bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION BETWEEN THE ATHEROGENIC INDEX OF PLASMA AND ADVERSE LONG-TERM PROGNOSIS IN PATIENTS DIAGNOSED WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME
Authors: Li Mingkang , Zhang Wenkang , Zhang Minhao , Tang Chengchun 
Published: May 2024

Objective:
Dyslipidemia is a key risk factor for coronary artery disease, and the atherogenic index of plasma (AIP) is a newly identified biomarker associated with lipid metabolism. However, none has addressed the association between AIP and clinical outcome in non-ST elevation acute coronary syndrome (NSTE-ACS) patients firstly implanted with drug-eluting stent (DES). Thus, we sought to evaluate the relationship between AIP and long-term prognosis in NSTE-ACS patients.

Design and method:
A total of 830 patients diagnosed with NSTE-ACS and who underwent DES were included in this study. The AIP index was calculated by log (triglycerides / high-density lipoprotein-cholesterol). Patients were divided into tertiles according to AIP levels (T 1: <0.195; T 2: 0.195∼0.252; and T 3: >0.252). The endpoints were major adverse cardiovascular events (MACE), including all-cause mortality, myocardial reinfarction, and target vessel revascularization during the follow-up period for all patients. Cox regression analysis and Kaplan-Meier curve analysis were performed to examine the relationship between AIP and MACE. Moreover, Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal cut-off value of AIP for predicting MACE.

Results:
During the 12 months of follow-up, a total of 108 patients experienced MACE. The patients with higher AIP values (T 3 group) exhibited a significantly higher incidence of MACE compared to those with lower AIP values (T 1 and T 2 groups) (20.2% vs. 6.2%, and 12.6% respectively; P < 0.05). The Kaplan-Meier curves reported that patients in T3 group had the highest risk of MACE relative to patients in the other groups (log-rank P < 0.001). Furthermore, the multivariate Cox regression analysis demonstrated that patients in the T3 group had a 1.422-fold increased risk of MACE compared to those in the T1 group. In addition, the ROC curve analysis revealed an optimal AIP cut-off value of 0.237 for predicting MACE in patients with NSTE-ACS.

Conclusions:
AIP is a novel and convenient independent predictor of MACE in patients with NSTE-ACS. It is necessary to monitor AIP for risk stratification in NSTE-ACS patients.
STRAIN RATE ECHOCARDIOGRAPHY IN ASSESSMENT OF CLINICAL CARDIAC STATUS IN HYPERTENSIVE PATIENTS
Authors: Karol Anubha , Karol Ajay 
Published: May 2024

Objective:
Strain Rate Echocardiography (SRE) measures rate of change of contraction (LS) of cardiac fibres, the major component of overall cardiac contractility. Cardiac end organ involvement in Hypertension is omnipotent. We assessed utility of SRI in identifying clinical dysfunction of myocardial contractility in Hypertensives subjects.

Design and method:
We looked at Colour Doppler and Strain Rate Echocardiography data of 523 patients, with sequential Blood Pressure measurements(Thrice over 10 minutes). Hypertensives (n=136) constituted patients with average BP >130/80. Rest were designated as Normotensives(n=387). Left Ventricular Mass (LVM), Left Atrial Volume (LAV), Mitral E/e‘ ratio as surrogate for LV end diastolic pressure (LVEDP), were analysed for comparison. Unpaired Chi square test determined statistical significance.

Results:
Ejection Fraction were similar (56%+/-0.41 vs 58%+/-0.11). Normotensives showed positive correlation between LS and Systolic BP. However, negative correlation was observed in Hypertensives. In bothgroups, moderate inverse correlation between LVM, LVEDP versus GLS was observed. In both groups,LS was reduced in patients with high LVMi(p<0.0001), high LVEDP(p<0.003), increased LAV(p<0.01). The difference was statistically, highly significant. Difference in LS between Dippers (n=227) and Non-Dippers(n=296) was statistically not significant. However, LVM, LVEDP and LAV were higher in Non-Dippers. (p<0.001,p<0.03,p<0.02 respectively)

Conclusions:
LS measures longitudinally arranged cardiac fiber's function (predominantly sub-endocardial region) Present study showed, increased LVM and High LVEDP depresses their contractility, may lead to heart failure in future. Efforts to reduce intracardiac pressures and LV mass and Blood pressure will preserve cardiac function in hypertensives. Thus, LS estimation can identify subset who will respond to aggressive afterload reduction in hypertensives.
THE CHARACTERISTICS AND CLINICAL COURSE OF SPONTANEOUS CORONARY ARTERY DISSECTION: DIFFERENCES BETWEEN PATIENTS WITH AND WITHOUT HYPERTENSION- INSIGHTS FROM SCAD-POL REGISTRY
Authors: Kadziela Jacek , Zalewska Joanna , Michalowska Ilona , Kochman Janusz , Januszewicz Magdalena , Zarebinski Maciej , Radecki Pawel , Szybka Wojciech , Koch Rafal , Adlam David , Januszewicz Andrzej , Witkowski Adam 
Published: May 2024

Objective:
Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome of unknown etiology. Potential risk factors and comorbidities are female gender, fibromuscular dysplasia (FMD) and increased tortuosity. HTN is associated with increased coronary tortuosity and both have been shown to increase the risk of recurrence after SCAD. The aim of this study was to assess angiographic data and clinical course of SCAD in patients with HTN.

Design and method:
the study group comprised of 94 consecutive patients (97.8% females, aged 44.4 ± 9.3 years) with a history of angiographically confirmed SCAD, included in nationwide SCAD-POL registry. All medical records were gathered and angiography images reviewed, classifying SCAD type according to ESC classification. Patients (n=87) underwent head-to pelvis computed tomography angiography for FMD screening.

Results:
34 patients (97.1% females) had HTN. Hypertensive patients were characterized by increased age (48.5 ± 10.0 vs 42.1 ± 8.1 years, p<0.005), had more often hyperlipidemia (32.3 vs 11.7%, p<0.05) and more frequently were diagnosed with NSTEMI (70.6 vs 48.43%, p<0.05). FMD was diagnosed more often in patients with HTN (48.5% vs 23.7%, p<0.05). Looking at the distribution of FMD, the prevalence of FMD in cervical arteries was significantly higher in patients with HTN (28.1% vs 8.5%, p<0.05). In patients with HTN, proximal segments of coronary arteries were much less frequently affected by SCAD (11.8 vs 31.7%, p<0.05) and type 2b SCAD was more often observed (26.5 vs 10.0%, p<0.05). There were no differences in terms of PCI (32.3 vs 36.7%) and conservative management (67.6 vs 58.3%) between hypertensive and non-hypertensive subjects. Although, the left ventricle dysfunction (EF<50%) was less frequently observed at discharge in patients with HTN (10.7 vs 41.8%, p<0.01).

Conclusions:
patients with HTN were characterized by more favorable angiographic characteristics and clinical course of SCAD and higher prevalence of FMD. Further investigation of the relationship between hypertension, coronary tortuosity and the course of SCAD is merited.
ERDOSTEINE REINSTATE MYOCARDIAL NECROSIS: INNOVATORY EFFECT THROUGH MODULATION OF MAPK AND NRF 2/HO 1 PATHWAY
Authors: Kumaraguruparan Nivetha , Verma Vipin Kumar , Bhatia Jagriti , Arya D S 
Published: May 2024

Objective:
Erdosteine, a mucolytic drug, proved as a potent anti-inflammatory agent via free radical scavenging, in several pre-clinical studies. To amend the effect of Erdosteine (thiol-based drug) against oxidative stress, inflammation, apoptosis/ necroptosis in a catecholamine rush-induced myocardial necrosis model was performed in male Wistar rats.

Design and method:
The 48 Male albino Wistar rats were divided into eight groups (n = 6), that is, Normal, Isoproterenol control, and 6 different erdosteine pretreatment groups at subsequent increasing doses from 5 to 160 mg/Kg followed by ISO (Isoproterenol) administration. Rats were given erdosteine orally for 28 days. Two doses of ISO (85 mg/kg), s.c. were given to Isoproterenol control and erdosteine pretreatment groups on the 27th and 28th day at 24-hour intervals. On the 29th day, hemodynamic parameters were recorded using BioPac systems BSL 4.0 MP36 software. After measuring left ventricular pressure, blood was withdrawn and the heart was excised for biochemical, histopathological and molecular parameters.

Results:
In Isoproterenol control rats, significantly increased levels of cardiac-injury markers (CK-MB, LDH), anti-oxidant oxidant ratio (MDA, GSH, and SOD), inflammatory markers (TNF-alpha and IL-6), Reactive Oxygen Species (ROS), inflammatory proteins (MAP kinases), apoptotic proteins (Bax, Bcl-2, Caspase-3) were observed as compared with the normal group. The Pathological and ultrastructural damage were also observed more in Isoproterenol control group as compared with normal group. Furthermore, immunohistochemistry and terminal deoxynucleotidyl transferase dUTP nick end labelling revealed an increased expression of apoptotic proteins. In Erdosteine pre-treatment groups, we found dose-dependent attenuation of inflammation, oxidation, and apoptosis. Erdosteine at 80 mg/kg countermand the detrimental effects of ISO and preserved the myocardium architecture. Erdosteine showed anti inflammatory, antiapoptotic, and antioxidant activities through the inhibition of MAPK and Nrf 2 |HO 1 pathways.

Conclusions:
Erdosteine was found protective in ISO induced myocardial necrosis through MAPK and Nrf 2 |HO 1 pathwaysand can be further used as an effective treatment against inflammation more specifically in myocardial infarction. Furthermore, more evidence is required for use of Erdosteine in clinical use.
BIO-HUMORAL AND HAEMODYNAMIC CORRELATES OF RENAL VENOUS CONGESTION IN THE HEART FAILURE SPECTRUM
Authors: Del Punta Lavinia , De Biase Nicolo’ , Filidei Francesco , Balletti Alessio , Armenia Silvia , Di Fiore Valerio , Pugliese Nicola Riccardo , Masi Stefano 
Published: May 2024

Objective:
Increased central venous pressure worsens systemic congestion in heart failure (HF); this has a particular pathophysiological significance in the renal vascular bed, which can be evaluated by Doppler analysis of renal venous flow (RVF). RVF is continuous in healthy subjects and becomes discontinuous with increased fluid retention; thus, RVF evaluation allows for refined pathophysiological characterisation in HF. We sought to analyse the relationship between different RVF patterns, echocardiography-derived haemodynamics and laboratory parameters in patients at risk of or with overt HF.

Design and method:
The study enrolled 304 patients. 63 patients were at risk of developing HF, while 241 had overt HF. Among the latter, 61 patients had preserved left ventricular ejection fraction (LVEF >=50%), and 180 had reduced LVEF (<50%). All subjects underwent a baseline echocardiographic examination, lung ultrasound, Doppler-derived RVF evaluation, and laboratory evaluation of blood and urine samples.

Results:
The most prevalent cardiovascular risk factor was arterial hypertension (AH), which was present in 60% of patients at risk of developing HF and in 72% of those with overt HF.
RVF was continuous in 230 patients (76%), and discontinuous in 74 (24%; dRVF). Among the latter, 39 showed pulsatile dRVF, 18 showed biphasic dRVF (i.e., two separate phases of venous flow), and 17 showed monophasic dRVF (i.e., only during diastole). dRVF was more prevalent in patients with overt HF. Monophasic dRVF was associated with more severe haemodynamic impairment and impaired renal function, as evaluated by estimated glomerular filtration rate and urinary albumin-to-creatinine ratio. After adjusting for clinical confounders, worsening RVF patterns were associated with increased natriuretic peptide levels, worse right ventricular-pulmonary arterial uncoupling, increased inferior vena cava diameter, and increased estimated pulmonary capillary wedge pressure (Figure). These results were confirmed in the subgroup of patients with overt HF, even after adjusting for LVEF.

Conclusions:
The evaluation of RVF patterns improves the characterisation of patients with HF. The pathophysiological significance of impaired RVF is independent of common cardiovascular risk factors and LVEF. Implementing RVF analysis in clinical practice could allow for timely identification of patients at greater risk for developing or worsening HF.
PREVALENCE AND CHARACTERISTICS OF ISOLATED NOCTURNAL HYPERTENSION IN TREATED PATIENTS
Authors: Rhee Moo -Yong 
Published: May 2024

Objective:
This study aimed to identify the prevalence and characteristics of isolated nocturnal uncontrolled hypertension (INUCH) in treated patients.

Design and method:
Participants (n=701) aged >=20 on antihypertensive drugs were recruited via advertisements between August 2018 and April 2020 and underwent 3-day office (3 readings every visit) and 24-hour ambulatory blood pressure (BP) measurements. Hypertension phenotypes were categorized as controlled (CH), isolated daytime uncontrolled (IDUCH), INUCH, and day-night uncontrolled hypertension (DNUCH), according to 2023 ESH guidelines.

Results:
Of 650 participants with valid BP data, INUCH prevalence was 32.3% (34.9% in patients with office BP <140/90 mmHg), with a higher prevalence of men and drinkers than CH. INUCH patients exhibited higher office systolic (SBP) and diastolic BP (DBP) than CH. INUCH prevalence was higher in patients with office BP <140/90 mmHg (34.9% vs. 18.9% for >=140/90 mmHg). INUCH rates decreased across office BP categories (37.6% in optimal, 38.5% in normal, 27.9% in high-normal, and 18.9% in uncontrolled office BP), while DNUCH increased (10.6% in optimal, 24.2% in normal, 53.5% in high-normal, and 71.7% uncontrolled office BP). Among INUCH patients, 48.1% had isolated uncontrolled DBP, 8.6% had isolated uncontrolled SBP, and 43.3% had both. Those with isolated uncontrolled DBP were younger (p=0.016), more males (p=0.017), and drinkers (p=0.006) than those with isolated uncontrolled SBP and DBP. Multivariate analysis in patients with office BP <140/90 mmHg revealed age and alcohol drinking as positive and high-normal OBP as negative INUCH factors. Isolated uncontrolled DBP and uncontrolled SBP and DBP were significantly associated with INUCH. Brachial-ankle pulse wave velocity was significantly higher in INUCH patients than in CH patients after excluding patients with isolated uncontrolled DBP.

Conclusions:
The considerable INUCH occurrence in normal/optimal office BP patients implies treatment challenges. The association of alcohol consumption with INUCH underscores moderation in hypertension treatment. Although the prognostic significance of INUCH with isolated uncontrolled DBP was undetermined, distinguishing between isolated uncontrolled DBP and uncontrolled SBP seems necessary in evaluating the prognostic significance of INUCH.
ARTERIAL HYPERTENSION AND BLOOD PRESSURE RESPONSE TO EXERCISE IN ATHLETES
Authors: Jelínek Libor , Moravcová Katarína , Ozana Jaromír , Sovová Markéta , Václavík Jan , Jiravský Otakar , Jiravská-godula Bogna , Pesová Petra , Puskasová Kristina , Sovová Eliska 
Published: May 2024

Objective:
Arterial hypertension is one of the most important risk factors for cardiovascular disease and the most common pathological finding in the examination of athletes. On the other hand, physical activity leads to a reduction in blood pressure and is thus an essential part of a regimen in the treatment of hypertension.
People who wish to engage in sport at the competitive level should be pre screened by a stress test. A number of those examined have resting hypertension and a part has an exaggerated response to exercise.
Our aim was to determine what proportion of the tested athletes had each hypertensive phenotypes and exercise BP hyperresponsiveness. Furthermore, we wanted to compare the prevalence of arterial hypertension between different types of sporting activity - mixed, endurance, strength and skill.

Design and method:
We retrospectively analyzed data from 1,733 adult athletes who underwent stress testing at two sports medicine centers between 2019 and 2023. The mean age was 24.9 years, 69% of the subjects were male and the relative performance was on average 4.08 W/kg. Clinical data at rest and during exercise were measured and recorded. Subsequently, the data were statistically processed.

Results:
A total of 431 (24.9%) subjects met the criteria for arterial hypertension when resting blood pressure was measured. Z 182 (10.5%) had isolated systolic hypertension and 104 (6%) had isolated 19 (1.1%) subjects had exertional hypertension. Elevated diastolic blood pressure occurs significantly more frequently in athletes with skill or strength type sports than in athletes with mixed type sports (24.0% and 24.2% vs. The hypertensive response to exercise occurs significantly more frequently in athletes with strength-type sports than in athletes with mixed-type sports (4.5% vs. 0.7%, p = 0.006).

Conclusions:
The higher incidence of resting and exertional arterial hypertension in specific types of sports should lead to more intensive diagnosis and care for these specific types of athletes.
The definition of exertional pressure hyperreaction is currently inconsistent. Longer follow-up of individuals with borderline and pathological values could lead to more effective indication for testing and subsequent treatment and regimen measures.
MOLECULAR MECHANISM OF PDE3A SIGNALING IN HYPERTENSION WITH BRACHYDACTYLY (HTNB)
Authors: Tiannan Liu , Enno Klussmann , Kerstin Zuhlke , Anastasiia Sholokh , Ranjan Pati Swaroop , Alexander Blume , Altuna Akalin , Yumi Sunaga -Franze Daniele , Tatiana Borodina 
Published: May 2024

Objective:
Hypertension with brachydactyly (HTNB) is a syndrome characterized by progressive hypertension, brachydactyly type E, and blood vessel hyperplasia. HTNB is caused by mutations in the gene encoding phosphodiesterase 3A (PDE3A). The mutations cause hypertension by increasing vascular smooth muscle cell (VSMC) proliferation and compromising relaxation of second-order mesenteric arteries. cAMP signaling occurs in defined cellular compartments where PDE3A hydrolyzes and thereby limits cAMP levels. The objective of this project is the elucidation of molecular mechanism of mutant PDE3A-induced hypertension to identify novel therapeutic strategies targeting PDE3A signaling compartments for the treatment of hypertension.

Design and method:
Experiments were performed with three models: thoracic aorta and second-order mesenteric artery VSMCs from wild-type and rat HTNB models, and VSMCs differentiated from human induced pluripotent stem cells carrying PDE3A mutations that cause HTNB (iPSC-VSMCs). RNA-seq, RT-qPCR and Western blotting were used to validate gene and protein expression differences of candidates. Intracellular Ca2+ signaling changes were analyzed by Ca2+ imaging.

Results:
RNA-seq and RT-qPCR results showed that several genes were differentially expressed between wild-type and HTNB VSMCs. For example, compared with wild-type, PDE3A expression was downregulated in blood vessels derived from HTNB rats, whether derived from thoracic aorta or second-order mesenteric arteries. The protein expression of regulatory subunits of protein kinase A (PKA) was decreased in the second-order mesenteric arteries of HTNB models but there was no significant change in the thoracic aorta. Ca2+ imaging of iPSC-VSMCs revealed greater contractility in cells carrying PDE3A mutations.

Conclusions:
Mutant PDE3A signaling may be a starting point for an innovative, PDE3A compartment-specific pharmacological concept for the treatment of hypertension.
SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH ELEVATED NATIVE T1 TIME IN CARDIAC MRI SUGGESTING MYOCARDIAL FIBROSIS IN PEDIATRIC KIDNEY TRANSPLANT RECIPIENTS
Authors: Von Der Born Jeannine , Ubenauf Tim , Sugianto Rizky I. , Grabitz Carl , Memaran Nima , Babazade Nigar , Falk Jan , Renz Diane , Schmidt Bernhard Mw , Kanzelmeyer Nele , Melk Anette 
Published: May 2024

Objective:
Cardiac alterations and complications are common after pediatric kidney transplantation (KTx). In adults, myocardial fibrosis is an established surrogate marker for cardiac mortality. Non-contrast native T1 time (nT1) in cardiac MRI offers the possibility to detect structural myocardial changes. Data for children after KTx is not available yet. We aimed to assess function and structure in cardiac MRI in pediatric KTx-recipients with a focus on nT1.

Design and method:
46 KTx-recipients (mean age 16±3.5 years; 7.9±5.3 years after KTx) and 46 sex- and age- matched healthy controls were examined with gadolinium-free cardiac MRI. nT1 and T2 time were measured at the interventricular septum (basal and mid-ventricular short-axis slice). Further parameters derived from MRI were: left ventricular mass index (LVMI), left ventricular ejection fraction (LV-EF) and global longitudinal strain (GLS). Multivariable linear regression analysis (co-variates: age, sex, height) was used to evaluate the association between nT1 and clinical parameters.

Results:
KTx-recipients had a significant higher nT1 than healthy controls (1198±48.8ms vs. 1155±23.4ms; p< 0.001). In 22 KTx-patients (48%) nT1 values were above the total range of controls.
T2 time showed no significant difference between the groups. KTx-recipients showed a higher LVMI z-score (LVMIz), a higher LV-EF and a lower GLS. Higher nT1 was associated with systolic blood pressure (SBP; ß=1.28; p=0.001; Fig. 1), LVMIz (ß=1.55, p<0.001) and LV-EF (ß=3.52, p=0.026) only in patients, but not in controls. Further evaluation of KTx-recipients revealed that nT1 tended to be higher with longer time on dialysis, no association was seen for time since KTx.

Conclusions:
Our data suggest the presence of cardiac remodeling with myocardial fibrosis in a significant proportion of young KTx recipients. Non-contrast CMR imaging has the potential as a diagnostic adjunct in the follow-up of KTx recipients for a better risk stratification. Longitudinal studies are needed to evaluate if preventive targeting of associated factors, especially optimization of BP control, might reduce the prevalence of sudden cardiac death in young KTx recipients.
TIME IN TARGET RANGE OF SYSTOLIC BLOOD PRESSURE AND EGFR SLOPE IN PATIENTS WITH TYPE 2 DIABETES
Authors: Sheng Chang -SHENG , Cheng Yi , Tian Jingyan 
Published: May 2024

Objective:
Time in target range (TTR) of systolic blood pressure, a novel measure to assess the effect of blood pressure control, is attracting attention in recent European guidelines. However, few studies have explored the renoprotective value of systolic TTR in patients with type 2 diabetes (T2D).

Design and method:
We used the database of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial, and 4409 eligible participants were enrolled in the present study. The systolic target range for the standard and intensive therapy was defined as 120 to 140 mm Hg and 110 to 130 mm Hg, respectively.

Results:
After adjustment for covariates, systolic TTR was significantly and positively associated with 2 indices of eGFR slope (P <= 0.0016), regardless of additional adjustment for systolic blood pressure average and variability. The association of systolic TTR and eGFR slope was significantly stronger in CKD patients than those without CKD (P for interaction <=0.044). When TTR was treated as a categorical variable, participants with the highest systolic TTR in the CKD group had a significantly positive association with eGFR slope (P <= 0.00046). Similar results were obtained in the further subgroup analysis.

Conclusions:
Among patients with diabetes, systolic TTR showed a significant and positive association with eGFR slope, with a stronger association observed in those with CKD. TTR reflects both blood pressure level and stability across blood pressure management, emphasizing the importance of maintaining stable blood pressure control for renoprotection in T2D patients, particularly in those with CKD.