Hsiu-Hao Lee

Adrenalectomy reverses myocardial fibrosis in patients with primary aldosteronism.

Objective: Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with more prominent left ventricular hypertrophy and increased myocardial fibrosis. However, the reversibility of cardiac fibrosis is still unclear. Our objective was to investigate myocardial fibrosis in primary aldosteronism patients and its change after surgery. Method: We prospectively analyzed 20 patients with aldosterone-producing adenoma (APA) who received adrenalectomy from December 2006 to October 2008 and 20 patients with essential hypertension were enrolled as the control group. Plasma carboxy-terminal propeptide of procollagen type I (PICP) determination and echocardiography including ultrasonic tissue characterization by cyclic variation of integrated backscatter (CVIBS) were performed in both groups and 1 year after operation in the APA group. Results: APA patients had significantly higher SBP and DBP, higher plasma aldosterone concentration (PAC), higher aldosterone–renin ratio (ARR), lower serum potassium levels, and lower plasma renin activity (PRA) than patients with essential hypertension. In echocardiography, APA patients had a higher left ventricular mass index than essential hypertension patients. APA patients had significantly lower CVIBS (6.2 ± 1.5 vs. 8.7 ± 2.0 dB, P < 0.001) and higher plasma PICP levels (107 ± 27 vs. 85 ± 24 &mgr;g/l, P = 0.009) than essential hypertension patients. In the correlation study, CVIBS is correlated with log-transformed PRA and log-transformed ARR and PICP is correlated with log-transformed PRA, log-transformed PAC, and log-transformed ARR. One year after adrenalectomy, CVIBS increased significantly (6.2 ± 1.5 to 7.3 ± 1.7 dB, P = 0.033) and plasma PICP levels decreased (107 ± 27 vs. 84 ± 28 &mgr;g/l, P = 0.026). Conclusion: Increases in collagen content in the myocardium of APA patients may be reversed by adrenalectomy.

Reversal of myocardial fibrosis in patients with unilateral hyperaldosteronism receiving adrenalectomy

BACKGROUND Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with more prominent left ventricular hypertrophy and increased myocardial fibrosis. Unilateral hyperaldosteronism can be cured by adrenalectomy. However, the reversibility of cardiac fibrosis is still unclear. METHODS We analyzed 11 patients prospectively with unilateral hyperaldosteronism (including 10 aldosterone-producing adenomas and 1 unilateral nodular hyperplasia) who received adrenalectomy from October 2006 to October 2007, and 17 patients with essential hypertension (EH) were enrolled as the control group. Echocardiography included ultrasonic tissue characterization by cyclic variation of integrated backscatter; it was performed in both groups and 1 year after operation in the unilateral hyperaldosteronism group. RESULTS Patients with unilateral hyperaldosteronism had significantly higher diastolic blood pressure, higher plasma aldosterone concentration, lower serum potassium level, and lower plasma renin activity than patients with EH. In echocardiography, patients with unilateral hyperaldosteronism had thicker interventricular septal thickness, left ventricular posterior wall thickness, and higher left ventricular mass index than EH patients. Patients with unilateral hyperaldosteronism had significant lower cyclic variation of integrated backscatter than EH patients (7.1 ± 2.1 vs 8.7 ± 1.5 dB, P = .037). After analyzing the correlation of cyclic variation of integrated backscatter with clinical parameters for all participants, only log-transformed plasma renin activity was correlated significantly with cyclic variation of integrated backscatter. One year after adrenalectomy, interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular mass index decreased significantly. In addition, cyclic variation of integrated backscatter increased significantly after adrenalectomy (7.1 ± 2.1 to 8.5 ± 1.5 dB, P = .02). CONCLUSION Adrenalectomy not only reversed left ventricular geometry but also altered myocardial texture in patients with unilateral hyperaldosteronism. This finding implies that increases in collagen content in the myocardium of patients with unilateral hyperaldosteronism might be reversed by adrenalectomy.

Angiotensin-converting enzyme inhibitors enhance the effect of cyclooxygenase inhibitors on breast cancer: a nationwide case-control study

Objectives: Angiotensin-converting enzyme (ACE) inhibitors are first-line antihypertensive and potential cancer preventive agents. Interest in breast cancer prevention is growing, and more clinical evidence is needed regarding the effects of preventive therapy, alone or in combination. Methods: This was a nationwide case–control analysis from the Taiwan National health Insurance Research Database. We analyzed 16 847 female breast cancer patients (diagnosed between 1 January 2002 and 31 December 2008) and 50 541 matched individuals. Longitudinal exposure to ACE inhibitors and cyclooxygenase inhibitors was compared. Results: The risk of developing breast cancer among patients taking both aspirin and an ACE inhibitor decreased as the ACE inhibitor dose increased. Among patients receiving between 28 and 364 cumulative defined daily doses (cDDDs) of aspirin, the adjusted odds ratios (ORs) were 0.97 (0.90–1.06), 0.91 (0.82–1.03), and 0.79 (0.68–0.92) for women taking ACE inhibitors for 0–27, 28–364, and more than 365 cDDD, respectively. Among women receiving more than 365 cDDD of aspirin, the adjusted ORs were 0.91 (0.80–1.03), 0.81 (0.70–0.94), and 0.81 (0.71–0.92) as the ACE inhibitor dose increased, respectively. Women taking nonaspirin NSAIDs along with an ACE inhibitor had the same finding. Among women taking 28–364 cDDD of NSAIDs, the adjusted ORs were 0.85 (0.81–0.89), 0.87 (0.81–0.94), and 0.80 (0.73–0.88); for women receiving more than 365 cDDD of NSAIDs, the adjusted ORs were 0.68 (0.62–0.74), 0.61 (0.53–0.70), and 0.60 (0.52–0.70) as the ACE inhibitor dose increased, respectively. Conclusion: The findings of this nationwide analysis support the hypothesis that ACE inhibitors enhance the antitumor effect of cyclooxygenase inhibitors on breast cancer.

Association between urine aldosterone and diastolic function in patients with primary aldosteronism and essential hypertension

OBJECTIVE To investigate the association between aldosterone and cardiac diastolic dysfunction. DESIGN AND METHODS We prospectively enrolled 20 patients with primary aldosteronism (PA) and 22 patients with essential hypertension (EH). Plasma aldosterone concentration, plasma renin activity, and 24-h urine aldosterone level were measured. Echocardiography, including tissue Doppler image recordings, was performed. RESULTS PA patients had a significantly higher left ventricular (LV) mass index and worse LV diastolic function than those in EH patients. Among various measures of aldosterone, log-transformed 24-h urine aldosterone level had the most consistent correlation with diastolic function. CONCLUSIONS Aldosterone is strongly associated with LV diastolic dysfunction. Twenty-four hour urine aldosterone is a good indicator to evaluate the impact of aldosterone on LV diastolic function.

Association of white blood cell count and peripheral arterial disease in patients with and without traditional risk factors.

Peripheral arterial disease (PAD) is an inflammatory process. The association between white blood cell (WBC) count and PAD in those with and without traditional risk factors is not clear. We examined data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. A total of 5260 participants were included. The result showed that the prevalence of PAD rose from 2.8% ± 0.5% in the lowest quartile of plasma WBC count to 8.0% ± 1.2% in the highest quartile. In subgroup analysis, the graded association between WBC count and PAD was significant in patients without hypertension, diabetes, smoking, chronic kidney disease (CKD), and in patients with or without hypercholesterolemia but not significant in patients with hypertension, smoking, diabetes, or CKD. In those without hypertension, diabetes, smoking, or CKD, the cutoff value for WBC count was 6.75 × 109/L. We concluded that the positive association between WBC count and PAD can be demonstrated in this national survey.

0248 Predicting physician’s duty stress by parasympathetic nervous function (also to be considered for mini-symposium: Early detection and management of workers under stress)

Objectives Early stress markers are useful in detecting workers with occupational stress. The aim of this study was to determine whether heart rate variability was associated with physicians’ duty loading, and also a good predictor for stress markers. Method An observational study on physicians with variable duty loading was conducted in a secondary referral medical centre in northern Taiwan in 2012. For every participant, 24-hr electrocardiography (EKG) and hourly blood pressure were obtained during three test days, i.e., regular-duty (only day shift), moderate-duty (day and night-shift with moderate number of patients cared), and high-duty days (day and night-shift with higher number of patients cared). Blood samples for stress markers were obtained at 8 am on the test day, and 8 am on the second morning. Results A total of 12 staff physicians satisfactorily completed the study. The number of patients covered at night shift was 0, 92 ± 8, and 187 ± 9, for regular-, moderate-, and high-duty nights, respectively. Total phone calls, urgent procedures, new patients admitted, critical patients cared and times of awakenings were significantly higher as the duty loads increased. The parasympathetic indicator derived from continuous EKG, high frequency normalised unit (HFnu), was negatively related to loading of total patient cared (P < 0.0001). Reduced HFnu predicted elevated night systolic blood pressure (P = 0.016) and serum uric acid (P = 0.024), and 24 h urine vanillylmandelic acid (P = 0.0045), dopamine (P = 0.011), and norepinephrine (P = 0.027). Conclusions HFnu derived from heart rate variability measurement may predict several important stress markers during nightshift duties.

Effects of night duty events on blood pressure and autonomic modulation in physicians

BACKGROUND The dynamic effects of duty events on the blood pressure (BP) and heart rate variability (HRV) of physicians on duty are unknown. METHODS A study was conducted among 12 physicians on night duty. BP and HRV with and without the effect of a duty event were compared. The risk of higher BP and impaired HRV after a phone call were calculated. RESULTS Physicians had higher mean BP (122.4 ± 11.1; 76.9 ± 7.1 mmHg) within 30 min after a phone calls than without a phone call (113.5 ± 5.3; 69.0 ± 3.8) and higher sympathetic tone (low frequency normalized units (LFnu) 68.5 ± 8.9; high frequency normalized units (HFnu) 27.7 ± 8.7) within 10 min of a phone call than without a phone call (62.9 ± 8.51; 33.5 ± 8.4). Elevated BP and sympathetic tone recovered to baseline levels 30 min after a phone call. CONCLUSIONS Among physicians on night duty, sympathetic tone and BP might be elevated by clinical events, and these effects last for 30 min.

WITHDRAWN: Association between the levels of carboxy-terminal propeptide of type I procollagen and aldosterone in patients with primary aldosteronism and essential hypertension

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A-005 MYOCARDIAL ULTRASOUND TISSUE CHARACTERIZATION IN PATIENTSWITH PRIMARY ALDOSTERONISM

Background Primary aldosteronism (PA), an underdiagnosed cause of hypertension, causes cardiac remodeling and myocardial fibrosis. Ultrasonic tissue characterization by cyclic variation ofintegrated backscatter(CVIBS) is a useful tool to evaluate the extent of myocardial fibrosis. The aim of this study is to assess the myocardial fibrosis caused by primary aldosteronism and to evaluate the relationship among CVIBS and baseline clinical parameters of PA patients. Methods We prospectively analyzed 62 patients with PA (including 46 patients with aldosterone-producing adenoma and 16 with bilateral hyperplasia) from October 2006 to October 2010, and 17 patients with essential hypertension (EH) were enrolled asthe control group. Echocardiography, included ultrasonic tissue characterization by CVIBS, was performed in both groups. Results In patients with PA, diastolic blood pressure and plasma aldosterone concentration were significantly higherthan patients with EH. Meanwhile, serum potassium level and plasma renin activity were significantly lower than patients with EH. In echocardiography, patients with PA had thickerinterventricularseptal thickness, left ventricular posterior wall thickness, and higher left ventricularmass index than EH patients. Patients with PA had significant lower CVIBS than EH patients (7.1 ± 2.2vs 8.7 ± 1.5 dB, P = .005). In correlation study, among various clinical parameters, only log-transformed plasma renin activity was correlated significantly with CVIBS. Conclusion Ultrasonic tissue characterization with CVIBS is a useful tool to detect the extent of myocardial fibrosis. PA patients have more severe degree of myocardial fibrosis detected by CVIBS. The severity of fibrosis detecting by CVIBS is correlated with log-transformed plasma renin activity.