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Tay JCK, Chia SY, Koh SHM, Sim DKL, Chai P, Loh SY, Jaufeerally FR, Guang Lee SS, Yun Lim PZ, Yap J. Clinical characteristics and outcomes in Asian patients with heart failure with mildly reduced ejection fraction. Singapore Med J 2023; 0:377785. [PMID: 37338492 DOI: 10.4103/singaporemedj.smj-2021-096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Introduction Data on heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is still emerging, especially in Asian populations. This study aims to compare the clinical characteristics and outcomes of Asian HFmrEF patients with those of HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Methods Patients admitted nationally for HF between 2008 and 2014 were included in the study. They were categorised according to ejection fraction (EF). Patients with EF <40%, EF 40%-49% and EF ≥50% were categorised into the following groups: HFrEF, HFmrEF and HFpEF, respectively. All patients were followed up till December 2016. Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death and/or HF rehospitalisations. Results A total of 16,493 patients were included in the study - HFrEF, n = 7,341 (44.5%); HFmrEF, n = 2,272 (13.8%); and HFpEF n = 6,880 (41.7%). HFmrEF patients were more likely to be gender neutral, of mid-range age and have concomitant diabetes mellitus, hyperlipidaemia, peripheral vascular disease and coronary artery disease (P < 0.001). The two-year overall mortality rates for HFrEF, HFmrEF and HFpEF were 32.9%, 31.8% and 29.1%, respectively. HFmrEF patients had a significantly lower overall mortality rate compared to HFrEF patients (adjusted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.83-0.95; P < 0.001) and a significantly higher overall mortality rate (adjusted HR 1.25, 95% CI 1.17-1.33; P < 0.001) compared to HFpEF patients. This was similarly seen with cardiovascular mortality and HF hospitalisations, with the exception of similar HF hospitalisations between HFmrEF and HFpEF patients. Conclusion HFmrEF patients account for a significant burden of patients with HF. HFmrEF represents a distinct HF phenotype with high atherosclerotic burden and clinical outcomes saddled in between those of HFrEF and HFpEF. Further therapeutic studies to guide management of this challenging group of patients are warranted.
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Affiliation(s)
| | - Shaw Yang Chia
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Ping Chai
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Seet Yoong Loh
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | | | | | | | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Tan YK, Kwan YH, Teo DCL, Velema M, Deinum J, Tan PT, Zhang M, Khoo JJC, Loh WJ, Gani L, King TFJ, Tan EJH, Soh SB, Au VSC, Tay TL, Dacay LMQ, Ng KS, Wong KM, Wong ASY, Ng FC, Aw TC, Chan YHB, Tong KL, Lee SSG, Chai SC, Puar THK. Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study. Endocr Connect 2021; 10:834-844. [PMID: 34223820 PMCID: PMC8346187 DOI: 10.1530/ec-21-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND In addition to increased cardiovascular risk, patients with primary aldosteronism (PA) also suffer from impaired health-related quality of life (HRQoL) and psychological symptoms. We assessed for changes in HRQoL and depressive symptoms in a cohort of Asian patients with PA, after surgical and medical therapy. METHODS Thirty-four patients with PA were prospectively recruited and completed questionnaires from 2017 to 2020. HRQoL was assessed using RAND-36 and EQ-5D-3L, and depressive symptoms were assessed using Beck Depression Inventory (BDI-II) at baseline, 6 months, and 1 year post-treatment. RESULTS At 1 year post-treatment, significant improvement was observed in both physical and mental summative scores of RAND-36, +3.65, P = 0.023, and +3.41, P = 0.033, respectively, as well as four subscale domains (physical functioning, bodily pain, role emotional, and mental health). Significant improvement was also seen in EQ-5D dimension of anxiety/depression at 1 year post-treatment. Patients treated with surgery (n = 21) had significant improvement in EQ-5D index score post-treatment and better EQ-5D outcomes compared to the medical group (n = 13) at 1 year post-treatment. 37.9, 41.6 and 58.6% of patients had symptoms in the cognitive, affective and somatic domains of BDI-II, respectively. There was a significant improvement in the affective domain of BDI-II at 1 year post-treatment. CONCLUSION Both surgical and medical therapy improve HRQoL and psychological symptoms in patients with PA, with surgery providing better outcomes. This highlights the importance of early diagnosis, accurate subtyping and appropriate treatment of PA.
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Affiliation(s)
- Yen Kheng Tan
- Duke-NUS Medical School, SingHealth, Singapore, Singapore
| | - Yu Heng Kwan
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Marieke Velema
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jaap Deinum
- Division of Vascular Medicine, Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pei Ting Tan
- Department of Clinical Trials Research Unit, Changi General Hospital, Singapore, Singapore
| | - Meifen Zhang
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Linsey Gani
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Thomas F J King
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Eberta Jun Hui Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Shui Boon Soh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | | | - Keng Sin Ng
- Department of Diagnostic Radiology, Changi General Hospital, Singapore, Singapore
| | - Kang Min Wong
- Department of Diagnostic Radiology, Changi General Hospital, Singapore, Singapore
| | | | - Foo Cheong Ng
- Department of Urology, Changi General Hospital, Singapore, Singapore
| | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | | | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | | | - Siang Chew Chai
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Troy Hai Kiat Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
- Correspondence should be addressed to T H K Puar:
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Jin X, Melle JV, Voors AA, Sim DKL, Jaufeerally FR, Lee SSG, Soon D, Loh SY, Ding ZP, Richard MA, Lam CSP, Ling LH. Left atrial function in heart failure with preserved ejection fraction vs. aortic stenosis: evidence for atrial myopathy? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Aim
Left atrial (LA) enlargement and impaired LA function are frequently found in patients with heart failure with preserved ejection fraction (HFpEF). Whether these structural and functional LA abnormalities are a consequence of increased LA pressure or whether HFpEF patients have an intrinsic LA myopathy is unknown. We compared LA pressure, size and function between patients with HFpEF and aortic stenosis, as a comparator with LA pressure overload, as well as community-dwelling control subjects.
Methods
Extensive echocardiographic assessments were performed in 219 patients with HFpEF (age 68 ± 11, 48% female), 173 patients with moderate to severe AS (age 69 ± 11, 55% female, aortic valve area index 0.55 ± 0.15 cm2/m2), and 219 controls (age 65 ± 9, 48% female, 42.2% hypertensive)
Results
Compared to controls, both patients with HFpEF and AS had larger LV and LA size and worse LV systolic, diastolic and LA function. Compared with AS patients, HFpEF patients had smaller LA volume index (40.2 ± 19.4 vs. 44.5 ± 11.9 ml/m2 p = 0.01) but similar LV filling pressure estimated by E/e’ (13.4 ± 4.8 13.4 ± 4.8 , p = 0.12). Despite smaller LA volume index and similar LV filling pressure, HFpEF patients had remarkably poorer LA function compared to AS [reservoir GLS, 22.6 ± 10% vs 31.4 ± 10.1 (p < 0.001); contractile GLS, 15.8 ± 6.1% vs 17.5 ± 6.9 (p < 0.05); LASrs, 0.92 ± 0.35% vs 1.27 ± 0.41 (p < 0.001); LASre, -1.49 ± 0.65 vs -1.86 ± 0.67 (p < 0.001)]. The differences in LA reservoir GLS and LASrs remained significant after adjustment for atrial fibrillation, diabetes, coronary artery disease, LV ejection fraction and LV mass index.
Conclusion
Patients with HFpEF had significantly worse LA function than patients with AS, despite similar LA pressure overload. These findings support the concept of an intrinsic LA myopathy in patients with HFpEF, beyond LA pressure overload.
Abstract Figure.
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Affiliation(s)
- X Jin
- National Heart Centre Singapore, Singapore, Singapore
| | - JV Melle
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - AA Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - DKL Sim
- National University Heart Centre, Singapore, Singapore
| | | | - SSG Lee
- Changi General Hospital, Singapore, Singapore
| | - D Soon
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - SY Loh
- Tan Tock Seng Hospital, Singapore, Singapore
| | - ZP Ding
- National Heart Centre Singapore, Singapore, Singapore
| | - MA Richard
- National University Heart Centre, Singapore, Singapore
| | - CSP Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - LH Ling
- National University Heart Centre, Singapore, Singapore
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Gambre AS, Liew C, Hettiarachchi G, Lee SSG, MacDonald M, Kam CJW, Poh ACC. Accuracy and clinical outcomes of coronary CT angiography for patients with suspected coronary artery disease: a single-centre study in Singapore. Singapore Med J 2018; 59:413-418. [PMID: 30175374 DOI: 10.11622/smedj.2018096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to assess the accuracy and outcomes of coronary computed tomography angiography (CCTA) performed in a regional hospital in Singapore. METHODS The Changi General Hospital CCTA database was retrospectively analysed over a 24-month period. Electronic hospital records, catheter coronary angiography (CCA) and CCTA electronic databases were used to gather data on major adverse cardiovascular events (MACE) and CCA results. CCTA findings were deemed positive if coronary artery stenosis ≥ 50% was reported or if the stenosis was classified as moderate or severe. CCA findings were considered positive if coronary artery stenosis ≥ 50% was reported. RESULTS The database query returned 679 patients who had undergone CCTA for the evaluation of suspected coronary artery disease. Of the 101 patients in the per-patient accuracy analysis group, there were six true negatives, one false negative, 81 true positives and 13 false positives, resulting in a negative predictive value of 85.7% and positive predictive value of 86.2%. The mean age of the study sample was 53 ± 13 years and 255 (37.6%) patients were female. Mean duration of patient follow-up was 360 days. Of the 513 negative CCTA patients, none developed MACE during the follow-up period, and of the 164 positive CCTA patients, 19 (11.6%) developed MACE (p < 0.001). CONCLUSION Analysis of CCTA studies suggested accuracy and outcomes that were consistent with published clinical data. There was a one-year MACE-free warranty period following negative CCTA findings.
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Affiliation(s)
| | - Charlene Liew
- Department of Radiology, Changi General Hospital, Singapore
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Ang CL, Au Eong KG, Lee SSG, Chan SP, Tan CSH. Patients' expectation and experience of visual sensations during phacoemulsification under topical anaesthesia. Eye (Lond) 2006; 21:1162-7. [PMID: 16710431 DOI: 10.1038/sj.eye.6702427] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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] Open
Abstract
PURPOSE To describe what patients expect to see and the visual sensations they actually experience during phacoemulsification under topical anaesthesia. We also sought to determine if patients find their intraoperative visual experience frightening and the factors associated with this. MATERIALS AND METHODS Ninety-eight patients who underwent phacoemulsification and intraocular lens implantation under topical anaesthesia were interviewed preoperatively on what they expected to see with their operated eye during surgery and again postoperatively on what they actually saw. No patient received counselling about possible intraoperative visual sensations. A logistic (multivariate) regression model was used for statistical analysis. RESULTS Preoperatively, 36 patients (36.7%) expected at least light perception, 38 (38.8%) expected no light perception, and 24 (24.5%) were unsure what to expect. Some patients also expected a variety of different visual sensations. Postoperatively, all patients (100%) reported seeing light intraoperatively and many experienced various other visual sensations. Nineteen patients (19.4%) found their visual experience frightening. The following factors were statistically associated with a frightening visual experience: preoperative anxiety, previous cataract surgery in the fellow eye, experiencing an intraoperative increase in clarity, not seeing movement intraoperatively, and not knowing what to expect. CONCLUSIONS The majority of patients in this study either expected that they would see nothing at all during the surgery or were unsure of what to expect. All patients subsequently saw at least some light, and many perceived various other visual sensations that were frightening to nearly one in five patients. Preoperative counselling should inform about possible intraoperative visual experience.
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Affiliation(s)
- C-L Ang
- The Eye Institute at Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
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Au Eong KG, Tan CSH, Ang CL, Lee SSG, Venkatesh R, Muralikrishnan R, Fanning GL, Kumar CM. Intraoperative visual experiences of cataract patients can be both pleasant and unpleasant. Br J Ophthalmol 2005; 89:1386. [PMID: 16170152 PMCID: PMC1772875 DOI: 10.1136/bjo.2005.074823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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