bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-C21-3: URINARY FREE CORTISOL EXCRETION AS A MARKER OF DECREASED BONE DENSITY IN PATIENTS WITH ADRENAL CUSHING'S SYNDROME
Authors: Takiguchi Miwa Kimura , Morimoto Satoshi , Watanabe Daisuke , Abe Koichiro , Ichihara Atsuhiro 
Published: January 2023

Objective:
Patients with adrenal Cushing's syndrome (CS) have a poor prognosis due to the autonomous hypersecretion of endogenous cortisol from the adrenal gland. Although several clinical examinations have been developed to manifest the autonomous hypersecretion of endogenous cortisol in this syndrome, it is unknown which parameter of cortisol overproduction is best associated with adrenal cortisol content and the bone and vascular complications of this syndrome. Therefore, the present study was undertaken to evaluate the parameter(s) associated with adrenal cortisol content in patients with adrenal CS, as well as to assess the associations between these parameters and the vascular and bone complications of this syndrome.

Design and method:
Patients with CS who were over 18 years old and had undergone adrenalectomy for this syndrome were enrolled in this study. Patients who were pregnant, had an allergy to iodine, or who were receiving medications that may interfere with the evaluation of 131I-adosterol single-photon emission computed tomography (SPECT) /computed tomography (CT) were excluded. Those taking medications that may interfere with the evaluation for the diagnosis of CS were also excluded. Relationships between office blood pressure and pulse rate, urinary examinations, blood examinations, endocrinological examinations, CT and 131I-adosterol SPECT/CT data, bone density, physiological function tests, and adrenal cortisol concentration/content were examined. In addition, relationships between the parameter associated with adrenal cortisol concentration/content and complications of CS were investigated.

Results:
Cardiovascular factors, except for diastolic blood pressure, failed to show an association with adrenal cortisol content. 24-h urinary free cortisol excretion (ρ = 0.893, P = 0.007) and plasma cortisol levels after the 1 mg (ρ = 0.857, P = 0.014) or 8 mg (ρ = 0.900, P = 0.037) overnight dexamethasone suppression test, but not plasma cortisol levels in the morning or at late night or indices of 131I-adosterol SPECT/CT, were significantly and positively associated with adrenal cortisol content. 24-h urinary free cortisol excretion, and not plasma cortisol levels after the 1 or 8 mg overnight dexamethasone suppression test was significantly and negatively associated with lumbar spine bone density (lumbar spine T-score, ρ = -0.883, P = 0.009; lumbar spine Z-score, ρ = -0.883, P = 0.009).

Conclusions:
24-h urinary free cortisol excretion is best associated with a decrease in bone density via increased adrenal cortisol overproduction and suggested that it could be used as a marker for osteoporosis in these patients.
PS-C21-8: THE CHANGING CLINICAL SPECTRUM OF PSEUDOALDOSTERONISM IN JAPAN: ANALYSIS OF REPORTED ADVERSE DRUG REACTIONS DATABASE
Authors: Takahshi Katsutoshi , Ikeda Yuzuru , Kurihara Isao , Katabami Takuya , Ueshiba Hajime , Tanabe Akiyo 
Published: January 2023

Background:
Pseudoaldosteronism is a severe primary aldosteronism-like syndrome with decreased plasma aldosterone levels. In Japan, it is often caused by herbal medicines containing licorice. However, there has been little evidence assessing the updated proportion of each drug and its recent trends.

Objective:
To identify recent major causes of pseudoaldosteronism in Japan and assess the possibility of chronological changes from 2005 to 2020.

Methods:
We collected data from the Japanese Adverse Drug Event Report (JADER) database, a spontaneous reporting system maintained at Japan's Pharmaceutical and Medical Devices Agency, reported between January 2005 and December 2020.

Findings:
In the JADER database, reported adverse events of pseudoaldosteronism, hypokalemia, rhabdomyolysis, and myopathy were extracted from 2016 to 2020. The drugs frequently implicated in the development of these pseudoaldosteronism-related events, including Syakuyakukanzoto, Yokukansan, Hochuekkito, Kakkonto, Rikkunshito, Daioukanzoto, Ryoukeijyutsukanto, Hangeshashinto, Bakumondoto, Saireito, were identified. Yokukansan, an herbal medicine increasingly used in the treatment of behavioral and psychological symptoms of dementia (BPSD), was shown to be the second most frequently associated drug with pseudoaldosteronism-related adverse events (232 cases), following Syakuyakukanzoto (255 cases). Furthermore, with regards to adverse events standardized by the content of licorice, Yokukansan was the most common. Between 2005 and 2020, the number of adverse events related to Yokukansan increased significantly, however, those associated with
Shakuyakukanzoto did not (Fig. 1).

Conclusion:
Yokukansan-induced pseudoaldosteronism appears to have increased significantly in Japan. Considering the aging population and limitations of conventional drugs for BPSD, this is an emerging trend and a potentially serious healthcare issue in Japan.
PS-C22-1: DIFFERENCE IN ALDOSTERONE DEPENDENCY BETWEEN CARDIOVASCULAR DISEASES AND RENAL IMPAIRMENTS IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Sone Masakatsu , Ohno Youichi , Kawashima Akiyuki , Inagaki Nobuya , Naruse Mitsuhide 
Published: January 2023

Recently, we assessed the PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) and compared the prevalences of CVD (stroke, ischemic heart disease, and heart failure), cardiomegaly (left ventricular mass index: LVMI) and renal impairment (proteinuria and lowered eGFR) among patients with PA and those with essential hypertension (EHT). We also performed logistic regression analysis to determine which parameters significantly increased the odds ratio for these complications.
As the results, the prevalence of CVD was significantly higher among patients with PA than among matched patients with EHT. The prevalence of proteinuria was also significantly higher among PA than EHT patients, whereas there was no significant difference in the prevalence of lowered eGFR. Multivariable logistic regression analysis showed that the PAC was not linearly related to the adjusted odds ratio for CVD and cardiomegaly though the PAC after saline infusion test and captopril challenge test was positively related to LVMI. By contrast, regarding renal complications, the PAC significantly increases the adjusted odds ratios for proteinuria and lowered eGFR independent of other known risk factors. The mechanism underlying the kidney damage in patients with PA may thus differ from that affecting the cardiovascular system.
PS-C22-5: PLASMA METANEPHRINES PROVIDE GREATER SPECIFICITY THAN URINARY METANEPHRINES IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A PROSPECTIVE TRIAL
Authors: Puar Troy H , Lenders Jacques , Saffari Seyed Ehsan , Wong Hang Siang , Mok Ying Juan , Mae Lily , King Thomas F 
Published: January 2023

Introduction:
Pheochromocytoma and paraganglioma (PPGL), and obstructive sleep apnea (OSA) are important secondary causes of hypertension. Both plasma and urinary metanephrines have high diagnostic sensitivity and specificity for diagnosis of PPGL. Patients with OSA have increased nocturnal catecholamine release, which can lead to increased metanephrines production over 24 hours. We hypothesized that morning plasma metanephrines have a higher diagnostic accuracy than 24-hour urinary metanephrines in patients with OSA.

Methods:
We recruited patients undergoing polysomnography for suspected OSA. Plasma and 24-hour urinary metanephrines were measured. Patients with elevated metanephrines had repeated measurements of metanephrines, imaging and follow-up, to diagnose, or exclude, PPGL.

Results:
Seventy-six patients completed polysomnography and biochemical testing, of which 68 had OSA. One patient had a PPGL, while PPGL was excluded in the remaining patients. At baseline, OSA patients were more likely to have falsely-elevated urinary (17 of 67, 25.4%), than falsely-elevated plasma metanephrines (2 of 67, 2.9%) (P < 0.01). Seven patients had normal metanephrines on repeat testing. Nine patients with persistently elevated metanephrines underwent abdominal imaging: six patients had no PPGL, one had lipid-rich adrenal adenomas, one had indeterminate adrenal adenoma, and one had bladder tumor. This final patient with biopsy-proven bladder PPGL had marginally-elevated urinary metanephrines, but false-negative plasma metanephrines, due to the small tumor size.
Falsely-elevated urine metanephrines were more common in patients with severe OSA (13 of 3, 38.2%), compared to moderate OSA (1 of 13, 7.7%) and mild OSA (3 of 20, 15%), P < 0.01. Falsely-elevated plasma and urine metanephrines were all due to elevation of normetanephrine, while metanephrine was normal in all patients. Declines in metanephrines were observed only in patients with OSA treated with continuous positive pressure ventilation, while those untreated had no improvements.

Conclusion:
In patients with OSA, metanephrines measured in plasma provide better specificity than those measured in urine for the diagnosis of PPGL. However, one patient with a small PPGL was missed by plasma metanephrines.
PS-C22-11: EFFICACY OF TRI-COMBINATION ACEI PLUS AMLODIPINE AND INDAPAMIDE VERSUS ARB AMLODIPINE AND THIAZIDE IN DIABETES WITH HYPERTENSION PATIENTS
Authors: Jain Rajesh , Shoghli Mohammadreza , Fesseha Hermon Eyob , Husseini Siyamal Jalal 
Published: January 2023

Introduction:
Global Burden of Disease (GBD) Study has estimated that Hypertension leads to
1.6 million deaths and 118 million disability-adjusted life years in INDIA1
40% of diagnosed Hypertension patients are treated1. The poor control rates among treated Hypertension patients are around 40% in Indian3.
Plausible reasons for poor Hypertension control rates in INDIA. This is mainly because most treated patients only receive monotherapy despite guidelines recognizing that most patients require combination therapy 2 and 3.
ISH 2020 guidelines support initiating with A+C SPC in Hypertension patients For patients uncontrolled on two drugs, recommended approaches are to increase doses as step 2 and add a third drug as step 3. 4
Every third Hypertension patient needs three or more drugs to reach the BP Perindopril + Amlodipine + Indapamide offers better blood pressure control.
In studies such as the ADVANCE CCB study5. Active treatment with Perindopril + Indapamide + CCB reduced the relative risk of death by -28%.
-The recent Mazza et al. study provides evidence for Cardiovascular risk reduction with Perindopril + Indapamide + Amlodipine combination. Left ventricular hypertrophy (LVH) regression was greater in the SPC group of Perindopril+ Indapamide+ Amlodipine vs. the FCT group (43.5% vs. 30.4%, P < 0.05).6
In our Indian study from 2019 to 2022, 110 patients with Diabetes with Moderate to severe Hypertension on Perindopril with Amlodipine and Indapamide were able to achieve a blood pressure target of < 130/80 mmHg with Minimum 6 months to a maximum of 2 years on this combination therapy, whereas Target of < 130/80 mmHg with ARB with Amlodipine and thiazide were achieved in 54% only, which was significant (Figure 1).
Indian patients are well Tolerated with triple single Pill, and adherence to therapy was Good.
PS-C23-6: THE ASSOCIATION OF ANTHROPOMETRY AND DIETARY PATTERNS WITH THE SEVERITY OF HYPERTENSION AT DIAGNOSIS IN HYPERTENSIVE PATIENTS IN SRI LANKA
Authors: Ralapanawa Udaya , Karunathilake Parackrama 
Published: January 2023

Objective:
The association between hypertension with anthropometric measurements and dietary patterns has been studied globally, giving variable results. This study analyses the anthropometry and dietary patterns of hypertensive patients in Sri Lanka.

Methods:
A cross-sectional descriptive study was designed to include hypertensive patients admitted to Teaching Hospital Peradeniya, Sri Lanka, from June 2015 to June 2016. An interviewer-administered questionnaire was used to collect data, and the clinical parameters were measured. Analysis was performed using the SPSS 26.0 statistical package.

Results:
371 patients were included in the study with a mean age of 64.6 ± 11.4 years, 68.2% females. The mean weight, height, body mass index (BMI), and the waist circumference (WC) of the population were 58.0 ± 12.2 kg, 152.5 ± 8.0 cm, 24.9 ± 4.8 kg/m2, and 90.1 ± 12.8 cm, respectively. The sample composition according to systolic blood pressure (SBP) at diagnosis was, normal (< 130 mmHg) 2.5%, high normal (130–139 mmHg) 14.2%, Grade 1 (140–159 mmHg) 51.9%, and Grade 2 (> 160 mmHg) 31.5%, and according to diastolic blood pressure (DBP) at diagnosis was, normal (< 85 mmHg) 6.8%, high normal (85–89 mmHg) 0.6%, Grade 1 (90–99 mmHg) 43.8%, and Grade 2 (> 100 mmHg) 48.8%. The mean weight, height, BMI, and WC did not differ between these groups (p > 0.050). Simple linear regression analysis did not reveal any correlation between the systolic or diastolic blood pressure at diagnosis with the weight, height, BMI, or WC (p > 0.050). Considering the diet, out of 14 food components, the consumption of rice, vegetables, sweat, and dairy products was the highest (18.8, 18.0, 12.4, and 8.5 mean number of meals per week). Regarding the variation of food consumption between the SBP groups, only grains and pulses (p < 0.001), and dairy products (p = 0.034) showed a significant variation. For the SBP categories normal, high normal, Grade 1 and Grade 2, the mean consumption of grains and pulses and dairy products per week were (14.0, 4.7, 3.8, 3.5) and (14.0, 8.2, 7.1, 7.4) respectively. Regarding the DBP categories, consumption of fried food showed a significant variation (p = 0.044) in addition to grains and pulses (p = 0.009) and dairy products (0.007). For the DBP categories normal, high normal, Grade 1 and Grade 2, the mean consumption of fried foods, grains and pulses and dairy products per week are (2.7, 0.0, 1.2, 1.9), (7.8, 0.0, 4.3, 3.4) and (11.5, 7.0, 6.4, 8.0) respectively. Between the bloods pressure groups, there was no significant variation in the consumption of salty foods.

Conclusion:
There is no association between the anthropometric measurements and the severity of hypertensionat the diagnosis, however the dietary components grains and pulses and dairy products showed a negative correlation, and fried foods only showed an effect on DBP.
PS-C24-2: SYSTOLIC BLOOD PRESSURE AND MORTALITY IN ELDERLY PATIENTS WITH HEART FAILURE
Authors: Inoue Taku , Shinjo Tetsuji , Matsuoka Mitsuteru , Tamashiro Masahiro , Arasaki Osamu , Arima Hisatomi 
Published: January 2023

Background:
Optimal blood pressure levels in elderly patients are controversial. Our previous results demonstrated that systolic blood pressure (SBP) lowering to less than 140 mmHg might not improve the prognosis in elderly hypertensive patients with frailty. Optimal blood pressure levels for elderly patients with heart failure (HF) have not yet been established.

Objective:
To examine the association between SBP level and mortality in elderly outpatients with or without HF.
Design and setting and participants: A prospective cohort study of older patients in an outpatient setting in Okinawa (Nambu Cohort Study) included 630 patients. Data were collected from 2017 to 2021. Patients were stratified into four categories according to SBP levels of more or less than 140mmHg and presence or absence of HF.

Results:
A total of 630 patients, with a median (IQR) age of 78 (71 - 84) years and 50% of whom were men, were followed for a median duration of 42 (34 - 43) months. 56% of them had SBP less than 140 mmHg, and 21% were diagnosed as HF. All-cause mortality occurred in 39 (11%) and 31 (11%) of patients with SBP less than 140 mmHg vs. SBP more than 140 mmHg, respectively (HR 1.02, 95%CI 0.64 - 1.65). Likewise, 32 (24%) and 38 (8%) of patients with HF vs. without HF were dead, respectively (HR 3.75, 95% CI 2.33 - 6.00). Adjusted HR (95%CI) for all-cause death of each category patients was as follows; SBP less than 140 mmHg / Non-HF (Reference), SBP more than 140mmHg / Non-HF 1.41 (0.74 - 2.71), SBP less than 140 mmHg / HF 2.71 (1.40 - 5.29), SBP more than 140mmHg / HF 3.75 (1.67 - 8.09) (Figure).

Conclusion:
In an elderly outpatient setting, an SBP level of more than 140mmHg was likely associated with an increased risk of all-cause mortality in HF and non-HF patients but not statistically significant. On the other hand, HF was associated with increased mortality risk.
PS-C24-10: HAEMODYNAMIC CHARACTERISTICS OF THE HEART BEFORE AND AFTER CRT IN PATIENTS WITH HEART FAILURE
Authors: Kuanyshbekova Roza Tokhtanalievna , Akhyt Bagdat , Mussagaliyeva Aisulu Tolekaevna , Koshumbaeva Kulzida Mukievna , Madaliev Kurmangazy Nurmaganbetovich 
Published: January 2023

The aim of the study:
to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure.

Materials and Methods:
seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration greater than 130 ms. and left ventricular ejection fraction less than 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study.

Results:
we observed significant increase in left ventricular ejection fraction (on 35.4 ± 3.7%, p < 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (on 20.2 ± 3.0%, p < 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by more than 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms.

Conclusions:
the response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant.
PS-C24-11: CLINICAL COURSE OF ACUTE DECOMPENSATED HEART FAILURE IN PATIENTS WITH RENAL DYSFUNCTION
Authors: Bezrodnyi Andrii , Mostbauer Galina , Rudenko Julia , Karasevska Tetyana 
Published: January 2023

The aim of the work:
To determine the influence of the presence of impaired renal function on the clinical course of the disease of acute decompensated heart failure.

Materials and methods:
The prospective study involved 72 patients with acute decompensated heart failure aged 48 to 82 years (mean age 68.4 ± 2.1), including 53 (73.6%) men, who were successively hospitalized in the cardiology department of the Oleksandrivska Clinical Hospital in Kyiv, Ukraine. Patients were divided into two groups depending on GFR at hospitalization: < 60 ml/h/1.73m2, i.e. significantly reduced, and < 60 ml/h/1.73m2, i.e. mildly to moderately decreased.

The results:
In the group with reduced GFR, patients were significantly older in age (63.7 ± 2.83 vs. 56.4 ± 2.48, p < 0.01) and differed in a higher frequency of hypertension (84.7% vs. 55.6%, p < 0.01), diabetes mellitus (30.6% vs. 15.3%, p < 0.05), a decrease in LVEF < 45% (88.9% vs. 69.4%, p < 0.01). The average time of hospital treatment was 14.7 ± 0.9 days in the GFR < 60 group, and 11.6 ± 0.5 days in the GFR < 60 ml/h/1.73m2 group, p < 0.01. A greater severity of HF according to NYHA classes with a predominance of IV FC in patients of this group was associated with a greater severity of clinical manifestations of congestion - shortness of breath according to the Borg scale, congestion index (all p < 0.05), as well as an increase in E/E‘ by 22.7% and NT-proBNP - by 24.2% (p < 0.01).

Conclusions:
In patients with acute decompensated heart failure, renal dysfunction is observed in 62,5% of cases and is associated with a more difficult clinical course of the inpatient treatment period, a higher frequency of arterial hypertension, more severe signs of congestion and the need for more aggressive decongestive treatment. An additional negative contribution is the development of acute kidney injury during the first 48 hours in a significant part of patients.
PS-C25-2: NOVEL AND SIMPLE INDEX USING BIOMARKERS FOR DETECTING SARCOPENIA IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Harada Haruhito , Nishiyama Yasuhiro , Niiyama Hiroshi , Katoh Atsushi , Kai Hisashi 
Published: January 2023

Objectives:
Sarcopenia has been highlighted as a common comorbidity in patients with cardiovascular disease (CVD), which is related to poor prognosis. Sarcopenia is generally diagnosed based on the decrease in skeletal muscle index (SMI) and the reduction of either handgrip strength or gait speed. However, SMI is difficult to measure for general physicians or cardiologists, because special, expensive equipment (i.e. bioelectrical impedance assay (BIA) or dual-energy X-ray absorptiometry) is necessary. Therefore, the aim of this study was to investigate a new, simple index to detect sarcopenia in CVD patients.

Design and Methods:
We retrospectively investigated the association of sarcopenia with physical examination data and circulating biomarkers of nutrition, inflammation, skeletal muscle homeostasis in CVD patients who admitted in our hospital. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) guidelines using SMI measurements by BIA method. The age criterion was not adopted for sarcopenia diagnosis in this study.

Results:
This study included 132 consecutive inpatients (72 [27–93] years, 80 males) with CVD and/or undergoing cardiovascular surgery. According to the modified AWGS guidelines, 39 patients were diagnosed as having sarcopenia and 93 patients as not having sarcopenia. Sarcopenic patients were older and had lower estimated glomerular filtration rates (eGFR) and lower Barthel index, and included higher numbers of females and subjects with chronic kidney disease, as compared with non-sarcopenic patients. Among the screened biomarkers (e.g. hsCRP and IL-6), serum adiponectin and sialic acid was significantly higher in sarcopenic patients than non-sarcopenic patients. On stepwise multivariate regression analysis, adiponectin, sialic acid, sex, age, and body mass index were independent detecting factors for sarcopenia based on the modified AWGS criteria. Sarcopenia index was obtained from the diagnostic regression formula for sarcopenia detection including the five independent factors. Sarcopenia index indicated a high accuracy in ROC curve analysis (sensitivity 94.9%, specificity 69.9%) and the cutoff value for sarcopenia detection was -1.6134. Sarcopenia index had a significant correlation with the conventional diagnostic parameters of sarcopenia.

Conclusion:
Novel biomarker-based sarcopenia index would be a simple, useful tool for detecting sarcopenia in CVD patients.