bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of different ages of onset on cardiopulmonary function in Chinese patients with systemic lupus erythematosus
Authors: Zhou M , Wong C K , Siu C W 
Published: November 2023

Abstract

Background
Despite being most prevalent in adults, systemic lupus erythematosus (SLE) can also be diagnosed in teenagers and older adults. The levels of sex hormones in people of different ages were varied and the clinical features and disease activity of SLE were affected by hormonal changes. Whether the ages of onset impact the cardiopulmonary manifestations was not well explored in patients with SLE.

Purpose
The purpose of this registry was to investigate the difference in clinical features and cardiopulmonary performance in patients with childhood-onset SLE, or young adulthood onset SLE and adulthood-onset SLE.

Methods
patients aged 18 or older and meeting the diagnostic standards of SLE which were established by the ACR in 1997 were included in this study. Patients were divided into childhood-onset (&lt; 18 years old ), young adulthood-onset (18∼35 years old ), and adulthood-onset groups (&gt;35 years old ) based on the different ages at diagnosis. Clinical and demographic data were collected from the clinical management system. In addition, laboratory tests, six-minute walk test (6MWT), electrocardiography, transthoracic echocardiography, and pulmonary function were performed for all patients.

Results
1054 patients with SLE were enrolled in this study. The adulthood-onset group has a higher systolic blood pressure, shorter 6MWTD, and a higher proportion of chronic kidney disease compared to the other two groups (p&lt;0.05). In contrast, mixed connective tissue disease (MCTD) has occurred more frequently in the childhood-onset group (14.5%) compared to the other two groups (p&lt;0.05). And thus, immunosuppressive was used more frequently in the childhood-onset group than in the other two groups (p&lt;0.05). The left ventricular diastolic function was evaluated by the ratio of peak early to late diastolic filling velocity (E/A ratio). The E/A ratio was significantly reduced in the adulthood-onset group (1.1±0.0) than in the childhood-onset group (1.4±0.0) and the young adulthood-onset group (1.3±0.0). Moreover, patients in the adulthood-onset group presented with a larger right atrial diameter (4.4±0.0) than the childhood-onset group (4.2±0.0) and the young adulthood-onset group (4.2±0.0). The adulthood-onset group (17.4%) has a high proportion of "pulmonary hypertension" which was evaluated based on the guideline established by the European society of cardiology. An impaired forced vital capacity (FVC) and forced expiratory flow at 75% of FVC (FEF75%) were observed in the adulthood-onset group compared to the other two groups (p&lt;0.05).

Conclusions
This registry has demonstrated that different ages of onset could impact the clinical and cardiopulmonary performance in Chinese patients with SLE. Patients in the adulthood-onset group presented higher blood pressure, shorter 6MWT, a higher proportion of chronic kidney disease, and impaired pulmonary function compared to the other two groups.Comparisons of clinical and cardiopulmo
Ventriculoarterial coupling as estimated by the PWV/GLS ratio correlates with disease severity in liver cirrhosis patients
Authors: Dimitroglou Y , Solomou E , Terentes-Printzios D , Angelis A , Valatsou A , Koukos M , Tsartsalis D , Patsourakos D , Alexopoulos T , Mani I , Alexopoulou A , Vlachopoulos C , Tousoulis D , Aggeli C , Tsioufis K 
Published: November 2023

Abstract

Introduction
Liver cirrhosis is characterized by vasodilation, reduced peripheral resistances and increased cardiac output. Recently, a novel parameter based on the ratio of carotid-femoral pulse wave velocity (PWV) to the absolute value of global longitudinal strain (GLS), has been proposed to estimate the relationship between left ventricle and aortic function (ventriculoarterial coupling- VAC).

Purpose
This study aimed to investigate the potential correlation between VAC, as estimated by the PWV/GLS ratio, and disease severity in patients with liver cirrhosis.

Methods
A total of 65 cirrhotic patients (mean age 59.1±8.3 years, 48 (73.8%) males) without cardiovascular disease were included in this study. PWV was calculated by dividing the estimated distance difference between the femoral and carotid arteries by the pulse transit time measured with a validated noninvasive device (simultaneous measurement with two transducers). Echocardiography was performed to determine GLS, which was calculated semi-automatically using dedicated software. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score.

Results
The mean PWV was 7.8 ± 1.6 m/s, mean GLS was 21.1 ± 2.7%, and mean PWV/GLS ratio was 0.38 ± 0.11. Spearman’s correlation analysis showed that both PWV and GLS were significantly correlated with MELD score (rho=-0.330, p=0.007 and rho=0.276, p=0.026, respectively), indicating that patients with higher disease severity had lower PWV and higher absolute GLS values. There was also a negative correlation between PWV and GLS (rho=-0.377, p=0.002). PWV/GLS ratio was negatively correlated with MELD score (rho=-0.354, p=0.004). In addition to MELD score, PWV/GLS ratio was significantly associated with age (rho=0.281, p=0.023) and systolic blood pressure (SBP) (rho=0.445, p&lt;0.001). A non-significant association with stroke volume (SV) was also observed (rho=-0.207, p=0.099), suggesting that cirrhotic patients with reduced afterload and increased cardiac output had lower values of the ventriculoarterial coupling index. Multivariate linear models confirmed the robustness of the association between PWV/GLS ratio and disease severity even after accounting for age, SBP, and SV (p=0.047).

Conclusions
Our findings suggest that the PWV/GLS ratio is reduced in cirrhotic patients with more severe disease. This association remains significant even after controlling for age, systolic blood pressure, and stroke volume, indicating that PWV/GLS ratio may serve as an early marker of cardiovascular dysfunction in patients with liver cirrhosis.Figure 1Table 1
The prevalence and assessment of cardiovascular symptoms as the risk factors for post-COVID syndrome at 12-month follow-up. Data from the Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study
Authors: Babicki M , Kolat D , Kapusta J , Kaluzinska-Kolat Z , Jankowski P , Mastalerz-Migas A , Banach M , Mordaka R , Chudzik M 
Published: November 2023

Abstract
Previous studies have indicated that after COVID-19, symptoms can persist for up to 12 months after recovery; however, the data on this are still limited.
The aim of this study was to assess the prevalence of cardiovascular symptoms at 3 and 12 months after COVID-19 and to assess whether cardiovascular co-morbidity before SARS-CoV-2 infection are the risk factors for the development of post-COVID syndrome in both hospitalized and non-hospitalized patients.
This longitudinal study was based on medical data collected during visits at 3 and 12 months after COVID-19 infection. Sociodemographic data, chronic conditions, and the most common clinical symptoms at 3 and 12 months after the disease were assessed during these in-person visits. The following symptoms were assessed as cardiovascular: palpitations/arrhythmias, anginal symptoms, dyspnea, venous thromboembolism, peripheral edema, newly diagnosed arterial hypertension, fainting/unconsciousness.
In total, 643 patients were enrolled in the final analysis.
The majority of the study group were women (63.1%), and the median age of the participants was 52 years. During the analysis of the clinical picture, after 12 months, 65.7% (62.1% – 69.6%) of patients declared the presence of at least one clinical symptom of post-COVID syndrome. The most common complaints were asthenia - 45.7% (41.9% - 49.6%) of patients, and neurocognitive symptoms - 40.0% (36.0% - 40.1%) of patients. Cardiovascular symptoms in 60.1% (56.2% – 63.8%) at 3 month FU and in 33.9% pts (31.1% – 37.9%) at 12 months FU were found (Figure 1). In a multivariate analysis, female sex (OR 1.59,p=0.012) and severe COVID-19 infection (OR 2.94,p&lt;0.001) were associated with the persistence of clinical symptoms up to 12 months after recovery. The history of coronary artery disease, hypertension and dyslipidemia has no impact on symptoms at 12 months after the COVID-19 (Figure 2).
To conclude, cardiovascular symptoms are the most common at 3 and 12 months after SARS-CoV-2 infection. The most burdensome level of COVID-19 severity was a predictor of post-COVID syndrome, neurocognitive symptoms, and fatigue. Cardiovascular comorbidity seems has no impact for post-COVID symptoms.Figure 1Figure 2
Low-grade endotoxemia, oxidative stress and thrombotic events in patients with primary antiphospholipid syndrome
Authors: Bucci T , Ames P R J , Cardamone C , Mangoni B , Pastori D , Cammisotto V , Ciampa A , Triggiani M , Pignatelli P 
Published: November 2023

Abstract

Introduction
The persistence of antiphospholipid antibodies (aPL) is associated with a procoagulant state that could precipitate thrombotic events in the presence of a second pro-inflammatory stimulus, realizing thus the antiphosholipid syndrome (APS). Circulating lipopolysaccharide (LPS) is associated with systemic inflammation, enhanced oxidative stress and cardiovascular events in different clinical conditions, however, its presence and significance has not been evaluated in APS.

Purpose
To investigate the relationship between LPS, oxidative stress markers and risk of thrombotic events in the prospective multicenter ATHERO-APS study.

Methods
Baseline serum levels comparison of LPS, soluble NADPH oxidase 2-derived peptide (sNOX-dp), H2O2 production, hydrogen peroxide breakdown activity (HBA), and nitric oxide (NO) bioavailability in 97 primary APS (PAPS), 20 aPL carriers and 20 healthy controls (CTRL) matched for age, sex and BMI. In patients with high LPS levels, Cox-regression analysis was performed to assess the risk for a composite outcome of cardiovascular death, venous (VTE) and arterial thromboembolism (ATE).

Results
In the whole population (median age 51 (IQR: 45-61) years, 72% female), LPS levels were inversely correlated with HBA (Rs: -0.231, p=0.009) and NO (rS: -0.286, p=0.001) and directly correlated with sNOX-dp (rS:0.423, p&lt;0.001) and H202 (rS: 0.211, p=0.017) (Table 1). Patients with PAPS showed a significant increased levels of LPS, sNOX-dp and H2O2 and a significant lower level of NO and HBA compared to aPL carriers and healthy CTRL. No correlation was found between LPS levels and anti-cardiolipin (aCL) IgG/IgM, anti-beta-2-Glycoprotein-I (aβ2GPI) IgG/IgM and lupus anticoagulant (LAC).
After a median follow-up of 4.7 (4.1-5.6) years, 11 composite outcomes were reported: 1 cardiovascular death (stroke related), 3 ischemic strokes, 2 myocardial infarctions, 3 peripheral ATE and 2 VTE. Patients with basal LPS levels above the median value (&gt;20.1 pg/ml) showed a higher annual incidence of composite outcome compared to those with LPS levels below the median value (4.0% vs 0.7%, p=0.013). On Cox-regression analysis, PAPS patients with LPS above the median value showed a 5-fold increased risk of composite outcome compared to patients with LPS below the median value, after adjustment for age, sex, aCL IgG, aβ2GPI IgG and LAC (Figure 1).

Conclusion
These preliminary data suggest that in PAPS, LPS is associated with a higher risk for a composite outcome of cardiovascular death, ATE and VTE. Further studies are needed to know which pharmacological approach may counteract the prothrombotic effect of LPS.
Effects of pirfenidone on scar size and ventricular remodeling after myocardial infarction: a preclinical study
Authors: Aimo A , Burchielli S , Aquaro G D , Barison A , Musetti V , Masotti S , Pucci A , Modena M , Passino C , Emdin M 
Published: November 2023

Abstract

Background
An intense fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Pirfenidone is a drug currently approved for the treatment of idiopathic pulmonary fibrosis, and reduces LV fibrosis in patients with heart failure and preserved ejection fraction. We aimed to characterize the different profiles or protein expression in the infarct zone in rats receiving or not receiving pirfenidone on top of standard therapy for MI.

Methods
Male Wistar rats were randomized to: sham procedure (group 1; n=13), reperfused MI induced by surgical ligation of the left anterior descending artery (LAD) for 45 minutes (group 2; n=17), reperfused MI plus standard therapy (aspirin, angiotensin-converting enzyme inhibitor, beta-blocker, and also mineralocorticoid receptor antagonist [MRA]) (group 3; n=17), reperfused MI plus pirfenidone alone (group 4; n=17), reperfused MI plus standard therapy and pirfenidone (group 5; n=17). Rats surviving LAD ligation and reperfusion underwent cardiac magnetic resonance (CMR) after 72 hours and 30 days from MI, and were sacrificed the day after the second CMR exam. The primary endpoint was the change in late gadolinium enhancement (LGE) mass as a percentage of LV mass.

Results
Forty-six rats survived until the second CMR. Percent changes in LV end-diastolic and end-systolic volume (p=0.370 and 0.423, respectively), ejection fraction (p=0.236) and mass (p=0.815) did not differ significantly between rats on pirfenidone plus standard therapy compared with those receiving standard therapy alone. The decrease in LGE mass was significantly greater in rats on pirfenidone plus standard therapy vs. those on standard therapy alone: -22.0% (interquartile range, -37.1 to -5.7, range -51.1 to +37.5) vs. +1.9% (-7.7 to +12.5, range -19.8 to +56.5), p=0.029.

Conclusions
Pirfenidone had additive effects to standard therapy for MI (including an MRA) in reducing LV fibrosis in a rat model of reperfused MI, while it did not further improve LV function, volumes or mass.
The power of optimal medical therapy in heart failure with secondary mitral regurgitation
Authors: Escabia Riera C , Codina P , Ruiz-Cueto M , Domingo M , Santiago-Vacas E , Cediel G , Zamora E , Borrellas A , Llibre C , Teis A , Ferrer E , Santesmases J , Delgado V , Lupon J , Bayes-Genis A 
Published: November 2023

Abstract

Background
Guideline-directed medical therapy (GDMT) for the management of heart failure (HF) may impact on the frequency of severe secondary mitral regurgitation (SMR).

Objective
To evaluate the impact of optimization of GDMT on the grade of SMR in a cohort of HF patients managed in a multidisciplinary HF clinic and to assess predictors and prognosis of deterioration of SMR.

Methods
In a prospective, consecutive, observational registry of HF patients, a 2-dimensional transthoracic echocardiography was performed at baseline and at 1 year of follow-up. Patients treated with surgical or interventional mitral valve repair were excluded. The primary endpoint was all-cause death.

Results
Of a total of 2.980 HF patients, 1814 patients had 2 echocardiograms performed 1 year apart. At baseline, 99 patients had a severe SMR (5.5%), 389 (21.4%) moderate and the remainder had mild, trace or none SMR. After 1-year, 80.8% of those with baseline severe SMR presented a regression to non-severe SMR, 66.6% of those with moderate SMR regressed to mild SMR and 1.1% of those with non-severe SMR at baseline worsened to severe SMR.
Older age (OR 1.42 per every decade; 95% CI 1.19-1.69, p&lt;0.001), ischaemic aetiology of HF (OR 1.64; 95% CI 1.11-2.42, p&lt;0.001) and baseline NTproBNP (OR 1.19; 95% CI 1.08-1.32, p&lt;0.001) were independently associated with worsening of SMR at 1 year of follow-up.
Patients with baseline severe SMR that improved at 1 year had a similar risk of the primary endpoint to those with non-severe SMR at both time points (HR 0.93; 95% CI 0.62-1.42; p=0.75), even after adjusting for age, sex and LVEF (HR 0.99; 95% CI 0.65-1.52; p= 0.98). On the contrary, patients with non-severe SMR that worsen showed the worst prognosis (Figure 1).

Conclusions
Most of the patients with HF and severe SMR show a regression of SMR within 1 year of GDMT. Patients with baseline severe SMR that improved at 1 year have a similar prognosis than those with non-severe SMR at both time points. Older age, ischaemic aetiology and higher levels of NTproBNP were associated with deterioration of SMR.Table 1.Population characteristicsFigure 1.Survival curves
Cardiovascular safety of non-steroidal anti-inflammatory drug use for gout: A Danish nationwide case-crossover study
Authors: Drewes A M , Bonnesen K , Hauge E M , Schmidt M 
Published: November 2023

Abstract

Background
Gout is associated with increased cardiovascular risk through inflammation and shared risk factors. Gout attacks are treated with a uric-lowering drug, such as allopurinol, and an anti-inflammatory drug, such as a non-steroidal anti-inflammatory drug (NSAID). Thus, NSAIDs could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic actions. Yet, no study has examined the cardiovascular safety of NSAIDs for the treatment of gout.

Purpose
To examine the risk of major adverse cardiovascular events (MACEs) associated with NSAID use in gout patients.

Methods
We conducted a nationwide, population-based case-crossover study of all Danes ≥18 years of age with first-time gout during 1997–2020, who experienced a MACE (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation or flutter, or all-cause death) (n=103,522). The patients were identified either via a hospital diagnosis for gout (12%) or via a filling of an allopurinol prescription (88%). The exposures were use of NSAIDs overall and according to subtype (ibuprofen, naproxen, or diclofenac). An individual was considered exposed from the time of a filled prescription until the end of a use period, estimated from average use of two tablets per day. In the case-crossover design, we used four reference dates at 120, 180, 240, and 300 days before the outcome. An individual was considered exposed if the use period covered a reference date or the outcome date. We used the Mantel-Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and MACE.

Results
NSAID use was overall associated with a 15% decreased risk of MACE (OR=0.85, 95% CI: 0.83–0.87). The ORs of the association between NSAID use and the individual cardiovascular events were 0.91 (95% CI: 0.84–0.99) for myocardial infarction, 0.88 (95% CI: 0.81–0.95) for ischemic stroke, 0.89 (95% CI: 0.83–0.94) for congestive heart failure, 0.80 (95% CI: 0.75–0.85) for atrial fibrillation or flutter, and 0.77 (95% CI: 0.75–0.80) for all-cause death. The decreased risk of MACE was observed for use of ibuprofen (OR=0.91, 95% CI: 0.88–0.95) and naproxen (OR=0.78, CI: 0.70–0.86), but not for use of diclofenac (OR=1.03, 95% CI: 0.97–1.09).

Conclusions
In patients with first-time gout, use of ibuprofen and naproxen was associated with a slightly decreased cardiovascular risk, whereas diclofenac was not.
Long-term serial changes in left atrial volume and function after catheter ablation for atrial fibrillation
Authors: Okada T , Kobori A , Sano M , Murai R , Sasaki Y , Toyota T , Taniguchi T , Kim K , Ehara N , Kinoshita M , Furukawa Y 
Published: November 2023

Abstract

Background
Catheter ablation for atrial fibrillation (AF) is an effective method to restore and maintain sinus rhythm. The value of left atrial (LA) volume and reservoir function at short-term after ablation have been shown to associate with clinical outcomes. However, data regarding serial changes in LA size and function after the ablation remain scarce.

Purpose
The purpose of this study was to investigate the serial changes in LA volume and function, and their relationship to the AF recurrence in patients who underwent primary ablation for AF and had preserved left ventricular ejection fraction (LVEF).

Methods
We retrospectively reviewed 1,204 patients (age: 72±10 years, male: 72%, LVEF: 62±4%, paroxysmal AF: 66%) for whom both pre- and post-procedural serial echocardiographic data were available. Echocardiography was performed at pre-, 1-year, 2-year and 3-year after the ablation procedure. The association between AF recurrence and changes in echocardiographic parameters were evaluated by A repeated measures ANOVA with a Greenhouse-Geisser correction and Bonferroni tests. The AF recurrence was defined as any documented atrial arrhythmia of &gt; 30 seconds after a single ablation procedure.

Results
During the mean follow-up of 1725±713 days, AF recurrence was observed in 418 patients (34.7%) and persistent AF at last follow-up was 41 patients (3.4%). Patients with AF recurrence had significantly larger LA volume index (LAVI) and lower LA emptying fraction (LAEF) at baseline than those without (50.0±15.5 vs 41.4±14.4 mL/m2, P&lt;0.001, and 31.2±14.9 vs 37.7±14.0 %, P&lt;0.001, respectively) and these differences were maintained thereafter during the follow-up. The trend of LAVI decreased until 6 months later and then remained unchanged regardless of the AF recurrence. These trends were maintained in patients divided into initial paroxysmal and persistent AF. The trend of LAEF increased until 6 months later and then gradually decreased regardless of the AF recurrence. These trends were maintained in patients with persistent AF, however, LAEF continued to decline in patients with paroxysmal AF. (Figure)

Conclusions
The catheter ablation was associated with significant reduction in LAVI and improvement of LAEF in patients with persistent AF regardless of recurrent AF. In contrast, LAEF decreased gradually in patients with paroxysmal AF. These findings may suggest LA function in patients with AF declines gradually, even when they are maintained in sinus rhythm. However, both LAVI and LAEF in paroxysmal AF were better than persistent AF, suggesting that catheter ablation may be more effective in the paroxysmal AF stage.