bluuebunny/crossref_metadata_2025_split huggingface dataset:
Veno-arterial extracorporeal membrane oxygenation as direct bridge to heart transplantation in a low and middle income country
Authors: Burgos L , Chicote F , Vrancic M , Seoane L , Costabel J , Furmento J , Ballari F , Baro Vila R , Piccinini F , Espinoza J , Navia D , Diez M 
Published: November 2023

Abstract

Introduction
The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid-term mortality compared with other interventions. In low- and middle-income countries (LMIC), where no other type of short-term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT).

Objective
To assess the outcomes of adult patients using VA ECMO as a direct bridge to heart transplantation in a LMIC and compare them with international registries.

Methods
We conducted a single-center study analyzing consecutive adult patients requiring VA-ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA-ECMO implantation were evaluated.

Results
Of 86 VA-ECMO, 22 (25.5%) were implanted as initial BTT strategy and 52.1% finally underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in all cases for CS and the most common underlying condition was coronary artery disease (30%), followed by idiopathic dilated cardiomyopathy (15%). Patient outcomes are described in Figure 1. Overall in-hospital mortality for VA ECMO as BTT was 50%. Survival to discharge was 83% in those who achieved HT and 10% in those who did not, p&lt;0.001. In those who did not achieve HT, the main cause of death was haemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA ECMO was 6 days (IQR 3-16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry (Barge Caballero et al 2018), in-hospital survival after HT was 66.7%, the United Network of Organ Sharing registry (Fukuhara et al 2018) estimated post-transplant survival at 73.1% ± 4.4%, and in the French national registry (Jasserson et al 2016), 1-year post-transplant survival was 70% in the VA ECMO group.

Conclusions
In adult patients with cardiogenic shock, VA-ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA-ECMO. VA-ECMO can be used to bridge critically ill candidates directly to HT in a setting where no other circulatory support is available, as a salvage strategy with acceptable mortality in a high-volume specialized center. We present a single center experience with results comparable to registries in Spain, France and the United States.
Arterial stiffness assessment in patients with resistant hypertension using pulse wave analysis
Authors: Akhmimi A , Sprung V S , Lip G Y H , Oxborough D , Shantsila A 
Published: November 2023

Abstract

Introduction
People living with resistant hypertension (RH) have a higher prevalence of target organ damage, and demonstrate increased risk of cardiovascular (CV) morbidity and mortality. There are distinctive vascular structural and functional changes associated with hypertension. Among these, endothelial dysfunction and increased arterial stiffness are prevalent. Increased aortic augmentation index (AIx) is a non-invasive hemodynamic indicator of systemic arterial stiffness, which has been associated with hypertension; however, there are less data in RH patients.

Purpose
To test the hypothesis that people living with RH have increased AIx compared to those with controlled essential hypertension (CH) and normotensive controls (NC); and to explore demographic and clinical variables related to AIx.

Methods
In our observational study, 54 participants: 17 with RH (mean age 60.5±12.4 years), 18 with CH (57.7±12.2 years), and 19 NC (54.7±11.9 years) were recruited. Anthropometric and resting office blood pressure (BP) measurements were obtained. Pulse wave analysis was performed using a commercially available device (Vicorder) to measure central BP, aortic pulse pressure, mean arterial pressure (MAP), aortic augmentation pressure and AIx.

Results
The study groups were matched for age, sex, ethnicity, height, body surface area and heart rate (P&gt;0.05) (Table 1). Both office and central BP readings were elevated in RH group compared to CH and NC (162/102mmHg vs 126/86mmHg and 118/80mmHg, P&lt;0.001) and (163/83mmHg vs 131/73mmHg and 120/67mmHg, P&lt;0.05). Aortic pulse pressure, MAP and aortic augmentation pressure were significantly increased in patients with RH compared to other groups (P&lt;0.001). AIx was markedly increased in RH compared to CH and NC (31±7% vs 23±8% and 21±9%, P=0.001, respectively). Antihypertensive medications were similar between both hypertensive groups, except for diuretics and beta-blockers which were more prevalent in the RH group (100% vs 28% and 47% vs 6%, P&lt;0.05, respectively). In stepwise regression analysis, elevated AIx was significantly and independently associated with the presence of RH (β=6.4, P=0.005), age (β=.23, P=0.005), female sex (β=6.3, P=0.003) and body mass index (β=.71, P=0.038).

Conclusion
AIx is increased in RH patients and independently related to the presence of RH, age, female sex and body mass index. Increased arterial stiffness and reduced arterial compliance in patients with RH may play an important role in the progression of serious CV complications seen in these patients. The non-invasive assessment of arterial stiffness indices such as AIx in RH patients may be valuable to provide prognostic and therapeutic insights.Table 1
Contribution of TNF-R1 to reduced exercise capacity in hypertensive heart disease. Mediating role of left atrial mechanical function reserve
Authors: Kosowski W , Zachwyc J , Woznicka A K , Mysiak A , Przewlocka-Kosmala M , Ponikowski P , Kosmala W 
Published: November 2023

Abstract

Background
Tumor necrosis factor alpha (TNF-alpha) plays a relevant pathophysiological role in cardiovascular disorders, including hypertensive heart disease (HHD) – a clinical condition frequently contributing to the development of heart failure with preserved ejection fraction (HFpEF). TNF receptor 1 (TNF-R1) has been found to mediate proinflammatory and proapoptotic effects of TNF-alpha, and its soluble circulating form proved to be effective in predicting incident HF. Existing evidence indicates the association between TNF pathways activation and cardiac dysfunction, but exact mechanisms mediating this link are unclear.

Objectives
We sought to investigate the association of TNF-R1 with exercise capacity, and left ventricular (LV) and left atrial (LA) function reserve in asymptomatic patients with HHD.

Methods
We enrolled 80 (55±12 yo) patients with HHD and normal exercise tolerance (stage A and B HF). Echocardiography (including LA and LV strain assessment) was performed at rest and immediately post exercise test. Blood samples for TNF-R1 were drawn in fasting conditions. Exercise reserve of cardiac function parameters was calculated by subtracting resting value from exercise value.

Results
The study population was categorized into 2 subsets using a median value of exercise capacity (9.2 METs). Patients with higher exercise capacity were characterized by lower TNF-R1 concentrations and higher LA reservoir and LA contractile strain reserves (Table). No significant intergroup differences were found for exercise reserves in LV ejection fraction (LVEF), LV global longitudinal strain and diastolic parameters (e’ and E/e’). TNF-R1 significantly correlated with peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) reserves (r=-0.27; p&lt;0.02 and r=-0.24; p&lt;0.04, respectively), but not with LVEF, global longitudinal strain (GLS), e’ and E/e’ reserves. Regression-based mediation analysis revealed that the relationships between TNF-R1 and exercise capacity were mediated by PALS and PACS reserve, as evidenced by the reduction in variance of exercise capacity (METs) explained by TNF-R1 after the inclusion of PALS and PACS reserve to the models (decrease in beta coefficient from -0.24 to -0.19 for PALS, and to -0.20 for PACS, Figure).

Conclusions
In patients with HHD, higher TNF-R1 is associated with lower exercise capacity, and this relationship may be mediated by lower LA strain reserve. This finding may contribute to elucidating the mechanisms behind the involvement of the left atrium in HF progression.Mediation analysis
Sympathetic nerve activity reactivity is associated with cardiac fibrosis in humans
Authors: Blythe H , Adams Z H , Hope K A , Baker R P , Sheikh A A , Suleiman M S , Nightingale A K , Hart E C 
Published: November 2023

Abstract

Background
Hypertension causes cardiac remodelling and left ventricular hypertrophy (LVH) in some individuals but not others [1-3]. 90% of people with heart failure preserved ejection fraction (HFpEF) have hypertension. One possible mechanism is increased sympathetic drive resulting in cardiac fibrosis. Resting sympathetic nerve activity (SNA) is associated with cardiac remodelling in both animals and humans and progressively increases from hypertension to LVH to HFpEF.
However, humans are not in a constant rested state, and are frequently exposed to multiple physiological stressors throughout the day, resulting in surges in SNA. Amplified SNA reactivity to stressors may contribute to cardiac remodelling more than elevated resting SNA levels, as intermittent β-adrenergic receptor stimulation with isoprenaline in mice has been shown to cause more severe cardiac fibrosis when compared to a sustained isoprenaline administration [4].

Purpose
To determine whether resting SNA and/or SNA reactivity to a physiological stressor (cold pressor test) were associated with cardiac fibrosis in humans.

Methods
Nineteen (10M, 9F; 48 ± 13 years; BMI: 25.9 ± 3.2 kg/m²) participants with varying ambulatory blood pressures (SBP: 126±13 mmHg, DBP: 83±8 mmHg, SBP range: 111-153 mmHg, DBP range: 68-96 mmHg), provided written informed consent. Blood pressure (Finometer), heart rate (ECG) and muscle SNA (peroneal microneurography) were recorded simultaneously during a 5-minute baseline, and a 2-minute rest, 3-minute cold pressor test (3-4°C) and 5-minute recovery. Cardiac extracellular volume (ECV) was measured using magnetic resonance imaging (1.5T Avanto, Siemens) as an index of cardiac fibrosis. Simple linear regressions were conducted between baseline SNA and ECV, and change in SNA from rest to peak cold pressor test and ECV using SPSS.

Results
Resting SNA was not associated with ECV. However, the absolute change in SNA burst incidence (bursts/100 heartbeats) and burst frequency (bursts/minute, Figure 1) from rest to peak cold pressor test, were positively associated with ECV, showing that the greater the SNA response to a stressor, the higher the ECV. Specifically, for every 1 burst/100 heartbeat increase in burst incidence (from rest to peak cold pressor test), ECV increased by 0.120%, and for every 1 burst/minute increase in burst frequency (from rest to peak cold pressor test), ECV increased by 0.128%.

Conclusion
SNA reactivity but not resting SNA level was found to be a predictor of ECV, where the greater the SNA response to a stressor, the higher the ECV. This indicates that intermittent surges in SNA may be more important for promoting cardiac fibrosis than the overall level of resting SNA in humans.Figure 1.
Plasma aldosterone concentration / plasma renin activity ratio in patients with essential hypertension before treatment
Authors: Nakayama M , Miyamoto Y , Morimoto T , Arima Y , Tsujita K 
Published: November 2023

Abstract

Background
The renin–angiotensin–aldosterone-sodium system, an important player in maintaining blood pressure, is influenced by antihypertensive drugs. However, the analysis of the renin-aldosterone-sodium system in hypertensive patients without adrenal adenoma without antihypertensive drugs is not still enough.

Purpose
We analyzed plasma aldosterone level, renin activity, serum potassium level, and serum sodium level in hypertensive patients without adrenal adenoma before treatment.

Methods
We measured plasma aldosterone concentration (PAC; pg/mL), plasma renin activity (PRA; ng/mL/h), serum potassium and sodium levels (mEq/L) in 456 consecutive new hypertensive patients untreated with antihypertensive drugs. We sampled all blood after 30 minutes bedrest. We excluded 28 cases with blood pressures less than 135/85 mmHg at rest, 4 patients with adrenal adenoma, and 3 patients with renovascular hypertension. We analyzed 421 patients with essential hypertension before treatment (232 males, mean age 56.5±12.8 years, and 189 females, mean age 61.0±13.5 years).

Results
There was a significant positive correlation between PRA and PAC (ρ=0.2445, p&lt;0.001). There was a significant positive correlation between PAC/PRA ratio and serum sodium levels (ρ=0.1604, p=0.0027); however, no correlation was observed between PAC/PRA ratio and serum potassium levels. There were significant negative correlations between PRA and serum sodium levels (ρ=-0.1925, p&lt;0.001). However, there was no correlation between PAC and serum sodium levels. On univariate analyses, a high PAC/PRA ratio (&gt;200) was significantly associated with female (p&lt;0.001), high serum sodium level (p=0.003), and low pulse rate (p=0.02). Multiple logistic analyses revealed that the most predictive independent factor for high PAC/PRA was female (p&lt;0.001). On analyses of gender differences, the incidence rates of high PAC/PRA (&gt;200) were 33.9% in females and 16.4% in males. There was a significant positive correlation between PRA and PAC in both genders (males: ρ=0.2731, p&lt;0.001; females: ρ=0.1976, p=0.0064). In females, there was a significant positive correlation between PAC/PRA and serum sodium levels (ρ=0.2221, p=0.0043); however, there were no significant correlations between PAC/PRA and serum sodium levels in males. In females, there was a significant negative correlation between PRA and serum sodium levels (ρ=-0.2668, p&lt;0.001); however, there were no significant correlations between PRA and serum sodium levels in males. Serum sodium levels were significantly higher in females than in males (p=0.02).

Conclusion
We revealed gender differences in the renin-aldosterone-sodium system in patients with essential hypertension before treatment.
Blood pressure and cardiovascular disease in Koreans with and without diabetes mellitus
Authors: Han S , Park S , Kim Y G , Park G M 
Published: November 2023

Abstract

Background
We sought to evaluate the association between blood pressure (BP) levels and development of cardiovascular diseases (CVDs) in Korean subjects with and without diabetes mellitus (DM).

Methods
Using the National Sample Cohort of Korea, we analyzed 272,736 subjects aged 20–80 years without previous CVDs who underwent regular health checks between 2009 and 2010. Subjects on anti-hypertensive medications were excluded. CVD was defined as a composite of cardiovascular death, myocardial infarction, and stroke. Participants were grouped by 10mm Hg intervals of systolic BP (SBP) (&lt;110, 110-119, 120-129, 130-139, 140-149, 150-159, &gt;160mmHg) and by 5mm Hg intervals of diastolic BP (DBP) (&lt;70, 70-74, 75-80, 80-84, 85-90, 90-99, &gt;100mmHg).

Results
The mean age of the study population was 44.5 ± 12.7 years and 144,179 (52.9%) were men. During the follow-up period (median 10.1 [interquartile range, 9.5–10.5] years), 2,715 subjects had 2,840 CVD events, namely, 952 cardiovascular deaths, 1,171 myocardial infarctions, and 717 strokes. In subjects without DM (n=250,302), compared with SBP &lt;110 mmHg as the reference group, the risk of CVD significantly increased with increasing SBP groups (all p&lt;0.05). On the other hand, in DBP groups analyses, only subjects with DBP &gt;100 mmHg was associated with a significantly higher risk of CVDs compared with DBP &lt;70 mmHg as the reference group. In subjects with DM (n=22,434), there was no increased risk of CVD among subjects with SBP 110-129 mmHg compared with SBP &lt;110 mmHg, but SBP ≥130 mm Hg was associated with a significant increase in the incidence of CVDs. However, in DBP groups analyses, there was no significant association of incidence CVDs across DBP groups compared with DBP &lt;70 mmHg.

Conclusions
In individuals without DM, those with SBP &gt;110 or DBP &gt;100mmHg have a significantly higher risk of CVD. However, in individuals with DM, those with SBP &gt;130 mmHg was only associated with an increased risk of CVD. These results suggest that hypertension management could vary according to the presence of DM.
Association of pulse pressure with risk of major adverse cardiovascular events among cardiovascular outcome trial participants
Authors: Agarwal N , St Jean J , Van Iterson E H , Laffin L 
Published: November 2023

Abstract

Background
Hypertension is a well-established risk factor for the development for cardiovascular (CV) disease and accumulating evidence also implicates elevated pulse pressure (PP), a surrogate marker for arterial stiffness, as an independent risk factor for major adverse cardiovascular events (MACE).

Purpose
The study aimed to assess the association of PP with MACE among participants in multiple CV outcome clinical trials. It also aimed to determine if the presence of various CV comorbidities impacts the association between PP and MACE.

Methods
Adult patients between the ages of 19-98 years (n = 65,382, mean age 63) enrolled in five large CV outcome trials (ACCELERATE, STRENGTH, PRECISION, ALECARDIO, and LIGHT) with independently adjudicated clinical end points were identified. Baseline demographics, medical history, blood pressures, and CV medications were collected. Univariate and multivariate analyses were generated and analyzed for temporal trends, risk, and adjusted survival.

Results
Participants had a mean baseline blood pressure of 128 /76 mm Hg and a mean PP of 52 mm Hg. Forty-five percent were women, 31% had coronary artery disease, 51% had type 2 diabetes mellitus, 84% had hypertension, 25% had history of myocardial infarction (MI), and 35% had a history of an acute coronary syndrome. The composite MACE end point included CV death, myocardial infarction, or stroke and occurred in 3712 participants (5.7%).The composite end point of all cause death, myocardial infarction, and stroke occurred in 4513 participants (6.9%).
For every 10 mm Hg increase in PP there was an increased risk of MACE (unadjusted hazard ratio (HR) 1.20, 95% CI 1.17 to 1.23). Similarly, a PP &gt; 60 mmHg demonstrated an unadjusted HR of 1.53 (95% CI 1.43 to 1.64) compared with PP &lt; 60 mm Hg. Although increased PP was a risk factor in both men and women, every 10 mm Hg increase in PP was associated with higher risk of MACE in women (adjusted HR 1.17, 95%CI 1.17, 1.12 to 1.22) compared with men (adjusted HR 1.09, 95% CI, 1.05 to 1.12).
Table 1 displays the adjusted HR for patients grouped by race, history of prior CV disease, or the presence of CV risk factors (diabetes and chronic kidney disease.) While most subgroups demonstrated an increased risk of MACE with increasing PP, PP was not associated with MACE among individuals with a history of stroke (HR 1.00, 95% CI 0.92 to 1.08). Kaplan-Meier survival curves comparing PP greater than or less than 60 mm Hg are seen in Figure 1.

Conclusions
Among CV outcome clinical trial participants, with independently adjudicated end points, baseline PP is associated with an increased risk for future MACE. The association stands for most participant subgroups except for participants with a prior history of stroke.Table 1Figure 1
Systolic blood pressure visit-to-visit variability and outcomes in Asian patients with established or multiple risk factors for atherosclerotic cardiovascular disease: results from the CORE-Thailand
Authors: Chichareon P , Suwanugsorn S , Wongcharoen W , Phrommintikul A 
Published: November 2023

Abstract

Background
It is well established that high blood pressure is associated with poor outcomes in many cardiovascular conditions. However, blood pressure (BP) is dynamic and may have variation during the follow-up. We aimed to assess the association between the systolic and diastolic blood pressure visit-to-visit variability (BP-VVV) and outcomes in Asian patients with established or multiple risk factors for atherosclerotic cardiovascular disease (ASCVD) in the Cohort Of patients with a high Risk of cardiovascular Events (CORE).

Methods
The CORE registry was a nationwide study enrolling patients with established atherosclerotic cardiovascular disease or those with multiple risk factors (at least three atherosclerotic risk factors) between April 2011 and March 2014 in 25 hospitals. Patients in the CORE registry with blood pressure measurements in at least three visits were included in the present study. BP-VVV was defined as the standard deviation (SD) of average blood pressure. Patients were grouped into quintiles of the SD of BP. The primary outcome was major adverse cardiac events (MACE), defined as all-cause mortality, all stroke, or myocardial infarction. The associations between BP-VVV (systolic and diastolic) and outcomes were assessed in the adjusted Cox regression model. The adjusted variables included age, sex, body weight, diabetes, chronic kidney disease, current smoking, established ASCVD, and treatment with ACEI or ARB. Restrict cubic spline was used to assess the association between SBP-VVV as a continuous variable and MACE in the adjusted Cox model.

Results
Of the 8,886 patients in the present study, 4041 patients (45.5%) were female, with a mean age of 65.6 years. The prevalence of hypertension was 95.9%. The mean SBP at baseline was 133 mmHg. The proportion of patients with established ASCVD was 51.1%. The mean follow-up time was 45.1 months.
The Kaplan-Meier rate of MACE at five years was 15.8%. Spline analysis showed a J-curve association between SBP-VVV and MACE. The group with the highest SBP-VVV (the fifth quintile) had a significantly higher risk of MACE than the group with the lowest SBP-VVV (the first quintile) (adjusted hazard ratio 1.26, 95% CI 1.05-1.51). Compared with the group with the lowest SBP-VVV (the first quintile), the fifth quintile had a significantly higher risk of stroke, all MI, heart failure, and renal function deterioration. The risk of PAD and bleeding were similar among the quintiles.

Conclusion
SBP-VVV significantly impacted the long-term outcomes of Asian patients with established or multiple risk factors for ASCVD. Adequate SBP control and maintaining SBP stability over time may prevent adverse events in this population.SBP-VVV and MACE