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Lin JC, Li CH, Chen YY, Weng CJ, Chien YS, Wu SJ, Lo CP, Tien HC, Lin CH, Huang JL, Lin YJ, Hsieh YC, Chen SA. Rhythm Control Better Prevents Dementia than Rate Control Strategies in Patients with Atrial Fibrillation-A Nationwide Cohort Study. J Pers Med 2022; 12:jpm12040572. [PMID: 35455688 PMCID: PMC9025212 DOI: 10.3390/jpm12040572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Atrial fibrillation (AF) increases the risk of dementia. Whether the pharmacological rhythm control of AF can reduce the risk of dementia compared to the rate control strategy remains unclear. We hypothesize that the rhythm control strategy is better than the rate control strategy in preventing dementia. Methods: AF patients aged ≥65 years were identified from the Taiwan National Health Insurance Database. Patients receiving anti-arrhythmic drugs at a cumulative defined daily dose (cDDD) of >30 within the first year of enrollment constituted the rhythm control group. Patients who used rate control medications for a cDDD of >30 constituted the rate control group. A multivariate Cox hazards regression model was used to determine the hazard ratio (HR) for dementia. Results: A total of 3382 AF patients (698 in the rhythm control group; 2684 in the rate control group) were analyzed. During a 4.86 ± 3.38 year follow-up period, 414 dementia events occurred. The rhythm control group had a lower rate of dementia than the rate control group (adjust HR: 0.75, p = 0.031). The rhythm control strategy reduced the risk of dementia particularly in those receiving aspirin (p = 0.03). Conclusions: In patients with AF, pharmacological rhythm control was associated with a lower risk of dementia than rate control over a long-term follow-up period, particularly in patients receiving aspirin treatment.
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Affiliation(s)
- Jiunn-Cherng Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Yun-Yu Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10617, Taiwan
| | - Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Yu-Shan Chien
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Shang-Ju Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
| | - Chu-Pin Lo
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
| | - Hui-Chun Tien
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40704, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- School of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yenn-Jiang Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Department of Data Science and Big Data Analytics, Providence University, Taichung 43301, Taiwan;
- Department of Financial Engineering, Providence University, Taichung 43301, Taiwan;
- School of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Correspondence: ; Tel.: +886-4-2251-6648; Fax: +886-4-2359-9257
| | - Shih-Ann Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (J.-C.L.); (C.-H.L.); (C.-J.W.); (Y.-S.C.); (S.-J.W.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 11217, Taiwan;
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
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Hsieh YC, Liao YC, Li CH, Lin JC, Weng CJ, Lin CC, Lo CP, Huang KC, Huang JL, Lin CH, Wang JS, Wu TJ, Sheu WHH. Hypoglycaemic episodes increase the risk of ventricular arrhythmia and sudden cardiac arrest in patients with type 2 diabetes-A nationwide cohort study. Diabetes Metab Res Rev 2020; 36:e3226. [PMID: 31655001 DOI: 10.1002/dmrr.3226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The impact of hypoglycaemic episode (HE) on the risk of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA) remains unclear. We hypothesized that HE increases the risk of both VA and SCA and that glucose-lowering agents causing HE also increase the risk of VA/SCA in patients with type 2 diabetes (T2D). METHODS Patients aged 20 years or older with newly diagnosed T2D were identified using the Taiwan National Health Insurance Database. HE was defined as the presentation of hypoglycaemic coma or specified/unspecified hypoglycaemia. The control group consisted of T2D patients without HE. The primary outcome was the occurrence of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. A multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA. RESULTS A total of 54 303 patients were screened, with 1037 patients with HE assigned to the HE group and 4148 frequency-matched patients without HE constituting the control group. During a mean follow-up period of 3.3 ± 2.5 years, 29 VA/SCA events occurred. Compared with the control group, HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, P = .04). Patients who had used insulin for glycaemic control showed an increased risk of VA/SCA compared with patients who did not receive insulin (adjusted HR: 3.05, P = .01). CONCLUSIONS The HEs in patients with T2D increased the risk of VA/SCA, compared with those who did not experience HEs. Use of insulin also independently increased the risk of VA/SCA.
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Affiliation(s)
- Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Jiunn-Cherng Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Chi-Jen Weng
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu-Pin Lo
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
| | - Kuo-Ching Huang
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Sing Wang
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Rong Hsing Research Center and PhD Program for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wayne H-H Sheu
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Hsieh YC, Liao YC, Li CH, Lin JC, Weng CJ, Lin CC, Lo CP, Huang KC, Huang JL, Lin CH, Wu TJ, Sheu WH. P5644Hypoglycemic episodes increase the risk of ventricular arrhythmias and sudden cardiac arrest in patients with type 2 diabetes - a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0587] [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
Hypoglycemic episode (HE) increases the risk of cardiovascular mortality. The impact of HE on the risk of sudden death remains unclear. We hypothesized that HE increases the risks of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA), and that anti-diabetic agents (ADAs) causing hypoglycemia also increase the risks of VA and SCA.
Methods
Patients aged ≥20 years with newly diagnosed diabetes were identified from the Taiwan National Insurance Database. HE was defined as the presentation of hypoglycemic coma or specified/unspecified hypoglycemia. For control group, we included diabetic patients without HE, and they were frequency-matched to the HE group at a 4:1 ratio. The primary outcome was the occurrence of any event of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA.
Results
A total of 54,303 diabetic patients were screened with 1,037 of them in the HE group, and 4,148 in the control group. During a mean follow-up period of 3.3±2.5 years, 29 VA/SCA events had occurred. Compared to the control group, the HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, p=0.04). Diabetic patients medicated with insulin for glycemic control increased the risk of VA/SCA compared to those without insulin (adjusted HR: 3.05, p=0.01).
Kaplan-Meier survival curves
Conclusions
HEs in patients with diabetes increased the risks of VA and SCA compared to those without. Their use of insulin also independently increased the risk of VA/SCA.
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Affiliation(s)
- Y C Hsieh
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Y C Liao
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C H Li
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - J C Lin
- Chiayi Branch, Taichung Veterans General Hospital, Department of Internal Medicine, Chiayi, Taiwan
| | - C J Weng
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C C Lin
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - C P Lo
- Providence University, Department of Financial Engineering, Taichung, Taiwan
| | - K C Huang
- Providence University, Department of Financial Engineering, Taichung, Taiwan
| | - J L Huang
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C H Lin
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - T J Wu
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - W H Sheu
- Taichung Veterans General Hospital, Division of Endocrinology and Metabolism, Department of Medicine, Taichung, Taiwan
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Weng CJ, Li CH, Liao YC, Lin CC, Lin JC, Chang SL, Lo CP, Huang KC, Huang JL, Lin CH, Hsieh YC, Wu TJ. Rhythm control better prevents stroke and mortality than rate control strategies in patients with atrial fibrillation - A nationwide cohort study. Int J Cardiol 2018; 270:154-159. [DOI: 10.1016/j.ijcard.2018.06.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
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Weng CJ, Li CH, Liao YC, Lin CC, Lin JC, Chang SL, Lo CP, Huang KC, Huang JL, Lin CH, Hsieh YC, Wu TJ. Data for rate versus rhythm control strategy on stroke and mortality in patients with atrial fibrillation. Data Brief 2018; 20:1279-1285. [PMID: 30238040 PMCID: PMC6143751 DOI: 10.1016/j.dib.2018.08.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/25/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022] Open
Abstract
The data relates to the cohort of patients with atrial fibrillation (AF) from the National Health Insurance Research Database of Taiwan, "Rhythm Control Better Prevents Stroke and Mortality than Rate Control Strategies in Patients with Atrial Fibrillation - A Nationwide Cohort Study" (Weng et al., in press). The AF patients might receive either rate or rhythm control strategy according to the medication used. The baseline medication in rate and rhythm control groups was included in this dataset. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for major adverse cardiovascular events (MACE), including ischemic/hemorrhagic stroke and mortality in AF patients receiving rate or rhythm control. The occurrence of MACE was identified from the ICD-9 CM codes. The data also contains the HR for MACE stratified by the CHA2DS2-VASc score, baseline characteristics, and the duration of strategy employed of the AF patients.
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Affiliation(s)
- Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiunn-Cherng Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan.,Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Shih-Lin Chang
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Pin Lo
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
| | - Kuo-Ching Huang
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Chan CW, Yu CL, Lin JC, Hsieh YC, Lin CC, Hung CY, Li CH, Liao YC, Lo CP, Huang JL, Lin CH, Wu TJ. Glitazones and alpha-glucosidase inhibitors as the second-line oral anti-diabetic agents added to metformin reduce cardiovascular risk in Type 2 diabetes patients: a nationwide cohort observational study. Cardiovasc Diabetol 2018; 17:20. [PMID: 29368615 PMCID: PMC5781294 DOI: 10.1186/s12933-018-0663-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 12/23/2022] Open
Abstract
Objective Metformin is the standard first-line drug for patients with Type 2 diabetes (T2DM). However, the optimal second-line oral anti-diabetic agent (ADA) remains unclear. We investigated the cardiovascular risk of various ADAs used as add-on medication to metformin in T2DM patients from a nationwide cohort. Methods T2DM patients using different add-on oral ADAs after an initial metformin therapy of > 90 days were identified from the Taiwan National Health Insurance Database. Five classes of ADAs, including sulphonylureas (SU), glinides, thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI), and dipeptidyl peptidase-4 inhibitors (DPP-4I) were selected for analysis. The reference group was the SU added to metformin. Patients were excluded if aged < 20 years, had a history of stroke or acute coronary syndrome (ACS), or were receiving insulin treatment. The primary outcomes included any major adverse cardiovascular event (MACE) including ACS, ischemic/hemorrhagic stroke, and death. A Cox regression model was used to estimate the hazard ratio (HR) for MACE. Results A total of 26,742 patients receiving their add-on drug to metformin of either SU (n = 24,277), glinides (n = 962), TZD (n = 581), AGI (n = 808), or DPP-4I (n = 114) were analyzed. After a mean follow-up duration of 6.6 ± 3.4 years, a total of 4775 MACEs occurred. Compared with the SU+metformin group (reference), the TZD+metformin (adjusted HR: 0.66; 95% CI 0.50–0.88, p = 0.004) and AGI+metformin (adjusted HR: 0.74; 95% CI 0.59–0.94, p = 0.01) groups showed a significantly lower risk of MACE. Conclusion Both TZD and AGI, when used as an add-on drug to metformin were associated with lower MACE risk when compared with SU added to metformin in this retrospective cohort study. Trial registration CE13152B-3. Registered 7 Mar, 2013, retrospectively registered Electronic supplementary material The online version of this article (10.1186/s12933-018-0663-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheng-Wei Chan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chu-Leng Yu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiunn-Cherng Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Internal Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.,Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan. .,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Department of Internal Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan. .,Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan.
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Ying Hung
- Department of Internal Medicine, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu, Taiwan.,Department of Nutrition, Hung-Kuang University, Taichung, Taiwan
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chu-Pin Lo
- Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Hsieh YC, Lin SF, Huang JL, Hung CY, Lin JC, Liao YC, Lo CP, Wang KY, Wu TJ. Moderate Hypothermia (33 °C) Decreases the Susceptibility to Pacing-Induced Ventricular Fibrillation Compared with Severe Hypothermia (30 °C) by Attenuating Spatially Discordant Alternans in Isolated Rabbit Hearts. Acta Cardiol Sin 2014; 30:455-465. [PMID: 27122819 PMCID: PMC4834958] [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] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/20/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND Severe hypothermia (SH, 30 °C) increases the risk of pacing-induced ventricular fibrillation (PIVF) by enhancing spatially discordant alternans (SDA). Whether moderate hypothermia (MH, 33 °C), which is clinically used for therapeutic hypothermia, also facilitates SDA remains unclear. We hypothesized that MH attenuates SDA occurrence compared with that achieved by SH, and decreases the susceptibility of PIVF. METHODS Using an optical mapping system, action potential duration (APD)/conduction velocity restitutions and thresholds of APD alternans were determined by S1 pacing in Langendorff-perfused isolated rabbit hearts. In the MH group (n = 7), S1 pacing was performed at baseline (37 °C), after 5-min MH, and after 5-min rewarming (37 °C). In the SH group (n = 9), pacing was also performed at baseline (37 °C), after 5-min SH, and after 5-min rewarming (37 °C). The thresholds of APD alternans were defined as the longest S1 pacing cycle length at which APD alternans were detected. RESULTS Although the thresholds of APD alternans were not different between the MH (273 ± 46 ms) and the SH (300 ± 35 ms) (p = 0.281) groups, SDA threshold was shorter (at a faster heart rate) during MH (228 ± 33 ms) than that during SH (289 ± 42 ms) (p = 0.028). At APD alternans threshold, SH hearts showed more SDA than that during MH (SH: 7 hearts, MH: 2 hearts, p = 0.049). SDA could be induced in all 9 SH hearts (100%), while only 4 MH hearts (57%) had SDA (p = 0.029). The PIVF inducibility during SH (44 ± 53%) was higher than that during MH (0%) (p = 0.043). CONCLUSIONS Compared with SH, the MH group showed greater attenuation of SDA and decreased the susceptibility of PIVF. Therefore, MH is safer as a procedural guideline for use in clinical therapeutic hypothermia than SH. KEY WORDS Cardiac alternans; Conduction velocity; Hypothermia; Optical mapping.
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Affiliation(s)
- Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
- Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan
| | - Shien-Fong Lin
- Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
- Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
| | - Chen-Ying Hung
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
| | - Jiunn-Cherng Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
| | - Chu-Pin Lo
- Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei
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8
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Hsiao PY, Tien HC, Lo CP, Juang JMJ, Wang YH, Sung RJ. Gene mutations in cardiac arrhythmias: a review of recent evidence in ion channelopathies. Appl Clin Genet 2013; 6:1-13. [PMID: 23837003 PMCID: PMC3699290 DOI: 10.2147/tacg.s29676] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past 15 years, molecular genetic studies have linked gene mutations to many inherited arrhythmogenic disorders, in particular, “ion channelopathies”, in which mutations in genes encode functional units of ion channels and/or their transporter-associated proteins in patients without primary cardiac structural abnormalities. These disorders are exemplified by congenital long QT syndrome (LQTS), short QT syndrome, Brugada syndrome (BrS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). Functional and pathophysiological studies have led to better understanding of the clinical spectrum, ion channel structures and cellular electrophysiology involving dynamics of intracellular calcium cycling in many subtypes of these disorders and more importantly, development of potentially more effective pharmacological agents and even curative gene therapy. In this review, we have summarized (1) the significance of unveiling mutations in genes encoding transporter-associated proteins as the cause of congenital LQTS, (2) the technique of catheter ablation applied at the right ventricular outflow tract may be curative for severely symptomatic BrS, (3) mutations with channel function modulated by protein Kinase A-dependent phosphorylation can be the culprit of CPVT mimicry in Andersen-Tawil syndrome (LQT7), (4) ablation of the ion channel anchoring protein may prevent arrhythmogenesis in Timothy syndrome (LQT8), (5) altered intracellular Ca2+ cycling can be the basis of effective targeted pharmacotherapy in CPVT, and (6) the technology of induced pluripotent stem cells is a promising diagnostic and research tool as it has become a new paradigm for pathophysiological study of patient- and disease-specific cells aimed at screening new drugs and eventual clinical application of gene therapy. Lastly, we have discussed (7) genotype-phenotype correlation in relation to risk stratification of patients with congenital LQTS in clinical practice.
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Affiliation(s)
- Pi-Yin Hsiao
- Institute of Life Sciences, National Central University, Taoyuan, Taiwan
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Sung RJ, Lo CP, Hsiao PY, Tien HC. Targeting intracellular calcium cycling in catecholaminergic polymorphic ventricular tachycardia: a theoretical investigation. Am J Physiol Heart Circ Physiol 2011; 301:H1625-38. [DOI: 10.1152/ajpheart.00696.2010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 01/24/2023]
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a malignant arrhythmogenic disorder linked to mutations in the cardiac ryanodine receptor (RyR2) and calsequestrin, predisposing the young to syncope and cardiac arrest. To define the role of β-adrenergic stimulation (BAS) and to identify potential therapeutic targeted sites relating to intracellular calcium cycling, we used a Luo-Rudy dynamic ventricular myocyte model incorporated with interacting Markov models of the L-type Ca2+ channel ( ICa,L) and RyR2 to simulate the heterozygous state of mouse RyR2 R4496C mutation (RyR2R4496C+/−) comparable with CPVT patients with RyR2 R4497C mutation. Characteristically, in simulated cells, pacing at 4 Hz or faster or pacing at 2 Hz under BAS with effects equivalent to those of isoproterenol at ≥0.1 μM could readily induce delayed afterdepolarizations (DADs) and DAD-mediated triggered activity (TA) in RyR2R4496C+/− but not in the wild-type via enhancing both ICa,L and sarcoplasmic reticulum (SR) Ca2+ ATPase ( IUP). Moreover, with the use of steady state values of isolated endocardial (Endo), mid-myocardial (M), and epicardial (Epi) cells as initial data for conducting single cell and one-dimensional strand studies, the M cell was more vulnerable for developing DADs and DAD-mediated TA than Endo and Epi cells, and the gap junction coupling represented by diffusion coefficient ( D) of ≤0.000766*98 cm2/ms was required for generating DAD-mediated TA in RyR2R4496C+/−. Whereas individual reduction of Ca2+ release channel of SR and Na-Ca exchanger up to 50% was ineffective, 30% or more reduction of either ICa,L or IUP could totally suppress the inducibility of arrhythmia under BAS. Of note, 15% reduction of both ICa,L and IUP exerted a synergistic antiarrhythmic efficacy. Findings of this model study confirm that BAS facilitates induction of ventricular tachyarrhythmias via its action on intracellular Ca2+ cycling and a pharmacological regimen capable of reducing ICa,L could be an effective adjunctive to β-adrenergic blockers for suppressing ventricular tachyarrhythmias during CPVT.
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Affiliation(s)
- Ruey J. Sung
- Institute of Life Sciences, National Central University, Taoyuan
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Chu-Pin Lo
- Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan; and
| | - Pi Yin Hsiao
- Institute of Life Sciences, National Central University, Taoyuan
| | - Hui-Chun Tien
- Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan; and
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Chang DC, Lee JT, Lo CP, Fan YM, Huang KL, Kang BH, Hsieh HL, Chen SY. Hyperbaric oxygen ameliorates delayed neuropsychiatric syndrome of carbon monoxide poisoning. Undersea Hyperb Med 2010; 37:23-33. [PMID: 20369650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Delayed neuropsychiatric syndrome (DNS) is characterized by mental impairment, motor dysfunction, dementia, or psychosis that develops between a few days and weeks after acute carbon monoxide (CO) poisoning. One possible mechanism responsible for CO-mediated encephalopathy involves oxidative stress, such as lipid peroxidation, caused by the cellular uptake of CO and which leads to an inflammatory cascade. There is no current effective treatment for DNS. We applied 8-40 sessions of hyperbaric oxygen therapy (HBO2) to patients with DNS and evaluated its effectiveness. METHODS After admission, all patients were administered piracetam or bromocriptine, or both, and received HBO2. Neuropsychiatric tests included EEG, mini-mental status examination (MMSE), brain MRI, event-related potential (ERP), and brain perfusion scan (brain SPECT). Results of these tests were compared before and after HBO2, and the clinical features were monitored during this period. RESULTS The symptoms of DNS for all patients improved significantly after HBOT. Although white matter changes remained evident in the brain MRI scans, other examinations such as EEG, MMSE, ERP, and 99mTc-ECD brain SPECT were nearly normal after HBOT. CONCLUSION Our results suggest that HBO2 decreases the severity of impairment in patients with DNS. Although a large randomized trial is required to address the efficacy of this therapy, therapeutic application of HBO2 may be recommended in patients with DNS after CO poisoning.
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Affiliation(s)
- D C Chang
- Department of Neurology, Chu Shang Show Chwan Hospital, Nantou, Taiwan, Republic of China
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11
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Sung RJ, Wu YH, Lai NHJ, Teng CH, Luo CH, Tien HC, Lo CP, Wu SN. β-Adrenergic modulation of arrhythmogenesis and identification of targeted sites of antiarrhythmic therapy in Timothy (LQT8) syndrome: a theoretical study. Am J Physiol Heart Circ Physiol 2010; 298:H33-44. [DOI: 10.1152/ajpheart.00232.2009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 01/03/2023]
Abstract
Timothy syndrome (TS) is a malignant form of congenital long QT syndrome with a mode of arrhythmia onset often triggered by enhanced sympathetic tone. We sought to explore mechanisms by which β-adrenergic stimulation (BAS) modulates arrhythmogenesis and to identify potential targeted sites of antiarrhythmic therapy in TS. Using a dynamic Luo-Rudy ventricular myocyte model incorporated with detailed intracellular Ca2+ cycling, along with its one-dimensional multicellular strand, we simulated various clinical scenarios of TS, with stepwise increase in the percentage of G406R Cav1.2 channels from 0 to 11.5 and 23%, and to 38.5 and 77%, respectively, for heterozygous and homozygous states of TS1 and TS2. Progressive prolongation of action potential duration (APD) and QT interval, accompanied by amplification of transmural dispersion of repolarization, steepening of APD restitution, induction of delayed afterdepolariztions (DADs), and both DAD and phase 3 early afterdepolariztion-mediated triggered activities, correlated well with the extent of G406R Cav1.2 channel mutation. BAS amplified transmural dispersion of repolarization, steepened APD restitution, and facilitated inducibility of DAD-mediated triggered activity. Systematic analysis of intracellular Ca2+ cycling revealed that sarcoplasmic reticulum Ca2+ ATPase (uptake current) played an essential role in BAS-induced facilitation of DAD-mediated triggered activity and, in addition to L-type calcium current, it could be an effective site of antiarrhythmic therapy under the influence of BAS. Thus G406R Cav1.2 channel mutation confers not only a trigger, but also a substrate for lethal ventricular arrhythmias, which can be exaggerated by BAS. It is suggested that, besides β-adrenergic blockers and L-type calcium current channel blockers, an agent aimed at reduction of sarcoplasmic reticulum Ca2+ ATPase uptake current may provide additional antiarrhythmic effect in patients with TS.
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Affiliation(s)
- Ruey J. Sung
- Institute of Life Sciences, College of Sciences, National Central University, Taoyuan
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yung-Han Wu
- Institute of Basic Medical Research, College of Medicine,
| | | | | | - Ching-Hsing Luo
- Institute of Electrical Engineering, College of Engineering and Computer Science, National Cheng Kung University, Tainan; and
| | - Hui-Chun Tien
- Department of Applied Mathematics, Providence University, Taichung, Taiwan; and
| | - Chu-Pin Lo
- Department of Applied Mathematics, Providence University, Taichung, Taiwan; and
| | - Sheng-Nan Wu
- Institute of Basic Medical Research, College of Medicine,
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12
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Luk HN, Lo CP, Tien HC, Lee D, Chen ZL, Wang F, Hsin ST, Day YJ. Mechanical characterization of rabbit pulmonary vein sleeves in in vitro intact ring preparation. J Chin Med Assoc 2008; 71:610-8. [PMID: 19114325 DOI: 10.1016/s1726-4901(09)70003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pulmonary vein (PV) sleeves, composed of cardiomyocytes, play certain roles in arrhythmogenesis. In the literature, it has been frequently reported that PV sleeves possess intrinsic spontaneous pacemaking activity and triggered activity in normal dogs and rabbits. In contrast, other research groups presented totally opposite findings which showed absence of such pacemakers in dogs, rabbits and rats. The present study was designed to clarify this puzzle and contradiction. METHODS A novel methodology using in vitro experimentation was used to examine the electromechanical activity of whole segments of PV sleeves. The ring preparation was composed of a small piece of left atrial (LA) free wall, PV ostium and sleeve from rabbits. A circumferential contraction of the PV sleeve was measured when the preparation was electrically driven from the LA free wall. Mechanical force of the ring preparation was measured using a force transducer. The action potentials were recorded using conventional intracellular recording technique in strip preparation. RESULTS In 15 rabbits, no spontaneous pacemaking activity or triggered activity was found in the in vitro ring preparation of PV sleeve. The circumferential contraction of PV sleeves was external calcium-dependent. Frequency-force relation displayed a negative staircase at 0.1-0.5 Hz and a positive staircase at 1-5 Hz. Post-rest potentiation was prominent between 15 s and 120 s. Intracellular action potential recording did not display any automaticity or triggered activity in PV sleeves. CONCLUSION In an intact ring preparation of rabbit PV sleeves, intrinsic spontaneous pacemaking activity or triggered activity was not found.
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Affiliation(s)
- Hsiang-Ning Luk
- Department of Anesthesiology, Taichung Veterans General Hospital, Providence University, Taichung, Taiwan, ROC.
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13
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Liu YJ, Juan CJ, Chen CY, Wang CY, Wu ML, Lo CP, Chou MC, Huang TY, Chang H, Chu CH, Li MH. Are the local blood oxygen level-dependent (BOLD) signals caused by neural stimulation response dependent on global BOLD signals induced by hypercapnia in the functional MR imaging experiment? Experiments of long-duration hypercapnia and multilevel carbon dioxide concentration. AJNR Am J Neuroradiol 2007; 28:1009-14. [PMID: 17569947 PMCID: PMC8134170 DOI: 10.3174/ajnr.a0535] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The relationship between the local blood oxygen level-dependent (BOLD) signals caused by neural stimulation (fBOLD) and the global BOLD signals induced by hypercapnia (hBOLD) has not been fully investigated. In this study, we examine whether fBOLD is modulated by hBOLD signals, by means of experiments using a relatively wide range of inhaled carbon dioxide (CO(2)) for a long duration of 5 minutes. MATERIALS AND METHODS Ten healthy volunteers were recruited, each undergoing 6 separate experiments by inhaling gas mixtures with different fractions of CO(2) (room air, 3%-7%). Each experiment contained 3 phases, prehypercapnic, hypercapnic, and posthypercapnic, during which boxcar visual stimulus was given. The local fBOLD signals were measured from areas showing activation patterns highly correlated with the visual stimulus paradigm, whereas the global hBOLD signals were measured from areas showing no visual activations. Percentage changes in fBOLD during transient-state hypercapnia and steady-state hypercapnia were both investigated in response to varying degrees of hypercapnic perturbations. RESULTS The hBOLD signals increased with increase of inhaled CO(2) fractions. The duration for the hBOLD signals to reach steady state prolonged with increase of inhaled CO(2) fractions. Normalized fBOLD ratio was inversely related to the inhaled CO(2) during steady-state hypercapnia but showed positive association with hBOLD during transient-state hypercapnia. CONCLUSION Our study concludes that the steady-state fBOLD signal intensity is dependent on and inversely related to the hBOLD signals. Previous reports documenting independent and additive relationships between hBOLD and fBOLD may likely be due to transient-state observations.
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Affiliation(s)
- Y J Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, ROC
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Hung SP, Hsu JR, Lo CP, Huang HJ, Wang JP, Chen ST. Genistein-induced neuronal differentiation is associated with activation of extracellular signal-regulated kinases and upregulation of p21 and N-cadherin. J Cell Biochem 2006; 96:1061-70. [PMID: 16149052 DOI: 10.1002/jcb.20626] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Neuronal differentiation in the mammalian CNS is driven by multiple events. When treated with retinoic acid (RA), hNTera-2 (NT-2) cells undergo postmitotic neuronal differentiation. Here, we show that a prolonged exposure of NT-2 cells with non-cytotoxic doses of genistein, a protein tyrosine kinase (PTK) inhibitor, induced differentiation of NT-2 cells. Additionally, genistein enhanced RA-induced neuronal differentiation by increasing the activation of extracellular signal-related kinase 1/2 (ERK1/2) via phosphorylation at Thr183 and Tyr185 in 3-7 days. Meanwhile, genistein also upregulated N-cadherin and p21 (a Cdk inhibitor), but downregulated proliferating cell nuclear antigen protein (PCNA). MEK1/2 inhibitors, such as PD98059 and U0126, reduced RA-induced ERK1/2 activity, but could not block the genistein effects. Our observations indicate that genistein-induced neuronal differentiation is not dependent of the MEK-ERK signaling cascade. Instead, genistein-upregulated ERK activation is likely due to this chemical's direct effect on chromosome and gene transcription, rather than its inhibition on tyrosine kinases. Failure of inhibition of ERK1/2 activation by the MEK1/2 inhibitors PD98059 and U0126 suggests presence of an unknown activator for ERK1/2 in neuronal cells.
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Affiliation(s)
- S P Hung
- Department of Life Sciences, National Cheng Kung University, Tainan City 701, Taiwan
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Abstract
A 50-year-old man presented with respiratory distress from central airway compression secondary to malignant mediastinal adenopathy. The stenosis involved the carinal triangle and created residual luminal diameters of 6 mm, 6 mm, and pinhole in the distal trachea and right and left mainstem bronchi, respectively. Airway patency at the carina was restored successfully with a stenting method that uses two overlapping Wall stents.
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Affiliation(s)
- C P Lo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
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Lo CP, Ong KC, Yang TY, Agasthian T, Ong YY. Active management of a patient with endstage pulmonary emphysema using lung volume reduction surgery and intensive rehabilitation. Ann Acad Med Singap 2000; 29:127-31. [PMID: 10748981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Lung volume reduction surgery (LVRS) and pulmonary rehabilitation are newer options available in the treatment of advanced emphysema. We describe the progress of our first local patient to have undergone these 2 new treatment modalities. CLINICAL PICTURE A 65-year-old man with advanced emphysema, limited by crippling dyspnoea despite maximal medical therapy with inhaled bronchodilator therapy, methylxanthines and supplementary oxygen. TREATMENT Physical reconditioning with a 4-week inpatient pulmonary rehabilitation programme, followed by LVRS and a further 6-week outpatient pulmonary rehabilitation. OUTCOME Dramatic improvements in spirometric indices, arterial blood gases, exercise capacity and overall functional status. Improvements maintained at one-year follow up period. CONCLUSIONS LVRS with pulmonary rehabilitation is an exciting new treatment option in a select group of patients with advanced emphysema. Their role in improving overall performance status and quality of life should be considered in patients otherwise considered to have reached the limits of medical therapy.
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Affiliation(s)
- C P Lo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Lo CP, Hsu AA, Eng P. Endobronchial stenting in patients requiring mechanical ventilation for major airway obstruction. Ann Acad Med Singap 2000; 29:66-70. [PMID: 10748968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To examine the value of therapeutic rigid bronchoscopy on subsequent ventilator weaning in ventilated patients with major airway obstruction. MATERIALS AND METHODS Retrospective review of the medical records of patients who were receiving mechanical ventilation up to the time of rigid bronchoscopy over the period from September 1994 to January 1999. The setting is in an acute tertiary hospital. All patients underwent rigid bronchoscopy with endoscopic techniques (forceps removal, balloon dilation Nd:YAG laser resection and stent insertion) aimed at restoration of major airway patency. RESULTS Seven patients were identified; 2 with benign stenosis and 5 with malignant stenosis. Six out of the 7 patients had presented with acute respiratory distress requiring emergent intubation, whilst 1 patient had extubation difficulties following general anaesthesia with endotracheal intubation. Three out of the 7 patients had previously failed extubation attempts. All 7 patients were successfully extubated within 48 hours following the procedure. CONCLUSIONS Therapeutic rigid bronchoscopy is effective in the acute management of respiratory distress from central airway obstruction. Dramatic improvements in ventilatory status following therapeutic rigid bronchoscopy allow ventilator liberation in a select group of patients with an otherwise good performance status.
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Affiliation(s)
- C P Lo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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