. 2023 Nov 3;11(Suppl 1):1–54. doi: 10.1159/000534378
Pulse (Basel). 2023 Nov 3;11(Suppl 1):12.
As individuals age, their arteries tend to become stiffer (a condition known as arteriosclerosis), which increases their risk of developing cardiovascular (CV) disease. However, the degree of arterial aging can vary significantly among individuals of the same chronological age due to differences in genetic background, environmental factors, and lifestyle choices. This suggests that accelerated arterial aging may occur when the interaction between genetic and environmental factors fails. While the final outcome of the vascular aging CV continuum, such as end-stage cardiac, cerebral, and renal diseases, and even death, is similar to that of the classic CV continuum, there are distinct differences in the underlying mechanisms. The classic CV continuum is primarily driven by atherosclerosis and cardiac hypertrophy, whereas the vascular CV continuum is characterized by the fracture of elastic lamellae, aortic stiffening, and dilatation, leading to pulse wave abnormalities like pulse wave encephalopathy, pulse wave nephropathy, renal disease, and dementia. Age-related arterial stiffness results in an increase in pulse wave velocity (PWV), which is a reliable measure used to predict CV disease. Although the impact of PWV on health outcomes has been extensively studied and suggested as a useful clinical tool for primary and secondary CV prevention [6], there are significant challenges in implementing PWV in clinical practice. Current hypertension guidelines give limited attention to the clinical use of PWV, and there is a lack of standardized measurement methods for PWV. Currently, PWV is the primary tool for assessing vascular aging, but different measurement methods exist. Carotid-femoral PWV (cfPWV) is favored in Europe, while in Asia, there is a preference for brachial-ankle PWV (baPWV) or the Cardio-Ankle Vascular Index (CAVI). The main differences between these methods lie in the arterial measurement sites, which range from the central elastic aorta to the aorta and peripheral muscular arteries. This session is to discuss the various methods of measuring PWV and provide recommendations for the clinical use of PWV.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):12.
Arterial stiffness (AS) generally refers to the loss of arterial compliance due to changes in structural and functional arterial wall properties. AS is a strong predictor for the development of cardiovascular disease, independent of conventional risk factors. The two strongest factors inducing arterial stiffening are aging and high BP, acting synergistically to increase AS. With aging, large arteries dilate, thicken, and get stiffer. Hypertension may produce arterial stiffening by both functional and structural mechanisms.
AS has long been viewed as a consequence of hypertension, rather than its cause. However, increasing evidence suggest that AS could precede and even contribute to the pathogenesis of hypertension itself by alterating systolic hemodynamic load. Thus, early assessment of AS may provide important information about complications, including hypertension, that develop years later.
According to latest ESC/ESH guidelines, detailed assessment of asymptomatic HMOD (including PWV) received a class IIb, which means that their use may be considered if it influences patient management. In fact, a PWV greater than 10 m/s, indicates a 4% risk for a first major cardiovascular event within the next 8 years in a middle-aged population. Indeed, AS is known to be a direct and independent predictor of all-cause mortality and CV mortality in hypertensive patients. Addition of PWV to cardiovascular prediction models was associated with a modest but significant improvement of risk prediction. Many studies showed a positive effect on reducing PWV after short and long-term treatments with various anti-hypertensive drugs, including the recent SPARTE study. Evidence concerning the improvement of CV prognosis in individuals in which BPlowering treatment is able to normalize arterial stiffness beyond BP control is also accumulating. Further possible uses of PWV in hypertensive patients, beyond upgrading an individual's CVD risk, would be: 1) indicate a need for instituting BP-lowering treatment in younger individuals with mildly elevated BP (who may otherwise not be treated), or in individuals with masked or white-coat hypertension; 2) indicate the need for more intensive BP treatment goals or the use of high-dose destiffening drugs in medium and high-risk hypertensive patients.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):13.
Large arterial stiffness can be accurately measured with aortic pulse wave velocity (PWV) by the use of various techniques, which have been increasingly available in clinical practice. There is evidence that arterial stiffness is a predictor of cardiovascular events, and is recommended for risk stratification by various current hypertension guidelines. There is also increasing evidence that arterial stiffness can be reversed or at least retarded by various treatments such as blood pressure, glucose and lipid lowering, fish oil intake, aerobic exercise and in patients with obstructive apnea even continuous positive airway pressure (CPAP). For now, there is still very little evidence about whether reducing arterial stiffness prevents target organ damage and cardiovascular events. Nonetheless, the SPARTE (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness) study, a multicenter open-label randomized controlled trial with blinded end point evaluation undertaken at 25 French research centers in university hospitals, provided promising results. After a median follow-up of 48.3 months, antihypertensive treatment with the combination of renin-angiotensin-system blockers and calcium channel blockers guided by PWV (n=264) was prescribed at higher dosage, and led to a more pronounced office and ambulatory systolic and diastolic blood pressure lowering (P<0.001 and P<0.01, respectively), and a less increase in PWV than the conventional antihypertensive treatment group (n=272). Although there was no statistically significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P=0.35), typically because of the lacking sufficient statistical power, a PWV-driven treatment for hypertension might still be beneficial in cardiovascular protection and prevention. A trial with adequate power is required to investigate whether reducing arterial stiffness would be clinically useful in cardiovascular prevention.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):13.
Arterial pulse wave velocity (PWV) is conventionally used as a noninvasive measure of stiffness of large conduit arteries. This association comes from the physical relationship of the well-known Moens-Korteweg formula (PWV2 = Eh/Dρ; E: wall elastic modulus; h: wall thickness; D: lumen diameter; ρ: blood density). The use of PWV as a measure of stiffness implies that any changes observed in PWV are mainly due to changes in E which are much greater than corresponding changes in h or D. This has potentiated many studies by quantifying changes in arterial stiffness with age and other conditions by measurement of carotid-femoral PWV (cfPWV), as a measure of stiffness of the aortic trunk. Studies show that cfPWV changes at a greater rate compared to PWV in the upper or lower limbs. However, recent studies show that the ratio of limb to central PWV, defined as a stiffness gradient has potential for improved characterisation of risk. Although of merit, the simple ratio does not account for the large difference in diameter of the aortic trunk and peripheral limbs. This presentation will examine the theoretical studies that show that when using ratios of central and peripheral PWV, the scaling of PWV by the square root of the diameter of the vessel in which it is measured will provide an improved comparison of arterial stiffness of large central and peripheral arteries. This will have important implication for future clinical applications of arterial stiffness assessment where conventional measurements of brachial-ankle PWV can be used to obtain a stiffness gradient and the PWV measurement can be complemented using ultrasound to obtain noninvasive measurement of vessel diameters.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):13–14.
The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016 with the primary objective of improving hypertension management and organ protection in Asia, with the ultimate goal of achieving zero cardiovascular events. To accomplish this, Asian experts collaborate and exchange knowledge to stay updated on the latest evidence, reach consensus, conduct clinical studies on the current status, disseminate the outcomes of HOPE Asia to each country, and facilitate hypertension research in Asia. Asians face a higher cardiovascular risk associated with hypertension, making blood pressure reduction particularly crucial for this population compared to Caucasians. In 2017-18, the HOPE Asia Network conducted the Asia BP@HOME study to shed light on hypertension control across Asia, revealing significant differences in the control status of hypertension, as evaluated by home blood pressure (BP), among 11 countries/regions. These findings underscore the importance of enhancing hypertension control through the widespread adoption of home blood pressure (BP) monitoring across Asia. In this context, the HOPE Asia Network has proposed a new concept called “Home BP-centered approach” (Hypertens Res. 2023, submitted). This approach promotes voluntary self-measurement of home BP readings to achieve personalized and optimized anticipation medicine, which can effectively predict individual risk and prevent the onset of cardiovascular events at an early stage. In this lecture, we provide a summary and presentation of the most up-to-date approaches for hypertension control.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):14.
Smartphone technology has spread rapidly around the globe. According to a report released by Korea Information Society Development Institute, about 95% of Koreans aged more than 30 years old owned smartphones. Recently, blood pressure (BP) measurement using photoplethysmography-based smartphone algorithm paired with smartwatch is continuously evolving. And in Korea, a photoplethysmography-based smartphone algorithm paired with a smartwatch for BP measurement was approved as a medical device. Here, I will present the feasibility and measurement stability of the smartphone-based BP measurement. The initial result showed acceptable accuracy in study population. However, in high or low BP ranges, there still exist considerable discrepancy compared with the conventional BP measurement. The use of smartwatch-based BP measurement can improve HTN awareness especially in younger population, however, there is still scanty evidence in the use of smartwatch device for the hypertensive patients. The convenience and easy-to-use is the moto of smartphone / smartwatch device, however it might be ‘double-edged sword’ if the measurement were not properly performed. Therefore, adequate education of the BP measurement method is essential to maximize benefit. Also, future efforts (and collaborations) should be made by both researchers and companies to evaluate the effectiveness and usability as medical devices for the hypertensive population.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):14–15.
Hypertension and atrial fibrillation (AF) are increasingly prevalent in the elderly. In the present study, we investigated in the elderly population the prevalence and management of AF and the relationship between more frequent electrocardiography (ECG) screening and incident AF. Our study participants were elderly (≥65 years of age) residents, recruited from communities from 2017 to 2022. A handheld single-lead ECG recorder with an artificial intelligent analysis system was used for AF screening. Participants without AF at baseline received ECG screening at various frequencies and were followed up for incident AF. In cross-sectional and prospective data analysis, the logistic regression model and Cox proportional hazard model were used to investigate the risk factors of prevalent AF, and the relationship between the risk of incident AF and quarterly ECG screening and new-onset hypertension in the elderly, respectively. In a nationwide AF screening study in the elderly population aged over 65 years (n=29,166), the overall prevalence of AF was 4.6%, and the prevalence of AF was significantly higher in rural than urban areas (5.6% vs. 4.3%; P<0.0001). The proportions of rural patients with AF receiving oral anticoagulation therapy (17.2% vs. 22.4%), rhythm control (10.1% vs. 22.8%), and rate control (22.8% vs. 34.4%) were significantly lower (P≤0.047) than that of urban patients. Among AF patients, the treatment rate for hypertension was significantly lower in rural than urban areas (70.2% vs. 77.7%, P=0.02), and the control rate was also slightly but non-significantly lower in rural than urban areas (46.1% vs. 49.8%, P=0.34). 6806 Shanghai residents attended at least one ECG follow-up during 2 years. After a median follow-up of 2.1 years, a total of 73 subjects developed new-onset AF: 26 in annual screening group (4.1 per 1000 person-years) and 47 in quarterly screening group (6.7 per 1000 person-years). Quarterly screening was associated with a significantly higher detection rate of new AF compared with annual screening (hazard ratio [HR] 1.71; 95% confidence interval [CI] 1.06-2.76; P=0.029). After adjustment for baseline CHA2DS2-VASc score, body mass index, current smoking and alcohol consumption, fasting plasma glucose, serum total cholesterol, and serum creatinine and uric acid, participants with ≥2-point increment in the CHA2DS2-VASc score had a significantly higher risk of AF than participants with no change in the CHA2DS2-VASc score (HR 6.23; 95% CI 3.26-11.90; P<0.0001). New-onset hypertension was the main contributor to the change in the CHA2DS2-VASc score, accounting for 59% of the total change. The prevalence of AF is high in elderly Chinese, especially in rural areas, and a large number of patients did not receive appropriate diagnosis, treatment or management. Intensive ECG screening, such as for example, quarterly screening, can significantly improve the detection rate of new AF.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):15.
Accurate measurement of blood pressure is regarded as one of the most important tests in clinical medicine. There are many potential sources of error in blood pressure measurement, including the accuracy of the device itself. Only devices that have been appropriately tested for accuracy (by comparison to cuff manual manometry), and passed, according to an international validation Standard should be used by health professionals and patients. Blood pressure measurement devices that do not have evidence of passing validation testing have greater variability, less accuracy, and may contribute to incorrect hypertension diagnosis and management. Concerningly, about 80% of the upper arm automated cuff blood pressure measurement devices available for sale online globally (and being purchased by consumers) do not have evidence of having passed appropriate validation testing. These non-validated devices are cheaper and have the same consumer star ratings compared with appropriately validated devices. Resources have been developed to assist health professionals and patients find appropriately validated upper arm cuff blood pressure measuring devices. Novel cuffless blood pressure measurement devices that record continuously over extended time periods are also now available for purchase, albeit not yet recommended for clinical use. The International Organization for Standardization recently released a new Standard (ISO 81060-3:2022) specifically to ensure the appropriate accuracy testing and essential performance of automated continuously measuring blood pressure devices. The Standard covers how to test absolute accuracy, as well as, trending blood pressure measurement by comparison to reference invasive blood pressure monitoring equipment. There is yet to be a published study using this Standard.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):15.
OBJECTIVE
Echocardiogram is commonly used to evaluate cardiac remodeling in hypertension (HTN). However, study on echocardiographic phenotypes and their prognostic implications in HTN is limited. This study aimed to elucidate these aspects. Method and Result: A total of 1881 community hypertensive patients without overt cardiovascular disease and severe renal disease (mean age 62.8 years, women 57.9%) were included. Using Two-Step cluster analysis with four conventional echocardiographic variables, two clusters with distinct echocardiographic phenotypes were identified. The Cluster 1 (namely “mild-remodeling” HTN; n=1492) had low prevalence of enlarged left atrium (LA; 0.9%) and left ventricular hypertrophy (LVH; 16.2%) and better LV diastolic function. They were younger and more likely to be men and had lower comorbid burden. The Cluster 2 (namely “severe-remodeling” HTN; n=389) had higher prevalence of enlarged LA (26.0%) and LVH (83.0%) and worse LV diastolic function. They were older and more likely to be women and had higher comorbid burden. After a median follow-up of 4.2 years, compared to the Cluster 1, the Cluster 2 had higher incidence of cardiovascular (4.1% vs 1.7%; P = 0.006) and all-cause (9.8% vs 4.8%; P < 0.001) death, with adjusted hazard ratio (HR) of 2.80 (95% confidence interval [CI] 1.39-5.62; P = 0.004) and 2.04 (95% CI 1.32-3.14; P < 0.001) respectively. Conclusion: These findings indicate that the conventional echocardiographic variables-based algorithm could help identify asymptomatic community hypertensive patients at risk for cardiovascular and all-cause death. Further studies are needed to develop and validate phenotype-specific prevention and intervention strategies in HTN.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):16.
There have been several evidence that increased blood pressure (BP) variability was associated with target organ damage and cardiovascular events. To detect BP variability during a certain period, continuous BP reading is ideal. For example, in the patients with obstructive sleep apnea, transient BP increase due to hypoxia during sleep period has been acknowledged. However, to detect BP readings induce by the episode of obstructive sleep apnea, invasive or complicated BP measurements, such as peripheral arterial tonometry, are needed. Pulse transit time (PTT), which refers to the travel time of the systolic pressure wave between two arterial sites, typically the aortic valve and a peripheral site, has been developed as a novel cuffless form of continuous BP monitoring. Previously, our study demonstrated that the advantage of continuous BP monitoring using PTT might be the ability to identify maximum and minimal BPs. This session will discuss the clinical significance of BP variability and the usefulness of PTT-estimate BP as a method of assessing BP variability.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):16.
The definitions of vascular aging have not been fully established, but vascular aging means functional abnormalities such as reduced vascular elastance, hyper/fair responses of vascular tonus, hemostatic abnormalities and also means morphological abnormalities such as hypertrophy, stenosis, enlargement and so on. These abnormalities can be assessed by physiological tests and also imaging tests. Vascular aging has two phenotypes as early vascular aging (EVA) and healthy vascular aging (HVA). EVA reflects poor cardiovascular outcomes and HVA reflects better cardiovascular outcomes. Recently, SPARTE study reported that arterial stiffness normalized strategy could not overcome the blood pressure driven strategy for cardiovascular outcomes. Therefore, prevention of EVA and keeping HVA may be important. For both, managements of cardiovascular risk factors are thought to be crucial. In this view, we evaluate the longitudinal association of cardiovascular risk factors with slow and fast progression of arterial stiffness in long-term multiple repeated measurements data.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):16–17.
Many studies have reported that the measures of arterial stiffness have prognostic value in patients with various diseases as well as in the general population. Of note, some studies have demonstrated the usefulness of arterial stiffness information for predicting future cardiovascular events in patients with CAD. Most of these studies used baseline values of arterial stiffness to predict future cardiovascular events. Since arterial stiffness is influenced by many different factors and changes over time, it is important to understand and interpret its changes. However, there have been only a few studies so far predicting the prognosis of patients with CAD using the patterns of changes in the degree of arterial stiffness. Recently, we published data on the usefulness of systolic blood pressure (SBP) corrected onemonth change of brachial-ankle pulse wave velocity (baPWV) in patients underwent percutaneous coronary intervention (PCI). A total of 405 patients (mean age, 62.0 ± 11.0 years; female sex, 27.7%) were prospectively enrolled and analyzed. During the median follow-up duration of 5.3 years (interquartile range. 2.9-7.9 years), there was 65 (16.0%) case of major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, coronary revascularization and ischemic stroke. There was no significant difference in clinical characteristics between patients with and without MACE except for higher prevalence of triple vessel disease in those with MACE. The baPWV value decreased at one month after index PCI (1,560 ± 305 to 1,530 ± 318 cm, P < 0.001). In multivariable cox regression analysis, the change of baPWV at one month was not associated with MACE occurrence (P > 0.05). However, the change in SBP-adjusted baPWV (baPWV/SBP) at one month (increased vs. decreased) was significantly associated with MACE occurrence even after controlling for potential confounders (hazard ratio, 2.25; 95% confidence interval, 1.37-3.69; P = 0.001). The results of this study suggest that baPWV/SBP changes at one month may be helpful in risk stratification of patients at a high coronary risk. Considering simplicity and reliability of baPWV, baPWV/SBP could be used as a useful marker for risk
Pulse (Basel). 2023 Nov 3;11(Suppl 1):17.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):17.
The prevalence of hypertension increasing along with the population aging, although the management level of hypertension has been improved obviously, the control rate is still very low. Telemonitoring and artificial intelligence offers new strategies for hypertension management. Based on remote transmission and big data technology, a web-based standardized blood pressure (BP) analysis and reporting system covers automatic office BP, ambulatory and home BP measurements, provides accurate BP readings, offers standardized interpretation, fully reflects the characteristics of individual' BP, and eventually contributes to the prediction and early warning of cardiovascular diseases. With the support of big data and artificial intelligence machine learning technology, it can not only improve the detection efficiency of secondary hypertension but also make it possible to describe the main pathophysiological causes of most traditional primary hypertension, and effective treatment for the etiological factors will helps to improve the hypertension control status.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):17–18.
Primary aldosteronism (PA) affects 5-13% of patients with hypertension, and is characterized by an inappropriate production of aldosterone. Increasing evidence indicates that PA is much more prevalent than previously believed, making this disease the most frequent cause of secondary hypertension. PA can be mainly divided into two subtypes: aldosteroneproducing adenoma (APA) and idiopathic adrenal hyperplasia (IAH). In recent studies, the incidence of PA is getting higher and higher. In AHA 2017 guideline for hypertension prevention, the incidence of PA is 8 % in general hypertension and 20% in resistant hypertension. Excessive aldosterone influences multiple systems in human body and cause numerous diseases including cardiovascular, renal, immune, metabolic and psychological diseases. These make PA is a very important issue in hypertensive society.
In clinical aspect, PA patients had more cardiovascular complications, including coronary artery disease, myocardial infarction, stroke, transient ischemic attack, atrial fibrillation and heart failure than in patients with essential hypertension (EH). Moreover, in structure of cardiovascular system, PA patients have more prominent left ventricular mass, cardiac fibrosis, impaired endothelial dysfunction and increased arterial stiffness than EH patients. The altered structure can be reversible partially after treatment.
Due to the important role of PA, our research team (TAIPAI) was assembled in 2005 to organize multi-discipline researches. There are more than 2000 cases in our data registry. About 75-100 PA patients are new-diagnosed or referred to our team each year. We had published more than 100 papers and more than half of them were in cardiovascular field. The cardiovascular research in TAIPAI study group includes large clinical cohort study, basic researches, and population science. We focus on cardiac and vascular structure / functional change of PA patients and the reversibility after treatment.
This speech will cover new insights of vascular complications of PA, including our recent works related to somatic mutation and cortisol co-secretion on cardiovascular system in PA patients.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):18.
It is the global consensus that regular exercise and physical activity, desirable diet, and emotional control are the triad in improving health status and managing chronic disease. However, it is more than difficult especially for the busy urbanites to approach to this integrative healthy lifestyle. Recently the concept of ICR, the intensive cardiac rehabilitation emerged to supplement the inefficiency of existing cardiac rehabilitation programs. As the name implies, this is the intensive educational program to have participants experience and be habituated to the healthy lifestyle in a certain period of time.
For the longest time, countries including Germany, Swiss, United Kingdom, and Japan have been administrating healing system by using forest environment. Many studies have shown there are lots of environmental factor in the forest that improve both physical and mental health status. In this sense, grafting ICRtype clinical program on to the forest-healing environment would be a complementary approach for the accomplishment of mutual purpose. Though it is little overdue, Korea also began to make use of forest for the purpose of healing and established several National Healing Center and Healing Forest. However, it leaves much to be desired in that those facilities have not been related to systemic use for the clinical purpose.
Our recent study was to investigate the effect of intensive primary prevention program that consisted of intensive education in the national healing center followed by selfguided practice at home. Person with CAD risks were recruited and divided into two groups; forest ICR and normal healthcare. Intensive education in the forest included natureoriented exercise such as forest tracking, healthy diet, and coping psychologic problem. Participants were indicated to keep the lifestyle during self-guided practice at home as they were educated. The forest near their residence were used for nature-friendly exercise routine. Normal healthcare group were indicated to keep healthy lifestyle with routine exercise in the fitness facility. This study showed better improvement in CAD risk factors such as body composition, blood lipid profile, hemodynamics and functional capacity in the forest ICR group. Moreover, significant difference in daily energy expenditure implied forest ICR group was likely to be more motivated to active lifestyle.
We propose National Healing Center and Healing Forest would give attention to develop collaboration with health-related institutions like clinics, health and fitness facilities for more efficient and meaningful use. Recommendation is the use of National Healing Center would not for isolated functioning, but for the net-working hub for more sophisticated health programs. Still it remains much things to do for this prospectiveness. This presentation was partly adopted from the research project supported by Korea Forestry Promotion Institute
Pulse (Basel). 2023 Nov 3;11(Suppl 1):18–19.
Forests make the human body and mind healthy, and by using the characteristics of forests, various environmental factors that exist in forests are used to enhance human immunity and restore physical and mental health. These elements of the forest are called healing factors, and as a result of the research, it was investigated that the healing factors of the forest are the main factors such as forest landscape, phytoncide, anion, sound, and sunlight.
As for the forest landscape, the color of green that forms the forest and the seasonality of the forest that changes with the time of day have the effect of bringing about eye fatigue and peace of mind. Phytoncide refers to a substance produced by trees to protect themselves from pests and wounds and is clinically known to relieve inflammation and stimulate the human sense of smell to bring peace of mind and peace of mind. In addition, negative ions that neutralize the human body, which is prone to acidification in daily life, exist in large amounts in pleasant natural environments such as forest respiration, soil transpiration, and valleys or waterfalls. In addition, it has the characteristics of white sound with a relatively wide sound range that makes humans comfortable with various sounds generated in the forest and improves concentration. Also, in the forest, the effect of blocking ultraviolet rays harmful to the human body is excellent, so even if you do outdoor activities for a long time, your body does not suffer.
Cardiovascular disease is a representative disease that develops as a result of a wrong lifestyle. It is caused by Western eating habits, lack of physical activity and exercise due to industrialization and urbanization, and social and psychological burdens, which act as risk factors for cardiovascular disease. It is known that the prevalence of metabolic abnormalities and diseases such as abdominal obesity, dyslipidemia, metabolic syndrome, and diabetes is increasing. In addition, cardiac rehabilitation includes the secondary prevention program (The Secondary Prevention), which prevents function recovery and recurrence after treatment of heart disease, and the primary prevention program (The primary Prevention), which prevents cardiovascular disease risk groups before onset. It is a concept of cardiovascular disease risk factor management, patient assessment, weight management, blood lipid management, blood pressure management, diabetes management, smoking cessation management, nutrition and diet management, psychological management, physical activity counseling, and exercise training. has been Recently, there has been a lot of interest in the efficacy of health management and healing using forests, and research on this has been conducted. Previous studies suggest that various environmental benefits provided by forests induce positive physiological and psychological responses, suggesting the possibility of health care and healing effects. Since it is said to have forest conditions to operate a program with the concept of health care and healing, it is considered very suitable to apply the short-term intensive cardiac rehabilitation program to the networking of primary and secondary prevention of cardiovascular disease. To this end, the forest healing factor and healing environment of the National Forest Therapy Center located in Yeongju were investigated to identify the effect of cardiac rehabilitation in the forest.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):19.
Large-artery stiffness (LAS) leads to increased pulse pressure (PP) and contributes to disease burden in various target organs. Whereas the role of LAS in cardiac, cerebral and kidney damage has been studied extensively, recent evidence suggests also suggests a causal role in the pathogenesis of diabetes and cardiometabolic traits. This is supported by observational data, as well as mendelian randomization analyses, which utilize genetic variants to reduce confounding by unmeasured exposures, providing insights into cause-effect relations. Whereas accumulating evidence continues to demonstrate the importance of LAS in human disease, therapeutic approaches remain limited. This is largely due to the incomplete understanding of the molecular pathogenesis of LAS. Identifying novel therapeutic targets to delay or improve LAS should be a priority in the field. Recent studies utilizing broad proteomics approaches have identified multiple proteins that correlate with LAS in the general population. Moreover, Mendelian Randomization using protein quantitative trait loci support a causal role for several novel molecules, which may represent therapeutic targets. These studies will be discussed, as well as the challenges for preclinical and clinical drug development in this space.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):19–20.
Vascular ageing refers to the age-related deterioration in vascular structure and function and it is accelerated in the presence of cardiovascular (CV) risk factors. This process is highly heterogeneous: some individuals display early vascular ageing (EVA) patterns at younger age, while others remain surprisingly protected by the deleterious effects of ageing and life-time exposure to risk factors on the cardiovascular system. This has led to the notion that vascular age, as opposed to chronological age, is better related to cardiovascular outcomes.
Though the concept of vascular aging is gaining popularity, its definition is still elusive. Biological age can be calculated based on regression models and classical CV risk factors, an approach applicable for large population screening and education, but insensitive to the cumulative effects of the environment, all known and unknown risk factors and individual susceptibility on the vasculature. These tools are not accurate enough in the precision medicine era. A direct assessment of large artery stiffness by PWV has demonstrated its advantages over indirect estimation as opposed to chronological age. EVA may be defined as inappropriately high PWV compared to the highest percentiles of normal reference values. A recent approach for the estimation of vascular age used a multivariable regression model with smoothing splines, applied on a single vascular ageing parameter (PWV), together with CV risk factors and treatments. This approach allowed identifying individuals with EVA, namely those whose vascular age is disproportionally higher than their chronological age, but also those with normal ageing, and with supernormal vascular ageing (SUPERNOVA). These three groups have different prognosis (worse with EVA, better for SUPERNOVA) as compared to normal ageing. Future studies will explore whether different intensity of cardiovascular preventive treatments may be proposed to individuals with different vascular ageing phenotypes.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):20.
Postganglionic sympathetic nerves innervate target organs such as the heart, peripheral arteries and the kidney and regulate acute alterations in blood pressure. Chronically elevated sympathetic nerve activity (SNA) is associated with cardiovascular target organ damage such as left ventricular hypertrophy, peripheral conduit artery remodeling and kidney damage. Chronic elevations in SNA are associated with central artery stiffness in some studies but whether this is a causal link or largely driven by age remains unclear. Chronically raised SNA is also associated with peripheral (femoral) artery wall remodeling (intimal medial thickness, IMT) but whether SNA is associated with central elastic artery (carotid) wall remodeling is unknown. In addition, acute experimental increases in SNA that are associated with increases in blood pressure result in reductions in compliance of both central and peripheral arteries, but are confounded by elevations in mean arterial pressure making interpretation difficult. In this regard, whether elevations in SNA modulate increases in stiffness of the central elastic arteries independent of mean arterial pressure remains controversial. We provide evidence that chronically higher SNA is associated with elevated carotidfemoral pulse wave velocity (PWV) and lower carotid artery compliance independent of mean arterial pressure but not age in healthy young and middle-aged/older adults. Experimentally raising SNA while holding mean arterial pressure constant using the lower body negative pressure maneuver results in significant elevations in carotid-femoral PWV among both young and middle-aged/older adults, whereas a decrease in carotid artery compliance observed in young appears blunted in middleaged/older adults. Consistent with this, experimental maneuvers known to raise SNA such as lower-limb venous occlusion also increase carotid-femoral PWV in adults with hypertension corroborating our findings. Furthermore, chronic elevations in SNA are associated with carotid artery IMT normalized for lumen diameter in men and women across the age range, with the exception of young women. Taken together, while the relation between chronic elevations in SNA and arterial stiffness may be explained largely by age, higher SNA is associated with carotid artery thickness in young and middle-aged/older adults except for young women. Acute elevations in SNA modulate acute increases in functional central artery stiffness in humans with some age-related differences between aorta and carotid arteries. Future studies are needed to test whether chronically elevated SNA with aging and/or hypertension is a potential therapeutic target for the treatment of accelerated central artery stiffness and wall remodeling.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):20–21.
Hypertension is the leading risk factor for cardiovascular events and death. If hypertension can be detected, treated and controlled to <140/90 mmHg, the risk for future cardiovascular events and death can be significantly lowered. In Australia, about 1 in 3 adults aged over 18 years have hypertension but only half these people are aware they have it. Critically, among those people in Australia whose hypertension has been detected, only 32% have it controlled. This poor statistic has remained unchanged for over a decade, and while it is above the average global hypertension control rates (23% for women, 18% for men), it falls well behind many countries. Indeed, the highest performing countries for hypertension control are South Korea, Canada and Iceland, where more than 70% of people with hypertension are treated and more than half of these have their hypertension controlled. A recent call to action in Australia emphasised that a national commitment to improve blood pressure control would lead to significant health and economic gains. This call to action has led to the establishment of an Australian Hypertension Taskforce, which is an initiative of Hypertension Australia and the Australian Cardiovascular Alliance, and aims to increase the hypertension control rate in Australia to at least 70% by 2030. The initiative was launched in December 2022 with support from the federal Department of Health, guided by an international expert advisory group and in collaboration with multiple national partners across sectors of health, government, non-government organisations, professional societies, academia and health consumers. The Hypertension Taskforce has identified key priority areas and is undertaking actions (to be detailed in the talk) towards achieving better blood pressure control in Australia.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):21.
Cardiac rehabilitation (CR) is a comprehensive program designed to help patients recover from cardiovascular events and includes a combination of exercise, education, and counseling to help patients improve their physical and mental health, reduce the risk of future cardiac events, and improve their overall quality of life. Initially, CR programs were limited to hospital-based programs that focused on exercise training and risk factor modification. Over time, the focus of cardiac rehabilitation has expanded to include education, counseling, and lifestyle interventions. The “core components” of cardiac rehabilitation have been described by the American Association of Cardiovascular and Pulmonary Rehabilitation and are presented in this figure.
Today, CR programs are available in a variety of settings, including hospitals, clinics, and community centers. These programs are typically interdisciplinary, with a team of healthcare professionals, working together to develop individualized treatment plans for patients. CR programs typically last 12-16 weeks and involve a combination of supervised exercise, education, and counseling sessions. The potential benefits of more “intensive” CR programs will be discussed in this symposium.
The future of cardiac rehabilitation must focus on the development of new technologies and approaches to improve patient outcomes, including the use of wearable technology to monitor patient activity levels, and the development of telemedicine and virtual reality-based programs that can be accessed from home. The development of telerehabilitation models will also be discussed in this symposium.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):21.
Will provide comprehensive overview of intensive cardiac rehabilitation and discuss the differences between traditional and intensive cardiac rehabilitation.
Will review data looking at differences between these two approaches.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):21–22.
This lecture traces the evolution of approaches in hemodynamics that have resulted in advances in assessing fundamental parameters in the circulation related to arterial function and arterial blood pressure. The approaches described will concentrate on the contribution of Michael O'Rourke in the quantification of pulsatile hemodynamics.
The early ideas on pulsatile haemodynamics associated with the work of Michael O'Rourke have their origin in the inquisitive mind of Donald McDonald, a surgeon in the British Army during the Second World War. His interest in blood flow in arteries of the brain led to a highly productive interdisciplinary collaboration with mathematician John Womersley to compute blood flow in arteries from measured pulsatile blood pressure and knowledge of arterial properties. This seminal collaborative work intrigued another inquisitive mind in Australia, that of Michael Taylor, Professor of Physiology at the University of Sydney, and doctoral thesis supervisor of Michael O'Rourke. The novel concepts of wave propagation, frequency analysis and arterial models generated from the work of McDonald, Womersley and Taylor, and associated with thoughtful and conceptually robust circulatory physiology, captivated the discerning mind of O'Rourke as a means of using the information contained in the arterial pulse to understand the dynamics of normal and abnormal cardiovascular physiology. He embraced these novel ideas with deep scholarly enthusiasm which intersected with the adventurous and thoughtful approach of Wilmer Nichols, whose mentor in America was Donald McDonald. They both caried forth the ideas of their illustrious predecessors, and it was this Australian connection that has nourished at least two generations of scientists globally investigating the basic and applied scientific concepts of pulsatile haemodynamics phenomena and has resulted in seven authoritative editions of McDonalds Blood Flow in Arteries over a fruitful period of scientific and scholarly enquiry spanning more than six decades. A significant outcome of this approach to pulsatile hemodynamics has been the development of the SphygmoCor technology. The approach involved the extension of the concept of vascular impedance as the relationship of blood pressure and flow in the frequency domain to the relation of two pressure signals measured at different locations. This resulted in the quantification of propagation characteristics that could be used in mathematical models as transfer functions. This concept enabled the use of the information content in the arterial pulse to estimate central aortic pressure from the calibrated peripheral pulse. The known inherent non-linearities in arterial properties due to the pressure dependency of elasticity of the arterial wall caused concern in the early approaches to quantifying vascular impedance. However, these were shown to have small effects at physiological pressure ranges. This also applies for the pressure transfer function which was found to be robust and consistent under physiological pressure ranges as obtained during the Valsalva manoeuvre.
Arterial properties affect the propagation characteristics of the arterial pulse through the velocity of propagation and the change in amplitude, determined by arterial stiffness and wave reflection. Thus, the measurement of pulse transit is used to compute pulse wave velocity, as an index of arterial stiffness, and a pressure-calibrated peripheral pulse can be used as a noninvasive estimation of central aortic pressure. These measurements were incorporated in the early SphygmoCor devices using applanation tonometry for detection of the arterial pulse. This novel technology broadened the research field for assessment of arterial function and for quantifying the effects of peripheral and central blood pressure on cardiovascular risk and response to pharmacological treatment in hypertension. Pulse detection has evolved from tonometric sensors to cuffbased sensors, and this has enabled a wider application of this technology to enhance both epidemiological studies and facilitate potential clinical applications.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):22.
The late Gerald Reaven introduced the term “Syndrome X” in his famous Banting lecture in 1988; Reaven's lecture has been cited over 10,000 times and represents the highest cited Banting lecture since the inception of the award in 1941. Reaven used the algebraic term “X” to refer to insulin resistance, which at the time was unrecognized as the key driver of cardiovascular disease, as well as type 2 diabetes. Reaven advocated for Syndrome X to be renamed the Insulin Resistance Syndrome. Electronic search of the term “Syndrome X” considers it synonymous with metabolic syndrome; however, Reaven considered the two as fundamentally different in their purpose. We will review how Reaven's Insulin Resistance Syndrome differs from metabolic syndrome and its relevance to cardiovascular disease and aging today.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):22–23.
Aortic stiffening and premature vascular aging were once thought to be consequences of “accelerated aging” of the aorta as a result of factors such as longstanding hypertension, obesity, diabetes and lipid abnormalities. However, an analysis from the Framingham Heart Study (FHS) demonstrated that aortic stiffness precedes and contributes to the pathogenesis of hypertension. Recent work from FHS investigators and others has shown that abnormal aortic stiffness also precedes and contributes to the pathogenesis of obesity, insulin resistance, diabetes and lipid abnormalities, potentially starting from an early age, suggesting that aortic stiffness represents a primordial risk factor that contributes to the pathogenesis of cardiometabolic disease and subsequent adverse clinical outcomes.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):23.
Immune responses are involved in vascular injury and dysfunction. In arteries, inflammatory responses are initiated by various stimulations, including mechanical factors, ischemic insults, metabolic factors, and cytokines. Moreover, senescent immune cells, particularly replicative-senescent T cells have pathogenic potential in vascular diseases including hypertension, atherosclerosis, and myocardial infarction, underscoring the detrimental roles of senescent immune cells in vascular injury and dysfunction. In addition, T cell senescence is strongly associated with human cytomegalovirus (HCMV) infection. In the present lecture, HCMV infection and T cell senescence will be discussed in relation to vascular injury and dysfunction.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):23.
OBJECTIVE
This study aims to investigate the causal inference by applying a mendelian randomization (MR) study using single-nucleotide polymorphisms (SNPs) from the genome-wide association study (GWAS) based on the UK biobank.
METHODS
The genetic instruments were chosen from BPV GWAS based on UK Biobank data. Four GWA studies were used for the genetic evaluation of dementia, including (1) The International Genomic of Alzheimer's Project (IGAP) GWAS for dementia; (2) and (3) UK Biobank GWAS for proxy phenotypes of Alzheimer's dementia: the maternal and paternal family history (MFH and PFH-UKBB); (4) A combined GWAS meta-analysis from the abovementioned three GWAS results. The following exclusion criteria were applied for SNPs: (1) confounding SNPs by searching hypertension and artery stiffness GWAS; (2) significant SNPs that are associated with dementia in the datasets; (3) palindromic SNPs with an effect allele frequency between 0.4 and 0.7. Proxy SNPs were manually selected for some SNPs. (4) only SNPs with linkage disequilibrium r2 < 0.01 were selected as genetic instruments, also known as independent SNPs. The effect/reference alleles were checked to ensure the consistency of the base pair between BPV and dementia GWAS, which is also known as data harmonization. After data harmonization, four MR methods were employed to measure the causal effect: IVWMR with random effect, IVW-MR with fixed effect, MR-Egger, and weighted median MR.
RESULTS
Finally, six independent SNPs were chosen as instrument variants for SBPV, and five for DBPV. Significant causal effects of SBPV on dementia were found in the PFH-UKBB dataset, and the odds ratio of dementia per 10-unit increase in SBPV was 1.028, 1.015, and 1.015 for MR-Egger, weighted median, and IVW-MR, respectively (Table 1). In contrast, only one significant result was found for DBPV in MFH-UKBB. No significant results were found on other datasets.
CONCLUSION
Along with the evidence from different observational studies, this GWAS study demonstrates that systolic blood pressure variability is a potential causal risk factor for Alzheimer's dementia, while the evidence from diastolic blood pressure variability is still uncertain.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):23.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):24.
Population cohort studies have consistently demonstrated the significant association between midlife hypertension and dementia. However, studies have also demonstrated a U shaped relationship between blood pressure and dementia in the elderly. In contrast, in randomized studies, there are evidence to suggest benefit of BP control in preventing cognitive decline. Also, the relationship between BP levels and risk of dementia may differ according to the types of dementia. In this talk, we will review the current evidence regarding the association of BP levels with risk of dementia.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):24.
Carotid-femoral pulse wave velocity (CFPWV) measures the stiffness of the aorta and stiffer aortas have been linked to worse cognitive function. However, CFPWV does not capture the stiffness of the proximal aorta, the part closest to the heart and brain. The proximal aorta may be more relevant for cognitive function, because it influences how much pulsatility of blood pressure/flow reaches the small vessels in the brain. Aging and accelerated stiffening of the proximal aorta may increase cerebral microvascular pulsatility and accelerate the development of cerebral small vessel disease, early cognitive impairment and vascular dementia.
We studied two groups of community people without stroke or dementia and measured their aortic stiffness using different methods. In one group of 992 participants (69.5% females; mean age: 67.3 years; education 13.6 years), we used excess pressure integral (XSPI), which is partly determined by the stiffness of the proximal aorta. We found that XSPI, but not CFPWV, was significantly associated with lower scores on Montreal Cognitive Assessment. In another group of 1461 participants (46.4% men, age range 35-96 years, average 59.9±11.8 years), we used aortic characteristics impedance (Zc), which is the stiffness of the proximal aorta. We found that Zc and CFPWV were significantly independently associated with lower scores on Mini-Mental State Examination. Moreover, the association was stronger for Zc than for CFPWV.
Our findings suggest that the stiffness of the proximal aorta is more important than the stiffness of the whole aorta for cognitive function. Therefore, measuring the stiffness of the proximal aorta may help identify people at risk of cognitive impairment and vascular dementia.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):24.
Well control is very important point for chronic disease, e.g. hypertension. Oscillometric measurement is classical method to check blood pressure, but blood pressure measurement using PPG device have various advantages over classic BP measurement. Ring type device using PPG can be a better alternative for classical cuff type BP measurement.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):24.
The radial artery tonometry device to measure hemodynamic parameter includes stroke volume and blood pressure will be introduced. The developed system is equipped with multichannel array transducers and precise moving actuator to apply pressure automatically by a given algorithm.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):24–25.
Temporary postoperative cardiac pacing requires devices with percutaneous leads and external wired power and control systems. This hardware introduces risks for infection, limitations on patient mobility, and requirements for surgical extraction procedures.
In this talk, I would like to introduce a transient closed-loop system that combines a time-synchronized, wireless network of skin-integrated devices with an advanced bioresorbable pacemaker to control cardiac rhythms, track cardiopulmonary status, provide multihaptic feedback, and enable transient operation with minimal patient burden. The result provides a range of autonomous, rate-adaptive cardiac pacing capabilities, as demonstrated in rat, canine, and human heart studies. This work establishes an engineering framework for closedloop temporary electrotherapy using wirelessly linked, body-integrated bioelectronic devices.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):25.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):25.
Because patients with COVID-19 may coexist with VTE, knowing how to prevent VTE in the context of COVID-19, along with treatment for VTE, will be helpful to healthcare professionals. In this lecture, we will learn about the treatment and prevention of VTE in the COVID-19 era.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):25.
Acute deep venous thrombosis (DVT) is a prevalent disease affecting the iliofemoral and/or popliteal region. This thrombotic disorder is often characterized by initial limb symptoms that may be quite severe, but there is also a substantial risk of serious complications such as pulmonary emboli. Long-term anticoagulation is routinely used in the treatment of this disease. It has been estimated that approximately two-thirds of patients with DVT will develop post-thrombotic syndrome, although the severity of symptoms varies considerably.
Catheter-directed thrombolytic therapy has been proven to be effective and safe in the treatment of DVT. Direct delivery of the drug into the thrombus will ensure that the drug is delivered into the thrombus in high concentrations (higher than would be anticipated with systemic delivery) and therefore the thrombolysis and bleeding complications rate can be presumed to be more favorable than with systemic delivery.
Although thrombolysis using drugs is very effective in removing blood clots in blood vessels, it also has several problems. 1) It takes a long drug injection time of 24-48 hours, making it difficult to apply clinically when rapid reopening of blood flow is required. 2) The risk of bleeding due to the systemic effect of the drug increases by continuous drug infusion for a long time, 3) The patient is in pain because they have to lie in bed for a long time, 4) In case the blood vessels are completely occluded, it is difficult to recanalize, and 5) that hospitalization costs increase because you have to stay in the intensive care unit while the drug is injected.
Therefore, mechanical thrombectomy is a method designed to solve the disadvantages of drug thrombolysis. It dissolves or slices blood clots in blood vessels and removes them by suction, so you can remove clots more quickly and save time, and also remove clots that are not soluble in drugs. It can reduce the amount and time of drug injection, prevent complications of dissolving agents, and improve treatment results, providing economic bnenfit.
Since the first publication by Bildsoe in 1989, there are many of mechanical clot removal devices have been developed in the market.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):26.
The Variant Angina Korea (VA-KOREA) registry is a nationwide prospective multicenter registry designed to reflect the real-world clinical data of Korean patients with VSA. A total of 2960 patients with chest pain and suspected VSA who underwent coronary angiography and an ergonovine (EG) provocation test at 11 tertiary hospitals in Korea were consecutively enrolled from May 2010 to June 2015. VSA was diagnosed on the basis of the criteria in the Guidelines for Diagnosis and Treatment of Patients with Vasospastic Angina of the Japanese Circulation Society. The definition of a positive result was total or subtotal (>90% luminal diameter narrowing) occlusion accompanied by ischemic symptoms and/or electrocardiographic (ECG) changes (the positive group). Patients who showed spontaneous total or subtotal coronary spasm on their baseline CAG resolved by nitrate were also included in the positive group. The definition of a negative result was <50% luminal narrowing without ischemic symptoms and ECG changes (the negative group). Additionally, intermediate constriction was defined as 50% to 90% luminal narrowing with or without ischemic symptoms and/or ECG changes (the intermediate group). The primary endpoint is the composite of death from any cause, acute coronary syndrome (ACS), and a new-on-set of symptomatic arrhythmia during the 3-year follow-up.
Among 2960 patients, 1,892 were judged to have positive (definite, 680) and intermediate (1,212) results in their provocation tests. The patients were younger (mean age 55.1 ± 11.3 years) than Japanese cohort (average age of 65.2 years), and 62.1% were male similar to high male ratio of Japanese or Western country reports. There was no sex difference in the occurrence of composite events (log-rank p = 0.649). Interestingly, obesity (body mass index [BMI] ≥ 25 kg/m2) was associated with better prognosis in female VA patients (hazard ration [HR], 0.22; 95% confidence interval [CI], 0.07–0.68; p = 0.008).
Contrary to β-receptor blocker for effort angina, calcium-channel blocker (CCB) is considered the main treatment for controlling angina symptom and improving outcomes in VSA patients. From VA-KOREA data, over 90% of patients were prescribed of CCBs. Diltiazem was the most widely used drug (79.0%) followed by amlodipine (11.1%), nifedipine (5.8%), and benidipine (4.1%). Although there was no statistical difference in terms of composite outcome according to the generation of CCBs (diltiazem and nifedipine vs. amlodipine and benidipine), the incidence of ACS was significantly lower in 2nd generation CCBs group with a person-month incidence rate of 1.66 vs. 0.35 (HR, 0.22; 95% CI, 0.05-0.89; p = 0.034). Interestingly, the use of benidipine showed a significant better control of angina symptom compared with diltiazem for 3 years (odds ratio, 0.17; 95% CI, 0.09-0.32; p < 0.0001 at 3rd year). Benidipine is the least prescribed medication for VSA now, however, there is a chance to improve control of angina symptom with the newer generation drug. VA-KOREA data showed the use of nitrates was a significant risk factor of primary outcome in patients with VSA (HR 1.99; 95% CI, 1.23-3.20; p = 0.005).
From VA-KOREA data, there was no significant difference in composite outcome between the aspirin and control groups (3.1% vs. 4.1%; HR, 1.18; 95% CI, 0.61–2.26; p=0.623). For dual antiplatelet therapy, primary composite outcome was significantly more common in the dual antiplatelets (aspirin plus clopidogrel) group, at 10.8% (14/130), as compared with the non-antiplatelet group, at 4.4% (44/1011), (HR 2.41; 95% CI, 1.32-4.40, p = 0.004). The aspirin-alone appears to be safe because of similar primary and individual event rate compared to the no-antiplatelet agent group (HR 0.96; 95% CI, 0.59-1.55, p = 0.872).
The primary outcome occurred in 32 patients (4.3%) in the statin and 28 patients (3.1%) in the no-statin group. In Kaplan–Meier analysis before and after propensity score matching, there was no significant difference in the cumulative incidence of primary outcomes between both groups.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):26.
Vascular aging results in structural and functional deterioration of the arterial wall with age. Early vascular aging (EVA) occurs earlier than expected, while healthy vascular aging (HVA) or super-normal vascular aging (SUPERNOVA) occurs later, indicating that arterial aging may not follow chronological aging. Arterial stiffness is a key component of vascular aging and a significant indicator of cardiovascular risk. Regular aerobic exercise is an effective approach to prevent or attenuate age-related arterial stiffening. However, the role of resistance training in arterial stiffness is controversial. Combining aerobic exercise with lifestyle modifications is essential in preventing vascular aging. Aerobic exercise is considered the best medicine for vascular health, and scientific evidence supporting its role in attenuating age-related arterial stiffening will be presented.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):27.
중심망막동맥폐쇄 (central retinal artery occlusion, CRAO)는 급성 허혈성 뇌졸중의 한 형태이며, 혈관 관련 이벤트의 위험을 높이는 것으로 알려져 있다. 망막동맥폐쇄는 나이가 들수록 증가하며 위험 인자로는 흡연, 고혈압, 고지혈증, 응고장애, 비만, 당뇨, 그리고심방 세동 등의 심장 질환이 있다. CRAO 환자 중 심장 질환 동반 비 율이 높기 때문에 경흉부 심초음파 검사 및 필요시 경식도 심초음파 검사를 시행하여야 하며 심방 세동 여부에 대한 스크리닝도 필요한 경우가 있다. 또한 응고 체계에 대한 검사 및 패혈성 색전증 등에 대 한 가능성도 검토가 필요하다. 망막동맥폐쇄 환자에서 필요한 검사 및 근거 자료 등에 대하여 살펴보고자 한다.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):27.
In this lecture, the clinical meaning of a significant difference between the measured blood pressure from both arms based on case studies would be discussed.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):27.
Sarcopenia is a pathologic condition defined as a progressive loss of muscle strength (dynapenia), mass (quantity), and function (quality). Visceral obesity results in a loss of muscle mass and strength, and vice versa. Inter or intramuscular fat accumulation promotes a proinflammatory cascade, oxidative stress, lipotoxicity, mitochondrial dysfunction, insulin resistance (IR), and muscle atrophy. Therefore, it is possible for sarcopenia to co-exist with obesity. Sarcopenic obesity (SO) is a new class of obesity and an important phenotype of sarcopenia. Sarcopenia and obesity share common pathophysiologic mechanisms including aging, hormones, and immunologic factors and may act synergistically on cardiometabolic diseases (CMD) than sarcopenia or obesity alone. In addition, the crosstalk between adipokines and myokines leads aggravation of SO and IR.
Recently, the association between SO and cardiovascular disease (CVD) or CMD has received increasing attention. However, there is no consensus between the definition and classification of SO and this gap contributes to inconsistent findings about its association with clinical outcomes.
In this review, I shall discuss the impact and mechanism of SO and IR on CVD and also discuss the available evidence for the implications of SO on CVD at this time.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):27.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):27–28.
Non-alcoholic fatty liver disease (NAFLD) is a significant public health concern, affecting approximately one-third of the global adult population. It is characterized by excessive accumulation of fat in the liver, accompanied by metabolic abnormalities, in the absence of significant alcohol consumption or other known liver diseases.
A growing body of evidence has highlighted the strong association between NAFLD and an increased risk of major cardiovascular events independent of traditional cardiovascular risk factors.
In recognition of its multidisciplinary importance, the nomenclature was changed from NAFLD to metabolic-associated fatty liver disease (MAFLD) in 2020. This updated term requires the presence of metabolic risk factors and eliminates the need for excluding alcohol intake or the presence of other liver diseases during diagnosis. Consequently, the clinical course of MAFLD may differ from that of NAFLD.
Recent studies have indicated a higher global prevalence of MAFLD compared to NAFLD, with MAFLD patients exhibiting a higher prevalence of metabolic comorbidities. Emerging data also suggest that both all-cause and cardiovascular mortality may be higher in MAFLD compared to NAFLD.
In this session, we will discuss the clinical significance of the newly proposed definition of MAFLD from the perspective of a cardiologist.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):28.
Vitamin D, the sunshine vitamin, is essential not only for bone health but also for various other health benefits, including reducing the risk of chronic diseases like cardiovascular diseases or cancers. In its natural form, vitamin D produced in the skin or obtained from the diet is biologically inactive. It undergoes two successive hydroxylations to become biologically active: the first one in the liver on carbon 25, forming 25-hydroxyvitamin D [25(OH)D], and the second one in the kidney on carbon 1, resulting in the biologically active form of vitamin D, 1,25-dihydroxyvitamin D [1,25(OH)2D].
To assess vitamin D status, methods have been developed to measure the levels of these metabolites in the bloodstream. While serum 1,25(OH)2D does not provide reliable information about vitamin D status and can be normal or elevated due to secondary hyperparathyroidism associated with vitamin D deficiency, serum 25(OH)D is considered the primary parameter for evaluating vitamin D status for routine testing in patients without renal disease. However, 1,25(OH)2D measurement may be used to investigate some patients with clinical evidence of vitamin D deficiency and renal impairment, sarcoidosis, or granulomatous diseases with hypercalcemia.
Since vitamin D requirements may vary by individuals, the optimal serum level of 25(OH)D is still controversial. Furthermore, there is no one 25(OH)D level that defines deficiency for all individuals, and results vary by testing method and between laboratories using the same testing methods. Levels are difficult to measure accurately. However, most experts agree that a serum 25(OH)D level of < 20 ng/ml is indicative of vitamin D deficiency, while a level between 21-29 ng/ml is considered insufficient. The goal should be to maintain an individual's level at a level > 30 ng/ml to fully benefit from the various health advantages provided by vitamin D. Levels above 50 ng/ml are too high and might cause vitamin D toxicity. Vitamin D testing is excessively used in clinical practice, despite of the clinical guidelines statements against population screening for vitamin D deficiency. Indeed, the US Preventive Services Task Force (USPSTF) concludes that the overall evidence on the benefits of screening for vitamin D deficiency is lacking. Therefore, the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults cannot be determined.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):28.
Vitamin D is mostly known for its role in intestinal calcium absorption and bone mineralization. Previous studies also reported an association between vitamin D deficiency and risk of hypertension, atherosclerosis, and heart failure. Let's take a look at how vitamin D deficiency is linked to cardiovascular disease risk and what the optimal vitamin D concentration is.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):28–29.
It seems that vitamin D deficiency is a pandemic. However, this phenomenon is due to an extremely high level of serum vitamin D, which corresponds to the recommended dietary allowance (RDA) of vitamin D. There has been a common misconception that the RDA for a certain nutrient is the cut point for its deficiency and that the entire populations must intake at least the RDA amount to achieve bone health. Thus, most people become to be diagnosed with vitamin D deficiency if they take vitamin testing. Also, injected or oral vitamin D supplementation is found to be ineffective for the prevention or treatment of osteoporosis or fractures/falls based on the findings from the meta-analyses of randomized controlled trials. Stop vitamin D screening and supplementation!
Pulse (Basel). 2023 Nov 3;11(Suppl 1):29.
Although measuring vitamin D levels and supplementing with oral vitamin D has become commonplace, no health benefits have been demonstrated in clinical trials. Routine vitamin D supplementation does not extend life, reduce the incidence of cancer or cardiovascular disease, or lower fracture rates.
Decisions about vitamin D testing and supplementation should be based on clinical reasons for an individual patient's risk of vitamin D deficiency. In the Vitamin D and Type 2 Diabetes study, vitamin D supplementation did not significantly reduce the risk of diabetes compared with placebo, but there was a significant benefit in patients with blood 25-hydroxyvitamin D [25(OH)D] levels below 12 ng/mL.
In patients with chronic kidney disease, calcitriol deficiency reduces intestinal absorption of calcium and causes hypocalcemia, which is a major stimulus for PTH secretion. This can lead to secondary hyperparathyroidism and Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Therefore, the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend measuring 25(OH)D levels in patients with stage 3 or higher CKD, suggesting repeat testing and therapeutic intervention based on baseline values, and correcting vitamin D deficiency.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):29.
Chat GPT is a state-of-the-art language model that can be effectively utilized in the medical and academic fields. As a language model, Chat GPT can assist in various tasks, such as natural language understanding and generation, which are crucial in the medical field. With its ability to understand and generate human-like responses, Chat GPT can be used for clinical documentation, medical record keeping, and even patient communication. Additionally, Chat GPT can aid in medical research by analyzing large amounts of medical data and generating insights. It can also assist in medical education by providing students with personalized learning experiences. Overall, Chat GPT's versatility makes it a valuable tool for the medical and academic communities.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):29.
ChatGPT is a state-of-the-art language model developed by OpenAI. It has attracted considerable attention for its remarkable ability to generate coherent and contextually relevant text. However, there are several pitfalls and cautions that need to be considered when using ChatGPT:
1. Factual Accuracy: ChatGPT tends to produce output that may appear highly plausible but lacks factual accuracy. The model relies solely on patterns learned from large amounts of data and has no fact-checking capabilities. Therefore, when using ChatGPT, it is important to critically evaluate and verify the information generated by ChatGPT rather than relying on it alone.
2. Bias in Training data: ChatGPT is vulnerable to bias in the training data. The model learns from a wide range of web texts, which may contain biased content. Also, the model may generate responses that may be perceived as inappropriate, offensive, or harmful. This can result in biased responses. Users should exercise caution and mitigate potential biases when using ChatGPT to ensure fair and unbiased outcomes.
In summary, while ChatGPT offers remarkable capabilities for generating text-based responses, caution must be exercised in its use. Critical evaluation of generated content, addressing biases, ensuring responsible deployment, and implementing safeguards against inappropriate or harmful outputs are necessary to harness the full potential of ChatGPT while minimizing its pitfalls. By considering these issues and working towards their mitigation, ChatGPT can be a valuable tool for various application.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):30.
As the role of artificial intelligence (AI) increased in various fields, the influence of AI also increased in research paper writing. AI has the potential to play a significant role in assisting with the writing of scientific papers. Google's conversational AI Bard answered that “AI can be used to help with a variety of tasks, such as generating new ideas for research papers by analyzing large datasets of scientific literature, writing the text of a scientific paper, including the introduction, methods, results, and discussion sections, checking for plagiarism in scientific papers by comparing the text of the paper to a large database of other papers, and formatting scientific papers according to the style guidelines of a particular journal.”
In contrast, there are many ethical concerns about the use of AI in scientific paper writing. In particular, the emergence of fake papers and systematic manipulation of papers have led to the need to upgrade tools to detect research integrity and research irregularities. The COPE (Committee on Publication Ethics) Forum (March 23, 2023) discussed various ethical issues in writing papers using AI including the questions about whether it is acceptable and ethical practice for authors to write academic papers using AI. COPE has joined organizations such as WAME (World Association of Medical Editors) and JAMA Network, stating that AI tools cannot be listed as authors of the paper.
COPE position statement denotes that “AI tools cannot meet the requirements for authorship as they cannot take responsibility for the submitted work. As non-legal entities, they cannot assert the presence or absence of conflicts of interest nor manage copyright and license agreements.”
The use of AI in scientific paper writing is a complex issue with both potential benefits and risks. It is important to be aware of the limitations of AI and to use it in a responsible way.
WAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications are well summarizing the issues as follows:
“1. Chatbots cannot be authors.
2. Authors should be transparent when chatbots are used and provide information about how they were used.
3. Authors are responsible for the work performed by a chatbot in their paper (including the accuracy of what is presented, and the absence of plagiarism) and for appropriate attribution of all sources (including for material produced by the chatbot).
4. Editors need appropriate tools to help them detect content generated or altered by AI and these tools must be available regardless of their ability to pay.”
Pulse (Basel). 2023 Nov 3;11(Suppl 1):33.
OBJECTIVE
Association of pulse pressure (PP) variability and kidney function in living kidney donors (LKD) is unknown. We aim to evaluate the association between PP variability and kidney function post-donation.
DESIGN AND METHOD
A retrospective cohort study using OPTN/SRTR database including adult LKD undergoing donation between 6/1972 and 9/2022 was utilized. PP variability was assessed by average real variability of PP (ARV-PP) defined as an average of absolute difference in consecutive PP at 6, 12, and 24 months post-donation. Risk of ≥35% decline in postdonation estimated glomerular filtration rate (eGFR) from predonation eGFR among quartiles (Q) for AVR-PP was examined by multivariable Cox proportional hazard regression analysis.
RESULTS
Of 136,984 LKD, mean±SD age was 42±12 years and 61% were female. Mean pre-donation and 6-, 12-, and 24-month post-donation SBP, DBP, and PP were shown in Table 1. Median (IQR) ARV-PP was 7.5 (4, 12) mmHg. Mean pre-donation eGFR was 102.1±29.1 mmHg and eGFR at 6-, 12-, and 24-months post-donation were 60.7± 42.6, 62.4±43.9, and 64.4±44.9 mmHg respectively (Figure 1A). The incidence rate of the event was 8.2 per 100 person-months and the median free of the event was 5.9 months after donation. Compared to Q1 of the ARV-PP, only Q3 and Q4 had a 4.5-5.6% higher risk for declined eGFR (HRQ3 (95%CI) 1.05 (1.01, 1.08), P 0.015 and HRQ4 1.06 (1.02, 1.09), P 0.003; Figure 1B). After adjusting for age, gender, race/ethnicity, U.S. citizenship status, level of education, history of hypertension, pre-donation BMI, PP, eGFR and post-donation proteinuria, Q2 and Q4 have a 7.1% and 6.9% significantly greater risk of the event (HRQ2 1.070518 (1.01, 1.13), P 0.012 and HRQ4 1.07 (1.01, 1.13), P 0.015). There is no effect modification of the covariates for the association between ARV-PP and ≥35% decline in post-donation eGFR.
CONCLUSIONS
Higher ARV-PP is associated with a higher risk for a 35% decline in post-donation kidney function. Variation in elevated SBP or low DBP may contribute to kidney function in the setting of glomerular hyperfiltration after unilateral nephrectomy.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):33–34.
OBJECTIVE
COVID-19 infection is associated with persistent impaired endothelial function, but it remains unclear whether individuals with post-acute sequelae of COVID-19 (PASC) also exhibit impaired endothelial function. Furthermore, the role of exercise training in restoring endothelial function in this population is not well understood. The aim of this study was to investigate whether individuals with PASC exhibit lower endothelial function compared to healthy individuals, and whether combined exercise training can restore endothelial function in individuals with PASC.
DESIGN AND METHOD
We employed two approaches. Protocol II involved a cross-sectional study comparing endothelial function between individuals with PASC (n=20, aged 22.8±3.2 years) and healthy individuals (n=42, aged 21.7±2.0 years). Protocol II, an intervention study, aimed to determine if combined exercise training could partially reverse the decline in endothelial function associated with PASC. Twenty individuals with PASC were randomly assigned to either the combined exercise group (EX; n=10), which underwent aerobic, resistance, and inspiratory muscle training three times per week for 8 weeks, or the control group (CON; n=10). Endothelial function was measured by flow-mediated dilation (FMD) of the brachial artery. Cardiorespiratory fitness, indicated by VO2peak, and patient-reported symptoms of dyspnea and fatigue were also evaluated at baseline and after the 8-week intervention.
RESULTS
Firstly, individuals with PACS exhibited significantly lower FMD compared to healthy individuals (4.74±1.5% vs 8.00±2.3%, p0.001). Secondly, EX group showed a significant increase in FMD (EX: 4.63±1.7% to 8.32±2.5%, CON: 5.05±1.5% to 6.07±1.8%, interaction effect: p=0.015), reaching levels similar to those of the healthy individuals. In addition, the EX group demonstrated a significant increase in VO2peak (39.0±7.3ml/min?kg to 44.9±7.6ml/min?kg, p0.001) and improvements in dyspnea and fatigue symptoms compared to the CON group (p0.05).
CONCLUSIONS
These findings indicate that individuals with PASC have lower endothelial function compared to healthy individuals, but combined exercise training can effectively restore endothelial function in individuals with PASC. Therefore, exercise training may serve as an effective lifestyle intervention to improve vascular function in individuals with PASC.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):34–35.
OBJECTIVE
In the arterial tree, a pressure gradient of the systolic blood pressure (SBP) is observed from the center to the periphery, with the pressure being higher in the periphery because of pressure wave reflection. However, this gradient is attenuated, with elevation of the central SBP (cSBP), in cases with abnormal pressure wave reflection in the arterial tree. It remains unclear if increase of the cSBP might be an independent risk factor for accelerated progression of arterial stiffness. We conducted this prospective observational study using latent growth curve model (LGCM) analyses to examine if elevated cSBP might be an independent risk factor for accelerated progression of the arterial stiffness in middle-aged Japanese men.
DESIGN AND METHOD
In this 9-year prospective observational study, we analyzed the data of 3862 middle-aged Japanese men (43±10years old) without cerebrocardiovascular disease at the study baseline who had undergone repeated annual measurements of the brachial-ankle pulse wave velocity (baPWV) and cSBP, as represented by the second peak of the radial pressure waveform (SBP2) in radial pressure waveform analysis.
RESULTS
During the follow-up period (6.3±2.5years), significant increases of both the baPWV and SBP2 were observed in all the subjects. Analysis using the LGCM confirmed that the SBP2, a marker of the cSBP (B=0.260, P 0.001), was a significant determinant of the slope of the annual changes of the baPWV during the study period.
CONCLUSIONS
Our finding may consolidate that elevated cSBP is an independent risk factor for accelerated progression of the arterial stiffness in middle-aged Japanese men.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):35.
OBJECTIVE
Chronic venous insufficiency (CVI) is a condition of the venous wall and/or valves' dysfunction in the leg veins prone to venous thrombosis and reducing quality of life. This study sought to find risk factors of CVI and develop a dedicated risk score model to predict the presence of chronic venous insufficiency in patients who experience leg edema.
DESIGN AND METHOD
In a total of 1,226 patients (age 65.2±15.0, 662 women) with leg swelling, specialized protocols for venous function tests were applied for diagnosis of CVI in a single center vascular ultrasound laboratory from Mar 2015 to Dec 2020 after exclusion of the presence of deep vein thrombosis. Duplex ultrasound scan on the greater and lesser saphenous veins was performed with patients erect or as upright as possible. Using a tilt table, patients' position was flexibly changed. For the distal augmentation to assess for venous incompetence, we used the Hokanson® E20 Rapid Cuff Inflator. Pathologic reflux is defined by reversal of flow greater than 500 milliseconds in duration. The new CVI scoring system was calculated from logistic regression model. The VEINscore were compared with cardiovascular risk scoring system established for other purposes.
RESULTS
The 607 patients (49.5%) were diagnosed with CVI. The final risk score ranged from 0 to 6 points and included six parameters: age ≥ 65 years, male sex, obesity (body mass index ≥ 25 kg/m2), hypertension, atrial fibrillation, and a history of myocardial infarction, which were derived from the results of logistic regression model (Figure A). The incidence of CVI gradually increased from 39% to 100%, as the score increased from 0 up to 6 points (Figure B). The new scoring system showed modest predictive value (C-index: 0.575, 95% CI: 0.544-0.606, cut-off value 3), higher than the CHA2DS2-VASc score and H2FPEF score.
CONCLUSIONS
Old age, male sex, obesity, history of atrial fibrillation and myocardial infarction were significant risk factors for CVI. We propose VEIN-SCORE as a dedicated risk score model to predict chronic venous insufficiency in patients with leg swelling.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):35–36.
OBJECTIVE
Pressure pulse waveform analysis is generally classified into the systolic analysis (using augmentation index) and diastolic analysis (using time constant). However, the diastolic waveform exhibits not only an exponential decay but also a transient elevation in mid-diastole (the dicrotic wave), while the latter mechanistic origin remains unclear. This study focused on a difference between the actually measured diastolic pressure waveform and the approximated mono-exponential decay, called the residual pressure waveform, to examine its determinant factors and association with flow pulse waveform.
DESIGN AND METHOD
Femoral pressure and flow pulse waveforms were recorded non-invasively in 592 patients with hypertension (55±14 years). The intra-diastolic pressure fluctuation was quantified as the residuals against the estimated mono-exponential curve. The residual curve had a negative peak in early diastole and a positive peak in mid-diastole; the pressure difference between these peaks was divided by the pulse pressure (PP) for standardization to calculate the diastolic pressure fluctuation index (PFId). The flow velocity waveform had a reverse peak in early diastole and a forward peak in mid-diastole; the peak velocity difference was divided by the total velocity pulse amplitude to calculate the diastolic flow fluctuation index (FFId). Additional pressure waveform recordings were made on the carotid, radial, and dorsal pedis arteries to measure the peripheral/aortic pulse wave velocity (PWV) and PP amplification ratios.
RESULTS
Close resemblances were found between the femoral diastolic residual pressure and flow waveforms. PFId and FFId were highly correlated (r=0.63). The flow peaks were temporally corresponding but precedent to the pressure peaks (P0.001). In multivariate-adjusted models, higher peripheral/aortic PWV and PP ratios were independently associated with greater PFId and FFId (P0.001). Mediation analysis showed the associations of PWV and PP ratios with PFId to be mediated by FFId [indirect/total effect ratio: 54 (30-100)% and 57 (42-80)%, respectively].
CONCLUSIONS
Diastolic pressure fluctuation responsible for dicrotic wave results from biphasic flow fluctuation, which depends on the stiffness and pressure gradients between the aorta and peripheral arteries. Aortic stiffening-induced reversal of the stiffness gradient may thus reduce diastolic runoff and thereby cause ischemic organ damage.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):36.
OBJECTIVE
This study aimed to investigate the association between domain-specific physical activity (PA), sedentary behavior (SB), and depressive symptoms among patients with cardiovascular disease (CVD).
DESIGN AND METHOD
This cross-sectional study analyzed 3,591 patients with CVD from the Korean National Health and Nutrition Examination Survey 2016, 2018, and 2020. Domain-specific PA (work, transport, and leisure PA) and SB were measured using a global PA questionnaire (G-PAQ). Depressive symptoms were assessed using the Patient Health Questionnaire?9 Korean version (PHQ-9K). We used a logistic regression to estimate the odds ratios (ORs) and their associated 95% confidence interval (CI) after adjusting for potential confounding parameters.
RESULTS
Participation of leisure PA is associated with lower prevalence of depressive symptoms (p for trend 0.001). Compared with participants with no leisure PA, participants with 1-175 and more than 176 min of leisure PA per week have 50% and 34% lower odds of having depressive symptoms. On the other hand, compared with participants with no work PA, participants with any work PA have about 3 times higher odds of having depressive symptoms. These associations remained significant even after adjusting for all covariates. The higher SB is also associated with higher odds of having depressive symptoms (ORs: 2.07, 95% CI: 1.34-3.22). These associations remain similar when stratified analyses were performed according to confounding factors (sex, income and economic activity status).
CONCLUSIONS
While higher leisure PA and lower SB levels are associated with lower odds of having depressive symptoms, higher work PA is associated with increased odds of depressive symptoms. These domain specific PA association with prevalence of depressive symptoms in people with history of CVD may suggest tailored domain specific PA program is needed according to their current PA participation type and times.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):36–37.
OBJECTIVE
Arterial stiffness is underappreciated in patients with aortic stenosis (AS) despite its contribution to increased left ventricular afterload in addition to valvular obstruction. Nitroglycerin (GTN) reduces arterial stiffness measurements by attenuating wave reflection, and we aimed to assess its effect on circulatory energy consumption in AS patients and those treated with transcatheter aortic valve replacement (TAVR).
DESIGN AND METHOD
Simultaneous aortic pressure and flow were obtained non-invasively using radial applanation tonometry calibrated to brachial cuff pressure and cardiac magnetic resonance phase-contrast imaging, with data acquisition at baseline and 10 minutes after 300mcg of sublingual GTN administration. Parameters of wave reflection were derived using SphygmoCor 8.1. Aortic characteristic impedance (Zc), pulsatile energy consumption (PEC), steady state power consumption (SEC) and circulatory afterload pulsatile efficiency (CAPE) were calculated in the frequency domain after a Fourier analysis of pressure and flow data.
RESULTS
Thirty-four patients (12 controls, 11 AS and 11 post TAVR) aged 79±6 years were assessed. In all patients, GTN reduced mean aortic pressure, stroke volume, augmented pressure, and magnitude of forward and reflected backward waves, but systemic vascular resistance (SVR) remained unchanged. Heart rate increased to maintain cardiac output in both the AS (69±13vs74±15, P=0.01; 4.3±0.8vs3.9±0.9L/min, P=0.18) and TAVR (60±9vs65±8, P0.01; 4.8±1.0vs4.5±1.1L/min, P=0.12) cohorts, but not in the controls (65±9vs68±8, P=0.21; 4.8±1.3vs4.2±1.3L/min, P0.01). Zc was unchanged in controls after GTN (116±30vs107±59dynes.s/cm5, P=0.56) but reduced in AS (181±94vs92±44dynes.s/cm5, P=0.01) and TAVR (111±43vs81±36dynes.s/cm5, P0.01) cohorts. Both PEC and SEC reduced after GTN, but the overall circulatory efficiency remained unchanged across all 3 groups (86±5vs85±3% controls, 85±10vs83±13% AS, 82±8vs82±11% TAVR, all P0.05).
CONCLUSIONS
Low dose sublingual GTN reduced vascular impedance and wave reflection without changing SVR and cardiac output in AS patients. The altered aortic flow profile in AS may lead to downstream vascular remodelling and increase arterial sensitivity to GTN-mediated afterload reduction, resulting in compensatory heart rate elevation and maintenance of cardiac output, with changes persisting post TAVR. CAPE remained unaltered although GTN reduced PEC and SEC, suggesting that CAPE is a marker of intrinsic vascular property independent of wave reflection.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):37–38.
OBJECTIVE
Coronary slow flow is an angiographic phenomenon defined as a decrease in thrombolysis in myocardial infarction (TIMI) grade resulting poor prognosis during the percutaneous coronary intervention (PCI). Many factors have been proposed to cause coronary slow flow, but the mechanisms are unclear. This study aimed to investigate the association between coronary slow flow and lipid burden in patients with coronary artery disease (CAD) by Near Infrared Spectroscopy (NIRS).
DESIGN AND METHOD
We retrospectively analyzed patients with CAD who performed intravascular ultrasound (IVUS) and NIRS during coronary angiography between September 2021 and August 2022. The lipid core burden index (LCBI) for the 4-mm segments at the target lesion was calculated by NIRS. We divided the patients into 2 groups based on whether they had slow flow (TIMI less than 3) or not. Age and anthropometric, echocardiographic, and angiographic data were collected, and logistic regression analysis was performed to identify predictive factors for coronary slow flow.
RESULTS
We enrolled 262 patients (61 years-old; male, 225) and NIRS was taken in 309 vessels. Coronary slow flow occurred in 20 (6.5%) patients, and mean target LCBI by NIRS was 127.5±128.9. Target LCBI significantly higher in the slow coronary flow group than normal flow group (p0.001, Table 1). Logistic regression analysis showed that age and target LCBI were significant predictors for coronary slow flow (p=0.038; p=0.011, Table 2).
CONCLUSIONS
Increased lipid burden is independently associated with coronary slow flow during PCI in patients with CAD. Caution should be needed with reperfusion during PCI in high-risk patients with high lipid burden.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):38.
OBJECTIVE
Acute myocardial infarction cases requiring urgent coronary revascularization are frequently underdiagnosed in real-world clinical practice. This study sought to develop a deep learning algorithm for swift identification of patients requiring urgent coronary revascularization in the emergency room (ER), leveraging the Emergency prognosis models using a federated learning platform (ELF). This methodology offers a solution to privacy and security challenges faced while integrating multicenter data for deep learning.
DESIGN AND METHOD
Utilizing patient data from the tertiary hospital between 2015 and 2020, we applied multilayer perceptron (MLP) on the ELF platform. The study incorporated data from 66,489 ER visitors who underwent a 12-lead electrocardiography (ECG) within 24 hours of admission, dividing them into development (59,840 patients) and validation (6,649 patients) datasets. We examined chief complaints, 12-lead ECG, and additional clinical data, intentionally excluding cardiovascular and ER-specific variables such as CK-MB, d-dimer, cardiac troponins, NT-proBNP, ER triage scale for broad clinical applicability. Variables for input data in the model were chosen based on SHAP values, and the established model underwent validation via a 5-fold cross-validation process.
RESULTS
The final algorithm, which integrates a selection of 4 chief complaints, 11 ECG variables, and 23 clinical variables, was ultimately optimized using the MLP model. Initial validation demonstrated moderate performance (accuracy 0.72, recall 0.75, AUROC 0.80). However, missing value imputation markedly improved accuracy (0.84) and AUROC (0.86). Data enrichment with the generation of cardiovascular specific and ER-specific variables further elevated the performance (accuracy 0.88, recall 0.70, AUROC 0.89).
CONCLUSIONS
The developed algorithm emerged as a practical clinical decision support system, capable of estimating the necessity for urgent cardiovascular intervention beyond mere clinical diagnosis. Importantly, it is applicable even in scenarios lacking some input data, including cardiovascular and ER-specific variables. The algorithm holds promise for serving as a valuable gate-keeper in the absence of cardiovascular specialists or emergency medicine doctors.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):42.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):42.
OBJECTIVE
Age-related arterial stiffness provides an additional afterload in aortic stenosis (AS) patients to the valvular obstruction. Transcatheter aortic valve replacement (TAVR) is an effective treatment for AS by reducing the load placed on the left ventricle (LV) by the stenotic valve. The effect of baseline trans-aortic valve mean gradient (MG) and flow rate (TFR) on the effect of arterial stiffness following TAVR on arterial stiffness assessed by aortic pressure augmentation index (AIx) is not well understood.
DESIGN AND METHOD
Radial tonometric pressure was acquired in moderate-to-severe symptomatic AS patients at baseline and after treatment with TAVR, calibrated to brachial cuff pressure. Aortic pressure was derived using SphygmoCor 8.1 (AtCor Medical, Sydney) from radial pressure waveforms. Aortic wave reflection indices were calculated. Subsequently, TFR and MG were assessed by transthoracic echocardiography.
RESULTS
Twenty patients aged 80±6 years (8 females) with a MG of 37±12mmHg were assessed at baseline and a median of 60 days post-TAVR. The mean arterial pressure (99±13vs98±11mmHg) were comparable at baseline and post TAVR. There was a significant reduction in pressure AIx following TAVR (36±8vs30±8%, P0.01) across the entire cohort, primary driven by those patients with MG greater than median (33±7vs27±6mmHg, P=0.03). When assessed by mean TFR, this effect on AIx was not observed in either the cohort above the median (33±9vs30±10%, P=0.33) or below (33±8vs37±6%, P=0.34).
CONCLUSIONS
In patients with AS, TAVR resulted in a reduction of pressure AIx which is most pronounced in patients with the highest MG at baseline, demonstrating the potential contribution of vascular function to traditional measurements of aortic stenosis severity.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):42–43.
OBJECTIVE
Ventricular-arterial coupling (VAC) has an important role in the pathophysiology of coronary artery disease and heart failure. The association of VAC with left ventricular (LV) function in patients with acute myocardial infarction (AMI) was investigated in this study.
DESIGN AND METHOD
Echocardiographic indexes of LV volumes, systolic function, and diastolic function were measured in the usual way. Effective arterial elastance (EA) was calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (ELV) was obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. RESULTS Eight-five patients (age 58.5±10.6 years) with AMI were enrolled. They were grouped as patients with reduced EF (rEF, 50%; n=27) and preserved ejection fraction (pEF, ≥50%; n=58). In patients with rEF, EA (2.14±0.55 vs. 1.84±0.51 mmHg/mL; P=0.017) and VAC (1.18±0.22 vs. 1.02±0.22; P=0.002) were increased, but peripheral and central systolic blood pressure, ELV and Zc were not different. In multiple linear regression analysis, VAC was significantly associated with E' velocity (beta −0.36, P=0.001) and Zc (beta 0.33, P=0.019), but neither with EF nor left ventricular longitudinal strain. The association between VAC and E' velocity was significant in patients with pEF (beta −2.64, P=0.011), but not in patients with rEF.
CONCLUSIONS
VAC was associated with LV diastolic dysfunction in AMI patients with pEF, but not with rEF. Figure
Pulse (Basel). 2023 Nov 3;11(Suppl 1):42.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):42.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):42–43.
OBJECTIVE
Non-alcoholic fatty liver disease (NAFLD) is a prevalent metabolic disorder associated with cardiovascular disease (CVD). While the positive relationship between fatty liver index (FLI), a marker of NAFLD, and hypertension has been studied in the general population, evidence in prehypertensive groups is limited. We investigated the association between FLI and incident hypertension and CVD outcomes in a large cohort of adults with suboptimal blood pressure (BP).
DESIGN AND METHOD
We analyzed 179,028 healthy Korean subjects from the National Health Insurance Service-National Sample Cohort (2009-2014) without traditional risk factors. Primary outcomes were new-onset hypertension and major adverse cardiac and cerebrovascular events (MACCE) in prehypertensive adults. The association between FLI and the primary outcomes was assessed by multivariate Cox proportional hazards regression analysis.
RESULTS
A total of 20,306 subjects (25.95%) developed new-onset hypertension during a median follow-up of 8.3 years. Subjects were divided into two groups based on BP and categorized into FLI quartiles. New-onset hypertension was significantly higher in the high-normal BP group than the normal BP group (p0.0001). A linear association was observed between higher FLI values and increased incidence of hypertension. Adjusted multivariable models showed hazard ratios of 2.321 (95% CI, 2.190?2.461) and 1.944 (95% CI, 1.856?2.036) for incident hypertension in the highest versus lowest FLI quartiles in the normal BP and high-normal BP groups, respectively. During a median 9.1-year follow-up, there were 1,820 cases (2.33%) of MACCE. MACCE occurrence was significantly associated with FLI quartile values. MACCE was more frequent in the high-normal BP group than the normal BP group. Individuals with higher FLI had a greater incidence of MACCE compared to those with lower FLI.
CONCLUSIONS
Higher FLI was independently associated with development of hypertension and MACCE in prehypertensive Korean adults without traditional risk factors. FLI may serve as an important predictor of new-onset hypertension and adverse cardiovascular outcomes.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):44.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):44.
OBJECTIVE
This research sought to determine the ideal quantity of blood pressure (BP) measurements required for a clinically relevant calculation of blood pressure variability (BPV), an independent cardiovascular event risk factor in hypertensive patients.
DESIGN AND METHOD
Electronic health records from three Korean tertiary hospitals were examined, analyzing 4,591 hypertensive patients, treated with at least two anti-hypertensive medications between January and December 2017. These patients recorded a minimum of nine BP measurements over a two-year monitoring period, with no incidence of myocardial infarction or stroke. The Coefficient of Variation (CV) of systolic BP was calculated to estimate BPV, producing CV values corresponding to 3, 5, 7, and 9 BP measurements. During the subsequent three-year period, we monitored major adverse cardiovascular events (MACE; heart failure hospitalization, myocardial infarction, stroke, cardiovascular death). The area under the Receiver Operating Characteristic (ROC) curves and multivariable Cox regression analysis were used to authenticate the optimal BPV measure for MACE prediction.
RESULTS
CV values generated from 3, 5, 7, and 9 BP measurements were 7.7, 8.3, 8.6, and 8.7, respectively, indicating an upward trend with increased measurements. The area under the ROC curves of MACE for varying numbers of BP measurements did not significantly differ, leading us to opt for three measurements. The Youden index-calculated optimal CV cut-off value of 7.53 was approximated to a clinical cut-off of 8. Patients were stratified based on CV derived from three measurements (CV-S3), revealing that those with a CV-S3 of 8 or more had a significantly higher 3-year incidence of MACE (144/1695 (8.5%) vs 189/2896 (6.5%), p-value 0.01). Furthermore, multivariable analysis identified CV-S3 as an independent MACE predictor.
CONCLUSIONS
For hypertensive patients, our findings suggest that three BP measurements are sufficient for BPV estimation. Moreover, a CV-S3 cut-off value of 8 can serve as an indicator of a higher risk of cardiovascular events.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):45.
OBJECTIVE
This study aimed to determine the relationship between obesity and other risk factors with hypertension in older people in Indonesia.
DESIGN AND METHOD
This research is a cross-sectional study with 4389 elderly aged over 60 years included in this study using secondary data analysis IFLS-5. Hypertension is defined as someone diagnosed with hypertension by a healthcare professional. The smoking behavior using questionnaire included questions about smoking habits. The physical activity questionnaire resulted from a translation from the International Survey on Physical Activities Questionnaire (IPAQ), which measured by asking what type of physical activity respondents had performed during at least 10 minutes in the past week. The sleep quality questionnaire modified from Patient Reported Outcomes Measurement Information Systems (PROMIS), which contained data on respondents' sleep experiences over the past week. The food security status using questionnaire resulted from a modified FFQ questionnaire, which asked ten types of food respondents had consumed over the past week. The Seca plastic height board scale model and weight measurement using the Camry EB1003 digital weight scale are used for height measurement. Chi-Square test and multivariate logistic regression were used for analysis.
RESULTS
The characteristic of respondents were mostly aged 60-74 years (87,5%), female (51%), and education level of 9 years (85,4%). The prevalence of hypertension was 27,5%. Most of the respondents did not have smoking behavior (55,3%), light to moderate physical activity (62,4%), poor sleep quality (83,4%), poor food security status (95,5 %), and did not obese (72,5%). Multivariate analysis showed that BMI, sex, sleep quality, and level of education had a significant association with hypertension (p 0,05). The dominant risk factor of hypertension was obesity (p = 0,000; OR = 1,778).
CONCLUSIONS
Obesity was found as a dominant risk factor associated with hypertension in older People in Indonesia. Obese elderly have a 1.7 times higher risk of developing hypertension. Female has a 1.6 times higher risk of developing hypertension. Having low education level is more at risk of developing hypertension 1.5 times. Elderly who have good sleep quality have a lower risk of developing hypertension.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):45–46.
OBJECTIVE
The aim of this study is to investigate the association between arthritis and four components of metabolic syndrome (hypertension, obesity, dyslipidemia, and diabetes mellitus) in Indonesian elderly individuals.
DESIGN AND METHOD
This was a cross-sectional study with data collected from the fifth wave of the Indonesian Family Life Survey carried out in 2014-2015. After applying sampling weight adjustments, a total of 3493 participants aged 60 years and older who resided in various regions of Indonesia are included in this study. Variables of interest are collected using yes/no interview questions which the participants should answer based on a previous medical diagnosis from a health worker. The association were tested using chi-square and multivariate logistic regression and reported as an odds ratio.
RESULTS
Arthritis was observed in 12.8% of the sample population. Among the elderly individuals, the prevalence of central obesity, hypertension, dyslipidemia, and diabetes mellitus was 44.1%, 28.4%, 8.2%, and 7.8%, respectively. The results of the multivariate analysis show a significant relationship between three components of metabolic syndrome: obesity, hypertension, and dyslipidemia toward arthritis (p0.05). Notably, hypertension emerges as the most prominent risk factor of arthritis among all the variables investigated in this study (OR 2.131; 95% CI 1.723 − 2.636).
CONCLUSIONS
The results of this study reveal a significant relationship between three metabolic syndrome components, specifically obesity, hypertension, and dyslipidemia on arthritis. As a result, initiating a timely and comprehensive intervention targeting these modifiable metabolic risk factors, particularly hypertension, could act as a potential strategy in reducing arthritis rates in the elderly.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):46.
OBJECTIVE
Multiple lipid parameters have been suggested to predict cardiovascular diseases. This study aimed to compare the association between multiple lipid parameters at baseline and average values over time and the risk of coronary artery calcification (CAC) in a Korean cohort.
DESIGN AND METHOD
Participants who underwent annual (biannual) health examinations and a coronary artery computed tomography to measure CAC at least twice between March 2010 and December 2019 with a baseline CAC=0 were included. Apolipoprotein B (ApoB), Apolipoprotein A-I (ApoA1), ApoB/ApoA1, non-high-density lipoprotein (non-HDL), low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), TG/HDL, TC/HDL, Remnant cholesterol (RC) was calculated. Average lipid parameters before study entry were calculated using data from 2002 to 2010. Participants were divided into quartiles (Q) according to parameter values. Cox proportional hazard modeling with confounding factors adjustment was performed
RESULTS
Among 29,278 participants (mean age, 39.19±5.21; men, 88.27%), 2,779 developed CAC0. Among the lipid parameters, ApoB had the strongest association with CAC risk (Q1: reference; Q2: HR,1.41, 95% CI,1.25?1.59; Q3: HR,1.97, 95% CI,1.75?2.21; Q4: HR,2.72, 95% CI,2.41?3.07). RC showed a modest association with CAC risk (Q1: reference; Q2: HR,1.13, 95% CI,0.99?1.28; Q3: HR,1.3, 95% CI,1.15?1.47; Q4: HR,1.7, 95% CI,1.51?1.91). The strength of the association was comparable between the parameters at baseline and average lipid parameters over time.
CONCLUSIONS
RC was a weaker predictive marker for CAC than ApoB. A lipid parameter at baseline can predict CAC development with a strength similar to the average of multiple measurements.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):47.
OBJECTIVE
Metabolic syndrome is closely related to cardiovascular disease, with insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) being significant contributors to metabolic syndrome and crucial determinants of cardiovascular outcomes. This study evaluated the usefulness of the metabolic indices, NAFLD and IR indices as predictive tool for overall cardiovascular disesase in middle-aged Korean adults.
DESIGN AND METHOD
The study obtained prospective data from the Ansung-Ansan cohort database, excluding participants with major adverse cardiovascular and cerebrovascular events (MACCE). The primary outcome was the incidence of MACCE identified during the follow-up period.
RESULTS
A total of 9,337 participants were included in the analysis, of whom 1,130(12.1%) experienced MACCE during the median follow-up period of 15.5 years. The 10-year atherosclerotic cardiovascular disease (ASCVD) score was found to be the most effective index for predicting MACCE events at 10 years, with a sensitivity of 0.768 and a specificity of 0.546. Moreover, the metabolic syndrome severity Z-score has an area under the curve value of 0.619, which was closest to the predictive power of the 10-year ASCVD risk score. The metabolic syndrome severity Z-score, metabolic syndrome severity score, Hepatic steatosis index, and NAFLD liver fat score were all found to significantly predict MACCE at values above the cut-off point and in the second and third tertiles. Among these indices, the odd ratios (ORs) of the metabolic syndrome severity score and metabolic syndrome severity Z-score were the highest [ORs 1.794, 95% CI 1.507-2.135); ORs 1.730, 95% CI 1.463-2.044] after adjusting confounding factors.
CONCLUSIONS
The metabolic syndrome severity score emerges as a highly reliable indicator, closely associated with the 10-year ASCVD risk score in predicting MACCE in the general population. Nonetheless, given the specific characteristics and limitations of metabolic syndrome severity scores, as well as indices of IR and NAFLD, a more practical scoring system that considers these factors is essential to achieve greater accuracy in forecasting cardiovascular outcomes.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):47.
OBJECTIVE
Metabolic syndrome (MetS) is associated with vascular dysfunction such as arterial stiffness. The carotid? femoral pulse wave velocity, which is considered the gold standard method for assessing arterial stiffness, can be estimated using two commonly assessed clinical variables? age and blood pressure. This study aimed to evaluate the association of estimated pulse wave velocity (ePWV) with incident MetS among Korean adults.
DESIGN AND METHOD
Using a dataset from the Ansan-Ansung Cohort Study of the Korean Genome and Epidemiology Study, 9,722 adults aged 40?69 years were followed up for over 18 years. They were subdivided into 3 tertile groups according to the ePWV.
RESULTS
The prevalence of metabolic syndrome was 9.0% in the first (lowest) tertile, 29.1% in the second tertile, and 42.0% in the third (highest) tertile of ePWV at baseline. During the follow-up period, 2,906 (40.8%) cases of incident MetS were identified. After adjusting for clinically relevant variables, participants in the second tertile (adjusted hazard ratio [HR], 1.322; 95% confidence interval [CI], 1.188?1.471) and participants in the third tertile (HR, 1.524; 95% CI, 1.330?1.747) had a significant higher risk of incident MetS than those in first tertile of ePWV.
CONCLUSIONS
The ePWV is expected to serve as a potential marker for identifying high-risk groups for developing MetS.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):49.
OBJECTIVE
Estimated pulse wave velocity (ePWV) serves as a simple surrogate estimate of carotid?femoral pulse wave velocity, which is considered the gold standard for assessing aortic stiffness. It has been shown to predict cardiovascular events in the general population. However, there is limited data regarding its predictive capacity for cardiovascular events specifically in the obese population. Therefore, the aim of this study was to examine the independent association between ePWV and cardiovascular events in the obese population.
DESIGN AND METHOD
Using a dataset from the Ansan-Ansung Cohort Study of the Korean Genome and Epidemiology Study, 4,129 adults aged 40?69 years with obesity (BMI ≥25) were followed up for over 18 years. The cut-off value for the high ePWV group was defined as ‘ePWV ≥8.892 m/s’. This value was determined to be the optimal cut-off point for distinguishing between subjects with events and event-free subjects, as obtained from the time-dependent receiver operating characteristic curve at the 16-year. Cox proportional hazard models were used to estimate the risk of cardiovascular events (composites of cardiovascular death, myocardial infarction, coronary artery disease, stroke, heart failure, and peripheral artery disease).
RESULTS
The incidence of cardiovascular events was 22.5% in the high ePWV group and 7.6% in the low ePWV group. After relevant covariate adjustments, the subjects in the high ePWV group showed a significantly higher risk of cardiovascular events (adjusted hazard ratio [HR], 1.582; 95% confidence interval [CI], 1.182?2.118) than those in low ePWV group.
CONCLUSIONS
The ePWV is anticipated to function as a potential marker for identifying high-risk groups for cardiovascular events in the obese population.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):48.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):48–49.
OBJECTIVE
The objective of this study was to better understand age- and sex-specific pulse wave velocity (PWV) in a normotensive population. Despite the common practice of measuring PWV in hypertensive patients, it is worthwhile to determine a reference range for PWV in a Korean population that does not have hypertension, diabetes, or overt cardiovascular disease (CVD).
DESIGN AND METHOD
We conducted a cross-sectional study with a health screening cohort, excluding those with hypertension, diabetes, or clear CVD. Demographic and clinical data, such as age, sex, blood pressure, fasting blood glucose and CVD risk factors, were collected through a structured questionnaire and health screening tests. The distribution of PWV was described according to age groups, and linear regression models were used to analyze the increases in PWV by aging.
RESULTS
The final analysis incorporated 138,417 individuals (average age 40.7 years; 41.7% women). We observed a steady increase in PWV with age in both men and women, even without the presence of traditional CVD risk factors like hypertension and diabetes. For each additional year of age, we recorded a rise of 9.4 cm/second in PWV in women and 5.5 cm/second in men. The increase in PWV became more noticeable in women than men beyond the age of 50 (16.7 cm/second vs. 14.7 cm/second). Additionally, we formulated age- and sex-specific reference values for PWV in this healthy cohort.
CONCLUSIONS
Our findings indicate a progressive increase in PWV according to age groups in those with no known hypertension, diabetes, or CVD. The PWV reference values derived from this research provide insights for future studies and clinical applications. These results will help clinicians identify the differences in arterial stiffness between those with and without CVD risk factors, and thereby improve the prevention and treatment of cardiovascular conditions in a healthy population.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):49.
OBJECTIVE
To determine the factors affecting medication compliance in the elderly with hypertension.
DESIGN AND METHOD
This study was a cross-sectional study of 253 hypertensive elderly diagnosed by a doctor and were taking antihypertensive medication using secondary data from the Indonesian Family Life Survey 2015. In this study, a person is said to be compliant with hypertension treatment if someone has taken the medicine prescribed by the doctor every week.
RESULTS
32.8% of respondents were not compliant with hypertension treatment. Multivariate analysis showed several significant factors (p-value 0,05) in determining medication compliance namely duration of hypertension, education about hypertension management, grade of hypertension, and complications due to hypertension. The most influential independent factor was the elderly who did not receive education about hypertension management (p=0.000; OR=5.216).
CONCLUSIONS
This study found several factors in determining medication compliance in the elderly, namely having a history of hypertension 5 years, having grade 2 of hypertension, receiving education on hypertension management, and having complications due to hypertension.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):50.
OBJECTIVE
A community blood pressure (BP) management cohort was set up in Hong Kong in 2016. Participants regularly measured BP and several showed symptoms of cognitive impairment. This study aims to investigate how memory functions affect the benefits of the BP management programme.
DESIGN AND METHOD
Participants with ages above 55 years were recruited from elderly centres and were prospectively followed-up since September 2016. Personal health conditions were interviewed by social workers. Those with suboptimal BP records, follow-up nursing calls and social engagement activities were offered. Participants with over 80% of weekly BP records in at least 2 years of follow-up were included. The seasonal BP fluctuations and random noise of the BP trend were adjusted by time-series models. The BP trends were tested by the Mann-Kendall test, and the downward BP trend was defined as the optimal BP control for the hypertensive participants. The logistic regression models were used to investigate the potential factors for optimal BP control.
RESULTS
A total of 1,151 participants with a mean age of 79 years were included in the study. Based on the trend testing, 662(58%) participants were classified as improved and stable BP trends, i.e. downward and consistency trends of BP records, and 489(42%) were classified as having deteriorated BP levels. The multivariate model showed that improved and stable BP trends were associated with baseline systolic BP levels, (OR 1.03, CI 1.02-1.04), cholesterol problems (OR 1.26, CI 0.98-1.63), and subjective memory complaints (OR 0.64, CI 0.47-0.85) (Table 1). Compared with daily junk food intake, eating less than once a week was good for BP management.
CONCLUSIONS
This study demonstrates that the long-term benefits of the BP management programme were limited by the elderly with memory complaints. Seasonal BP fluctuations are always the influential factor to confirm the benefits of BP management programmes, so time-series modelling is possible to figure out the real trend of personal BP after the removal of seasonal effects. When the trend of BP can be verified, studies can further investigate how to manage hypertensive patients with mild cognitive impairment or even dementia.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):50–51.
OBJECTIVE
Post-stroke survivors, particularly the older population, are at an increased risk of falls and incident fractures. Cigarette smoking is a widely recognized risk factor for fractures. However, the association between changes in smoking habits before and after an index stroke and increased risk of fracture remain unelucidated.
DESIGN AND METHOD
Using the Korean National Health Insurance program (K-NHIS), patients with ischemic stroke between 2010?2016 were enrolled. Individuals were classified by smoking habits: “never smoker,” “former smoker,” “smoking quitter,” “new smoker,” and “sustained smoker.” The primary outcome was the composite outcome of the vertebral, hip, and any fractures. Multivariate Cox proportional hazard regression analysis was used to obtain an adjusted hazard ratio and 95% confidence interval.
RESULTS
Among 177,787 patients with health screening data within two years before and after ischemic stroke, 14,991 (8.43%) patients any fractures. After multivariate adjustment, the sustained smokers had a significantly increased risk of composite primary outcomes of any, vertebral, and hip fractures (adjusted HR 1.222, 95% CI 1.124?1.329any; aHR 1.27, 95% CI 1.13?1.428; aHR 1.502, 95% CI 1.218?1.853, respectively). Additionally, the new smoker group exhibited a similar or higher risk of any fractures and hip fractures (aHR 1.218, 95% CI 1.062?1.397; aHR 1.772, 95% CI 1.291?2.431, respectively).
CONCLUSIONS
Sustained smokers had a significantly increased risk of vertebral and hip fractures after an ischemic stroke. The risk of any and hip fractures were higher in new smokers after ischemic stroke. As post-stroke fractures are detrimental to the rehabilitation process of patients with stroke, physicians should actively advise patients to stop smoking.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):51–52.
OBJECTIVE
The creation of a noval organic substance derived from superfood beetroot, this levan has the ability to increase the precursors of Nitric Oxide safely in the body. It o investigate the relaxation of blood vessels, thoracic aorta was excised and a 3-5 mm aortic ring was made and Krebs solution (in mM, NaCl 120, KCl 4.75, Glucose 6.4, NaHCO3 25, KH2PO4 1.2, MgSO4 1.2, CaCl2 1.7) suspended in a filled organ bath. During the experiment, the temperature was maintained at 37°C and the pH of the solution was maintained at 7.4 by feeding carbogen (95% O2, 5% CO2). The resting tension of the aortic ring was adjusted to 1.5g, and the solution was replaced every 20 minutes and stablized for 1 hour. The relaxation of the vessels was recorded by connecting the other side of the fixed aortic ring to an isometric force- displacement transducer (FT03, Grass, AD instruments, USA) and recording with a physiograph recorder (PowerLab/400, AD instruments, USA), analyzed with Chart 8 Program. Endothelium-dependent relaxation experiments were performed by using 10-6 M phenylephrine (PE) on the endothelial cells, pre-contracting the vessels, and then measuring acetylcholine (Ach) respectively.has the potential to prevent blood vessels bursting or hardening, and its potential application in preventing cardiovascular diseases.
DESIGN AND METHOD
To investigate the relaxation of blood vessels, thoracic aorta was excised and a 3-5 mm aortic ring was made and Krebs solution (in mM, NaCl 120, KCl 4.75, Glucose 6.4, NaHCO3 25, KH2PO4 1.2, MgSO4 1.2, CaCl2 1.7) suspended in a filled organ bath. During the experiment, the temperature was maintained at 37°C and the pH of the solution was maintained at 7.4 by feeding carbogen (95% O2, 5% CO2). The resting tension of the aortic ring was adjusted to 1.5g, and the solution was replaced every 20 minutes and stablized for 1 hour. The relaxation of the vessels was recorded by connecting the other side of the fixed aortic ring to an isometric force- displacement transducer (FT03, Grass, AD instruments, USA) and recording with a physiograph recorder (PowerLab/400, AD instruments, USA), analyzed with Chart 8 Program. Endothelium-dependent relaxation experiments were performed by using 10-6 M phenylephrine (PE) on the endothelial cells, pre-contracting the vessels, and then measuring acetylcholine (Ach) respectively.
RESULTS
At the end of the experiment, the endotheliumenriched thoracic aorta was excised from each group and pre-treated with phenylephrine (10-6 M) and treated with acetylcholine (ACh, 10-9 ˜ 10-4 M) respectively. Compared with the normotensive group (SD), the SHR was responsive to Ach, i.e the relaxation effect was reduced. There was no statistically significant difference between the EC50 statistical groups, however, the effect of the vascular relaxation was increased in the Sample 2 group (G4) compared to the other groups.
CONCLUSIONS
In the case of Sample 1 (100% Beet), the blood pressure lowering effect was not observed by oral administration to hypertensive animals, but the tendency to increased was observed, and an increase in the kidney weight was observed. Sample 2 (Our Product) showed significant blood pressure lowering effect, increase of nitrite and MDA, and no significant change in body weight and organ index during oral administration to hypertensive animals. We also observed improved vascular reactivity to acetylcholine.
Pulse (Basel). 2023 Nov 3;11(Suppl 1):52.
OBJECTIVE
To determine relationship between systemic disease and special sensory impairment with global cognition of aging population in Jakarta.
DESIGN AND METHOD
This is a cross-sectional study of 711 elderly aged 60 or more who live in Jakarta. Participants were required to answer a demographic questionnaire; global cognitive function assessment by MMSE instrument; and an olfactory function standardized examination done by 8 scents commonly found in Indonesia. Chi-square and multivariate logistic regression were used for analysis of 6 determinant factors, consisting of 3 systemic diseases (hypertension, diabetes mellitus, cardiovascular disease) and 3 sensory impairments (olfactory, visual, auditory) by global cognitive function. These factors were then further analysed for association with impairment in each domain of cognitive function.
RESULTS
The respondents of this study are mostly aged less than 70 (72.4%), female (69.2%), with less than 9 years of education (75.6%). Out of 6 factors assessed for association with global cognition, only hypertension (p-value = 0.006, OR 1.720, 95% CI; 1.167-2.535) and olfactory (p-value 0.001, OR = 2.339, 95% CI; 1.591-3.439) showed significant association. Further analysis of each domain of cognitive function showed that the most influential domain was orientation on hypertension (p-value 0.001, OR = 1.178, 95% CI; 1.086-1.278), while for olfactory was construction (p-value 0.001, OR = 1.995, 95% CI; 1.331-2.992).
CONCLUSIONS
Hypertension and olfactory impairment as determinant factors of global cognitive impairment. Thus, we recommend hypertension to be reduced. Orientation and construction domains were found to be most affected on subanalysis of each domain of global cognitive function.
