Tae Joon Cha

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.

Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients

This study aimed to investigate the effects of gender on the association between epicardial fat thickness (EFT) and circadian blood pressure (BP) changes in patients with recently diagnosed essential hypertension (EH). A total of 441 patients with EH (male/female: 236/205, mean age: 50.7 ± 13.8) and 83 control patients underwent 24-hour ambulatory BP monitoring and echocardiography. Obese EH patients had higher circadian BP profile with BP variability, wall thickness, and left ventricular mass than nonobese EH patients and controls (all ps <0.05) without gender differences. EFT was higher in female than in male patients (7.0 ± 2.5 versus 5.9 ± 2.2u2009mm, p < 0.001) and higher in the obese female EH group (7.5 ± 2.6u2009mm) than in the control (6.4 ± 2.8u2009mm) or nonobese EH group (6.7 ± 2.8u2009mm) among women, whereas EFT did not vary among males (5.9 ± 1.9 versus 6.0 ± 2.7 versus 5.9 ± 2.4u2009mm, p = 0.937). Multivariate logistic regression analysis demonstrated that the 24-hour mean BP variability was associated with SBP (p = 0.018) and EFT (p = 0.016) in female patients, but not in male patients. The relationships among circadian BP variability, obesity, and EFT were affected by gender in different manners. EFT may be a more valuable parameter in the evaluation of BP severity and obesity in women than in men.

Impact of Pheochromocytoma on Left Ventricular Hypertrophy and QTc Prolongation: Comparison with Takotsubo Cardiomyopathy

Background and Objectives Excessive catecholamine causes the alteration of cardiac structure and function. This study evaluated if there is any difference in left ventricular hypertrophy (LVH) and QTc prolongation in conditions with pheochromocytoma and Takotsubo cardiomyopathy (TC). Subjects and Methods We reviewed the medical records of 20 pheochromocytoma patients for cardiovascular events prior to diagnosis. The patients clinical history and electrocardiographic and echocardiographic findings were compared to those of 20 patients diagnosed with TC. Results Left ventricular (LV) mass index (133.3±37.8 vs. 113.3±17.3, p=0.031), relative wall thickness (0.55±0.15 vs. 0.47±0.07, p=032) and elevated blood pressure (BP) were more prominent in pheochromocytoma compared to TC. The mean creatinine kinase-MB elevation, reduced LV systolic function and ST segment changes were more prominent in the TC group compared to the pheochromocytoma groups (all p<0.05). The prevalence of QTc prolongation was high in patients with pheochromocytoma (45%) and TC (55%), and TC male patients appeared to have a more prolonged QTc interval. Urine epinephrine (r=0.844, p=0.004) and norepinephrine level (r=0.782, p=0.013) were significantly correlated with LV mass index, and the predictors for the QTc prolongation were male gender and the presence of LVH. Conclusion A prolonged QTc was prominent in pheochromocytoma and TC regardless of BP and systolic LV function, and LVH was more prominent in pheochromocytoma than TC.

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 (pu2009=u20090.009) and global circumferential strain (pu2009=u20090.002).ConclusionsThese findings indicate that local shear stress is associated with carotid vascular deformation, which could be an underlying mechanism for the progression of atherosclerosis.

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 (27.6u200a±u200a20.1 vs. 31.7u200a±u200a22.9, pu200a=u200a0.015) and maximal systolic BP during exercise was significantly increased in patients with CSX (176.6u200a±u200a23.7 vs. 171.4u200a±u200a19.9, pu200a<u200a0.001). The proportion of blunted HRR (32.7% vs. 26.0%, pu200a=u200a0.034) and EBBR (21.3% vs. 11.6%, pu200a<u200a0.001) 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 (pu200a<u200a0.001) 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 (ru200a=u200a−0.292, pu200a=u200a0.044). 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; 7.3u200a±u200a3.0 vs. dipper; 6.1u200a±u200a2.0 vs. normotensive; 5.5u200a±u200a1.9 mm, pu200a<u200a0.001). NLR was the highest in the non-dipper group than those of dipper group and normotensive group (non-dipper, 2.75u200a±u200a2.81; dipper, 2.01u200a±u200a1.32; control, 1.92u200a±u200a1.11; pu200a<u200a0.001). EFT was significantly correlated with age (ru200a=u200a0.160, pu200a<u200a0.001), body mass index (ru200a=u200a0.091, pu200a=u200a0.042), 24 hours mean BP variability (ru200a=u200a0.152, pu200a=u200a0.001), and NLR (ru200a=u200a0.353, pu200a<u200a0.001). Furthermore, An EFT > 6.9 mm was associated with the non-dipper BP pattern with 49.8% sensitivity and 71.5% specificity (pu200a=u200a0.005). In a multivariate analysis, EFT (adjusted odds ratio, ORu200a=u200a2.97, 95% CIu200a=u200a1.17–7.50, pu200a=u200a0.022) and NLR (ORu200a=u200a1.20, 95% CIu200a=u200a1.04–1.37, pu200a=u200a0.012) 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 pu200a<u200a0.001), whereas global LA strain was significantly lowest in non-dippers (normotensives; 23.2u200a±u200a2.0% vs. dippersu200a=u200a19.0u200a±u200a3.3% vs. non-dippersu200a=u200a17.4u200a±u200a3.0%, Pu200a<u200a0.001). Moreover, LA strain was significantly associated with LV filling pressure (ru200a=u200a−0.422, pu200a<u200a0.001), EFT (ru200a=u200a−0.187, pu200a<u200a0.001), and 24 hour mean BP variability (ru200a=u200a−0.184, pu200a<u200a0.001). 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.

Relations between microvascular function and aortic stiffness in metabolic syndrome.

Address for Correspondence/Yaz›şma Adresi: Dr. Tae Joon Cha, Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kosin University, 34 Amnam-Dong Seo-Ku, Busan 602-702-South Korea E-mail: chatjn@hanafos.com Accepted Date/Kabul Tarihi: 11.01.2013 Available Online Date/Çevrimiçi Yayın Tarihi: 06.02.2013 ©Telif Hakk› 2013 AVES Yay›nc›l›k Ltd. Şti. Makale metnine www.anakarder.com web sayfas›ndan ulaş›labilir. ©Copyright 2013 by AVES Yay›nc›l›k Ltd. Available online at www.anakarder.com doi:10.5152/akd.2013.069 Editorial Comment Editöryel Yorum 235

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.