Background and ObjectivesAmbulatory arterial stiffness index (AASI) is well known as a predictor of cardiovascular mortality in hypertensive patients. Mathematically, AASI reflect the standard deviation (SD) of blood pressure (BP) variation. AASI is measured higher levels in non-dipper than dipper. Thus, AASI has a possibility of not only reflecting arterial stiffness but also BP variability and/or autonomic nervous dysfunction.Subjects and MethodsConsecutive data from 418 untreated hypertensive patients were analyzed retrospectively. We examined the association between the 24-hour ambulatory BP monitoring (ABPM) parameters and AASI.ResultsAASI had a simple correlation with age (R=0.189, p<0.001), relative wall thickness (RWT) (R=0.115, p=0.019), left ventricular mass index (LVMI) (R=0.192, p<0.001), average systolic BP (SBP) (R=0.232, p<0.001), average pulse pressure (PP) (R=0.363, p<0.001), SD of diastolic BP (DBP) (R=-0.352, p<0.001), SD of PP (R=0.330, p<0.001), SD of heart rate (HR) (R=-0.268, p<0.001), and nocturnal dipping (R=-0.137, p=0.005). In multiple linear regression analysis model including clinical parameters and 24 hour-ABPM parameters, independent predictors of AASI were SD of PP (β=1.246, p<0.001), SD of DBP (β=-1.067, p<0.001), SD of SBP (β=-0.197, p<0.001), and non-dipper (β=0.054, p=0.033).ConclusionAASI is closely correlated with BP variability. The result of this study shows that AASI is not only a parameter for arterial stiffness, but also a parameter for BP variability.

Background and ObjectivesInappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass.Subjects and MethodsUsing the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day.ResultsDaytime, nighttime and 24 hours BP in hypertensive patients was 140.4±14.8 mmHg, 143.7±15.2 mmHg and 129.4±20.0 mmHg, respectively. OPR was 106.3±19.9% and nocturnal dipping was 10.2±10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (β=0.097, p=0.043) and nocturnal dipping (β=-0.098, p=0.046) were independent determinants of OPR as well as age (β=0.130, p=0.025) and body mass index (BMI) (β=0.363, p<0.001). Odds ratio of the non-dipper pattern was 2.134 for iLVM (p=0.021) and 3.694 for obesity (p<0.001; BMI >25 kg/m2).ConclusionThe non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

Background and ObjectivesThe extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT).Subjects and MethodsData from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program.ResultsIn patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC.ConclusionBMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

BackgroundMultiple organ infarctions combined with Leriche syndrome due to embolic particles of myxoma are very rare. There is no definite guideline for immediate medical treatment.Case presentationA 36-year-old married female was referred to the emergency department (ED) with severe pain of both lower extremities and gradual decreased mental status. Brain magnetic resonance imaging (MRI) and computed tomography angiography (CTA) revealed acute multiple organ infarctions including the brain, spleen, and bilateral kidneys combined with Leriche syndrome. To evaluate the embolic source, echocardiography was performed and it revealed biatrial myxoma. Because of the risk of progression in systemic embolic events, surgical excision and embolectomy were performed urgently. After the operation, renal function was recovered, and the pain of both limbs was relieved. However, the visual field defect due to the brain infarction remained. She was discharged uneventfully on the fourteenth postoperative day.ConclusionThis was an extremely rare case of multiple organ infarctions combined with Leriche syndrome as the initial presentation of biatrial myxoma. The treatment of choice for myxoma is surgical excision, but the optimal timing of operations is still controversial in patients who have had recent neurological insults. Echocardiography was useful to clarify the diagnosis and decide on the proper treatment modality: surgical treatment or thrombolysis.

baPWV had significant direct and indirect effects on morning SBP. The indirect effect was mediated by nocturnal SBP, but not by morning surge. The 24 h UNa had neither significant direct nor indirect effects on morning SBP.