bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 73: Use of an ED- Based Observation Unit Followed by Outpatient Stress Testing in Chest Pain Patients with Prior Coronary Artery Disease History: Evaluation of Safety and Prognostic Utility
Authors: Khalil Yasser , Pandey Prasant , Schwartz Mel , Abdul-Latif Maida , Matsumura Martin E 
Published: March 2022

Objective:
Chest pain (CP) observation units are increasingly being used to efficiently triage patients with CP but without high-risk features such as positive biomarkers or pathologic ECG changes. However, little data is available regarding the use of a CP observation strategy in patients presenting with low-risk CP but with history of prior CAD events. The aim of the present study was to determine the outcomes of patients with CP and established CAD managed with observation followed by outpatient stress myocardial perfusion imaging (MPI) and to determine the prognostic value of this strategy.

Methods:
Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI at a single community teaching hospital and followed up for 3 years for CV events (defined as death, MI, or need for urgent revascularization). Follow-up event rates were stratified by CAD history at the time of initial CP evaluation.

Results:
A total of 375 patients were included: 111 with and 264 without a CAD history. All patients safely completed outpatient stress MPI within 72 hours of observation. Stress MPI effectively identified patients at risk for CV events regardless of CAD history, although patients with CAD history had a significantly higher rate of +MPI (35/111 (31.5%) vs. 28/264 (10.6%) for patients with +CAD vs. [[Unable to Display Character: &#8211;]]CAD history, respectively, p=<0.001).

Patients managed in an observation unit followed by a non-ischemic outpatient stress MPI and without a CAD history had, as expected, very low rates of short- and long-term CAD events (2/264 (0.8%), and 3/264 (1.1%) at 1 year and 3 years, respectively). In contrast, follow-up event rates of those patients with a non-ischemic test but a +CAD history were significantly higher (6/111 (5.4%) and 7/111 (6.3%) at 1 year and 3 years, respectively; p=0.044 and p=0.034 compared to CAD- patients).
To determine if stress MPI testing contributed independent prognostic information regarding CP patients with a history of CAD, we developed a multivariable logistic regression model using patient demographic and risk factor data as well as MPI results: in this model a positive MPI proved to be a strong independent predictor of long-term CV events (OR=4.75 for CV events at 3yr follow-up, 95% CI 1.35-16.70, p=0.015).

Conclusion:
A strategy of observation followed by stress MPI can safely and effectively risk stratify CP patients with prior CAD for long-term CV events. However, our data suggests these patients are at increased risk of CV events even after a low-risk follow-up stress MPI study. Thus, patients presenting with CP and managed with a strategy of observation and a non-ischemic stress MPI still warrant close short and long term monitoring for recurrent events.
Abstract 253: Bottom up Costing Ventricular Assist Device Therapy And Optimal Medical Management-first Steps To Establishing Cost Effectiveness.
Authors: Prichard Roslyn A , Kershaw Louise , Goodall Stephen , Davidson Patricia M , Macdonald Peter , Newton Phillip , Hayward Christopher 
Published: March 2022

Background:
Since Left Ventricular Assist Devices were approved in the US for destination therapy, there has been a rapid increase in their use. Information on the cost of advanced heart failure management (AHF), transplant (HTX) and VAD programs is variable across health systems, as most cost data is derived from casemix costing, charges or claims against insurers. This weakens comparative studies as eligible AHF patients are cost outliers in the broader heart failure population.

We outline a cost effectiveness study of VAD therapy vs AHF as part of an HTX program, using Time Driven Activity Based Costing of identified models of care in an Australian setting.

Methods:
All patients activated to the HTX waitlist between 07/2009 and 06/2012 (n=101) were screened and 86 included (62 AHF, 24 VAD). Models of care were defined through 13/86 file reviews, clinician interviews and analysis of activity. Detailed costing was undertaken for 5 VAD and 8 AHF patients for 12 months pre and post HTX listing or VAD implant and included medical, allied health, nursing activities, inpatient care and clinic visits (ClinV), consumables, drugs, pathology, medical imaging, and prosthetics.

Results:
Mortality at 1 yr was 12% (3/24) for VADs post implant and 11% (7/62) for AHF post HTX activation. 148 service activities were identified in 13 file reviews ranging from basic documentation to ECMO insertion. The two groups were matched for age, AHF etiology and gender.

In house database interrogation yielded a median pathology cost per patient of $4811 in 17/24 Pre VAD, and $12,294 in 20/24 Post VAD patients,.
Median allied Health cost for 19/24 Pre VAD patients was $545 and in 23/24 Post VAD was $2938 ($AUD)
Hospitalisations and costs borne beyond the transplant center made comparison between VAD therapy and AHF incomplete.

Conclusion:
The BTT VADs were sicker, with more days hospitalized pre and post VAD.

From an institutional and health system perspective, correct identification of, and reimbursement for activities related to best practice models of care is crucial. Cost effectiveness, capturing costs borne at other hospitals as well as federal, drug and GP reimbursements should be addressed in this cohort.
Abstract 132: Transvenous Lead Extraction: One Center Experience
Authors: Yager Neil , Balulad Sujata , Hosannah Hilton , Venditti Ferdinand J , Tan Henry 
Published: March 2022

Introduction:
Indications for cardiovascular implantable electronic devices (CIED) and implant procedures for the management of arrhythmia and heart failure continue to grow. Transvenous lead extraction (TLE) is the gold standard for treatment of CIED-related infection and lead malfunction. Operator experience and pathological issues, such as lead adhesions, can affect results and complications rates of TLE. Comparative safety and efficacy associated with TLE of implantable cardioverter-defibrillator (ICD), bi ventricular ICD (BIVICD or ICD+ LV lead) and pacemaker (PPM) leads for our center have not been characterized.

Methods/Results:
Retrospective chart analysis was done of 75 patients (63 males; mean age 65
+
14.8 years) using ICD-9 codes for TLE indications, techniques, results and associated complications (April 2006 to July 2013).

TLE was done for ICDs 41%, BIVICD 32% and PPM 27% of the time. The most common cause (88%) of extraction was device related infection. Other causes were lead fracture, malfunction and patient request (12%). Primary prevention ICD (+/- LV lead) was the most commonly extracted device (56%) TLE due to infection was seen in patients with diabetes (DM 30%), chronic renal insufficiency (CRI 11%), end stage renal disease on hemodialysis (ESRD on HD 11%) and in patients with device and nondevice related procedures in the year prior to TLE (38%). Methicillin sensitive staphylococcus aureus was the most common organism (29%).
Laser assisted TLE (31%) was required in superior vena cava (SVC) coil extraction at the SVC/atrial (70%) scar site and in lead extraction at subclavian vein (26%) scar for both right atrial and ventricular (RA/RV) leads. RA tip fragment was abandoned in scar tissue in 4 patients. Interventional radiology assisted atrial tip retrieval was done in one patient. One TLE related atrial tear was repaired by cardiac surgery. There were 5 deaths unrelated to the TLE procedure.

Conclusion:
Of the total 75 patients with TLE, infection was more common in patients with DM, CRI, ESRD on HD and in males. Our experience showed that primary prevention ICD (+/- LV lead) was the most commonly extracted device. In our center, TLE success rate was independent of the cause of TLE, age of the patient, and may be related to operator experience and technique.
Abstract 193: Urinary Angiotensinogen Could be a Prognostic Marker of Renoprotective Effects of Alogliptin in Patients with Type 2 Diabetes
Authors: Mizushige Tomoko , Kobori Hiroyuki , Nishijima Yoko , Yano Yuichiro , Sakata Koji , Hayakawa Manabu , Nishiyama Akira 
Published: March 2022

The development of dipeptidyl peptidase-IV (DPP-4) inhibitors, such as alogliptin, has led to the improvement in glycemic control in type 2 diabetes (T2D) by preventing the degradation of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide. However, the renoprotective effects of alogliptin have not been addressed yet. This 12-week study in Japanese patients with T2D was performed to address the renoprotective effects of alogliptin. In addition, urinary angiotensinogen (AGT), a marker of intrarenal renin-angiotensin system (RAS) activity, was examined to demonstrate the clinical usage as a prognostic marker.
Forty-three patients with T2D (18 women, age: 66.1+/-11.2) were recruited in Miyazaki University and its affiliated hospitals, and alogliptin (25 mg/day) was added on the top of the traditional hypoglycemic agents. The urinary concentrations of albumin (Alb) and AGT were measured using commercially available ELISA kits before and after the alogliptin treatment, and normalized by the urinary concentration of creatinine (Cr) (UAlbCR and UAGTCR, respectively).
The alogliptin treatment tended to decrease UAlbCR (99.6 +/- 26.8 vs. 114.6 +/- 36.0, mg/g Cr). However, this change was not statistically significant (p = 0.1976). Then, we defined good responders to the alogliptin treatment in terms of %change in UAlbCR less than -25% after the 12-week treatment, and a logistic analysis of UAGTCR before the treatment showed the area under the curve (AUC) as 0.644. When we set the cutoff value of UAGTCR as 20.8 μg/g Cr, the maximum specificity (17/27 = 63.0%) and sensitivity (10/16 = 62.5%) were obtained (Youden index = 0.255). Based on this cutoff value of UAGTCR before the treatment, we divided all patients into 2 groups as higher (group H, N = 20) and lower (group L) values of UAGTCR at the baseline. %Change in UAlbCR was significantly lower in the group H compared with the group L (-14.6% +/- 8.6% vs. +22.8% +/- 16.8%, p = 0.0327). These data indicate that the T2D patients with the higher UAGTCR before the treatment would show more decrease in UAlbCR by the alogliptin treatment.
In conclusion, urinary AGT could be a prognostic marker of renoprotective effects of alogliptin in T2D patients.
Abstract 314: Arterial Stiffness and Pulse Pressure Variability
Authors: Bahrainwala Jehan , Patel Ami , Diaz Kieth M , Veerabadrappa Praveen , Cohen-Stein Debbie , Cuchiarra Andrew , Townsend Raymond R 
Published: March 2022

Blood pressure variability (BPV) is associated with adverse cardiovascular outcomes. Factors determining BPV are unclear. Arterial stiffness manifested by pulse pressure (PP) may be related to BPV, and is reflected in the pulse wave velocity (PWV), as well as the regression of diastolic on systolic pressure determined by the Ambulatory Arterial Stiffness Index (AASI). We hypothesized that arterial stiffness was associated with PP variability (PPVAR) and determined arterial stiffness using AASI and PWV.
Ambulatory blood pressure (BP) data from untreated subjects (n=56, 28 men) with SBP >130 to <160 mmHg with a mean age 49 ±11 yrs were obtained in our Research Center. We calculated AASI as 1-regression slope of diastolic on systolic BP and PWV by carotid-femoral tonometry (Sphygmocor). We calculated PPVAR by the Standard Deviation (SD) and the Average Real Variability (ARV) of PP over 24h, day, and night periods (by patient diary).
AASI correlated positively with day PPVAR (r=0.57, p <0.000) and night PPVAR (r=0.34, P = 0.01) by SD. AASI correlated positively with day PPVAR (r=0.53, P <0.000 Fig1A) and night PPVAR (r=0.43 and p<0.001 Fig1B) by ARV. AASI was not significantly correlated with 24h PPVAR by SD or ARV. PWV was not correlated with any PPVAR estimate.
The relationship between AASI and PPVAR was only evident when the blood pressure periods were broken down into day and night. The 24 hour regression relationship of diastolic on systolic blood pressure with PPVAR appears different between day or night compared with the 24 hour aggregate, suggesting circadian differences in factors which modify PPVAR. Poor PWV correlation with PPVAR is likely due to relatively young age of our subjects.
Abstract 36: Adult Hypertension Risk is More than Quadrupled in Obese Children
Authors: Watson Sara E , Hannon Tamara S , Eckert George J , Pratt J Howard , Rosenman Marc , Tu Wanzhu 
Published: March 2022

There is a known association between adiposity and hypertension (HTN). However, whether and to what extent body mass index (BMI) predicts adult HTN has not been well examined longitudinally. In this study, we attempt to quantify the effects of childhood overweight and obesity on adult HTN in a prospective cohort.
The original cohort was established in 1986, and consisted of 1117 healthy children (47% male), recruited from schools in Indianapolis, Indiana (mean age 12.1; SD 5.7 years). During the course of follow-up, blood pressure, height, and weight were measured semiannually with a mean of 8.4 visits per child (SD 7.2). BMI was calculated from recorded height and weight; weight status was determined by age and sex-adjusted BMI percentile values (BMI%). Subjects were classified as normal weight, overweight (BMI% ≥ 85% and < 95%), or obese (BMI% ≥ 95%) based on either their mean BMI % or maximum BMI % during childhood. Evaluation based on mean childhood BMI % revealed that 765 (68%) were normal weight, 176 (16%) were overweight, and 176 (16%) were obese. The mean age of the subjects as of 2013 was 33.4 years (SD 3.9). From the cohort, we identified 119 adult cases of HTN through active follow up and medical chart review. In those with normal weight as children, 6% were hypertensive as adults. The rate of HTN was higher for those classified as overweight or obese as children (14% and 26% respectively, p = <0.0001). Children classified as overweight or obese had double and quadruple the risk to have a diagnosis of HTN in adulthood, respectively, as compared to normal weight children [OR = 2.2 (95% CI = 1.3, 3.6), OR = 4.4 (95% CI = 2.8, 6.9) respectively]. Additional measures of adiposity were similarly associated with HTN in adulthood including waist circumference and tricep skinfold. This pattern was also seen when analyzed by maximum BMI%. However, the increased risk of HTN in adulthood for children classified as overweight or obese was not as great [OR = 1.3 (95% CI = 0.7, 2.3), OR = 3.7 = (2.4, 5.7) respectively].
In conclusion, the degree of adiposity in childhood significantly impacts the risk for HTN in adulthood. Childhood obesity is associated with a quadrupled risk of adult HTN. This has significant implications for early prevention of childhood obesity and public health.
Abstract 45: Reduced Vascular Remodeling and Improved Endothelial Function in Transglutaminase 2 Knock-Out Mice Treated with Angiotensin II
Authors: Savoia Carmine , Arrabito Emanuele , Sada Lidia , Michelini Serena , Pucci Lorenzo , Briani Martina , Nicoletti Carmine , Candi Eleonora , Schiffrin Ernesto L , Volpe Massimo 
Published: March 2022

Transglutaminase 2 (TG2) may modulate cell-matrix interactions by inducing cross-linking of proteins. We previously demonstrated that angiotensin II (Ang II) positively regulated TG2 expression in vascular smooth muscle cells from SHR. Here we hypothesized that Ang II induces vascular remodeling in part through TG2.
TG2-knockout mice (TG2-K/O, 8 weeks old, 6 for each group) and age-matched wild type (WT) control mice were treated or not with Ang II (400 ng/kg/min) for 14 days. Blood pressure (BP) was measured by tail-cuff method. Endothelium-dependent and -independent relaxation were assessed by concentration-response curves to acetylcholine (1 nM to 100 μM) ± L-NAME (100 μM) and sodium nitroprusside (10 nM to 1 mM) respectively, in mesenteric arteries pre-contracted with norepinephrine (10 μM). Media-to-lumen ratio (M/L) and cross sectional area (CSA) were evaluated on pressurized preparations.
BP was higher in TG2-K/O mice compared to WT (120.3±1.3 mmHg vs 88.3±1.9 mmHg, P<0.05), Ang II infusion significantly increased BP only in WT (+28% vs untreated WT, P<0.05), whereas BP was unchanged in TG2-K/O after Ang II infusion. Endothelium-dependent relaxation was similarly preserved in untreated WT, TG2-K/O and Ang II-treated TG2-K/O. Ang II infusion impaired acetylcholine-induced relaxation only in WT (-50% vs untreated WT, P<0.05). L-NAME blunted acetylcholine-induced relaxation in all the groups except in Ang II-treated WT, suggesting an impairment of NO production only in this group. Endothelium-independent relaxation was similar in all groups. TG2-K/O presented reduced M/L as compared to WT (4.8±0.3% vs 6.5±0.2%, P<0.05). Ang II infusion increased M/L only in WT (+13% vs untreated WT, P<0.05). M/L resulted unchanged in TG2-K/O after Ang II infusion. CSA was similar in all groups.
In conclusion, despite the higher BP values, TG2-K/O presented improved vascular remodeling compared to WT. Ang II failed to increase M/L and impair endothelial function in TG2-K/O. Hence TG2 may play a role in Ang II-induced vascular structural and functional alterations.
Abstract 007: Effects Of Finerenone - A Novel Non-steroidal Mineralocorticoid Receptor Antagonist In A Model Of Pressure Overload-induced Cardiac Hypertrophy
Authors: Grune Jana , Benz Verena , Brix Sarah , Ban Zsofia , Salatzki Janek , Hoeft Beata , Foryst-Ludwig Anna , Klopfleisch Robert , Kolkhof Peter , Kintscher Ulrich 
Published: March 2022

Activation of mineralocorticoid receptors (MR) by its agonist aldosterone induces several unwanted processes like inflammation, fibrosis, increase of blood pressure and ventricular hypertrophy. Inversely, the blockade of MR is known as a highly efficacious therapy in chronic heart failure and arterial hypertension. Therapy with currently approved MR antagonists is often limited due to side effects. Recently, new highly selective, non-steroidal aldosterone antagonists such as finerenone have been developed.
To investigate the effects of finerenone on progressive cardiac hypertrophy the transverse aortic constriction (TAC) model was used. C57BL/6 male mice underwent a TAC-operation and were treated daily by oral gavage with finerenone (fin; 10 mg/kg/d), eplerenone (200 mg/kg/d) or vehicle (veh). The treatment started one week before the TAC-operation, and was continued 4 weeks postoperative. To examine the efficacy of finerenone on myocardial wall thickening echocardiography was performed one week before and 4 weeks after TAC and left ventricular mass (LVM) was calculated. Furthermore, gene expression analysis in heart and kidney were carried out to investigate molecular mechanisms.
TAC-operated mice treated with finerenone showed a significant lower LVM relative to body weight compared with vehicle-treated mice (fin: 3.89 mg/g; veh: 4.32 mg/g; p<0.05). Also the percentage increase of LVM four weeks after TAC was significantly lower in finerenone-treated animals than in vehicle-treated mice (fin: +37.16 %, veh: +52.9 %, p<0.05). Furthermore, markers of pathological hypertrophy like atrial natriuretic factor (ANF) and β-myosin heavy chain (β-MyHC) were measured in the left ventricle, and showed a higher expression in vehicle-treated than finerenone-treated animals. Treatment with eplerenone did not significantly reduce cardiac hypertrophy after 4 weeks post TAC.
In conclusion, these data show for the first time beneficial effects of the new non-steroidal MR-antagonist finerenone on LVM development in a TAC-model. The distinct actions of finerenone when compared to eplerenone may result from different MR-blocking properties.
Abstract 411: Diurnal Variation of Blood Pressure in Medical Residents: MARINE 1 (Measures of Active Residents in Numerous Environments)
Authors: Brown Lorrel , Chaisson Jordan , Cheng Henry , Labaki Wassim , Cingolani Oscar , Schulman Steve , Desai Sanjay 
Published: March 2022

Residency training subjects healthy young people to frequent fluctuation in sleep-wake cycles. Although shift work is known to increase cardiovascular risk, little is known about the physiology of phase-shifted sleep in residency. This study uses 24-hr ambulatory blood pressure monitoring to investigate diurnal BP variation in medical residents working alternating day/night periods. We hypothesized that diurnal variation of BP is dependent upon sleep/wake status, not upon day/night hours.
Residents were recruited from the Johns Hopkins Medicine Residency Program during the 2013-2014 academic year. Thirty-six individuals participated while working in three clinical environments (intensive care unit, general medicine wards, outpatient clinic), and during various sleep-wake schedules (night shift, 24-hr overnight call, day shift). BP was measured every 30 min during waking hours and every 2 hr during sleep. Residents self-reported during which hours they slept. Ninety-eight separate 24-hr periods of data were collected (Table 1).

There is no difference in
mean
24-hr SBP,
awake
SBP/DBP, or
asleep
SBP/DBP between those working different schedules. However, there are statistically significant differences in
day
SBP/DBP and
night
SBP/DBP between participants working different schedules. In all schedules, participants showed at least a 9 mmHg drop in SBP between
awake
and
asleep
. Diurnal variation of BP in this population is present, and dependent upon sleep/wake status, not day/night hours. Further investigation into the correlation between this reversal of diurnal BP variation and cardiovascular outcomes in shift workers is warranted.
Abstract 520: Na/H Exchanger Participates in Tubuloglomerular Feedback
Authors: Wang Hong , D’Ambrosio Martin A , Ren YiLin , Monu Sumit , Leung Pablo , Kutskill Kristopher , Garvin Jeffrey L , Peterson Edward L , Carretero Oscar A 
Published: March 2022

The afferent arteriole (Af-Art) accounts for most renal vasculature resistance, thus controlling glomerular filtration and renal function. The nephron regulates Af-Art resistance via two mechanisms, the vasoconstrictor tubuloglomerular feedback (TGF), initiated in the macula densa via Na/K/2Cl cotransporters (NKCC2), and the vasodilator connecting tubule glomerular feedback (CTGF), initiated in the connecting tubule via the epithelial Na channels (ENaC). However, when TGF and CTGF are inhibited by furosemide and benzamil, a novel form of TGF is observed.
We hypothesize that in addition to NKCC2, TGF can be initiated by Na/H exchangers (NHE). Furthermore, we hypothesize that when NKCC2 and NHE are blocked, CTGF causes Af-Art dilation.
In vivo, using the nephron micropuncture technique, we performed two consecutive stop-flow pressure (PSF) curves (an index of glomerular capillary pressure) by increasing the perfusion of the nephron from 0 to 40 nL/min while adding drugs to the tubular perfusate.
TGF was blocked by furosemide (vehicle -7.9±0.2 mmHg at 40 nL/min, furosemide -0.4±0.2; P<0.001). An NKCC2-independent form of TGF was revealed by blocking TGF with furosemide and CTGF with the ENaC inhibitor benzamil (furosemide: -0.2±0.1 mmHg, furosemide+benzamil: -4.3±0.3 mmHg, P<0.001). TGF was completely blocked by the combination of furosemide and the NHE inhibitor dimethylamiloride (DMA), resulting in vasodilatation (furosemide+DMA: 2.7±0.5 mmHg, n=6), that was blocked by CTGF inhibition (furosemide+DMA+benzamil: -1.1±0.2 mmHg, P<0.01, n=6).
We conclude that NHE in the nephron causes TGF when NKCC2 and ENaC are inhibited and that CTGF causes dilation of the Af-Art when TGF is completely blocked with NKCC2 and NHE inhibitors.