bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver stiffness assessed by Fibrosis-4 index predicts heart failure in AMI patients
Authors: Nunohiro T , Furukawa K , Uchida M , Kuwasaki S , Kusumoto S , Furudono S , Suenaga H , Takeno M , Takeshita S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
It has been recently reported that the liver stiffness, which reflects increased central venous pressure, measured by transient elastography increases along with decompensated heart failure (HF) developing and decreases with clinical improvement. A simple index for the assessment of liver stiffness and/or impairment of liver reserve may be useful in patients with HF. We calculated each patient´s FIB4 index(F4I) using the following formula: (age (years)× aspartate aminotransferase (IU/L)/platelet count (10９/L)× square root of alanine aminotransferase (IU/L)). Patients with an F4I≥2.67 were classified into the high F4I group and these patients were strongly suspected to have non-alcoholic fatty liver disease (NAFLD). NAFLD is also said to be a form of metabolic syndrome expressed in the liver. And lately NAFLD is associated with increased risk of acute myocardial infarction (AMI) and stroke and cardiovascular surrogate markers. But Little is known about F4I with the influence of AMI prognosis. This study included 167 AMI patients who underwent primary percutaneous coronary intervention within 24h of onset. Consecutive patients were divided into two groups based on their F4I at discharge: First group (2.67 ≤F4I, n = 27), second group (F4I &lt;2.67, n = 140) . And we assessed the association between F4I and CV events including cardiac death, recurrent AMI, recurrent PCI (TLR) and re-hospitalization of heart failure during 13 months. Result: High F4I (2.67≤ F4I ,19% VS F4I &lt;2.67, 6%: P = 0.045) related to the re-hospitalization of heart failure. Univariate odds ratio was 3.45. F4I is significantly related to the re-hospitalization of heart failure. Conclusion: A simple index F4I is significantly related to the prognosis of adverse cardiac events after AMI patients. Abstract Figure. Predictor of Re-hospitalization of HF
Demographic analysis and clinical outcomes of COVID-19 and myocardial infarction from a tertiary care centre in south India
Authors: Kongara R , Sankaran RAMESH , Muralidharan T R , Manokar P , Sadhanandham S , Nagendra Boopathy S , Vinod Kumar B , Balasubramaniyan J V , Preetham K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Back ground – COVID-19 is reported in India from March 2020. It is known to cause myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction.

PURPOSE
–We intent to study outcomes of acute coronary syndrome associated with COVID-19 patients .

METHODS
– This is a single center case-control study done in an University hospital in south India , from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without COVID -19 in the same period.
RESULITS – 508 patients were admitted between May 2020 to October 2020 with ACS and out of which 58 patients were positive for COVID-19 and 450 patients were COVID-19 negative. In COVID positive group, most of the patients were above 50 years with 17 % of them being female sex. 60 % were having diabetes and 44.8 % had hypertension . 55% of them had STEMI with the rest being NSTE- ACS . 43.1 % patients were thrombolysed . 25% patients underwent revascularization either with PCI / CABG . 10.3% died in the COVID - 19 positive group , at the same time there were only 2.2 % deaths in the control group . Most the patients were asymptomatic COVID-19 at presentation . Among the symptomatic COVID-19 patients the onset of myocardial infarction after COVID-19 ranged from 9 – 90 days .

CONCLUSION
– Acute coronary syndrome in COVID-19 patients can present as late as 3 months after index infection, and these patients had higher mortality compared with those who did not have COVID -19 .
Greater mitral valve area in obese patients with rheumatic heart disease: a new evidence of obesity paradox ?
Authors: Lestari A N , Akbar M R , Alie I R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
The existence of obesity paradox’s been proposed this past decade, suggesting obese individuals may have survival benefit when there"s acute cardiovascular decompensation or congestive heart failure. Adiponectin, a residual protein from fat, has a cardioprotective role against inflammation.
PURPOSE : In this study, we look at mitral valve stenosis (MS), an inflammatory result of rheumatic heart disease (RHD), to determine the relationship between BMI (body mass index) and degree of MS.

METHODS
A cross-sectional study was conducted over 463 medical records from RHD patients at a Heart Service Installation. Anthropometric and echocardiography results were taken and analysed statistically. Mitral valve area (MVA) was calculated using planimetry method and classified based on EAE/ASE guideline.

RESULTS
Based on BMI criteria (WHO Asia Pacific), the underweight, normal, overweight, and obese percentage of all patients are 16.8%, 46.7%, 15.1%, and 21.4% respectively. Most patients have normal BMI in all stenosis degree. Categorically, the relationship between BMI and MS degree is insignificant (p &gt; 0.05). Meanwhile, the median of MVA in the obese group shows the greatest (1.0 vs 0.79, 0.86, and 0.90 ; p value &lt;0.05). A post-hoc analysis carried out and shows significant difference among MVA value in underweight to obese patients (p &lt; 0.05) and also in normal to obese patients (p &lt; 0.05)

CONCLUSION
Significant relationship of MVA value in RHD patients according to BMI is noted with greater median of MVA in obese group. This may provide evidence of the obesity paradox in RHD patients with mitral stenosis. Abstract Table 1 Abstract Table 2
Arrhythmogenic right ventricular cardiomyopathy patients with a markedly enlarged RV compressing LV to left side have an atypical distribution of epsilon waves and elevated plasma BNP
Authors: Funabashi N , Okamoto M , Nakamura K , Sasaki T , Naito S , Kobayashi Y 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Epsilon waves on V1-3 leads are specific ECG findings in patients with arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) suggesting RV conduction delay. Four dimensional (4D) cardiac CT visualizes ARVC characteristics, such as fibro-fatty invasion into RV and left ventricular (LV) myocardium (RVM, LVM), an enlarged RV, reduced RV motion, and bulging.

Purpose
We hypothesize that Epsilon waves in V4-6 leads suggest LV invasion in ARVC. Alternatively, extreme RV enlargement may compress the LV and cause clockwise rotation; an enlarged RV may itself cause epsilon waves in V4-6 leads.

Methods
Retrospective analysis of 17 patients (11 males, 57 ± 17 yrs) with suspected ARVC undergoing cardiac CT and ECG, 9 of whom met 2010 ARVC task force criteria.

Results
All 9 patients had epsilon waves on ECG; 5 had fibro-fatty invasion into the LVM. We divided the 9 into 5 groups by CT: 1) markedly enlarged RV compressing the LV to the left side with fibro-fatty changes exclusively in RVM (N = 1); 2) similar findings in both RVM and LVM (N = 2); 3) moderately enlarged RV without compression of the LV to the left side and fibro-fatty changes exclusively in RVM (N = 3); 4) the same in both RVM and LVM (N = 2); 5) severe mitral valve regurgitation, a markedly enlarged LV, and a fibro-fatty change in both RVM and LVM (N = 1). The patient in group (gp) 1 showed epsilon waves in V1-6 leads, patients in gp 2 had epsilon waves in V1-6 (N = 1), and V3-5 (N = 1) leads; patients in gp 3 had epsilon waves in V1-4 (N = 2), and V1-3 (N = 1) leads, patients in gp 4 had epsilon waves in V1-3 (N = 1), and V1, 2 (N = 1) leads; finally, the patient in gp 5 had epsilon waves in V4-6 leads. Plasma brain natriuretic peptide (BNP) levels were significantly greater in patients in gp 1 & 2 than gp 3 & 4 (1255 ± 838 vs 80 ± 52 pg/ml, P = 0.016).

Conclusions
ARVC patients with a markedly enlarged RV compressing the LV to the left side (gp 1,2) had a broad (V1-6) or different range (V3-5) distribution of epsilon waves and significantly elevated plasma BNP independent of fibro-fatty invasion of the LV, different from typical ARVC (gp 3,4). Additionally, structural change due to complicated heart disease, such as valvular disease (gp5), may also influence the distribution of epsilon waves in ARVC. Abstract Figure. CT and ECG in ARVC group 1
Diagnostic delay in congenital heart disease related pulmonary arterial hypertension: insights from the single tertiary hospital center of pulmonary hypertension registry in East-Java Indonesia
Authors: Icmi Dian Rochmawati I C M I , Muhamad Rizki Fadlan FADLAN , Heny Martini HENY 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
CHD-Pulmonary arterial hypertension (PAH) is a progressive and fatal disorder. There could be more severe, permanent pathological changes and right ventricular failure in patients diagnosed in later stages, contributing to worse prognosis.
Purpose : The aim of this study was to determine the time from the onset of symptoms to the diagnosis of PAH associated with CHD in our general hospital and to determine the factors with delayed definitive diagnosis.
Methods : The Registry enrolled 128 adult patients with CHD-PAH from January 2019 to December 2020. Patients were considered to have delayed disease recognition if . 2 years elapsed between symptom onset and the patient receiving a CHD-PAH diagnosis, starting on PAH-specific therapy, or receiving a diagnosis by right-sided heart catheterization.
Results : In 54.6% of patients, symptoms were experienced &gt; 2 years before CHD-PAH was recognized. The mean diagnostic interval from symptom onset to diagnostic RHC was 3.18 ± 1.75 years, while Overall, 9.3%, 25% and 65.7% of patients were diagnosed after &lt;1, 1–2 and &gt; 2 years, respectively). There was significant proportion of delayed diagnosed &gt; 2 years in Secundum ASD compare than ≤ 2 years (74.3% vs 51.7%. Respectively, ,p = 0.014, OR 2.6 95%CI : 1.2-5.6). Patients who life in remote area (OR 1.82; 95%CI 1.48-2.26), and General practitioner as Physician consulted at symptom onset (OR 1.72;95%CI 1.64-2.46) were independent predictors of longer diagnostic interval. We found significant different level of MPAP and PVR in patients who was delayed time to diagnosed CHD related to PAH &gt; 2 years compare than ≤ 2 years (55.32 ± 8.8 vs 42.4 ± 10.2, 10.6 ± 1.28 vs 4.2 ± 1.42 respectively ,P = 0.014, P = 0.012). The proportion positive oxygen response was lower in patients who was delayed time to diagnosed CHD related to PAH &gt; 2 years compare than ≤ 2 years (25.7% vs 52.7%,P = 0.001).

Conclusions
We show that there remains significant diagnostic delay of CHD-PAH in East Java, Indonesia. ASD secundum as subtype of CHD, Patients who life in remote area, and General practitioner as Physician consulted at symptom onset were independent predictors of longer diagnostic interval.
Anatomical obstacles and their impact on the sheath to balloon time while intervening through a trans-radial approach in patients undergoing primary percutaneous coronary intervention
Authors: Kumar DILEEP , Abdul Bari SYED , Saghir TAHIR , Khan NASIR , Awan ROMANA , Kumar VICKY , Qamar NADEEM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Trans-radial approach has been considered a safe and useful vascular access site for cardiac catheterization in comparison with the conventional trans-femoral approach. However, radial access has many challenges, such as access difficulty related to anatomical variations, radial artery spasm, occlusion, loops, tortuosities, and aberrant origin of radial and subclavian arteries. These factors were ignored in the large randomized trials that might have a significant impact on the outcome.

Purpose
To determine the predictors of anatomical obstacles and their impact on the sheath to balloon time while intervening through a trans-radial approach in patients undergoing primary percutaneous coronary intervention.

Methods
This was a case-control study comprised of 466 patients who underwent primary percutaneous coronary intervention to determine the predictors of anatomical obstacles including radial artery spasm, radioulnar loops, aberrant radial artery, tortuous configuration, and subclavian tortuosity. Sheath to balloon time was determined in both the groups with and without anatomical obstacles.

Results
Patients with and without anatomical obstacles were recruited in a 1:3 ratio. Female gender was found to be associated with anatomical obstacles with the distribution of 28.6% (32/112) vs. 19.2% (68/354); p = 0.035 for the patients with and without anatomical obstacles. Patients with obstacles were comparatively older than patients without obstacles with the mean age of 59.11 ± 8.86 vs. 55.6 ± 9.45 years; p &lt; 0.001. Diabetes as co-morbid was another clinical factor observed to be associated with the presence of anatomical obstacles with the distribution of 50.9% (57/112) vs. 40.1% (142/354); p = 0.044 for with and without obstacles cohort respectively. Among patients with anatomical obstacles, the most common type of obstacle was observed to be subclavian tortuosity (40.2%) followed by radial artery spasm (25.9%), tortuous configuration (17.0%), radioulnar loop (12.5%), and abnormal origin of the RA (4.5%). A significantly higher sheath to balloon time was observed for the patients with anatomical obstacles as compared to those without with a mean duration of 30.92 ± 13.25 vs. 19.42 ± 6.2 minutes; p &lt; 0.001.

Conclusion
Older age, female gender, and diabetes were found to be the major predictors for anatomical obstacles and hence significantly increasing the sheath to balloon time. Moreover, Subclavian tortuosity was the most common obstacle followed by the radial artery spasm. Therefore, predicting the factors prolonging the procedure time could be beneficial to select the access site and can improve the overall outcome.
Blood pressure variability in hypertension patients in Indian clinical settings
Authors: Abhyankar M , Jinghan A K , Das C , Datta S , Goswami A D , Silki S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Blood pressure variability (BPV) is a potential predictor for complications such as coronary artery disease, heart failure, stroke, and all-cause death, independently of mean blood pressure (BP) in patients with hypertension.(1)

Objective
The survey was carried out to seek the opinion of Indian clinicians on the burden, measurement and management of BPV in patients with hypertension.

Method
This PAN-India survey used a structured web-based objective questionnaire that was administered to 200 clinicians via google forms. The responses were analyzed descriptively.

Results
This study suggests that &gt;80% of the clinicians reported that 10-40% of their hypertensive patients experience BPV while 13% and 6.5% respectively, reported having BPV issues in &lt;10% and &gt;40% of their patients.
A large majority of the clinicians (88.5%) agreed that effective control of BPV in hypertensive patients exerts benefits to prevent complications like target organ damage, cardiovascular disease and mortality.
A combination of home and office BP monitoring was the most recommended approach for the measurement of BPV by 28% of the clinicians, followed by home monitoring (23%) &gt; ambulatory monitoring (22.5%) &gt; combination of ambulatory and office monitoring (21%) &gt; office monitoring (4.5%) of BP. A majority of clinicians opted for angiotensin receptor blocker (ARB) + calcium channel blocker (CCB), ARB + beta blocker (BB) and ARB + diuretic as most preferred antihypertensive combination for effective control of BP and BPV (Figure 1). In particular, the clinicians opined for Telmisartan + Amlodipine (45.5%) &gt; Telmisartan + Chorthalidone (27%) &gt; Telmisartan + Cilnidipine (14%) &gt; Telmisartan + Hydrochlorothiazide (13%) as the preferred antihypertensive combinations.
41% and 30.5% of the clinicians reported that they would shift their patients with high BPV to a dual and a triple combination of antihypertensives, respectively followed by increasing the antihypertensive dose (18%) and shifting to new antihypertensive medication (8.5%).

Conclusion
The survey underlined the considerable prevalence of BPV in hypertensive individuals and that its control can be beneficial in reducing the risk of future complications. The study also reflects that both home and office BP monitoring are important to identify BPV while ARBs particularly, Telmisartan in combination with CCB or a diuretic is the preferred regimen for effective control of BP and BPV. Abstract Figure 1
The safety and efficacy of efonidipine, an L- and T-Type dual calcium channel blocker, on heart rate and blood pressure in indian patients with mild-to-moderate essential hypertension
Authors: Jariwala P , Jadhav KARTIK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Efonidipine hydrochloride, an L- and T-type dual calcium channel blocker, have a heart rate (HR)-slowing action in addition to a blood pressure (BP)-lowering effect. Many younger Indian hypertensive patients has sinus tachycardia. Beta blockers are not first line of antihypertensive agents. The aim of this study was to determine the effect of efonidipine on HR and BP in Indian patients with mild-to-moderate hypertension.

Methods
In a single center, prospective, open-labeled, single-armed study, we enrolled 335 patients who had mild-to-moderate hypertension [Systolic blood pressure ≥ 140 mm Hg and ≤ 160 mm Hg; Diastolic blood pressure ≥ 90 and ≤ 110 mm Hg]. After a 2-week washout, eligible patients were treated with efonidipine (40 mg once daily for 12 weeks). The primary end point was the change in HR from baseline to week 12. The secondary endpoint included the change in trough sitting office BP between baseline and week 12. Laboratory and clinical adverse events were monitored at each study visit (4, 8, and 12 weeks). A dedicated nurse using mercury sphygmomanometer recorded blood pressure thrice spacing 15 minutes apart. The initial two readings were discarded, and third reading was accepted as final reading of actual blood pressure.

Results
335 patients were included in the intention-to-treat analysis. After 12 weeks of treatment with efonidipine, the resting HR decreased significantly from baseline to week 12 {from 96.5 ± 15.3 to 71.8 ± 9.9 beats/minute, p &lt; 0.0001}. The trough BP {sitting systolic blood pressure (SiSBP) and SiDBP} also decreased significantly (SiSBP: from 158.6 ± 10.2 to 122.9± 5.5 mmHg, p &lt; 0.0001; SiDBP: from 99.6 ± 8.4 to 87.3 ± 7.6 mmHg, p &lt; 0.0001) The incidence of pedal oedema was seen in 0.5% of patients. The symptomatic hypotension was not seen any patients. The adherance to the therapy was 98.9%. 18% patients required second antihypertensive medication to achieve the BP target of ≤ 130/80 mm Hg.

Conclusion
Efonidipine was effective in controlling both HR and BP in patients with mild-to-moderate hypertension in Indian patients. Its safe drug as a mono therapy with good adherence and minimal side effects.
Circulating extracellular vesicles correlate with nocturnal blood pressure and vascular organ damage and may serve as an integrative biomarker of vascular health.
Authors: Lugo Gavidia L M , Burger D , Robinson S , Nolde J , Carnagarin R , Matthews V B , Schlaich M P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Council on Science and Technology, Mexico (CONACYT).

Background
Elevated blood pressure (BP) has been associated with increased levels of circulating extracellular vesicles (EVs) which could potentially serve as a novel integrative biomarker for vascular health.

Purpose
The present study therefore aimed to assess the relationship between increased EV release, blood pressure and macrovascular organ damage.

Methods
A total of 83 patients with BP ranging from normal to high were included in the present analysis. Extracellular vesicles were evaluated by flow cytometry (CD41+/Annexin v+). BP evaluation included unobserved automated office BP (AOBP) and ambulatory BP monitoring (24hr-BP, day-BP and night-BP). Carotid-femoral pulse wave velocity (PWV) was measured by the SphygmoCor XCEL as a marker of macrovascular organ damage.

Results
Hypertensive patients (n = 73, BP 132.9 ± 17.4/79.4 ± 14.0) compared to normotensive patients (n = 10, BP 113.4 ± 10.4/71.3 ± 9.6) had higher levels of EVs (10.6 ± 8.2 vs 6.5 ± 4.5 EV/µL; p = 0.02). Circulating EVs were positively correlated with nocturnal systolic BP (r= 0.3; p = 0.01) and night-time dipping (r= -0.26; p = 0.02) in univariable analysis. In contrast, systolic AOBP, 24hr-BP and day-BP did not show significant associations. No significant correlations were found with diastolic BP. EVs were significantly correlated with PWV (r = 0.26 p = 0.02).While all BP measures were associated with PWV, average systolic night-time BP demonstrated the strongest correlation with PWV (r = 0.55; p &lt; 0.001) compared to systolic AOBP (r = 0.51; p &lt; 0.001), 24hr-BP (r = 0.46; p &lt; 0.001), and average day-BP (r = 0.48; p &lt; 0.001). Multivariable regression models confirmed robustness of the models.

Conclusion
We demonstrate a close positive relationship between a variety of BP measures and levels of circulating EVs as well as macrovascular damage assessed by PWV. The strongest correlation with EVs was found for average systolic nocturnal BP. Given that average nocturnal BP is the strongest predictor of CV events, EVs may serve as a useful integrative marker of vascular health and useful biomarker for CV risk assessment, a proposition that will need to be tested in prospective clinical trials. Abstract Figure.