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Yan H, Zhou X, Gan G, Zhang J. Clinical application of acupressure in patients with essential hypertension. Asian J Surg 2024; 47:1957-1958. [PMID: 38242783 DOI: 10.1016/j.asjsur.2023.12.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/25/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Hui Yan
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, PR China
| | - Xia Zhou
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, PR China
| | - Guorong Gan
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, PR China.
| | - Jinhui Zhang
- Zigong Tourism Vocational High School, Zigong, PR China
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2
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Tao LY, Gan G, Liu J. [Interpretation of Consolidated Health Economic Evaluation Reporting Standards 2022]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:667-672. [PMID: 37147843 DOI: 10.3760/cma.j.cn112338-20221127-01002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The number of studies related to health economics evaluation is increasing. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) contains 28 items. Based on CHEERS 2013, CHEERS 2022 adds a health economic analysis plan, model sharing, and community, patient, public, and other relevant stakeholders' participation in the statement, taking into account the future development direction of health economics evaluation. It provides a useful review tool for peer reviewers, editors, and readers and supports health technology assessment agencies in establishing standard reporting standards for health economics evaluations. In this study, we briefly introduced and interpreted the CHEERS 2022 statement and analyzed an example of health economics evaluation in infectious disease epidemiology to provide a reference for researchers to report studies regarding health economics evaluation standardly.
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Affiliation(s)
- L Y Tao
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - G Gan
- China National Health Development Research Center,National Health Commisson, Beijing 100033, China
| | - J Liu
- School of Public Health, Peking University, Beijing 100191, China
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3
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Zannad N, Michy B, Brisse A, Halalchi M, Simon G, Aubert R, Parizel E, Gan G, Yassine M. Atrial flutter caused by migration of a superior vena cava stent into the right atrium. Ann Cardiol Angeiol (Paris) 2022; 71:331-334. [PMID: 36068113 DOI: 10.1016/j.ancard.2022.07.003] [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: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
We describe the case of a patient presenting with an atrial flutter mechanically induced by a stent migration from the superior vena cava to the right atrium.
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Affiliation(s)
- N Zannad
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France.
| | - B Michy
- CHR Metz-Thionville, service de pneumologie, Hôpital Bel Air 1 allée Frescaty 57100 Thionville , France
| | - A Brisse
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - M Halalchi
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - G Simon
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - R Aubert
- CHR Metz-Thionville, service de cardiologie, Hôpital Bel Air, 1 allée Frescaty 57100 Thionville, France
| | - E Parizel
- CHR Metz-Thionville, service radiologie, Hôpital Bel Air 1 allée Frescaty 57100 Thionville , France
| | - G Gan
- CHR Metz-Thionville, service ophtalmologie, Hôpital Mercy 1 allée du château 57530 Ars Laquenexy, France
| | - M Yassine
- CHR Metz-Thionville, service de cardiologie, Hôpital Mercy 1 allée du château 57530 Ars Laquenexy , France
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4
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Juloori A, Gan G, Zhang J, Abazeed M, Hara J, Baschnagel A, Traynor A, Bassetti M, Patel J, Chmura S, Bestvina C. EP14.03-001 DARES: A Phase II Trial of Durvalumab and Ablative Radiation in Extensive Stage Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.968] [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: 11/26/2022]
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5
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Chen H, Bhat A, Goode E, Latumahina A, Farghaian H, Omaimah N, Patel R, Tan T, Burgess D, Gan G. Performance of a Multi-Disciplinary Heart Failure Clinic Model of Care in Western Sydney: A Blacktown Hospital Pilot Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.112] [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: 11/27/2022]
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6
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Implications of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Sclerosis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.369] [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: 10/16/2022]
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7
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Nawaz S, Gu K, Fernandez F, Chen H, Bhat A, Gan G, Tan T. Utility of Myocardial Work in Predicting Cardiovascular Outcomes in a Diabetic Population. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.302] [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: 11/27/2022]
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8
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Impact of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Lupus Erythematosus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.368] [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: 10/16/2022]
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9
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Gan G, Bhat A, Gu K, Chen H, Fernandez F, Thomas L. Left Ventricular Global Longitudinal Strain Predicts Adverse Cardiovascular Outcomes in Patients With Comorbid Chronic Kidney Disease and Diabetes Mellitus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.263] [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: 10/16/2022]
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10
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Chen H, Bhat A, Lee C, Fernandez F, Gan G, Negishi K, Tan T. Prognostic Value of Right Ventricular Free Wall Strain in Stable Non-Ischaemic Cardiomyopathy Patients With Reduced Left Ventricular Systolic Function. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.121] [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: 11/17/2022]
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11
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Gan G, Bhat A, Rao A, Gu K, Thangarajah M, Kean A, Michail D, Tanous D, Thomas L. Prevalence and Impact of Comorbid Atrial Fibrillation in Patients With Pulmonary Hypertension. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.365] [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: 10/16/2022]
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12
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Malaty M, Chen HHL, Gan G. Left atrial reservoir strain is reduced in patients with myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a management conundrum given the poorly understood pathogenic mechanisms. In recent years, novel echocardiographic measures such as deformation/strain analysis have enabled early identification of left atrial (LA) remodelling and dysfunction which take place prior to structural alterations. LA dysfunction is an important biomarker of cardiovascular disease and an independent predictor of atrial arrhythmias which may play a fundamental role in the pathogenesis of MINOCA.
Purpose
The goal of our study was to evaluate and characterise LA function by speckle tracking strain echocardiography in patients with MINOCA.
Methods
Patients admitted to our institution with acute myocardial infarction were assessed and those diagnosed with MINOCA who underwent transthoracic echocardiogram (TTE) within 48-hours of their coronary angiogram were included. Diagnosis of MINOCA was based on the 2017 ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Two-dimensional speckle tracking strain analysis of the LA and left ventricle (LV) was performed offline using vendor independent software (TomTec Arena). Clinical and echocardiographic measures were compared to healthy controls identified from our echocardiography database. We excluded patients with history of atrial fibrillation, heart failure and LV dysfunction (LVEF <50%).
Results
The cohort consisted of 82 patients; 41 patients with MINOCA were compared to 41 age and sex matched controls (61% male, mean age 51±12.8 years). At baseline, patients with MINOCA had a higher prevalence of modifiable vascular risk factors including smoking, hypertension and diabetes (p<0.001 for all). Of the echocardiographic parameters, no differences in left ventricular (LV) parameters including LV global longitudinal strain (p=0.463), indexed LV mass (p=0.084) and the E/e' (p=0.391) was appreciated. Though there was no difference in LA volumes or volumetric parameters of LA function (LAEF; p=0.328), patients with MINOCA had a lower LA reservoir strain (29.7±8.5% vs 33.2±6.5%; p=0.04; 95% CI 0.32–5.33).
Conclusion
Patients with MINOCA demonstrated lower LASr despite normal LV and LA volumes. This suggests that LA dysfunction may play a role in the pathogenesis of MINOCA. Further studies are required to evaluate the significance of our findings.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Malaty
- Blacktown Hospital, Department of Cardiology, Blacktown, Australia
| | - H H L Chen
- Blacktown Hospital, Department of Cardiology, Blacktown, Australia
| | - G Gan
- Blacktown Hospital, Department of Cardiology, Blacktown, Australia
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Sot M, Gan G, François J, Chaussard D, Da Costa M, Luc MS, Goetz C, Dinot V, Lhuillier L, Perone JM. Risk factors for keratoconus progression after treatment by accelerated cross-linking (A-CXL): A prospective 24-month study. J Fr Ophtalmol 2021; 44:863-872. [PMID: 34059330 DOI: 10.1016/j.jfo.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/15/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Identification of potential predictive factors for keratoconus progression after treatment by accelerated Cross-linking (A-CXL) SECONDARY OBJECTIVES: Evaluation of clinical and topographic outcomes for two years following accelerated cross-linking treatment for progressive keratoconus including: best spectacle corrected visual acuity (BSCVA), thinnest pachymetry, maximum keratometry (Kmax), cylinder. STUDY Prospective, interventional, monocentric study. SITE: Metz-Thionville Regional Medical Center, Lorraine University, Mercy Hospital, Metz, France. PATIENTS AND METHODS We included 82 eyes of 60 patients between March 2014 and June 2016 who underwent accelerated corneal cross-linking (A-CXL) with epithelial debridement for progressive keratoconus, with a minimum follow-up of 2 years. A complete clinical evaluation and corneal topography were performed before cross-linking, and subsequently at 6, 12 and 24 months post-procedure. The following parameters were monitored during follow-up: best spectacle corrected visual acuity (BSCVA), minimal pachymetry, maximum keratometry (Kmax), mean anterior and posterior curvatures, maximum posterior curvature, presence of optical aberrations, subdivided into spherical aberration, coma, astigmatism, higher order optical aberrations and residual optical aberrations. After a 2-year follow-up, two groups, defined as "responders" and "non-responders" to treatment, were separated for analysis, and their initial characteristics were compared. RESULTS Data for 82 eyes of 60 patients with progressive keratoconus with a mean age of 24±7 years were studied. Fourteen eyes (17.1%) showed signs of progression after treatment by A-CXL (non-responders), and 68 eyes (82.9%) showed stabilization of the disease (responders). Characteristics of non-responding eyes after A-CXL included a younger mean age (20±5 vs. 25±7 years) (P=0.04) and a lower initial mean BCVA for non-responders of 0.44±0.16 logMAR vs. 0.29±0.19 logMAR (P=0.03). Non-responders also had a higher mean maximal posterior curvature (AKB) of -10.84±1.72D vs. -9.46± 1.12D (P=0.03). They also showed more higher order optical aberrations (3.84±1.72D vs. 2.4±1.02D; P=0.01), including coma (3.85±1.81D vs. 2.1±1.01D; P=0.03) and more residual aberrations than responders (1.05±0.44D vs. 0.45±0.6D; P=0.005). No significant differences were found between responders and non-responders for the other parameters in our study. CONCLUSION Eyes with progressive keratoconus who did not respond to A-CXL treatment were the most aggressive cases in the youngest patients, with highest maximum corneal curvatures and most pronounced optical aberrations. These patients should be informed in advance of the high risk of non-response to A-CXL treatment, and of the potential need for additional treatment in the future.
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Affiliation(s)
- M Sot
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - G Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - J François
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - D Chaussard
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - M Da Costa
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - M S Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - C Goetz
- Clinical Research Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - V Dinot
- Clinical Research Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - L Lhuillier
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
| | - J M Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, 1, allee du Chateau CS 45001, 57085 Metz Cedex 03, France.
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Bhat A, Chen H, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan G, Dobbins T, MacIntyre C, Tan T. Diagnostic and Prognostic Value of Novel Echocardiographic Biomarkers in Identification of Cardioembolism and Prediction of Outcomes in Patients with Stroke of Undetermined Source. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.006] [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: 10/20/2022]
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15
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Khanna S, Newman J, Gupta A, Wen I, Bhat A, Chen H, Gan G, Tan T. Left Ventricular Global Longitudinal Strain is a Predictor of Adverse Cardiovascular Outcomes in Patients With Rheumatoid Arthritis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.226] [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: 11/16/2022]
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16
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Malaty M, Chandrakumar D, Li C, Aladdin A, Jethwani U, Gan G, Tan T. Prevalence of Cardiotoxicity in Cancer Patients Treated With Single and Combination Immune Checkpoint Inhibitor Therapy—A Single Centre Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.319] [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: 10/20/2022]
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17
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Stefani L, Gan G, Trivedi S, Ferkh A, Altman M, Thomas L. LA Strain Mechanics are Altered in Hypertensive Patients vs Healthy Individuals. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.221] [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: 10/20/2022]
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18
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Malaty M, Chandrakumar D, Li C, Aladdin A, Jethwani U, Gan G, Tan T. Factors Impacting on the Early Versus Late Major Adverse Cardiovascular Events Amongst Oncology Patients Receiving Non-Anthracycline Chemotherapy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.284] [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: 10/20/2022]
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Wen I, Khanna S, Thakur A, Chen H, Bhat A, Gan G, Tan T. Patients With Neuro-Immunological Disorders With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.235] [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: 10/20/2022]
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20
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Khanna S, Amarasekera A, Li C, Bhat A, Chen H, Gan G, Tan T. Characterisation of Myocardial Structure and Function by Cardiac Magnetic Resonance Imaging in Adult Patients With Acute-Phase Myocarditis: A Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.196] [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: 10/20/2022]
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Abstract
Abstract
Background
Hypertension (HTN) and diabetes mellitus (DM) are prevalent cardiovascular disease states which have been shown to be associated with adverse cardiac remodelling and subclinical myocardial dysfunction. Myocardial work (MW) indices are novel non-invasive measures of left ventricular (LV) function. We aimed to characterise key differences in MW indices in patients with these conditions.
Methods
Outpatients with HTN and DM undergoing transthoracic echocardiography (TTE; 2016–2019) at our institution were assessed and compared to healthy controls. Only patients without cardiac disease with normal diastolic parameters on TTE were recruited. Patients with impaired LV function, cardiac ischaemia or arrhythmia, structural and valvular heart disease or poor-quality images were excluded. Recruited patients were stratified into 3 groups (Group1: Healthy Controls; Group 2: HTN; Group 3: HTN-DM). MW assessment was performed using GE E-95 EchoPac v2.2 system.
Results
Three hundred patients (57.3±17.4y, 51% female) were recruited. HTN and HTN-DM patients were associated with higher resting systolic blood pressure (SBP), indexed LV mass (LVMI), e' and E/e' compared to controls but no differences were noted in these parameters between HTN and HTN-DM. Global myocardial work index (GWI) was higher in HTN patients compared to Controls but not different compared to HTN-DM. Of interest, HTN-DM patients had higher global myocardial wasted work (GWW) and lower global myocardial work efficiency (GWE) compared to HTN patients and Controls.
Conclusions
MW indices may be a sensitive tool for the detection of subclinical changes in cardiac function in cardiometabolic disease states.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | | | | | - M Kodsi
- Blacktown Hospital, Sydney, Australia
| | - G Gan
- Blacktown Hospital, Sydney, Australia
| | - T.C Tan
- Blacktown Hospital, Sydney, Australia
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22
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Bhat A, Gan G, Chen H, Gu K, Denniss M, Burgess D, MacIntyre R, Tan T. Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population.
Purpose
The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD.
Methods
Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to <6 months.
Results
2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p<0.01), with lower eGFR (p<0.01) and higher rates of renal replacement therapy (p<0.01). They also had a greater burden of coronary disease (p<0.01), heart failure (p<0.01), stroke (p<0.01), obstructive sleep apnoea (p<0.01), chronic obstructive pulmonary disease (p<0.01), anaemia (p<0.01) and obesity (p<0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p<0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p<0.01).
Conclusions
Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD.
Figure 1. Kaplan Meier Curve
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Bhat
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - G Gan
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - H.H.L Chen
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - K Gu
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - M Denniss
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - D.C Burgess
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - R MacIntyre
- University of New South Wales, Sydney, Australia
| | - T.C Tan
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
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Thangarajah M, Gan G, MacIntyre R, Tan T. 180 The Impact of Influenza, Pneumococcal and Herpes Zoster Vaccinations on Hospital Presentations for Acute Heart Failure Exacerbations in a Cohort of Patients With Chronic Heart Failure. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.187] [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: 10/23/2022]
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24
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Khanna S, Tan J, Chen H, Bhat A, Gan G, Tan T. 372 Left Ventricular Sphericity Index is a Predictor of Cardiovascular Events in Patients With Anterior Transmural Myocardial Infarction but not in Takotsubo Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.379] [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: 11/16/2022]
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25
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Gan G, Kadappu K, Bhat A, Fernandez F, Gu K, Cai L, Eshoo S, Thomas L. P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Nil
Background and objectives
Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients.
Methods
Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE.
Results
243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p < 0.01), history of diabetes mellitus (p < 0.01), indexed LV mass(LVMI) (p < 0.01), LV global longitudinal strain(GLS) (p < 0.01), indexed LA volume(LAVI) (p < 0.01), E/e’ ratio (p < 0.01) and LA strain (LAs) (p < 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p < 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point.
Conclusions
LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD.
Abstract P1709 Figure. Kaplan Meier curve of LAs
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Affiliation(s)
- G Gan
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Kadappu
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - A Bhat
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - F Fernandez
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Gu
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Cai
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - S Eshoo
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Thomas
- Westmead Hospital, Department of Cardiology, Sydney, Australia
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Chen H, Bhat A, Chandrakumar D, Fernandez F, Fernandez A, Stephens M, Kodsi M, Gan G, Tan T. 361 Key Differences in Myocardial Work Indices in Cardiometabolic Disease States. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.368] [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]
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27
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Chen H, Oh F, Cheng T, Bhat A, Fernandez F, Gan G, Tan T. 415 The Immediate Impact of Electrical Cardioversion on Right Ventricular Systolic Function in Patients With Non-Valvular Atrial Fibrillation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.422] [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: 11/15/2022]
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Bhat A, Makarious D, Mahajan V, Husen Y, Tan E, Burdusel C, Gan G, Lee L, Chow C, Tan T. 720 Characterisation of Recent Trends in Cardiovascular Risk Factors in Young Patients With Ischaemic Stroke. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.727] [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]
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29
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Gan G, Bhat A, Chen H, Gu K, Fernandez F, Kadappu K, Byth K, Eshoo S, Thomas L. 367 Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: A Powerful Determinant of Exercise Capacity in Chronic Kidney Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.374] [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: 11/26/2022]
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Chandrakumar D, Bhat A, Chen H, Gan G, Fernandez A, Cheng T, Fernandez F, Tan T. 357 Indices of Myocardial Work Correlates With Maximum Metabolic Equivalents and is Predictive of Exercise Capacity. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.364] [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: 11/28/2022]
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Tan J, Tan S, Mok C, Shehab S, Chen H, Bhat A, Gan G, Tan T, Khanna S. 500 Impact of Left Ventricular Hypertrophy Phenotypes on Electrocardiographic Detection of Left Ventricular Hypertrophy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.507] [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: 11/29/2022]
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32
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Chandrakumar D, Jethwani U, Bhat A, Chen H, Gan G, Tan T. 425 Uptake of Cardiac Screening by Echocardiography in Patients with Solid Organ Malignancies Undergoing Chemotherapy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.432] [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: 10/23/2022]
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Chen H, Khanna S, Kayes T, Bhat A, Gan G, Ahlenstiel G, Tan T. 300 Characterisation of Atrial and Ventricular Myocardial Deformation Indices with Increasing Body Mass Index. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.307] [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: 10/23/2022]
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34
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Khanna S, Newman J, Bhat A, Chen H, Fernandez F, Gan G, Tan T. 385 Patients with Systemic Lupus Erythematosus With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.392] [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: 10/23/2022]
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35
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Chen H, Chandrakumar D, Fernandez F, Bhat A, Gan G, Tan T. 293 Assessment of the Accuracy of Right Ventricular Fractional Area Change Using an Automated Feature Tracking Algorithm in a Clinical Laboratory. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.300] [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: 11/29/2022]
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Gan G, Kadappu K, Bhat A, Fernandez F, Chen H, Eshoo S, Thomas L. 1679 E/e predicts exercise capacity and adverse cardiovascular outcomes in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Nil
OnBehalf
NA
Background
Patients with chronic kidney disease(CKD) have reduced physical fitness that contributes to the disproportionately elevated risk of cardiovascular disease in this population. Our aim was to assess the association between E/e’ and exercise capacity in CKD patients and the prognostic role of E/e’.
Methods
Patients with Stage 3/4 CKD, without previous cardiac disease were prospectively recruited. Recruited patients underwent transthoracic echocardiogram and exercise stress echocardiogram with assessment of exercise E/e’. Patients were compared, one to one, to age, gender and risk factor matched controls and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular events (MACE). Exercise capacity was assessed as metabolic equivalents (METs) with reduced exercise capacity defined as METS of ≤7. Raised exercise E/e’ was defined as exercise E/average e’ of >13.
Results
156 CKD patients (62.8 ± 10.6 yrs, male 62%) were compared to 156 matched controls. CKD patients had higher rates of anemia (p < 0.01), larger left ventricular indexed mass (p < 0.01), larger LAVI (p < 0.01) and higher resting (p < 0.01) and exercise E/e’ (p < 0.01). Overall, CKD patients achieved lower METs (p < 0.01) with exercise and a greater proportion of CKD patients had METs ≤7 (p < 0.01). Receiver operating curves (Figure1) showed exercise E/e’ (AUC 0.89, CI 0.84-0.95, p < 0.01) to be the strongest predictor of reduced exercise capacity in CKD patients. Exercise E/e’ of >13 was also associated with higher rates of cardiovascular death and MACE amongst CKD patients.
Conclusion
Exercise E/e’ is a strong predictor of exercise capacity amongst CKD patients, who commonly have reduced exercise capacity presumably consequent to diastolic dysfunction. Raised exercise E/e’ in CKD patients is predictor of cardiovascular death and MACE.
Abstract 1679 Figure.
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Affiliation(s)
- G Gan
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Kadappu
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - A Bhat
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - F Fernandez
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - H Chen
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - S Eshoo
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Thomas
- Westmead Hospital, Department of Cardiology, Sydney, Australia
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Chen H, Stephens M, Fernandez F, Bhat A, Gan G, Pathan F, Tan T. 371 Left Ventricular Geometry Impacts on Left Ventricular Function and Myocardial Energetics. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.378] [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: 11/26/2022]
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38
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Stephens M, Chen H, Bhat A, Gan G, Tan T. 401 Relationship of Myocardial Work Indices to Quantitative Measures of Mitral Regurgitation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.408] [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: 10/23/2022]
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39
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Fernandez F, Nawaz S, Bhat A, Chen H, Fernandez A, Gan G, Hung J, Handschumacher M, Nunes M, Tan T. 364 Left Atrial Cross Sectional Area as a Measure of Left Atrial Remodelling in Patients With Hypertension and Diabetes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.371] [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: 11/16/2022]
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40
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Makarious D, Bhat A, Khanna S, Chen H, Drescher A, Stephens M, Fernandez F, Gan G, Tan T. 312 Correlation between Atrial Fibrillation Burden and Changes in Indices of Left Atrial Size and Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.319] [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: 10/23/2022]
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41
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Gan G, Kadappu K, Bhat A, Fernandez F, Chen H, Eshoo S, Thomas L. P246 Exercise E/e refines diagnosis of diastolic impairment in patients with chronic kidney disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.108] [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
Diastolic dysfunction is common in chronic kidney disease (CKD) patients and is associated with reduced exercise capacity. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) correlates with invasively measured left ventricular pressures, both at rest and during exercise. The aim of our study was to evaluate the relationship of resting and exercise E/e’ to exercise capacity in patients with stage 3 and 4 CKD.
Methods
CKD patients were prospectively recruited. All patients were required to be in sinus rhythm, without previous cardiac disease and with normal LVEF. The E/e’ ratio was assessed at rest and patients were stratified into 3 groups based on conventional clinical classifications (normal: ≤8, indeterminate: 8-14, raised: >14). Patients then underwent a symptom limited exercise stress echocardiogram whereby patients with resting E/e’ <14 additionally had post exercise E/e’ measured. Exercise capacity was assessed as metabolic equivalents (METs). A raised exercise E/e’ was defined as exercise E/e’ of ≥13. Lastly, we grouped patients based on abnormalities of baseline and exercise E/e’ (resting E/e’<14 & exercise E/e’<13, resting E/e’<14 & exercise E/e ≥13, resting E/e’ ≥14) and the relationship to METs achieved was evaluated.
Results
The cohort consisted of 156 CKD patients (62.8 ± 10.6 yrs, male 62%). 85% had hypertension and 39% had diabetes mellitus. 52/156 (34%) CKD patients had resting E/e’ of ≥14. Of the 104/156 (66%) CKD patients with normal/indeterminate resting E/e’, 66/104(63%) had normal exercise E/e’ <13 whilst 38/104(37%) had exercise E/e’ ≥13. Patients with resting E/e" & raised exercise E/e’ ≥13 achieved significantly lower METs compared to CKD patients with resting E/e’ <14 & exercise E/e’ <13 (5.0 ± 2.2 vs 8.8 ± 2.5, p< 0.01). Of note, METs achieved in this group were comparable to that achieved by CKD patients with raised resting E/e’ ≥ 14 (5.0 ± 2.2 METs vs 5.3 ± 2.6 METs, p = 0.55).
Conclusion
In CKD patients with normal/indeterminate resting E/e’, there is utility in performing exercise E/e’, which was increased in 37% of patients. Raised exercise E/e’ is associated with poorer exercise capacity and is a potential tool to refine diastolic abnormalities in patients with CKD.
Group Total (n,%) METs Achieved Exercise Duration (minutes) Resting E/e’ ≤ 14 & Exercise E/e’ ≤ 13 66/156 (42%) 8.8 ± 2.5 8.4 ± 3.1 Resting E/e’ ≤ 14 & Exercise E/e’ ≥ 13 38/156 (24%) 5.0 ± 2.2 6.0 ± 3.1 Resting E/e’ ≥ 14 52/156 (34%) 5.3 ± 2.6 5.6 ± 2.2
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Affiliation(s)
- G Gan
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - K Kadappu
- Liverpool Hospital, Department of Cardiology , Sydney, Australia
| | - A Bhat
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - F Fernandez
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - H Chen
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - S Eshoo
- Blacktown Hospital , Department of Cardiology , Sydney, Australia
| | - L Thomas
- Westmead Hospital, Department of Cardiology, Sydney, Australia
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Rao A, Hales S, Bhat A, Chen H, MacIntyre R, Tan T, Gan G. 470 COVID-19 Experience in New South Wales (NSW) - A Case Series. Heart Lung Circ 2020. [PMCID: PMC7648880 DOI: 10.1016/j.hlc.2020.09.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Rao A, Hales S, Roach K, Bhat A, Chen H, Tanous D, Gan G. 654 Coronary Arteriovenous Fistulae in Setting of Giant Coronary Artery in a Patient with Sarcoidosis-Lymphoma Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.661] [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: 10/23/2022]
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44
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Fernandez F, Nawaz S, Chen H, Bhat A, Makarious D, Gan G, Hung J, Handschumacher M, Nunes M, Tan T. 430 Validation of Left Atrial Mid Cross-Sectional Area, a Novel 2D Measure of Left Atrial Remodelling, Using 3D Echocardiography in a Cohort of Healthy Subjects. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.437] [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: 10/23/2022]
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45
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Bhat A, Karthikeyan S, Denniss M, Kayes M, Gupta A, Chen H, Gan G, MacIntyre R, Tan T. 261 The Impact of Non-Valvular Atrial Fibrillation on Cardiovascular Outcomes in Patients with Chronic Kidney Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.268] [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]
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46
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Gan G, Bhat A, Gu K, Fernandez F, Byth K, Kadappu K, Eshoo S, Thomas L. 368 Left Atrial Reservoir Strain is an Independent Predictor of End Stage Renal Impairment in Patients With Chronic Kidney Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.375] [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: 10/23/2022]
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47
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Vien A, Yardi S, Bhat A, Chen H, Chandrakumar D, Rao A, Latumahina A, Goode E, Tan T, Sindone A, Gan G. 075 Anaemia is a Driver of Heart Failure Rehospitalisation in Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.082] [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]
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48
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Khanna S, Newman JM, Gan G, Bhat A, Chen H, Tan T. P4353Global longitudinal strain is a measure of subclinical left ventricular dysfunction in chronic inflammatory autoimmune conditions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0760] [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: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial deformation indices are proposed to be a more sensitive marker of subclinical dysfunction compared to standard measures of left ventricular (LV) systolic function. We hypothesize that subclinical myocardial dysfunction is present in chronic inflammatory autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), despite both conditions being mediated by different pro-inflammatory modulators.
Purpose
Identify subclinical myocardial dysfunction through assessment of global longitudinal strain in two different chronic autoimmune conditions, SLE and RA.
Methods
Consecutive patients admitted to our institution with known history of SLE or RA (>1 year disease activity) were examined. Patients with preexisting cardiac disease, LVEF <50% and those without comprehensive transthoracic echocardiograms (TTE) were excluded. Mean longitudinal LV strain was performed offline using vendor-independent software (TomTec v4.6) and compared to age- and gender-matched controls with normal LV function and no history of cardiac disease.
Results
Of the 86 patients examined (mean age 53.01±21.74, 85.4% female), 51 (59.3%) had SLE and 35 (40.7%) had RA. No significant difference in BMI, hypertension, hypercholesterolemia, diabetes, obesity, obstructive sleep apnea and stroke was observed between controls and patients with SLE or RA. While there was no significant difference in LVEF between RA patients and matched controls, there was a significantly lower GLS in the RA cohort. Conversely, patients with SLE had significantly lower LVEF and GLS when compared to matched controls, despite LVEF being in the normal range. See Table 1. Receiver operator curve analysis revealed that mean GLS is a better discriminator for autoimmune disease with an area under the curve of 0.829 (95% CI, 0.77 to 0.89; p<0.01) compared to LVEF with an area under the curve of 0.632 (95% CI, 0.55 to 0.72; p<0.01).
Echocardiographic Parameters SLE (n=51) Controls (n=51) Sig (p value) RA (n=35) Controls (n=35) Sig (p value) LVEDV (mls) 102±30 85±20 <0.01 84±28 89±30 0.43 LVESV (mls) 36±17 29±9 0.02 26±14 30±12 0.24 Biplane LVEF % 59±6 63±4 <0.01 62±6 62±5 0.81 LV Mass (grams/m2) 96±34 72±20 <0.01 79±26 82±23 0.67 LV Mean GLS % 16.7±2.8 21.3±2 <0.01 17.8±1.7 19.1±2.5 0.02
Conclusions
Our results suggest that chronic inflammatory conditions (SLE and RA) are associated with subclinical cardiac dysfunction. Impaired GLS may reflect early myocardial damage and be used as a tool for screening of patients with inflammatory conditions.
Acknowledgement/Funding
None
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Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | | | - G Gan
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | - H Chen
- Blacktown Hospital, Sydney, Australia
| | - T Tan
- Blacktown Hospital, Sydney, Australia
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Adila N, Tey K, Teh A, Abdul Rahman M, Ng S, Bee P, Gan G. UPFRONT AHSCT IN NON HODGKIN LYMPHOMA-BETTER OUTCOME? Hematol Oncol 2019. [DOI: 10.1002/hon.108_2631] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- N. Adila
- Hematology; University Malaya Medical Centre; Kuala Lumpur Malaysia
| | - K. Tey
- Hematology; University Malaya Medical Centre; Kuala Lumpur Malaysia
| | - A. Teh
- Hematology; Ramsay Sime Darby Medical Centre; Subang Jaya Malaysia
| | | | - S. Ng
- Hematology; Ramsay Sime Darby Medical Centre; Subang Jaya Malaysia
| | - P. Bee
- Hematology; University Malaya Medical Centre; Kuala Lumpur Malaysia
| | - G. Gan
- Hematology; University Malaya Medical Centre; Kuala Lumpur Malaysia
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Rao A, Hales S, Patani B, Mou D, Kanagaratnam L, Barin E, Sindone A, Gan G. AF-Mediated Heart Failure: A Retrospective Observational Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.061] [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: 11/26/2022]
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