bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS-C24-4: QUANTIFICATION OF EXERCISE-INDUCED HEMODYNAMIC CHANGE BY HEART SOUND ANALYSIS IN PATIENT WITH HEART FAILURE
Authors: Kaneko Tetsuya , Kotooka Norihiko , Node Koichi 
Published: January 2023

Objective:
Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure, early and non-invasive detection of that sign is useful in heart failure care. The purpose of this study was to assess whether a non-invasive technology called cardiac acoustic biomarkers (CABs) to quantify heart sounds can detect the exercise-induced elevation of PAP in patients with heart failure.

Design and Methods:
Patients with heart failure scheduled to undergo right heart catheterization (RHC) were prospectively enrolled between February 2020 to September 2021. CABs were concurrently recorded with PAP and pulmonary capillary wedge pressure (PCWP) at rest (baseline) and while applying a handgrip (exercise).

Results:
Forty-nine patients were included in the analysis dataset and their mean PAP significantly increased at exercise compared to baseline (32.45 ± 11.28 mmHg vs 23.52 ± 8.41 mmHg; p < 0.001). Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p < 0.05 and r = 0.363; p < 0.05) and S3 Strength (r = 0.375; p < 0.05 and r = 0.386; p < 0.05) were consistent throughout baseline and exercise. The response of CABs to PAP elevation caused by exercise was divided into two patterns: increasing and decreasing. The frequency of cardiac index less than 2.2 mL/m2 was significantly higher in the decreasing pattern.

Conclusions:
CABs related to S2 and S3 can quantify heart sounds which reflect the exercise-induced hemodynamic change in patients with heart failure. It should be noted, however, that their reactions to hemodynamic change can be different depending on the background hemodynamics of individuals.
PS-C24-8: PLASMA ANGIOTENSIN CONVERTING ENZYME 2 ACTIVITY IN HOSPITALISED PATIENTS WITH ACUTE HEART FAILURE CLASSIFIED BY LEFT VENTRICULAR EJECTION FRACTION
Authors: Doumtsis Nicholas Alexander , Patel Sheila , Ramchand Jay , Lu Ken , Srivastava Piyush , Burrell Louise 
Published: January 2023

Objective:
Angiotensin-converting enzyme 2 (ACE2) is present on endothelial cells with a role to degrade angiotensin II. In this study, we investigate plasma ACE2 levels in patients admitted with acute decompensated heart failure (ADHF) and determine if levels differ according to ejection fraction (EF).

Design and Method:
We prospectively recruited 9 controls and 117 ADHF inpatients, determined EF using echocardiography, measured plasma ACE2 activity using an in-house assay and NT-proBNP levels using a commercially available assay. Patients were classified according to 2021 European Guidelines as HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF) or preserved EF (HFpEF).

Results:
In addition to NT-proBNP level, median plasma ACE2 activity was increased in ADHF patients (n = 117) compared to controls (1.33 [0.02, 4.02] vs 15.36 [9.02, 27.9] pmol/mL/min, p < 0.0001). In ADHF, plasma ACE2 activity was negatively associated with EF (r = -0.43, p < 0.0001). Overall, 58% of patients had HFrEF, 10% had HFmrEF and 32% had HFpEF. Patients with HFrEF had a higher median plasma ACE2 activity compared to those with HFpEF (18.3 [12.3, 30.0] vs 11.4 [4.8, 17.9] pmol/mL/min, p = 0.001) and higher NT-proBNP levels (p = 0.001). There was no difference in plasma ACE2 activity between patients with HFmrEF and HFpEF or HFmrEF and HFrEF.

Conclusions:
Plasma ACE2 activity is elevated in patients hospitalised with ADHF and is significantly higher in HFrEF compared to other types of HF. Further studies are needed to determine if measurement of plasma ACE2 can assist in better definition /classification of the patient phenotype to facilitate improved treatment.
PS-C24-12: HEALTH-RELATED QUALITY OF LIFE, AND OUTCOMES IN ADULTS WITH HEART FAILURE: AGE AND SEX-RELATED DIFFERENCES AND THE ROLE OF HYPERTENSION
Authors: Amusa Ganiyu Adeniyi 
Published: January 2023

Objective:
Hypertension is the commonest cause of heart failure. Heart failure is a pandemic and major driver of mortality; limiting disease progression and improving health related quality of life remains the cornerstone of management. There is dearth of information on quality of life in Africans with heart failure. This study examined age and sex related differences and the role of hypertension in the profile, health related quality of life, and clinical outcomes in African adults with heart failure.

Design and method:
A cross sectional study conducted at the outpatient cardiology clinics of Jos University Teaching Hospital. Two hundred adults with stable heart failure were enrolled using a simple random method. Relevant history, functional class, Charlson comorbidity index were obtained. Physical examination which included electrocardiography, echocardiography, 6 minutes walk distance were done using standard guidelines. Health related quality of life was assessed using the Minnesota living with heart failure questionnaire and graded as good, moderate or poor. Data was analyzed using SPSS version 21. Simple descriptive statistics and multiple logistic regression to determine predictors of moderate and poor quality of life were done.

Results:
The participants comprised of 104 females and 96 males. More males belonged to higher social class, 21% of the males had health insurance compared to 17% of the females. 48% of the males had atrial fibrillation compared to 33% of the females. About 50% of the participants have heart failure with reduced ejection fraction, there was significant difference in heart failure aetiology below 45 years versus above 45 years in both sexes. The burden of comorbidities was significantly higher in the males and those above 45 years old. There were differences in the individual domain scores of MLHF scores across age groups and sex, the males have a statistically significant poorer quality of life similarly for above 45 year old compared to below 45 year old. The females had higher numbers of hospital admission within the past 12 months and higher hospitalization frequency. functional class 3 or more, 6MWT below 300metres, ejection fraction above 50% and above 6 classes of medication emerged as predictors of moderate/poor MLHF scores in both males and females.

Conclusion:
This study found significant age and sex-related differences in clinical profile, HRQOL, and clinical outcomes in African adults with HF. Hypertension was the commonest cause of HF. Improved control of hypertension and periodic health related quality of life assessment in patients with HF are advocated to improve outcomes.
PS-C25-1: ANGIOTENSIN II RECEPTOR BLOCKER AND STATIN COMBINATION THERAPY ASSOCIATED WITH HIGHER SKELETAL MUSCLE INDEX IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Harada Haruhito , Nishiyama Yasuhiro , Niiyama Hiroshi , Katoh Atsushi , Kai Hisashi 
Published: January 2023

Objectives:
Reduction in skeletal muscle mass is the most important component in the diagnosis of sarcopenia. Aging and chronic heart failure due to cardiovascular diseases (CVDs) accelerate the reduction in skeletal muscle. However, no effective drugs for sarcopenia are available. The purpose of this study was to explore the associations of prescribed medications with higher skeletal muscle mass in patients with CVD.

Design and Methods:
This was a single-center, retrospective, cross-sectional analysis. The subjects were 636 inpatients with CVD who had been taking prescribed medicines for at least 4 weeks at the time of admission. Prescription data were collected from electronic medical records database. Drugs and drug combinations were selected for analysis when they were prescribed to more than 10% (64 cases) of all subjects. Because of their frequent use in clinical practice for CVD, various combinations of angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCBs), and statins were also examined. Skeletal muscle volume was assessed with a bioelectrical impedance assay.

Results:
The mean age was 73 ± 12 years (male, 54.4%). The body mass index and skeletal muscle index (SMI) were 23.8 ± 4.3 kg/m2 and 6.46 ± 1.42 kg/m2, respectively. ACC/AHA stage C/D heart failure was shown in 21.4%. Single regression analysis showed that SMI was positively associated with the use of CCBs, ARBs, statins, antihyperuricemic agents, dipeptidyl peptidase-4 (DPP-4) inhibitors, oral antidiabetic agents excluding DPP-4 inhibitors, ARB/CCB combination, statin/CCB combination, ARB/statin combination, and ARB/beta-blocker combination. Diuretics, antiarrhythmic agents, and anticoagulants were negatively associated with SMI. Stepwise multivariate regression analysis revealed that ARB/statin combination was independently and positively associated with SMI whereas diuretics and antiarrhythmic agents were independently and negatively associated with SMI. After adjustment using propensity score matching, SMI was significantly higher in ARB/statin combination users than in non-users.

Conclusion:
Combination use of an ARB and a statin was associated with a higher SMI in patients with CVD. A future randomized, controlled trial is warranted to determine whether the ARB/statin combination will increase the SMI and prevent sarcopenia in CVD patients. The results of the present study may be useful for drug repositioning to screen for drug candidates.
PS-C25-6: HYPERTENSIVE RESPONSE TO EXERCISE AS PREDICTOR FOR DEVELOPMENT OF ESSENTIAL HYPERTENSION AND HOSPITALIZATION DUE TO MAJOR ADVERSE CARDIAC EVENT
Authors: Jagannatha Gusti Ngurah Prana , Yasmin AA Ayu Dwi Adelia , Pradnyana I Wayan Agus Surya , Kamardi Stanly , Wibawa Ida Bagus Satriya , Pangkahila Elionardo Enrique 
Published: January 2023

Objective:
The aim of this study was to determine the structural and metabolic factors associated with hypertensive response to exercise (HRE) in non hypertensive patients and role of HRE in predict development of essential hypertension during follow-up and predict hospitalization due to major adverse cardiac event (MACE).

Design and method:
This study was a cross-sectional retrospective study using cardiac treadmill stress test (TST) data at Sanglah General Hospital, Bali from 2016–2020. Data analysis used SPSS version 21. Subjects were divided into positive HRE and negative HRE. Pearson-chi square test and Mann-Whitney test were used to compare categorical variables based on age, gender, smoking status, nutritional status, alcohol status, dyslipidemia, type 2 diabetes mellitus (T2DM), HbA1C, total cholesterol, LDL, HDL, triglycerides, history of kidney disease, and mean echocardiographic parameters based on the presence of HRE. Development of essential hypertension during follow up and history of hospitalization after cardiac TST due to MACE until April 2022 based on the presence of HRE was evaluated using receiver operating characteristics.

Results:
We evaluated 202 non hypertensive patients (47,1% with HRE) who underwent cardiac TST. During follow up, 19.8% experienced hospitalization and 26.1% developed hypertension. Obesity (PR1.727; 95%CI = 1.235–2.413), smoking status (PR1.773; 95%CI = 1.170–2.687), T2DM (PR2.29; 95%CI = 1.16–3.37), HbA1C (PR3.13; 95%CI = 2.31–4.22), high LDL level (PR1.853, 95%CI = 1.229–2.794) and history of kidney disease (PR1.985; 95%CI = 1.478–2.665), were significantly associated with positive HRE (all p-value < 0.05). Regarding the clinical outcomes, patients with HRE were associated with an increased risk of developing essential hypertension (PR1.72; 95%CI = 1.235–2.413 p = 0.05) and hospitalization due to MACE (OR2.27, 95% CI = 1.62–3.16, p = 0.0001) during follow up, with sensitivity of 76.7% and specificity of 93.6%. Subjects with HRE had higher LV mass index (82.34 ± 15.05 vs 70.62 ± 9.76), higher E/E ratio (16.31 ± 2.95 vs 16.01 ± 13.23), higher LAVI (39.75 ± 15.21 vs 34.27 ± 11.15) with all p-value were < 0.05.

Conclusions:
Patients with impaired cardiometabolic and the presence of cardiac remodeling commonly have HRE that could be detected by cardiac TST examination, which may predict the development of essential hypertension and major adverse cardiac events in the future.
PS-C25-9: COMPARISON OF ANTIHYPERTENSIVE EFFECTS OF ISOMETRIC HANDGRIP VERSUS AEROBIC EXERCISE IN ELDERLY HYPERTENSIVE PATIENTS: A RANDOMIZED CONTROLLED TRIAL
Authors: Jae Sae Young , Yoon Eun Sun , Kim Hyun Jeong , Cho Min Jeong 
Published: January 2023

Purpose:
The purpose of this study was to compare the antihypertensive effects of isometric handgrip exercise (IHG) versus aerobic exercise (AE) on clinic, central and 24-hour ambulatory blood pressures in elderly hypertensive patients.

Methods:
We conducted a randomized controlled trial with a three-arm design. Fifty-four elderly hypertensive patients (mean age 69 ± 6 years) were randomized to IHG training (n = 17), AE training (n = 19), or non-exercise control group (n = 18; CON) for 12 weeks (3 times per week). Bilateral IHG training was performed four times of 2 min at 30% of maximal voluntary contraction using a digital handgrip device. AE training was a brisk walking and bike exercise for 30-min at moderate intensity. Resting clinic, central, and 24-hour ambulatory blood pressures were obtained at baseline and after 12-week intervention.

Results:
Compared with CON, office and 24-hour systolic blood pressure were significantly reduced in both IHG and AE groups (P < 0.05, both) and the magnitude of SBP reduction was not significantly different between both the exercise intervention groups. However, office, central and 24-hour diastolic blood pressure were more decreased in IHG vs. AE group as compared with CON.

Conclusion:
These findings suggest that both IHG and AE training reduced resting office blood pressure and 24-hour ambulatory blood pressure, but IHG training is more effective in improving office, central and 24-h ambulatory diastolic blood pressure than AE. Thus, IHG training may be an alternative antihypertensive therapy for elderly hypertensive patients.
PS-C25-10: ASSOCIATION BETWEEN SKELETAL MUSCLE MASS AND BLOOD PRESSURE DECLINE OVER A FIVE-YEAR PERIOD FOR COMMUNITY-DWELLING OLDER ADULTS
Authors: Ohata Yuka , Kabayama Mai , Kido Michiko , Godai Kayo , Nagano Masahiro , Kamide Kei 
Published: January 2023

Objective:
To determine the association between skeletal muscle mass and systolic blood pressure decline over a 5-year period in older adults over 75 years old.

Methods:
Of those who got health checkups at private A clinic from May 2020 to March 2021, 118 subjects for whom data on systolic blood pressure (SBP) levels consequently collected for five years were included. Skeletal muscle mass was measured at the health checkup in this clinic, and the Skeletal Muscle Index (SMI) was calculated by dividing the sum of limb muscle mass by the square of height using the multi-frequency bioimpedance method. Lower SMI was classified as a relative skeletal muscle mass index less than 7.0 kg/m2 and 5.7 kg/m2 in men and women, respectively. SBP levels used the mean of office SBP at A clinic visits in 2020 and 2015. 5-year SBP changes were calculated and categorized into two groups: SBP decline group (decline of -3 or more) and SBP maintenance group. The main outcome was SBP decline, and the association with SMI was examined by chi-square test and logistic regression analysis adjusted for age and gender.

Results:
The mean age of the subjects was 81.1 ± 4.5 years, 76 (64.4%) were female, 76(64.4%) were taking anti-hypertensive medication, 40(33.9%) were lower SMI, and 39 (33.1%) for SBP decline group. The SBP decline group had a lower BMI and a higher percentage of lower SMI than the maintenance group (p < 0.05). Furthermore, logistic regression analysis showed that lower SMI was independently associated with SBP decline (odds ratio: 2.44, 95% CI: 1.07–5.54).

Conclusion:
Our results suggest that there may be an association between lower SMI and SBP decline over a 5-year period in community-dwelling older adults over 75 years old. Long term changes of SBP might be the useful biomarker for muscle mass decline for older adults, although further mechanistic investigations are necessary.
PS-C26-7: A SINGLE-CENTER, RETROSPECTIVE STUDY OF BLOOD PRESSURE EFFECTS OF DAPAGLIFLOZIN IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Kawano Rina , Hirawa Nobuhito , Haruna Aiko , Ozawa Moe , Haze Tatsuya , Suzuki Shota , Ohki Yuki , Kobayashi Yusuke , Fujiwara Akira , Saka Sanae , Tamura Kouichi 
Published: January 2023

Backgrounds:
Sodium-glucose transporter 2(SGLT2) inhibitors are reported to have blood pressure lowering effects in addition to glucose-lowering effects. Previous studies have shown SGLT2 inhibitors, including dapagliflozin, reduce systolic blood pressure among patients with type 2 diabetes. Its mechanism is still uncertain; however, previous studies suggest plasma reduction by osmotic diuresis and natriuresis may contribute to lowering blood pressure. Dapagliflozin was recently approved as the treatment for chronic kidney disease in Japan. Blood-pressure lowering effects of SGLT2 inhibitors among patients with chronic kidney disease (CKD) are still unknown; therefore, we investigated blood-pressure effects of dapagliflozin in patients with CKD.

Design and method:
Patients with chronic kidney disease (estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2, or markers of kidney damage, or both, of at least 3 months duration) were given 10 mg dapagliflozin daily for at least 4 weeks. Patients who had any changes in their antihypertensive drug prescription during this observation period were excluded. Clinical data including blood pressure measurements, eGFR, urine protein/creatinine ratio, and urinary sodium excretion before and after administration were taken and compared.

Results:
Contrary to previous reports, there was no significant difference in blood pressure at two months after administration. However, there was a trend of blood pressure decline at four months. Since this study is retrospective, measurement procedures were not aligned among patients, and body fluid evaluation was not considered. These inconsistent conditions may have affected the results. Also, dapagliflozin was administered to most patients in this study at the end of fall or beginning of winter, as it was approved for CKD patients in Japan in August 2021. Decreasing temperature may have limited or countervailed the blood pressure lowering effect of dapagliflozin in the first two months.

Conclusions:
Our findings indicate that the use of Dapagliflozin may serve as adjunct blood pressure lowering therapy in patients with CKD. Prospective study is needed to further investigate the blood pressure effects of dapagliflozin in CKD patients.
PS-C26-12: SIGNIFICANCE OF PODOCYTE DNA DAMAGE AND GLOMERULAR DNA METHYLATION IN CKD WITH PROTEINURIA
Authors: Yoshimoto Norifumi , Hayashi Kaori , Hishikawa Akihito , Nakamichi Ran , Sugita Erina , Yoshida Eriko , Hashiguchi Akinori , Itoh Hiroshi 
Published: January 2023

Objective:
Previously we have reported that altered DNA methylation is associated with DNA damage repair in podocytes in CKD, including diabetic nephropathy or IgA nephropathy (Cell Rep 2019, Sci Rep 2020). This study is aim to investigate the association of podocyte DNA damage and DNA methylation with clinical manifestations and renal prognosis in various types of kidney diseases, which has not been adequately investigated.

Design and Method:
Patients diagnosed with minor glomerular abnormalities (MGA, n = 33), membranous nephropathy (MN, n = 9) or diabetic nephropathy (DN, n = 10), following kidney biopsy at Keio University Hospital from 2015 to 2017 were included. We evaluated podocyte DNA double strand breaks (DSBs) using both long-distance PCR of nephrin gene and γH2AX immunostaining, and glomerular DNA methylation levels by immunostaining of 5mC, and examined the relationship between clinical parameters of patients, and DNA damage and methylation.

Results:
In MGA patients, both podocyte DNA damage and glomerular DNA methylation was associated with the amount of proteinuria. Moreover, glomerular DNA methylation was also associated with 3-year eGFR decline. We also examined in DN patients, in which podocyte DNA damage has been found to be involved in our previous study. It was demonstrated that podocyte DSBs were associated with a decline in eGFR over 6 months, whereas glomerular DNA methylation was associated with 2 year- and 3 year-eGFR decline. In addition, samples from MN patients were evaluated, in which activation of DNA repair pathways in the glomeruli has been suggested. Interestingly, the association of DNA DSBs or DNA methylation with proteinuria or kidney function was not indicated in MN.

Conclusions:
To our knowledge, this is the first study to demonstrate the possible association of podocyte DNA damage and glomerular DNA methylation with kidney function and its decline in MGA patients, whereas it was not observed in MN patients, despite a limitation of small sample size. Focusing on podocyte DNA damage and following DNA methylation changes may lead us to novel approaches to estimate renal prognosis in addition to traditional evaluation of renal biopsy as well as to develop novel therapeutic targets in specific types of CKD.
PS-C27-3: MEASURING ANTIHYPERTENSIVE DRUG CONCENTRATIONS TO DETERMINE NON-ADHERENCE IN HYPERTENSIVE PATIENTS WITH AND WITHOUT KIDNEY TRANSPLANTATION
Authors: Peeters Laura EJ , Hesselink Dennis A , de Winter Brenda CM , Lafeber Melvin , Severs David , van den Hoogen Martijn WF , Sonneveld Michelle AH , Ramakers Chris RB , Bahmany Soma , van Gelder Teun , Koch Birgit CP , Versmissen Jorie 
Published: January 2023

Introduction:
Non-adherence to antihypertensive drugs (AHDs) is one of the main causes of resistant hypertension which is defined as uncontrolled blood pressure despite the prescription of at least 3 AHDs.

Objectives:
Our primary objective was to determine the prevalence of non-adherence to AHDs in patients visiting the nephrology and vascular outpatient clinics. Inclusion rates at both departments allowed comparison between non-adherence of kidney transplantation (KT) patients with patients without KT as secondary objective.

Design and method:
This was a prospective observational study called RHYME-AD (Resistant Hypertension: MEasure Antihypertensive Drugs, MEC-2020–0096). Patients were eligible if they used at least 2 AHDs that could be measured with a validated UPLC-MS/MS method and had an office blood pressure > 140 and/or 90 mmHg. After informed consent was signed, rest material was collected from a regular venipuncture measurement. The total absence of drug in blood (<lower limit of detection) was defined as non-adherent. We made comparisons between patients with and without KT and with and without resistant hypertension, defined as an office blood pressure > 140 and/or 90 mmHg despite the use of 3 or more AHDs.

Results:
Material was available from 143 patients of which 93 had a KT and 66 patients fulfilled the definition of resistant hypertension. The overall adherence rate was 78.3%. From the non-adherent patients 87.8% was partially non-adherent and 12.2% non-adherent for all prescribed AHDs. When looking at the two separate groups, with and without KT, more patients in the non-KT cohort fulfilled the definition of resistant hypertension as compared to the KT-cohort (62.0% vs 37.6%, p = 0.005). There was a significant difference between having resistant hypertension and being non-adherent (non-adherence RH vs non-RH, 31.8% vs 13.0%, p = 0.023) and having KT and being non-adherent (non-adherence KT vs non-KT, 14.0% vs 36.0%, p = 0.005). In addition, patients with KT and no resistant hypertension were the most adherent to AHDs (91.2%).

Conclusions:
Hypertensive patients with a KT are less likely to be non-adherent to their AHDs as compared to hypertensive patients without a KT. However, patients fulfilling the definition of having resistant have a higher risk of being non-adherent to AHDs.