Sung Il Choi

Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group.

Background/Aims: The detection of white coat hypertension (WCH), treated normalized hypertension, and masked hypertension (MH) is important to improve the effectiveness of hypertension management. However, whether global cardiovascular risk (GCR) profile has any effect on the discordance between ambulatory blood pressure (ABP) and clinic blood pressure (CBP) is unknown. Methods: Data from 1,916 subjects, taken from the Korean Multicenter Registry for ABP monitoring, were grouped according to diagnostic and therapeutic thresholds for CBP and ABP (140/90 and 135/85 mmHg, respectively). GCR was assessed using European Society of Hypertension 2007 guidelines. Results: The mean subject age was 54.1 ± 14.9 years, and 48.9% of patients were female. The discordancy rate between ABP and CBP in the untreated and treated patients was 32.5% and 26.5%, respectively (p = 0.02). The prevalence of WCH or treated normalized hypertension and MH was 14.4% and 16.0%, respectively. Discordance between ABP and CBP was lower in the very high added-risk group compared to the moderate added-risk group (odds ratio [OR], 0.649; 95% confidence interval [CI], 0.487 to 0.863; p = 0.003). The prevalence of WCH or treated normalized hypertension was also lower in the very high added-risk group (OR, 0.451; 95% CI, 0.311 to 0.655). Conclusions: Discordance between ABP and CBP was observed more frequently in untreated subjects than in treated subjects, and less frequently in the very high added-risk group, which was due mainly to the lower prevalence of WCH or treated normalized hypertension.

Unilateral pulmonary edema: a rare initial presentation of cardiogenic shock due to acute myocardial infarction.

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

Prevalence of Atrial Fibrillation and Relation to Echocardiographic Parameters in a Healthy Asymptomatic Rural Korean Population.

Atrial fibrillation (AF) is the most common arrhythmia worldwide and a potent independent risk factor for stroke. This study aimed to determine the prevalence of AF in a population-based sample of adults in a rural region of Korea. Between January 2005 and December 2009, 4,067 individuals (60.2 ± 11.2 yr old, M: F = 1,582:2,485) over 21 who were residents of the county of Yangpyeong, Korea, participated in the study. AF was assessed on a resting 12-lead electrocardiogram (ECG) in 4,053 of the participants. Blood tests and transthoracic echocardiography (TTE) were also performed to investigate the relationship between left ventricular mass and AF in the study group. Fifty-four cases (32 men) were diagnosed as AF among the 4,053 subjects. The crude prevalence of AF was 1.3%. It was highest (2.3%) among sixty- and seventy- year olds, and higher in men than women in all age groups over 50. The prevalence in men was 2.0%, and in women 0.9%. In univariate analysis, age, male gender, body mass index, total serum cholesterol, alanine transaminase, serum creatinine, adiponectin level, and ischemic heart disease were associated with AF. Among the TTE parameters, systolic and diastolic left ventricular systolic internal dimension (LVID), and LV ejection fraction were associated with AF. In this relatively healthy population in a rural area of Korea, the prevalence of AF is 1.3%, and increases with age. Of the TTE parameters, systolic and diastolic LVID and left atrial diameter are related to prevalence of AF. Graphical Abstract

A case of deep vein thrombosis after coronary angiography in a patient using antidepressants and anxiolytics.

Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG) affecting just under 5 in 10000 patients. Most of the cases regarding DVT after CAG reported in the literature were associated with procedure-related vascular complications or with risk factors for venous thromboembolism (VTE). Here, we describe the case of a 50-year-old woman during treatment for anxiety disorder, who developed significant DVT after CAG without a history of VTE and with no significant risk factors for VTE, which was treated with an anticoagulant. This case reminds us that clinicians should consider the possible occurrence of VTE after diagnostic CAG even in patients without significant risk factors.

The timing of intra-coronary infusion of G-CSF mobilized peripheral blood stem cells influences cardiac function and in-stent restenosis in patients with myocardial infarction

We hypothesized that delaying the timing of intra-coronary infusion of G-CSF mobilized stem cell until at least 4 weeks after coronary stenting should avoid the stimulation of vascular smooth muscle cells during the early active cellular proliferative phase, thus decreases in-stent restenosis while preserving the beneficial effect of stem cell therapy on cardiac function in patients with myocardial infarction (MI). 25 patients with ST-elevation myocardial infarction (STEMI) treated with stenting were enrolled in this pilot study. The ages of MI at the time of cell treatment were from 1 month to 59 months. At 6 months follow-up, the left ventricular ejection fraction (LVEF) increased from 32% to 37.7% and the stress thallium perfusion defect decreased from 31.4% to 28.1%. Cell treatment-related complications such as arrhythmias were not observed. 9 patients who underwent cell treatment less than 3 months after coronary stenting were evaluated for in-stent restenosis; it was found in only 1 patient. This pilot study shows that delayed more than 4 weeks after coronary stenting but less than 3 months after MI, intra-coronary infusion of G-CSF mobilized PBSCs may improve cardiac function without triggering in-stent restenosis.

Abdominal Wall Hematoma as a Rare Complication following Percutaneous Coronary Intervention

Abdominal wall hematoma is a rare but potentially serious vascular complication that may develop after coronary angiographic procedures. In particular, an oblique muscle hematoma caused by an injury of the circumflex iliac artery is very rare, yet can be managed by conservative treatment including hydration and transfusion. However, when active bleeding continues, angiographic embolization or surgery might be needed. In this study, we report an uncommon case of injury to the circumflex iliac artery by an inappropriate introduction of the hydrophilic guidewire during the performance of a percutaneous coronary intervention.

PS 14-30 PREVALENCE OF RESISTANT HYPERTENSION AND ASSOCIATED FACTORS FOR BLOOD PRESSURE CONTROL STATUS USING KOREAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY DATA

Objective: Resistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management. The misdiagnosis of RH by clinic blood pressure (BP) is important clinical problem. Aim of the study were to investigate the prevalence of RH by ambulatory blood pressure monitoring (ABPM) and the factor associated with control status of ambulatory BPs. Design and Method: For 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated which was defined as uncontrolled BP by three AHM classes including diuretic or BP in need of four or more AHM classes. The prevalence determined by clinic versus ambulatory BP was compared. Results: The age was 59.3 ± 12.5 years, and 44.3% were female (n = 1230). Among them 72 subjects were taking three AHM drugs including diuretics and 105 subjects were taking four or more AHM classes. With uncontrolled daytime ambulatory BP in 41 among 72 subjects, prevalence of RH was 11.9% (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for clinic versus nighttime BP (146/177 vs. 159/177, p = 0.0124). For control status of daytime BP, masked uncontrolled BP was 16.9% and controlled BP with white-coat effect was 14.1%. For nighttime BP control status, odd ratios for smoking (0.624), drinking (1.512), coronary artery disease (0.604), calcium antagonist (1.705), and loop diuretics (0.454) were all significant. Conclusions: The prevalence of RH was 11.9% by daytime BP and it was significantly higher when using nighttime BP criteria. Control status of daytime BP was misclassified in 31.0%. Smoking, drinking, coronary artery disease, calcium antagonist, and loop diuretics were associated with nighttime BP control status.

PS 18-22 Relationship of nocturnal BP and dipping according to 24-hour urinary sodium excretion and nocturnal heart rate

Objective: Blood pressure (BP) normally decreases during the night. Non-dipping is associated with increased cardiovascular risk. Altered autonomic and endocrine function is suspected to play a role. On the other hand, urinary sodium excretion is mainly controlled by pressure-natriuresis. However, relation between urinary sodium excretion and nocturnal dipping is complex and uncertain. Therefore, this study investigates the relation of 24hour urinary salt excretion and nocturnal dipping according to nighttime heart rate (HR). Design and Method: From 2011 to 2012, data from 315 patients hospitalizing tertiary referral center in Korea were analyzed. These patients underwent ambulatory blood pressure monitoring (ABPM) and 24-hour urine collection. Results: Mean nocturnal HR is 65.9 bpm. Mean 24-hour urine sodium excretion is 135.0 mEq/day. In the group with HR < the mean, nocturnal systolic and diastolic BP in patients excreting ≥ mean 24 hour urine sodium are 120.9/72.2 mmHg, significantly higher than 113.5/67.4 mmHg in patients excreting < mean 24 hour urine sodium. In the group with HR ≥ the mean, nocturnal dipping in patients excreting ≥ mean 24 hour urine sodium is 9.0%, significantly higher than 6.2% in patients excreting < mean 24 hour urine sodium. Conclusions: According to nocturnal HR and 24-hour urine sodium excretion, nocturnal dipping, systolic BP and diastolic BP show different feature. We wish to draw attention to differences in the relationship of nocturnal BP to nocturnal HR and sodium excretion and to how pressure–natriuresis, autonomic function, and sodium sensitivity of blood pressure interact.

Erratum to: Prevalence of resistant hypertension and associated factors for blood pressure control status using Korean ambulatory blood pressure monitoring registry data

[This corrects the article DOI: 10.1186/s40885-016-0045-x.].

926 WITHIN-VISIT BLOOD PRESSURE VARIABILITY AND RELEVANT FACTORS IN THE GENERAL POPULATION

Objectives: In this, study, we aimed to investigate within-visit BP variability and its relevant factors in a nationwide epidemiologic survey. Design & Methods: We analyzed the Korean National Health and Nutrition Examination Survey (KNHNES) data for 2005 (n = 5488). BP was measured three times in KNHNES. We examined three within-visit BP variability parameters: the alarm reaction (AR), within-visit BP discrepancy (&Dgr;BPmax) and standard deviation (BPSD). Results: First BP, age, estimated glomerular filtration rate (eGFR) and female gender were associated with AR. Moreover, age, fasting glucose, eGFR, total cholesterol, LDL cholesterol, and the metabolic syndrome (MetS) score were relevant factors for systolic AR, &Dgr;SBPmax and SBPSD. Multiple linear regression models revealed that age (&bgr; = 0.043, p < 0.0001), official systolic BP level (&bgr; = - 0.022, p < 0.0001), the MetS score (&bgr; = 0.290, p < 0.0001), female gender (&bgr; = 0.674, p = 0.007) and eGFR (&bgr; = 0.017, p = 0.049) were independently associated with systolic AR, while age (&bgr; = 0.031 and 0.017, p < 0.0001), official systolic BP level (&bgr; = 0.035 and 0.018, p < 0.0001), and female gender (&bgr; = 0.455 and 0.246, p = 0.024 and 0.022) were independently associated with &Dgr;SBPmax and SBPSD, respectively. Conclusions: Within-visit BP variability, especially in systolic BP is significantly associated with greater age, female gender and cardiovascular risk factors such as hypertension, low eGFR, and adverse glucose and lipid profiles. In addition, greater age, female gender, eGFR and MetS score were independently relevant factors for systolic AR.