bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION BETWEEN BMI AND AMBULATORY BLOOD PRESSURE CHARACTERISTICS: EVIDENCE FROM POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT
Authors: Zhang Xinmin , Cai Qiujing , Zhao Xiaolei , Zeng Mingfa , Liu Lisheng , Hu Aihua 
Published: June 2023

Objective:
The aim of our study was to investigate the association between BMI and Chinese hypertensive patients’ ambulatory blood pressure characteristics.

Design and method:
According to the inclusion criteria and exclusion criteria, recruiting participants for analysis. Overweight was defined as BMI = > 18.5 kg/m2, and obesity as BMI = > 25 kg/m2. ABPM characteristics were defined according to European guidelines. Hypertension was defined as elevated mean ambulatory BP (>135/85 mmHg in day-time, >120/70 mmHg in the night-time, >130/80 mmHg over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers, and extreme dippers. The effects of BMI on ambulatory blood pressure characteristics were analyzed using between-group analysis of variance and logistic regression analysis.

Results:
In our cohort, 35367 hypertensive patients who were eligible for this study were analyzed finally, including 19380 men (54.8%) and 15987 women (45.2%) aged from 19 to 99 (mean age 58.86 years). The mean 24hBP of the study subjects was 126.41±16.00/78.79±11.62 mmHg. The different BMI groups showed that ambulatory BP increased with BMI, and the obese group had the highest increase in BP, HR, and systolic BP (P < 0.05). Blood pressure variability and systolic load tended to increase with BMI, while the nocturnal blood pressure drop rate tended to decrease. When analyzing the type of hypertension among the participants, the prevalence of MBPS and morning hypertension increased significantly with the elevated BMI (P < 0.05), and the highest prevalence of MBPS was found in the obese group. Logistic regression analysis revealed that the increased risks of MBPS and morning hypertension were the highest in the obese group, corresponding to a 2.1-fold (P < 0.05) and 1.6-fold (P < 0.05) increase in risk, respectively, with no change in trend after adjustment.

Conclusions:
BMI may affect the characteristics of hypertensive patients’ ambulatory blood pressure. The blood pressure variability and 24h SBP tended to increase with BMI, and the incidence of MBPS was highest in the obese group.
EFFECT OF COVID-19 ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS
Authors: Dumitrescu Silviu Ionel , Munteanu Alice , Stanciu Silviu , Hantulie Ileana , Popescu Raluca , Gurzun Magdalena , Ionescu Ruxandra , Ciobanu Diana , Cecoltan Serghei , Boingiu Rares , Prisascariu Irina 
Published: June 2023

Objective:
To investigate the influence of COVID-19 on blood pressure variability in hypertensive patients with known subclinical organ damage (SCOD) previously assessed by evaluation of brachial artery Flow Mediated Dilatation (FMD), carotid artery Intima Media Thickness (IMT), left ventricular mass indexed to BSA (LVMI), E/e` ratio, left atrial volume indexed to BSA (LAVI).

Design and method:
We assessed 108 hypertensive patients who had SARS-CoV-2 infection in the previously 3 months before evaluation. All subjects included where evaluated for the presence of SCOD in the last 12 months before COVID-19 and underwent a 24-hour noninvasive ABPM on a working day, performing usual daily activities and avoiding heavy physical exercise. BP and heart rate readings were obtained every 15 minutes during daytime and every 30 minutes during nighttime. Subjects recorded a journal of the activities performed and the time of retiring to bed, ABPM recordings being divided into ‘awake’ or ‘asleep’ periods based on diary entries and not on predefined time intervals. BP variability was calculated as the standard deviation (SD) of mean blood pressure.

Results:
The hypertensive patients with previously known subclinical disease (SCOD+) compared with those without it (SCOD–) had significantly higher systolic and diastolic BP after SARS-CoV-2 infection, and significantly increased variability of both systolic and diastolic BP. Also, they had a significantly reduced decrease of nocturnal systolic BP (table 1). The analysis for each marker of subclinical organ damage indicated that increased systolic BP variability in hypertensive COVID-19 patients was significantly correlated with carotid IMT (r = 0.517, p = 0.001), brachial artery FMD (r = 0.426, p = 0.008), LVMI (r = 0.397, p = 0.009), E/e` ratio (r = 0.543, p = 0.001), left atrial volume indexed to BSA (LAVI) (r = 0.478, p = 0.003) and that diastolic BP variability is significantly correlated with carotid IMT (r = 0.362, p = 0.09), brachial artery FMD (r = 0.491, p = 0.006), LVMI (r = 0.369, p = 0.008), E/e` ratio (r = 0.422, p = 0.005), left atrial volume indexed to BSA (LAVI) (r = 0.407, p = 0.002).

Conclusions:
Our study indicates that SARS-CoV-2 infection in hypertensive patients induces an increased blood pressure variability which is significantly correlated with the presence of previously diagnosed subclinical disease.
IMPLICATION OF PULMONARY ARTERY SYSTOLIC PRESSURE FOR PROLONGED CARDIOPULMONARY BYPASS DURATION IN PATIENTS UNDERGOING RE-REPAIR FOR DEGENERATIVE MITRAL REGURGITATION
Authors: Xu Hang , Liu Sheng 
Published: June 2023

Objective:
Emerging evidence revealed that the longer duration of cardiopulmonary bypass (CPB) during cardiac surgery renders patients at higher risk of adverse outcomes. However, little is known regarding the risk factor of prolonged CPB in patients undergoing re-repair of degenerative mitral regurgitation (DMR). We aimed to explore the prognostic significance of pulmonary artery systolic pressure (PASP) on CPB duration in patients undergoing re-repair of DMR.

Design and method:
Patients with DMR undergoing re-repair in our center were consecutively enrolled from Jan 2009 to Dec 2021. Patients were stratified into the prolonged CPB group (CPB time < 132 min, n = 61) and the shorter CPB (CPB time < 132, n = 59). Preoperative Univariable and multivariable logistic regression analyses were used to evaluate the impact of PASP on the risk of prolonged CPB duration.

Results:
Of the 120 patients enrolled, 61 had prolonged CPB time (50.8%). The mean preoperative PASP was higher in the prolonged CPB group compared with the shorter CPB group (45.2±21.9 vs. 37.7±15.1, P < 0.05). CPB time increased with higher preoperative PASP (P < 0.05). For per 10 units of pre-PASP value increase in patients undergoing re-repair for DMR, there were 1.25 times more likely to be associated with a prolonged CPB time (adjusted odds ratio [OR] 1.25, 95% confidence interval [CI] 1.01-1.56, P < 0.05). Patients with preoperative PASP > 50mmHg had an adjusted OR of 3.66 (95% CI 1.36-9.84, P < 0.05) for a prolonged CPB period compared with those with preoperative PASP < 50mmHg.

Conclusions:
Preoperative PASP in patients requiring re-repair for DMR was associated with a higher likelihood of an extended time of CPB. Regular screening of pulmonary hypertension may aid in perioperative risk-stratification in patients prior to re-repair for DMR.
VACUOLAR H+-ATPASE AS A NOVEL TARGET TO LOWER LOW DENSITY LIPOPROTEIN CHOLESTEROL
Authors: Wang Na , Liu Xinyu , Lin Hui , Danser A.H Jan , Lu Xifeng 
Published: June 2023

Objective:
Low density lipoprotein cholesterol (LDL-c) is cleared from the circulation through binding to the hepatic LDL receptor (LDLR). The (pro)renin receptor [(P)RR, also known as vacuolar H+-ATPase (V-ATPase) accessory protein 2 or ATP6AP2)] is a regulator of this process. Indeed, (P)RR silencing markedly reduced LDLR protein abundance and thereby LDL uptake. Since V-ATPase is a multi-subunit complex (consisting of 13 subunits), in this study we evaluated the role of subunits other than the (P)RR.

Design and method:
siRNAs were designed against all V-ATPase subunits, transfected into HepG2 cells, and evaluated for their capacity to affect cell surface LDLR. Given that silencing subunit ATP6V1B2 upregulated LDLR most, we next designed an adeno-associated virus expressing shAtp6v1b2 and injected this into C57BL/6 mice and then investigated the effects of Atp6v1b2 knocking-down on LDL metabolism in vivo.

Results:
Silencing subunit ATP6V1B2 in HepG2 cells increased surface LDLR and total LDLR protein abundance by 1.5- and 2.3-fold, respectively. This was accompanied by both LDLR mRNA upregulation, suggestive for de novo protein synthesis, and enhanced LDL uptake following exposure to excess LDL. Silencing ATP6V1B2 significantly increased the mRNA levels of sterol regulatory element-binding protein 2 (SREBP2)-targeted genes (SQLE, HMGCR, and NPC1) as well as the nuclear SREBP2 protein level. In vivo, knocking-down Atp6v1b2 decreased plasma total cholesterol by 23%, without affecting total triglycerides. This was accompanied by LDLR upregulation in the liver, both at the mRNA and protein levels.

Conclusions:
The V-ATPase subunit ATP6V1B2 is an important regulator of LDLR expression. This involves the transcription factor SREBP2, and allows substantial LDL-c lowering. V-ATPase might be a novel pharmacological target to lower cholesterol.
TRANSGENERATIONAL IMPACT OF EARLY CHILDHOOD FAMINE EXPOSURE IN THE COHORT OF LENINGRAD SIEGE SURVIVORS’ OFFSPRINGS
Authors: Tolkunova Kristina , Moguchaya Ekaterina , Boiarinova Maria , Usoltsev Dmitrii , Vasilyeva Elena , Rotar Oxana , Konradi Aleksandra , Shlyakhto Evgeny , Artomov Mykyta 
Published: June 2023

Objective:
Famine exposure in early life may promote the epigenetic transgenerational inheritance of phenotypic variability. It may increase susceptibility or contribute to disease resistance in offspring. The research aims to assess the prevalence of cardiometabolic risk factors in the descendants of besieged Leningrad residents and in controls from population-based sample comparable in sex, age, and body mass index (BMI).

Design and method:
The besieged Leningrad residents were exposed to famine in early childhood during the Second World War (1941-1944). There were examined 87 descendants of Leningrad Siege survivors aged 18 to 63 (56 children and 29 grandchildren) without cardiovascular complications. Anthropometry, blood pressure (BP) measurement, biochemical blood tests were performed, glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. Controls from the population-based national epidemiological ESSE-RF study (n = 175) were matched by sex, age, and BMI. Phenotypes of controls and descendants were compared, correcting for multiple hypothesis testing.

Results:
After multiple comparison correction only higher creatinine level and low GFR were recorded as statistically significant differences between Siege survivors’ descendants and the control group (Table 1).
Table 1. Comparative analysis of Leningrad Siege survivors’ descendants and control group.

Conclusions:
Ancestral famine exposure in early childhood contributed to a decrease of kidney filtration capacity in offspring. One of the potential mechanisms could be associated with alterations in epigenome through programming of nephron deficiency in germ cells but further molecular studies would be required for confirmation.
OXALATE-DEGRADING ACTIVITY IN FECAL MICROBIOTA IS ASSOCIATED WITH OBESITY AND CARDIOVASCULAR EVENTS IN END-STAGE KIDNEY DISEASE PATIENTS
Authors: Stepanova Natalia , Tolstanova Ganna , Akulenko Iryna , Savchenko Svitlana , Dobbynchuk Taisa 
Published: June 2023

Objective:
In contrast to the general population, the obesity paradox observed in end-stage kidney disease (ESKD) patients is associated with a better CVD prognosis. Considering the similar signature of the gut microbiota in oxalate metabolism, obesity, and CVD, we hypothesized that altered oxalate-degrading activity (ODA) in the fecal microbiota, rather than obesity per se, might influence the development of CVD in ESKD patients.

Design and method:
A total of 32 ESKD patients aged 52.5 (40-62) years were enrolled in this retrospective observational cohort pilot study. CVD events were defined as any new-onset disease of the heart and associated blood vessels during the 3-year follow-up period after completion of evaluation.
The fecal total ODA, defined as the total ability of the different strains of oxalate-degrading bacteria to metabolize oxalate, was determined by redoximetric titration with KMnO4; results were expressed as % oxalate degradation per 0.01 g of feces. Data analysis and all graphs were generated using MedCalc software.

Results:
Total fecal ODA ranged from -16 to 24%/0.01 g feces and was inversely correlated with BMI (Fig. 1). During the 3-year follow-up period, 5/7 (71.4%) obese patients, 2/11 (18.2%) overweight patients, and 2/14 (14.3%) normal-weight patients experienced CVD (⇙2 = 8.4, p = 0.01). The ROC analysis showed that a negative total fecal ODA (<-1%/0.01 g feces) was the most appropriate cut-off point for predicting CVD events in ESKD patients, with a sensitivity of 77.8% and a specificity of 74% (Fig. 2). In univariate Cox regression analysis, both obesity (HR 8.2, 95% CI 1.2; 18.1) and negative fecal total ODA (HR 9.4, 95% CI 2.3; 19.4) were associated with CVD events. In the multivariate model of Cox regression analysis adjusted for age, dialysis vintage, diabetes, and dyslipidemia, negative total fecal ODA, but not obesity, was associated with CVD events in our cohort (Fig. 3).

Conclusions:
Our findings provide preliminary evidence that a decrease in fecal total ODA is associated with obesity and the development of CVD in ESKD patients. Further studies are needed to determine altered fecal total ODA as a risk factor for the development of CVD in ESKD patients.
PROGNOSTIC VALUE OF LV GLOBAL STRAIN FOR PREDICTING POSTOPERATIVE MYOCARDIAL INJURY AND MORTALITY IN PATIENTS WITH MAJOR NONCARDIAC SURGERY: MULTICENTER, PROSPECTIVE, OBSERVATIONAL
Authors: Seo Hye Sun , Park Soo Young , Moon Inki , Jung In Hyun , Kim Minkwan 
Published: June 2023

Objective:
The role of preoperative echocardiography at rest is less well studied. We analyzed the prognostic value of left ventricular global longitudinal strain (LVGLS) for predicting postoperative 30-day cardiovascular events and myocardial injury after noncardiac surgery (MINS).

Design and method:
We performed a prospective cohort study in two referral hospitals enrolling participants over 45-year-old with more than one cardiovascular risk factor or 65-year-old aged who planned elective noncardiac major surgery and underwent resting echocardiography before surgery. Preoperative demographic, clinical, and echocardiographic data, including LVGLS, were collected. Subjects with minor surgery, reduced ejection fraction below 40%, more than moderate valvular heart disease, and presence of regional wall motion abnormality were excluded. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) needing urgent revascularization at early postoperative period. MINS was defined as absolute increase troponin of at least 14 pg/mL between two measurements.

Results:
From 2020 June to 2022 March, 871 participants were enrolled; the mean age was 72.9 (SD 9.3) and 60.8% were female. There were 12 cases of the primary endpoint (1.4%): 10 cases of death, and 3 cases of revascularization due to ACS. Participants with impaired LVGLS <16.6% had a higher incidence of the primary endpoint (log-rank P = 0.015) than those without. This result was concordant after adjustment with clinical variable and preoperative troponin-T level (hazard ratio 1.30, 95% confidence interval [CI] 1.03–1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had incremental value for predicting the primary endpoint after noncardiac surgery. Among 538 (61.8%) participants available pre and post-troponin assay, LVGLS can predict MINS independently (odds ratio 3.54, 95% CI 1.70–7.36; P = 0.001).

Conclusions:
Preoperative LVGLS has independent and incremental value to predict early postoperative cardiovascular events and MINS.
INDEPENDENT ASSOCIATION BETWEEN URIC ACID LEVELS AND MYOCARDIAL MECHANO-ENERGETIC EFFICIENCY AS ASSESSED BY ECHOCARDIOGRAPHY
Authors: Paini Anna , Bertacchini Fabio , Aggiusti Carlo , Stassaldi Deborah , Capellini Sara , Muiesan Maria Lorenza , Salvetti Massimo 
Published: June 2023

Objective:
In the last decades several studies have investigated the relationship between serum uric acid (SUA) levels and cardiovascular disease and heart failure. Low myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM) is an independent predictor of cardiovascular (CV) events and heart failure.

Design and method:
Aim of the study was to evaluate the relationship between SUA and myocardial mechano-energetic efficiency index (MEEi) in 694 consecutive uncomplicated patients attending the outpatient at an ESH Excellence Centre in Italy.
Methods BP values were measured by the physician with an automated oscillometric device, after 5 minutes of rest. All patients underwent transthoracic echocardiography, and standard indices of systolic function were calculated. In all patients myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) (de Simone et al, 2016).

Results:
Results Mean age was 57±13 yrs, 52% female, 21 % obese, 10 % diabetics, 69 % with a previous diagnosis of hypertension (77 % treated). MEEi was lower in males (0.42±0.14 vs 0.49±0.16, p<0.001), and in patients with diabetes (0.38±0.11 vs 0.47±0.16, p<0.001). At multivariate analysis the variables independently correlated with MEEI were male sex, systolic blood pressure, presence of obesity, plasma glucose levels, and serum uric acid, but not age and eGFR (CKD EPI).
At receiver operating curves (ROC) analysis the optimal cutoff of uric acid for the prediction on reduced MEEI was 5.4 mg/dl (AUC 0.611. 95 CI 0.574-0.648).

Conclusions:
Conclusions In a large sample of uncomplicated patients attending the outpatient clinic at an ESH Excellence Centre in Italy uric acid is an independent predictor of myocardial mechanoenergetic efficiency. In this population the optimal cutoff of uric acid for reduced MEEI is 5.4 mg/dl. These findings may contribute to the explanation of the greater risk of heart failure in patients with increased uric acid levels.
CARDIOVASCULAR EVENTS IN TYPE 2 DIABETIC PATIENTS
Authors: Rihab Zouaoui , Meriem Khadhar , Sarra Haddad , Mouna Jerbi , Hanen Gaied , Raja Trabelsi , Rim Goucha 
Published: June 2023

Objective:
Cardiovascular diseases represent the first cause of death of patients with type 2 diabetes.
The aim of our work is to identify the prevalence of cardiovascular disease in type 2 diabetes.

Design and method:
This is a retrospective descriptive study conducted over a period of three years (January 2013- January 2016) including type 2 diabetic patients followed up at the nephrology consultation of Mongi slim hospital. Clearance was calculated according to the MDRD formula. The stage of chronic kidney disease (CKD) was defined according to the KDIGO 2012 classification.

Results:
Our study included 42 patients with diabetic kidney disease followed at our nephrology consultation.
The mean age was 63.3 [31-80] with a sex ratio M/F = 1.47.
Eighty-eight percent of our patients had hypertension.
At the first consultation our patients already had macrovascular disease: 4 patients were suffering from peripheral artery disease, 4 patients had heart failure, a history of ischemic stroke was found in 4 patients and acute coronary syndrome in 11 patients.
Regarding cardiovascular risk factors, obesity was found in 13 patients, 6 patients were smokers and 25 patients (59.5%) had dyslipidemia with a mean cholesterol level of 4.48 +/- 1.09 mmol/l.
The mean fasting blood glucose level was 10.5 +/-5.23 mmol/l and a mean glycated hemoglobin was 8.24 +/-2.22%.
The renal impact was as follows: chronic kidney disease stage 3A in 12 patients (28.6%), stage 3B in 14 patients (33.3%), stage 4 in 6 patients (14.3%) and stage 5 in 2 patients.
During the course of the study, 7 patients had an acute coronary syndrome and 1 patient had an ischemic stroke.

Conclusions:
Diabetes is a cardiovascular risk factor in itself. Although nothing can be done about the non-modifiable risk factors (heredity, age, gender), it is possible to act early and effectively on the other modifiable factors.
FOLINIC ACID OR L-METHYLFOLATE SUPPLEMENTATION FOR THE TREATMENT OF HYPERHOMOCYSTEINEMIA
Authors: Papadakis Ioannis , Papadomanolaki Maria , Vougiouklakis George , Spentzouri Despoina , Mazokopakis Elias 
Published: June 2023

Objective:
Hyperhomocysteinemia (HHcy) is recognized as a risk factor for for cardiovascular disease. The aim of this study was to investigate and compare the efficacy of two tHcy-lowering treatments including FNA or L-methylfolate in healthy Greek adults.

Design and method:
Two hundred and seventy two (272) health Greek adults (143 men; mean age±SD: 43.0±15.3 years), with elevated serum tHcy levels (>10 mmol/L) received randomized folinic acid (Group 1) or L-methylfolate (Group 2) orally both with hydroxycobalamine im for three months. Serum folate, Cbl and tHcy levels were determined using immunoassays methods at the beginning and the end of the study period. The MTHFR C677T and A1298C gene polymorphisms were genotyped using polymerase chain reaction and reverse hybridization.

Results:
At the end of the 3-month intervention period the levels of serum folate and Cbl were significantly increased, whereas serum tHcy concentrations were significantly decreased in both groups. The individuals with 677TT genotype had significantly higher reduction of serum tHcy levels than individuals with the 677CC or 677CT genotypes.
Although the individuals of Group 1 had significantly greater increase of their serum folate levels than those of Group 2, the reduction of serum tHcy concentrations between the two groups did not differ significantly. The individuals with 677CT genotype had statistically significant greater reduction of serum tHcy levels when received folinic acid than methylfolate supplementation.

Conclusions:
The tHcy-lowering treatment which included FNA supplementation compared to treatment which included L-methylfolate supplementation caused a greater increase of serum folate levels but no difference in reduction of serum tHcy levels. The reduction of serum tHcy levels was influenced by the existence of MTHFR C677T and not A1298C gene polymorphisms. The individuals with 677CT genotype appear to benefit more by the treatment which included FNA than L-methylfolate supplementation.