bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic valve reconstruction in nonelderly adults: a systematic review, meta-analysis and microsimulation study
Authors: Notenboom M , Rhellab R , Veen K M , Etnel J R G , Taverne Y H J H , Van De Woestijne P C , Roos-Hesselink J W , Bogers A J J C , Takkenberg J J M 
Published: November 2023

Abstract

Background
Aortic valve disease (AVD) calls for careful planning of treatment strategies that adheres to a patient-tailored lifetime perspective, especially in younger patients. Aortic valve reconstruction (AVr) provides an attractive option in patients with aortic valve regurgitation (AR).

Purpose
This study aims to provide a comprehensive overview of published outcome after AVr in nonelderly adults and to use microsimulation to obtain age-specific estimates of outcomes.

Methods
A systematic review of published literature reporting clinical outcome after AVr in nonelderly adults (mean age ≥18y and ≤55y) published between 1/1/1990 and 17/10/2022 was conducted. Publications reporting outcome after AVr were considered for inclusion, including publications on valve-sparing root surgery. Studies that included patients without AVD as the primary indication for AVr were excluded. Early risks (&lt;30d), late event rates (&gt;30d) and time-to-event data were pooled and entered into a microsimulation model. Subgroup analyses were performed for AVr for isolated AR and AVr for bicuspid aortic valves (BAV).

Results
Thirty-seven studies, all retrospective cohort studies, were included, yielding a total of 4,573 patients with 16,524 patient-years of follow-up (median follow-up: 4.0y; range 0.6-10.5y). Pooled mean age for all repairs, AVr for AR and AVr for BAV was 48.1±13.8, 48.3±13.8, and 42.4±12.5 years, respectively. Pooled early mortality for all repairs, AVr for AR and AVr for BAV, respectively, was 1.7% (95%CI: 1.2-2.3%), 1.5% (1.0-2.1%), and 1.0% (0.6-1.9%), and late pooled mortality rate was 1.0%/y (0.7-1.5%/y), 1.3%/y (0.8-2.1%/y), and 0.8%/y (0.5-1.4%/y), respectively. Microsimulation-based life-expectancy relative to the general population 20 years postoperatively was 92.6% (95% Credible Interval: 90.1-95.3%) after all repairs, 89.0% (85.0-93.0%) after AVr for isolated AR and 94.9% (92.0-97.4%) after AVr for BAV. Microsimulation-based 20-year risk of aortic valve reintervention for all repairs, isolated AR and BAV, respectively, was 25.0%(23.8-26.2%), 25.1%(23.5-26.9%) and 49.9%(48.2-52.0%). The main cause for reintervention was repaired valve dysfunction for all three groups, followed by endocarditis. Estimates of other late complications are shown in Figure 2.

Conclusions
Aortic valve reconstruction for aortic valve regurgitation effectively postpones valve replacement in nonelderly with satisfactory long-term outcomes but reintervention risks are still considerable, especially in BAV patients. Reconstructive valve surgery is associated with low risks of bleeding and thrombo-embolic events and should be considered in nonelderly adults with aortic regurgitation and carefully weighed against hazards of primary aortic valve replacement.Pooled Kaplan-Meier curves for mortalityMicrosimulation-based event risks (20y)
Validation of miR-181A-5p as a biomarker of acute rejection after heart transplantation. Multicenter study
Authors: Crespo-Leiro M , Constanso-Conde I P , Almenar-Bonet L , De Antonio M , Garcia-Cosio M D , Lopez-Vazquez P , Miranda-Quintana P , Mirabet S , Lopez-Vilela R , Marco-Clement I , Villamarin-Lopez P , Domenech-Garcia N 
Published: November 2023

Abstract

Background
Acute Cellular Rejection (ACR) remains a major complication in heart transplantation (HT) being endomyocardial biopsy (EMB) the gold standard for ACR early detection. However, this invasive procedure has several limitations so last years new non-invasive ACR biomarkers have been evaluated. Previous studies have shown miR-181a-5p (miR-181) is overexpressed in serum samples from patients with moderate/severe ACR. However, techniques performed in these studies (mainly RT-qPCR) express miRs results as relative quantification and this leads to a lack of harmonization of both the technique and clinical decision-making. This would be solved with a new technique for absolute quantification of miRs, the digital PCR (dPCR). The aim of this study is the validation of miR-181a-5p as ACR biomarker in a multicentric collaboration. The results obtained by the conventional RT-qPCR technique will also be compared with those obtained by the new and promising dPCR.

Methods
four reference centers in HT from Spain were included in the study named "A,B,C, D". All centers performed a retrospective search in their serum libraries to find sera from patients with ACR≥2R. The same number of ACR=0R samples (control group) were also sent. All samples were processed at one center by RT-qPCR and dPCR. With the collected data we studied the correlation between both techniques, the expression of miR-181 in each ACR group (2R vs 0R) as well as in each center. Finally, the diagnostic accuracy was studied using ROC curves. A two-sided p&lt;0.05 was considered statistically significant.

Results
ACR≥2R samples involved in the study were from: Center A, 41(42%), Center B, 32 (33%), Center C, 18(19%) and Center D 6 (6%). All centers sent the same number of samples with no rejection 0R. Correlation obtained between both techniques was not good (Spearman correlation coeficient, r = 0,60; [0,50-0,70]; p&lt;0,0001). In both techniques, miR-181 is overexpressed in ACR≥2R group, although only RT-qPCR performed it significantly (p&lt;0,0005). There was no significant difference between centers in miR-181 expression. Diagnostic accuracy achieved by RT-qPCR was similar to that of previous studies (AUC=0,65; [0,57-0,73], p=0,0006).

Conclusion
Our findings confirm previous results obtained by miR-181a-5p as ACR biomarker using conventional techniques as RT-qPCR. In addition, robustness of miR-181a-5p has been shown using serum samples from 4 different centers. Digital PCR shows promising results but we still optimize it for the quantification of miRs.miR181 expression
Assessing the accuracy of an online chat-based artificial intelligence model in providing recommendations on arterial hypertension in accordance with the 2018 ESC/ESH guidelines
Authors: Kassab J , El Dahdah J , Chedid El Helou M , Harb S C 
Published: November 2023

Abstract

Background
The rise of online chat-based artificial intelligence (AI) models has opened up new possibilities in the field of medicine. One of the promising contributions of AI chatbots could be their ability to provide accurate and accessible medical information to patients. This could help bridge the gap between patients and healthcare providers, especially in under-resourced areas where access to medical information and care is limited.

Purpose
We aimed to evaluate the ability of a commercially available AI-based online chat to provide answers to commonly asked questions related to arterial hypertension in accordance with the latest 2018 ESC/ESH guidelines (1).

Methods
We selected 30 commonly asked questions covering a range of arterial hypertension topics, including risk factors, symptoms, diagnosis, and treatment. These questions were submitted to the online AI interface, and the responses were recorded and evaluated by a team of four experienced cardiologists from our institution. To ensure consistency, each question was asked three times. All questions – except question 2 – were preceded by "according to the 2018 ESC/ESH Guidelines for the management of arterial hypertension". Each answer was rated as "accurate," "inaccurate," or "incomplete" based on the specialists’ clinical judgment, the 2018 ESC/ESH guidelines, and the content of the response. A response was considered "accurate" if it included all essential information, "inaccurate" if information provided was not in accordance with the guidelines, and "incomplete" if any essential information was missing.

Results
The AI model's responses to 24 out of the 30 questions (80%) were deemed accurate by cardiologists. Three responses were rated as incomplete (10%) and three responses were found to be inaccurate (10%). The AI responses were consistent in 28 out of the 30 questions (93%) (Tables 1-2).

Conclusion
We found that a popular online AI model provided largely accurate responses to commonly asked arterial hypertension questions. These answers were mostly in accordance with the 2018 ESC/ESH guidelines on the management of arterial hypertension. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology to improve the healthcare experience for patients is significant.Table 1:(1) Assessment of AnswersTable 2:(2) Assessment of Answers
Daytime blood pressure measurements performed by a cuffless blood pressure monitor compared to 24-hour ambulatory blood pressure monitor: preliminary comparative results of a single-centre study
Authors: Paggi De Almeida T , Cortes M , Perruchoud D , Alexandre J , Vermare P , Sola J , Shah J , Marques L , Pellaton C 
Published: November 2023

Abstract

Background
Ambulatory blood pressure (BP) monitors (ABPM) measure systolic and diastolic BP (SBP, DBP), limited to 24-48-hour snapshots, using uncomfortable cuff-based oscillometric sphygmomanometers. Some cuffless BP devices overcome these limitations, supporting continual BP monitoring. There is currently intense debate whether cuffless devices generate data comparable to ABPM.

Purpose
Here, we present preliminary results of daytime BP measurements performed by a validated and commercially available cuffless BP monitor compared to 24-hour ABPM.

Methods
52 out of 63 estimated total patients (NCT04548986, age 53.2±7.1 years, 18.9% female, arm circumference 28.5±2 cm) had been enrolled in a 12-week cardiac rehabilitation (CR) program. The patients used a validated, CE-marked, over-the-counter optical cuffless wrist BP monitor during the entire CR program, while 24-hour cuff-based ABPM was performed on the first and last day of the CR program. For each patient, average daytime (9am-9pm) SBP and DBP were calculated – and compared – for 1 day of ABPM and 7 days of cuffless monitor (session 1: ABPM first day vs. cuffless monitor first week; session 2: ABPM last day vs. cuffless monitor last week). Only sessions that had 20 or more valid daytime measurements on both modalities were included in the study.

Results
50 patients (35 in session 1, 15 in session 2) had 20 or more valid daytime measurements on both modalities, and were included in the study. Bias between the cuffless monitor and ABPM for daytime DBP was (mean ± SD [95% CI] ) -2.2±8.0 [-4.5, 0.1] mmHg, R2 = 0.66 (Figure 1A), with agreements of 78% and 96% within ±10 mmHg (dark grey) and ±15 mmHg (light grey) regions of interest (ROI), respectively. Bias between the cuffless monitor and ABPM for daytime SBP was 1.6±10.5 [-1.5, 4.6] mmHg, R2 = 0.70 (Figure 1B), with agreements of 60% and 84% within the ±10/±15 mmHg ROI, respectively.

Conclusions
The results suggest that 1-week monitoring with the investigated cuffless monitor yields equivalent daytime BP values to 24-h ABPM, which supports the use of cuffless BP monitor for long-term, continual daytime BP monitoring. The present preliminary study is limited by the partially recruited population and daytime measurements only. Night-time analysis will be covered in subsequent studies.Figure 1
Neuroprotective efficacy of combined antihypertensive treatment with the inclusion of nitrendipine in patients with arterial hypertension
Authors: Yusupova K H F , Abdullaeva G J , Khamidullaeva G A , Ibrohimov N N 
Published: November 2023

Abstract

Aim
To evaluate the efficacy of 12-months combined antihypertensive treatment with the inclusion of nitrendipine on cognitive functions in patients with arterial hypertension (AH).

Material and methods
Surveyed 59 patients with I – III AH degree (ESH / ESC, 2018) of both sexes. The average age of patients was 58,8 ± 11.6 years, the average duration of AH 11.1 ± 7.04 years. An average daily dose 13.18±7.4 mg of nitrendipine was prescribed to patients with AH in combination with other antihypertensive drugs. Furthermore, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in all patients before and after 12 months treatment. Cognitive functions were evaluated using neuro-psychological tests: the Mini-Cog test (drawing a clock, reproduction of words), Montreal Cognitive Assessment (MoCA), a self-assessment questionnaire of memory, attention, thinking, ability to cope with their affairs, ability to make decisions. The results are presented as M ± SD.

Results
Analysis of office BP indicators showed a good 12-month antihypertensive efficacy with the inclusion of Nitrendipine in patients with AH. In particular, the SBP before treatment was 157,8 ± 16,18 mm Hg, after – 125,5 ± 10,7 (p = 0,000); the DBP 96,35 ± 8,55 mm Hg versus 79,7 ± 5,9 mm Hg, respectively (p = 0,000); MBP (mean blood pressure) 116,8 ± 9,95 mm Hg versus 94,97 ± 7,09 mm Hg, respectively (p = 0,000). The analysis of influence of AHT with the inclusion of Nitrendipine on cognitive functions in patients with AH showed an increase in the total score on the Mini-Cog test: 3,83 ± 1,11 versus 4,49 ± 0,81 points (p = 0,000), mainly due to a significant improvement in the reproduction of words: 2,16 ± 0,87 versus 2,69 ± 0,62 points (p = 0,000). According to the MOCA scale, abstract thinking significantly improved: initially amounting to 1,37±0,66 points versus 1,81±0,5 points in dynamics (p=0,000), as well as delayed reproduction of words: 2,49±1,23 points initially versus 3,2±1,4 points in dynamics (p=0,004). Significant memory improvement was observed against the background of 12-month antihypertensive therapy based on nitrendipine, initially was 7,04±2.34 points against 8,22±1.24 in dynamics (p=0,000) and decision-making function was 7,8±2,2 points initially against 9,02±1,3 in dynamics (p=0,000).

Conclusion
Thus, high antihypertensive efficacy and improvement of cognitive functions were shown against the background of antihypertensive combination therapy with the inclusion of nitrendipine in patients with AH.
Therapeutic inertia in the management of hypertension by moroccan general practitioners
Authors: Aloutmani B , Ismaili N , El Ouafi N 
Published: November 2023

Abstract

Background
Hypertension is an important and remediable risk factor for cardiovascular disease. Therapeutic inertia has been identified as one of the main factors associated with poor blood pressure control.

Purpose
This study aims to evaluate predictive factors of therapeutic inertia in the management of hypertension among moroccan general practitioners.

Methods
We conducted a descriptive and analytical cross-sectional study, from October 2021 to January 2022, involving moroccan general practitioners using a standardized, anonymous questionnaire, covering numerous areas; their socio-demographic characteristics, assessment of hypertension knowledge, reasons not to intensify therapy and clinical scenarios. A univariate analysis was performed using the Chi-square test for the comparison of percentages. A multivariable logistic regression analysis was also applied to study variables possibly associated with therapeutic inertia.

Results
A total of 130 physicians participated in our study. The majority of the practitioners were female (62.3%). The average age was 38.61 years (±13,95). The percentage of physicians who had practiced for 5 years or less was 51.5% vs. 48,5% having practiced for more than 5 years. The median number of patients seen per day was estimated at 30 patients with an interquartile range of [15, 50]. The average medical visit time was estimated at 11,88 ± 7,03 minutes. The overall frequency of therapeutic inertia among general practitioners was estimated at 78,5% CI 95% [70,4-85,2]. Furthermore, the two main reasons for therapeutic abstention reported by physicians were: the importance of improving patient compliance, lifestyle and dietary measures before intensifying treatment (81,5%), in addition to the fact that the office blood pressure does not reflect the patient's "true" BP and didn’t need any further ambulatory monitoring (43,8%). Multivariable regression showed that when the patient is diabetic, the general practitioners tend to be 4 times more ‘therapeutically inert’ [OR 4.42 (95% CI 1.2–7.23)]. A patient’s history of ischemic stroke was also positively associated with TI [OR 1.53 (95% CI 1.23–4.23)].

Conclusion
This study revealed a significant frequency of therapeutic inertia in primary care. A good understanding of the determinants of this phenomenon will lead to better management of hypertension and therefore better blood pressure control. According to our study, a history of diabetes or stroke was positively associated with inertia, even though this would normally require exhaustive BP control. Thus, the development of operational and consensual definitions based on empirical data and the exploration of the intimate mechanisms underlying this inertia is of crucial importance.Table 1
The safety and efficacy of quadruple ultra-low-dose combination (quadpill) for hypertension treatment: a meta-analysis of randomized controlled trials
Authors: Abuelazm M , Siddiq A , Saleh O , Badr A , Altobaishat O , Albarakat M M , Aboutaleb A M , Ibrahim M , Abdelazeem B 
Published: November 2023

Abstract

Background
Hypertension is a significant healthcare burden, with an average global prevalence of 1.28 billion adults aged between 30 -79 years old. Using antihypertensive drug combinations is considered more effective in controlling elevated blood pressure than monotherapy; however, psychological factors of the patients and the physicians’ caution from the drugs' adverse effects are still barriers against antihypertensive drug combinations. Quadpill, a single pill containing a quadruple combination of quarter doses of four antihypertensive agents, has been investigated for hypertension treatment.

Purpose
We aim to evaluate the efficacy and safety of the quadruple ultra-low-dose combination of antihypertensive drugs (quadpill) in patients with hypertension.

Methods
We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) evaluating quadpill versus monotherapy or placebo in patients with hypertension, which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through February 17th, 2023. Continuous and dichotomous outcomes were pooled using mean difference (MD) and risk ratio (RR) along with confidence interval (CI), using Revman V. 5.4 software.

Results
Four RCTs with a total of 781 patients (372 in the quadpill group and 425 in the control group) were included in our analysis. Quadpill was effective in controlling automated systolic blood pressure on the short-term (4-6 weeks) (RR: -13.00 with 95% CI [-17.22, -8.78], P= 0.00001) and on the long-term (12 weeks) (RR: -6.18 with 95% CI [-9.35, -3.01], P= 0.0001). Quadpill was also effective in controlling automated diastolic blood pressure on the short-term (4-6 weeks) (MD: -8.15 with 95% CI [-9.42, -6.89], P= 0.00001) and on the long-term (12 weeks) (MD: -6.35 with 95% CI [-10.37, -2.33], P= 0.002). Moreover, patients in the quadpill group significantly achieved target blood pressure &lt; 140/90 (RR: 1.77 with 95% CI [1.26, 2.51], P= 0.001), compared to the control group. Finally, there was no difference between the quadpill and the control groups regarding the safety outcomes, including the incidence of any adverse events (RR: 1.36 with 95% CI [0.86, 2.15], P= 0.19), any serious adverse events (RR: 1.13 with 95% CI [0.56, 2.25], P= 0.74), and any adverse events leading to drug discontinuation (RR: 0.89 with 95% CI [0.19, 4.11], P= 0.88).

Conclusion
Quadruple ultra-low-dose combination of antihypertensive drugs (quadpill) was effective and safe for hypertension treatment. However, further large-scale multicenter RCTs are still warranted before endorsement in the clinical practice as current evidence is based on a small number of RCTs and quadpill holds a promising strategy for hypertension treatment.Figure 1Figure 2
Ultra-processed food consumption and cardiovascular events risk
Authors: Qu Y , Hu W , Xing C , Yuan L , Huang J 
Published: November 2023

Abstract

Background
The consumption of ultra-processed food (UPF) has been suggested to be associated with cardiovascular events risk, but their dose-response relationship have not reached a consensus.

Methods
We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for manuscripts published from inception to November 17, 2021, which reported the relationship between UPF consumption and cardiovascular events risk. A total of ten studies were included with 325,403 participants and 38,720 cardiovascular events cases. Using the fixed/random-effects models, hazard ratios of pooled outcomes were estimated.

Results
A non-linear relationship of UPF consumption with cardiovascular events risk was identified (P for heterogeneity = 0.013, P for dose-response &lt; 0.001, P for non-linearity = 0.013). Compared with the lowest UPF consumption category, the third highest pooled HR for cardiovascular events risk was 1.02 (95% CI, 0.98 to 1.05), the second highest was 1.08 (95% CI, 1.04 to 1.12) and the highest was 1.24 (95% CI, 1.16 to 1.32). A linear association between UPF consumption and coronary heart disease (CHD) risk was identified (P for heterogeneity = 0.110, P for dose-response &lt; 0.001, P for non-linearity = 0.202). A 10% increase in UPF consumption in daily calorie intake was associated with a 6% increase in CHD risk. UPF consumption was non-linearly associated with cerebrovascular disease (CeVD) risk (P for heterogeneity = 0.001, P for dose-response &lt; 0.001, P for non-linearity = 0.026).

Conclusions
There was a nonlinear relationship between UPF consumption and cardiovascular events. Moderate intake of UPF was associated with a lower risk of cardiovascular events, with the lowest risk at &lt;15%/day of UPF consumption out of total calorie intake. Heavy UPF consumption was significantly and positively associated with increased risk of cardiovascular events.