Suk-Won Choi

Incidence, Risk Factors, and Clinical Characteristics of Peripartum Cardiomyopathy in South Korea

Background: Peripartum cardiomyopathy (PPCM) is a rare disorder associated with pregnancy that can lead to life-threatening conditions. The incidence and clinical characteristics of this condition remain poorly understood. Methods and Results: We aimed to perform the first population-based study of PPCM in South Korea, using the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who fulfilled predefined diagnostic criteria for PPCM from January 1, 2010, to December 31, 2012, were identified from International Classification of Diseases, Tenth Revision, Clinical Modification codes. To discriminate PPCM from other causes of heart failure, we excluded subjects who already had heart failure-related International Classification of Diseases, Tenth Revision, Clinical Modification codes at least 1 year before delivery. During the study period, there were 1 404 551 deliveries in South Korea, and we excluded 20 159 patients who already had heart failure. In those, a total of 795 cases were identified as PPCM. Patients with PPCM were older, had a higher prevalence of preeclampsia and gestational diabetes mellitus, and were more likely to be primiparous and have multiple pregnancies. Moreover, cesarean section and pregnancy-related complications and in-hospital death were also more common in patients with PPCM. Intriguingly, a considerable number of heart failure cases (n=64; 8.1% of total PPCM) were noted between 5 and 12 months after delivery. Conclusions: The incidence of PPCM was 1 in 1741 deliveries in South Korea. Patients with PPCM were older, were more associated with primiparity and multiple pregnancy, had more pregnancy-related complications, and revealed higher in-hospital mortality than controls. The number of cases diagnosed as PPCM were decreased over time after delivery; however, a large number of patients were still noted through 12 months after delivery.

Functional changes of the myocardium in survivors of high-voltage electrical injury

IntroductionThere are limited long-term follow-up data on functional changes in the myocardium after high-voltage electrical injury (HVEI).MethodsTwenty-three patients who had been exposed to HVEI (>20,000 volts) and preserved left ventricular ejection fraction (≥55%) were enrolled in the study. Echocardiographic parameters, including peak systolic strain (S) and strain rate (SR), were evaluated at baseline, six weeks and six months later. These data were compared with a healthy control group who were matched in terms of age, sex and body mass index.ResultsThe systolic and diastolic blood pressure and the heart rate were significantly higher in the HVEI group compared with the control group at baseline and at six weeks, but not at the six-month follow-up. Conventional echocardiographic data showed no differences between the groups during the study period. In contrast to the S, the baseline and six weeks, SR was significantly increased in the HVEI group compared with the control group. However, at the six-month follow-up, there was no difference in the SR between the groups. Among the 23 patients with HVEI, 17 of the patients had vertical current injury, and 6 patients had horizontal current injury. There was no difference in terms of the conventional echocardiography, S and SR between the patients with vertical injury and those with horizontal injury at baseline and at the six-month follow-up.ConclusionsThe long-term contractile performance of the myocardium is preserved when patient do not experience left ventricular dysfunction in the early stages after HVEI.

PS 06-04 CLINICAL CHARACTERISTICS OF HYPERTENSION WITH OBESITY IN KOREA: DATA FROM KOREAN HYPERTENSION REGISTRY (KorHR)

Objective: To investigate the characteristics, control rate, and factors affecting blood pressure (BP) control in treated hypertensive patients with obesity in Korea. Design and Method: The Korean hypertension registry (KorHR) is an on-going prospective nation-wide multicenter (15 teaching hospitals) cohort study since 2013. As of Jan 2016, the interim analysis of 1,318 consecutive subjects was performed to understand the baseline characteristics of the population. Obesity was defined as body mass index (BMI) ≥ 25 kg/m2). Results: Of all cohort patients, we selected 430 patients taking antihypertensive drug who have visited clinic more than once. Obesity hypertension (Ob-HT) group (232, 54%) was younger (54.9 ± 11.2 vs. 57.4 ± 11.2 year, p = 0.029) and fatter (28.1 ± 2.6 vs. 23.1 ± 1.5 kg/m2, p < 0.001), included more men (63.4% vs. 49.0%, p = 0.003) and dyslipidemia (60.3% vs. 47.5%, p = 0.009) and had the higher level of hemoglobin, hematocrit, glycated hemoglobin and uric acid than non-obese hypertension (nonOb-HT) group. Ob-HT was treated with more antihypertensive drugs (1.9 ± 0.7 vs. 1.7 ± 0.8, p = 0.007) usually in combination (69.4% vs. 53.0%, p = 0.001). There was no significant group difference regarding systolic and diastolic BP (130.9 ± 12.9 vs. 130.6 ± 14.9 mmHg; 79.7 ± 11.3 vs. 77.8 ± 10.4 mmHg) and BP control rates (73.6% vs. 70.4%). Among antihypertensive drugs, angiotensin receptor blocker was most frequently used (81.9%) in Ob-HT but calcium channel blocker (68.7%) in nonOb-HT. Although there was no significant difference in clinical characteristics between patients with controlled and uncontrolled BP in nonOb-HT group, uncontrolled BP patients in Ob-HT group were younger (50.5 ± 11.8 vs. 56.5 ± 10.6 year, p < 0.001) and heavier (79.4 ± 11.4 vs. 75.9 ± 11.2 kg, p = 0.032). Conclusions: Ob-HT group consisting of more than half of treated hypertension was younger and male gender was more prevalent in the group. Although the overall BP control rate was relatively high regardless of obesity, the younger and much heavier patients were associated with poor BP control in Ob-HT. Those patients need to be received more focus on the treatment.

PS 05-70 RELATIONS OF CENTRAL AND AMBULATORY BLOOD PRESSURE PARAMETERS TO MICROALBUMINURIA IN HYPERTENSIVE PATIENTS; DATA FROM THE KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION (KorHR)

Objective: To examine the relationship of central and ambulatory blood pressure (BP) parameters to microalbuminuria in hypertensive patients. Design and Method: This study analyzed 670 hypertensive patients from the Korean registry of target organ damages in hypertension, who performed a laboratory test of urinary albumin and creatinine (age 48 ± 12 years; 65% male). Patients underwent clinical and demographic evaluation, laboratory analyses, 24-hour ambulatory BP monitoring, and central BP measurement. Urinary microalbumin/creatinine ratio was obtained from an untimed spot urine specimen. Results: Microalbuminuria (urinary albumin/creatinine ratio 30 to 300 mg/g of creatinine) was detected in 19.7%. All BP parameters, including office BP, daytime and nighttime BP, and central BP, had significant correlations with log-transformed urinary albumin/creatinine ratio. Central diastolic BP showed the best correlation among BP parameters (Pearson r = 0.311, p < 0.001). In univariate analysis, patients with microalbuminuria had higher values of body mass index (BMI), waist, fasting blood glucose, triglyceride, and office/ambulatory/central BPs. In a logistic regression analysis, BMI (odds ratio [OR] 1.084, 95% confidence interval [CI] 1.005–1.168) and central diastolic BP (OR 1.055, 95% CI 1.03–1.08) were independently associated with the presence of microalbuminuria. Conclusions: Compared with office and ambulatory BP parameters, central diastolic BP showed the best correlation with log-transformed urinary microalbumin/creatinine ratio. Central diastolic BP and BMI, was significantly related to microalbuminuria. This finding suggests that measurement of central BPs could be meaningful in the risk stratification of hypertensive patients.

PS 17-48 IMPLICATION OF CENTRAL AND AMBULATORY BLOOD PRESSURE PARAMETERS TO ECHOCARDIOGRAPHIC OR ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS; DATA FROM THE KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION (KorHR)

Objective: To examine the relationship between central and ambulatory blood pressure (BP) parameters and echocardiographic or electrocardiographic left ventricular hypertrophy (LVH) in hypertensive patients. Design and method: This study analyzed 670 hypertensive patients from the Korean registry of target organ damages in hypertension (age 49 ± 12 years; 62.5% male). Left ventricular (LV) mass indexed to body surface area (BSA) was used to detect echocardiographic LVH – threshold values of 95 and 115 g/m2 for women and men. Electrocardiographic LVH was determined using the Sokolow-Lyon index and Cornell product. Results: Echocardiographic and electrocardiographic LVH was found in 19.7% and 20.5% of the patients, respectively. Daytime systolic BP and nighttime diastolic BP among ambulatory BP parameters and central BPs had significant correlations (Pearson r = 0.137, p = 0.032 for daytime systolic BP; r = 0.164, p = 0.01 for nighttime diastolic BP; r = 0.184, p = 0.003 for central systolic BP; r = 0.174, p = 0.005 for central diastolic BP). The patients with echocardiographic LVH were older; had higher values for pulsed wave velocity, central BPs and augmentation index. Older patients and higher ambulatory BPs and central BPs were associated with electrocardiographic LVH. In logistic regression analysis of echocardiographic LVH, the association of age (odds ratio [OR] 1.039, 95% confidence interval [CI] 1.011–1.067) and central systolic BP (OR 1.03, 95% CI 1.013–1.047) with echocardiographic LVH remained significant. In the multivariate analysis of electrocardiographic LVH, daytime systolic BP were independently significant (OR 1.03, 95% CI 1.012–1.048). Conclusions: Central systolic BP and old age were related to the presence of echocardiographic LVH. On the other hand, daytime systolic BP was associated with electrocardiographic LVH. This finding suggests that implication of each BP parameter is different in terms of investigating high risk hypertensive patients.

PS 05-71 CROSS-SECTIONAL RELATIONS OF PERIPHERAL BLOOD PRESSURE AND CENTRAL BLOOD PRESSURE ACCORD TO AGE; DATA FROM THE KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION(KorHR)

Objective: To determine the relationship between peripheral blood pressure (BP) parameters and central BP parameters accord to age. Design and Method: The Korean Registry of Target Organ Damages in Hypertension (KorHR) is a multi-centered prospective study which has enrolled 1318 essential hypertension patients without any cardiovascular diseases since March 2013. Among these patients, this study analyzed 417 patients whose central BP data were available. Central and peripheral BP parameters were evaluated in relation to age groups (young: 20–39 yrs, n = 113; middle: 40–59 yrs, n = 292; old: 60 or more yrs, n = 112). Results: Despite similar central systolic BP across the 3 categories (130.1 ± 18.7 vs. 130.5 ± 17 vs. 132.6 ± 17.5, p = 0.614), there were a significant decreasing trend of peripheral systolic BP with age (151.1 ± 21.4 vs. 145.8 ± 18.5 vs. 140.4 ± 21, p = 0.002). In multivariate regression analysis, peripheral systolic BP was an independent determinant of central systolic BP only in the old age category (age≥60 yrs; &bgr; = 0.387, p < 0.001). Peripheral diastolic BP was more powerful predictor of central systolic BP compared to peripheral systolic BP in the young (age 20–39 yrs; &bgr; = 0.356, p < 0.001) and the middle aged (40–59 yrs; &bgr; = 0.219, p < 0.001) patients. Brachial PWV was the only variable which predicted central systolic BP significantly across all the 3 age groups. Conclusions: Peripheral systolic BP could predict central systolic BP only in old aged hypertensive individuals whose PWV was faster than that of younger individuals. These data suggests that peripheral systolic BP might have a limited value for predicting central systolic BP in young and middle aged individuals due to less degree of arterial stiffness compared to old aged individual.

PS 05-46 QRS DURATION REFLECTS LEFT VENTRICULAR STRUCTURAL CHANGES IN HYPERTENSIVE PATIENTS WITHOUT CARDIOVASCULAR COMPLICATIONS; DATA FROM THE KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION(KorHR)

Objective: To determine the relationship between QRS duration and Left ventricular structural and functional changes in the hypertensive population. Design and Method: The Korean Registry of Target Organ Damages in Hypertension (KorHR) is a multi-centered prospective study which enrolled1318 essential hypertension patients without any cardiovascular diseases from March 2013. Among 1318 subjects enrolled in the registry, This study analyzed 378 patients whose Electrocardiogram (ECG) and echocardiographic data were available. QRS duration was evaluated as categorical variables (QRS 110 ms and QRS < 110 ms) and a continuous variable. Results: Patients with prolonged QRSduration (QRS 110 ms)were more likely to be male (82.1% vs. 59.4%, p = 0.025)and current smokers (42.9 vs. % vs. 18.3% p = 0.004). Duration of hypertension and cardiovascular risk factors (Dyslipidemia, diabetes mellitus, systolic and diastolic blood pressure and eGFR) were not significantly different between the two groups. Diastolic LV internal dimension (LVIDd)(median 48.5[IQR:46–52] vs. median 51[IQR:49.8–53.2], p = 0.015), diastolic Interventricular Septal thickness (IVSd)(median 31[IQR:28–34] vs. median 33[IQR:29–34.5], p = 0.001), diastolic LV posterior wall dimension (LVPWd)(median 9[IQR:8–10] vs. median 10[IQR:9–11.3], p = 0.008) and LV mass index (median 9[IQR:8–10] vs. median 10[IQR:9–11.3], p = 0.008) were significantly greater in the prolonged QRS group. QRS duration was positively correlated to LVIDd (r = 0.224, p < 0.001), IVSd (r = 0.224, p < 0.001), LVPWd (r = 0.261, p < 0.001) and LV mass index (r = 0.23 p < 0.001). Conclusions: QRS duration showed significant positive correlations with LV dimensions and LV mass index. This result suggests that QRS duration might be an early marker of structural change of LV in the hypertensive patients without cardiovascular complications.

[PP.27.13] USE OF 15-MINUTE AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT TO REDUCE WHITE COAT EFFECT: 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING STUDY

Objective: Repeated, automated OBPM has showed a possible alternative to 24 h ambulatory blood pressure (ABP) monitoring. We aimed to compare 15-minute blood pressure (BP) readings with the mean awake ABP. Figure. No caption available. Design and method: A total of 298 never-treated patients with high BP were enrolled. After consultation with a physician, BP was measured automatically every 3 minutes for 15 minutes, with the patient resting alone in a quiet room. Routine office BP, mean BP for 15 minutes after consultation, and BP measured at 15-minute was compared with mean awake ABP. Results: Systolic BP measured at 15 minute after consultation (144 ± 15 mmHg, p = 0.008) was approximately 2 mmHg higher than mean awake ABP. (142 ± 12 mmHg) Other BP parameters such as mean BP for 15 minutes (146 ± 15, p < 0.001) and routine office BP (152 ± 18, p < 0.001), were 4 to 10 mmHg higher than mean awake ABP. Pearson R value was highest in 15-minute SBP (r = 0.451). Especially, when systolic BP measured at 15-minute after consultation was less 160 mmHg, the difference with mean awake ABP was almost negligible. (139 vs. 140 mmHg, p = 0.207). Conclusions: In never-treated Korean hypertensives, automated office BP measured at 15-minute after consultation was well correlated with mean awake ABP. When systolic BP measured at 15 minute after consultation was less than 160 mmHg, white coat effect could virtually be prevented.

OS 01-03 NEUTROPHIL TO LYMPHOCYTE RATIO IS CLOSELY RELATED WITH BLOOD PRESSURE LEVEL IN HYPERTENSIVE INDIVIDUALS WITHOUT CARDIOVASCULAR DISEASES; DATA FROM THE KOREAN REGISTRY OF TARGET ORGAN DAMAGES IN HYPERTENSION (KorHR)

Objective: Neutrophil to lymphocyte ratio (NLR) is a marker of systemic inflammation and predictive of cardiovascular risk. We aimed to determine the relationship between NLR and blood pressure (BP) parameters. Design and Method: We reviewed data of 670 hypertensive subjects without cardiovascular diseases from the Korean registry of target organ damages in hypertension (KorHR) which were available from March 2013 to February 2016. Among these patients, 202 subjects (aged 45.3 ± 11.1, male n = 141, 69.8%) were available for central blood pressure, urine mircoalbuminuria and NLR data. Results: Peripheral diastolic BP(r = 0.170, p = 0.018) and central systolic BP(r = 0.154, p = 0.032) correlated positively with log-transformed NLR with adjustment for age, sex, presence of diabetes mellitus(DM) and dyslipidemia, duration of hypertension and estimated glomerular filtration rate (eGFR). Peripheral systolic BP, brachial pulse wave velocity, peripheral pulse pressure, central augmentation index were not significantly correlated with log-transformed NLR. Multiple regression analysis of log-transformed NLR showed that peripheral diastolic BP was the only significant predictor of log-transformed NLR.(&bgr;=0.183, p = 0.009) Conclusions: NLR was correlated positively with blood pressure levels. These data suggests higher blood pressure level is associated with increased systemic inflammation response.

APSH YI-04 EXPANSION OF IMMUNOSENESCENT T CELL FRACTION IN CHRONIC KIDNEY DISEASE PATIENTS: EXPLORING NEW PATHOGENIC MECHANISMS OF INCREASED ARTERIAL STIFFNESS.

Objective: Chronic kidney disease (CKD) is associated with increased arterial stiffness, which is a well-known predictor of future cardiovascular events. However, the underlying mechanism of arterial stiffening in CKD is not well known. Accelerated immune aging, characterized by expansion of immunosenescent T cell fraction might be involved in the pathogenesis of arterial stiffening in CKD. We aimed to evaluate the relationship between arterial stiffness and immunosenescent T cell (CD8+CD57+ or CD8+CD28- T cell) fraction in patients with CKD. Design and method: Four hundred and twenty-nine consecutive hypertensive patients with CKD (266 male, mean age 61 ± 10 years) who registered in Cardiovascular and Metabolic Disease Etiology Research Center - High Risk Cohort (CMERC-HI, NCT02003781) were enrolled. Arterial stiffness was evaluated by pulse wave velocity (PWV) and the frequency of CD57+ or CD28- senescent T cells in peripheral blood lymphocytes were examined by multicolor flow cytometry. Results: Immunosenescent T cell fraction showed significantly increased tendency according to CKD stages (CD8+CD57+ T cell fraction, p < 0.001: 40.8 ± 16.4% in stage 1, 47.5 ± 17.0% in stage 2, 48.3 ± 16.0% in stage 3, 51.9 ± 19.3% in stage 4, 52.0 ± 18.0% in stage 5, CD8+CD28- T cell fraction, p < 0.001: 46.8 ± 17.9% in stage 1, 50.4 ± 19.7% in stage 2, 50.7 ± 17.7% in stage 3, 60.2 ± 19.3% in stage 4, 60.0 ± 16.5% in stage 5). Multivariate analysis revealed that CD8+CD57+ T cell fraction is independently associated with PWV even after adjustment with age, gender, body mass index, renal function and systolic blood pressure (&bgr; = 0.102, p = 0.038). Conclusions: In CKD patients, CD8+CD57+ T cell fraction are expanded and independently associated with increased arterial stiffness. These findings may explain the role of immunosenescence in the pathogenesis of accelerated arterial stiffening in patients with CKD.