal geometry, concentric remodeling, eccentric and concentric LV hypertrophy (LVH).

Results
A total of 6427 patients (age 53±11 years, 43% females) were included. At baseline, a normal geometric pattern was less common in female than in male patients (50% vs. 72%, p&lt;0.001). LVH was more prevalent among female than male patients (47% vs. 23%, p&lt;0.001), with a higher prevalence of eccentric LVH (40% vs. 18%, p&lt;0.001). Female sex was independently associated with LV remodeling (odds ratio, 2.36, 95% confidence intervals, 2.12-2.62, p&lt;0.001). At long-term follow-up (mean 6.1 years, IQR 2.8-8.6 years), the proportion of patients with LV remodeling increased in both sexes, although a normal LV geometry remained less frequent in female than male patients (43% vs. 67%, p&lt;0.001), with differences persisting in eccentric (41% vs. 21%, p&lt;0.001) and concentric LVH (11% vs. 5%, p&lt;0.001).

Conclusions
We found relevant sex-related differences in LV geometry among patients with hypertension. Females have a higher risk of LV remodeling at baseline compared with men, with differences persisting at long-term follow-up.
Application of the 2016 ase-eacvi criteria for the assessment of diastolic function in arterial hypertension
Authors: Canciello G , Izzo R , Bossone E , Piccolo R , Pacella D , Ferrara F , Lembo M , Manzi M V , Carbone A , Mancusi C , Simonetti F , Cittadini A , Esposito G , Losi M A 
Published: October 2024

Abstract

Background
No data are available on diagnostic algorithms recommended by guidelines for the assessment of diastolic dysfunction (DD) in patients with arterial hypertension.

Purpose
To fill this gap, we evaluated left ventricular (LV) diastolic function in hypertensive patients matched with healthy subjects.

Methods
Healthy subjects, hypertensive patients without and with LV hypertrophy (LVH) were matched 1:1:1 based on age, sex, and body mass index from two prospective registries. All participants had normal LV ejection fraction (EF). Diastolic function was assessed basing on 2016 ASE-EACVI guidelines, by applying algorithm A, recommended in normal LVEF, and algorithm B recommended in reduced LVEF or normal LVEF and myocardial disease.

Results
A total of 717 participants were enrolled. By applying algorithm A, an indeterminate pattern was found in 0.4% of healthy subjects, in 6.3% of hypertensive patients without LVH (p=0.015 vs. healthy subjects), and in 21% of hypertensive patients with LVH (p=0.001 vs. healthy subjects). DD was absent in healthy individuals, whereas it was found in 2% and 8% of hypertensives without (p=0.06) and with LVH (p=0.001 vs. healthy subjects), respectively. By applying algorithm B, no cases of indeterminate diastolic function were found. DD was observed in 2.9% of healthy subjects, 7% and 10.5% of hypertensives without (p=0.001 vs. healthy subjects) and with LVH (p=0.002 vs. healthy subjects).

Conclusion
When diastolic function is assessed by echocardiography, the use of algorithm A should be limited only to truly normal subjects, whereas algorithm B should be applied to all patients with hypertension irrespective of LVH
The role of IL15 in angiotensin II-mediated cardiac remodelling
Authors: Booth E , Nosalski R , Saju B , Loughrey C , Maffia P , Guzik T J 
Published: October 2024

Abstract
Hypertension (HTN) mediated target organ damage, such as cardiac remodelling, is a major cause of death and disability. Cytokines are important regulators of cardiac function, inflammation, and remodelling in cardiovascular disease. Increased levels of interleukin 15 (IL15) have been noted in HTN, but its role in HTN heart disease remains unknown.
This study investigates the role of the IL15 axis in the pathogenesis of cardiac remodelling in HTN.
Male 12-week-old IL15 receptor α knock-out (IL15RAKO), IL15 knock-out (IL15KO) and matching wild type (WT) mice were administered vehicle or angiotensin II (AngII) (490 ng/min/kg) for 2 weeks by osmotic minipump. Blood pressure was measured by tail cuff (n=5-8). Cardiac function was analysed by echocardiography (n=3-4). Cardiac infiltrating immune cells were analysed by flow cytometry (n=2-3 for IL15RAKO, n=6-10 for IL15KO). Cardiac remodelling was assessed by picrosirius red, WGA staining (n=5-8) and expression of markers of remodelling using RT-qPCR and western blots (n=5-8). Data are presented as mean±SEM and analysed using two-way ANOVA.
AngII infusion caused a significant increase in systolic blood pressure in WT and IL15KO animals. In contrast, in IL15RAKO, the response to AngII was blunted. This was in line with a decrease in ejection fraction, however only WT mice had an increase in global longitudinal strain (-20.3±2.0 vs -10.9±1.2, p=0.0039 in WT and 19.9±0.8 vs -16.0±2.1, p=0.1878 in IL15RAKO). HTN was associated with increased cardiac IL15 protein levels in mice. The heart-to-body ratio, along with cardiomyocyte cross-sectional, were significantly increased in WT, but not in IL15RAKO HTN mice. Furthermore, histological analysis showed significantly higher cardiac collagen accumulation in WT but not IL15RAKO upon AngII infusion (5.8±1.0% in WTvvs. 2.1±0.5% in IL15RAKO, p=0.0021). This was in line with a higher expression of col1a1 in WT but not IL15RAKO HTN hearts (20.0±6.0 vs 4.5±1.7, p=0.0173). Similarly, the FN1 protein level was significantly increased in WT but not IL15RAKO AngII-treated mice. These changes were associated with a higher number of Cd11b+ macrophages accumulated in WT hypertensive hearts only.
In contrast to IL15RAKO, mice lacking IL15 showed similar increases in global longitudinal strain, heart hypertrophy, and cardiomyocyte cross-sectional area as WT mice upon AngII infusion. Similarly, IL15KO hypertensive hearts showed a significant increase of col1a1 and FN1 in comparison to vehicle-treated mice. A similar level of Cd11b+ macrophages was found in hypertensive IL15KO and WT mice's hearts.
In conclusion, IL15RA, but not IL15, plays a critical role in cardiac remodelling mediated by AngII infusion. This suggests that the IL15-IL15RA axis may play an important yet complex role in hypertensive heart disease.
Combining fractional flow reserve and the index of microcirculatory resistance for prognosis prediction in renal artery stenosis interventions: a feasibility sub-study of FAIR-pilot trial
Authors: Liu X , Li Y X , Liu Z H , Zhang Y , Li J P 
Published: October 2024

Abstract

Background
Interventional therapies for renal artery stenosis (RAS) was debatable in previous randomized trials. Fractional flow reserve (FFR), while useful in coronary interventions, does not assess microcirculatory status, which may be critical in RAS. The index of microcirculatory resistance (IMR) provides additional microvascular information, which has not been used in RAS patients.

Purpose
To investigate the feasibility of IMR measurement in RAS patients and the association with the outcome.

Methods
FAIR-pilot study is a multicenter pilot randomized controlled trial exploring the application of FFR to guide the renal artery stenting in patients with renovascular hypertension (NCT05732077). A pressure-temperature sensor guidewire was used to measure the IMR. To derive mean transit time at rest, thermodilution curves were obtained by 3 injections of 4 mL of room temperature saline down the renal artery. Hyperemia was induced using dopamine 50μg/kg bolus to the renal artery. The IMR was calculated as distal arterial pressure (Pd) x mean transit time during hyperemia (TmnH) (Figure 1). Prognostic evaluation was based on improvements in postoperative blood pressure, which was assessed using both ambulatory blood pressure monitor (ABPM) and anti-hypertensive medication number, along with renal function, as determined by the estimated glomerular filtration rate (eGFR).

Results
The IMR was measured among five patients enrolled in FAIR-pilot study. As shown in Table 1 and 2, stent implantation was conducted on five lesions across patients 1 to 4 based on renal FFR &lt; 0.8, with each experiencing varying degrees of improved blood pressure control subsequently. Patient 5 did not receive a stent and was lost to follow-up. At three-month, the recorded decrease in systolic blood pressure ranged from a maximum of 34 mmHg to a minimum decrease of -6 mmHg among the four patients. The antihypertensive medication number showed a maximum reduction of 2 and no change as the minimum. We observed a correlation between baseline IMR and baseline renal function. No significant change in IMR was noted after interventional procedures. Preliminary findings suggest that IMR measurement is feasible in patients with RAS, while the ∆T (temperature change time) was very small, which potentially increasing the measurement bias.

Conclusion
The study suggests measuring IMR in patients with RAS is feasible and can offer information into the renal microvasculature. However, the small ∆T encountered during measurement may introduce increased bias, which should be considered when interpreting results.
LV reverse remodeling after SAVR in patients with severe symptomatic aortic stenosis: impact on the clinical outcome
Authors: Lima M R L , Abecasis J A , Reis Santos R R S , Maltes S M , Guerreiro S G , Freitas P F , Ferreira A F , Ribeiras R R , Andrade M J A , Madeira M M , Ramos S R , Sousa Uva M S U , Adragao P A 
Published: October 2024

Abstract

Introduction
Surgical aortic valve replacement (SAVR) is the treatment of choice for young patients with severe aortic stenosis (AS) and low surgical risk. Left ventricular (LV) reverse remodeling (RR) after surgery is expected to occur. However, this is not always the case following afterload relief, and this may impact the prognosis. We aimed to assess the prognostic effect of distinct definitions of LV RR after SAVR in the long-term outcome of patients with severe AS.

Methods
Single-centre prospective study including patients referred for SAVR due to severe symptomatic AS, with no previous history of ischemic cardiomyopathy. Both pre- and post-operative transthoracic echocardiographic (TTE) and cardiac magnetic resonance (CMR) study (at the 3rd to 6th month after SAVR) were performed. LV RR was defined when in presence of at least one of the imaging criteria: &gt;15% decrease in end-diastolic volume (EDV) by CMR; &gt;15% decrease in LV indexed mass (LVM) by CMR; &gt;10% decrease in geometric remodeling (LV mass/EDV ratio) by CMR; &gt;10% increase in LV ejection fraction (LVEF) by CMR; &gt;50% increase on global longitudinal strain (GLS) by TTE. We assess the prognostic value of RR definitions for the outcome after SAVR using Cox regression and Kaplan-Meier analysis. The primary endpoint was defined as all-cause mortality, heart failure (HF) hospitalization or worsening HF.

Results
We enrolled 140 patients – mean age 71±9 years-old, 49% male, predominantly high-gradient-normal flow AS (mean gradient 65±18mmHg, aortic valve area 0.7±0.2cm2, index stroke volume 47±11mL/m2) submitted to SAVR. At a mean follow-up (FUP) of 34±12 months, 23 (16%) patients met the primary endpoint: 4% (5 patients) died immediately after surgery; three patients died at the FUP (overall mortality rate of 6%). 12 patients (9%) were admitted for HF and 7 (5%) had at least one episode of worsening HF. 118 patients had complete pre and post-surgery imaging study (mean FUP: 36±10 months): 103 patients (87%) had at least one RR parameter (Table 1). Post-operative RR was not independently associated with the clinical outcome (Figure 1A). LVM was the sole independent predictor of the outcome at univariate analysis (Figure 1B–F).

Conclusions
LV RR after SAVR is highly prevalent in a cohort of patients with classical severe symptomatic AS. However, only LVM regression independently predicts the clinical outcome after surgery. This may stand the greater importance of structural reverse remodeling, rather than LV functional improvement, after pressure overload relief.
Association of hypertension and the risk of cancer: a study based on the UK Biobank
Authors: Wu H , Li Z H , Ou Y Q 
Published: October 2024

Abstract

Introduction
With the increasing incidence rate of hypertension and carcinoma, there is a growing interest in investigating the potential link between these two diseases. The subdiscipline of hypertension, Onco-hypertension, has been proposed and attracted much attention. However, there are still few researches on this subdiscipline.

Purpose
This study aims to investigate the relationship between hypertension and the occurrence of cancer. Additionally, we explore whether anti-hypertensive treatment has any impact on the incidence of cancer.

Methods
This study involved 244,496 participants recruited between 2006-2010 from the UK Biobank, with 21,765 participants were diagnosed with the hypertension according to the ICD10 coding. The Cox regression was used to analyse the the risk of cancer associated with hypertension. The effect of anti-hypertensive treatment on the occur of cancer was also verified according to the Cox regression and the Drug target Mendelian randomization.

Results
Compared to those participants without hypertension, those people with hypertension have higher risk of the occur of cancer(adjusted hazard ratio(aHR) 1.35, 95% confidence interval(CI)1.3-1.4), especially in breast cancer(aHR 1.43, 95% CI 1.27-1.61), prostate cancer(aHR 1.85, 95% CI 1.7-2.02), lung cancer(aHR 2.15, 95% CI 1.86-2.48), renal cancer(aHR 1.91, 95% CI 1.46-2.49), pancreas cancer(aHR 1.55, 95% CI 1.2-2). Compared to those people with hypertension but without anti-hypertensive treatment, the anti-hypertensive treatment increase the cancer risk(aHR 1.19, 95% CI 1.06-1.33). However, thiazide diuretic have protect effect for hypertension patients on occur of the prostate cancer (aHR 0.74, 95% CI 0.61-0.89) and beta-receptor blocker have protect effect for hypertension patients on occur of the lung cancer (aHR 0.71, 95% CI 0.54-0.93). The result of Drug target Mendelian randomization shows the anti-hypertensive treatment have no significant effect on the risk of cancer.

Conclusion
The onset of high blood pressure is linked to an elevated risk of several cancers. However, it cannot be conclusively determined whether the use of medications for high blood pressure increases or decreases the overall risk of cancer. This study provides instructive evidences for the further study of Onco-hypertension.The result of main analyseThe analyse of the antihypertensive drug