Sung Il Im

Impact of periodontitis as representative of chronic inflammation on long-term clinical outcomes in patients with atrial fibrillation

Objectives Relationship between atrial fibrillation (AF) and inflammation was shown in previous studies. However, there was limited data about the association between the periodontitis and AF in the long-term follow-up. The aim of this study was to evaluate the impact of periodontitis on long-term clinical outcomes in patients with AF. Methods The Kosin University echocardiography, ECG and periodontitis database were reviewed from 2013 to 2015 to identify patients with AF. Those patients were divided into two groups according to the presence of periodontitis and clinical events including any arrhythmic attack, thromboembolic and bleeding and death were collected during a median of 18 months. Results Among 227 patients with AF, 47 (20.7%) patients had periodontitis. Major adverse cardiac events (MACE) were significantly higher in patients with periodontitis compared with those without periodontitis (p<0.001). Arrhythmias including AF, atrial tachycardia, atrial premature beat, ventricular tachycardia and ventricular premature beat also occurred in 44 (93.6%) patients, which was higher significantly higher incidence in patients with periodontitis than in those without periodontitis (p<0.001). In univariate analysis, age, CHA2DS2-VASc, left atrial volume index (LAVi) and periodontitis were significantly associated with arrhythmic events and MACE including bleeding events, thromboembolic events, arrhythmic events and mortality. In multivariate analysis, LAVi (p=0.005) and periodontitis (p<0.001) were independent risk factors for arrhythmic events and periodontitis (p<0.001) for MACE at the long-term follow-up. Conclusions The periodontitis as representative of chronic inflammation was an independent predictor of arrhythmic events and MACE in patients with AF.

Association of frequent premature ventricular complex >10% and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack

Introduction Premature ventricular complex (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. However, there was limited data about the association between high PVCs burdens (>10%) and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up. Methods The Kosin University 24-hours holter monitoring, echocardiography, electrocardiogram (ECG) database were reviewed from 2013 to 2015 to identify patients with frequent PVCs (>10%). We compared the long-term clinical outcomes between the patients with frequent PVCs (>10%) and control group without PVC. Results Among 572 patients who underwent 24-hours holter monitoring, finally, 373 consecutive patients (mean age; 59.5 ± 15.8 years, 45.2% male) were enrolled. Among them, 203(54.4%) patients had high PVCs burdens (>10%). There was no difference of the baseline characteristics. In the long term follow-up, PVCs burden was not associated with PVCs -related symptoms (P = 0.210). In univariate analysis, female, non-sustained ventricular tachycardia (VT), sinus QRS duration, PVC coupling interval (CI), post- PVC CI, and late precordial R-wave transition of PVCs were associated with PVCs-related symptoms. In multivariate analysis, non-sustained VT (P = 0.022) and late precordial R-wave transition of PVCs (P = 0.044) were independent risk factors for PVCs-related stroke-like symptoms with frequent idiopathic PVCs > 10%. Conclusion High PVCs burdens (>10%) were associated with and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up, suggesting more intensive medical therapy with close clinical follow-up will be required.

Clinical and electrocardiographic characteristics for prediction of new-onset atrial fibrillation in asymptomatic patients with atrial premature complexes

Backgrounds Identification of precursors of atrial fibrillation (AF) may lead to early detection and prevent associated morbidity and mortality. Atrial premature complexes (APCs) are commonly seen in healthy subjects. However, there was limited data about the clinical and electrocardiographic (ECG) characteristics for prediction of new-onset AF in asymptomatic patients with APCs in the long-term follow up. Methods The Kosin University (No. 2014-02-04) 24-h holter monitoring, echocardiography, ECG database were reviewed from 2008 to 2016 to identify new- onset AF in patients with APCs. We analyzed demographic and clinical features and the nature of the APCs by ECG according to new-onset AF in those patients. Results Among 652 patients who underwent 24-h holter monitoring, 226 (34.4%) patients had new-onset AF. There was no difference of the baseline characteristics between new-onset AF group and non-AF group. In univariate analysis, hypertension (HTN), renal failure (CRF), high APC burdens, fastest APC running heart rate (HR), minimal HR, left ventricular ejection fraction (LVEF), left atrial volume index, peak mitral flow velocity of the early rapid filling wave and tricuspid regurgitation grade were significantly associated with new-onset AF. In multivariate analysis, higher APCs burden (P = 0.047), higher fastest APCs running HR (P = 0.034) and lower minimal HR (P = 0.025) were independent risk factors for new-onset AF in asymptomatic patients with APCs. Conclusion Higher APCs burden, higher fastest APCs running HR and lower minimal HR were associated with new-onset AF in asymptomatic patients with APCs in the long-term follow up.

CLINICAL AND ELECTROCARDIOGRAPHIC CHARACTERISTICS FOR PREDICTION OF NEW-ONSET LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH FREQUENT IDIOPATHIC VENTRICULAR PREMATURE COMPLEX >10%

Background: There was limited data about the clinical and ECG characteristics for prediction of new-onset LV dysfunction in patients with frequent idiopathic VPCs >10% in the long-term follow up. Methods: The Kosin University 24-hours holter monitoring, echocardiography, ECG database were reviewed

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.

RELATION OF BLOOD PRESSURE VARIABILITY AND OBESITY IN PATIENTS WITH HYPERTENSION DIAGNOSED WITH AMBULATORY BLOOD PRESSURE MONITORING

Obesity is characterized by hemodynamic and metabolic alterations including blood pressure and heart rate. However the relation of autonomic control on blood pressure is not fully evaluated. The aim of the study was to assess the association with obesity and variability of circadian blood pressure