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Lim HS, Scott T, Glancy J. Pre-hospital heparin with thrombolysis. BRITISH HEART JOURNAL 2009; 95:2029; author reply 2029. [DOI: 10.1136/hrt.2009.180463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zhu ZY, Wang CM, Lo LC, Lin G, Feng F, Tan J, Chou R, Lim HS, Orban L, Yue GH. A standard panel of microsatellites for Asian seabass (Lates calcarifer). Anim Genet 2009; 41:208-12. [PMID: 19793264 DOI: 10.1111/j.1365-2052.2009.01973.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Microsatellites are the most popular markers for parentage assignment and population genetic studies. To meet the demand for international comparability for genetic studies of Asian seabass, a standard panel of 28 microsatellites has been selected and characterized using the DNA of 24 individuals from Thailand, Malaysia, Indonesia and Australia. The average allele number of these markers was 10.82 +/- 0.71 (range: 6-19), and the expected heterozygosity averaged 0.76 +/- 0.02 (range: 0.63-1.00). All microsatellites showed Mendelian inheritance. In addition, eight standard size controls have been developed by cloning a set of microsatellite alleles into a pGEM-T vector to calibrate allele sizes determined by different laboratories, and are available upon request. Seven multiplex PCRs, each amplifying 3-5 markers, were optimized to accurately and rapidly genotype microsatellites. Parentage assignment using 10 microsatellites in two crosses (10 x 10 and 20 x 20) demonstrated a high power of these markers for revealing parent-sibling connections. This standard set of microsatellites will standardize genetic diversity studies of Asian seabass, and the multiplex PCR sets will facilitate parentage assignment.
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Yang MJ, Kang SJ, Yoon MH, Hwang YH, Lim HS, Choi BJ, Choi SY, Hwang GS, Shin JH, Hong YS, Tahk SJ. Acute Mitral Regurgitation due to Spontaneous Chordal Rupture in a Patient With Obstructive Hypertrophic Cardiomyopathy. Korean Circ J 2009; 39:292-4. [PMID: 19949615 PMCID: PMC2771821 DOI: 10.4070/kcj.2009.39.7.292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 04/14/2009] [Indexed: 11/15/2022] Open
Abstract
A 69-year-old male presented with obstructive hypertrophic cardiomyopathy, mitral valve regurgitation, and myxomatous mitral valve prolapse. A spontaneous chordal rupture and acute severe mitral regurgitation resulted in abrupt clinical deterioration despite complete relief of severe left ventricular outflow tract obstruction and systolic anterior motion of the anterior mitral leaflet. The patient underwent extensive cardiac surgery due to intractable heart failure. Surgical procedures included a mitral valve replacement, a septal myectomy, and the Maze procedure.
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Yang HM, Tahk SJ, Woo SI, Lim HS, Choi BJ, Choi SY, Yoon MH, Park JS, Zheng M, Hwang GS, Kang SJ, Shin JH. Long-term clinical and angiographic outcomes after implantation of sirolimus-eluting stents with a “modified mini-crush” technique in coronary bifurcation lesions. Catheter Cardiovasc Interv 2009; 74:76-84. [DOI: 10.1002/ccd.22020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yoon MH, Tahk SJ, Yang HM, Park JS, Zheng M, Lim HS, Choi BJ, Choi SY, Choi UJ, Hwang JW, Kang SJ, Hwang GS, Shin JH. Comparison of the intracoronary continuous infusion method using a microcatheter and the intravenous continuous adenosine infusion method for inducing maximal hyperemia for fractional flow reserve measurement. Am Heart J 2009; 157:1050-6. [PMID: 19464416 DOI: 10.1016/j.ahj.2009.03.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 03/07/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inducing stable maximal coronary hyperemia is essential for measurement of fractional flow reserve (FFR). We evaluated the efficacy of the intracoronary (IC) continuous adenosine infusion method via a microcatheter for inducing maximal coronary hyperemia. METHODS In 43 patients with 44 intermediate coronary lesions, FFR was measured consecutively by IC bolus adenosine injection (48-80 microg in left coronary artery, 36-60 microg in the right coronary artery) and a standard intravenous (IV) adenosine infusion (140 microg x min(-1) x kg(-1)). After completion of the IV infusion method, the tip of an IC microcatheter (Progreat Microcatheter System, Terumo, Japan) was positioned at the coronary ostium, and FFR was measured with increasing IC continuous adenosine infusion rates from 60 to 360 microg/min via the microcatheter. RESULTS Fractional flow reserve decreased with increasing IC adenosine infusion rates, and no further decrease was observed after 300 microg/min. All patients were well tolerated during the procedures. Fractional flow reserves measured by IC adenosine infusion with 180, 240, 300, and 360 microg/min were significantly lower than those by IV infusion (P < .05). Intracoronary infusion at 180, 240, 300, and 360 microg/min was able to shorten the times to induction of optimal and steady-stable hyperemia compared to IV infusion (P < .05). Functional significances were changed in 5 lesions by IC infusion at 240 to 360 microg/min but not by IV infusion. CONCLUSIONS The results of this study suggest that an IC adenosine continuous infusion method via a microcatheter is safe and effective in inducing steady-state hyperemia and more potent and quicker in inducing optimal hyperemia than the standard IV infusion method.
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Choi BJ, Kang DK, Tahk SJ, Choi SY, Yoon MH, Lim HS, Kang SJ, Yang HM, Park JS, Zheng M, Hwang GS, Shin JH. Comparison of 64-slice multidetector computed tomography with spectral analysis of intravascular ultrasound backscatter signals for characterizations of noncalcified coronary arterial plaques. Am J Cardiol 2008; 102:988-93. [PMID: 18929698 DOI: 10.1016/j.amjcard.2008.05.060] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 05/23/2008] [Accepted: 05/23/2008] [Indexed: 01/17/2023]
Abstract
In vivo identification of plaque composition may allow the detection of vulnerable plaques before rupture. However, the clinical relevance of multidetector computed tomography (MDCT) in characterizing coronary plaques is currently a subject of debate. We compared 64-slice MDCT with virtual histology to investigate the potential role of 64-slice MDCT in the differentiation of composition of noncalcified coronary plaques. Fifty-nine consecutive patients (stable/unstable angina 34/21) were enrolled. Mean computed tomographic (CT) density (Hounsfield units) of noncalcified coronary plaques (n = 80) was compared with a relative volume of each plaque component (fibrous, fibrofatty, calcium, and necrotic core) analyzed by virtual histology. Mean heart rate during MDCT was 58 +/- 9 beats/min. There was a negative correlation between mean CT density and the necrotic core (r = -0.539, p <0.001) and a positive correlation between mean CT density and the fibrotic tissue component (r = 0.571, p <0.001). Mean CT density of the plaques with a <10% necrotic core was significantly higher than that of a >or=10% necrotic core (93.1 +/- 37.5 vs 41.3 +/- 26.4 HU, p <0.001). However, overlapping of mean CT densities between plaques with a <10% necrotic core and those with a >or=10% necrotic core was found. In conclusion, mean CT density of noncalcified coronary plaques measured by 64-slice MDCT may depend on the relative volumes of the necrotic core and fibrotic component. Sixty-four-slice MDCT may have the potential for determining composition of noncalcified coronary plaques, which needs further studies for clinical application.
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Kang SJ, Lim HS, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Tahk SJ. The Impact of Exercise-Induced Changes in Intraventricular Dyssynchrony on Functional Improvement in Patients with Nonischemic Cardiomyopathy. J Am Soc Echocardiogr 2008; 21:948-53. [DOI: 10.1016/j.echo.2008.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Indexed: 10/22/2022]
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Lim HS, Kang SJ, Choi JH, Ahn SG, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. Is E/E′ reliable in patients with regional wall motion abnormalities to estimate left ventricular filling pressure? Int J Cardiovasc Imaging 2008; 25:33-9. [PMID: 18636341 DOI: 10.1007/s10554-008-9340-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 07/02/2008] [Indexed: 11/29/2022]
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Yoon MH, Tahk SJ, Yang HM, Woo SI, Lim HS, Kang SJ, Choi BJ, Choi SY, Hwang GS, Shin JH. Comparison of accuracy in the prediction of left ventricular wall motion changes between invasively assessed microvascular integrity indexes and fluorine-18 fluorodeoxyglucose positron emission tomography in patients with ST-elevation myocardial infarction. Am J Cardiol 2008; 102:129-34. [PMID: 18602508 DOI: 10.1016/j.amjcard.2008.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/24/2022]
Abstract
We compared the accuracy in predicting regional wall motion score index (RWMSI) changes between microvascular integrity indexes measured during primary percutaneous coronary intervention (PCI) and fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in ST-elevation myocardial infarction (STEMI). Fifty patients with STEMI were enrolled. Microvascular integrity indexes were measured using an intracoronary Doppler wire and a pressure wire after primary PCI. We performed FDG-PET 7 days after PCI. RWMSI on follow-up echocardiogram (5.8 +/- 1.7 months) revealed good correlations with coronary flow reserve (r = -0.442, p = 0.002), diastolic deceleration time (r = -0.511, p <0.001), microvascular resistance index (r = 0.443, p = 0.002), coronary wedge pressure (r = 0.474, p <0.001), and FDG uptake rate (r = -0.571, p <0.001). There were no significant differences in areas under the curve for predicting RWMSI changes between microvascular integrity indexes and FDG-PET (coronary flow reserve 0.696, diastolic deceleration time 0.731, microvascular resistance index 0.748, coronary wedge pressure 0.694, Thrombolysis In Myocardial Infarction myocardial perfusion grade 0.702, and FDG-PET 0.755). In conclusion, microvascular integrity indexes assessed during primary PCI are useful and comparable to FDG-PET in predicting left ventricular functional changes in STEMI.
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Lim HS, Lip GYH. Circulating matrix metalloproteinase-9 levels in atherosclerotic vascular disease: a possible measurement of systemic or specific disease pathophysiology? J Intern Med 2008; 263:620-2. [PMID: 18479262 DOI: 10.1111/j.1365-2796.2008.01937.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kang SJ, Lim HS, Hwang J, Choi JH, Seo KW, Choi BJ, Choi SY, Hwang GS, Yoon MH, Shin JH, Tahk SJ. Impact of Changes in Myocardial Velocity Assessed by Tissue Doppler Imaging during Exercise on Dynamic Mitral Regurgitation in Patients with Nonischemic Cardiomyopathy. Echocardiography 2008; 25:394-400. [DOI: 10.1111/j.1540-8175.2007.00621.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Patel JV, Lim HS, Gunarathne A, Tracey I, Durrington PN, Hughes EA, Lip GYH. Ethnic differences in myocardial infarction in patients with hypertension: effects of diabetes mellitus. QJM 2008; 101:231-6. [PMID: 18204065 DOI: 10.1093/qjmed/hcm151] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It has been reported that hypertension carries a greater risk of myocardial infarction (MI) in South Asians living in the UK than in the indigenous British population. This has been attributed to some specifically Asian susceptibility factor. DESIGN Using a longitudinal approach, we investigated the relationship between coronary heart disease (CHD) risk factors amongst hypertension patients attending Sandwell and City Hospitals, and the onset of cardiovascular events over a 5-year follow-up period. RESULTS A total of 350 Caucasian (83.7% male) and 104 South Asian (66.3% male) patients with hypertension [age 63.7 (7.6) years and 57.1 (11.1) years respectively, P < 0.001] were followed-up for a mean (SD) period of 64.7(12.1) months. There were 11 (6.4/1000 patient years) cases of MI in Caucasian patients vs. 11 (17.8/1000 patient years) in South Asians, with event-free survival times being significantly lower amongst South Asians (log-rank test P = 0.04). The prevalence of diabetes mellitus was 22.9% higher amongst South Asians (P < 0.001), whilst mean serum cholesterol and fasting triglyceride levels were higher amongst Caucasians (P = 0.001). There were no ethnic differences in HDL cholesterol concentrations, the use of tobacco, statin therapy or anti-platelet therapies (all P = NS), or in composite endpoint (MI, angina, peripheral vascular disease, stroke, revascularization or death; P = 0.74). On Cox regression analysis of all independent cardiovascular risk variables, associated treatments and ethnicity, MI risk was associated with diabetes mellitus (odds ratio 3.77, 95%CI 1.55-9.15, P = 0.003) but not ethnicity per se (P = 0.26). CONCLUSION Increased risk of MI in hypertensive South Asians in the United Kingdom appears to be the result of a higher prevalence of diabetes mellitus. Further work is required to understand the pathophysiological basis with which diabetes increases CHD risk in this ethnic group.
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Seo KW, Tahk SJ, Choi SY, Yoon MH, Choi BJ, Lim HS, Shin JH, Hwang GS, Kang SJ, Kim JW, Lim NK, Lee MH. A Case of Huge Coronary Aneurysm After Implantation of a Sirolimus-Eluting Stent. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.4.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Shin JH, Choi UJ, Lim HS, Kang SJ, Hwang JW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ. How can we grade impaired relaxation pattern with elevated E/E′ as grade 1 diastolic dysfunction by echocardiography? Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2007.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choi UJ, Yoon MH, Choi SY, Lim HS, Yang HM, Woo SI, Hwang JW, Kang SJ, Choi BJ, Hwang GS, Shin JH, Park JS, Park SJ, Lee YH, Lee YS, Tahk SJ. Correlation Between the Serum Bilirubin Level and the Coronary Microvascular Integrity in Diabetic Patients. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.8.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hwang JW, Choi UJ, Ahn SG, Lim HS, Kang SJ, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH, Kang DK. Echocardiographic Plains Reflecting Total Amount of Epicardial Adipose Tissue as Risk Factor of Coronary Artery Disease. J Cardiovasc Ultrasound 2008. [DOI: 10.4250/jcu.2008.16.1.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kang SJ, Lim HS, Choi JH, Choi BJ, Choi SY, Yoon MH, Shin JH, Tahk SJ. Assessment of intraventricular systolic asynchrony in patients with atrial fibrillation using triplane tissue Doppler imaging. J Am Soc Echocardiogr 2007; 21:219-23. [PMID: 17628420 DOI: 10.1016/j.echo.2007.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Triplane tissue Doppler imaging (TDI) makes it possible to simultaneously obtain three apical view images and to measure the dyssynchrony index (DS) for 12 segments in patients with atrial fibrillation (AF). We evaluated the feasibility of using triplane TDI to assess intraventricular asynchrony in AF. METHODS In 50 patients with AF, triplane TDI was used for the analysis of myocardial velocity curves of 12 (six basal and six mid) left ventricular (LV) segments by apical two-, three-, and four-chamber views. Time to peak systolic velocity (Ts) was measured, and DS was calculated as the standard deviation (SD) of Ts over 12 segments. The DS(avg) was defined as the average of DS of eight consecutive cycles. To assess the cyclic variability of DS, the coefficient of variation of DS (CoV(DS)) was calculated as the SD of DS for eight cycles divided by DS(avg) [SD(DS)/DS(avg)]. CoV(RR), representing the variability of RR intervals, was defined as [SD(RR)/RR(avg)]. Patients with a left ventricular ejection fraction (LVEF) of 45% or more were classified as group A, and patients with an LVEF less than 45% as were classified as group B. RESULTS The mean LVEF was 47% +/- 12%. Group B showed larger LV volume and lower sphericity index compared with group A. Intraobserver and interobserver variability of DS(avg) were 6% and 9%, respectively. More severe dyssynchrony was observed in group B (DS(avg); 23.5 +/- 8.5 ms in group B vs. 17.7 +/- 6.1 ms in group A, P = .008). DS(avg) was not related to RR(avg) or CoV(RR). DS(avg) negatively correlated with ejection fraction (r = -0.404, P = .004) and sphericity index (r = -0.317, P = .025) and showed positive correlation with LV volume. CONCLUSION Analysis of asynchrony by triplane TDI was feasible in patients with AF. DS(avg) correlated with echocardiographic parameters of systolic function.
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Woo SI, Tahk SJ, Yoon MH, Choi SY, Choi BJ, Lim HS, Yang HM, Hwang GS, Shin JH, Kang SJ, Choi UJ, Hwang JW, Seo GW, Kim JW, Park JS. Correlation between Thrombolysis in Myocardial Infarction, the Myocardial Perfusion Grade and the Myocardial Viability Indices after Primary Percutaneous Coronary Intervention in ST Segment Elevation Myocardial Infarction. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.11.581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lim HS, Tahk SJ, Yoon MH, Woo SI, Choi WJ, Hwang JW, Li DH, Seo KW, Park JS, Kim JW, Kang SJ, Choi BJ, Choi SY, Hwang GS, Shin JH. A Novel Index of Microcirculatory Resistance for Invasively Assessing Myocardial Viability after Primary Angioplasty for Treating Acute Myocardial Infarction: Comparison with FDG-PET Imaging. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.7.318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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145
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Lim HS, Patel JV, Lip GYH. Reactive oxygen species production by circulating monocytes: insights from pathophysiology to clinical hypertension. J Hum Hypertens 2006; 20:307-9. [PMID: 16467861 DOI: 10.1038/sj.jhh.1001994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Patel JV, Lim HS, Hughes EA, Lip GYH. Adiponectin and hypertension: a putative link between adipocyte function and atherosclerotic risk? J Hum Hypertens 2006; 21:1-4. [PMID: 16871286 DOI: 10.1038/sj.jhh.1002078] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lim HS, Tayebjee MH, Tan KT, Patel JV, Macfadyen RJ, Lip GYH. Serum adiponectin in coronary heart disease: ethnic differences and relation to coronary artery disease severity. Heart 2006; 91:1605-6. [PMID: 16287748 PMCID: PMC1769205 DOI: 10.1136/hrt.2004.047803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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148
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Yoon MH, Tahk SJ, Choi SY, Choi BJ, Joe DY, Koh BR, Lim HS, Woo SI, Whang JW, Choi JH, Zheng ZG, Kang SJ, Hwang GS, Shin JH. Comparison between Microvascular Integrity Indexes Assessed by Pressure/Doppler Wire and %FDG Uptake in AMI following Primary PCI. Korean Circ J 2006. [DOI: 10.4070/kcj.2006.36.10.701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Tan KT, Tayebjee MH, Lim HS, Lip GYH. Clinically apparent atherosclerotic disease in diabetes is associated with an increase in platelet microparticle levels. Diabet Med 2005; 22:1657-62. [PMID: 16401308 DOI: 10.1111/j.1464-5491.2005.01707.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The commonest cause of mortality in patients with Type 2 diabetes is atherothrombosis, which can be related to abnormalities in the coagulation and fibrinolytic pathways, as well as in platelet function. Platelet microparticles (PMPs) may contribute to the prothrombotic state and may promote the progression of atherosclerosis. We hypothesized that PMPs are elevated in Type 2 diabetes and that patients with Type 2 diabetes and clinically apparent atherosclerosis would have the highest levels. Similarly, we hypothesized that soluble plasma P-selectin (sPsel) and CD40L (both molecules which are released by activated platelets), as well as %CD62P (P-selectin) and %CD63 positivity on platelets quantified by flow cytometry, would be highest in patients with Type 2 diabetes and clinically apparent atherosclerotic disease, and might be correlated to PMP levels. METHODS Venous blood was obtained from 21 Type 2 diabetic patients without atherosclerotic complications, 18 diabetic patients with clinically apparent atherosclerotic disease and 21 non-diabetic control subjects. PMPs, as well as %CD62P and %CD63 positivity on platelets, were quantified by flow cytometry. sPsel and CD40L were measured using ELISA. RESULTS Patients with Type 2 diabetes and clinically apparent atherosclerotic disease had the highest PMP (P=0.045) and sPsel (P=0.046) levels, compared with patients without complications (who had intermediate PMP levels) and control subjects. Control subjects had the lowest CD40L levels (P<0.001) when compared with patients with Type 2 diabetes, with no difference in sCD40L levels between the two diabetic subgroups. %CD62P and %CD63 positivity did not differ between the groups. PMP levels correlated with %CD62P positivity (P=0.026) but not to %CD63 positivity (P=0.089), sCD40L (P=0.407) or sP-sel (P=0.163); sCD40L levels did not correlate with any other marker of platelet activation. CONCLUSION PMPs are elevated in Type 2 diabetes. In addition, patients with clinically apparent atherosclerosis had the highest levels of PMPs and sPsel. Thus, PMPs may be a marker of symptomatic atherosclerotic vascular disease in Type 2 diabetes, and may both represent a useful risk stratification tool as well as a novel therapeutic target for anti-thrombotic drugs.
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Lim HS, Lip GYH, Beevers DG, Blann AD. Factors predicting the development of metabolic syndrome and type II diabetes against a background of hypertension. Eur J Clin Invest 2005; 35:324-9. [PMID: 15860044 DOI: 10.1111/j.1365-2362.2005.01495.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The metabolic syndrome (MetS), predicting coronary heart disease (CHD), is a compound of risk factors including diabetes, obesity and hypertension. The relationship between the development of MetS, diabetes and CHD in patients with established hypertension is unclear. We hypothesized that patients with hypertension developing MetS are at increased risk of type II diabetes and CHD compared with patients who do not develop MetS. MATERIALS AND METHODS We prospectively studied 284 patients (100 with existing/established MetS) with hypertension but without diabetes and CHD over 4 years. MetS and diabetes were diagnosed by the modified NCEP and ADA criteria, and CHD risk by the Framingham risk equation; all patients had annual fasting blood sampling. RESULTS Over 4 years of follow up, 75 of the 184 patients (41%) initially free of MetS at baseline subsequently fulfilled the criteria for MetS. These patients (i.e. 'developing MetS') had higher baseline BMI, triglycerides and lower HDL cholesterol, with a higher calculated CHD risk (all P <or= 0.001) than those who did not develop MetS. The 4-year odds ratios of developing diabetes in the patients with established MetS (23%) and the patients developing MetS (13.3%) vs. the patients not developing MetS (3.7%, P < 0.001) were 7.8 (95% CI: 2.6-23.5) and 4.0 (95% CI: 1.2-13.4), respectively. CONCLUSIONS Patients with hypertension developing MetS have an increased CHD risk and risk of developing type II diabetes even before fulfilling the criteria for MetS, and the former is comparable to patients with established MetS. These data suggest a high-risk phase not adequately identified by current diagnostic thresholds for MetS.
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