bluuebunny/crossref_metadata_2025_split huggingface dataset:
RISK OF MAJOR ADVERSE CARDIAC EVENTS IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND METABOLIC SYNDROME: RESULTS OF A LONGITUDINAL COHORT STUDY
Authors: Abulimiti Ayinigeer , Luo Qin , Heizhati Mulalibieke , Li Nanfang 
Published: May 2024

Objective:
Obstructive sleep apnea (OSA) and metabolic syndrome (MS) may act synergistically and possibly accelerate the initiation and progression of cardiovascular events disease. We examined the joint effect of OSA and MS on the risk of major adverse cardiovascular events (MACE) in hypertensives in a Longitudinal cohort study.

Design and method:
We conducted a retrospective cohort study enrolling 3134 participants, no history of myocardial infarction (MI), coronary revascularization, unstable angina, and hospitalization for heart failure at baseline, from the Urumqi Research on Sleep Apnea and Hypertension study. An apnoea-hypopnoea index (AHI) of greater than or equal to 5 events per hour recorded by PSG was defined as the diagnostic criterion for OSA. MS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria (ATP III). The outcome was the composite of MACE, which included cardiac death, MI, coronary revascularization, unstable angina and hospitalization for heart failure. We divided participants into four groups for the primary exposure according to the presence/absence of OSA or MS. The Kaplan-Meier method helped to calculate the cumulative incidence of MACE in different groups. Cox proportional hazards regression models were used to evaluate the association of OSA and/or MS with the risk of MACE.

Results:
During a median follow-up period of 7.06 years (interquartile range: 6.18-8.08 years), 190 incident MACE were identified. Overall, after adjusting for confounding variables, participants with OSA and MS were associated with a 2.51-fold and 1.60-fold increased risk of MACE with corresponding HRs (95% CI) of 2.51 (1.01, 6.21) and 1.60 (1.10, 2.31), compared with participants without OSA and MS, and participants with OSA or MS, respectively. Similar results were obtained in various subgroup and sensitivity analyses.
The combination of OSA and MS was associated with the highest risk of MACE among participants who in younger age, and have shorter duration of hypertension. Sensitivity analyses further validated our primary findings.

Conclusions:
Combination of OSA and MS in hypertension could significantly increase the risk of MACE, suggesting that recognition and treatment of OSA and MS may decrease the cardiovascular risk in hypertensives.
ACUTE EFFECTS OF SODIUM CHLORIDE OR ITS SUBSTITUTE POTASSIUM CHLORIDE ON VASCULAR FUNCTION IN HEALTHY VOLUNTEERS
Authors: Rammo Randa , Stock-schröer Annika Marie , Kantauskaite Marta , Rump Lars Christian , Streese Lukas , Stegbauer Johannes 
Published: May 2024

Objective:
High blood pressure, one of the most important risk factors for cardiovascular mortality, leads to vascular dysfunction and subsequently to arteriosclerosis, stroke, kidney and heart failure. High salt intake and low potassium intake are associated with high blood pressure and an increased risk of cardiovascular disease and mortality. Partial replacement of sodium with potassium led to a lower risk of cardiovascular events and death in a long-term follow-up study. However, the exact mechanism remains unclear. Our aim was to investigate the acute effects of sodium or potassium intake on vascular health to unravel the underlying mechanisms leading to vascular adaptations.

Design and method:
Six male and nine female healthy individuals (mean age 31 years) were randomized to either 9g of sodium chloride (high salt group), 6g of sodium chloride (regular salt group) or 6 g of sodium chloride plus 3g of potassium chloride group (substitution group). Individuals received a salty soup with the corresponding sodium or potassium load. Blood analyses, blood pressure, body composition and macro- as well as microvascular measurements were performed before as well as four (t4) and 24 hours (t24) after soup intake. To investigate macrovascular health, carotid-to-femoral pulse wave velocity was analyzed. Microvascular health was measured by investigating retinal vessel diameters.

Results:
The high (139±2mmol/l vs. 143±2mmol/l p=0,003) and regular salt group (140±2mmol/l vs. 141±0,6 mmol/l p=0,029) showed both higher serum sodium concentrations at t4 compared to baseline. These higher values were normalized at t24. The serum sodium concentration of the substitution group showed no statistically significant difference between timepoints. The substitution group showed improved microvascular health, quantified by higher arteriolar-to-venular diameter ratio from baseline to t4 (0,86±0,09 vs. 0,89±0,08 p=0,005). These improvements were regressive at t24 (0,88±0,09). No statistically significant changes were found on pulse wave velocity. The high and regular salt group showed no statistically significant differences at any timepoint on micro- or macrovascular health parameters.

Conclusions:
Replacement of sodium by potassium seems to improve microvascular function directly after potassium intake. These results might explain the long-term beneficial effects of potassium on cardiovascular outcomes.
ROLE OF CAROTID ULTRASONOGRAPHY IN RECLASSIFYING TOTAL CARDIOVASCULAR RISK
Authors: Stathopoulou Panagiota , Komnianou Aikaterini , Menti Ariadni , Kyriakoulis Konstantinos , Stergiou George , Kollias Anastasios 
Published: May 2024

Objective:
The estimation of total cardiovascular risk (CVR) is essential for optimal treatment decisions including drug treatment initiation and treatment goals. The aim of this study was to evaluate the contribution of ultrasonographic identification of asymptomatic carotid atherosclerosis in the reclassification of the CVR compared to the reference Systematic COronary Risk Evaluation 2 (SCORE2) algorithm.

Design and method:
Individuals aged 40-69 years, without established cardiovascular disease or diabetes and at least 1 CVR factor (hypertension, hyperlipidemia, smoking) were assessed by blood pressure (BP) measurements, blood tests and carotid ultrasonography. According to SCORE2 they were classified into 3 CVR categories: (i) low-moderate, (ii) high, and (iii) very high CVR. According to carotid ultrasonography they were classified into 3 CVR categories: (a) no plaque: low-moderate CVR, (b) plaque(s) with <50% stenosis: high CVR, (c) plaque(s) with >= 50% stenosis: very high CVR.

Results:
140 participants were analyzed (age 57±7 years, male 49%, smokers 24%, treated for dyslipidemia 37%, treated for hypertension 51%, body mass index 28±5 kg/m2, systolic BP 127±14 mmHg, LDL-cholesterol 121±35 mg/dl). Based on SCORE2 the CVR of the participants was categorized as low-moderate 41%, high 50%, and very high 9%, while based on carotid ultrasonography the respective percentages were 33%, 65%, and 2%. 48% of the individuals (53% of men; 45% of women), identified as low-moderate CVR based on SCORE2 were reclassified into a higher risk category by carotid ultrasonography. On the contrary, 23% the individuals (28% of men; 15% of women) categorized as high CVR by SCORE2 were reclassified as low-moderate CVR by carotid ultrasonography. The agreement between the two methods for the 3 CVR categories was 70% for low-moderate CVR (kappa 0.33, P<0.001), 59% for high CVR (kappa 0.18, P=0.03), 90% for very high CVR (kappa 0.09, P=NS). Among 94 individuals classified as high or very high CVR based on carotid ultrasonography, only 4 had LDL-cholesterol <70 mg/dl.

Conclusions:
These preliminary findings suggest that carotid ultrasonography appears to have considerable reclassification value for CVR estimation in middle aged individuals with important implications in optimizing treatment.
PERIPHERAL ARTERIAL STIFFNESS PREDICTS INDEPENDENTLY FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE
Authors: Kaminski Krzysztof , Kowalczyk Kamil , Kwarciany Mariusz , Narkiewicz Krzysztof , Karaszewski Bartosz , Gasecki Dariusz 
Published: May 2024

Objective:
Aortic stiffness is a strong predictor of morbidity in various clinical conditions, including ischemic stroke. However, the prognostic significance of the peripheral arterial stiffness, defined as radial -carotid pulse wave velocity - for functional outcome in ischemic stroke remains unknown.

Design and method:
We enrolled 189 patients (126 males, age 62.9±11.9 years, mean±SD) with acute ischemic stroke (NIHSS score at admission 6.4±5.1 points). Radial-carotid pulse wave velocity (CR PWV), peripheral blood pressure (BP) and heart rate (HR) were measured (SphygmoCor®) within several (6±2) days after stroke onset. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale (mRS) with an mRS score of 0 to 1 considered as an excellent outcome.

Results:
In univariate analysis, age, severity of stroke, heart rate, previous stroke, predicted stroke functional outcome. By contrast, CR PWV had no significant predictive value for stroke outcome (8.91±1.66 vs 8.56±1.50 m/s; p=0.14). In a multivariate analysis, the predictive value of CR PWV was significantly associated with functional outcome (OR, 1.34; 95% CI, 1.77–1.01; p=0.04) after adjustment for covariates, with higher values of CR PWV being associated with better prognosis.

Conclusions:
We found that the CR PWV in patients in the subacute phase of ischemic stroke is associated with functional outcome independently of traditional neurologic and hemodynamic factors. This PWV index might be useful in clinical practice, including therapeutic decisions, but needs broader studies in patient populations of stroke subtypes.
THE IMPACT OF WINTER SWIMMING ON FUNCTIONAL MICROVASCULAR CHANGES
Authors: Kaczmarczyk Karolina , Matuszewska Urszula , Sajdak Wojciech , Dabrowska Edyta , Michnowska Aleksandra , Hellmann Marcin , Wolf Jacek , Narkiewicz Krzysztof , Dabrowska-kugacka Alicja , Lasocka Zofia 
Published: May 2024

Objective:
Microcirculation plays an important role in the development of cardiovascular control. Therefore, the aim of our study was to investigate the impact of winter swimming on functional changes in cutaneous microcirculation Flow-mediated skin fluorescence (FMSF) is a novel and non-invasive technique assessing microvascular function based on the measurements of nicotinamide adenine dinucleotide hydrogen (NADH) fluorescence intensity in the epidermis and post occlusive reactive hyperemia test. NADH intensity changes in response to blockage and release of blood flow in the brachial artery, which corresponds to microvascular function.

Design and method:
FMSF examinations were performed before and after the winter swimming period lasting from November 2022 to April 2023 in 37 subjects (mean age 46±4,0 years, 65% women). The mean frequency of winter swimming activity was 1,3 times per week. We analysed the following variables: the ischemic response (IRmax and IRindex) – the ratio of relative to baseline maximal increase in fluorescence intensity during cuff occlusion and the hyperaemic response after cuff release (HRmax and HRindex). Flowmotion, measured at baseline (FM) and at reperfusion (FM(R)), reflects flow oscillations. Normoxia oscillatory index (NOI) represents the proportion of endothelial and neurogenic blood flow oscillations in relation to all oscillations detected in low frequency range. The hypoxia sensitivity (HS), measured during reperfusion, reflects the intensity of flowmotion related to myogenic oscillations.

Results:
The statistical analysis revealed following results according to the winter swimming:

Conclusions:
Increase in microvascular oscillations denoted by NOI and HS suggests a beneficial impact of winter swimming on cutaneous microcirculation. Improvement in microcirculation performance may partly explain lowering of cardiovascular risk in regular winter swimmers.
ORTHOSTATIC RESPONSE OF PERIPHERAL AND CENTRAL BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND ATHEROSCLEROTIC CAROTID STENOSIS
Authors: Ionov Mikhail , Gurevich Alexandra , Sagynbaeva Ay -Churek , Emelyanov Igor , Vanyurkin Almaz , Rotar Oxana , Boyarinova Maria , Moguchaia Ekaterina , Kolesova Ekaterina , Chernyavskiy Mikhail , Konradi Alexandra 
Published: May 2024

Objective:
To determine the frequency and severity of orthostatic responses of central and peripheral blood pressure (BP) during the Active Stand Test (AST) in patients with arterial hypertension (HTN) and hemodynamically significant stenosis of the internal carotid artery (ICA).

Design and method:
The intervention group included patients aged 18 years and older with HTN and ICA stenosis >50% (NASCET) of atherosclerotic origin. Patients with HTN without ICA lesions were considered as controls. In all patients AST was performed with the measurement of peripheral BP in the sitting and standing positions after 3 minutes. Orthostatic hypotension (OH) was diagnosed as per current Guidelines: fall of systolic (S)BP equal or more than 20 mmHg or diastolic BP equal or more than 10 mmHg during AST. In the intervention group, central BP assessment during AST and pulse wave contour analysis were also performed.

Results:
There were 77 patients in the intervention group (69±8 years, 44 men) and 77 patients in the control group (68±6 years, 43 men). According to the dynamics of peripheral BP, OH was diagnosed in 21 patients (27%) in the intervention group and in 17 patients (22%) in the control group (p=0,46), but systolic OH was more frequently observed in the former (21 vs. 9 patients; p=0.015). The reduction in central systolic (S)BP was more pronounced than delta peripheral SBP (p =0.001). Changes in peripheral SBP during AST were associated with the presence of a significant ICA lesion (beta in ICA =0.201, p=0.03) and baseline SBP (beta= -0.348, p=0.001). The same variables (the fact of ICA lesion and baseline SBP) mostly explained the development of systolic OH (OR 2.95 (95% CI [1.1-7.7], p=0.03 and beta= 0.437, p<0.001, respectively).

Conclusions:
Asymptomatic OH occurred in 27% of patients with HTN and ICA stenosis, more frequently in the form of isolated systolic OH. The amplitude of central SBP reduction significantly exceeded the dynamics of peripheral SBP The presence of carotid stenosis and higher initial values of peripheral SBP associated with the dynamics of SBP in standing and the occurrence of OH.
HIGH SALT DIET EFFECTS ON CEREBRAL AND SYSTEM HEMODYNAMICS IN RESPONSE TO BREATH HOLDING TEST AND HYPERVENTILATION
Authors: Drenjancevic Ines , Dumancic Dijana , Stupin Ana , Goswami Nandu , Debeljak Zeljko 
Published: May 2024

Objective:
High salt (HS) diet impairs endothelium-dependent vasodilation in many vascular beds, including cerebral microcirculation, and may affect vascular resistance. The aim of present study was to determine if 7-day HS diet affected cerebral and system hemodynamics in response to breath holding test (BHT) and hyperventilation in healthy young persons.

Design and method:
In this controlled intervention study 27 persons participated (F:21, M:6, age range 19-24). Participants consumed 7-day low salt (LS) diet (<2.3g NaCl/day) and afterwards 7-day of HS diet (>11.2g NaCl/day). Blood and urine analysis and anthropometric measurements were performed after each diet. Arterial blood pressure, heart rate and heart rate variability (HRV), cerebral and systemic hemodynamic parameters were recorded simultaneously with transcranial Doppler ultrasound and the Task Force® Monitor in response to BHT and hyperventilation.

Results:
The subjects remained normotensive during both protocols. After hyperventilation test, HS diet did not affect parameters of cerebral or systemic hemodynamics. HRV was more decreased after HS diet, while baroreceptor sensitivity (BRS) decreased in both LS and HS diet. Similar lack of effects of HS diet on cerebral and system hemodynamics was observed in BHT. Urine concentration of noradrenaline and vanillylmandelic acid was significantly decreased by HS diet.

Conclusions:
Results suggest that HS diet suppresses sympathetic activity. However, physiological hemodynamic responses to BHT and hyperventilation are preserved, which could be contributed to salt-resistant phenotype of participants and some, still unexplained (chemoreceptors-mediated) compensatory mechanisms preserving cerebral and systemic blood flow.
CLINICAL DETERMINANTS OF THE MACROVASCULAR REACTIVITY RESPONSE AS ASSESSED BY FLOW MEDIATED SLOWING IN PEOPLE AT RISK FOR CARDIOVASCULAR DISEASE
Authors: Decorte Elise , Cauwenberghs Nicholas , Claes Jomme , De Wilde Camille , Michielsen Matthijs , Bekhuis Youri , Hansen Dominique , Van Craenenbroeck Emeline , Goetschalckx Kaatje , Claessen Guido , Kutznetsova Tatiana , De Smedt Delphine , Cornelissen Véronique 
Published: May 2024

Objective:
Non-invasive methods assessing endothelial function may enhance cardiovascular risk evaluation in primary care. Previous research showed that flow-mediated slowing (FMS) of the brachial-radial pulse wave velocity (PWV) reflects cardiovascular risk, but larger studies on the FMS response in at-risk populations are required to further unravel its clinical and added value for cardiovascular risk stratification. We investigated clinical correlates on the FMS response in people at risk for cardiovascular disease.

Design and method:
We collected baseline FMS data from a subsample of 157 participants enrolled in the PRIORITY-trial. Participants had at least one of following risk factors: systolic blood pressure (BP) / diastolic BP between 130/80 – 159/99mmHg and/or antihypertensive treatment, prediabetes with fasting plasma glucose of 5.6-6.9mmol/L or HbA1c 5.7%-6.4%, diabetes mellitus, obesity (BMI > 30kg/m2), or evidence of subclinical diastolic dysfunction.
We continuously recorded brachial-radial PWV using a Vicorder in supine position at rest and after 5-minutes of supra-systolic occlusion of the upper arm. Stepwise linear regression analyses assessed clinical correlates of the FMS response. We illustrated the effect of important correlates on the FMS response by plotting the estimated marginal means for each FMS post-occlusion interval by the mean and one standard deviation.

Results:
The study sample was on average 60.2±11.2 years and included 74 women(47.1%). Until 180 seconds post-occlusion, lower FMS response was significantly associated with higher DBP and higher triglycerides levels (P<0.05 for 0-180s intervals). Higher age only correlated with less decline in brachial-radial PWV in the 60 to 90 seconds post-occlusion interval (P=0.050). Participants with elevated triglycerides or elevated DBP or both exhibited significantly less decline in brachial-radial PWV as compared to those with average or below average levels (Figure1).

Conclusions:
In individuals at increased risk for cardiovascular disease, worse macrovascular reactivity was associated with hypertriglyceridemia and high DBP. Our findings suggest that the use of FMS may have clinical value for cardiovascular risk evaluation and highlight the importance of optimal control of triglycerides and DBP for adequate cardiovascular risk management. More studies are needed for assessing the additive value of such testing for cardiovascular disease prediction and management.
IMPACT OF ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR ON VENTRICULO-ARTERIAL PERFORMANCE AND LEFT ATRIAL FUNCTION: COMPARATIVE PILOT STUDY
Authors: Dadanski Emil , Olszanecka Agnieszka , Zydzik Lukasz , Stopa Marek , Bochenek Michal , Kolodziejski Marcin , Krawczyk Kacper , Piwowarczyk Marek , Rajzer Marek 
Published: May 2024

Objective:
Ventriculo-arterial (VA) coupling characterizes the interaction between myocardial contractile function and the load opposed by the arterial circulation. Clinically, measurable indicators allowing for non-invasive cardiovascular performance assessment include pulse wave velocity (PWV), left ventricular (GLS) and left atrial strain (LA strain). Endovascular repair of the aortic aneurysm is related with changes in arterial properties, yet the impact of these changes on left ventricular and atrial function remains unclear.
Aim: This study aimed to compare selected parameters of cardiovascular performance between individuals post-endovascular abdominal aortic aneurysm repair and age- and sex-matched group of hypertensive individuals without aortic aneurysm.

Design and method:
The study group comprised 36 patients who underwent endovascular stent grafting of the abdominal aorta (mean time from surgery 21,8±8,9 months). Control group included 43 hypertensives matched for age, sex and BMI. In all subjects structured echocardiographic examination was performed, including evaluation of LA strain, left ventricular ejection fraction (EF) and GLS.
Carotid-femoral PWV using SphygmoCor device was measured in all participants. Statistical analysis was conducted using SPSS statistics software.

Results:
The study and control groups did not differ in age (68,9±8,7 vs 67,6±6,6 years; p >0.05), sex (M/F: 32/4 vs 38/5; p>0.05) or BMI (28,9±4,9 vs 29,7 kg/m2; p>;0.05). The study group exhibited significantly higher PWV compared to controls (10,02±1,98 vs 8.99±1,08 m/s; p<0.05).
Furthermore, in the study group lower left ventricular ejection fraction (54,7±9,2 vs 59,0± 5,72%; p<0,01), lower absolute values of LV GLS (16,3±2,5 vs 19,0±3,2%, p=0,05) and lower LA strain (23,5±6,2 vs 29,5±10,8%; p<0.01) were observed.

Conclusions:
This pilot study suggests that changes in arterial stiffness related to endovascular aortic aneurysm repair are associated with worse left ventricular systolic function and left atrial performance. Elucidating their etiology and dynamics necessitates further investigation through prospective studies that account for confounding factors, such as other risk factors that may influence the outcomes of the assessed parameters.
CLUSTER ANALYSIS OF PULSE WAVE VELOCITY LONGITUDINAL TRENDS IN HYPERTENSIVE PATIENTS
Authors: Eula Elisabetta , Cesareo Marco , Pappaccogli Marco , Veglio Franco , Bruno Rosa Maria , Milan Alberto , Rabbia Franco 
Published: May 2024

Objective:
Arterial stiffness (AS) is an important predictor of cardiovascular disease and mortality. Its trend over time, assessed through multiple measurements, is still largely unexplored. The aim of this study was to assess the determinants of trajectories of carotid-femoral pulse wave velocity (PWV) in a cohort of Italian hypertensive adults.

Design and method:
From a population of 2581 hypertensive patients referred to Hypertension Unit of Internal Medicine Division at University Hospital Città della Salute e della Scienza of Turin (Italy) from 2005 to 2023, those who had at least 3 PWV recordings over time were included in this study. Those with rare vascular diseases were excluded. Cluster analysis of PWV trajectories was performed using K-means method.

Results:
A total of 271 patients were included. Median follow-up time was 4.5 [0.6-8.4] years). Three clusters of PWV trends were identified: low-stable (A, n=126), high-increasing (B, n=107), and high-stable (C, n= 38) clusters. Patients in the clusters B and C were progressively older than those in cluster A (60.4±8.9 and 65.8±10.3 vs. 51.9±13.3 years, respectively). Mean BP (MBP) and PWV at baseline were progressively higher in the high-increasing and high-stable clusters compared to the low-stable one (MBP was 103±15 and 111±22 mmHg in clusters B, and C vs. 97±11mmHg in cluster A; PWV was 10.1±0.7 and 13.6±1.4 m/s in clusters B, and C vs. 7.8±0.9 m/s in cluster A; all p<0.001). There were no significant differences in sex distribution or anti-hypertensive treatment among the clusters.
On multinomial regression analysis, older age and higher MBP at baseline were independently associated to increased probability of belonging to either B or C clusters when compared to the low-stable one.

Conclusions:
Through multiple PWV assessment in hypertensive patients during a large time span, this study shows that patients with less favorable arterial stiffness behavior present higher PWV values at baseline. Older age and higher MBP at baseline are associated with worse evolution of PWV over time.