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GW27-e0947 Image quality of coronary computed tomography angiography with 320-Row area detector computed tomography in children with congenital heart disease
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
Differences in the metabolic parameters and liver enzyme of two groups may relate to alcohol consumption. GW27-e0947 Image quality of coronary computed tomography angiography with 320Row area detector computed tomography in children with congenital heart disease Jie Qin,1 Songwang Cai,2 Lingrong Peng,1 Wenjie Tang1 Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University; 2Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University 1
OBJECTIVES To assess factors affecting image quality of 320-row computed tomography angiography (CTA) of coronary arteries in children with congenital heart disease (CHD). METHODS We retrospectively reviewed 28 children up to 3 years of age with CHD who underwent prospective electrocardiography (ECG)gated 320-row CTA with iterative reconstruction. We assessed image quality of proximal coronary artery segments using a five-point scale. Age, body weight, average heart rate, and heart rate variability were recorded and compared between two groups: patients with good diagnostic image quality in all four coronary artery segments and patients with at least one coronary artery segment with nondiagnostic image quality. RESULTS 96 of 112 segments (85.7%) had diagnostic-quality images. Patients with nondiagnostic segments were significantly younger (10.0 11.6 months) and had lower body weight (5.9 2.9 kg) (each p < 0.05) than patients with diagnostic image quality of all four segments (20.6 13.8 months and 8.4 2.5 kg, respectively; each p < 0.05). Differences in heart rate and heart rate variability between the two imaging groups were not significant. Receiver operating characteristic analyses for predicting patients with nondiagnostic image quality revealed an optimal body weight cutoff of 5.6 kg and an optimal age cutoff of 12.5 months. CONCLUSIONS Prospective ECG-gated 320-row CTA with iterative reconstruction provided feasible image quality of coronary arteries in children with CHD. Younger age and lower body weight were factors that led to poorer image quality of coronary arteries. GW27-e0972 The Study of Each Period Blood Pressure’s Relevance and Their Relationship with Target Organ Damage in Essential Hypertension Group Chen Xiaoping, Gong Shenzhen, Liu Kai, Chen xiaoping West China Hospital of Sichuan University OBJECTIVES 1. To investigate whether morning blood pressure (MBP) can reflect levels of daytime and nocturnal blood pressure (BP) 2. To access the relationship between each period’s BP (morning, daytime, nighttime and 24-hour, orderly) and subclinical target organ damage. METHODS The authors recruited 1140 patients with essential hypertension in West China Hospital from January 2015 to December 2015. 24-hour ambulatory blood pressure monitoring, demographic data and relevant target organ damage index measurements were performed. Patients were divided into untreatment and treatment groups to discuss respectively. Pearson correlation analysis, Kappa consistency test, multiple linear regression, Logistic regression and AUC were used. RESULTS 1. In untreatment group, the coefficients of consistency Kappa between MBP and daytime, nighttime, 24-hour BP were 0.775, 0.418, 0.643 (all P< 0.001) respectively; 0.743, 0.482, 0.677 (all P< 0.001) in treatment group. 2. By Pearson correlation analysis, in untreatment group, each period’s SBP was positively correlated with UACR, LA, IVS, LVPW, and IMT (all P< 0.05), but no significant difference statistically in LVMI (P > 0.05). In treatment group, each period’s SBP was positively correlated with UACR, IVS, LVPW, LVMI and IMT (all P< 0.05), but not in LA (P > 0.05). 3. By multiple linear regression and Logistic regression models, in untreatment group, the coefficients of regression b and odds ratio (OR) of each period’s SBP and UACR, IMT had significant difference statistically (all P< 0.05), but not in LVMI (all P> 0.05). In treatment group, the coefficients of regression b and OR in UACR, IMT, LVMI had significant difference statistically (all P< 0.05). 4. In untreatment group, each period’s SBP had significant difference statistically (AUC: 0.658, 0.686, 0.726, 0.704, respectively, all P< 0.01) in discriminating UACR, but not in IMT and left ventricular
hypertrophy (all P> 0.05). In treatment group, each period’s SBP had significant difference statistically (AUC: 0.676, 0.682, 0.726, 0.702, respectively, all P< 0.01) in discriminating UACR and left ventricular hypertrophy (AUC: 0.646, 0.683, 0.684, 0.687, respectively, all P< 0.01), but not in IMT (all P> 0.05). 5. Among population with controlled MBP, patients with uncontrolled nocturnal BP had higher IMT (0.830.17 vs 0.740.17, P¼0.009), UACR (1.250.72 vs 0.920.58, P¼0.005) than patients with controlled nocturnal BP. In 24-hour BP, the uncontrolled had higher UACR (1.290.72 vs 0.990.64, P¼0.040) than the controlled. In daytime BP, target organ damage had no significant statistical difference between the uncontrolled and the controlled (all P>0.05). CONCLUSIONS MBP levels mainly reflected the daytime BP levels rather than nighttime BP. Each period’s BP had impact on target organ damage, but organ target was not completely same. The association between MBP and target organ damage didn’t show a distinct advantage over that of other periods’ BP. But nocturnal BP had a special advantage of reflecting renal and vascular damage. GW27-e0983 Effects of blood pressure on coronary flow reserve in patients with hypertension Du Lanfang,1 Li zhaoping2 1 Emergency department, Peking University Third Hospital; 2 Department of Cardiology, Peking University Third Hospital OBJECTIVES It has been reported that hypertension can cause coronary microvascular dysfunction which was related with increased risk of death and cardiovascular event. Coronary flow reserve (CFR) was calculated as the ratio of hyperemic to rest absolute myocardial blood flow. In the absence of obstructive stenosis of the epicardial arteries, reduced CFR (CFR<3) is a marker of coronary microvascular dysfunction. The aim of this study is to investigate the effects of blood pressure on CFR in patients with hypertension. METHODS We had retrospectively enrolled 236 patients without significant coronary stenosis (defined as <50% luminal narrowing which was confirmed by coronary angiography or coronary artery CT scan) between January 2011 to July 2015. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography. They were divided into hypertension group (n¼173) and non-hypertension group (n¼63). The hypertension patients were further divided into ideally controlled (n¼31, defined as SBP <120 mmHg (1 mmHg¼0.133 kPa) and DBP <80 mmHg), controlled (n¼82, defined as SBP 120 to 139 mmHg and DBP <90 mmHg) and uncontrolled groups (n¼60, defined as SBP140 mmHg and/or diastolic DBP90 mmHg) based on their blood pressure after systematic antihypertensive therapy. CFR was compared between different groups and univariate and multivariate eregression analyses were performed to identify the independent determinants of reduced CFR in hypertensive patients. RESULTS Coronary microvascular dysfunction (CFR<3) was found in 57.8% (100/173) hypertensive patients. Patients with coronary microvascular dysfunction were elder [(63.79.6) years vs.(57.78.3) years, P<0.001], present significant higher LVMI [(81.719.6) g/m2 vs. (74.714.8) g/m2, P¼0.02] and lower DBP [(74.09.1) mmHg vs. (77.610.5) mmHg, P¼0.02) than that of patients without coronary microvascular dysfunction. We found that higher systolic blood pressure (b¼ -0.12, P¼0.02), age (b¼ -0.02, P¼0.04) and diabetic mellitus as the underlying disease(b¼ -0.30, P¼0.02) was independent predictor of impaired CFR in patients with hypertension. Compared with non-hypertension group, the CFR was significantly lower in controlled (3.270.71 vs. 2.870.56, p<0.001) and uncontrolled groups (3.270.71 vs. 2.610.71, P<0.001), but was similar in ideally controlled group (3.270.71vs. 3.210.85, P¼0.68). Furthermore, the CFR was significantly lower in uncontrolled group than that of the other two hypertension groups and was significantly lower in controlled group than that of ideally controlled group. CONCLUSIONS Age, higher systolic blood pressure and diabetic mellitus as the underlying disease are independent predictors of decreased CFR in patients with hypertension without overt coronary artery stenosis. For hypertensive patients without significant coronary artery stenosis, therapeutically lowering blood pressure less than 120/80mmHg may be more benefical for improvement of CFR.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
Differences in the metabolic parameters and liver enzyme of two groups may relate to alcohol consumption. GW27-e0947 Image quality of coronary computed tomography angiography with 320Row area detector computed tomography in children with congenital heart disease Jie Qin,1 Songwang Cai,2 Lingrong Peng,1 Wenjie Tang1 Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University; 2Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University 1
OBJECTIVES To assess factors affecting image quality of 320-row computed tomography angiography (CTA) of coronary arteries in children with congenital heart disease (CHD). METHODS We retrospectively reviewed 28 children up to 3 years of age with CHD who underwent prospective electrocardiography (ECG)gated 320-row CTA with iterative reconstruction. We assessed image quality of proximal coronary artery segments using a five-point scale. Age, body weight, average heart rate, and heart rate variability were recorded and compared between two groups: patients with good diagnostic image quality in all four coronary artery segments and patients with at least one coronary artery segment with nondiagnostic image quality. RESULTS 96 of 112 segments (85.7%) had diagnostic-quality images. Patients with nondiagnostic segments were significantly younger (10.0 11.6 months) and had lower body weight (5.9 2.9 kg) (each p < 0.05) than patients with diagnostic image quality of all four segments (20.6 13.8 months and 8.4 2.5 kg, respectively; each p < 0.05). Differences in heart rate and heart rate variability between the two imaging groups were not significant. Receiver operating characteristic analyses for predicting patients with nondiagnostic image quality revealed an optimal body weight cutoff of 5.6 kg and an optimal age cutoff of 12.5 months. CONCLUSIONS Prospective ECG-gated 320-row CTA with iterative reconstruction provided feasible image quality of coronary arteries in children with CHD. Younger age and lower body weight were factors that led to poorer image quality of coronary arteries. GW27-e0972 The Study of Each Period Blood Pressure’s Relevance and Their Relationship with Target Organ Damage in Essential Hypertension Group Chen Xiaoping, Gong Shenzhen, Liu Kai, Chen xiaoping West China Hospital of Sichuan University OBJECTIVES 1. To investigate whether morning blood pressure (MBP) can reflect levels of daytime and nocturnal blood pressure (BP) 2. To access the relationship between each period’s BP (morning, daytime, nighttime and 24-hour, orderly) and subclinical target organ damage. METHODS The authors recruited 1140 patients with essential hypertension in West China Hospital from January 2015 to December 2015. 24-hour ambulatory blood pressure monitoring, demographic data and relevant target organ damage index measurements were performed. Patients were divided into untreatment and treatment groups to discuss respectively. Pearson correlation analysis, Kappa consistency test, multiple linear regression, Logistic regression and AUC were used. RESULTS 1. In untreatment group, the coefficients of consistency Kappa between MBP and daytime, nighttime, 24-hour BP were 0.775, 0.418, 0.643 (all P< 0.001) respectively; 0.743, 0.482, 0.677 (all P< 0.001) in treatment group. 2. By Pearson correlation analysis, in untreatment group, each period’s SBP was positively correlated with UACR, LA, IVS, LVPW, and IMT (all P< 0.05), but no significant difference statistically in LVMI (P > 0.05). In treatment group, each period’s SBP was positively correlated with UACR, IVS, LVPW, LVMI and IMT (all P< 0.05), but not in LA (P > 0.05). 3. By multiple linear regression and Logistic regression models, in untreatment group, the coefficients of regression b and odds ratio (OR) of each period’s SBP and UACR, IMT had significant difference statistically (all P< 0.05), but not in LVMI (all P> 0.05). In treatment group, the coefficients of regression b and OR in UACR, IMT, LVMI had significant difference statistically (all P< 0.05). 4. In untreatment group, each period’s SBP had significant difference statistically (AUC: 0.658, 0.686, 0.726, 0.704, respectively, all P< 0.01) in discriminating UACR, but not in IMT and left ventricular
hypertrophy (all P> 0.05). In treatment group, each period’s SBP had significant difference statistically (AUC: 0.676, 0.682, 0.726, 0.702, respectively, all P< 0.01) in discriminating UACR and left ventricular hypertrophy (AUC: 0.646, 0.683, 0.684, 0.687, respectively, all P< 0.01), but not in IMT (all P> 0.05). 5. Among population with controlled MBP, patients with uncontrolled nocturnal BP had higher IMT (0.830.17 vs 0.740.17, P¼0.009), UACR (1.250.72 vs 0.920.58, P¼0.005) than patients with controlled nocturnal BP. In 24-hour BP, the uncontrolled had higher UACR (1.290.72 vs 0.990.64, P¼0.040) than the controlled. In daytime BP, target organ damage had no significant statistical difference between the uncontrolled and the controlled (all P>0.05). CONCLUSIONS MBP levels mainly reflected the daytime BP levels rather than nighttime BP. Each period’s BP had impact on target organ damage, but organ target was not completely same. The association between MBP and target organ damage didn’t show a distinct advantage over that of other periods’ BP. But nocturnal BP had a special advantage of reflecting renal and vascular damage. GW27-e0983 Effects of blood pressure on coronary flow reserve in patients with hypertension Du Lanfang,1 Li zhaoping2 1 Emergency department, Peking University Third Hospital; 2 Department of Cardiology, Peking University Third Hospital OBJECTIVES It has been reported that hypertension can cause coronary microvascular dysfunction which was related with increased risk of death and cardiovascular event. Coronary flow reserve (CFR) was calculated as the ratio of hyperemic to rest absolute myocardial blood flow. In the absence of obstructive stenosis of the epicardial arteries, reduced CFR (CFR<3) is a marker of coronary microvascular dysfunction. The aim of this study is to investigate the effects of blood pressure on CFR in patients with hypertension. METHODS We had retrospectively enrolled 236 patients without significant coronary stenosis (defined as <50% luminal narrowing which was confirmed by coronary angiography or coronary artery CT scan) between January 2011 to July 2015. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography. They were divided into hypertension group (n¼173) and non-hypertension group (n¼63). The hypertension patients were further divided into ideally controlled (n¼31, defined as SBP <120 mmHg (1 mmHg¼0.133 kPa) and DBP <80 mmHg), controlled (n¼82, defined as SBP 120 to 139 mmHg and DBP <90 mmHg) and uncontrolled groups (n¼60, defined as SBP140 mmHg and/or diastolic DBP90 mmHg) based on their blood pressure after systematic antihypertensive therapy. CFR was compared between different groups and univariate and multivariate eregression analyses were performed to identify the independent determinants of reduced CFR in hypertensive patients. RESULTS Coronary microvascular dysfunction (CFR<3) was found in 57.8% (100/173) hypertensive patients. Patients with coronary microvascular dysfunction were elder [(63.79.6) years vs.(57.78.3) years, P<0.001], present significant higher LVMI [(81.719.6) g/m2 vs. (74.714.8) g/m2, P¼0.02] and lower DBP [(74.09.1) mmHg vs. (77.610.5) mmHg, P¼0.02) than that of patients without coronary microvascular dysfunction. We found that higher systolic blood pressure (b¼ -0.12, P¼0.02), age (b¼ -0.02, P¼0.04) and diabetic mellitus as the underlying disease(b¼ -0.30, P¼0.02) was independent predictor of impaired CFR in patients with hypertension. Compared with non-hypertension group, the CFR was significantly lower in controlled (3.270.71 vs. 2.870.56, p<0.001) and uncontrolled groups (3.270.71 vs. 2.610.71, P<0.001), but was similar in ideally controlled group (3.270.71vs. 3.210.85, P¼0.68). Furthermore, the CFR was significantly lower in uncontrolled group than that of the other two hypertension groups and was significantly lower in controlled group than that of ideally controlled group. CONCLUSIONS Age, higher systolic blood pressure and diabetic mellitus as the underlying disease are independent predictors of decreased CFR in patients with hypertension without overt coronary artery stenosis. For hypertensive patients without significant coronary artery stenosis, therapeutically lowering blood pressure less than 120/80mmHg may be more benefical for improvement of CFR.