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Rudiktyo E, Soesanto AM, Cramer MJ, Yonas E, Teske AJ, Siswanto BB, Doevendans PA. Global Left Ventricular Myocardial Work Efficiency in Patients With Severe Rheumatic Mitral Stenosis and Preserved Left Ventricular Ejection Fraction. J Cardiovasc Imaging 2023; 31:191-199. [PMID: 37901998 PMCID: PMC10622643 DOI: 10.4250/jcvi.2022.0124] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/18/2023] [Accepted: 07/09/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Maarten J Cramer
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Arco J Teske
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A Doevendans
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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Rudiktyo E, Yonas E, Cramer MJ, Siswanto BB, Doevendans PA, Soesanto AM. Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation. Glob Heart 2023; 18:15. [PMID: 36936249 PMCID: PMC10022539 DOI: 10.5334/gh.1192] [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] [Received: 09/20/2022] [Accepted: 02/16/2023] [Indexed: 03/19/2023] Open
Abstract
Background Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established. Purpose Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR. Methods The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation. Results The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3). Conclusions Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Emir Yonas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Maarten J. Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bambang B. Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A. Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Central Military Hospital Utrecht, the Netherlands
- Netherlands Heart Institute Utrecht the Netherlands
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian 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Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Abstract
The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.
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Affiliation(s)
- Raksheeth Agarwal
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Kenari, Kec. Senen, Jakarta Pusat, DKI Jakarta
| | - Ruth G Aurora
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta
| | - Hary S Muliawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Rumah Sakit Universitas Indonesia, Jl. Prof Bahder Djohan, Pondok Cina, Beji, Depok, Jawa Barat, Indonesia
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Andryan DP, Lestiadi ID, Siswanto BB. C76. Primary Cardiac Tumors : Benign or Malignant ? The Importance of Clinicopathologic Confirmation : a case series. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab125.075] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Cardiac tumor is a rare condition of space-occupying lesion mass in cardiac chamber. The incidence of clinically diagnosed Primary Cardiac Tumors is approximately 1,380/100 million individuals. Majority of cases are benign, with nearly half of them are cardiac myxoma. Although early clinical symptom of benign and malignant cardiac tumor are similar, the management and prognosis are much different.
Objective
To present serial cases of benign and malignant primary cardiac tumor.
Case Description
Mrs. RH, a 60-year-old woman referred to heart failure clinic National Cardiovascular Center Harapan Kita with chief complaint of short of breath on exercise. Echocardiography confirmed a huge mass obstructed her left atrium. She was hospitalized urgently with giant Left Atrial Myxoma with normal coronary artery, then underwent surgery of LA myxoma extirpation, Mitral Valve repair and Tricuspid Valve repair. Histopathological analysis confirmed of LA myxoma.
Mr. RBM, a 42-years-old man came to emergency unit at National Cardiovascular Center Harapan Kita with chief complaint shortness of breath and palpitation in about 1 month. A history of a cardiac tumor extirpation and mitral valve replacement was done in Penang Adventist hospital 10 months before. Transthoracal and transesophageal echocardiography found solid mass obstructing mechanical valve. Histopathology analysis showed undifferentiated cardiac sarcoma and against LA myxoma.
Discussion
Clinical course and management of cardiac tumor depends on early detection and histopathologic analysis. Although surgery is the cornerstone for cardiac tumor management, but confirmation of histopathologic findings is important.
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Affiliation(s)
- D P Andryan
- Department of Cardiology and Vascular Medicine. Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - I D Lestiadi
- Mother and Children Hospital Harapan Kita, Jakarta, Indonesia
| | - B B Siswanto
- Department of Cardiology and Vascular Medicine. Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Andryan DP, Lestiadi ID, Siswanto BB. C76. Primary Cardiac Tumors : Benign or Malignant ? The Importance of Clinicopathologic Confirmation : a case series. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab124.075] [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] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background
Cardiac tumor is a rare condition of space-occupying lesion mass in cardiac chamber. The incidence of clinically diagnosed Primary Cardiac Tumors is approximately 1,380/100 million individuals. Majority of cases are benign, with nearly half of them are cardiac myxoma. Although early clinical symptom of benign and malignant cardiac tumor are similar, the management and prognosis are much different.
Objective
To present serial cases of benign and malignant primary cardiac tumor.
Case Description
Mrs. RH, a 60-year-old woman referred to heart failure clinic National Cardiovascular Center Harapan Kita with chief complaint of short of breath on exercise. Echocardiography confirmed a huge mass obstructed her left atrium. She was hospitalized urgently with giant Left Atrial Myxoma with normal coronary artery, then underwent surgery of LA myxoma extirpation, Mitral Valve repair and Tricuspid Valve repair. Histopathological analysis confirmed of LA myxoma.
Mr. RBM, a 42-years-old man came to emergency unit at National Cardiovascular Center Harapan Kita with chief complaint shortness of breath and palpitation in about 1 month. A history of a cardiac tumor extirpation and mitral valve replacement was done in Penang Adventist hospital 10 months before. Transthoracal and transesophageal echocardiography found solid mass obstructing mechanical valve. Histopathology analysis showed undifferentiated cardiac sarcoma and against LA myxoma.
Discussion
Clinical course and management of cardiac tumor depends on early detection and histopathologic analysis. Although surgery is the cornerstone for cardiac tumor management, but confirmation of histopathologic findings is important.
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Affiliation(s)
- D P Andryan
- Department of Cardiology and Vascular Medicine. Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita , Jakarta, Indonesia
| | - I D Lestiadi
- Mother and Children Hospital Harapan Kita , Jakarta, Indonesia
| | - B B Siswanto
- Department of Cardiology and Vascular Medicine. Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita , Jakarta, Indonesia
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Karunawan NH, Pinzon RT, Siswanto BB. The comparison of clinical features and clinical outcomes in stroke patients with atrial fibrillation and non-atrial fibrillation: a hospital-based stroke registry in Indonesia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2060] [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
Background
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia associated with stroke. Based on the National Health Survey (Riskesdas) the prevalence of stroke in Indonesia increased from 7% in 2013 to 10.9% in 2018. Understanding the clinical features and clinical outcomes differences between AF and non-AF in stroke can help the clinician for further management.
Purpose
To compare the clinical features and clinical outcomes of stroke patients with AF and non-AF by using the data from the Bethesda Stroke Registry in Indonesia.
Methods
This cross-sectional study was based on a stroke registry, data were collected using the electronic medical record in our hospital. All patients ≥18 years of age, who developed stroke between January 1, 2011, and December 31, 2018, were included in this study. Data about clinical features and clinical outcomes were collected. The clinical outcomes included mortality, prolonged hospitalization (LOS >6 days), and disability was evaluated using the modified Rankin scale (MRS). The statistical measures calculated were Chi-square-test and Fischer's exact test.
Results
Data of the total 8447 patients enrolled in the registry, data of 8248 patients who fulfilled inclusion criteria were analyzed, and AF was seen in 226 (2.7%) stroke patents. Comparing with non-AF patients, AF patients were older (47.8% vs 26.0%), higher proportion on of women (48.2% vs39.9%), higher prevalence of ischemic heart disease (16.4% vs 4.7%), loss of consciousness (37.6% vs 23.2%), aphasia (29.6% vs 13.6%) mortality (20.8% vs 10.6%), prolonged hospitalizaton (10.24 [1–80] vs 7.18 [1–73]), worse disability (67.3% vs 43.2%), p<0.05. Comparing with AF patients, non-AF patients had a significantly higher prevalence of hypertension (52.9% vs 40.3%) and diabetes mellitus (33.5% vs 32.7%), p<0.05. Stroke patients with AF was significantly associated with higher in-hospital mortality (RR: 1.19, 95% CI: 1.05–1.35, p<0.001), worse disability (RR: 1.16, 95% CI: 1.11–1.22, p<0.001), and prolonged hospital stay RR: 1.39, 95% CI: 1.22–1.59, p<0.001) than in stroke patents with non-AF.
Conclusions
AF in stroke affected the poor outcomes by contributing to higher in-hospital mortality, prolonged hospitalization, and worse disability. Older age, Women and IHD were more strongly associated with Stroke n AF than non AF
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - R T Pinzon
- Duta Wacana Christian University, Yogyakarta, Indonesia
| | - B B Siswanto
- Universitas Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
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8
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Lazarus G, Kirchner HL, Siswanto BB. Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis. J Telemed Telecare 2020; 28:632-641. [PMID: 32996348 DOI: 10.1177/1357633x20960627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. METHODS A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = -25.53 minutes, 95% confidence interval (CI) -36.08 to -14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36-0.92) and long-term mortality (OR = 0.52, 95% CI 0.39-0.69) rates, both with negligible heterogeneity (I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence.Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.
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Affiliation(s)
| | - H L Kirchner
- Department of Population Health Sciences, Geisinger Clinic, USA
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesia
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9
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Pranata R, Lim MA, Yonas E, Vania R, Lukito AA, Siswanto BB, Meyer M. Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis. Diabetes Metab 2020; 47:101178. [PMID: 32738402 PMCID: PMC7388778 DOI: 10.1016/j.diabet.2020.07.005] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/04/2020] [Accepted: 07/12/2020] [Indexed: 01/08/2023]
Abstract
Background There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated. Aim This meta-analysis aims to evaluate the dose–response relationship between body mass index (BMI) and poor outcome in patients with COVID-19. Methods A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity. Results A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P < 0.001; I2: 55.6%), mortality (OR 1.55 [1.16, 2.06], P = 0.003; I2: 74.4%), and severity (OR 1.90 [1.45, 2.48], P < 0.001; I2: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P < 0.001; I2: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P = 0.002; I2: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P < 0.001; I2: 11.7%). The dose–response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P < 0.001 for every 5 kg/m2 increase in BMI (Pnon-linearity < 0.001). The curve became steeper with increasing BMI. Conclusion Dose–response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19.
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Affiliation(s)
- R Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | - M A Lim
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - E Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - R Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - A A Lukito
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - B B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - M Meyer
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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10
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Pranata R, Tondas AE, Vania R, Toruan MPL, Lukito AA, Siswanto BB. Remote ischemic preconditioning reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2020; 96:1200-1212. [PMID: 31912996 DOI: 10.1002/ccd.28709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/03/2019] [Accepted: 12/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. METHODS We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. RESULTS There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p < .001; I2 : 22%). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p < .001; I2 : 26%) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p < .001; I2 : 0%). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p = .001; I2 : 0%). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate-high risk subgroup, and PCI-only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small-study effects (p = .157). CONCLUSIONS Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate-high risk at developing CIN.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Alexander E Tondas
- Faculty of Medicine Universitas Sriwijaya, Department of Cardiology and Vascular Medicine, Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Mangiring P L Toruan
- Faculty of Medicine Universitas Sriwijaya, Department of Cardiology and Vascular Medicine, Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Antonia A Lukito
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.,Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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11
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Sakti Muliawan H, Widyantoro B, Soerarso R, Hersunarti N, Sahara E, Atmadikoesoemah CA, Kasim M, Adiarto S, Raharjo SB, Sukmawan R, Siswanto BB. P194 Trimetazidine preserves right ventricular function on pulmonary arterial hypertension patients in national cardiovascular center harapan kita hospital indonesia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.068] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
National Cardiovascular Center Harapan Kita Hospital
Background
Right ventricular dysfunction is the worst mortality predictor in pulmonary arterial hypertension (PAH). Recent animal PAH studies have demonstrated the benefit of partial fatty acid inhibitor such as trimetazidine in improving right ventricular function. Therefore, we hypothesize that trimetazidine can improve right ventricular ejection fraction (RVEF) in PAH patients.
Purpose
Investigating the effect of trimetazidine on right ventricle function in PAH patients.
Methods
We conducted 3 months randomized double blind placebo controlled trial on PAH patients at outpatient clinic in National Cardiovascular Center Harapan Kita Hospital Indonesia. Those who fulfilled the inclusion criteria will be randomized into trimetazidine or placebo group for 3 months on top of their standard PAH regime. Clinical and cardiovascular magnetic resonance imaging (CMR) parameters will be evaluated before and after 3 months therapy. The primary outcome of this study is the differences of RVEF from CMR.
Results
We randomly enrolled 26 PAH patients equally to receive placebo or trimetazidine for 3 months on top of their standard PAH regime. Total of 10 patients in each group was able to finish the study. There was significant improvement of RVEF in trimetazidine group 3.78 + 1.5% compared to placebo 2.76 + 1.6% (p 0.008, CI 1.96 to 10.96). Furthermore, we also observed improvement of functional capacity in trimetazidine group 0.24 + 0.09 compared to placebo -0.44 + 0.16 (p 0.002, CI 0.28 s/d 1.08).
Conclusions
Trimetazidine therapy for 3 months on top of standard PAH regime significantly improve RVEF and functional capacity in PAH patients.
Abstract P194 Figure. Effect of trimetazidine on RV function
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Affiliation(s)
- H Sakti Muliawan
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - B Widyantoro
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - R Soerarso
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - N Hersunarti
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - E Sahara
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - C A Atmadikoesoemah
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - M Kasim
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - S Adiarto
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - S B Raharjo
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - R Sukmawan
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
| | - B B Siswanto
- University of Indonesia, Cardiology and Vascular Medicine, Jakarta, Indonesia
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12
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MacDonald MR, Tay WT, Teng THK, Anand I, Ling LH, Yap J, Tromp J, Wander GS, Naik A, Ngarmukos T, Siswanto BB, Hung CL, Richards AM, Lam CSP. Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN-HF Registry. J Am Heart Assoc 2019; 9:e012199. [PMID: 31852421 PMCID: PMC6988158 DOI: 10.1161/jaha.119.012199] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Data comparing outcomes in heart failure (HF) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction (EF; <40%) versus preserved EF (≥50%). Methods and Results The ASIAN‐HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced rEF). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P<0.001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01633398.
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Affiliation(s)
| | | | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore Singapore.,School of Population & Global Health University of Western Australia Perth Australia
| | - Inder Anand
- Veterans Affairs Medical Center Minneapolis MN
| | - Lieng Hsi Ling
- Cardiovascular Research Institute National University Heart Centre Singapore
| | | | - Jasper Tromp
- National Heart Centre Singapore Singapore.,Department of Cardiology University Medical Center Groningen Groningen The Netherlands
| | | | - Ajay Naik
- Care Institute of Medical Sciences Ahmedabad India
| | | | | | | | - A Mark Richards
- Cardiovascular Research Institute National University Heart Centre Singapore.,University of Otago New Zealand
| | - Carolyn S P Lam
- National Heart Centre Singapore Singapore.,Department of Cardiology University Medical Center Groningen Groningen The Netherlands.,Duke-National University of Singapore Medical School Singapore
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13
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Yap J, Tay WT, Teng THK, Anand I, Richards AM, Ling LH, MacDonald MR, Chandramouli C, Tromp J, Siswanto BB, Zile M, McMurray J, Lam CSP. Association of Diabetes Mellitus on Cardiac Remodeling, Quality of Life, and Clinical Outcomes in Heart Failure With Reduced and Preserved Ejection Fraction. J Am Heart Assoc 2019; 8:e013114. [PMID: 31431116 PMCID: PMC6755825 DOI: 10.1161/jaha.119.013114] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Diabetes mellitus frequently coexists with heart failure (HF), but few studies have compared the associations between diabetes mellitus and cardiac remodeling, quality of life, and clinical outcomes, according to HF phenotype. Methods and Results We compared echocardiographic parameters, quality of life (assessed by the Kansas City Cardiomyopathy Questionnaire), and outcomes (1‐year all‐cause mortality, cardiovascular mortality, and HF hospitalization) between HF patients with and without type 2 diabetes mellitus in the prospective ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) Registry, as well as community‐based controls without HF. Adjusted Cox proportional hazards models were used to assess the association of diabetes mellitus with clinical outcomes. Among 5028 patients with HF and reduced ejection fraction (HFrEF; EF <40%) and 1139 patients with HF and preserved EF (HFpEF; EF ≥50%), the prevalences of type 2 diabetes mellitus were 40.2% and 45.0%, respectively (P=0.003). In both HFrEF and HFpEF cohorts, diabetes mellitus (versus no diabetes mellitus) was associated with smaller indexed left ventricular diastolic volumes and higher mitral E/e′ ratio. There was a predominance of eccentric hypertrophy in HFrEF and concentric hypertrophy in HFpEF. Patients with diabetes mellitus had lower Kansas City Cardiomyopathy Questionnaire scores in both HFpEF and HFrEF, with more prominent differences in HFpEF (Pinteraction<0.05). In both HFpEF and HFrEF, patients with diabetes mellitus had more HF rehospitalizations (adjusted hazard ratio, 1.27; 95% CI, 1.05–1.54; P=0.014) and higher 1‐year rates of the composite of all‐cause mortality/HF hospitalization (adjusted hazard ratio, 1.22; 95% CI, 1.05–1.41; P=0.011), with no differences between HF phenotypes (Pinteraction>0.05). Conclusions In HFpEF and HFrEF, type 2 diabetes mellitus is associated with smaller left ventricular volumes, higher mitral E/e′ ratio, poorer quality of life, and worse outcomes, with several differences noted between HF phenotypes. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01633398.
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Affiliation(s)
| | | | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore Singapore.,School of Population and Global Health University of Western Australia Perth Australia
| | - Inder Anand
- Veterans Affairs Medical Center Minneapolis MN
| | - A Mark Richards
- Cardiovascular Research Institute National University Heart Centre Singapore.,Department of Medicine University of Otago New Zealand
| | - Lieng Hsi Ling
- Cardiovascular Research Institute National University Heart Centre Singapore
| | | | | | - Jasper Tromp
- National Heart Centre Singapore Singapore.,Department of Cardiology University Medical Center Groningen Groningen the Netherlands
| | | | | | - Michael Zile
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - John McMurray
- Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Carolyn S P Lam
- National Heart Centre Singapore Singapore.,Department of Cardiology University Medical Center Groningen Groningen the Netherlands.,Duke-National University of Singapore Medical School Singapore
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14
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Dharma S, Mahavira A, Haryono N, Sukmawan R, Dakota I, Siswanto BB, Rao SV. Association of Hyperglycemia and Final TIMI Flow with One-Year Mortality of Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI. Int J Angiol 2019; 28:182-187. [PMID: 31452586 DOI: 10.1055/s-0039-1691811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The association of hyperglycemia at admission and final thrombolysis in myocardial infarction (TIMI) flow with 1-year mortality of patient with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not much been explored. We evaluated the association of hyperglycemia and final TIMI flow with 1-year mortality in patients with acute STEMI who underwent primary PCI. We retrospectively analyzed 856 patients with STEMI who underwent primary PCI in a tertiary care academic center between January 2014 and July 2016. Based on the receiver operating characteristics curve, the cutoff used for hyperglycemia in this study was greater than or equal to 169 mg/dL. Cox proportional hazard model was used to determine the association of hyperglycemia and TIMI flow with 1-year mortality. Compared with patients with lower blood glucose level (<169 mg/dL; n = 549), a greater proportion of patients who presented with hyperglycemia (≥169 mg/dL; n = 307) had final TIMI flow 0 to 1 (3.3 vs. 0.5%; adjusted odds ratio = 5.58, 95% confidence interval [CI] 1.30-23.9, p = 0.02). Hyperglycemia was associated with an increased risk for 1-year mortality (adjusted hazard ratio [HR]= 2.0, 95% CI: 1.13-3.53, p = 0.017). Multivariable Cox regression showed that the interaction of hyperglycemia and final TIMI flow 0 to 1 was associated with an elevated risk for 1-year mortality (adjusted HR= 9.4, 95% CI: 2.34-37.81, p = 0.002). A higher proportion of patients with acute STEMI who presented with hyperglycemia had final TIMI flow 0 to 1 after primary PCI. The interaction of hyperglycemia and final TIMI flow 0 to 1 was associated with an increased risk for 1-year mortality. This study suggests that aggressive control of hyperglycemia prior to primary PCI may facilitate better angiographic and clinical outcomes after primary PCI. Clinical Trial Registration Clinicaltrials.gov Identifier number: NCT02319473.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Andi Mahavira
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Nur Haryono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
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15
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Tromp J, Teng TH, Tay WT, Hung CL, Narasimhan C, Shimizu W, Park SW, Liew HB, Ngarmukos T, Reyes EB, Siswanto BB, Yu CM, Zhang S, Yap J, MacDonald M, Ling LH, Leineweber K, Richards AM, Zile MR, Anand IS, Lam CSP. Heart failure with preserved ejection fraction in Asia. Eur J Heart Fail 2018; 21:23-36. [PMID: 30113120 DOI: 10.1002/ejhf.1227] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a global public health problem. Unfortunately, little is known about HFpEF across Asia. METHODS AND RESULTS We prospectively studied clinical characteristics, echocardiographic parameters and outcomes in 1204 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions, grouped as Northeast Asia (Hong Kong, Taiwan, China, Japan, Korea, n = 543), South Asia (India, n = 252), and Southeast Asia (Malaysia, Thailand, Singapore, Indonesia, Philippines, n = 409). Mean age was 68 ±12 years (37% were < 65 years) and 50% were women. Seventy per cent of patients had ≥2 co-morbidities, most commonly hypertension (71%), followed by anaemia (57%), chronic kidney disease (50%), diabetes (45%), coronary artery disease (29%), atrial fibrillation (29%) and obesity (26%). Southeast Asian patients had the highest prevalence of all co-morbidities except atrial fibrillation, South Asians had the lowest prevalence of all co-morbidities except anaemia and obesity, and Northeast Asians had more atrial fibrillation. Left ventricular hypertrophy and concentric remodelling were most prominent among Southeast and South Asians, respectively (P < 0.001). Overall, 12.1% of patients died or were hospitalized for heart failure within 1 year. Southeast Asians were at higher risk for adverse outcomes, independent of co-morbidity burden and cardiac geometry. CONCLUSION These first prospective multinational data from Asia show that HFpEF affects relatively young patients with a high burden of co-morbidities. Regional differences in types of co-morbidities, cardiac remodelling and outcomes of HFpEF across Asia have important implications for public health measures and global HFpEF trial design.
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Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore, Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,Duke-NUS Medical School, Singapore, Singapore
| | - Tiew-Hwa Teng
- National Heart Centre Singapore, Singapore, Singapore
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | | | | | - Wataru Shimizu
- Nippon Medical School's Department of Cardiovascular Medicine, Tokyo, Japan
| | | | - Houng Bang Liew
- Jeffrey Cheah School Of Medicine And Health Sciences, Monash University Malaysia & Department of Cardiology, Queen Elizabeth Hospital 2, Malaysia
| | | | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | - Cheuk-Man Yu
- Heart Centre, Hong Kong Baptist Hospital, Hong Kong, SAR, The People's Republic of China
| | - Shu Zhang
- Fuwai Hospital, Beijing, The People's Republic of China
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Singapore
| | | | - Lieng Hsi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Singapore, Singapore 119228.,Cardiac Department, National University Health System, Singapore
| | | | - A Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Singapore, Singapore 119228.,National University Heart Centre, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand
| | - Michael R Zile
- Medical University of South Carolina, and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Inder S Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National University Heart Centre, Singapore, Singapore
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16
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Dharma S, Dakota I, Sukmawan R, Andriantoro H, Siswanto BB, Rao SV. P5566Two-year mortality of primary angioplasty for acute myocardial infarction during regular working hours versus off-hours. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5566] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Dharma
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - I Dakota
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - R Sukmawan
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - H Andriantoro
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - B B Siswanto
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - S V Rao
- Duke University Medical Center, Durham VA Medical Center, Durham, United States of America
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Chia YMF, Teng THK, Tan ESJ, Tay WT, Richards AM, Chin CWL, Shimizu W, Park SW, Hung CL, Ling LH, Ngarmukos T, Omar R, Siswanto BB, Narasimhan C, Reyes EB, Yu CM, Anand I, MacDonald MR, Yap J, Zhang S, Finkelstein EA, Lam CSP. Disparity Between Indications for and Utilization of Implantable Cardioverter Defibrillators in Asian Patients With Heart Failure. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.116.003651. [PMID: 29150533 DOI: 10.1161/circoutcomes.116.003651] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are lifesaving devices for patients with heart failure (HF) and reduced ejection fraction. However, utilization and determinants of ICD insertion in Asia are poorly defined. We determined the utilization, associations of ICD uptake, patient-perceived barriers to device therapy and, impact of ICDs on mortality in Asian patients with HF. METHODS AND RESULTS Using the prospective ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, 5276 patients with symptomatic HF and reduced ejection fraction (HFrEF) from 11 Asian regions and across 3 income regions (high: Hong Kong, Japan, Korea, Singapore, and Taiwan; middle: China, Malaysia, and Thailand; and low: India, Indonesia, and Philippines) were studied. ICD utilization, clinical characteristics, as well as device perception and knowledge, were assessed at baseline among ICD-eligible patients (EF ≤35% and New York Heart Association Class II-III). Patients were followed for the primary outcome of all-cause mortality. Among 3240 ICD-eligible patients (mean age 58.9±12.9 years, 79.1% men), 389 (12%) were ICD recipients. Utilization varied across Asia (from 1.5% in Indonesia to 52.5% in Japan) with a trend toward greater uptake in regions with government reimbursement for ICDs and lower out-of-pocket healthcare expenditure. ICD (versus non-ICD) recipients were more likely to be older (63±11 versus 58±13 year; P<0.001), have tertiary (versus ≤primary) education (34.9% versus 18.1%; P<0.001) and be residing in a high (versus low) income region (64.5% versus 36.5%; P<0.001). Among 2000 ICD nonrecipients surveyed, 55% were either unaware of the benefits of, or needed more information on, device therapy. ICD implantation reduced risks of all-cause mortality (hazard ratio, 0.71; 95% confidence interval, 0.52-0.97) and sudden cardiac deaths (hazard ratio, 0.33; 95% confidence interval, 0.14-0.79) over a median follow-up of 417 days. CONCLUSIONS ICDs reduce mortality risk, yet utilization in Asia is low; with disparity across geographic regions and socioeconomic status. Better patient education and targeted healthcare reforms in extending ICD reimbursement may improve access. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT01633398. Unique identifier: NCT01633398.
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Affiliation(s)
- Yvonne May Fen Chia
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Tiew-Hwa Katherine Teng
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Eugene S J Tan
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Wan Ting Tay
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - A Mark Richards
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Calvin Woon Loong Chin
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Wataru Shimizu
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Sang Weon Park
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Chung-Lieh Hung
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Lieng H Ling
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Tachapong Ngarmukos
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Razali Omar
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Bambang B Siswanto
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Calambur Narasimhan
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Eugene B Reyes
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Cheuk-Man Yu
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Inder Anand
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Michael R MacDonald
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Jonathan Yap
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Shu Zhang
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Eric A Finkelstein
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Carolyn S P Lam
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.).
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18
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Goh VJ, Tromp J, Teng THK, Tay WT, Van Der Meer P, Ling LH, Siswanto BB, Hung CL, Shimizu W, Zhang S, Narasimhan C, Yu CM, Park SW, Ngarmukos T, Liew HB, Reyes E, Yap J, MacDonald M, Richards MA, Anand I, Lam CSP. Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction. ESC Heart Fail 2018; 5:570-578. [PMID: 29604185 PMCID: PMC6073031 DOI: 10.1002/ehf2.12279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 10/01/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Aims Recent international heart failure (HF) guidelines recognize anaemia as an important comorbidity contributing to poor outcomes in HF, based on data mainly from Western populations. We sought to determine the prevalence, clinical correlates, and prognostic impact of anaemia in patients with HF with reduced ejection fraction across Asia. Methods and results We prospectively studied 3886 Asian patients (60 ± 13 years, 21% women) with HF (ejection fraction ≤40%) from 11 regions in the Asian Sudden Cardiac Death in Heart Failure study. Anaemia was defined as haemoglobin <13 g/dL (men) and <12 g/dL (women). Ethnic groups included Chinese (33.0%), Indian (26.2%), Malay (15.1%), Japanese/Korean (20.2%), and others (5.6%). Overall, anaemia was present in 41%, with a wide range across ethnicities (33–54%). Indian ethnicity, older age, diabetes, and chronic kidney disease were independently associated with higher odds of anaemia (all P < 0.001). Ethnicity modified the association of chronic kidney disease with anaemia (Pinteraction = 0.045), with the highest adjusted odds among Japanese/Koreans [2.86; 95% confidence interval (CI) 1.96–4.20]. Anaemic patients had lower Kansas City Cardiomyopathy Questionnaire scores (P < 0.001) and higher risk of all‐cause mortality and HF hospitalization at 1 year (hazard ratio = 1.28, 95% CI 1.08–1.50) compared with non‐anaemic patients. The prognostic impact of anaemia was modified by ethnicity (Pinteraction = 0.02), with the greatest hazard ratio in Japanese/Koreans (1.82; 95% CI 1.14–2.91). Conclusions Anaemia is present in a third to more than half of Asian patients with HF and adversely impacts quality of life and survival. Ethnic differences exist wherein prevalence is highest among Indians, and survival is most severely impacted by anaemia in Japanese/Koreans.
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Affiliation(s)
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Peter Van Der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shu Zhang
- Fuwai Cardiovascular Hospital, Beijing, China
| | | | | | | | | | - Houng Bang Liew
- Queen Elizabeth II Hospital, Clinical Research Center, Sabah, Malaysia
| | | | | | | | - Mark A Richards
- National University Heart Centre, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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Radi B, Santoso A, Siswanto BB, Mansyur M, Ibrahim N, Kusmana D. Early Exercise Program for Patients with Heart Failure after Hospital Discharge. ACTA ACUST UNITED AC 2017. [DOI: 10.4172/2329-9096.1000392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Lam CSP, Teng THK, Tay WT, Anand I, Zhang S, Shimizu W, Narasimhan C, Park SW, Yu CM, Ngarmukos T, Omar R, Reyes EB, Siswanto BB, Hung CL, Ling LH, Yap J, MacDonald M, Richards AM. Regional and ethnic differences among patients with heart failure in Asia: the Asian sudden cardiac death in heart failure registry. Eur Heart J 2016; 37:3141-3153. [PMID: 27502121 DOI: 10.1093/eurheartj/ehw331] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/06/2016] [Accepted: 07/10/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS To characterize regional and ethnic differences in heart failure (HF) across Asia. METHODS AND RESULTS We prospectively studied 5276 patients with stable HF and reduced ejection fraction (≤40%) from 11 Asian regions (China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Philippines, Singapore, Taiwan, and Thailand). Mean age was 59.6 ± 13.1 years, 78.2% were men, and mean body mass index was 24.9 ± 5.1 kg/m2. Majority (64%) of patients had two or more comorbid conditions such as hypertension (51.9%), coronary artery disease (CAD, 50.2%), or diabetes (40.4%). The prevalence of CAD was highest in Southeast Asians (58.8 vs. 38.2% in Northeast Asians). Compared with Chinese ethnicity, Malays (adjusted odds ratio [OR] 1.97, 95% CI 1.63-2.38) and Indians (OR 1.44, 95% CI 1.24-1.68) had higher odds of CAD, whereas Koreans (OR 0.38, 95% CI 0.29-0.50) and Japanese (OR 0.44, 95% CI 0.36-0.55) had lower odds. The prevalence of hypertension and diabetes was highest in Southeast Asians (64.2 and 49.3%, respectively) and high-income regions (59.7 and 46.2%, respectively). There was significant interaction between ethnicity and region, where the adjusted odds were 3.95 (95% CI 2.51-6.21) for hypertension and 4.91 (95% CI 3.07-7.87) for diabetes among Indians from high- vs. low-income regions; and 2.60 (95% CI 1.66-4.06) for hypertension and 2.62 (95% CI 1.73-3.97) for diabetes among Malays from high- vs. low-income regions. CONCLUSIONS These first prospective multi-national data from Asia highlight the significant heterogeneity among Asian patients with stable HF, and the important influence of both ethnicity and regional income level on patient characteristics. CLINICALTRIALSGOV IDENTIFIER NCT01633398.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore .,Duke-National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore, Singapore.,School of Population Health, University of Western Australia, WA, Australia
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Inder Anand
- VA Medical Center, University of Minnesota, Minneapolis, USA
| | - Shu Zhang
- Fuwai Hospital, Beijing, The People's Republic of China
| | | | | | | | - Cheuk-Man Yu
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | | | - Razali Omar
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | - Lieng H Ling
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Singapore
| | | | - A Mark Richards
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
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Dharma S, Hapsari R, Siswanto BB, van der Laarse A, Jukema JW. Blood Leukocyte Count on Admission Predicts Cardiovascular Events in Patients with Acute Non-ST Elevation Myocardial Infarction. Int J Angiol 2015; 24:127-32. [PMID: 26060384 DOI: 10.1055/s-0035-1544178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We aim to test the hypothesis that blood leukocyte count adds prognostic information in patients with acute non-ST-elevation myocardial infarction (non-STEMI). A total of 585 patients with acute non-STEMI (thrombolysis in myocardial infarction risk score ≥ 3) were enrolled in this cohort retrospective study. Blood leukocyte count was measured immediately after admission in the emergency department. The composite of death, reinfarction, urgent revascularization, and stroke during hospitalization were defined as the primary end point of the study. The mean age of the patients was 61 ± 9.6 years and most of them were male (79%). Using multivariate Cox regression analysis involving seven variables (history of smoking, hypertension, heart rate > 100 beats/minute, serum creatinine level > 1.5 mg/dL, blood leukocyte count > 11,000/µL, use of β-blocker, and use of angiotensin-converting enzyme inhibitor), leukocyte count > 11,000/µL demonstrated to be a strong predictor of the primary end point (hazard ratio = 3.028; 95% confidence interval = 1.69-5.40, p < 0.001). The high blood leukocyte count on admission is an independent predictor of cardiovascular events in patients with acute non-STEMI.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rosmarini Hapsari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Arnoud van der Laarse
- Department of Cardiology and Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Abstract
Copeptin is a provasopressin-derived peptide, the precursor for arginine vasopressin (AVP), which is an antidiuretic hormone from the hypothalamus. Copeptin is secreted together with AVP equally as a response of AVP stimulation. While AVP’s main function is water and blood volume regulation and maintaining electrolyte homeostasis, copeptin’s function is still not fully understood. AVP, copeptin, and other vasopressinergic neuropeptides’ levels are elevated in acute stress caused by pathological conditions. Clinical use of AVP levels has many weaknesses. Copeptin can act as a replacement because of its molecular stability, easier testing methods, and faster results. For example, combination of copeptin and cardiac troponins can eliminate myocardial infarction (MI) diagnosis faster, while combined with brain-type natriuretic peptide (BNP) or its precursor can predict heart failure (HF) outcome. In cardiovascular shock, copeptin levels are elevated. As such, copeptin is a potential biomarker for MI diagnosis and predictor for HF mortality and morbidity.
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Asbarinsyah NA, Soerarso RS, Hersunarti N, Siswanto BB. Chronic thromboembolic pulmonary hypertension in young woman with history of caesarian section. Med J Indones 2015. [DOI: 10.13181/mji.v23i4.1067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of subgroups of pulmonary hypertension. This is a serious medical condition that severely under diagnosed. CTEPH is commonly underdiagnosed due to non specific symptoms and lack of diagnostic tools. The aim of this presentation is to discuss the etiology, risk factors, diagnosis and management of CTEPH. A 36-year-old woman presented with easily fatigue and dyspneu on effort since two years ago. The symptom occured about three months after she gave birth with caesarian section due to preeclampsia. Further history taking, physical examination, electrocardiography (ECG) and echocardiography were highly suggestive of pulmonary hypertension. No deep vein thrombosis (DVT) was found on vascular femoral sonography. It was found after the lung perfusion scintigraphy performed that she actually had CTEPH. This patient was categorized as inoperable because CT pulmonary angiography showed no thrombus. The patient got pulmonary vasodilator and oral anticoagulant for lifelong.
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Saragih WM, Sulistiowati S, Haryono N, Siswanto BB, Hersunarti N, Soesanto AM. Case report of secondary hypertension due to renal artery stenosis in young patient. Med J Indones 2014. [DOI: 10.13181/mji.v23i2.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Secondary hypertension is rare to occur, but should become suspicion in young age. Secondary hypertension must be appropriately diagnosed and treated. Renal artery stenosis is one of many causes of secondary hypertension. The aim of this case report is to describe diagnosis, pathophysiology and management of secondary hypertension due to renal artery stenosis in young patient. A 17 year old man with symptom of shortness of breath was diagnosed with hypertension stage 3 on his medical examination at Pasar Rebo Hospital, Jakarta. Abdominal CT scan examination revealed bilateral renal artery stenosis. Percutaneous transluminal angiography (PTA) of left renal artery was performed at National Cardiovascular Centre Harapan Kita. Stent was placed succesfully and the blood pressure was normalized.
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Rizki R, Siswanto BB. Challenges on management of heart failure in Indonesia: a general practitioner’s perspective. Med J Indones 2014. [DOI: 10.13181/mji.v23i1.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Aryadi A, Purwowiyoto SL, Suryaatmadja B, Siswanto BB, Wibisono D, Purwowiyoto B. PM409 Positive Correlation between ECG Dispersion Mapping (HeartVue™) with Prediabetes. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kasim M, Currie GM, Tjahjono M, Siswanto BB, Harimurti GM, Kiat H. Myocardial Perfusion SPECT Utility in Predicting Cardiovascular Events Among Indonesian Diabetic Patients. Open Cardiovasc Med J 2013; 7:82-9. [PMID: 24155798 PMCID: PMC3795403 DOI: 10.2174/1874192401307010082] [Citation(s) in RCA: 3] [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: 08/06/2012] [Accepted: 09/01/2012] [Indexed: 11/22/2022] Open
Abstract
Background: Indonesia has the fourth largest number of diabetes patients after India, China and the USA. Coronary artery disease (CAD) is the most common cause of death in diabetic patients. Early detection and risk stratification is important for optimal management. Abnormal myocardial perfusion imaging (MPI) is an early manifestation in the ischemic cascade. Previous studies have demonstrated the use of MPI to accurately diagnose obstructive CAD and predict adverse cardiac events. This study evaluated whether MPI predicts adverse cardiac event in an Indonesian diabetic population. Method: The study was undertaken in a consecutive cohort of patients with suspected or known CAD fulfilling entry criteria. All had adenosine stress MPI. The end point was a major adverse cardiac event (MACE) defined as cardiac death or nonfatal myocardial infarction (MI). Results: Inclusion and exclusion criteria were satisfied by 300 patients with a mean follow-up of 26.7 ± 8.8 months. The incidence of MACEs was 18.3% among diabetic patients, versus 9% in the non-diabetic population (p < 0.001). A multivariable Cox proportional hazard model demonstratedin dependent predictors for a MACE as abnormal MPI [HR: 9.30 (3.01 – 28.72), p < 0.001], post stress left ventricular ejection fraction (LVEF) ≤30% [HR:2.72 (1.21 – 6.15), p = 0.016] and the patients diabetic status [HR:2.28 (1.04 – 5.01), p = 0.04]. The Kaplan Meier event free survival curve constructed for the different subgroups based on the patients’ diabetic status and MPI findings demonstrated that diabetic patients with an abnormal MPI had the worst event free survival (log rank p value < 0.001). Conclusions: In an Indonesian population with suspected or known CAD abnormal adenosine stress MPI is an independent and potent predictor for adverse cardiovascular events and provides incremental prognostic value in cardiovascular risk stratification of patients with diabetes.
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Affiliation(s)
- Manoefris Kasim
- National Cardiovascular Center, Harapan Kita Hospital, Department of Cardiology, Indonesia University
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Munawar M, Siswanto BB, Harimurti GM, Nguyen TN. Transcatheter closure of coronary artery fistula using Guglielmi detachable coil. J Geriatr Cardiol 2012; 9:11-6. [PMID: 22783318 PMCID: PMC3390105 DOI: 10.3724/sp.j.1263.2012.00011] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/11/2011] [Accepted: 10/18/2011] [Indexed: 01/26/2023] Open
Abstract
Background Coronary artery fistula (CAF) is a rare anomaly. Transcatheter CAF closure has been introduced using various materials, but only few data are available on the Guglielmi detachable coil (GDC). The advantage of using GDC for transcatheter CAF closure is more controllable, therefore much safer when compared to other coils. This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital. Methods & Results From 2002 to 2007, there were 10 patients with CAFs (age range: 28 to 56 year-old, 7 males) who underwent transcatheter CAF closure. There were a total of 19 CAFs which originated from right coronary (n = 5), left circumflex (n = 3), left anterior descending artery (n = 10) and left main trunk (n = 1). Median number of coil deployment for each fistula was 3 (range: 1 to 6). The pulmonary artery was the most common site of the distal communication of CAFs (n = 14), followed by right atrium (n = 3), left atrium (n = 1) and left ventricle (n = 1). Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2%) CAFs, significant reduction of the flow in 5 (26.3%), while 2 (10.5%) could not be closed due to small size. Nine (90%) patients underwent a repeated angiography within 3 to 8 months. Among 12 CAFs that were occluded immediately post-deployment, there were 2 CAFs with insignificant residual flow. Among 6 CAFs with significantly decreased flow immediately post-deployment, 2 were occluded totally in the follow-up angiography. In total, 12 (70.5%) CAFs were occluded completely and 5 (29.5%) CAFs still had insignificant residual flow, which did not need any additional coil deployment. During a mean follow up of 4.3 ± 0.7 year, all patients remained symptom and complication free. Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.
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Siswanto BB. Accurate diagnoses, evidence based drugs, and new devices (3 Ds) in heart failure. Med J Indones 2012. [DOI: 10.13181/mji.v21i1.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mulia E, Siswanto BB. Cardiocerebral resuscitation: advances in cardiac arrest resuscitation. Med J Indones 2011. [DOI: 10.13181/mji.v20i4.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Siswanto BB, Aryani R. Recent advances in diagnosis and management of hypertrophic cardiomyopathy. Heart Asia 2009; 1:16-19. [PMID: 27325920 PMCID: PMC4898324 DOI: 10.1136/ha.2008.000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Accepted: 12/22/2008] [Indexed: 06/06/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterised by a thickened but non-dilated left ventricle in the absence of another cardiac or systemic condition capable of producing the magnitude of hypertrophy evident. It is the most common familial genetic disease of the heart (1/500 to 1/1000), as well as the most common cause of sudden cardiac death in young people and athletes. Survival rates of patients with HCM have improved from the 1960s onwards. Natural history in patients with HCM might vary from developing severe heart failure or atrial fibrillation, some die suddenly, often at a young age and in the absence of previous symptoms. Because of its heterogeneous clinical course and expression, HCM frequently presents uncertainty and represents a management dilemma to cardiovascular specialists and other practitioners.
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Affiliation(s)
- B B Siswanto
- Department of Cardiology & Vascular Medicine, Faculty of Medicine, University of Indonesia/National Cardiovascular Center Harapan Kita, Indonesia Heart Association, Jakarta, Indonesia
| | - R Aryani
- Department of Cardiology & Vascular Medicine, Faculty of Medicine, University of Indonesia/National Cardiovascular Center Harapan Kita, Indonesia Heart Association, Jakarta, Indonesia
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Sanjaya W, Siswanto BB. Effect of beta blocker therapy on survival in severe heart failure. Med J Indones 2002. [DOI: 10.13181/mji.v11i3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Makmun LH, Abdurachman N, Alwi I, Afandi D, Siswanto BB, Andriantoro H, Ratnaningsih E, Utomo H. A randomized comparative trial of first-dose response to Angiotensin- Converting Enzyme Perindopril and Captopril in Indonesian heart failure patients. Med J Indones 2002. [DOI: 10.13181/mji.v11i1.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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