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P-198 Association Between Carotid Intima-Media Thickness and the Metabolic Syndrome in a Population of Middle-Aged Koreans
Poster Sessions 6: Atherosclerosis Results: Carotid IMTs were associated independently with waist circumference and systolic blood pressure, while lower limb IMTs with waist circumference, LDL cholesterol, hemoglobin A1C, fasting glucose, and 2-hour post-challenge glucose levels. These associations were stronger in total arteries. Independent associations of ALT levels and smoking habit with IMT appeared only in total arteries. Conclusion: Lower limb but not carotid IMTs are associated independently with hemoglobin A1C, fasting glucose, and 2-hour post-challenge glucose levels in middle-aged healthy subjects. P-195 Predictive Value of Calcifications of the Aortic and Mitral Valve for Coronary Artery Disease Rowena Ona, Maureen V. Valentin, Dondi Lim, Alvin Lim, Crismelita Banez, Wilson Tan De Guzman. Cardiology, University of Santo Tomas Hospital, Philippines Background: The presence of mitral annular calcification (MAC), mitral valve sclerosis (MVS), aortic annular calcification (AAC) and aortic valve sclerosis (AVS) represent a degenerative process and are associated with similar risk factors as atherosclerosis. Objective: This study would like determine the predictive value of MAC, MVS, AAC and AVS detected by transthoracic echocardiography (TTE) for coronary artery disease (CAD). Methods: Clinical and angiographic features and TTE findings were analyzed in a blinded fashion for 124 patients. The positive predictive value, negative predictive value, sensitivity and specificity of MAC, MVS, AAC and AVS for coronary artery disease were evaluated. Results: The patients with MAC, MVS, AAC and AVS and CAD had similar clinical and biochemical profile. Left ventricular ejection fraction was significantly lower in patients with MVS and AVS. The sensitivity, specificity, positive predictive value and negative predictive value of MAC and MVS in diagnosing CAD were 13.4%, 100%, 100% and 12.3%, respectively. For AAC, the sensitivity, specificity, positive predictive value and negative predictive value in diagnosing CAD were 28.3%, 83.3%, 93.3% and 12.3%. Lastly, the sensitivity, specificity, positive predictive value and negative predictive value of AVS for diagnosing CAD were 22%, 90.9%, 95.2% and 12.3%. Conclusion: Presence of calcifications in the aortic and mitral valves has a high specificity and positive predictive value for CAD. The presence of any of these findings should alert the physician to the possibility of CAD. P-196 Assessment of Aortic Stiffness Using a Two-Dimensional Aortic Strain Imaging: in Relation to Changes in Aging Yoshifumi Oishi, Yukio Mizuguchi, Hirokazu Miyoshi, Arata Iuchi, Norio Nagase, Takashi Oki. Department of Cardiolgy, Higashi Tokushima National Hospital, National Hospital Organization, Japan Objective: The aim of this study was to determine the best predictor of aortic stiffness using 2-dimensional strain imaging in 80 consecutive patients (15 88 years), including 48 patients with cadiovascular risk factors, with preserved left ventricular (LV) pump function. Methods: We recorded short-axis echocardiogram of the abdominal aorta (Ao), and determined the peak circumferential strain (Ao-S) and strain rate (Ao-SR) with a 2-dimensional strain software (EchoPac). The LV systolic (S), early diastolic (E), and atrial systolic (A) SRs in the longitudinal (L), circumferentia (C), and radial (R) directions were measured in the apical 4-chamber and parasternal short-axis views.
S107 Results: There were no significant correlations between the Ao-S and -SR and the LV mass index and LV ejection fraction. The peak Ao-S correlated with E-SR in the L and R directions, A-SR in the L, C, and R directions, pulse pressure, E/A of transmitral flow, and age. The peak Ao-SR correlated with E-SR in the L, C, and R directions, A-SR in the L, C, and R directions, pulse pressure, cardiovascular risk factor scores, E/A of transmitral flow, and age. Multivariate regression analyses revealed that age was a only independent factor for predicting the Ao-S and Ao-SR. Conclusions: Aortic stiffness was strongly associated with age, independent of blood pressure, cardiovascular risk factors, or LV diastolic function. P-197 Determinants of Long-Term Mortality in Patients with Type B Acute Aortic Dissection Kenichi Sakakura1 , Norifumi Kubo1 , Junya Ako2 , Naoki Fujiwara1 , Hiroshi Funayama1 , Nahoko Ikeda1 , Tomohiro Nakamura1 , Yoshitaka Sugawara1 , Takanori Yasu1 , Masanobu Kawakami1 , Shin-ichi Momomura1 . 1 Department of Cardiology, Jichi Medical University, Saitama Medical Center, Japan, 2 Division of Cardiovascular Medicine, Stanford University School of Medicine, USA Background: Type B acute aortic dissection (AAD) carries a high short- and mid-term mortality rate; however, knowledge related to long-term outcome is largely incomplete. The objective of this study was to identify long-term predictors including antihypertensive medications in type B AAD. Methods: We conducted a clinical follow-up study on 202 type B AAD patients. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. Results: There were 44 post discharge deaths in 202 consecutive type B AAD patients with a median followup of 55 months. In multivariate Cox regression analysis, Calcium channel brockers (CCBs) were a significant predictor of increased survival (HR 0.38, 95% CI 0.16 0.94, P = 0.04). Impaired renal function was a significant predictor of death (HR 3.49, 95% CI 1.63 7.45, P = 0.001). Four or more classes of antihypertensive medications at discharge was marginally associated with increased survival (vs. none or 1 class; HR 0.21, 95% CI 0.04 1.20, P = 0.08). Conclusions: Impaired renal function was a predictor for adverse outcome in patients with type B AAD. CCBs and 4 or more classes of antihypertensive medication at discharge were associated with increased survival. P-198 Association Between Carotid Intima-Media Thickness and the Metabolic Syndrome in a Population of Middle-Aged Koreans Mina Suh, Myoung Ha Lee, Ju Young Lee, Song Vogue Ahn, Hyeon Chang Kim, Il Suh. Department of Preventive Medicine, Yonsei University College of Medicine, Korea, Republic of (South Korea) Carotid intima-media thickness (IMT) has been known as a prognostic factor for cardiovascular diseases. Metabolic syndrome is a sum of cardiovascular risk factors. Therefore, we examine association between carotid IMT and the metabolic syndrome (MS) in a population of middle-aged Koreans. The sample comprised 2867 patients from a communitybased survey in Kanghwa county, Korea between 2006 and 2007. In all subjects hsCRP, body-mass index (BMI), waist circumference, serum lipid concentrations, fasting glucose concentrations, smoking status and blood pressure were measured.
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Abstracts of the 17th Asian Pacific Congress of Cardiology
The mean of carotid IMT was 0.948±0.28 mm in men and 0.881±0.22 mm in women (p < 0.001). The prevalence of the MS was 31.6% in men and 45.2% in women. Mean carotid IMT increased with an increasing number of risk factors (p for trend <0.001) and carotid IMT values were 0.815 mm, 0.848 mm, 0.869 mm, 0.889 mm and 0.940 mm for 0, 1, 2, 3, 4, and 5 risk factors, respectively. After adjustment, those with more components of MS had higher odds ratios for highest quartile carotid IMT compared with those without components. Carotid IMT was increased with the increasing number of components of MS. There is a strong relationship between carotid IMT and the MS. Current findings indicate the need for prevention and control of metabolic syndrome in a population of middle-aged Koreans. P-199 Gender Disparity in the Risk Factors for Coronary Vasospasm Without Hemodynamically Significant Coronary Artery Disease 1
2
3
Ming-Yow Hung , Kuang-Hung Hsu , Ming-Jui Hung . 1 Graduate Institute of Clinical Medical Sciences, Department of Cardiology, Chang Gung University, Shuang-Ho Hospital, Taiwan, 2 Department of Health Care Management, Chang Gung University, Taiwan, 3 Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital at Keelung, Taiwan Background: To determine gender differences in the risk factors for coronary vasospasm (CV) and the effect of hypertension associated with inflammation on the prediction of CV in patients without hemodynamically significant coronary artery disease (CAD). Methods: A total of 722 patients (39% women) who underwent diagnostic coronary angiography with or without proven CV and without CAD (>50% stenosis) during an 8-year period were included. The levels of high-sensitivity C-reactive protein (hs-CRP) were analyzed in a subset of 375 patients. Results: In women, only the highest hs-CRP tertile (>3 mg/L) was independently associated with CV (odds ratio [OR]: 3.21; 95% confidence interval [CI]: 1.28 8.07), while hypertension was negatively associated with CV (OR: 0.42; 95% CI: 0.19 0.94). In men, age (>58 years) and the highest hsCRP tertile were independently associated with CV, with the highest tertile being the most significant factor (OR: 2.88; 95% CI: 1.35 6.18). In the presence of hypertension, the OR (95% CI) for CV in the highest hs-CRP tertile declined from 6.01 (1.45 24.88) to 1.48 (0.48 4.51) in men and from 6.35 (1.96 20.56) to 2.69 (1.00 7.21) in women. Conclusions: We found gender disparity in the risk factors for developing CV and a negative association between hypertension and CV development in both genders. This study also demonstrated a negative interaction between hypertension and hs-CRP in patients with CV. P-200 Prevalence of Polyvascular Disease in Patients with Coronary Artery Disease in Japanese Population Masanori Taniwaki, Shuzou Tanimoto, Kengo Tanabe, Shunsuke Sasaki, Shuji Ohtsuki, Sen Yachi, Masataka Nakano, Satoru Kishi, Teruhiko Imamura, Kazuhiro Mutoh, Yoshifumi Nakajima, Satoru Shimizu, Hiroyoshi Nakajima, Kazuhiro Hara. Department of Cardiology, Mitsui Memorial Hospital, Japan Background and Purpose: Prevalence of polyvascular disease, including carotid artery stenosis (CAS), renal artery stenosis (RAS) and arteriosclerosis obliterans (ASO), in
patients with coronary artery disease (CAD) has not been elucidated in Japanese population. Methods: The study populations consisted of 193 consecutive patients who underwent coronary angiography because of suspicion of CAD. All patients underwent carotid and renal artery ultrasonography, and ankle brachial index (ABI) before coronary angiography. Results: Coronary anigiography revealed 126 patients (65.3%) had CAD. The prevalence rate of polyvascular disease in patients with CAD was 31.2%. Conclusion: Although the number of patients with PAD has been considered to be low in Japanese population, the prevalence rate of polyvascular disease with patients with CAD is high in the present study. P-201 Relation Between Functional Exercise Capacity and Functional Stenosis with Patients of Stable Angina with Moderate Coronary Stenosis Tomoko Hirose1 , Shinichiro Tanaka1 , Toshiyuki Noda1 , Tomonori Segawa1 , Reiko Matsuoka1 , Shintaro Abe1 , Yoshiaki Goto1 , Takashi Katou1 , Shunichiro Warita1 , Tai Kojima1 , Takeshi Hirose1 , Makoto Iwama1 , Koji Ono1 , Haruki Takahashi1 , Taro Minagawa2 , Sachiro Watanabe1 . 1 Department of Cardiology, Gifu Prefectural General Medical Center, Japan, 2 Gifu Cardiovascular Institution, Japan Purpose: Stable angina patients with significant coronary stenosis are known to have low exercise capacity. But some patients can have higher exercise capacity. Coronary pressure-derived fractional flow reserve (FFR) is functional index of coronary stenosis. We hypothesized that there are some relevance between functional exercise capacity and functional stenosis, and assessed those with pressure wire and cardiopulmonary exercise test (CPX). Method: The subjects were fifteen male (65.8±8.9years old) of stable angina with lesion estimated 75%-stenosis visually by coronary angiography. Eligible patients received CPX, and were measured peak oxygen uptake (PeakVO2: ml/kg/min) and oxygen uptake at anaerobic threshold (AT: ml/kg/min). We assessed the relation between FFR and values of CPX. Result: Lesions were localized eight in left anterior descending artery, five in left circumflex, and two in right coronary artery. %diameter stenosis (%DS) was 65.8±8.9% by quantitative coronary angiography. FFR was 0.84±0.66. PeakVO2 was 17.1±3.2, and AT was 11.1±2.0. Significant correlation was not observed between %DS and FFR (r = 0.12). There are no entirely correlation between %DS and PeakVO2 (r = 0.05), and between %DS and AT (r = 0.01). The correlation coefficient between FFR and PeakVO2 was r = 0.53 (p < 0.05), between FFR and AT was r = 0.54 (p < 0.05): which have positive correlations. Conclusion: In this study, PeakVO2 and AT have some correlation to FFR. Functional exercise capacity with patients of stable angina could be affected by functionally stenosis rather than angiographic stenosis.
S107 Results: There were no significant correlations between the Ao-S and -SR and the LV mass index and LV ejection fraction. The peak Ao-S correlated with E-SR in the L and R directions, A-SR in the L, C, and R directions, pulse pressure, E/A of transmitral flow, and age. The peak Ao-SR correlated with E-SR in the L, C, and R directions, A-SR in the L, C, and R directions, pulse pressure, cardiovascular risk factor scores, E/A of transmitral flow, and age. Multivariate regression analyses revealed that age was a only independent factor for predicting the Ao-S and Ao-SR. Conclusions: Aortic stiffness was strongly associated with age, independent of blood pressure, cardiovascular risk factors, or LV diastolic function. P-197 Determinants of Long-Term Mortality in Patients with Type B Acute Aortic Dissection Kenichi Sakakura1 , Norifumi Kubo1 , Junya Ako2 , Naoki Fujiwara1 , Hiroshi Funayama1 , Nahoko Ikeda1 , Tomohiro Nakamura1 , Yoshitaka Sugawara1 , Takanori Yasu1 , Masanobu Kawakami1 , Shin-ichi Momomura1 . 1 Department of Cardiology, Jichi Medical University, Saitama Medical Center, Japan, 2 Division of Cardiovascular Medicine, Stanford University School of Medicine, USA Background: Type B acute aortic dissection (AAD) carries a high short- and mid-term mortality rate; however, knowledge related to long-term outcome is largely incomplete. The objective of this study was to identify long-term predictors including antihypertensive medications in type B AAD. Methods: We conducted a clinical follow-up study on 202 type B AAD patients. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. Results: There were 44 post discharge deaths in 202 consecutive type B AAD patients with a median followup of 55 months. In multivariate Cox regression analysis, Calcium channel brockers (CCBs) were a significant predictor of increased survival (HR 0.38, 95% CI 0.16 0.94, P = 0.04). Impaired renal function was a significant predictor of death (HR 3.49, 95% CI 1.63 7.45, P = 0.001). Four or more classes of antihypertensive medications at discharge was marginally associated with increased survival (vs. none or 1 class; HR 0.21, 95% CI 0.04 1.20, P = 0.08). Conclusions: Impaired renal function was a predictor for adverse outcome in patients with type B AAD. CCBs and 4 or more classes of antihypertensive medication at discharge were associated with increased survival. P-198 Association Between Carotid Intima-Media Thickness and the Metabolic Syndrome in a Population of Middle-Aged Koreans Mina Suh, Myoung Ha Lee, Ju Young Lee, Song Vogue Ahn, Hyeon Chang Kim, Il Suh. Department of Preventive Medicine, Yonsei University College of Medicine, Korea, Republic of (South Korea) Carotid intima-media thickness (IMT) has been known as a prognostic factor for cardiovascular diseases. Metabolic syndrome is a sum of cardiovascular risk factors. Therefore, we examine association between carotid IMT and the metabolic syndrome (MS) in a population of middle-aged Koreans. The sample comprised 2867 patients from a communitybased survey in Kanghwa county, Korea between 2006 and 2007. In all subjects hsCRP, body-mass index (BMI), waist circumference, serum lipid concentrations, fasting glucose concentrations, smoking status and blood pressure were measured.
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Abstracts of the 17th Asian Pacific Congress of Cardiology
The mean of carotid IMT was 0.948±0.28 mm in men and 0.881±0.22 mm in women (p < 0.001). The prevalence of the MS was 31.6% in men and 45.2% in women. Mean carotid IMT increased with an increasing number of risk factors (p for trend <0.001) and carotid IMT values were 0.815 mm, 0.848 mm, 0.869 mm, 0.889 mm and 0.940 mm for 0, 1, 2, 3, 4, and 5 risk factors, respectively. After adjustment, those with more components of MS had higher odds ratios for highest quartile carotid IMT compared with those without components. Carotid IMT was increased with the increasing number of components of MS. There is a strong relationship between carotid IMT and the MS. Current findings indicate the need for prevention and control of metabolic syndrome in a population of middle-aged Koreans. P-199 Gender Disparity in the Risk Factors for Coronary Vasospasm Without Hemodynamically Significant Coronary Artery Disease 1
2
3
Ming-Yow Hung , Kuang-Hung Hsu , Ming-Jui Hung . 1 Graduate Institute of Clinical Medical Sciences, Department of Cardiology, Chang Gung University, Shuang-Ho Hospital, Taiwan, 2 Department of Health Care Management, Chang Gung University, Taiwan, 3 Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital at Keelung, Taiwan Background: To determine gender differences in the risk factors for coronary vasospasm (CV) and the effect of hypertension associated with inflammation on the prediction of CV in patients without hemodynamically significant coronary artery disease (CAD). Methods: A total of 722 patients (39% women) who underwent diagnostic coronary angiography with or without proven CV and without CAD (>50% stenosis) during an 8-year period were included. The levels of high-sensitivity C-reactive protein (hs-CRP) were analyzed in a subset of 375 patients. Results: In women, only the highest hs-CRP tertile (>3 mg/L) was independently associated with CV (odds ratio [OR]: 3.21; 95% confidence interval [CI]: 1.28 8.07), while hypertension was negatively associated with CV (OR: 0.42; 95% CI: 0.19 0.94). In men, age (>58 years) and the highest hsCRP tertile were independently associated with CV, with the highest tertile being the most significant factor (OR: 2.88; 95% CI: 1.35 6.18). In the presence of hypertension, the OR (95% CI) for CV in the highest hs-CRP tertile declined from 6.01 (1.45 24.88) to 1.48 (0.48 4.51) in men and from 6.35 (1.96 20.56) to 2.69 (1.00 7.21) in women. Conclusions: We found gender disparity in the risk factors for developing CV and a negative association between hypertension and CV development in both genders. This study also demonstrated a negative interaction between hypertension and hs-CRP in patients with CV. P-200 Prevalence of Polyvascular Disease in Patients with Coronary Artery Disease in Japanese Population Masanori Taniwaki, Shuzou Tanimoto, Kengo Tanabe, Shunsuke Sasaki, Shuji Ohtsuki, Sen Yachi, Masataka Nakano, Satoru Kishi, Teruhiko Imamura, Kazuhiro Mutoh, Yoshifumi Nakajima, Satoru Shimizu, Hiroyoshi Nakajima, Kazuhiro Hara. Department of Cardiology, Mitsui Memorial Hospital, Japan Background and Purpose: Prevalence of polyvascular disease, including carotid artery stenosis (CAS), renal artery stenosis (RAS) and arteriosclerosis obliterans (ASO), in
patients with coronary artery disease (CAD) has not been elucidated in Japanese population. Methods: The study populations consisted of 193 consecutive patients who underwent coronary angiography because of suspicion of CAD. All patients underwent carotid and renal artery ultrasonography, and ankle brachial index (ABI) before coronary angiography. Results: Coronary anigiography revealed 126 patients (65.3%) had CAD. The prevalence rate of polyvascular disease in patients with CAD was 31.2%. Conclusion: Although the number of patients with PAD has been considered to be low in Japanese population, the prevalence rate of polyvascular disease with patients with CAD is high in the present study. P-201 Relation Between Functional Exercise Capacity and Functional Stenosis with Patients of Stable Angina with Moderate Coronary Stenosis Tomoko Hirose1 , Shinichiro Tanaka1 , Toshiyuki Noda1 , Tomonori Segawa1 , Reiko Matsuoka1 , Shintaro Abe1 , Yoshiaki Goto1 , Takashi Katou1 , Shunichiro Warita1 , Tai Kojima1 , Takeshi Hirose1 , Makoto Iwama1 , Koji Ono1 , Haruki Takahashi1 , Taro Minagawa2 , Sachiro Watanabe1 . 1 Department of Cardiology, Gifu Prefectural General Medical Center, Japan, 2 Gifu Cardiovascular Institution, Japan Purpose: Stable angina patients with significant coronary stenosis are known to have low exercise capacity. But some patients can have higher exercise capacity. Coronary pressure-derived fractional flow reserve (FFR) is functional index of coronary stenosis. We hypothesized that there are some relevance between functional exercise capacity and functional stenosis, and assessed those with pressure wire and cardiopulmonary exercise test (CPX). Method: The subjects were fifteen male (65.8±8.9years old) of stable angina with lesion estimated 75%-stenosis visually by coronary angiography. Eligible patients received CPX, and were measured peak oxygen uptake (PeakVO2: ml/kg/min) and oxygen uptake at anaerobic threshold (AT: ml/kg/min). We assessed the relation between FFR and values of CPX. Result: Lesions were localized eight in left anterior descending artery, five in left circumflex, and two in right coronary artery. %diameter stenosis (%DS) was 65.8±8.9% by quantitative coronary angiography. FFR was 0.84±0.66. PeakVO2 was 17.1±3.2, and AT was 11.1±2.0. Significant correlation was not observed between %DS and FFR (r = 0.12). There are no entirely correlation between %DS and PeakVO2 (r = 0.05), and between %DS and AT (r = 0.01). The correlation coefficient between FFR and PeakVO2 was r = 0.53 (p < 0.05), between FFR and AT was r = 0.54 (p < 0.05): which have positive correlations. Conclusion: In this study, PeakVO2 and AT have some correlation to FFR. Functional exercise capacity with patients of stable angina could be affected by functionally stenosis rather than angiographic stenosis.