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So KCY, Kam KKH, Tang GHL, Lee APW. Feasibility of Using TriClip Guide for Combined MitraClip and TriClip Transcatheter Edge-to-Edge Repair: First-in-Human Experience. JACC Cardiovasc Interv 2024; 17:1071-1072. [PMID: 38658124 DOI: 10.1016/j.jcin.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
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Kam KKH, Chan JSK, Lee APW. Non-vitamin K oral anticoagulants versus warfarin for the treatment of left ventricular thrombus. Hong Kong Med J 2024; 30:10-15. [PMID: 38327164 DOI: 10.12809/hkmj2210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Conventional treatment comprises warfarin-mediated anticoagulation; it is unclear whether non-vitamin K oral anticoagulants (NOACs) exhibit comparable efficacy and safety. Limited data are available for Asian patients. This study compared NOACs with warfarin in terms of clinical efficacy and safety for managing LVT. METHODS Clinical and echocardiographic records were retrieved for all adult patients with echocardiography-confirmed LVT at a major regional centre in Hong Kong from January 2011 to January 2020. Discontinuation of anticoagulation by 1 year was recorded. Outcomes were compared between patients receiving NOACs and those receiving warfarin. Primary outcomes were cumulative mortality and net adverse clinical events (NACEs). Secondary outcomes were complete LVT resolution and percentage reduction in LVT size at 3 months. RESULTS Forty-three patients were included; 28 received warfarin and 15 received NOACs, with follow-up periods (mean ± standard deviation) of 20 ± 12 months and 22 ± 9 months, respectively (P=0.522). Use of NOACs was associated with significantly lower NACE risk (hazard ratio [HR]=0.111, 95% confidence interval [CI]=0.012-0.994; P=0.049) and a tendency towards lower cumulative mortality (HR=0.184, 95% CI=0.032-1.059; P=0.058). There were no significant differences in secondary outcomes. Considering LVT resolution, discontinuation of anticoagulation by 1 year was not significantly associated with different outcomes. CONCLUSION Non-vitamin K oral anticoagulants may be an efficacious and safe alternative to warfarin for LVT management. Future studies should explore the safety and efficacy of anticoagulation discontinuation by 1 year as an overall strategy.
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Affiliation(s)
- K K H Kam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - J S K Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - A P W Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wong RHL, Fan Y, Izumo M, Lee APW. Editorial: Advanced echocardiographic techniques in structural heart intervention. Front Cardiovasc Med 2022; 9:970515. [PMID: 35924216 PMCID: PMC9341281 DOI: 10.3389/fcvm.2022.970515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Randolph H. L. Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Randolph H. L. Wong
| | - Yiting Fan
- Division of Cardiology, Shanghai Jiao Tong University, Shanghai, China
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Alex P. W. Lee
- Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Alex P. W. Lee
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Cheng IT, Meng H, Li M, Li EK, Wong PC, Lee J, Yan BP, Lee APW, So H, Tam LS. Serum Calprotectin Level Is Independently Associated With Carotid Plaque Presence in Patients With Psoriatic Arthritis. Front Med (Lausanne) 2022; 9:932696. [PMID: 35872782 PMCID: PMC9305068 DOI: 10.3389/fmed.2022.932696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Whether calprotectin could play a role in augmenting cardiovascular (CV) risk in patients with psoriatic arthritis (PsA) remains uncertain. The aim of this study is to elucidate the association between serum calprotectin level and subclinical atherosclerosis in patient with PsA. Method Seventy-eight PsA patients (age: 52 ± 10 years, 41 [52.6%] male) without CV disease were recruited into this cross-sectional study. Carotid intima-media thickness (cIMT) and the presence of plaque were determined by high-resolution ultrasound. Calprotectin levels in serum were quantified by enzyme-linked immunosorbent assay. The variables associated with the presence of carotid plaque (CP) were selected from the least absolute shrinkage and selection operator (LASSO) regression analysis. Results 29/78 (37.2%) of patient had carotid plaque (CP+ group). Serum calprotectin level was significantly higher in the CP+ group (CP− group: 564.6 [329.3–910.5] ng/ml; CP+ group: 721.3 [329.3–910.5] ng/ml, P = 0.005). Serum calprotectin level correlated with PsA disease duration (rho = 0.280, P = 0.013) and mean cIMT (rho = 0.249, P = 0.038). Using LASSO regression analysis, the levels of Ln-calprotectin (OR: 3.38, 95% CI [1.37, 9.47]; P = 0.026) and PsA disease duration (OR: 1.09, 95% CI [1.01, 1.18]; P = 0.013) were screened out from a total of 19 variables. The model in predicting the presence of CP was constructed by Ln-calprotectin and PsA disease duration with an area under the receiver-operating characteristic (ROC) curve of 0.744, (95 CI% [0.59, 0.80], P = 0.037). Conclusion Serum calprotectin level is associated with the presence of CP in PsA. Further studies are required to confirm whether this pathway is associated with CV events in PsA.
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Affiliation(s)
- Isaac T. Cheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Huan Meng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Martin Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Edmund K. Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Priscilla C. Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jack Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ho So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Lai-Shan Tam,
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Kam K, Ng JKC, Kwong VWK, Szeto CC, Lee APW. The prognostic value of reduced global longitudinal strain (GLS) on cardiac outcomes in patients on peritoneal dialysis: a prospective study. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
This study aims to evaluate the capacity of left ventricular global longitudinal strain (GLS) in end stage renal failure patients on peritoneal dialysis (PD) to predict cardiovascular mortality and major adverse cardiac events (MACE). GLS has been an established parameter in detecting subclinical left ventricular systolic dysfunction in the setting of preserved ejection fraction (EF > = 50%). We hypothesized that reductions of GLS (i.e. less negative value) are associated with adverse cardiovascular outcome.
Methods
We prospectively recruited a total of 60 PD patients from a single dialysis center in a tertiary hospital. GLS was determined by two-dimensional speckle-tracking echocardiography, under Philips QLab system. A less negative value reflects underlying subclinical LV dysfunction. The primary outcome was 4-point MACE, which was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure. Surrogate markers of inflammation (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha), nutrition (serum albumin), arterial stiffness (pulse wave velocity [PWV]), and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were also measured.
Results
16 (26.7%) and 34 (56.7%) PD patients had reduced GLS (≥ -18.3%) and left ventricular hypertrophy (LVH) respectively. In 12-month follow up, 4-point MACE occurred in 13.6% and 59.8% of normal and compromised GLS patients respectively (log-rank, P = 0.004), as illustrated by Kaplan-Meier curves (Fig 1). Patients with reduced GLS had higher proportion of uncontrolled blood pressure and higher prevalence of coronary artery disease. Their EF were significantly lower (53.6 ± 7.4% vs. 61.3 ± 4.1%, P= 0.001) compared with patients with normal GLS. In addition, GLS correlated with EF (r = -0.57, P <0.0001) and PWV (r= 0.33, P = 0.01). There was a trend towards an association between GLS and ln(CRP) (r= 0.25, P = 0.057), and ln(NT-proBNP) (r = 0.22, P= 0.09), respectively.
Conclusions
Subclinical LV systolic dysfunction was present in one-fourth of peritoneal dialysis patients despite having preserved EF. Reduced GLS (less negative than 18.3%, illustrated in Fig 2) is a strong predictor of poor cardiovascular prognosis among PD population. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- K Kam
- Prince of Wales Hospital, The Chinese University of Hong Kong, Division of Cardiology, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - JKC Ng
- Prince of Wales Hospital, The Chinese University of Hong Kong, Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - VWK Kwong
- Prince of Wales Hospital, The Chinese University of Hong Kong, Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - CC Szeto
- Prince of Wales Hospital, The Chinese University of Hong Kong, Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - APW Lee
- Prince of Wales Hospital, The Chinese University of Hong Kong, Division of Cardiology, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
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Abstract
INTRODUCTION Patients with non-valvular atrial fibrillation (NVAF) may be prescribed warfarin or a non-vitamin K oral anticoagulant (NOAC). There is increasing evidence that NOACs are superior to warfarin in terms of renal function preservation. This study aimed to compare renal outcomes in Chinese patients with NVAF between patients receiving NOACs and patients receiving warfarin. METHODS In total, 600 Chinese patients with NVAF receiving oral anticoagulant therapy were retrospectively identified from an administrative database. The renal outcomes (≥30% decline in estimated glomerular filtration rate [eGFR], doubling of serum creatinine, and kidney failure) were compared among four propensity-weighted treatment cohorts (warfarin, n=200; rivaroxaban, n=200; dabigatran, n=100; and apixaban, n=100). RESULTS The mean follow-up period across all groups was 1000 ± 436 days. Compared with warfarin, the three NOACs (pooled for consideration as a single unit) had significantly lower risks of ≥30% decline in eGFR (hazard ratio [HR]=0.339; 95% confidence interval [CI]=0.276-0.417) and doubling of serum creatinine (HR=0.550; 95% CI=0.387-0.782). Dabigatran and rivaroxaban users both had lower risks of ≥30% decline in eGFR (both P<0.001) and doubling of serum creatinine (both P<0.05). Apixaban was only significantly associated with a lower risk of ≥30% decline in eGFR (P<0.001). CONCLUSIONS Compared with warfarin, NOACs may be associated with a significantly lower risk of decline in renal function among Chinese patients with NVAF.
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Affiliation(s)
- T S Shahzada
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - C L Guo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - A P W Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Hu J, Lee APW, Wei X, Cheng ZY, Ho AMH, Wan S. Update on surgical repair in functional mitral regurgitation. J Card Surg 2021; 37:3328-3335. [PMID: 34165825 DOI: 10.1111/jocs.15771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional mitral regurgitation (FMR) is common in patients with myocardial infarction or dilated cardiomyopathy, and portends a poor prognosis despite guideline-directed medical therapy (GDMT). Surgical or transcatheter mitral repair for FMR from recent randomized clinical trials showed disappointing or conflicting results. AIMS To provide an update on the role of surgical repair in the management of FMR. MATERIALS AND METHODS A literature search was conducted utilizing PubMed, Ovid, Web of Science, Embase, and Cochrane Library. The search terms included secondary/FMR, ischemic mitral regurgitation, mitral repair, mitral replacement, mitral annuloplasty, transcatheter mitral repair, and percutaneous mitral repair. Randomized clinical trials over the past decade were the particular focus of the current review. RESULTS Recent data underlined the complexity and poor prognosis of FMR. GDMT and cardiac resynchronization, when indicated, should always be applied. Accurate assessment of the interplay between ventricular geometry and mitral valve function is essential to differentiate proportionate FMR from the disproportionate subgroup, which could be helpful in selecting appropriate transcatheter intervention strategies. Surgical repair, most commonly performed with an undersized ring annuloplasty, remains controversial. Adjunctive valvular or subvalvular repair techniques are evolving and may produce improved results in selected FMR patients. CONCLUSION FMR resulted from complex valve-ventricular interaction and remodeling. Distinguishing proportionate FMR from disproportionate FMR is important in exploring their underlying mechanisms and to guide medical treatment with surgical or transcatheter interventions. Further studies are warranted to confirm the clinical benefit of appropriate surgical repair in selected FMR patients.
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Affiliation(s)
- Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Alex P W Lee
- Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiang Wei
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhao-Yun Cheng
- Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Anthony M H Ho
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Woo KS, Yip TWC, Chook P, Koon KV, Leong HC, Feng XH, Lee APW, Kwok TCY. Vitamins B-12 and C Supplementation Improves Arterial Reactivity and Structure in Passive Smokers: Implication in Prevention of Smoking-Related Atherosclerosis. J Nutr Health Aging 2021; 25:248-254. [PMID: 33491041 DOI: 10.1007/s12603-020-1529-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atherosclerosis is an important medical problem of modern society. High environmental tobacco smoke in casino is associated with an accelerated atherogenic process. We have previously shown vitamin B12 and C supplementation improves vascular reactivity and may be beneficial in vascular protection. OBJECTIVE To evaluate the impact of vitamin supplementation on atherosclerosis (brachial artery reactivity FMD and carotid intima-media thickness IMT) in subjects exposed to high environmental tobacco smoke. DESIGN Double-blind 2x2 factorial design fashion. SETTING Computer randomization in 4 treatment groups: placebo (n=24), vitamin B12 (n=21), vitamin C (n=23) and vitamin B12+C (n=23) groups. PARTICIPANTS 91 passive-smoking casino employees (19.2% male, mean age 45.0±8.2 years). INTERVENTION Subjects were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules for 1 year. MEASUREMENT Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and on completion at 12 months. METHODS 91 passive smoking casino employees (19.2% male, mean age 45.0±8.2 years) were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules in double-blind 2 x 2 factorial design fashion for 1 year. Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and 12 months. RESULTS Of the 78 (85.7%) passive-smoking employees completed the study, 11.5% had hypertension, 5.1% diabetes mellitus and 15.4% hypercholesterolemia. There were no significant changes in their blood pressures, lipid profiles, glucose and body mass index after supplementation for 1 year, but mild decrease in DBP (p<0.001) and blood creatinine (p<0.01) after combined vitamin B12 and C, and significant increase in blood B12 after vitamin B12 (p<0.01) and vitamin B12+C supplementations (p<0.001). Brachial FMD and cartotid IMT improved after the 3 vitamin supplementations (p<0.001), but not after placebo, being more significant after combined vitamin supplementations (p<0.0001). No adverse effects were reported. CONCLUSION Vitamin B12 or C supplementation in passive smokers improved vascular reactivity and structures at 1 year, with implication in long term atherosclerosis prevention.
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Affiliation(s)
- K S Woo
- Professor KS Woo, Adjunct Professor, Department of Medicines and Therapeutics, 4th Floor, Tsang Shiu Tim Building, United College, The Chinese University of Hong Kong, , Phone: (852) 26474966
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Sadasivan C, Chow JTY, Sheng B, Chan DKH, Fan Y, Choi PCL, Wong JKT, Tong MMB, Chan TN, Fung E, Kam KKH, Chan JYS, Chi WK, Paterson DI, Senaratne M, Brass N, Oudit GY, Lee APW. Screening for Fabry Disease in patients with unexplained left ventricular hypertrophy. PLoS One 2020; 15:e0239675. [PMID: 32987398 PMCID: PMC7521938 DOI: 10.1371/journal.pone.0239675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Fabry Disease (FD) is a systemic disorder that can result in cardiovascular, renal, and neurovascular disease leading to reduced life expectancy. FD should be considered in the differential of all patients with unexplained left ventricular hypertrophy (LVH). We therefore performed a prospective screening study in Edmonton and Hong Kong using Dried Blood Spot (DBS) testing on patients with undiagnosed LVH. Participants found to have unexplained LVH on echocardiography were invited to participate and subsequently subjected to DBS testing. DBS testing was used to measure α-galactosidase (α-GAL) enzyme activity and for mutation analysis of the α-galactosidase (GLA) gene, both of which are required to make a diagnosis of FD. DBS testing was performed as a screening tool on patients (n = 266) in Edmonton and Hong Kong, allowing for detection of five patients with FD (2% prevalence of FD) and one patient with hydroxychloroquine-induced phenocopy. Left ventricular mass index (LVMI) by GLA genotype showed a higher LVMI in patients with IVS4 + 919G > A mutations compared to those without the mutation. Two patients were initiated on ERT and hydroxychloroquine was discontinued in the patient with a phenocopy of FD. Overall, we detected FD in 2% of our screening cohort using DBS testing as an effective and easy to administer screening tool in patients with unexplained LVH. Utilizing DBS testing to screen for FD in patients with otherwise undiagnosed LVH is clinically important due to the availability of effective therapies and the value of cascade screening in extended families.
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Affiliation(s)
- Chandu Sadasivan
- Department of Medicine, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Josie T. Y. Chow
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bun Sheng
- Princess Margaret Hospital, Hong Kong SAR, China
| | - David K. H. Chan
- Clinical Genetic Service, Department of Health, Hong Kong SAR, China
| | - Yiting Fan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, Hong Kong SAR, China
| | - Paul C. L. Choi
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jeffrey K. T. Wong
- Department of Imaging and Interventional Radiology, Hong Kong SAR, China
| | - Mabel M. B. Tong
- Department of Radiology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Tsz-Ngai Chan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Erik Fung
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kevin K. H. Kam
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joseph Y. S. Chan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-Kin Chi
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - D. Ian Paterson
- Department of Medicine, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Manohara Senaratne
- Department of Medicine, University of Alberta, Edmonton, Canada
- Division of Cardiology, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | - Neil Brass
- Department of Medicine, University of Alberta, Edmonton, Canada
- Division of Cardiology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Gavin Y. Oudit
- Department of Medicine, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Alex P. W. Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, Hong Kong SAR, China
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Chow SCY, Wong RHL, Cheung GSH, Lee APW, Chui HKL, So KCY, Wu EB. Short term clinical outcomes and analysis of risk factors for pacemaker implantation: a single center experience of self-expandable TAVI valves. J Cardiothorac Surg 2020; 15:200. [PMID: 32727521 PMCID: PMC7391583 DOI: 10.1186/s13019-020-01241-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives Transcatheter aortic valve implantation is a recognized treatment for patients with severe aortic stenosis at all risk groups. However, permanent pacemaker rates remain high for self expandable transcatheter valves and permanent pacemaker implantation has been associated with increased morbidity. In this analysis we aim to evaluate short term clinical outcomes post self expandable transcatheter aortic valve implantation and determine risk factors for permanent pacemaker implantation. Methods 88 patients with severe aortic stenosis with transcatheter aortic valve implantation performed between the year 2016–2018 were retrospectively analyzed. Outcomes of interest included 1- year all cause mortality, 30-day major adverse cardiovascular events, permanent pacemaker and paravalvular leak rates. Survival analysis was performed with Kaplan Meier analysis and risk factors for survival and permanent pacemaker rates were identified with log rank test and regression analysis. Results The mean age of the cohort was 80.3 +/− 6.9 years. The mean STS score was 9.25. The 30 day all-cause mortality was 5.7% and 1-year all cause mortality was 16.7%. 80 patients had transfemoral transcatheter aortic valve implantation, and a majority of the patients (85.2%) were implanted with Corevalve Evolut R device. The device success rate was 88.6%. Multivariate analysis identified concomitant severe coronary artery disease (OR = 18.2 +/− 0.9; P = 0.002), pre transcatheter aortic valve implantation atrial fibrillation (OR = 8.6 +/− 0.91; P = 0.02) and post procedural disabling stroke (OR = 32.6 +/− 1.35; P = 0.01) as risk factors for 1-year mortality. The 30-day pacemaker rate was 17.6%. The presence of right bundle branch block (OR 11.1 +/− 0.86; P = 0.005), non-coronary cusp implantation depth (OR = 1.34 +/− 0.15; P = 0.05) and a non coronary cusp implantation depth / membranous septal length ratio of more than 50% were associated with post procedural pacemaker implantation (OR = 29.9 +/− 1.72; P = 0.05). Among the 15 patients with post procedural pacemaker implantation, 40% were found to be non-pacemaker dependent at 1 year. Conclusion Short term outcomes of transcatheter aortic valve implantation in severe aortic stenosis patients are promising. Pacemaker rates remain high. More studies are needed to evaluate the factors that influence pacemaker rates and dependence to further improve transcatheter aortic valve implantation outcomes.
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Affiliation(s)
- Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Gary S H Cheung
- Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Alex P W Lee
- Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Henry K L Chui
- Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Kent C Y So
- Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Eugene B Wu
- Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
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Abstract
Echocardiography is a key evaluation tool for the diagnosis, prognosis, and guidance of interventional management of numerous cardiovascular conditions, including ischaemia, heart failure, and structural heart diseases. Recent technological advancements have also seen the exploration of artificial intelligence, intracardiac vortex imaging, and three-dimensional printing in echocardiography. With cardiovascular diseases increasing in prevalence worldwide, it is important for clinicians including general practitioners to have updated knowledge of appropriate use of echocardiography. As such, this article reviews the current literature and summarises the latest developments and the general clinical usage of echocardiography.
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Affiliation(s)
- J S K Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - G Tse
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - H Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - X X Luo
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - C N Jin
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - K Kam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Y T Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong.,Laboratory for Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - A P W Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong.,Laboratory for Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
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Abstract
OBJECTIVES Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance. DESIGN Observational study. SETTING We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative. PARTICIPANTS Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre. MEASUREMENTS Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml. RESULTS Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD. CONCLUSIONS Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.
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Affiliation(s)
- X Yang
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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Yang X, Lui LT, Li Q, Cheng KF, Liu S, Yau F, Sahota D, Fan Y, Lee APW, Woo J, Fung E. P39 Cross-sectional analysis of 6-minute walk distance and diastolic function in a Hong Kong cohort of community-living older adults. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
CUHK Direct Grant, CUHK Lui Che Woo Institute of Innovative Medicine, Food and Health Bureau of HKSAR (EF); Hong Kong Jockey Club Charities Trust (JW)
Background/Introduction
6-min walk distance (6MWD) can indicate frailty extent, cardiac dysfunction, and heart failure (HF) trajectory. Association of 6MWD with diastolic dysfunction (DD) or cardiac biomarker in community-living elderly without a history of HF remains underexplored.
Purpose
This study aims to determine the association between 6MWD, serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and DD in a community-living elderly population without known HF.
Methods
Between Nov 2017 and Aug 2018, 302 Hong Kong Chinese aged ≥60 y and without known HF were recruited into the Undiagnosed heart Failure in Older individuals (UFO) study consisting of robust, pre-frail and frail older adults stratified by FRAIL scale in a ratio of 1:1:1. 6MWD was divided into tertiles. Transthoracic echocardiography and serum NT-proBNP were used to assess cardiac dysfunction. Diastolic function was classified according to international guidelines and NT-proBNP >300 pg/ml was considered elevated.
Results
The ages of participants in the bottom, middle and top tertiles were 80.3 ± 7.4, 73.9 ± 6.3 and 70.0 ± 5.7 years (P < 0.01), respectively, corresponding to a female preponderance of 85.0%, 75.2%, 46.5% (P < 0.01). The highest prevalence rates of hypertension (HT, 76.0% vs 68.3% vs 51.5%, P < 0.01), diabetes mellitus (DM, 41.0% vs 30.7% vs 12.9%, P < 0.01), and ischaemic heart disease (IHD, 14.0% vs 4.0% vs 2.0%, P < 0.01) were observed in the bottom tertile of 6MWD. However, the prevalence of atrial fibrillation (AF) was distributed equally across tertiles (2.0% vs 2.0% vs 2.0%). Frail (63.0% vs 25.7% vs 3.0%, P < 0.01) and pre-frail (36.5% vs 44.6% vs 24.8%, P < 0.01) individuals were most frequently seen in the bottom and middle tertiles of 6MWD.
Using multiple linear regression analysis, S’ velocity, E:E’ ratio and E’ velocity were associated with 6MWD independent of age and sex. Associations between 6MWD and S’, left atrial volume index, E’ and E:E’ remained statistically significant even after adjusting for HT, DM, IHD, AF, stroke, chronic pulmonary disease and arthritis. No correlation was observed between 6MWD and left ventricular ejection fraction.
Compared with the top tertile of 6MWD, the bottom tertile was associated with increased risks for grade II–IV DD (odds ratio (OR) 3.47, 95% confidence interval (CI) 1.52–7.96, P < 0.01) and NT-proBNP >300pg/ml (OR 10.20, CI 3.74–27.85, P < 0.01, respectively, after adjusting for co-morbidities. The association between reduced 6MWD and elevated NT-proBNP, but not between 6MWD and DD, remained significant (OR 6.00, CI 2.06–17.46) after adjusting for age and sex. The middle tertile was not significantly associated with an increased risk for grade II–IV DD or elevated NT-proBNP.
Conclusion(s)
In this cohort of community-living Hong Kong Chinese elderly recruited equally by frailty status, performance of 6MWD in the bottom and top tertiles was inversely associated with NT-proBNP levels but not with DD.
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Affiliation(s)
- X Yang
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - L T Lui
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - Q Li
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - K F Cheng
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - S Liu
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - F Yau
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - D Sahota
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - Y Fan
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - A P W Lee
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - J Woo
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - E Fung
- The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
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Woo J, Yang X, Tin Lui L, Li Q, Fai Cheng K, Fan Y, Yau F, Lee APW, Lee JSW, Fung E. Utility of the FRAIL Questionnaire in Detecting Heart Failure with Preserved Ejection Fraction. J Nutr Health Aging 2019; 23:373-377. [PMID: 30932136 DOI: 10.1007/s12603-019-1158-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To test the utility of the FRAIL questionnaire as a screening tool for heart failure. DESIGN Cross sectional study. SETTING Chinese older people in Hong Kong. PARTICIPANTS Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. MEASUREMENTS Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). RESULTS The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. CONCLUSION Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.
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Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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15
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Fung E, Hui E, Yang X, Lui LT, Cheng KF, Li Q, Fan Y, Sahota DS, Ma BHM, Lee JSW, Lee APW, Woo J. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us. Front Physiol 2018; 9:347. [PMID: 29740330 PMCID: PMC5928128 DOI: 10.3389/fphys.2018.00347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.
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Affiliation(s)
- Erik Fung
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- Faculty of Medicine, Gerald Choa Cardiac Research Centre, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Elsie Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Xiaobo Yang
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leong T. Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - King F. Cheng
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Qi Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiting Fan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daljit S. Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Bosco H. M. Ma
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Tai Po, Hong Kong
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- CUHK Jockey Club Institute of Ageing, Chinese University of Hong Kong, Sha Tin, Hong Kong
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Cheung GSH, Kam KKH, Lam YY, Lee APW. Transcatheter tricuspid valve edge-to-edge repair for severe tricuspid regurgitation in a Chinese patient. Heart Asia 2018; 10:e010997. [PMID: 29682008 DOI: 10.1136/heartasia-2017-010997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gary S H Cheung
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, China
| | - Kevin K H Kam
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, China
| | | | - Alex P W Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, China
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Tse G, Lai ETH, Lee APW, Yan BP, Wong SH. Electrophysiological Mechanisms of Gastrointestinal Arrhythmogenesis: Lessons from the Heart. Front Physiol 2016; 7:230. [PMID: 27378939 PMCID: PMC4906021 DOI: 10.3389/fphys.2016.00230] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/30/2016] [Indexed: 01/09/2023] Open
Abstract
Disruptions in the orderly activation and recovery of electrical excitation traveling through the heart and the gastrointestinal (GI) tract can lead to arrhythmogenesis. For example, cardiac arrhythmias predispose to thromboembolic events resulting in cerebrovascular accidents and myocardial infarction, and to sudden cardiac death. By contrast, arrhythmias in the GI tract are usually not life-threatening and much less well characterized. However, they have been implicated in the pathogenesis of a number of GI motility disorders, including gastroparesis, dyspepsia, irritable bowel syndrome, mesenteric ischaemia, Hirschsprung disease, slow transit constipation, all of which are associated with significant morbidity. Both cardiac and gastrointestinal arrhythmias can broadly be divided into non-reentrant and reentrant activity. The aim of this paper is to compare and contrast the mechanisms underlying arrhythmogenesis in both systems to provide insight into the pathogenesis of GI motility disorders and potential molecular targets for future therapy.
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Affiliation(s)
- Gary Tse
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, The University of Hong KongHong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China
| | - Eric T H Lai
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, The University of Hong Kong Hong Kong, China
| | - Alex P W Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Hong Kong, China
| | - Bryan P Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong Hong Kong, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong Hong Kong, China
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Affiliation(s)
- Anthony M H Ho
- Professor, Department of Anesthesiology and Perioperative Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Po T Chui
- Consultant, Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Alex P W Lee
- Assistant Professor, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Song Wan
- Professor, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Wan S, Lee APW, Jin CN, Wong RHL, Chan HHM, Ng CSH, Wan IYP, Underwood MJ. The choice of mitral annuloplastic ring-beyond "surgeon's preference". Ann Cardiothorac Surg 2015; 4:261-5. [PMID: 26309828 DOI: 10.3978/j.issn.2225-319x.2015.01.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/15/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Song Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex P W Lee
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Chun-Na Jin
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph H L Wong
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Herman H M Chan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Y P Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Ho AMH, Critchley LAH, Leung JYC, Kan PKY, Au SS, Ng SK, Chan SKC, Lam PKN, Choi GYS, Wai JKM, Lee APW, Chan SO. Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation. Teach Learn Med 2015; 27:307-313. [PMID: 26158333 DOI: 10.1080/10401334.2015.1044657] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PROBLEM The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment. INTERVENTION All 133 final-year students completed a 2-week anesthesia rotation, which began with a half-day session consisting of a lecture and hands-on practice session during which they learned 9 basic transthoracic echocardiography views using 4 basic ultrasound probe positions. CONTEXT Each student was required to perform a transthoracic echocardiography-examine under supervision of 1 patient/week for 2 weeks, and their results were compared against that of the supervisor's. Most patients were elective cardiac surgery patients. One long question on transthoracic echocardiography was included in their end-of-year surgery examination paper. Students provided feedback on their experience. OUTCOME Most students learned the basic transthoracic echocardiography views fairly efficiently and had variable, though generally favorable, success rates in identifying obvious cardiac anomalies, including use of color Doppler. A few common mistakes were identified but were easily correctable. Logistics for mobilizing enough bedside supervision were challenging. Students reported positive feedback on the teaching initiative. LESSONS LEARNED We were able to execute a successful short training course on transthoracic echocardiography during the final-year medical degree anesthesia rotation. Our initiative may set an example for other clinical departments to design similar courses pertinent to their specialties and syllabuses.
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Affiliation(s)
- Anthony M-H Ho
- a Department of Anaesthesia and Intensive Care , The Chinese University of Hong Kong , Shatin , NT , Hong Kong SAR
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