bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of atrial fibrillation on in-hospital outcomes of coronary artery bypass graft surgery: an analysis by propensity score matching
Authors: Rosler A , Constantin G , Nectoux P , Ferreira G , Borges A , Sales M C , Lucchese F A 
Published: October 2022

Abstract

Background/Introduction
Many patients referred for coronary artery bypass graft (CABG) surgery have persistent or permanent atrial fibrillation (AF). Despite the significant occurrence, the impact of this arrythmia on surgical outcomes remains uncertain.

Purpose
To assess the impact of persistent or permanent AF on post-CABG in-hospital outcomes.

Methods
A cohort of 3,124 patients undergoing to isolated CABG between 2010 and 2020 was evaluated. A propensity score pairing was applied, considering persistent or permanent AF as a dependent variable and another 19 baseline characteristics as independent variables in the regression model used to build the propensity score. Pairing was performed at a ratio of 3:1 – Group 1: 324 patients without persistent or permanent AF; Group 2: 108 patients with the documented diagnosis of persistent or permanent AF. The statistical plan also included normality analyses, descriptive and univariate analyses, binary logistic regression, ROC curves and DeLong test to compare de curves. The significance level adopted was 5%. The analyses were performed by the programming language Python.

Results
None of the baseline characteristics evaluated showed a significant difference between the groups, including the EuroScore II (Group 1: 1.54±1.45 vs Group 2: 1.49±1.59; p=0.990). Likewise, none of the analysed surgical characteristics showed a significant difference, indicating a very approximate pattern of complexity of the surgeries. The absence of differences demonstrated a high degree of homogeneity between the groups. The use of pairing by propensity score aimed to form two extremely similar study groups, which differed only in relation to the diagnosis of the arrhythmia under study. Among the outcomes evaluated, AMI (1.5 vs 6.5; p=0.013), MACCE (7.1% vs 14.8%; p=0.015) and death (1.5% vs 6.5%; p=0.013) had significantly higher incidences in Group 2, formed by patients with persistent or permanent AF. From the multivariate analysis, it can be identified that permanent AF was an independent risk predictor for the occurrence of in-hospital death (OR: 5.009; 95% CI 1.433–17.507; p=0.012). Finally, it was also possible to verify that the association of EuroScore II with persistent or permanent AF showed higher predictive accuracy than EuroScore II alone (ESII+FA = AUC 0.852 vs ESII alone = AUC 0.775, p&lt;0,05).

Conclusion(s)
Patients with persistent or permanent AF had significantly higher incidences of AMI, MACCE and in-hospital death. Persistent or permanent AF was characterized as an independent predictor for the occurrence of death and the association with the EuroScore II resulted in a 9.9% increase in the predictive accuracy of the surgical risk score.

Funding Acknowledgement
Type of funding sources: None.
Relationship between Pulse Wave Velocity and Myocardial Work in untreated hypertensive patients with preserved LVEF
Authors: Lofrumento F , Mandraffino G , Trimarchi G , Mancinelli A , Restelli D , De Sarro R , Sinicropi D , Cinquegrani M , Cusma-Piccione M , Manganaro R , Recupero A , Di Bella G , Zito C , Carerj S 
Published: October 2022

Abstract

Introduction
Hemodynamic interaction between left ventricular (LV) and arterial system is a key determinant of cardiovascular performance. The non-invasive carotid-femoral Pulse Wave Velocity (PWV), obtained with applanation tonometry, is considered the most precise way of estimating arterial stiffness. The LV myocardial work (MW), based on non-invasive LV pressure-strain loop (PSL), is a new promising tool to assess LV function.

Purpose
The aim of the study was to evaluate the correlation between PWV and MW parameters in a population of non-hypertensive and newly diagnosed untreated hypertensive people.

Material and methods
50 people (M=30), divided in hypertensive (group 1: n=25, 40±8 years) and non-hypertensive (group 2: n=25, 38±9 years), were prospectively enrolled. All underwent conventional transthoracic echocardiography and at the same day carotid femoral PWV was calculated with applanation tonometry (SphygmoCor® XCEL). MW parameters were obtained using 2D Speckle-tracking technique.

Results
Comparing the two groups, PWV and Global Work Wasted (GWW) were significantly higher in the hypertensives group (9.44±2.4 vs 7.56±1.1; p=0.001 and 130±2.5 vs 80.60±1.5, p=0.002), as shown in Figure 1, whereas Global Work Efficiency (GWE) and Global Work Constructive (GWC) were significantly lower (94±2.5 vs 95.8±1.2, p=0.003 and 2393±20 vs 2166±18, p=0.02). We found a linear and positive correlation of PWV with GWW (r=0.315, p=0.026), as seen in Figure 2, and a linear and negative correlation of PWV with GWE (r=−0.315, p=0.026).

Conclusion
This study highlights the role of PWV and MW evaluation in hypertensives. Higher PWV and GWW could be considered as red flags of myocardial damage suggesting the need of an early appropriate antihypertensive therapy.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Ospital G. Martino - Messina
Intracranial carotid arteriosclerosis mediates the association between blood pressure and cerebral small vessel disease: the Rotterdam Study
Authors: Melgarejo J , Vernooij M W , Ikram M A , Zhang Z Y , Bos D 
Published: October 2022

Abstract

Background
Cerebral arteriosclerosis could explain the physiopathological mechanisms linking high blood pressure (BP) and cerebral small vessel disease (CSVD).

Objectives
To test the hypothesis that ICAC mediates the association between BP and CSVD.

Methods
1458 stroke-free participants from the Rotterdam Study underwent nonenhanced computed tomography to quantify ICAC and brain magnetic resonance imaging scans to assess CSVD. ICAC subtypes included atherosclerotic (intimal) and non-atherosclerotic internal elastic lamina (IEL) calcifications. We analyzed systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Mediation analysis included a two way decomposition to compute the natural direct effect (NDE), natural indirect effect (NIE) and percentage of mediation (%) of ICAC on the association between BP and CSVD.

Results
The study population had a mean age of 68.0 years old, and 52% (n=758) of the participants were women. In analyses including participants with predominantly IEL calcification, we observed that larger log-ICAC volume was positively related to a higher pulse pressure (β=0.020; P&lt;0.001), and lower diastolic BP (β=0.024; P=0.001). None of the BP components were associated with log-ICAC volume among participants with predominantly intimal calcifications (β≤0.008; P≥0.060). Among all participants, log-ICAC volume mediated the association of DBP (NIE, 0.003; −14.5%) and PP (NIE,0.003; 16.5%) with log-white matter hyperintensities (log WMH). In participants with IEL calcification, log-ICAC volume mediated the association of DBP with log-WMH (NIE, 0.004, −19.5%); no mediations were observed for intimal ICAC. For Lacunes, in all participants, log-ICAC volume mediated the association of DBP (NIE, −0.015, −40%) and PP (NIE,0.015; 26.9%). In participants with IEL calcification; the NIE was 0.020 (45.8%) for DBP and 0.017 (18.2%) for PP. No interactions were detected.

Conclusions
ICAC mediated the association between BP and CSVD. Non-atherosclerotic IEL calcification, considered a proxy of arterial stiffness, was the main physiopathological mechanism explaining how BP links to CSVD due to cerebral arteriosclerosis.

Funding Acknowledgement
Type of funding sources: None.
Regional inequality of socioeconomic status and the prevalence of hypertension between rural and urban areas
Authors: Cho D , Ha M C , Jo H R , Kang S H 
Published: October 2022

Abstract

Background
Lower socioeconomic status (SES) is associated with greater burdens of cardiovascular disease in a community. The regional disparity of SES may result in an uneven distribution of hypertension (HTN) by a region. This study aims to analyze the regional disparity in the SES and HTN burden between rural and urban areas of the Korea.

Methods
We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) V (2010–2012), VI (2013–2015), and VII (201–2018). We analyzed 11,206 and 1739 subjects from Seoul metropolitan and rural area (Gangwon province), respectively. We compared socioeconomic characteristics, the distribution of HTN between two regions. Finally, we performed a multivariate logistic regression adjusting for traditional CV risk factors and SES status to examine differences in the prevalence of HTN.

Results
Subjects in Gangwon province were older than Seoul (54.6±0.4 vs 49.4±0.2 years old, p&lt;0.001). The proportions of subjects with low economic status and low education level were significantly higher in Gangwon province compared to Seoul (low economic status; 25.6 vs 14.4%, p&lt;0.001, low education level; 35.3 vs 16.5%, p&lt;0.001). Mean systolic blood pressure (SBP) was higher in Gangwon compared to Seoul (121.6±0.4 vs 118.1±0.2 mmHg, p&lt;0.001). In the longitudinal trend from KNHANES V to VII, the difference of SBP between the two regions increased (Figure). The age-matched prevalence of HTN was significantly higher in Gangwon compared to Seoul (23.8 vs 21.6%, p&lt;0.05), and the difference of prevalence of HTN by regions longitudinally increased (Figure). In the univariate analysis, the residency in Gangwon was associated with the presence of HTN (reference: Seoul, OR=1.63; 95% CI: 1.45–1.83). In the multivariate logistic regression model, the residency in Gangwon was not associated, however, low economic status and low education level were significantly associated with the presence of HTN (economic status, OR=1.39; 95% CI: 1.17–1.67, education level, OR=1.88; 95% CI: 1.57–2.24).

Conclusion
The SES status was lower and the prevalence of HTN was higher in Gangwon compared to Seoul. The burden of HTN longitudinally increased in Gangwon, but not in Seoul. The poor SES was significantly associated with HTN. It suggests that the inequalities of SES in Gangwon may contribute to the increasing prevalence of HTN. The regional and individual disparity of SES should be considered in the establishment of public health strategies for HTN.

Funding Acknowledgement
Type of funding sources: None.
Bi-directional relationships of arterial stiffness with hypertension and diabetes mellitus from the early pathophysiological stages: a 16-year prospective observational study
Authors: Nakano H , Shiina K , Takahashi T , Fujii M , Iwasaki Y , Matsumoto C , Yamashina A , Chikamori T , Tomiyama H 
Published: October 2022

Abstract

Background
Hypertension and diabetes mellitus frequently coexist; however, it has not yet been clarified if the bidirectional longitudinal relationships between arterial stiffness and hypertension are independent of those between arterial stiffness and diabetes mellitus.

Methods
In this 16-year prospective observational study, 3960 middle-aged employees of a Japanese company without hypertension/diabetes mellitus at the study baseline underwent annual repeated measurements of the blood pressure, serum glycosylated hemoglobin A1c levels (HbA1c), and brachial-ankle pulse wave velocity (baPWV).

Results
By the end of the study period, 664, 779, 154, and 406 subjects developed hypertension, prehypertension, diabetes mellitus, and prediabetes, respectively. Increased baPWV at the baseline was associated with a significant odds ratio (per 1 standard deviation increase) for new onset of prehypertension/hypertension with (2.45/3.28, P&lt;0.01) or without (2.49/2.76, P&lt;0.01) coexisting prediabetes/diabetes mellitus, but not for new onset of prediabetes/diabetes mellitus without coexisting hypertension. Analyses using the latent growth curve model confirmed the bidirectional relationships between baPWV and hypertension, but no such relationship was observed between baPWV and abnormal glucose metabolism. Moreover, after the adjustments, higher mean blood pressure at baseline accelerated the increases in the baPWV over follow-up (unstandardized coefficient [B] = 0.39, standard error [SE] = 0.05x10–1, P&lt;0.01). Similarly, higher baPWV at baseline accelerated the increases in mean blood pressure over follow-up (B = 0.02x10–1, SE = 0.01x10–1, P&lt;0.01) (Figure 1). On the other hands, higher HbA1c levels at baseline accelerated the increases in the baPWV over follow-up (B = 0.43, SE = 0.05x10–1, P&lt;0.01), but higher baPWV at baseline did not accelerate the increases in HbA1c levels over follow-up (B &lt;0.01, SE &lt;0.01, P=0.52) (Figure 2).

Conclusions
In middle-aged employees of a Japanese company, in contrast to the bidirectional relationships that exist between arterial stiffness and hypertension, increased arterial stiffness preceding the development of diabetes mellitus may represent that associated with the development of hypertension, as it is observed only in cases of diabetes mellitus coexisting with hypertension. Therefore, arterial stiffness may be associated to a greater degree with the development of hypertension than with the development of diabetes mellitus.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Omron Health Care Company (Kyoto, Japan),Teijin Pharma Company (Tokyo, Japan)
Correlation between central aortic stiffness indices and cardiac mechanics in hypertensive patients: new insights from speckle tracking echocardiography imaging
Authors: Marzouk D , Eldeep H , Baghdady Y , Youssef G 
Published: October 2022

Abstract

Background
Left ventricular (LV) and left atrial (LA) mechanics are altered in hypertensive patients. Recent evidence suggests that central aortic pressure, rather than brachial pressure is strongly related to future cardiovascular events. Currently, oscillometric non-invasive devices are considered a reliable method for estimation of central aortic pressure and stiffness indices.

Purpose
To evaluate the relation between central aortic pressure measured using oscillometric non-invasive device and cardiac mechanics assessed by speckle tracking echocardiography (STE).

Methods
Fifty hypertensive patients with apparently structural normal heart were consecutively enrolled. A new oscillometric device was programmed to measure blood pressure over a period of 30 minutes (total of 15 sequential readings) and then data was transferred to a computer-based software where the central aortic pressure and stiffness indices (Augmentation index {AIx} and Pulse wave velocity {PWV}) were automatically calculated. All patients underwent conventional transthoracic echocardiography and STE. STE analysis of LV and LA functions was done using a specific software. LV systolic (global longitudinal strain {GLS}) as well as diastolic (measured at peak mitral filling {E} and at isovolumetric relaxation time {IVRT}) strain/strain rate were measured. LA strain was measured during reservoir (LASr), conduit (LAScd) and contraction (LASct) phases.

Results
The mean age was 45.9±10.6 years and 38% of patients were males. Most of the population was overweight with mean BMI 28±1.9 kg/m2. About 2/3 of population has uncontrolled hypertension (mean brachial systolic and diastolic blood pressure was 139.8±17.5 and 88.4±11.3 mmHg, respectively). The mean central systolic (cSBP) and diastolic blood pressures (cDBP) were elevated (122.2±13.3 and 84.6±10.8 mmHg, respectively). cSBP and cDBP showed significant weak negative correlation with LV diastolic strain rate (Dsr) at peak E (cSBP: r=−0.33, p=0.02; cDBP: r=−0.28, p=0.04). There was no significant correlation between LV GLS and central stiffness indices (p&gt;0.05). cDBP was significantly negatively correlated with LASct (r=−0.3, p=0.03), with no other significant correlation between central stiffness indices and other LA functions (LASr and LAScd) (p&gt;0.05).

Conclusions
Changes in LV diastolic strain/strain rate parameters assessed by STE are related to central aortic pressure particularly cSBP and cDBP in patients with hypertension. This relation was also observed with LA strain parameters namely LASct.

Funding Acknowledgement
Type of funding sources: None.
The music therapy effectiveness in hypertensive patients with acute myocardial infarction after previous coronary artery bypass surgery; 18-year experience of the MUSIC study
Authors: Mitrovic P , Paladin A , Radovanovic M , Radovanovic N , Rajic D , Matic G , Jozic T , Dizdarevic I , Jankovic J , Radovanovic M N 
Published: October 2022

Abstract

Patients who have clinical evidence of hypertension (HT) after coronary artery bypass surgery (CABS) have a poor prognosis in expression of acute myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. The purpose of this study was to evaluate the effectiveness of music therapy on prognosis of patients with HT and AMI, after CABS.

Methods
314 patients (males 78.4%, mean age 59.8±1.2 yrs) with AMI after previous CABS have been selected from the patients consecutively submitted from January 2003 to January 2019. HT was registered in 166 (53.0%) pts with AMI after previous CABS. All patients with HT were randomized and divided in 2 groups: Study group of 83 patients treated with music therapy and Control group of 83 patients with no music therapy. Each patient in study group underwent two sessions of medical therapy (12 minutes) in a day. Both groups were similar in baselines, post-AMI characteristics and post-AMI medical therapy. The plasma cytokine and catecholamine were measured in both groups.

Results
In the Study group, heart rate was significantly decreased by music therapy (p=0.0196). In the Control group, there were no significant changes in heart rate. Among cytokines (p=0.0160), plasma interleukin-6 (IL-6) (p=0.0179) in the Study group was significantly lower than those in the Control group, as well as plasma adrenaline (p=0.0162) and noradrenalin (p=0.0218) levels.

Conclusion
This study provides support for the use of musical therapy in patients with HT and AMI after previous CABS. The positive effects of music therapy, in these patients, are probably because of enhanced of parasympathetic activities and reduction of plasma cytokine and catecholamine levels.

Funding Acknowledgement
Type of funding sources: None.
Valsartan reduces arterial stiffness along with level of soluble ST2 independently of blood pressure changes
Authors: Tomasik A , Kozielska E , Kawecki D , Jachec W , Wojciechowska C 
Published: October 2022

Abstract

Introduction
Arterial stiffness is one of end-organ damage signs in patients with arterial hypertension. Carotid femoral pulse wave velocity (cfPWV) is a clinical measure of arterial stiffness and its values above 10 m/sec are associated with increased cardiovascular risk. Soluble ST2 is a cytokine involved in fibrotic processes. There is paucity of data on the association between sST2, arterial stiffness, and effect of valsartan on these parameters.

Objectives
The aim of the study was to assess the effect of valsartan on arterial stiffness and level of soluble ST2 over a 12-month long treatment.

Methods
This was a randomized, blinded, placebo controlled single center study. There was a 24-hour-long wash-out period from angiotensin converting enzyme inhibitors (ACEI) and other than valsartan, angiotensin receptor blockers ARB (previous use of valsartan was an exclusion criterion). Drugs other than ACEI and ARB were allowed in follow-up to control blood pressure. CfPWV was assessed at baseline and at 12 months using applanation tonometry. Soluble ST2 was measured with lateral flow cassette-based immunofluorescent assay. We present the data for 28 placebo patients (Plac) and 60 valsartan patients (Vals).

Results
Patients from both groups have had comparable peripheral and central blood pressures. CfPWV has risen in Plac by 6.2% and has fallen by 6.2% in Vals (P=0.01) over 12 months. Soluble ST2 has risen in Plac by 9.4% and has fallen by 43.3% in Vals (P=0.001) over 12 months.

Conclusion
Valsartan has positive effect on improvement of arterial stiffness. Decrease in soluble ST2 concentration may help explain the alternative mechanism for protective role of valsartan.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Silesia
Blood pressure reduction in higher cardiovascular risk patients in the Global SYMPLICITY Registry
Authors: Rodriguez O , Mahfoud F , Schmieder R , Schlaich M , Narkiewicz K , Ruilope L , Williams B , Fahy M , Mancia G , Boehm M 
Published: October 2022

Abstract

Background/Introduction
The Global SYMPLICITY Registry (GSR) was designed to evaluate the safety and efficacy of renal denervation (RDN) in real-world patients. Inclusion and exclusion criteria are limited to allow assessment of the effects of RDN on patients with a wide range of comorbidities. The current analysis examines blood pressure (BP) reduction after RDN in higher cardiovascular risk patients.

Purpose
To evaluate blood pressure reduction after RDN in higher cardiovascular risk patients in GSR.

Methods
GSR is a prospective all-comers registry to evaluate the safety and efficacy of RDN. Patients are enrolled in GSR and receive radiofrequency RDN using the Symplicity Flex or Symplicity Spyral catheter. Office and ambulatory BP are measured at each follow-up (3, 6, 12, 24, and 36 months). In this post-hoc analysis, changes from baseline in office and 24-hour ambulatory systolic blood pressure were assessed in patients at higher cardiovascular risk. Higher risk was defined using baseline office systolic or diastolic BP as well as additional risk factors (Figure 1).

Results
As of March 2021, there were 2621 patients characterized as higher cardiovascular risk in GSR. Baseline characteristics included mean age 60.7±12.1 years, 57.6% male, 37.9% type 2 diabetes, 35.8% hypocholesterolemia, 19.7% eGFR &lt;60 mL/min/1.73 m2, 16.2% left ventricular hypertrophy, 10.2% previous stroke and 9.3% previous myocardial infarction. Baseline office systolic BP (OSBP) was 168.8±22.7 mmHg and baseline ambulatory systolic BP (ASBP) 155.3±18.6 mmHg. Mean OSBP reductions after RDN in this higher risk population ranged from −13.1 mmHg at 3 months to −17.5 mmHg at 24 months and −18.9 mmHg at 36 months, and mean ASBP reductions ranged from −7.8 mmHg at 3 months to −9.8 mmHg at 24 months and −9.3 mmHg at 36 months (Figure).

Conclusions
Higher risk patients in GSR had sustained office and ambulatory systolic BP reductions out to 3 years after catheter-based radiofrequency RDN.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic