bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of tafamidis treatment on cardiovascular aging in patients with Transthyretin cardiomyopathy. An observational study
Authors: Bampatsias D , Georgiopoulos G , Delialis D , Angelidakis L , Theodorakakou F , Petropoulos I , Tselegkidi M E , Zervas G , Dimoula A , Patras R , Kyriazopoulou A , Trougakos I , Briasoulis A , Kastritis E , Stamatelopoulos K 
Published: November 2023

Abstract

Background
Sporadic cardiac transthyretin amyloidosis (wtATTR) is a degenerative age-related disease with dismal prognosis and continuously increasing incidence. ATTR may have adverse effects also on vascular function and accelerate vascular aging. Tafamidis, a new agent that stabilizes the TTR tetramer improves wtATTR prognosis; however, whether tafamidis exerts any effect on vascular aging processes is unknown.

Purpose
To evaluate the effect of tafamidis treatment on markers of vascular aging.

Methods
This is an observational, non-interventional longitudinal study. wtATTR patients receiving tafamidis were evaluated prospectively at baseline, 3 months, 6 months and 1 year for non-invasive markers of vascular aging including arterial stiffness by pulse wave velocity (PWV, primary outcome measure), and markers derived from pulse wave analysis and compared to non-amyloidosis elderly controls (N=30, age&gt;70 years) who were re-assessed for vascular function 1 year after their baseline visit.

Results
Twenty-one patients with wtATTR and were receiving tafamidis completed all 4 visits. Linear mixed model analysis revealed that PWV progressively decreased compared to baseline, during follow-up visits in patients receiving tafamidis [baseline vs a) 3 months: -0.95 mean difference (95%CI -1.73, -0.159) p-value=0.0121, b) 6 months: -1.36 mean difference (95%CI -2.19, -0.54) p-value=0.0002, c) 1 year: -1.08 mean difference (95%CI -2.03, -0.12) p-value=0.002]. The non-amyloidosis elderly control group presented a significant increase in PWV after 1 year compared to baseline (13.63 m/s vs 11.99 m/s, p =0.001 respectively, Wilcoxon rank test), while PWV was significantly lower in wtATTR group after 1 year compared to the control group despite younger mean age of the latter (p for interaction=0.0089). Central systolic blood pressure was decreased after 6 months of treatment, while it returned to baseline levels after 1 year [mixed model analysis, baseline vs 6 months -5.95 mean difference (95%CI -10.31, -1.60) p-value=0.007, baseline vs 1 year -0.47 mean difference (95%CI -5.42, 4.49) p-value=0.854]. A similar trend was observed for central diastolic blood pressure, although not achieving statistical significance (mixed model analysis, baseline vs 6 months -2.66 mean difference (95%CI -5.72, 0.40) p-value=0.088, baseline vs 1 year 0.005 mean difference (95%CI -3.47, 3.48) p-value=0.998].

Conclusion
The results of this prospective study suggest that tafamidis may delay vascular aging in addition to cardiac aging in patients with wtATTR.
Anti-diabetic medication adherence and cardiovascular outcomes in patients with cancer: a nationwide population-based cohort study
Authors: Jung M , Jung M , Kim J , Lee S , Kim K , Kang D , Kyoung D , Chung W , Jung H , Youn H , Kim H , Youn J 
Published: November 2023

Abstract

Background
Diabetes is an important cause of morbidity, which predisposes patients to major cardiovascular (CV) events and mortality. However, clinical implications of anti-diabetic medication adherence for cancer patients have not been well studied in the real clinical practice.

Purpose
This study aimed to evaluate the association between anti-diabetic medication adherence and clinical outcomes in adult patients with cancer.

Methods
Using the prospective nationwide cohort (Korean NHIS-NSC), we extracted adult cancer patients treated with anti-diabetic medications. Based on the medication possession ratio (MPR) value, participants were divided into 3 groups: good (MPR ≥0.8), moderate (0.5 ≤ MPR &lt; 0.8), and poor (MPR&lt;0.5) adherence groups. The primary outcomes were overall and CV mortality. The secondary outcome was CV events requiring hospitalization due to major CV diseases.

Results
Among 8,052 cancer patients with concomitant diabetes, 59.4% were nonadherence group (21.5% were moderate and 37.9% were poor adherence group). Over a median of 8.4 years of follow-up, 1,475 deaths and 2,931 CV events occurred. Compared to the good adherence group, the moderate and poor adherence groups had a 1.61-fold and 2.00-fold increased risk for overall mortality; and 1.66-fold and 1.98-fold elevated risk for CV mortality, respectively, after adjustment for possible confounders. Furthermore, moderate and poor adherence groups had a 1.29-fold and 1.38-fold elevated risk for new-onset CV events. These trends were consistent across CV event subtypes.

Conclusions
Nonadherence to anti-diabetic medication is common in cancer patients and is associated with worse clinical outcomes in adult cancer patients with diabetes. More attention should be paid to improve adherence to anti-diabetic medication among patients with cancer.
Protective effects of nicotinamide mononucleotide on radiation-related cardiac injury
Authors: Wang Z , Zhao X , Zhou Z , Wang F , Zhang X , Tse G , Li G , Liu Y , Liu T 
Published: November 2023

Abstract

Background
Radiation therapy for cancer treatment can cause damage to the heart. There are numerous possible mechanisms related to radiation-related cardiac dysfunction, among which increased oxidative stress is an important factor. However, the detailed mechanisms remain unclear and effective treatments on radiation-related cardiac dysfunction are still lacking. Nicotinamide mononucleotide (NMN), the most direct precursor of nicotinamide adenine dinucleotide (NAD+), can effectively reduce reactive oxygen species (ROS) production and thus could be a candidate to alleviate radiation-induced damage. However, the protective effects and the underlying mechanisms of NMN on radiation-related cardiac injury remain to be elucidated. Therefore, this study was designed to identify the mechanisms of radiation-related cardiac injury and investigate the protective actions of NMN.

Methods
Wild-type c57 mice were divided into radiation exposure (7.2Gy radiation) and non-exposure groups. Wild-type C57BL6/J mice supplied with NMN for 12 months before radiation. Echocardiography to detect mice cardiac function. Epicardial electrical mapping technique to detect electrical conduction in the heart. Non-targeted metabolomics was used to detect cardiac different metabolites. In parallel, we observed the effect of radiation on survival and mitochondrial function (ROS production and ATP content) of H9C2 cells with or without NMN.

Results
In the radiation exposure group, echocardiography showed that the left ventricular ejection fraction (LVEF) and fractional shortening (FS) were reduced, whilst epicardial mapping demonstrated slowed conduction velocity and change in the direction of propagation. Non-targeted metabolomics showed the different metabolites between the radiation group and the control group were mainly in nucleotide and amino acid metabolism. Metabolic pathway enrichment analysis showed that different metabolites were implicated in the metabolism of pyrimidine, folate, arginine and proline, and tryptophan. Mice with NMN before radiation showed reduced mechanical and electrical dysfunction, with non-targeted metabolomic results showed NMN rescued the radiation-induced down-regulation of 1-(4-aminobutyl)urea, 4-aminobenzoic acid, 3-hydroxyanthranilic acid, which ultimately exerted cardioprotective effects. We also found that radiation can reduce the survival, increase ROS production, and reduce ATP content of H9C2 cells in vitro, and these harmful effects can be partially reversed by NMN.

Conclusion
The mechanical and electrical dysfunction caused by radiation were associated with altered nucleotide and amino acid metabolism in the myocardium, and these harmful effects could be partially mitigated by NMN supplement.
The use of high sensitivity troponin T as a biomarker of anthracycline cardiotoxicity
Authors: Bannister C , Tam To B , Patel T , Yap R , Cannata A , Bromage D , Mcdonagh T 
Published: November 2023

Abstract

Introduction
Anthracyclines are a highly effective class of chemotherapy used to treat a wide variety of malignancies. Their use is complicated by the development of cancer therapy-related cardiac dysfunction (CT-RCD), defined broadly as the development of left ventricular systolic dysfunction following cancer treatment. Troponin, a well-established marker of myocardial necrosis and early myocardial injury following anthracycline chemotherapy, may predict the subsequent development of CT-RCD. It is not known, however, at what timepoint troponin should be measured, or if there is a clinically relevant threshold that best predicts the development of CT-RCD.

Purpose
1. To investigate if high sensitivity troponin T (hsTnT) accurately predicts the development of anthracycline CT-RCD
2. To establish the best timepoint at which hsTnT should be measured to predict CT-RCD
3. To establish the most clinically relevant hsTnT concentration to predict CT-RCD

Methods
In 2020 we introduced a clinical pathway for outpatients receiving anthracycline chemotherapy at our Institution. As part of this pathway, hsTnT concentrations are measured at baseline (pre-chemotherapy) and prior to each anthracycline cycle. In this study, we performed a prospective audit of outpatients receiving anthracycline chemotherapy for the treatment of breast or haematological malignancies. Troponin concentrations prior to each chemotherapy cycle were assessed and ROC curve analyses were performed to determine the most accurate timepoint and threshold to predict CT-RCD. CT-RCD was defined as a drop in the left ventricular ejection fraction (LVEF) of &gt;10% from baseline to a value of &lt;50%.

Results
118 outpatients were treated with anthracycline chemotherapy between August 2020 and May 2022. 64 patients (54%) were treated for breast cancer and 54 (46%) for haematological malignancies. The mean age was 54±15yrs, with 71% females. At baseline, 27 (23%) of patients had a diagnosis of hypertension, 16 (14%) diabetes, 28 (24%) smoking history, 10 (8%) chronic kidney disease and 31 (26%) obesity. The median cumulative dose was 360mg/m² for Epirubicin and 300mg/m² for Doxorubicin. The baseline mean LVEF was 60.5±4%. 97/118 (82%) of patients had a follow up echocardiogram. 11/97 (11%) of patients developed CT-RCD. Mean hsTnT concentrations rose incrementally as the cumulative dose of anthracycline increased (Fig 1). Baseline hsTnT concentration was the most accurate predictor of subsequent CT-RCD (AUC 0.75), with a 75% sensitivity and 80% specificity for predicting CT-RCD if the baseline hsTnT concentration was ≥10.5ng/L. In addition, the baseline mean hsTnT concentration was significantly higher in patients with CT-RCD vs. those with no CT-RCD, P=0.0008 (Fig 2).

Conclusions
High sensitivity troponin T concentrations appear to be clinically useful in predicting subsequent CT-RCD, with the most accurate point of measurement being at baseline, prior to chemotherapy commencing.
Pregnancy associated hypertensive disorders and risk of cardiovascular disease: a mendelian randomisation study
Authors: Tschiderer L , Van Der Schouw Y T , Onland-Moret N C , Bloemenkamp K W M , Seekircher L , Burgess S , Willeit P , Peters S A E 
Published: November 2023

Abstract

Background
Pregnancy associated hypertensive disorders including pre-eclampsia/eclampsia and gestational hypertension have been related to unfavourable maternal cardiovascular risk factor profiles and a significantly higher risk to develop maternal cardiovascular disease (CVD) events in observational studies. However, whether these associations are causal is not yet fully understood.

Purpose
We conducted a Mendelian Randomisation study to investigate whether genetic liability to pre-eclampsia/eclampsia and gestational hypertension is related to cardiovascular risk factors and the risk of experiencing CVD outcomes.

Methods
We analysed individual-participant data of women and men from the UK Biobank. The rationale for also analysing men was to study the role of genetic liability to pre-eclampsia/eclampsia and gestational hypertension in CVD risk without experiencing the underlying phenotype. We studied a range of CVD outcomes including myocardial infarction, stroke (including subtypes), and combined CVD endpoints. Furthermore, we analysed a set of blood pressure-, lipid-, liver-, and kidney-related cardiovascular risk factors. To study the genetic association with pre-eclampsia/eclampsia and gestational hypertension we used effect sizes and standard errors from a large-scale genome-wide association study. For the genetic associations with cardiovascular risk factors and CVD outcomes, we used individual-participant data from the UK Biobank. We applied Mendelian Randomisation analysis using inverse variance weighted regression in our primary analysis and implemented additional regression methods as sensitivity analyses.

Results
We included 264,160 women and 223,043 men from the UK Biobank with available genetic data. Mean age at baseline was 56.5 (standard deviation 8.1) and 56.7 (8.2) years in women and men, respectively. Of all women and men, 44.3% and 50.9% had a history of hypertension and mean age at hypertension was 50.0 (10.8) and 51.2 (9.1) years, respectively. Genetically proxied pre-eclampsia/eclampsia and gestational hypertension were related to a higher risk of CVD in both sexes, with odds ratios of 1.20 (1.01, 1.43) and 1.22 (1.10, 1.36) in women and 1.29 (1.08, 1.53) and 1.28 (1.16, 1.42) in men, respectively. The relations were more pronounced for ischaemic than for haemorrhagic outcomes. Furthermore, genetically proxied pre-eclampsia/eclampsia and gestational hypertension were associated with higher levels of systolic and diastolic blood pressure and earlier age at hypertension in both women and men.

Conclusion
Genetic liability to pregnancy associated hypertensive disorders including pre-eclampsia/eclampsia and gestational hypertension is associated with higher CVD risk, implying biological mechanisms relating to these disorders are causally related to CVD risk in both women and men.
Reverse remodelling of right ventricle induced by pregnancy
Authors: Machado Araujo J , Ferreira A F , Azevedo M J , Saraiva F , Machado A P , Sousa C , Sampaio-Maia B , Leite-Moreira A , Ramalho C , Santos M , Falcao-Pires I 
Published: November 2023

Abstract

Introduction
During pregnancy, the cardiovascular (CV) system is exposed to haemodynamic overload and is required to meet the increased demands of the growing foetus. Many studies have focused on left ventricular remodelling, overlooking right cardiac chamber changes.

Aim
To characterize the right cardiac reverse remodelling (RR) through echocardiography during pregnancy and postpartum.

Methods
This prospective cohort study included volunteer pregnant women (healthy and women with CV risk factors - obese and/or hypertensive and/or with gestational diabetes) recruited at two tertiary centres from 2019 to 2021. Women were evaluated by transthoracic echocardiography at the 3rd trimester [PT3, 30-35 weeks, peak of cardiac remodelling] of pregnancy and 6 months after delivery [PP2] (RR). Wilcoxon test was used to compare values between PT3 and PP2.

Results
We included 130 pregnant women with a median age of 33 years, 42% had CV risk factors. RV volume reduced significantly from PT3 to PP2 (33.9 mL to 30.5 mL, p=0.015). Similar significant regression of RA area was observed (13.6 cm2 to 13.1 cm2, p=0.045). Regarding systolic function of the RV, a significant increase in fractional area change (FAC) was reported from PT3 to PP2 (47.4% to 49.4%, p=0.019), while the opposite progression was found for tricuspid annular plane systolic excursion (TAPSE, 24.6 mm to 23.4 mm, p&lt;0.001) and S' tricuspid wave (14.2 cm/s to 12.7 cm/s, p&lt;0.001). In terms of myocardial deformation, a significant increase of RV global longitudinal strain (GLS) (-23% to -25%, p=0.016) and RA (34% to 37%, p=0.026) from the pre- to the postpartum period. Regarding the changes in diastolic function, E/A tricuspid ratio increased significantly after delivery (1.3 to 1.7, p&lt;0.001), mostly due to a decrease of A wave velocity (38 cm/s to 29 cm/s, p&lt;0.001), while no significant difference was found in E/e’ from PT3 to PP2 (3.8 to 3.7, p=0.140). No differences were observed in pulmonary vascular resistance and pulmonary artery systolic pressure (1.3 woods in both and 18 mmHg in both, respectively).

Conclusion
We report a significative regression of right chambers size up to 6 months after delivery. Pregnancy significantly impacts right systolic function as assessed by decreased FAC and strain analysis with a compensatory increase of TAPSE. Right diastolic function reflects pregnancy adaptation to volume overload as observed by the augmented velocity of atrial contraction.
Impact of coronary flow reserve on the mortality and major adverse cardiac and cerebrovascular event in hemodialysis patients, regardless of diabetes
Authors: Umemoto N , Oshima S , Takemoto K , Takikawa S , Itou R , Sakakibara S , Sumino M , Murohara T 
Published: November 2023

Abstract

Background
Ischemic heart disease (IHD) is still a major problem not only in general patients but also in regular hemodialysis (HD) patients. We have reported about prognostic value of coronary flow reserve (CFR) derived from N13-ammonia PET in HD population for all-cause mortality and major adverse cardiac event (MACE) in prior studies. We investigated the impact of diabetes and low CFR on the mortality in HD population.

Methods
A total 1,027 HD patients who undergone 13N-ammonia PET for suspected IHD were enrolled. We divided them into four groups according to CFR (cut off value = 2.0) and whether DM or not. We collected and evaluated their all-cause mortality, cardiovascular (CV) mortality and MACE, and analyzed using Kaplan-Meier methods and uni/multivariate cox regression model.

Results
The number of DM with better CFR group was 194, DM with worse CFR was 244, non-DM with better CFR was 361 and non-DM with worse CFR was 221. We found 285 case of all-cause mortality, 121 case of CV mortality, 164 case of CV mortality and 424 case of MACCE. Whether DM or not, CFR predicts HD patients’ prognosis precisely (See figure). Furthermore, multivariate Cox regression model showed CFR (continuous value) was an independent predictor for all-cause mortality (hazard ratio (HR); 0.774, 95% confidential interval (CI) 0.606-0.979, p value=0.037) and MACCE (HR0.769, 95%CI0.630-0.932, p=0.009) in DM and HD population. Furthermore, CFR predicted all-cause mortality (HR0.731, 95%CI 0.569-0.940, p=0.015) and non-CV death (HR0.636, 95%CI0.451-0.896, p=0.010) in non-DM and HD population.

Conclusion
The HD patients with DM and low CFR had worst prognosis in all-cause mortality, CV death, non-CV death and MACCE.
Renal insufficiency increases the risk of left ventricular remodeling
Authors: Li Q , Liu J , Kang Y , Lu X Z , Sheng S H , Chen S Q , Tan N , Chen J Y , Liu Y 
Published: November 2023

Abstract

Background
Renal insufficiency (RI) is a common disease and associated with heart failure (HF). Left ventricular remodeling (LVR) is a vital process in the progression of HF. However, few studies investigate the relationship between RI and LVR.

Methods
We included 4,973 consecutive patients undergoing coronary angiography (CAG) from January 2007 to December 2018 at Guangdong Provincial People's Hospital (NCT04407936). RI was defined as estimated glomerular filtration rate (eGFR) &lt; 90 ml/min/1.73m2. LVR was defined as: 1) left ventricular ejection fraction (LVEF) decreased by ≥ 10% from baseline, or 2) a follow-up measurement of LVEF &lt; 40%. Univariate and multivariate logistical regressions were used to assess the association between RI and LVR.

Results
Of the 4,973 patients (61.8 ± 10.5 years, female 30.8%) included in the study. The patients who developed LVR have lower eGFR (73.7 ± 24.2 vs. 78.4 ± 24.2 ml/min/1.73m2, p&lt;0.001). Among the 3,568 (60.6%) patients with RI, 526 (14.7%) had LVR. After adjusting for confounding, multivariate logistic regression showed that RI was associated with a significantly higher risk of LVR (mild RI: OR: 1.23, 95%CI 1.00-1.51, P=0.050; moderate RI: OR: 1.48, 95%CI 1.15-1.92, P = 0.003; severe RI: OR: 1.50, 95%CI 0.91-2.40, P = 0.096). In addition, LVR patients had higher all-cause mortality compared to non-LVR patients (18.1% vs. 9.3%).

Conclusions
Worse renal function increases the risk of decrease in left ventricular systolic function, and severe renal function insufficiency increases the risk of decreased left ventricular systolic function as high as 80% in patients following coronary angiography.Central Illustration
Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation on chronic haemodialysis: a systematic review and meta-analysis of randomised controlled trials
Authors: Navalha D D P , Felix N S , Nogueira A K S , Clemente M R C , Fernandes G C 
Published: November 2023

Abstract

Background
Patients with atrial fibrillation (AF) and end-stage renal disease on chronic haemodialysis (HD) are at risk for thromboembolic and bleeding events. The safety and efficacy of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in this population remains unclear.

Purpose
This systematic review and meta-analysis aimed to compare DOACs with VKAs in patients with AF on chronic HD with regards to cardiovascular mortality, all-cause mortality, ischaemic or uncertain type of stroke, and major or life-threatening bleeding.

Methods
We systematically searched PubMed, EMBASE, and Cochrane Library for randomised controlled trials (RCTs) comparing DOACs with VKAs in patients with AF on chronic HD from inception to February 2023 in accordance with PRISMA guidelines. Statistical analyses were performed using Review Manager 5.4.1. Heterogeneity was evaluated using I2 statistics. We performed the data extraction following the intention-to-treat principle.

Results
We selected three RCTs including 341 patients, of whom 176 (51.6%) were randomised to DOACs. Follow-up ranged from 174 days to 3.38 years. There was no significant difference between groups in terms of cardiovascular mortality (RR 1.35; 95% CI 0.71–2.60; p=0.36; I2=0%; Fig. 1A), all-cause mortality (RR 0.99; 95% CI 0.76–1.30; p=0.96; I2=11%; Fig. 1B), ischaemic or uncertain type of stroke (RR 0.52; 95% CI 0.18–1.48; p=0.22; I2=0%; Fig. 2A), or major or life-threatening bleeding (RR 0.69; 95% CI 0.42–1.14; p=0.15; I2=20%; Fig. 2B), with an overall low between-study heterogeneity.

Conclusion
In this meta-analysis, no significant difference was observed between DOACs and VKAs in cardiovascular mortality, all-cause mortality, ischaemic or uncertain type of stroke, nor major or life-threatening bleeding in patients with AF on chronic HD.Figure 1Figure 2