Jung Ho Heo

The Combined Impact of Neutrophil-to-Lymphocyte Ratio and Type 2 Diabetic Mellitus on Significant Coronary Artery Disease and Carotid Artery Atherosclerosis

Background Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a new important inflammatory marker for predicting cardiovascular events. This study aimed to evaluate the combined impact of NLR and type 2 diabetes mellitus (T2DM) on significant coronary artery disease (CAD) and carotid artery atherosclerosis. Methods This study includes a total of 828 patients evaluated by coronary angiography and carotid ultrasonography. Significant CAD was defined as at least one vessel with stenosis greater than 50%. We employed logistic regression models to investigate the association of NLR and T2DM with significant CAD. The goodness-of-fit and discriminability of the models were assessed by the loglikelihood ratio test and C-index, respectively. Also, we investigated the clinical relevance of the categorized NLR that classifies patients into three risk groups (low, intermediate, high). Results According to logistic regression analysis, both NLR {adjusted odds ratio (OR) 1.31, p < 0.001} and T2DM (adjusted OR 2.46, p = 0.006) were independent risk factors of significant CAD. The addition of NLR and T2DM into a logistic regression model including conventional cardiovascular risk factors significantly improved the goodness-of-fit (p < 0.001) and the discriminability of the model (p = 0.004). Also, T2DM patients assigned into the high risk group (NLR > 2) showed the greater prevalence of significant CAD and carotid artery atherosclerosis compared with patients without T2DM or type 2 diabetic patients assigned into the low risk group (NLR ≤ 1). Conclusion Our results suggest that type 2 diabetic patients with high inflammatory state would be more vulnerable to significant CAD and carotid artery atherosclerosis.

Low Carotid Artery Wall Shear Stress is Associated with Significant Coronary Artery Disease in Patients with Chest Pain

AIM To investigate the relationships among carotid wall shear stress (WSS), carotid intima-media thickness (IMT), and total plaque area (TPA) using ultrasound (US) in the common carotid artery (CCA) in patients with suspected coronary artery disease (CAD). METHODS Carotid artery US was performed in 950 patients with suspected CAD, and mean IMT, TPA, and hemodynamic parameters of CCA, including peak and mean WSS, were measured. We analyzed the carotid parameters according to the presence of CAD and the predictive values of WSS and TPA for the presence of significant CAD. RESULTS Compared with patients without CAD (n=667), patients with CAD (n=283) demonstrated significantly higher mean IMT (0.66 vs. 0.74 mm, p ＜ 0.001), TPA (0.13 vs. 0.20 cm(2), p=0.002), and beta stiffness index (5.12 vs. 5.60, p=0.045) and lower mean WSS (2.59 vs. 2.23 dyne/cm(2), p ＜ 0.001). Mean WSS revealed significant negative correlations with the beta stiffness index (r=-0.116, p ＜ 0.001), mean IMT (r=-0.193, p=0.007), and TPA (r =-0.296, p ＜ 0.001). Mean WSS, mean IMT and TPA revealed significant difference with respect to CAD severity (for all p ＜ 0.001). Age [OR, 1.038 (95% CI, 1.010-1.066), p=0.007], diabetes mellitus [1.606 (1.194-1.807), p= 0.011], smoking [1.758 (1.564-1.866), p ＜ 0.001], carotid TPA [2.615 (1.320-5.183), p=0.006], and mean WSS [0.554 (0.371-0.838), p=0.005] were significant CAD predictors. CONCLUSIONS In patients with chest pain, low local shear stress and high plaque burden in the carotid arteries were significant CAD predictors. These findings indicate that carotid WSS has a role as an index of atherosclerosis and serves as a predictor of significant coronary atherosclerosis.

Hypoadiponectinemia in Patients With Paroxysmal Atrial Fibrillation

Background and Objectives Adiponectin is an adipose tissue-derived hormone that has beneficial effects on cardiac function and has been reported to be associated with lipid metabolism, glucose metabolism, and insulin resistance. Serum levels of adiponectin are reduced in obese individuals compared with non-obese individuals. Obesity is associated with an increased incidence of atrial fibrillation (AF); however, the role of adiponectin in AF is unclear. The aim of this study is to evaluate the relationship between the plasma adiponectin level and AF. Subjects and Methods Sixty-one consecutive patients were prospectively enrolled for this study. Subjects were divided into two groups: patients with AF (n=30) and controls (n=31). Laboratory evaluation, including levels of plasma adiponectin, was performed and echocardiographic parameters were measured. Results The baseline characteristics were not different between the two groups. The plasma adiponectin level of patients in the AF group was significantly lower than in the control group (14.9±7.2 vs. 19.±8.9 µg/mL, p<0.05). In addition, when we divided the AF patients into paroxysmal and chronic AF, the plasma adiponectin level was significantly lower in patients with paroxysmal AF, compared with the control group. In multiple binary logistic regression analysis to evaluate the independent predictors for AF, adiponectin and left atrial diameter were strong independent predictors of AF. Conclusion In this study a lower plasma adiponectin concentration was significantly associated with that of paroxysmal AF. Hypoadiponectinemia can potentially be an important risk factor for AF.

Wall shear stress in hypertensive patients is associated with carotid vascular deformation assessed by speckle tracking strain imaging

IntroductionWall shear stress (WSS) is critically important in both vascular remodeling and atherosclerosis. Carotid intima-media thickness (IMT) and deformation parameters have been used as relevant indicators of carotid atherosclerosis. This study aimed to investigate the relationships between hemodynamic parameters in the common carotid artery (CCA) and the severity of carotid atherosclerosis in untreated hypertensive patients.MethodsCarotid artery ultrasound was performed in 100 untreated hypertensive patients. Morphologic and hemodynamic parameters of the CCA, including peak and mean WSS, global circumferential strain, peak posterior radial strain assessed by two-dimensional speckle tracking method, and IMT, were measured.ResultsIn patients with hypertension, there were significant correlations between carotid strain parameters and peak/mean WSS. Stepwise multiple regression analysis for carotid strain parameters after adjustment for age, carotid IMT, and brachial pulse wave velocity showed that peak WSS was an independent determinant of peak posterior radial strain (p = 0.009) and global circumferential strain (p = 0.002).ConclusionsThese findings indicate that local shear stress is associated with carotid vascular deformation, which could be an underlying mechanism for the progression of atherosclerosis.

EFFECTS OF WHITE COAT HYPERTENSION ON HEART RATE RECOVERY AND BLOOD PRESSURE RESPONSE DURING EXERCISE TESTING

OBJECTIVE Increased sympathetic activity is one of the proposed mechanisms underlying exaggerated blood pressure (BP) response to exercise (EBPR). Heart rate recovery (HRR) is a simple non-invasive measurement analyzing autonomic nervous dysfunction, and has been shown to predict cardiovascular disease mortality. We aimed to the association between HRR and EBPR in patients with hypertension according to the circadian pattern and white coat hypertension. DESIGN AND METHOD A total of 409 consecutive patients who simultaneously underwent Treadmill test and 24-hours ambulatory BP monitoring (ABPM) were included to this cross-sectional case-control study. Patients were classified according to the ABPM; 147 patients with hypertension with dipper pattern (dipper), 140 patients with hypertension with non-dipper pattern (non-dipper) and 71 normotensive controls. EBPR was defined as a peak exercise systolic BP ≥ 210 mmHg in men and ≥ 190 mmHg in women. HRR was defined as peak heart rate minus heart rate after a 1-minute recovery; abnormal HRR was defined as ≤ 12 beats/min. These parameters were compared with respect to occurrence of EBPR. RESULTS HRR values were significantly lower (p < 0.001) in subjects with white coat hypertension and both hypertensive groups when compared with normotensive subjects, especially in non-dipper. In patients with white coat hypertension, there was a significant negative correlation between the decrease in systolic BP during the recovery and degree of HRR (r = -0.292, p = 0.044). The percentages of blunted HRR and EBPR were significantly highest in patients with white coat hypertension (35.3% and 33.3%, respectively). In multivariate logistic regression analyses, HRR and resting systolic BP were the only determinants associated with the occurrence of EBPR. CONCLUSIONS Blunted HRR indicating impaired parasympathetic reactivation and higher prevalence of EBPR indicating increased sympathetic activation suggest that these autonomic dysfunctions could be the important future cardiovascular risk factors in subjects with white coat hypertension.

PS 11-66 HEART RATE RECOVERY AFTER EXERCISE AND BLOOD PRESSURE RESPONSE DURING EXERCISE TESTING IN PATIENTS WITH CARDIAC SYNDROME X.

Objective: The syndrome of angina pectoris with a normal coronary arteriogram, often termed cardiac syndrome X (CSX), is an important clinical entity, however, its causes are still unclear. Autonomic dysfunction is one of the possible causes, so we aimed to investigate the parasympathetic dysfunction assessed by heart rate recovery (HRR) and increased sympathetic activity assessed by exaggerated blood pressure (BP) response to exercise (EBPR) in CSX. Design and Method: A total of 1393 consecutive patients without significant coronary artery disease (CAD) with anginal chest pain underwent both ergonovine provocation test and a treadmill exercise test between Jan. 2008 and Feb. 2015. Among them, the patients without significant coronary artery spasm (<70%) and positive exercise stress test with uniform ST depression ≥1 mm were enrolled as CSX. EBPR was defined as a peak exercise systolic BP ≥210 mmHg in men and ≥190 mmHg in women. HRR was defined as peak heart rate minus heart rate after a 1-minute recovery; blunted HRR was defined as ⩽12 beats/min. These parameters were compared between patients with CSX and the controls. Results: A total of 15.1% (211/1393) patients were diagnosed as CXS documented by negative ergonovine provocation test and positive exercise test (68.7% female) and 787 patients with negative ergonovine test and normal exercise test were compared as controls. HRR was significantly reduced in patients with CSX compared to the controls (27.6 ± 20.1 vs. 31.7 ± 22.9, p = 0.015) and maximal systolic BP during exercise was significantly increased in patients with CSX (176.6 ± 23.7 vs. 171.4 ± 19.9, p < 0.001). The proportion of blunted HRR (32.7% vs. 26.0%, p = 0.034) and EBBR (21.3% vs. 11.6%, p < 0.001) were significantly higher in patients with CSX than those without CSX. Conclusions: Blunted HRR and EBBR were associated with CSX, which suggests a link between CSX and autonomic dysregulation.

OS 37-04 EFFECTS OF WHITE COAT HYPERTENSION ON HEART RATE RECOVERY AND BLOOD PRESSURE RESPONSE DURING EXERCISE TESTING.

Objective: Increased sympathetic activity is one of the proposed mechanisms underlying exaggerated blood pressure (BP) response to exercise (EBPR). Heart rate recovery (HRR) is a simple non-invasive measurement analyzing autonomic nervous dysfunction, and has been shown to predict cardiovascular disease mortality. We aimed to the association between HRR and EBPR in patients with hypertension according to the circadian pattern and white coat hypertension. Design and Method: A total of 409 consecutive patients who simultaneously underwent Treadmill test and 24-hours ambulatory BP monitoring (ABPM) were included to this cross-sectional case-control study. Patients were classified according to the ABPM; 147 patients with hypertension with dipper pattern (dipper), 140 patients with hypertension with non-dipper pattern (non-dipper) and 71 normotensive controls. EBPR was defined as a peak exercise systolic BP ≥ 210 mmHg in men and ≥ 190 mmHg in women. HRR was defined as peak heart rate minus heart rate after a 1-minute recovery; abnormal HRR was defined as ⩽ 12 beats/min. These parameters were compared with respect to occurrence of EBPR. Results: HRR values were significantly lower (p < 0.001) in subjects with white coat hypertension and both hypertensive groups when compared with normotensive subjects, especially in non-dipper. In patients with white coat hypertension, there was a significant negative correlation between the decrease in systolic BP during the recovery and degree of HRR (r = −0.292, p = 0.044). The percentages of blunted HRR and EBPR were significantly highest in patients with white coat hypertension (35.3% and 33.3%, respectively). In multivariate logistic regression analyses, HRR and resting systolic BP were the only determinants associated with the occurrence of EBPR. Conclusions: Blunted HRR indicating impaired parasympathetic reactivation and higher prevalence of EBPR indicating increased sympathetic activation suggest that these autonomic dysfunctions could be the important future cardiovascular risk factors in subjects with white coat hypertension.

OS 14-09 EPICARDIAL FAT THICKNESS AND NEUTROPHIL TO LYMPHOCYTE RATIO ARE INCREASED IN THE NON-DIPPER PATTERN.

Objective: Epicardial fat tissue reflects visceral adiposity and inflammation, and neutrophil to lymphocyte ratio (NLR) has been investigated as important inflammatory marker in cardiovascular disease. We aimed to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and NLR with diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. Design and Method: A total of 647 hypertensive patients underwent echocardiography and 24-hours ambulatory BP monitoring. EFT was measured with echocardiography, while NLR was measured by dividing neutrophil count by lymphocyte count. The patients were categorized into three groups according to their BP pattern: 112 patients (17.3%) were in the normotensive group, 269 patients (41.6%) were in the dipper hypertensive group and 266 patients (41.1%) were in the non-dipper hypertensive group. Results: The mean EFT of the non-dipper group was significantly higher in both hypertensive groups as compared to the control group and was the highest in the non-dipper group (non-dipper; 7.3 ± 3.0 vs. dipper; 6.1 ± 2.0 vs. normotensive; 5.5 ± 1.9 mm, p < 0.001). NLR was the highest in the non-dipper group than those of dipper group and normotensive group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001), body mass index (r = 0.091, p = 0.042), 24 hours mean BP variability (r = 0.152, p = 0.001), and NLR (r = 0.353, p < 0.001). Furthermore, An EFT > 6.9 mm was associated with the non-dipper BP pattern with 49.8% sensitivity and 71.5% specificity (p = 0.005). In a multivariate analysis, EFT (adjusted odds ratio, OR = 2.97, 95% CI = 1.17–7.50, p = 0.022) and NLR (OR = 1.20, 95% CI = 1.04–1.37, p = 0.012) were independent predictors of a non-dipper pattern after adjustment of cardiovascular risk factors. Conclusions: EFT and NLR are independently associated with impaired diurnal blood pressure profiles in the hypertensive individuals. EFT measured by echocardiography and NLR appears to be helpful in cardiometabolic risk stratification.

Ps 05-30 Circadian Blood Pressure Pattern, Epicardial Fat Thickness and Left Atrial Function:

Objective: Epicardial adipose tissue reflects visceral adiposity and inflammation which can contribute to the fibrotic remodeling of the atrial myocardium. We aimed to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and left atrial (LA) deformation parameter with diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. Design and method: This cross-sectional study included 511 recently diagnosed hypertensive patients, who underwent echocardiography and 24-hours ambulatory BP monitoring. EFT was measured with echocardiography, and global LA strain was obtained by two-dimensional speckle imaging with automated software. The patients were classified as non-dippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Results: The mean EFT, LA volume index as well as left ventricular (LV) filling pressure (E/Ea) were significantly higher in hypertensive patients, especially in non-dippers (all p < 0.001), whereas global LA strain was significantly lowest in non-dippers (normotensives; 23.2 ± 2.0% vs. dippers = 19.0 ± 3.3% vs. non-dippers = 17.4 ± 3.0%, P < 0.001). Moreover, LA strain was significantly associated with LV filling pressure (r = −0.422, p < 0.001), EFT (r = −0.187, p < 0.001), and 24 hour mean BP variability (r = −0.184, p < 0.001). Conclusions: Non-dipper hypertensive patients were associated with increased EFT and impaired LA deformation. This indicates that these subjects may be more prone to atrial rhythm disturbances.

Correlation of right atrial appendage velocity with left atrial appendage velocity and brain natriuretic Peptide.

Background Left atrial appendage (LAA) anatomy and function have been well characterized both in healthy and diseased people, whereas relatively little attention has been focused on the right atrial appendage (RAA). We sought to evaluate RAA flow velocity and to compare these parameters with LAA indices and with a study of biomarkers, such as brain natriuretic peptide, among patients with sinus rhythm (SR) and atrial fibrillation (AF). Methods In a series of 79 consecutive patients referred for transesophageal echocardiography, 43 patients (23 with AF and 20 controls) were evaluated. Results AF was associated with a decrease in flow velocity for both LAA and RAA [LAA velocity-SR vs. AF: 61 ± 22 vs. 29 ± 18 m/sec (p < 0.01), RAA velocity-SR vs. AF: 46 ± 20 vs. 19 ± 8 m/sec (p < 0.01)]. Based on simple linear regression analysis, LAA velocity and RAA velocity were positively correlated, and RAA velocity was inversely correlated with brain natriuretic peptide (BNP). Conclusion AF was associated with decreased RAA and LAA flow velocities. RAA velocity was found to be positively correlated with LAA velocity and negatively correlated with BNP. The plasma BNP concentration may serve as a determinant of LAA and RAA functions.