The Research Team of Dr. Byung-Jo Kim and Dr. Jin-Woo Park of the Department of Neurology Suggested a Test Method to Increase the DiagnosticRate of Orthostatic Hypotension

The Valsalva maneuver reduces the examination stress and makes it possible to predict the examination time optimized for each patient

Orthostatic hypotension is a disease that causes dizziness, visual field defect, and fainting due to a sudden drop in blood pressure when a person wakes up due to an abnormality in the autonomic nervous system.Its characteristic is that you have a normal blood pressure when lying down, but a significant drop in blood pressure when sitting or standing up.

Because it occurs due to chronic diseases such as diabetes, degenerative diseases of the nervous system such as Parkinson's disease, other abnormalities in the autonomic nervous system, and the effects of medications; regardless of age, it is important to determine the exact cause of the disease at an early stage, along with diagnosis of the diseases.

The head up tilt test is a test to screen patients with orthostatic hypotension.The time required for the test varies depending on the symptom onset time. The test mostly showssymptoms such as headaches and dizziness within 10 minutes. However, in the case of patients with delayed orthostatic hypotension, which account for about 20 to 45% of patients with orthostatic hypotension, symptoms may appear after 10 minutes, resulting in missed diagnosis or extended examination time.

Through joint research with Vanderbilt University's Autonomic Dysfunction Center, the research team of Dr. Byung-Jo Kim and Dr. Jin-Woo Park of the Department of Neurology, Korea University Anam Hospital, announced study result showing that the Valsalva maneuver increases the efficiency and diagnostic rate of orthostatic hypotension test.

The research team analyzed the relationship between orthostatic hypotension and performance of the Valsalva maneuver by comparing heart rate variability and blood pressure recovery time of 2,498 patients who received autonomic nerve testing from March 2016 to May 2022.

The Valsalva maneuver is an autonomic nerve testing that evaluates cardiovascular function,which measures changes in heart rate and blood pressure by making a patient exhalethrough applying force to the stomach as if blowing up a balloon with the nose and mouth closed. Through this test, the medical staff can determine whether the patient's blood pressure drop is due to an abnormality in the autonomic nervous system.

The study showed that the head up tilt test of more than 30 minutes is necessary if the change in heart rate was small and the time to recover to normal blood pressure was long when the Valsalva maneuver was performed for 15 seconds.

This provides an implication that the medical staff can predict the time required forthe head up tilt test for the patient. Previously, it was difficult to select the optimal test time for each patient because there was no objective guideline on how long the head up tilt test is necessary for each patient. The Valsalva maneuver can not only reduce the patient's stress by predicting the symptom onset time during the head up tilt test, it can also improve test efficiency by allowing medical staff to set the optimal test time for each patient.

“This study is to increase the diagnostic rate of orthostatic hypotension and sensitively detecting patients with abnormal findings,” said Dr. Byung-Jo Kim. “It is an important study that reduces unnecessary tests while performing the head up tilt test and also helps in diagnosis and treatment of patientsusing various indicators of the Valsalva maneuver,” he added.

This research was published in the international journal Hypertension of the American Heart Association (AHA) under the title of “Use of Valsalva Maneuver to Detect Late-Onset Delayed Orthostatic Hypotension.” This study was also selected as one of the “High Impact Journal Papers (Hanbitsa)” by the Biological Research Information Center (BRIC).

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Dr. Kisoo Pahk of Ansan Hospital visualized Anti-Stress Effect of Exercise for the First Time

- Utilizing a state-of-the-art nuclear medicine imaging technique¹⁸F-FDG PET/CT

- Obese women have 1.5 times more metabolic activity of amygdala compared to normal people

- Metabolic activity of amygdala was decreased by 20% after completion of 3 months of exercise

Dr. Kisoo Pahk of the Department of Nuclear Medicine, Korea University Ansan Hospital proved anti-stress effect of exercise for the first time in the world via nuclear medicine imaging technique.

Stress is regarded as a major risk factor for all diseases including cardiovascular disease. In particular, people with obesity are known to have higher stress level than non-obese people. Although exercise is well known to relieve stress, there have been no imaging studies to support objectively. Dr. Pahk and his research team visualized the anti-stress effect of exercise through ¹⁸F-FDG PET/CT, a state-of-the-art nuclear medicine imaging technique.

First, the research team visualized and quantified the metabolic activity of amygdala in a cerebral region which is known to control the stress response, in both obese women and normal people through ¹⁸F-FDG PET/CT. It was confirmed that the metabolic activity of amygdala in obese women group was about 1.5 times higher than that of normal people. Namely, obese women have a higher stress level assessed by imaging biomarker than that of normal people.

Furthermore, the obese women took aerobic- with subsequent muscle-resistant exercise for 3 months, and as a result, it was confirmed that the metabolic activity of amygdala decreased by about 20% through the stress imaging biomarker. In addition, their body mass index (BMI), waist circumference, and blood pressure all decreased significantly along with the reduction of amygdala metabolic activity.

“This is the first study that objectively proved the anti-stress effect of exercise through imaging,” said Dr. Kisoo Pahk. “Nuclear medicine imaging could be a very potential and valuable stress assessment surrogate marker in various therapeutic interventions targeted to stress reduction” he emphasized.

This research paper was published in the latest issue of Frontiers in Endocrinology under the title of “Chronic physical exercise alleviates stress-associated amygdala metabolic activity in obese women: A prospective serial ¹⁸F-FDG PET/CT study.”

25 to 34 Year Olds “Economically Non-active+Divorced” Men,

17.5 Times Higher Chance of Committing Suicide

Prof. Yo Han Lee and the research team of Korea University announced research results on the socioeconomic reasons for the risk of suicide for the economically active population.

A study reported that young men who are not economically active and divorced have a 17.5 times higher risk of suicide.

Prof. Yo Han Lee and the research team of the Department of Preventive Medicine, Korea University College of Medicine, announced the study results (first author, research professor Minjae Choi, Graduate School of Public Health) that investigated the association between socioeconomic factors and suicide in the working-age population.

This study is the result of analyzing all data of suicide deaths from 2008 to 2017. The risk of suicide is higher if the population has a lower education level, is not economically active or is divorced. Such phenomenon was observed in all age groups, but it was prominent in those between 25 to 34 years old, and the risk gradually decreased as the group became older. In particular, women from 25 to 34 years old who experienced divorce showed a 7.9 times higher risk of suicide than that of married young people (25 to 34 years old).

Additionally, the risk of suicide increased further in the case when combining two of: education level, economic activity, and marital status. The risk of suicide was highest for those who were not economically active and their marital state is divorced. In particular, the risk of suicide was 17.5 times higher for 25 to 34-year-old men.

This study suggested that suicide cases are closely related to socioeconomic factors in Korea and the risk of suicide differs according to the economically active age groups that are most exposed to social environments.

The research team emphasized that socio-economic difficulties that individuals suffer from must be responded to by providing them with psychological and social support simultaneously. In particular, the team mentioned that as those who experienced negative events such as losing a job or getting divorced tend to suffer from greater mental difficulties; it is important to understand such difficulties in detail and prepare social supporting measures.

“Young people in their early stage of entering modern Korean society face various social difficulties. Their social safety net is lacking compared to other adult groups, so their difficulties are likely to be greater,” said the research director Prof. Yo Han Lee. “Due to the COVID-19 pandemic, young people’s unemployment and divorce rates are increasing, along with their mental difficulties. We must provide social support to help them overcome their mental difficulties,” he added.

This study was published in the latest issue of SSM-Population Health (IF=4.08), a social and medical SCI journal, under the title of “Single and combined effects of marital status, education attainment, and employment status on suicide among the working-age population: A case-control study in South Korea.”

Prof. Seung-Woon Rha's Research Team of Cardiovascular Center Discovered the Risk of Stroke and Re-hospitalization due to Heart Failure Changes Depending on Which Drug (RAS Inhibitor) to Choose following Percutaneous Coronary Intervention in Elderly (≥65) Acute Myocardial Infarction Patients without Hypertension

Analysis of prognosis in choice of medication (ACEI or ARB) for patients with acute myocardial infarction undergoing percutaneous coronary intervention with drug-eluting stents who are aged 65 years or older without hypertension

Suggesting a guideline of selecting drugs for elderly patients and publishing the study results in SCI-level international journals

By analyzing prognosis in choosing medication for patients with acute myocardial infarction (AMI) who are aged 65 years or older without hypertension, the patient group taking an angiotensin converting enzyme inhibitors (ACEI) had 64.5% and 47.2% lower risk of stroke and heart failure, respectively, than the group taking angiotensin receptor blocker (ARB) after 3 years of follow-up study.

The research team of Prof. Seung-Woon Rha of the Cardiovascular Center, Korea University Guro Hospital, and Prof. Byoung Geol Choi of Cardiovascular Research Institute, Korea University, divided 1,380 AMI patients with age of 65 years or older who were not diagnosed with hypertension into 2 groups from patients registered in the “Prospective Follow-up Study for the Development of Prognosis and Management Indicators of Patients with Acute Myocardial Infarction (KAMIR-NIH)” database. These patients were followed up for 3 years from November 2011 to December 2015.

After a comparative analysis of the prognosis of patients in the 2 groups by applying inverse probability weighting (IPTW), the patient group (872 patients) who took ACEI, showed 1.2% and 2.6% of stroke and heart failure, respectively. On the other hand, the group (508 patients) who took ARB showed 2.9% and 4.5%, respectively. The 2 groups had no difference in terms of blood pressure lowering effect and blood pressure control.

“The two drugs analyzed in this study have been primarily selected for the prevention of myocardial remodeling and chronic heart failure after AMI, regardless of the presence or absence of hyperten sion, but studies directly comparing the 2 drugs in elderly patients were especially limited,” said Prof. Seung-Woon Rha of the Cardiovascular Center, Korea University Guro Hospital. “Appropriate drug selection after AMI is a part that requires great attention because it greatly affects the patient's quality of life and prognosis. Considering the rapidly aging population, research on this should be actively conducted in the future,” he added while emphasizing the study purpose.

“ACEI and ARB are used in both AMI and hypertension treatment and they may have different effects depending on the characteristics of each patient. We need to subdivide the indications and verify their effectiveness,” said Dr. Byoung Geol Choi of Cardiovascular Research Institute, Korea University.

“This study confirmed the potential benefits of using ACEI for elderly patients. I hope that this study will help selecting appropriate drugs (RAS inhibitor) in the future clinical field,” said Woo Jin Ahn (MD, Korea University College of Medicine), the primary author of this study. “I am glad I was able to conduct a good study under the supports from my professors. As I still have much to learn, I want to thank Prof. Seung-Woon Rha and Prof. Byoung Geol Choi for guiding me,” he added.

This study result was published in the latest issue of Heart and Vessels, an SCI-level international journal, under the title of“The impact of angiotensin-converting-enzyme inhibitors versus angiotensin receptor blockers on 3-year clinical outcomes in elderly (≥65) patients with acute myocardial infarction without hypertension.”