Effect of periprocedural furosemide-induced diuresis with matched isotonic intravenous hydration in patients with chronic kidney disease undergoing transcatheter aortic valve implantation.

BACKGROUND: Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is a serious complication which is associated with increased mortality. The RenalGuard system was developed to reduce the risk of AKI after contrast media exposition by furosemide-induced diuresis with matched isotonic intravenous hydration. The aim of this study was to examine the effect of the RenalGuard system on the occurrence of AKI after TAVI in patients with chronic kidney disease. METHODS: The present study is a single-center randomized trial including patients with severe aortic valve stenosis undergoing TAVI. Overall, a total of 100 patients treated by TAVI between January 2017 and August 2018 were randomly assigned to a periprocedural treatment with the RenalGuard system or standard treatment by pre- and postprocedural intravenous hydration. Primary endpoint was the occurrence of AKI after TAVI, and secondary endpoints were assessed according to valve academic research consortium 2 criteria. RESULTS: Overall, the prevalence of AKI was 18.4% (n = 18). The majority of these patients developed mild AKI according to stage 1. Comparing RenalGuard to standard therapy, no significant differences were observed in the occurrence of AKI (RenalGuard: 21.3%; control group: 15.7%; p = 0.651). In addition, there were no differences between the groups with regard to 30-day and 12-month mortality and procedure-associated complication rates. CONCLUSION: In this randomized trial, we did not detect a reduction in AKI after TAVI by using the RenalGuard system. A substantial number of patients with chronic kidney disease developed AKI after TAVI, whereas the majority presented with mild AKI according to stage 1 (ClinicalTrials.gov number NCT04537325).

Dynamic contact effects: Individuals' positive and negative contact history influences intergroup contact effects in a behavioral game.

Positive contact between members of different groups reduces prejudice and increases cooperation, findings known as intergroup contact effects. Yet in real-world settings not only positive, but also negative intergroup contact occurs, which have opposing effects. To date little is known about whether and how an individual's valenced history of intergroup contact influences contact effects and how this dynamic change happens during specific instances of intergroup contact. A pilot study examined the psychological impact of a novel paradigm to assess intergroup contact using a behavioral game. We then conducted two studies, which allowed us to observe a sequence of up to 23 in- and outgroup interactions and their behavioral outcomes in a continuous prisoner's dilemma behavioral game (N = 116, 2,668 interactions; N = 89, 1,513 interactions). As expected, participants showed a clear ingroup bias in expectations and cooperation. Furthermore, the quality of contact history moderated contact effects. Specifically, intergroup contact following a positive history of intergroup contact had a stronger effect on intergroup expectations than contact following a negative history thereof. Findings are discussed in view of the importance of considering the valenced history of intergroup contact, as well as new research questions on intergroup contact that can be addressed with this novel contact paradigm. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

High-sensitivity troponin I with or without ultra-sensitive copeptin for the instant rule-out of acute myocardial infarction.

Background: The instant, single-sampling rule-out of acute myocardial infarction (AMI) is still an unmet clinical need. We aimed at testing and comparing diagnostic performance and prognostic value of two different single-sampling biomarker strategies for the instant rule-out of AMI. Methods: From the Biomarkers in Acute Cardiac Care (BACC) cohort, we recruited consecutive patients with acute chest pain and suspected AMI presenting to the Emergency Department of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany. We compared safety, effectiveness and 12-month incidence of the composite endpoint of all-cause death and myocardial infarction between (i) a single-sampling, dual-marker pathway combining high-sensitivity cardiac troponin I (hs-cTnI) and ultra-sensitive copeptin (us-Cop) at presentation (hs-cTnI ≤ 27 ng/L, us-Cop < 10 pmol/L and low-risk ECG) and (ii) a single-sampling pathway based on one-off hs-cTnI determination at presentation (hs-cTnI < 5 ng/L and low-risk ECG). As a comparator, we used the European Society of Cardiology (ESC) 0/1-h dual-sampling algorithm. Results: We enrolled 1,136 patients (male gender 65%) with median age of 64 years (interquartile range, 51-75). Overall, 228 (20%) patients received a final diagnosis of AMI. The two single-sampling instant rule-out pathways yielded similar negative predictive value (NPV): 97.4% (95%CI: 95.4-98.7) and 98.7% (95%CI: 96.9-99.6) for dual-marker and single hs-cTnI algorithms, respectively (P = 0.11). Both strategies were comparably safe as the ESC 0/1-h dual-sampling algorithm and this was consistent across subgroups of early-comers, low-intermediate risk (GRACE-score < 140) and renal dysfunction. Despite a numerically higher rate of false-negative results, the dual-marker strategy ruled-out a slightly but significantly higher percentage of patients compared with single hs-cTnI determination (37.4% versus 32.9%; P < 0.001). There were no significant between-group differences in 12-month composite outcome. Conclusions: Instant rule-out pathways based on one-off determination of hs-cTnI alone or in combination with us-Cop are comparably safe as the ESC 0/1 h algorithm for the instant rule-out of AMI, yielding similar prognostic information. Instant rule-out strategies are safe alternatives to the ESC 0/1 h algorithm and allow the rapid and effective triage of suspected AMI in patients with low-risk ECG. However, adding copeptin to hs-cTn does not improve the safety of instant rule-out compared with the single rule-out hs-cTn at very low cut-off concentrations.

Subjective social status and health-related quality of life-A cross-lagged panel analysis.

Objective: Subjective social status (SSS) refers to individuals' perceived position in the social hierarchy. Prior research suggests that SSS relates to health above and beyond objective socioeconomic status (OSS) such as income, occupation, or education. Most findings in this field, however, stem from cross-sectional studies or longitudinal studies with one-time measurements of SSS only. The aim of this study was to examine reciprocal longitudinal associations of both national SSS (i.e., comparison with people in one's country) and local SSS (i.e., comparison with people in one's social environment) with health-related quality of life. Method: A two-wave cross-lagged panel design with a 2-year follow-up was used to analyze data for national SSS, local SSS, physical and mental health-related quality of life (PHQL and MHQL), as well as OSS from initially 2,156 individuals who participated in the German Socioeconomic Panel Study-Innovation Sample (SOEP-IS). Results: Local and national SSS at baseline predicted PHQL at follow up and partially mediated associations between OSS and PHQL. Local SSS (but not national SSS) also predicted MHQL at follow-up but this association was only marginally significant after inclusion of OSS in the model. Regarding a reverse health-to-SSS pathway, PHQL (but not MHQL) at baseline predicted local and national SSS at follow-up and these associations were partially mediated by income. Conclusion: This study extends cross-sectional observations by confirming that both local and national SSS have unique longitudinal associations with health and provides novel insights into longitudinal pathways linking SSS, OSS, and health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Low testosterone concentrations and prediction of future heart failure in men and in women: evidence from the large FINRISK97 study.

AIMS: The increased incidence of heart failure in men suggests that endogenous sex hormones might play a role in the development of heart failure, but epidemiological data remain sparse. Here, we evaluated the predictive value of low testosterone levels on future heart failure in the large population-based FINRISK97 study. METHODS AND RESULTS: Baseline serum testosterone concentrations were measured in 7855 subjects (3865 men and 3990 women) of the FINRISK97 study. During a median follow-up (FU) of 13.8 years, a total of 564 heart failure events were recorded. The age-adjusted baseline testosterone levels did not differ significantly between subjects developing incident heart failure during FU and those without incident events during FU (men: 16.6 vs. 17.1 nmol/L, P = 0.75; women: 1.15 vs. 1.17 nmol/L, P = 0.32). Relevant statistically significant correlations of testosterone levels were found with high-density lipoprotein cholesterol levels (R = 0.22; P < 0.001), body mass index (R = -0.23; P < 0.001), and waist-to-hip ratio (R = -0.21; P < 0.001) in men, while statistically significant correlations in women were negligible in effect size. In sex-stratified Cox regression analyses, taking age into account, a quite strong association between low testosterone and incident heart failure was found in men [hazard ratio (HR) 1.51 (95% confidence interval, CI: 1.09-2.10); P = 0.020 for lowest vs. highest quarter], but not in women [HR 0.70 (95% CI: 0.49-0.98); P = 0.086 for lowest vs. highest quarter]. Nevertheless, this association turned non-significant after full adjustment including body mass index and waist-to-hip ratio, and testosterone levels were no longer predictive for incident heart failure-neither in men [HR 0.99 (95% CI: 0.70-1.42); P = 0.77 for lowest vs. highest quarter] nor in women [HR 0.92 (95% CI: 0.64-1.33); P = 0.99 for lowest vs. highest quarter]. Accordingly, Kaplan-Meier analyses did not reveal significant association of testosterone levels with heart failure. CONCLUSIONS: Low levels of testosterone do not independently predict future heart failure.

Application of a machine learning-driven, multibiomarker panel for prediction of incident cardiovascular events in patients with suspected myocardial infarction.

Background: In patients with suspected myocardial infarction (MI), we sought to validate a machine learning-driven, multibiomarker panel for prediction of incident major adverse cardiovascular events (MACE). Methodology & results: A previously described prognostic panel for MACE consisting of four biomarkers was measured in 748 patients with suspected MI. The investigated end point was incident MACE within 1 year. The prognostic value of a continuous score and an optimal cut-off was investigated. The area under the curve was 0.86 for the overall model. Using the optimal cut-off resulted in a negative predictive value of 99.4% for incident MACE. Patients with an elevated prognostic score were at high risk for MACE. Conclusion: Among patients with suspected MI, we validated a multibiomarker panel for predicting 1-year MACE. Clinical Trial Registration: NCT02355457 (ClinicalTrials.gov).

Meeting a nice asylum seeker: Intergroup contact changes stereotype content perceptions and associated emotional prejudices, and encourages solidarity-based collective action intentions.

Intergroup contact can improve majority members' perception of minorities. Integrating the intergroup contact hypothesis with the stereotype content model and BIAS-Map, we hypothesized that positive intergroup contact improves German majority members' evaluations of asylum seekers on the warmth and competence dimensions. Using cross-sectional survey data and structural equation modelling, we found support for this hypothesis (Study 1a, N = 182). Warmth and competence perceptions, in turn, predicted specific intergroup emotions (Study 1b, N = 255). A causal effect of intergroup contact on changes in stereotype content, emotions, and solidarity-based collective action intentions as an important facilitative behavioural intention debated in the intergroup contact literature is established with experimental data (Study 2, N = 74). Participants interacting with an asylum seeker rated asylum seekers higher on warmth and specific intergroup emotions and were more supportive of solidarity-based collective actions in favour of asylum seekers. Our study demonstrates that contact has differential effects on cognitive, affective, and behavioural components of prejudice towards asylum seekers that are systematically linked.

Right bundle branch block in patients with suspected myocardial infarction.

AIMS:: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction. METHODS AND RESULTS:: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71-2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17-2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28-4.05; P=0.005) for BFB. CONCLUSION:: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.

Brief Report: Subjective Social Mobility and Depressive Symptoms in Syrian Refugees to Germany.

Previous findings indicate that refugees are at increased risk for mental health problems. In addition to stressful pre-migration experiences, post-migration factors may contribute to poor mental health outcomes. Among immigrants to the United States, downward mobility in subjective social status (SSS) was associated with depression, corroborating the potentially detrimental mental health consequences of a decline in one's perceived social position. The present study examined whether downward mobility in SSS among male refugees from Syria to Germany is associated with depression. We found that refugees who experience stronger downward mobility in SSS exhibit more severe depressive symptoms and were more likely to fulfill provisional DSM-IV criteria for a diagnosis of Major Depression. Our findings highlight the importance to consider the 'social pain' of downward social mobility during the post-migration phase.

Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome.

BACKGROUND: The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men. METHODS AND RESULTS: We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex-specific differences in management of patients with ACS were ascertained and a 2-year follow-up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex-related differences in diagnostic performance in a "first contact" setting (medical history and symptoms) or after "complete triage" (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two-year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men. CONCLUSIONS: In a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two-year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).

Testosterone Levels and Type 2 Diabetes-No Correlation with Age, Differential Predictive Value in Men and Women.

Most studies reporting on the association of circulating testosterone levels with type 2 diabetes in men are of cross-sectional design. Reports on the relevance of altered testosterone levels in women are scarce. Here, we evaluate the role of low serum testosterone levels for incident diabetes in men and women in a population setting of 7706 subjects (3896 females). During a mean follow up time of 13.8 years, 7.8% developed type 2 diabetes. Significant correlations of testosterone with high density lipoprotein (HDL)-cholesterol (R = 0.21, p < 0.001), body-mass-index (R = -0.23, p < 0.001), and waist-to-hip-ratio (R = -0.21, p < 0.001) were found in men. No correlation was found with age in men; in women, the correlation was negligible (R = 0.04, p = 0.012). In men, low testosterone levels predicted high risk of type 2 diabetes, while in women this relationship was opposite. Men with low testosterone levels showed increased risk of future diabetes (hazard ratio (HR) 2.66, 95% confidence interval (CI) 1.91⁻3.72, p < 0.001 in basic model; HR 1.56 95%, CI 1.10⁻2.21, p = 0.003). In women, low testosterone levels indicated lower risk with (HR 0.53, 95% CI 0.37⁻0.77, p = 0.003), while the association lost significance in the fully adjusted model (HR 0.72, 95% CI 0.49⁻1.05, p = 0.09). Low levels of testosterone predicted future diabetes in men. A borderline opposite association was found in women.

Intrinsic Iron Release Is Associated with Lower Mortality in Patients with Stable Coronary Artery Disease-First Report on the Prospective Relevance of Intrinsic Iron Release.

Intrinsic iron release is discussed to have favorable effects in coronary artery disease (CAD). The aim of this study was to evaluate the prognostic relevance of intrinsic iron release in patients with CAD. Intrinsic iron release was based on a definition including hepcidin and soluble transferrin receptor (sTfR). In a cohort of 811 patients with angiographically documented CAD levels of hepcidin and sTfR were measured at baseline. Systemic body iron release was defined as low levels of hepcidin (<24 ng/mL) and high levels of sTfR (≥2 mg/L). A commercially available ELISA (DRG) was used for measurements of serum hepcidin. Serum sTfR was determined by using an automated immunoassay (). Cardiovascular mortality was the main outcome measure. The criteria of intrinsic iron release were fulfilled in 32.6% of all patients. Significantly lower cardiovascular mortality rates were observed in CAD patients with systemic iron release. After adjustment for body mass index, smoking status, hypertension, diabetes, dyslipidemia, sex, and age, the hazard ratio for future cardiovascular death was 0.41. After an additional adjustment for surrogates of the size of myocardial necrosis (troponin I), anemia (hemoglobin), and cardiac function and heart failure severity (N-terminal pro B-type natriuretic peptide), this association did not change (Hazard ratio 0.37 (95% confidence interval 0.14⁻0.99), p = 0.047). In conclusion, significantly lower cardiovascular mortality rates were observed in CAD patients with intrinsic iron release shown during follow-up.

Adverse Outcome Prediction of Iron Deficiency in Patients with Acute Coronary Syndrome.

Acute myocardial infarction remains a leading cause of morbidity and mortality. While iron deficient heart failure patients are at increased risk of future cardiovascular events and see improvement with intravenous supplementation, the clinical relevance of iron deficiency in acute coronary syndrome remains unclear. We aimed to evaluate the prognostic value of iron deficiency in the acute coronary syndrome (ACS). Levels of ferritin, iron, and transferrin were measured at baseline in 836 patients with ACS. A total of 29.1% was categorized as iron deficient. The prevalence of iron deficiency was clearly higher in women (42.8%), and in patients with anemia (42.5%). During a median follow-up of 4.0 years, 111 subjects (13.3%) experienced non-fatal myocardial infarction (MI) and cardiovascular mortality as combined endpoint. Iron deficiency strongly predicted non-fatal MI and cardiovascular mortality with a hazard ratio (HR) of 1.52 (95% confidence interval (CI) 1.03-2.26; p = 0.037) adjusted for age, sex, hypertension, smoking status, diabetes, hyperlipidemia, body-mass-index (BMI) This association remained significant (HR 1.73 (95% CI 1.07⁻2.81; p = 0.026)) after an additional adjustment for surrogates of cardiac function and heart failure severity (N-terminal pro B-type natriuretic peptide, NT-proBNP), for the size of myocardial necrosis (troponin), and for anemia (hemoglobin). Survival analyses for cardiovascular mortality and MI provided further evidence for the prognostic relevance of iron deficiency (HR 1.50 (95% CI 1.02⁻2.20)). Our data showed that iron deficiency is strongly associated with adverse outcome in acute coronary syndrome.

Chronic stress moderates the impact of social exclusion on pain tolerance: an experimental investigation.

BACKGROUND: Experiences of social pain due to social exclusion may be processed in similar neural systems that process experiences of physical pain. The present study aimed to extend the findings on social exclusion and pain by examining the impact of social exclusion on an affective (ie, heat pain tolerance) and a sensory component of pain (ie, heat pain intensity). Whether a potential effect may be moderated by chronic life stress, social status, or social sup-port was further examined. MATERIALS AND METHODS: A community-based sample of 59 women was studied. Social exclusion and inclusion were experimentally manipulated by using a virtual ball-tossing game called Cyberball in which participants were randomly assigned to either being excluded or being included by two other virtual players. Heat pain tolerance and intensity were assessed before and after the game. Potential psychosocial moderators were assessed via a questionnaire. RESULTS: The main finding of this study is that chronic stress moderates the impact of social exclusion on pain tolerance (p<0.05). When chronic stress was high, socially excluded participants showed a lower heat pain tolerance than participants who were socially included. Contrary to the authors' hypothesis, pain sensitivity was increased in socially included participants compared with socially excluded participants after the game (p<0.05). CONCLUSION: Higher levels of chronic stress may enhance the vulnerability of affective pain processing to acute social exclusion.

(Bad) Feelings about Meeting Them? Episodic and Chronic Intergroup Emotions Associated with Positive and Negative Intergroup Contact As Predictors of Intergroup Behavior.

Based on two cross-sectional probability samples (Study 1: N = 1,382, Study 2: N = 1,587), we studied the interplay between positive and negative intergroup contact, different types of intergroup emotions (i.e., episodic intergroup emotions encountered during contact and more general chronic intergroup emotions), and outgroup behavior in the context of intergroup relations between non-immigrant Germans and foreigners living in Germany. In Study 1, we showed that positive and negative contact are related to specific episodic intergroup emotions (i.e., anger, fear and happiness). Results of Study 2 indicate an indirect effect of episodic intergroup emotions encountered during contact experiences on specific behavioral tendencies directed at outgroup members via more chronic situation-independent intergroup emotions. As expected, anger predicted approaching (discriminatory) behavioral tendencies (i.e., aggression) while fear predicted avoidance. The results extend the existing literature on intergroup contact and emotions by addressing positive and negative contact simultaneously and differentiating between situation-specific episodic and chronic intergroup emotions in predicting discriminatory behavioral tendencies.

The effect of subjective social status on depressive thinking: An experimental examination.

Subjective social status (SSS) predicts health outcomes above and beyond objective measures of social status. Both objective and subjective measures of social status are strongly related with depression. Cognitive mechanisms such as depressive cognitions, rumination, and a negative cognitive style are seen as both concomitant and antecedent to depression. This experiment examined the causal role of SSS in developing depressive thinking. Participants were randomly assigned to a low and a high status group and followed a manipulation procedure targeting their SSS. Depressive thinking was subsequently assessed by depressive cognitions, stress-reactive state rumination and negative cognitive style. Low status participants exhibited higher levels of depressive cognitions and rumination compared to their high status counterparts, but both groups did not differ regarding their cognitive style. Findings support the causal nature of the relationship between SSS and depressive thinking. Several mechanisms of how low SSS may lead to depression are discussed.

Parameters of blood viscosity do not correlate with the extent of coronary and carotid atherosclerosis and with endothelial function in patients undergoing coronary angiography.

While the role of physical forces on the control of atherogenesis and the modulation of endothelial function is well known, studies investigating the impact of shear stress on the extent of central atherosclerosis and flow-mediated dilation in humans produced controversial results. We investigated the relationship between viscosity, coronary atherosclerosis, carotid intima-media thickness and flow-mediated dilation in patients undergoing coronary angiography. 451 patients (306 males, mean age 66 ± 10) were enrolled. Viscosity, which was calculated using a validated formula, showed a positive association with platelet activation (P = 0.01), leukocyte counts (P = 0.006) and C-reactive protein (P = 0.03), a marker of inflammation; surprisingly, visocsity showed a negative association with FMD (FMD decreased 0.14 ± 0.05% per each cPoise increase in viscosity) but only in patients without coronary artery disease. Viscosity showed no association with the extent of coronary or carotid artery disease. We provide cross-sectional data on the relationship between whole blood viscosity and parameters of vascular structure and function. While viscosity correlated with parameters of vascular inflammation, it showed no relationship with the presence and severity of central atherosclerosis.