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Wang C, Leng S, Tan RS, Chai P, Fam JM, Teo LLS, Chin CY, Ong CC, Baskaran L, Keng YJF, Low AFH, Chan MYY, Wong ASL, Chua SJT, Wu Q, Tan SY, Lim ST, Zhong L. Coronary CT Angiography-based Morphologic Index for Predicting Hemodynamically Significant Coronary Stenosis. Radiol Cardiothorac Imaging 2023; 5:e230064. [PMID: 38166346 DOI: 10.1148/ryct.230064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Purpose To develop a new coronary CT angiography (CCTA)-based index, α×LL/MLD4, that considers lesion entrance angle (α) in addition to lesion length (LL) and minimal lumen diameter (MLD) and to evaluate its efficacy in predicting hemodynamically significant coronary stenosis compared with invasive coronary angiography (ICA)-derived fractional flow reserve (FFR). Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD4. Diagnostic performance and accuracy of α×LL/MLD4 and LL/MLD4 in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD4 was 54.0 degree/mm3 (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm3 (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (P < .001). The per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for discriminating ischemic lesions were 86.2%, 83.1%, 88.4%, 84.1%, and 87.7% for α×LL/MLD4 and 80.5%, 66.3%, 90.9%, 84.3%, and 78.6% for LL/MLD4, respectively. Area under the receiver operating characteristic curve for discriminating hemodynamically significant stenosis was 0.93 for α×LL/MLD4, which was significantly greater than the values of 0.84 for LL/MLD4 and 0.63 for diameter stenosis (both P < .001). Conclusion The new morphologic index, α×LL/MLD4, incorporating lesion entrance angle achieved higher diagnostic performance in detecting hemodynamically significant lesions compared with diameter stenosis and LL/MLD4. Keywords: CT Angiography, Cardiac, Coronary Arteries, Ischemia, Infarction, Technology Assessment Clinical trial registration no. NCT03054324 Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Fairbairn and Nørgaard in this issue.
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Affiliation(s)
- Chenxi Wang
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Shuang Leng
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ru-San Tan
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ping Chai
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Jiang Ming Fam
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Lynette Li San Teo
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Chee Yang Chin
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ching Ching Ong
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Lohendran Baskaran
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Yung Jih Felix Keng
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Adrian Fatt Hoe Low
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Mark Yan-Yee Chan
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Aaron Sung Lung Wong
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Siang Jin Terrance Chua
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Qinghua Wu
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Swee Yaw Tan
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Soo Teik Lim
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Liang Zhong
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.)
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Loh EDW, Huang W, Sultana R, Kong SC, Tan SY, Chin CWL, Yeo KK. Predictors of left ventricular mass and coronary artery calcium phenotypes. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.101] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Medical Research Council, Ministry of Health, Singapore and the Lee Foundation
Background
Left ventricular (LV) mass and coronary artery calcium score (CACS) are both independent predictors of cardiovascular risk. There is paucity of data on the interplay of risk factors on LV mass in the presence or absence of subclinical coronary atherosclerosis.
Purpose
The objective of this present study was to explore the relationship of risk factors to indexed LV mass and CACS in a healthy Southeast-Asian population.
Methods
This study recruited volunteers with no known cardiovascular disease. LV mass, measured by cardiovascular magnetic resonance, was indexed to body surface area (LVMI), and CACS determined by non-contrast CT scanning. Blood pressure (BP) was measured via both office and ambulatory monitoring, and physical activity assessed through wearable devices. Analysis of LVMI was stratified into high, normal and low defined as more than one standard deviation away from the mean for each sex, with inter-group differences evaluated using chi-squared or ANOVA statistical tests. Subjects in each LVMI group were further subdivided by the presence and absence of coronary calcification (total 6 subgroups; LVMI/CACS phenotypes).
Results
A total of 880 subjects were included, including 428 males and 452 females. There was no significant difference in prevalence of coronary calcification across the LVMI groups for males, while females with high LVMI had significantly greater proportion of positive CACS (p = 0.036). Higher LVMI was observed in younger male subjects, but not in females.
In both sexes, body mass index was positively associated with LVMI (p = 0.004 for males, p = 0.037 for females), but not CACS. Waist circumference was associated with higher LVMI in males only.
Greater amounts of weekly self-reported exercise (p = 0.006) and daily calories burned (p = 0.022) were associated with increased LVMI for males only. However, wearable-derived measures of daily physical activity and step counts did not significantly affect LVMI or LVMI/CACS phenotypes in both sexes.
BP was a strong predictor of LVMI in both sexes regardless of office or ambulatory readings, in both day and night-time. The association was also observed with LVMI/CACS phenotypes: higher systolic or diastolic BP was significantly associated with positive CACS across all risk groups. Notably, subjects with low LVMI and positive CACS were normotensive (office BP 129/82 for males, 123/77 for females).
Higher HDL cholesterol levels correlated to absence of coronary calcification in males only (p = 0.010). In females, lower levels of total (p = 0.001) and LDL (p = 0.005) cholesterol were associated with absence of coronary calcification across all LVMI categories.
Conclusion
Only BP was strongly associated with LVMI and LVMI/CACS phenotypes in both sexes. There appears to be no correlation between physical activity and LVMI/CACS phenotypes. There is a need for causative studies to better evaluate the varying influence of risk factors on LVMI and CACS.
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Affiliation(s)
- E D W Loh
- Lee Kong Chian School of Medicine , Singapore , Singapore
| | - W Huang
- National Heart Centre Singapore , Singapore , Singapore
| | - R Sultana
- Duke-NUS Graduate Medical School Singapore , Singapore , Singapore
| | - S C Kong
- National Heart Centre Singapore , Singapore , Singapore
| | - S Y Tan
- National Heart Centre Singapore , Singapore , Singapore
| | - C W L Chin
- National Heart Centre Singapore , Singapore , Singapore
| | - K K Yeo
- National Heart Centre Singapore , Singapore , Singapore
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Cheng N, Tan EWP, Leng S, Baskaran L, Teo L, Yew MS, Singh M, Huang WM, Chan MYY, Ngiam KY, Vaughan R, Chua T, Tan SY, Lee HK, Zhong L. Machine learning accurately quantifies epicardial adipose tissue from non-contrast CT images in coronary artery disease. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.124] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Industry Alignment Fund – Pre-positioning Programme
Background
Epicardial adipose tissue (EAT) is the visceral fat deposit within the pericardium that surrounds the heart and the coronary arteries. EAT volume measured from non-contrast CT (NCCT) has been demonstrated to be significantly associated with adverse cardiovascular risk,1 particularly in patients with coronary artery disease.2 However, routine measurement of EAT volume is still challenging in clinical practice, as it is a tedious manual process and prone to human error.
Purpose
We aimed to develop a fully automated AI toolkit (i.e., AI EAT) for the quantification of EAT from routine NCCT scans and assess its performance in reference to clinical ground truth.
Methods
This is a multicenter study which performs CT scans in 5000 Asian Admixture patients (APOLLO study NCT05509010). In the current stage of this study, NCCT data analysis were conducted in 551 patients with 26,037 images. AI EAT was developed via a novel deep learning framework using an ensemble region-based UNet. The region-based UNet uses 2 component UNet models to perform segmentation of pericardium at the apex region and non-apex region (middle and basal). EAT volume was obtained by automated thresholding of the voxels (-190 to -30 Hounsfield Unit) within the pericardium (Figure 1). The network was trained in 501 patients with 23,712 NCCT images and tested in 50 patients with 2,325 NCCT images. The performance of AI EAT was evaluated with respect to clinical ground truth using Dice similarity coefficient (DSC), Pearson correlation, and Bland-Altman analysis.
Results
The AI EAT quantification process took less than 10 seconds per subject, compared with 20-30 minutes for expert readers. Compared to clinical ground truth, our AI EAT achieved a DSC of 0.96±0.01 and 0.91±0.02 for pericardium and EAT segmentations, respectively. There was strong agreement between the AI EAT and clinical ground truth in deriving the EAT volume (r=0.99, P<0.001) with minimal error of 7±5%.
Conclusion
End-to-end deep learning system accurately quantifies epicardial adipose tissue in standard NCCT images without manual segmentation.
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Affiliation(s)
- N Cheng
- Bioinformatics Institute, A*STAR , Singapore , Singapore
| | - E W P Tan
- Bioinformatics Institute, A*STAR , Singapore , Singapore
| | - S Leng
- National Heart Centre Singapore; Duke-NUS Medical School , Singapore , Singapore
| | - L Baskaran
- National Heart Centre Singapore; Duke-NUS Medical School , Singapore , Singapore
| | - L Teo
- National University Hospital; National University of Singapore, Department of Diagnostic Imaging; Yong Loo Lin School of Medicine , Singapore , Singapore
| | - M S Yew
- Tan Tock Seng Hospital , Singapore , Singapore
| | - M Singh
- Bioinformatics Institute, A*STAR , Singapore , Singapore
| | - W M Huang
- Institute for Infocomm Research, A*STAR , Singapore , Singapore
| | - M Y Y Chan
- National University Heart Centre; National University of Singapore, Department of Cardiology; Yong Loo Lin School of Medicine , Singapore , Singapore
| | - K Y Ngiam
- National University Hospital; National University of Singapore; National University Health System, Department of Surgery; Yong Loo Lin School of Medicine , Singapore , Singapore
| | - R Vaughan
- Duke-NUS Medical School , Singapore , Singapore
| | - T Chua
- National Heart Centre Singapore; Duke-NUS Medical School , Singapore , Singapore
| | - S Y Tan
- National Heart Centre Singapore; Duke-NUS Medical School , Singapore , Singapore
| | - H K Lee
- Bioinformatics Institute, A*STAR , Singapore , Singapore
| | - L Zhong
- National Heart Centre Singapore; Duke-NUS Medical School , Singapore , Singapore
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Baskaran L, Lee JK, Ko MSM, Al’Aref SJ, Neo YP, Ho JS, Huang W, Yoon YE, Han D, Nakanishi R, Tan SY, Al-Mallah M, Budoff MJ, Shaw LJ. Comparing the pooled cohort equations and coronary artery calcium scores in a symptomatic mixed Asian cohort. Front Cardiovasc Med 2023; 10:1059839. [PMID: 36733301 PMCID: PMC9887040 DOI: 10.3389/fcvm.2023.1059839] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Background The value of pooled cohort equations (PCE) as a predictor of major adverse cardiovascular events (MACE) is poorly established among symptomatic patients. Coronary artery calcium (CAC) assessment further improves risk prediction, but non-Western studies are lacking. This study aims to compare PCE and CAC scores within a symptomatic mixed Asian cohort, and to evaluate the incremental value of CAC in predicting MACE, as well as in subgroups based on statin use. Methods Consecutive patients with stable chest pain who underwent cardiac computed tomography were recruited. Logistic regression was performed to determine the association between risk factors and MACE. Cohort and statin-use subgroup comparisons were done for PCE against Agatston score in predicting MACE. Results Of 501 patients included, mean (SD) age was 53.7 (10.8) years, mean follow-up period was 4.64 (0.66) years, 43.5% were female, 48.3% used statins, and 50.0% had no CAC. MI occurred in 8 subjects while 9 subjects underwent revascularization. In the general cohort, age, presence of CAC, and ln(Volume) (OR = 1.05, 7.95, and 1.44, respectively) as well as age and PCE score for the CAC = 0 subgroup (OR = 1.16 and 2.24, respectively), were significantly associated with MACE. None of the risk factors were significantly associated with MACE in the CAC > 0 subgroup. Overall, the PCE, Agatston, and their combination obtained an area under the receiver operating characteristic curve (AUC) of 0.501, 0.662, and 0.661, respectively. Separately, the AUC of PCE, Agatston, and their combination for statin non-users were 0.679, 0.753, and 0.734, while that for statin-users were 0.585, 0.615, and 0.631, respectively. Only the performance of PCE alone was statistically significant (p = 0.025) when compared between statin-users (0.507) and non-users (0.783). Conclusion In a symptomatic mixed Asian cohort, age, presence of CAC, and ln(Volume) were independently associated with MACE for the overall subgroup, age and PCE score for the CAC = 0 subgroup, and no risk factor for the CAC > 0 subgroup. Whilst the PCE performance deteriorated in statin versus non-statin users, the Agatston score performed consistently in both groups.
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Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore,*Correspondence: Lohendran Baskaran,
| | - Jing Kai Lee
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Michelle Shi Min Ko
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Subhi J. Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Yu Pei Neo
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jien Sze Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Weiting Huang
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Leslee J. Shaw
- Icahn School of Medicine at Mount Sinai, Blavatnik Family Women’s Health Research Institute, New York, NY, United States
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Koh SJQ, Yap J, Jiang Y, Tay JCK, Quah KKH, Thiagarajan N, Tan SY, Amanullah MR, Lim ST, Aziz ZA, Govindasamy S, Chao VTT, Ewe SH, Ho KW. Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation. Ann Acad Med Singap 2022. [DOI: 10.47102/annals-acadmedsg.2022167] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Data on patients with small aortic annuli (SAA) undergoing transcatheter aortic valve implantation (TAVI) are limited. We aim to describe the impact of aortic annular size, particularly SAA and TAVI valve type on valve haemodynamics, durability and clinical outcomes.
Method: All patients in National Heart Centre Singapore who underwent transfemoral TAVI for severe symptomatic native aortic stenosis from July 2012 to December 2019 were included. Outcome measures include valve haemodynamics, prosthesis-patient mismatch (PPM), structural valve degeneration (SVD) and mortality.
Results: A total of 244 patients were included. The mean Society of Thoracic Surgeons score was 6.22±6.08, with 52.5% patients with small aortic annulus (<23mm), 33.2% patients with medium aortic annulus (23–26mm) and 14.3% patients with large aortic annulus (>26mm). There were more patients with self-expanding valve (SEV) (65.2%) versus balloon-expandable valve (BEV) (34.8%). There were no significant differences in indexed aortic valve area (iAVA), mean pressure gradient (MPG), PPM, SVD or mortality across all aortic annular sizes. However, specific to the SAA group, patients with SEV had larger iAVA (SEV 1.19±0.35cm2/m2 vs BEV 0.88±0.15cm2/m2, P<0.01) and lower MPG (SEV 9.25±4.88 mmHg vs BEV 14.17±4.75 mmHg, P<0.01) at 1 year, without differences in PPM or mortality. Aortic annular size, TAVI valve type and PPM did not predict overall mortality up to 7 years. There was no significant difference in SVD between aortic annular sizes up to 5 years.
Conclusion: Valve haemodynamics and durability were similar across the different aortic annular sizes. In the SAA group, SEV had better haemodynamics than BEV at 1 year, but no differences in PPM or mortality. There were no significant differences in mortality between aortic annular sizes, TAVI valve types or PPM.
Keywords: Aortic stenosis, small aortic annulus, transcatheter aortic valve implantation
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Huang B, Huang W, Allen JC, Sun L, Goh HJ, Kong SC, Lee D, Ding C, Bosco N, Egli L, Actis-Goretta L, Magkos F, Arigoni F, Leow MKS, Tan SY, Yeo KK. Prediction of subclinical atherosclerosis in low Framingham risk score individuals by using the metabolic syndrome criteria and insulin sensitivity index. Front Nutr 2022; 9:979208. [PMID: 36352897 PMCID: PMC9639788 DOI: 10.3389/fnut.2022.979208] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Subclinical atherosclerosis can be present in individuals with an optimal cardiovascular risk factor profile. Traditional risk scores such as the Framingham risk score do not adequately capture risk stratification in low-risk individuals. The aim of this study was to determine if markers of metabolic syndrome and insulin resistance can better stratify low-risk individuals. Methods A cross-sectional study of 101 healthy participants with a low Framingham risk score and no prior morbidities was performed to assess prevalence of subclinical atherosclerosis using computed tomography (CT) and ultrasound. Participants were compared between groups based on Metabolic Syndrome (MetS) and Insulin-Sensitivity Index (ISI-cal) scores. Results Twenty three individuals (23%) had subclinical atherosclerosis with elevated CT Agatston score ≥1. Presence of both insulin resistance (ISI-cal <9.23) and fulfillment of at least one metabolic syndrome criterion denoted high risk, resulting in significantly improved AUC (0.706 95%CI 0.588–0.822) over the Framingham risk score in predicting elevated CT Agatston score ≥1, with net reclassification index of 50.9 ± 23.7%. High-risk patients by the new classification also exhibited significantly increased carotid intima thickness. Conclusions The overlap of insulin resistance and presence of ≥1 criterion for metabolic syndrome may play an instrumental role in identifying traditionally low-risk individuals predisposed to future risk of atherosclerosis and its sequelae.
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Affiliation(s)
- Benjamin Huang
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Benjamin Huang
| | - Weiting Huang
- Singapore General Hospital, Singapore, Singapore
- National Heart Center Singapore, Singapore, Singapore
| | | | - Lijuan Sun
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Hui Jen Goh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | | | - Dewaine Lee
- National Heart Center Singapore, Singapore, Singapore
| | - Cherlyn Ding
- Nestlé Institute of Health Sciences Singapore, Singapore, Singapore
| | - Nabil Bosco
- Nestlé Institute of Health Sciences Singapore, Singapore, Singapore
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Leonie Egli
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | | | | | - Fabrizio Arigoni
- Nestlé Institute of Health Sciences Singapore, Singapore, Singapore
| | - Melvin Khee-Shing Leow
- Duke-NUS Medical School, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Center Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Center Singapore, Singapore, Singapore
- Khung Keong Yeo
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7
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Tian T, Liao XC, Zhang M, Wu XM, Guo YT, Tan SY. [Effects of celastrol on autophagy and endoplasmic reticulum stress-mediated apoptosis in a mouse model of nonalcoholic fatty liver disease]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:656-662. [PMID: 36038329 DOI: 10.3760/cma.j.cn501113-20210817-00408] [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: 06/15/2023]
Abstract
Objective: To investigate the effect of celastrol (CEL) on autophagy and endoplasmic reticulum stress-mediated apoptosis in a mouse model of nonalcoholic fatty liver disease (NAFLD). Methods: Eighteen male C57BL/6J mice were randomly divided into normal control (NC, n=6), high-fat diet (HFD, n=6) and celastrol group (HFD+CEL, n=6). The normal control group was fed with regular diet, and the high-fat diet and celastrol group were fed with high-fat diet for 12 weeks. After successful modeling, celastrol group were injected with 100 μg⋅kg-1⋅d-1 celastrol intraperitoneally for 4 weeks, and NC and HFD group were injected intraperitoneally with the same doses of normal saline. Serum concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured in mouse after 4-weeks of intervention. HE and Oil Red O staining were used to observe the pathomorphological changes and lipid droplet deposition in mouse liver, and the findings were scored according to NAFLD activity score (NAS). Western blot was used to detect the expression levels of liver microtubule associated protein 1 light chain 3 (LC3), P62, glucose-regulated protein 78 (GRP78), protein kinase R-like endoplasmic reticulum kinase (PERK), phosphorylated PERK (p-PERK), activated transcription factor 4 (ATF4), C/EBP homologous protein (CHOP), cleaved Caspase-3(cleaved caspase-3), B-cell lymphoma-2 (Bcl-2) and Bcl-2 related X protein (Bax).TUNEL staining was used to observe the apoptosis of hepatocytes. One-way analysis of variance was used for the intergroup comparison. Results: Serum levels of ALT (68.71±8.57) U/L, AST (209.63±28.64) U/L, TG (0.97±0.14) mmol/L, TC (4.12±0.64) mmol/L, and LDL -C (0.40±0.06) mmol/L were lower in celastrol group mouse than HFD group [(110.19±10.79) U/L, (399.72±73.47) U/L, (1.44±0.13) mmol/L, (5.65±0.54) mmol /L, (0.61±0.07) mmol/L] (P<0.05); while the serum HDL-C level (1.29±0.17) mmol/L was higher in celastrol than HFD group (0.72±0.13) mmol/L (P<0.05). HE and Oil Red O staining showed that lipid deposition and intralobular inflammation were apparent in the liver tissue of HFD group mouse, and the NAS score was significantly increased, while the hepatocyte steatosis and intralobular inflammation were alleviated after celastrol intervention, and the NAS score was decreased significantly (P<0.05). Compared with HFD group, the ratio of LC3II/I was significantly increased in the liver of celastrol group mouse, and the P62 was significantly decreased (P<0.05). Meanwhile, the expression level of GRP78, p-PERK/PERK , ATF4, and CHOP was significantly lower in celastrol than HFD group (P<0.05). In addition, the expressions of cleaved caspase-3 and Bax were significantly lower in celastrol than HFD group, and the expression of Bcl-2 was significantly increased (P<0.05). At the same time, the apoptosis rate of hepatocytes was also significantly lower in celastrol than HFD group (P<0.05). Conclusion: Celastrol can effectively alleviate the lipid deposition, protect hepatocytes and delay the progression of non-alcoholic fatty liver disease in mouse liver with non-alcoholic fatty liver disease. In addition, its mechanism of action may be related to the induction of autophagy, inhibition of endoplasmic reticulum stress PERK/ATF4/CHOP pathway and its mediated apoptosis.
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Affiliation(s)
- T Tian
- Department of Gastroenterology, Renmin Hospital of Wuhan University & Key Laboratory of Hubei Province for Digestive Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - X C Liao
- Department of Gastroenterology, Renmin Hospital of Wuhan University & Key Laboratory of Hubei Province for Digestive Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - M Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University & Key Laboratory of Hubei Province for Digestive Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - X M Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University & Key Laboratory of Hubei Province for Digestive Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Y T Guo
- Department of Gastroenterology, Renmin Hospital of Wuhan University & Key Laboratory of Hubei Province for Digestive Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - S Y Tan
- Department of Gastroenterology, Renmin Hospital of Wuhan University & Key Laboratory of Hubei Province for Digestive Disease, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Baskaran L, Neo YP, Lee JK, Yoon YE, Jiang Y, Al'Aref SJ, van Rosendael AR, Han D, Lin FY, Nakanishi R, Maurovich Horvat P, Tan SY, Villines TC, Bittencourt MS, Shaw LJ. Evaluating the Coronary Artery Disease Consortium Model and the Coronary Artery Calcium Score in Predicting Obstructive Coronary Artery Disease in a Symptomatic Mixed Asian Cohort. J Am Heart Assoc 2022; 11:e022697. [PMID: 35411790 PMCID: PMC9238474 DOI: 10.1161/jaha.121.022697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The utility of a given pretest probability score in predicting obstructive coronary artery disease (CAD) is population dependent. Previous studies investigating the additive value of coronary artery calcium (CAC) on pretest probability scores were predominantly limited to Western populations. This retrospective study seeks to evaluate the CAD Consortium (CAD2) model in a mixed Asian cohort within Singapore with stable chest pain and to evaluate the incremental value of CAC in predicting obstructive CAD. Methods and Results Patients who underwent cardiac computed tomography and had chest pain were included. The CAD2 clinical model comprised of age, sex, symptom typicality, diabetes, hypertension, hyperlipidemia, and smoking status and was compared with the CAD2 extended model that added CAC to assess the incremental value of CAC scoring, as well as to the corresponding locally calibrated local assessment of the heart models. A total of 522 patients were analyzed (mean age 54±11 years, 43.1% female). The CAD2 clinical model obtained an area under the curve of 0.718 (95% CI, 0.668–0.767). The inclusion of CAC score improved the area under the curve to 0.896 (95% CI, 0.867–0.925) in the CAD2 models and from 0.767 (95% CI, 0.721–0.814) to 0.926 (95% CI, 0.900–0.951) in the local assessment of the heart models. The locally calibrated local assessment of the heart models showed better discriminative performance than the corresponding CAD2 models (P<0.05 for all). Conclusions The CAD2 model was validated in a symptomatic mixed Asian cohort and local calibration further improved performance. CAC scoring provided significant incremental value in predicting obstructive CAD.
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Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology National Heart Centre Singapore.,Duke-National University of Singapore Singapore
| | - Yu Pei Neo
- Duke-National University of Singapore Singapore
| | | | | | - Yilin Jiang
- Department of Cardiology National Heart Centre Singapore
| | - Subhi J Al'Aref
- Division of Cardiology Department of Medicine University of Arkansas for Medical Sciences Little Rock AR
| | | | - Donghee Han
- Department of Imaging Cedars-Sinai Medical Center Los Angeles CA
| | - Fay Y Lin
- Department of Radiology New York-Presbyterian Hospital and Weill Cornell Medicine New York NY
| | - Rine Nakanishi
- Department of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo Japan
| | | | - Swee Yaw Tan
- Department of Cardiology National Heart Centre Singapore.,Duke-National University of Singapore Singapore
| | - Todd C Villines
- Division of Cardiovascular Medicine University of Virginia Health System Charlottesville VA
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research University Hospital University of Sao Paulo School of Medicine Sao Paulo Brazil
| | - Leslee J Shaw
- Blavatnik Family Women's Health Research Institute Mount Sinai School of Medicine New York NY
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Wong CJ, Choo HMC, Baskaran L, Koh NSY, Huang Z, Chua TSJ, Tan SY, Huang W. Prevalence and distribution of coronary artery calcium in a southeast asian cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.011] [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
Funding Acknowledgements
Type of funding sources: None.
Background
The coronary artery calcium score (CACS) independently predicts the risk of cardiovascular disease and major adverse cardiovascular events. While previous studies have demonstrated regional and ethnic differences in coronary calcification, the distribution of CACS in Southeast Asian (SEA) adults has not been investigated.
Purpose
The aim of this study was to determine CACS distribution in a SEA cohort living in Singapore.
Methods
This study involved 4945 asymptomatic patients who underwent CT coronary angiography and calcium scoring as part of screening for cardiovascular disease. Similar to the MESA study, patients with diabetes were analyzed separately due an increased prevalence of coronary calcification. A nonparametric analytical approach was used to determine CACS distribution stratified by age, gender and ethnicity.
Results
A positive CACS was seen in 43.7% of the overall SEA cohort with a higher prevalence in males (45.2%) than females (36.7%). The onset and burden of coronary calcification was also earlier and more severe in male subjects. There were no significant differences in CACS distribution amongst the three major ethnic groups in our study (p = 0.177). The presence of coronary calcification (CACS >0) was associated with increasing age, male gender and hypertension. Ethnicity, dyslipidemia, smoking and a family history of coronary artery disease did not significantly affect the presence of CACS.
Conclusions
This study provides a reference CACS distribution in an asymptomatic SEA population. There were no significant differences in CACS distribution amongst the three major ethnic groups living in Singapore.
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Affiliation(s)
- C J Wong
- National Heart Centre Singapore, Singapore, Singapore
| | - H M C Choo
- National Heart Centre Singapore, Singapore, Singapore
| | - L Baskaran
- National Heart Centre Singapore, Singapore, Singapore
| | - N S Y Koh
- National Heart Centre Singapore, Singapore, Singapore
| | - Z Huang
- National Heart Centre Singapore, Singapore, Singapore
| | - T S J Chua
- National Heart Centre Singapore, Singapore, Singapore
| | - S Y Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - W Huang
- National Heart Centre Singapore, Singapore, Singapore
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Huang Z, Ho JS, Ven Yap Q, Chan YH, Tan SY, Ya NKS, Low LP, Tan HC, Koh WP, Chua TSJ, Yoon S. Patterns of motivators and barriers to heart health behaviors among adults with behavior-modifiable cardiovascular risk factors: A population-based survey in Singapore. PLoS One 2022; 17:e0262752. [PMID: 35051229 PMCID: PMC8775312 DOI: 10.1371/journal.pone.0262752] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Motivators and barriers are pivotal factors in the adoption of health behaviors. This study aims to identify patterns of the motivators and barriers influencing heart health behaviors among multi-ethnic Asian adults with behavior-modifiable risk factors for heart disease, namely obesity, physical inactivity and smoking. METHODS A population-based survey of 1,000 participants was conducted in Singapore. Participants were assessed for behavior-modifiable risk factors and asked about motivators and barriers to heart health behaviors. Exploratory and confirmatory factor analyses were conducted to identify factors underlying motivator and barrier question items. Logistic regression was conducted to examine the associations of motivator and barrier factors with sociodemographic characteristics. RESULTS The twenty-five motivator and barrier items were classified into three (outcome expectations, external cues and significant others including family and friends) and four (external circumstances, limited self-efficacy and competence, lack of perceived susceptibility, benefits and intentions and perceived lack of physical capability) factors respectively. Among participants with behavior-modifiable risk factors, those with lower education were more likely to be low in motivation factor of "outcome expectations" and "external cues". The well-educated were more likely to be high in the barrier factor of "lack of perceived susceptibility, benefits and intention" and were less likely to have the motivation factor of "significant others (family or friends)". Those aged 60-75 years had low motivations and high barriers compared to their younger counterparts. Older age was more likely to be low in motivation factor of "outcome expectations" and "external cues" and high in barrier factor of "limited self-efficacy and competence" and "perceived lack of physical capability". CONCLUSIONS Findings underscore the importance of a targeted intervention and communication strategy addressing specific motivation and barrier factors in different population segments with modifiable risk factors.
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Affiliation(s)
- Zijuan Huang
- National Heart Centre Singapore, Singapore, Singapore
| | - Jien Sze Ho
- National Heart Centre Singapore, Singapore, Singapore
| | - Qai Ven Yap
- Department of Biostatistics, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yiong Huak Chan
- Department of Biostatistics, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore, Singapore
| | | | - Lip Ping Low
- Low Cardiology Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Woon Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | | | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore
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11
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Wang L, Yeo TJ, Tan B, Destrube B, Tong KL, Tan SY, Chan G, Huang Z, Tan F, Wang YC, Lee JY, Fung E, Mak GYK, So R, Wanlapakorn C, Ambari AM, Cuenza L, Koh CH, Tan JWC. Asian Pacific Society of Cardiology Consensus Recommendations for Pre-participation Screening in Young Competitive Athletes. Eur Cardiol 2021; 16:e44. [PMID: 34815752 PMCID: PMC8591617 DOI: 10.15420/ecr.2021.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
Sports-related sudden cardiac death is a rare but devastating consequence of sports participation. Certain pathologies underlying sports-related sudden cardiac death could have been picked up pre-participation and the affected athletes advised on appropriate preventive measures and/or suitability for training or competition. However, mass screening efforts - especially in healthy young populations - are fraught with challenges, most notably the need to balance scarce medical resources and sustainability of such screening programmes, in healthcare systems that are already stretched. Given the rising trend of young sports participants across the Asia-Pacific region, the working group of the Asian Pacific Society of Cardiology (APSC) developed a sports classification system that incorporates dynamic and static components of various sports, with deliberate integration of sports events unique to the Asia-Pacific region. The APSC expert panel reviewed and appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. Consensus was reached when 80% of votes for a recommendation were agree or neutral. The resulting statements described here provide guidance on the need for cardiovascular pre-participation screening for young competitive athletes based on the intensity of sports they engage in.
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Affiliation(s)
- Luokai Wang
- National Heart Centre Singapore Singapore.,Sengkang General Hospital Singapore
| | | | | | | | | | | | - Gregory Chan
- The Occupational and Diving Medicine Centre Singapore
| | | | - Frankie Tan
- Sports Science and Medicine Centre, Singapore Sports Institute Singapore
| | - Yu Chen Wang
- Department of Cardiology, Department of Internal Medicine, Asia University Hospital Taichung City, Taiwan
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul, Republic of Korea
| | - Erik Fung
- The Chinese University of Hong Kong Hong Kong
| | | | - Raymond So
- Elite Training Science & Technology, Hong Kong Sports Institute Hong Kong
| | | | - Ade Meidian Ambari
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, University of Indonesia Jakarta, Indonesia
| | - Lucky Cuenza
- Sports and Exercise Medicine Center, Medical Center Manila Philippines
| | | | - Jack Wei Chieh Tan
- National Heart Centre Singapore Singapore.,Sengkang General Hospital Singapore
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12
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Zhang JM, Han H, Tan RS, Chai P, Fam JM, Teo L, Chin CY, Ong CC, Low R, Chandola G, Leng S, Huang W, Allen JC, Baskaran L, Kassab GS, Low AFH, Chan MYY, Chan KH, Loh PH, Wong ASL, Tan SY, Chua T, Lim ST, Zhong L. Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method. Front Cardiovasc Med 2021; 8:739633. [PMID: 34746257 PMCID: PMC8564016 DOI: 10.3389/fcvm.2021.739633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/11/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to evaluate a new analytical method for calculating non-invasive fractional flow reserve (FFRAM) to diagnose ischemic coronary lesions. Patients with suspected or known coronary artery disease (CAD) who underwent computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) with FFR measurements from two sites were prospectively recruited. Obstructive CAD was defined as diameter stenosis (DS) ≥50% on CTCA or ICA. FFRAM was derived from CTCA images and anatomical features using analytical method and was compared with computational fluid dynamics (CFD)-based FFR (FFRB) and invasive ICA-based FFR. FFRAM, FFRB, and invasive FFR ≤ 0.80 defined ischemia. A total of 108 participants (mean age 60, range: 30–83 years, 75% men) with 169 stenosed coronary arteries were analyzed. The per-vessel accuracy, sensitivity, specificity, and positive predictive and negative predictive values were, respectively, 81, 75, 86, 81, and 82% for FFRAM and 87, 88, 86, 83, and 90% for FFRB. The area under the receiver operating characteristics curve for FFRAM (0.89 and 0.87) and FFRB (0.90 and 0.86) were higher than both CTCA- and ICA-derived DS (all p < 0.0001) on per-vessel and per-patient bases for discriminating ischemic lesions. The computational time for FFRAM was much shorter than FFRB (2.2 ± 0.9 min vs. 48 ± 36 min, excluding image acquisition and segmentation). FFRAM calculated from a novel and expeditious non-CFD approach possesses a comparable diagnostic performance to CFD-derived FFRB, with a significantly shorter computational time.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Huan Han
- National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Ching Ching Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Ris Low
- National Heart Centre Singapore, Singapore, Singapore
| | | | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore
| | | | - Lohendran Baskaran
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Adrian Fatt Hoe Low
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Koo Hui Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aaron Sung Lung Wong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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13
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Yang S, Tan SY, Chen S. [Research progress on the effect of selective autophagy receptor p62 on fibrotic diseases]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:797-800. [PMID: 34727668 DOI: 10.3760/cma.j.cn121094-20201218-00699] [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] [Indexed: 11/05/2022]
Abstract
Selective autophagy keeps cell homeostasis by degrading aggregated proteins, damaged or over-abundant organelles, and other cytoplasmic substances. The maintenance of its normal function needs to ensure that the autophagy receptor can effectively recognize and isolate undegraded substances. As an important autophagy receptor protein, p62 participates in the process of selective autophagy by mediating multiple signaling pathways. Fibrosis is a pathological feature of most chronic inflammatory diseases. When fibrosis develops for a long time, it will cause substantial scar formation and eventually lead to cell dysfunction and organ failure. The accumulation, overexpression and ectopic expression of p62 can aggravate the occurrence and development of lung, liver and kidney fibrosis diseases. Therefore, it is very critical to explore the effect of selective autophagy receptor p62 on fibrotic diseases.
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Affiliation(s)
- S Yang
- School of Medicine, Hunan Normal University, Changsha 410000, China
| | - S Y Tan
- School of Medicine, Hunan Normal University, Changsha 410000, China
| | - S Chen
- School of Medicine, Hunan Normal University, Changsha 410000, China
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14
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Tan SY, Zou H, Yang C, Chen G, Chen S. [The study of the impact by atractylenolide-1 on inflammatory cytokine, autophagy and apoptosis in alveolar macrophages of silicosis patients]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:721-725. [PMID: 34727650 DOI: 10.3760/cma.j.cn121094-20200601-00310] [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] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effect of atractylenolide-1 (ATL-Ⅰ) on alveolar macrophages in silicosis patients. Methods: In December 2019, 12 male silicosis patients treated in Beidaihe Sanatorium for Chinese Coal Miners from July to September 2019 were selected by random sampling. Their alveolar macrophages were collected and divided into control group, ATL-Ⅰ group (100 μmol/L) and dimethyl sulfoxide (DMSO) group (100 μmol/L) . The exprossion levels of inflammatory factor interleukin-1β (IL-1β) , interleukin-6 (IL-6) , tumor necrosis factor α (TNF-α) were detected by enzyme-linked immunosorbent assay. The expression levels of autophagy associated protein microtubule associated protein light chain 3 (LC3) , autophagy substrate protein p62, lysosome associated membrane protein 2 (LAMP2) , apoptosis associated protein Cleaved caspase-3, nuclear factor kappa B (NF-κB) and its phosphorylated form (p-NF-κB) were detected by Western blot. Results: Compared with the control group and DMSO group, the expression levels of IL-1β, IL-6, TNF-α in alveolar macrophages decreased significantly in the ATL-Ⅰ group (P<0.05) , and the expression levels of p-NF-κB, the ratio of LC3-Ⅱ/LC3-Ⅰ also decreased significantly in the ATL-Ⅰ group (P<0.05) . However, the expression levels of NF-κB, LAMP2, p62 and Cleaved caspase-3 in the ATL-Ⅰ group were not statistically different from those in the control group and DMSO group (P>0.05) . There was no statistically significant differences in the expression of the above indexes between the control group and DMSO group (P>0.05) . Conclusion: ATL-Ⅰ may reduce the release of inflammatory factors from alveolar macrophages and inhibit the activity of autophagy in silicosis patients, but it may not reduce the level of apoptosis.
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Affiliation(s)
- S Y Tan
- School of Medicine, Hunan Normal University, Changsha 410000, China
| | - H Zou
- School of Medicine, Hunan Normal University, Changsha 410000, China
| | - C Yang
- School of Medicine, Hunan Normal University, Changsha 410000, China
| | - G Chen
- Beidaihe Sanatorium for Chinese Coal Miners, Qinhuangdao 066100, China
| | - S Chen
- School of Medicine, Hunan Normal University, Changsha 410000, China
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15
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Chandola G, Zhang JM, Tan RS, Chai P, Teo L, Allen JC, Low R, Huang W, Leng S, Fam JM, Chin CY, Kassab GS, Low AFH, Tan SY, Chua T, Lim ST, Zhong L. Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention. Front Bioeng Biotechnol 2021; 9:739667. [PMID: 34557479 PMCID: PMC8452917 DOI: 10.3389/fbioe.2021.739667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Invasive fractional flow reserve (FFR) is recommended to guide stent deployment. We previously introduced a non-invasive FFR calculation (FFRB) based on computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamics (CFD) and resistance boundary conditions. Current study aimed to assess the feasibility and accuracy of FFRB for predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference. Twenty-five patients who had undergone CTCA were prospectively enrolled before invasive coronary angiography (ICA) and FFR-guided percutaneous coronary intervention (PCI) on 30 coronary vessels. Using reduced-order CFD with novel boundary conditions on three-dimensional (3D) patient-specific anatomic models reconstructed from CTCA, we calculated FFRB before and after virtual stenting. The latter simulated PCI by clipping stenotic segments from the 3D coronary models and replacing them with segments to mimic the deployed coronary stents. Pre- and post-virtual stenting FFRB were compared with FFR measured pre- and post-PCI by investigators blinded to FFRB results. Among 30 coronary lesions, pre-stenting FFRB (mean 0.69 ± 0.12) and FFR (mean 0.67 ± 0.13) exhibited good correlation (r = 0.86, p < 0.001) and agreement [mean difference 0.024, 95% limits of agreement (LoA): −0.11, 0.15]. Similarly, post-stenting FFRB (mean 0.84 ± 0.10) and FFR (mean 0.86 ± 0.08) exhibited fair correlation (r = 0.50, p < 0.001) and good agreement (mean difference 0.024, 95% LoA: −0.20, 0.16). The accuracy of FFRB for identifying post-stenting ischemic lesions (FFR ≤ 0.8) (residual ischemia) was 87% (sensitivity 80%, specificity 88%). Our novel FFRB, based on CTCA with reduced-order CFD and resistance boundary conditions, accurately predicts the hemodynamic effects of stenting which may serve as a tool in PCI planning.
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Affiliation(s)
| | - Jun-Mei Zhang
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Ris Low
- National Heart Centre Singapore, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Chee Yang Chin
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Adrian Fatt Hoe Low
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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16
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Wang J, Fu Y, Lou V, Tan SY, Chui E. A systematic review of factors influencing attitudes towards and intention to use the long-distance caregiving technologies for older adults. Int J Med Inform 2021; 153:104536. [PMID: 34325206 DOI: 10.1016/j.ijmedinf.2021.104536] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Long-distance caregiving (LDC) technologies play a significant role in enabling distant care and facilitating living-alone older adults to keep socially connected. However, there is scarce research exploring the older adults' attitudes towards and intention to use such technologies. This paper is based on a systematic review of existing literature to explore the multifarious factors influencing independent community-living older adults' attitudes towards and intention to use LDC technologies. METHODS Articles published in English between 2006 and 2020 were reviewed by searching electronic databases of PubMed, ProQuest, EBSCOhost. The inclusion criteria were limited to quantitative, qualitative, or mixed-methods studies that involved: 1) distant caregiving; 2) older adults aged 60 years or above, who were living alone or with only their spouse in the community (even though the samples might also involve other non-older adults); 3) technologies including ICT-based devices, systems, or programs enabling data transmission were used; 4), intention to use or behavioral usage in regard to the technologies were reported or discussed. RESULTS In total, 41 out of 8674 articles were included. Both determinants and moderators of affecting the use of the ICT-based LDC technologies were identified with theoretical guidance. To summarize, there are personal factors involved, such as personality, concerns regarding security and privacy, health conditions, requisite knowledge, financial conditions, and influence from significant others, encompassing formal and informal caregivers; and factors related to the devices, in terms of their user-friendliness and functionality. CONCLUSION This review highlights the importance of striking a good balance between functionality and privacy concerns, besides considering the direct and indirect cost to users. LDC technology education should be promoted at the societal level to facilitate older adults' better understanding of the device utilities by enhancing their technological literacy. Implications for various stakeholders to cope with the challenges of an aging population are also discussed.
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Affiliation(s)
- J Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | - Y Fu
- School of Social Development and Public Policy, Beijing Normal University, North Main Building 2003, 19 Xinjiekou Wai St., Beijing 100875, China.
| | - V Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | - S Y Tan
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore 259772, Singapore.
| | - E Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong.
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17
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Huang Z, Yap QV, Chan YH, Ho JS, Tan SY, Koh WP, Chua T, Yoon S. Knowledge of Heart Disease, Preventive Behavior and Source of Information in a Multi-ethnic Asian Population: A Population-Based Survey. J Community Health 2021; 46:31-40. [PMID: 32415522 DOI: 10.1007/s10900-020-00838-4] [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] [Indexed: 01/13/2023]
Abstract
Several population-based studies have been conducted to better understand the public knowledge of cardiovascular disease (CVD) and behavior. However, most studies have predominantly focused on Western populations. This study aimed to investigate heart disease knowledge, preventive behavior and source of information on heart disease in a multi-ethnic Asian population. We conducted a nation-wide population-based survey of 1000 participants of three ethnic groups (Chinese, Malay, Indian) in Singapore. A structured questionnaire was used to collect sociodemographics, knowledge on CVD risk factors, symptoms, emergency action, preventive health behaviors and sources of information on heart disease. Univariate and multivariate analyses were conducted to identify factors associated with the CVD knowledge and behavior. Knowledge on CVD risk factors was generally high. Knowledge on emergency actions was low particularly in younger people. More than 60% did not meet the recommended levels of physical activity, and this was more evident for individuals of overweight/obese status, lower education and workforce. Chinese were less likely to be obese/overweight compared to the Malays and Indians. Malays were less likely to seek information from internet and social media compared to their ethnic counterparts. This study highlighted heterogeneity in the levels of knowledge and health behavior across population segments, suggesting the need for a tailored approach to heart health interventions and optimal channels for information dissemination. Our findings will form the basis for contextually and culturally appropriate interventions to combat the growing CVD burden and prevent its toll on a rapidly ageing population.
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Affiliation(s)
- Zijuan Huang
- National Heart Centre Singapore, Singapore, Singapore
| | - Qai Ven Yap
- Department of Biostatistics, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yiong Huak Chan
- Department of Biostatistics, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jien Sze Ho
- National Heart Centre Singapore, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - Woon Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. .,Regional Health System, Singapore Health Services, Singapore, Singapore.
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18
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Wong MYZ, Yap J, Huang W, Tan SY, Yeo KK. Impact of Age and Sex on Subclinical Coronary Atherosclerosis in a Healthy Asian Population. JACC: Asia 2021; 1:93-102. [PMID: 36338370 PMCID: PMC9627875 DOI: 10.1016/j.jacasi.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
Background The influence of age and sex on clinical atherosclerotic cardiovascular disease is well reported, but literature remains sparse on whether these extend to the disease in its preclinical stage. Objectives The purpose of this study was to report the prevalence, risk factors, and impact of age and sex on the burden of subclinical coronary atherosclerosis in a healthy Asian population. Methods Healthy subjects age 30 to 69 years, with no history of cardiovascular disease or diabetes were recruited from the general population. Subclinical coronary atherosclerosis was quantified via the coronary artery calcium score (CAC) with CAC of 0 indicating absence of calcified plaque, 1 to 10 minimal plaque, 11 to 100 mild plaque, and >100 moderate to severe plaque. Results A total of 663 individuals (mean age 49.4 ± 9.2 years; 44.8% men) were included. The prevalence of any CAC was 29.3%, with 9% having CAC >100. The prevalence was significantly higher in men than women (43.1% vs 18.0%; P < 0.001). Multivariable analysis revealed significant associations of increasing age, male sex, higher blood pressure, increased glucose levels, and higher low-density lipoprotein cholesterol levels with the presence of any CAC. Low-density lipoprotein cholesterol was more significantly associated with CAC in women compared with men (Pinteraction = 0.022). Conclusions The prevalence of preclinical atherosclerosis increased with age, and was higher in men, with sex-specific differences in associated risk factors. These results will better inform individualized future risk management strategies to prevent the development and progression of coronary artery disease within healthy individuals.
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19
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Dewey M, Rochitte CE, Ostovaneh MR, Chen MY, George RT, Niinuma H, Kitagawa K, Laham R, Kofoed K, Nomura C, Sakuma H, Yoshioka K, Mehra VC, Jinzaki M, Kuribayashi S, Laule M, Paul N, Scholte AJ, Cerci R, Hoe J, Tan SY, Rybicki FJ, Matheson MB, Vavere AL, Arai AE, Miller JM, Cox C, Brinker J, Clouse ME, Di Carli M, Lima JAC, Arbab-Zadeh A. Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease - Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study. J Cardiovasc Comput Tomogr 2021; 15:485-491. [PMID: 34024757 DOI: 10.1016/j.jcct.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). METHODS At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). RESULTS Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). CONCLUSIONS Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. CLINICAL TRIAL REGISTRATION NCT00934037.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Carlos E Rochitte
- InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil
| | - Mohammad R Ostovaneh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Marcus Y Chen
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard T George
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Hiroyuki Niinuma
- Memorial Heart Center, Iwate Medical University, Morioka, Japan; Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Roger Laham
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Klaus Kofoed
- Department of Cardiology, Rigs Hospitalet, University of Copenhagen, Denmark
| | - Cesar Nomura
- Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Vishal C Mehra
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | | | | | - Michael Laule
- Department of Medicine/Cardiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Narinder Paul
- Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodrigo Cerci
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - John Hoe
- Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre, Singapore
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Vavere
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Andrew E Arai
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julie M Miller
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey Brinker
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Melvin E Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Marcelo Di Carli
- Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - João A C Lima
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Armin Arbab-Zadeh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA.
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Tan SY, Kuganesan A, Buchan K, Lau KK. Iterative Model Reconstruction in Lumbar Spine Image Retrieval from Computed Tomography of the Abdomen and Pelvis. Hong Kong Journal of Radiology 2021. [DOI: 10.12809/hkjr2117150] [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: 11/05/2022] Open
Affiliation(s)
- SY Tan
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
| | - A Kuganesan
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
| | - K Buchan
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
| | - KK Lau
- Diagnostic Imaging Department, Monash Health, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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21
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Gan CC, Jalalonmuhali M, Nordin NZ, Abdul Wahab MZ, Yahya R, Ng KP, Tan SY, Lim SK. ABO-Incompatible Living-Donor Kidney Transplantation in a Developing Country: A Multicenter Experience in Malaysia. Transplant Proc 2021; 53:856-864. [PMID: 33487455 DOI: 10.1016/j.transproceed.2020.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022]
Abstract
Malaysia has a low deceased-donor donation rate and has not embarked on a paired kidney exchange program; therefore, ABO-incompatible and HLA-incompatible transplantation remain the main contributor to the sustainability of the national kidney transplantation (KT) program. There were 26 cases of ABO-incompatible KTs performed from 2011 to 2018 in 3 major transplant centers, namely, Hospital Kuala Lumpur, University Malaya Medical Centre, and Prince Court Medical Centre. We collected perioperative and follow-up data through June 2019. The desensitization protocol varies and is center specific: the localized Japanese protocol and Swedish protocol with a target anti-A/B isoagglutinin titer of 16 or 32 on the day of transplant. The induction and tacrolimus-based maintenance protocol was nearly identical. The median follow-up time was 62.3 months (interquartile range, 37.0-79.7). Fifteen subjects had the highest predesensitization anti-A/B titer of ≥32 (57.7%). The acute cellular rejection and antibody-mediated rejection incidence were 12.5% (3 cases) and 8.3% (2 cases), respectively. Patient, graft, and death-censored graft survival rates were 96.2%, 92.3%, and 96.0%, respectively, 1 year post-living-donor KT (LDKT) and 96.2%, 87.2%, and 90.7%, respectively, 5 years post-LDKT. Our experience shows that ABO-incompatible LDKT using a suitable desensitization technique could be a safe and feasible choice for LDKT even with varied desensitization regimens for recipients with relatively high baseline isoagglutinin titers.
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Affiliation(s)
- C C Gan
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - M Jalalonmuhali
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - N Z Nordin
- Department of Nephrology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, Kuala Lumpur, Malaysia
| | - M Z Abdul Wahab
- Department of Nephrology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, Kuala Lumpur, Malaysia
| | - R Yahya
- Department of Nephrology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, Kuala Lumpur, Malaysia
| | - K P Ng
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - S Y Tan
- Department of Nephrology, Prince Court Medical Center, Kuala Lumpur, Malaysia
| | - S K Lim
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur, Malaysia.
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22
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Huang W, Lim LMH, Aurangzeb AS, Wong CJ, Koh NSY, Huang Z, Teo HK, Chua TSJ, Tan SY. Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification. Clin Cardiol 2021; 44:267-275. [PMID: 33434373 PMCID: PMC7852173 DOI: 10.1002/clc.23539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Coronary artery calcium score (CAC) is an objective marker of atherosclerosis. The primary aim is to assess CAC as a risk classifier in stable coronary artery disease (CAD). Hypothesis CAC improves CAD risk prediction, compared to conventional risk scoring, even in the absence of cardiovascular risk factor inputs. Methods Outpatients presenting to a cardiology clinic (n = 3518) were divided into two cohorts: derivation (n = 2344 patients) and validation (n = 1174 patients). Adding logarithmic transformation of CAC, we built two logistic regression models: Model 1 with chest pain history and risk factors and Model 2 including chest pain history only without risk factors simulating patients with undiagnosed comorbidities. The CAD I Consortium Score (CCS) was the conventional reference risk score used. The primary outcome was the presence of coronary artery disease defined as any epicardial artery stenosis≥50% on CT coronary angiogram. Results Area under curve (AUC) of CCS in our validation cohort was 0.80. The AUC of Models 1 and 2 were significantly improved at 0.88 (95%CI 0.86–0.91) and 0.87 (95%CI 0.84–0.90), respectively. Integrated discriminant improvement was >15% for both models. At a pre‐specified cut‐off of ≤10% for excluding coronary artery disease, the sensitivity and specificity were 89.3% and 74.7% for Model 1, and 88.1% and 71.8% for Model 2. Conclusion CAC helps improve risk classification in patients with chest pain, even in the absence of prior risk factor screening.
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Affiliation(s)
- Weiting Huang
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Leon Ming Hsien Lim
- Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore, 117597, Singapore
| | | | - Cheney Jianlin Wong
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Natalie Si Ya Koh
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Zijuan Huang
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Hooi Khee Teo
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | - Swee Yaw Tan
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
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23
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Chen PR, Tan SY. [The clinical characteristics of 89 cases of non-tuberculous mycobacterium pulmonary disease complicated with tracheobronchial lesions]. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43:947-952. [PMID: 33137861 DOI: 10.3760/cma.j.cn112147-20200309-00288] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical characteristics of non-tuberculous mycobacterium(NTM) pulmonary disease complicated with tracheobronchial lesions. Methods: From January 2014 to December 2018, there were 1 006 patients who were admitted to Guangzhou Chest Hospital for the first time and received examination by bronchoscopy. A total of 89 patients with complete data were selected, including 40 males and 49 females, aged 20 to 85 years, with 46 patients (52%) aged 60 years or older. The clinical symptoms and signs of the patients were analyzed with chest imaging, bronchoscopy and pathological examination results. Comparisons between groups were made by Chi-square test and t test. Results: The number of patients with NTM complicated with tracheobronchial lesions accounted for 8.9%(89/1 006) of those hospitalized with NTM and received bronchoscopy during the same period. Clinical symptoms included cough and sputum (89/89), different degrees of hemoptysis or blood sputum (52/89), and shortness of breath (50/89). Chest CT showed that 72 cases (72/89, 81%) had lung lesions involving more than 3 lung fields, and 83 cases (93%) had bronchiectasis and 63 cases (63/89, 71%) with cavities. Pulmonary atelectasis was shown in 45 cases (45/89, 51%). By bronchoscopy, 39 cases (39/89, 44%) were diagnosed as tuberculous lesions involving bilateral upper bronchi, while lesions of the right lower bronchus was found in 27 cases (27/89, 30%).The percentage of patients with multilobar bronchial involvement was 50.6%(45/89). The morphological characteristics of the bronchial lesions included scar stenosis or atresia in 63 cases (63/89, 71%), hyperemia and edema in 46 cases (46/89, 52%), and multiple types of lesions in 48 cases (48/89, 54%). Conclusions: Patients with NTM lung disease complicated with tracheobronchial inflammatory lesions did not have specific manifestations clinically. Lung lesions are extensive, often accompanied by bronchiectasis and cavity formation. Endoscopic changes were mostly manifested as multilobar tracheobronchial involvement characterized by scar stenosis, congestion and edema, mainly involving bilateral upper bronchi and the right lower bronchus.
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Affiliation(s)
- P R Chen
- State Key Laboratory of Respiratory Disease,Department of Tuberculosis in Guangzhou Chest Hospital,Guangzhou 510095,China
| | - S Y Tan
- State Key Laboratory of Respiratory Disease,Department of Tuberculosis in Guangzhou Chest Hospital,Guangzhou 510095,China
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24
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Tan SY, Leong WH, Ong LH, Mohd-Amin MZ. A Cost-Effective Alternative for Lateral Femoral Wall Perforation in Anterior Cruciate Ligament (ACL) Reconstruction: A Case Report. Malays Orthop J 2020; 14:138-140. [PMID: 32983390 PMCID: PMC7513645 DOI: 10.5704/moj.2007.023] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lateral femoral wall perforation is a rare intra-operative complication in anterior cruciate ligament (ACL) reconstruction surgery. However, it can be challenging to manage if it occurs. We share our experience on lateral femoral wall perforation managed by a large fragment washer. A 25-year-old man with right ACL injury presented with knee instability despite physiotherapy. Anterior drawer test (ADT) and Lachman test were grade 3, glide on pivot shift was positive. During ACL reconstruction, the lateral femoral wall was perforated. Due to unavailability of the rescue endobutton and budget constraint, we passed the endobutton through a washer and allowed it to sit on the washer over the lateral femoral wall. ADT and Lachman test on post-operative 6, 12 and 24 weeks were grade 1, with a negative pivot shift test. Lysholm knee score improved from 69 pre-operatively to 98 post-operatively. Conventionally, lateral femoral wall perforation can be managed by rescue endobutton, or screw and washer post technique. As this complication is rare, the rescue endobutton may not be available at all times, and the cost of the implant is also another important factor to consider. A washer can be used as an alternative technique to manage lateral femoral wall perforation in ACL reconstruction as it is not only cost-effective but also provides stable fixation with good functional outcome.
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Affiliation(s)
- S Y Tan
- Department of Orthopaedic, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - W H Leong
- Department of Orthopaedic, Sarawak General Hospital, Kuching, Malaysia
| | - L H Ong
- Department of Orthopaedic, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - M Z Mohd-Amin
- Department of Orthopaedic, Universiti Malaysia Sarawak, Kuching, Malaysia
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25
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Zhang JM, Chandola G, Tan RS, Chai P, Teo LLS, Low R, Allen JC, Huang W, Fam JM, Chin CY, Wong ASL, Low AF, Kassab GS, Chua T, Tan SY, Lim ST, Zhong L. Quantification of effects of mean blood pressure and left ventricular mass on noninvasive fast fractional flow reserve. Am J Physiol Heart Circ Physiol 2020; 319:H360-H369. [DOI: 10.1152/ajpheart.00135.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/02/2023]
Abstract
While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ping Chai
- National University Hospital, Singapore
| | | | - Ris Low
- National Heart Centre Singapore, Singapore
| | - John Carson Allen
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore
| | | | | | - Aaron Sung Lung Wong
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | | | | | - Terrance Chua
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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26
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Affiliation(s)
- S Y Tan
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei
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27
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Tan SY, Chong CF, Chong VH. Response to: Approach to evaluation of choledocholithiasis in patient with or without acute cholangitis. QJM 2020; 113:449-450. [PMID: 32125414 DOI: 10.1093/qjmed/hcaa076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
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28
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Wang GS, Xu L, Chen HT, Shi LP, Huang MJ, Xi L, Xu LS, Wang F, Li HY, Li S, Zhang YJ, Tan SY, Hong RT, Lyu NH, Ye M, Gan HT, Liu M, Wu BY. [Treatment of postprandial discomfort syndrome in the elderly: a multi-centered prospective randomized controlled clinical study]. Zhonghua Nei Ke Za Zhi 2020; 59:117-123. [PMID: 32074684 DOI: 10.3760/cma.j.issn.0578-1426.2020.02.005] [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] [Indexed: 02/05/2023]
Abstract
Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym(®)) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym(®) group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym(®) group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym(®) group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym(®) group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym(®) group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym(®) group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions: The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.
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Affiliation(s)
- G S Wang
- Department of Gastroenterology, The Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - L Xu
- Department of Gastroenterology, Beijing Hospital, Beijing 100730, China
| | - H T Chen
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
| | - L P Shi
- Department of Geriatric Gastroenterology, Shaanxi Provincal People's Hospital, Xi'an 710068, China
| | - M J Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - L Xi
- Department of Geriatrics, The First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - L S Xu
- Department of Geriatrics, Guangdong Provincal People's Hospital, Guangzhou 510080, China
| | - F Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - H Y Li
- Department of Geriatrics, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
| | - S Li
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Y J Zhang
- Department of Geriatric Gastroenterology, PLA Southern Theater General Hospital, Guangzhou 510010, China
| | - S Y Tan
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - R T Hong
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - N H Lyu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - M Ye
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - H T Gan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - M Liu
- Department of Gastroenterology, The Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - B Y Wu
- Department of Gastroenterology, The Second Medical Center of PLA General Hospital, Beijing 100853, China
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Tan SY, Lau K, Borsaru A, Jackson D, Nandurkar D. Efficacy of Iodine Perfusion Maps from Dual-energy Computed Tomography of the Pulmonary Arteries in Pulmonary Embolism Assessment. Hong Kong Journal of Radiology 2019. [DOI: 10.12809/hkjr1916942] [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: 11/05/2022] Open
Affiliation(s)
- SY Tan
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
| | - K Lau
- Diagnostic Imaging Department, Monash Health, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - A Borsaru
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
| | - D Jackson
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
| | - D Nandurkar
- Diagnostic Imaging Department, Monash Health, Victoria, Australia
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30
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Huang PZ, Peng SY, Yu HC, Huang L, Yao Q, Wang XL, Tan SY, Zhou JM, Wang PN, Huang AP, Bai LL, Luo YX, Huang MJ. Decreased expression of SorCS1 in colorectal cancer: An independent predictor of poor prognosis. Neoplasma 2019; 67:119-128. [PMID: 31829024 DOI: 10.4149/neo_2019_190221n146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/10/2019] [Indexed: 11/08/2022]
Abstract
Previously, we identified that sortilin related VPS10 domain containing receptor 1 (SorCS1) was hypermethylated in colorectal cancer (CRC) tissues. Here, we aimed to investigate the association between CRC and SorCS1. DNA methylation was determined by methylation-specific polymerase chain reaction (MSP) or quantitative real-time methylation analysis (MethyLight). Colorectal cancer tissue specimens from 239 patients that had undergone surgical treatment were evaluated using immunohistochemistry (IHC) analysis for the expression of SorCS1 and correlated with clinicopathological variables and prognosis. We found that SorCS1 was hypermethylated in CRC cell lines and 67.5% (27/40) CRC tumor tissues. The loss of SorCS1 mRNA (p<0.001) and protein expression (p=0.033) were highly correlated with promoter methylation. In addition, SorCS1 expression was significantly increased in younger patients (p=0.006), low CEA level (p<0.001) and pT1-2 stage (p=0.005). Survival analysis revealed that decreased expression of SorCS1 was an independent factor for predicting the increased risk of recurrence (p=0.024) and poor overall survival (p=0.006). Subgroup analysis for CEA level, pT and pN classifications showed that SorCS1 retained its stratified significance only in patients with low CEA level, pT3-4 tumors and pN1-2 lymph node status. Our findings suggest that SorCS1 is epigenetically inactivated in a substantial fraction of CRC, and its expression may be a promising prognostic factor in CRC patients.
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Affiliation(s)
- P Z Huang
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - S Y Peng
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - H C Yu
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - L Huang
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - Q Yao
- Department of Coloproctology Surgery, Shenzhen People's Hospital, Shenzhen, China
| | - X L Wang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - S Y Tan
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - J M Zhou
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - P N Wang
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - A P Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Laboratory of Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - L L Bai
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - Y X Luo
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
| | - M J Huang
- Department of Colon and Rectum Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, China
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Yap J, Lim WK, Sahlén A, Chin CWL, Chew KMYC, Davila S, Allen J, Goh V, Tan SY, Tan P, Lam CSP, Cook SA, Yeo KK. Harnessing technology and molecular analysis to understand the development of cardiovascular diseases in Asia: a prospective cohort study (SingHEART). BMC Cardiovasc Disord 2019; 19:259. [PMID: 31752689 PMCID: PMC6873552 DOI: 10.1186/s12872-019-1248-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 11/07/2019] [Indexed: 01/01/2023] Open
Abstract
Background Cardiovascular disease (CVD) imposes much mortality and morbidity worldwide. The use of “deep learning”, advancements in genomics, metabolomics, proteomics and devices like wearables have the potential to unearth new insights in the field of cardiology. Currently, in Asia, there are no studies that combine the use of conventional clinical information with these advanced technologies. We aim to harness these new technologies to understand the development of cardiovascular disease in Asia. Methods Singapore is a multi-ethnic country in Asia with well-represented diverse ethnicities including Chinese, Malays and Indians. The SingHEART study is the first technology driven multi-ethnic prospective population-based study of healthy Asians. Healthy male and female subjects aged 21–69 years old without any prior cardiovascular disease or diabetes mellitus will be recruited from the general population. All subjects are consented to undergo a detailed on-line questionnaire, basic blood investigations, resting and continuous electrocardiogram and blood pressure monitoring, activity and sleep tracking, calcium score, cardiac magnetic resonance imaging, whole genome sequencing and lipidomic analysis. Outcomes studied will include mortality and cause of mortality, myocardial infarction, stroke, malignancy, heart failure, and the development of co-morbidities. Discussion An initial target of 2500 patients has been set. From October 2015 to May 2017, an initial 683 subjects have been recruited and have completed the initial work-up the SingHEART project is the first contemporary population-based study in Asia that will include whole genome sequencing and deep phenotyping: including advanced imaging and wearable data, to better understand the development of cardiovascular disease across different ethnic groups in Asia.
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Affiliation(s)
- Jonathan Yap
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
| | - Anders Sahlén
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Calvin Woon-Loong Chin
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | - Sonia Davila
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - John Allen
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Vera Goh
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Swee Yaw Tan
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
| | - Carolyn S P Lam
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Stuart Alexander Cook
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore
| | - Khung Keong Yeo
- Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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Teo JX, Davila S, Yang C, Hii AA, Pua CJ, Yap J, Tan SY, Sahlén A, Chin CWL, Teh BT, Rozen SG, Cook SA, Yeo KK, Tan P, Lim WK. Digital phenotyping by consumer wearables identifies sleep-associated markers of cardiovascular disease risk and biological aging. Commun Biol 2019; 2:361. [PMID: 31602410 PMCID: PMC6778117 DOI: 10.1038/s42003-019-0605-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 09/09/2019] [Indexed: 01/30/2023] Open
Abstract
Sleep is associated with various health outcomes. Despite their growing adoption, the potential for consumer wearables to contribute sleep metrics to sleep-related biomedical research remains largely uncharacterized. Here we analyzed sleep tracking data, along with questionnaire responses and multi-modal phenotypic data generated from 482 normal volunteers. First, we compared wearable-derived and self-reported sleep metrics, particularly total sleep time (TST) and sleep efficiency (SE). We then identified demographic, socioeconomic and lifestyle factors associated with wearable-derived TST; they included age, gender, occupation and alcohol consumption. Multi-modal phenotypic data analysis showed that wearable-derived TST and SE were associated with cardiovascular disease risk markers such as body mass index and waist circumference, whereas self-reported measures were not. Using wearable-derived TST, we showed that insufficient sleep was associated with premature telomere attrition. Our study highlights the potential for sleep metrics from consumer wearables to provide novel insights into data generated from population cohort studies.
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Affiliation(s)
- Jing Xian Teo
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Sonia Davila
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chengxi Yang
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - An An Hii
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Chee Jian Pua
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Anders Sahlén
- Department of Cardiology, National Heart Centre, Singapore, Singapore
- Department of Medicine, Karolinska Institutet, Karolinska, Sweden
| | | | - Bin Tean Teh
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Steven G. Rozen
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Stuart Alexander Cook
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- National Heart and Lung Institute, Imperial College London, London, UK
- MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Biomedical Research Council, Agency for Science, Technology and Research, Singapore, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
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Chen QY, Luo XB, Xie DH, Li ML, Ji XY, Zhou R, Huang YB, Zhang W, Feng W, Zhang Y, Huang L, Hao QQ, Liu Q, Zhu XG, Liu Y, Zhang P, Lai XC, Si Q, Tan SY. Orbital-Selective Kondo Entanglement and Antiferromagnetic Order in USb_{2}. Phys Rev Lett 2019; 123:106402. [PMID: 31573295 DOI: 10.1103/physrevlett.123.106402] [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] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/22/2019] [Indexed: 06/10/2023]
Abstract
In heavy-fermion compounds, the dual character of f electrons underlies their rich and often exotic properties like fragile heavy quasiparticles, a variety of magnetic orders and unconventional superconductivity. 5f-electron actinide materials provide a rich setting to elucidate the larger and outstanding issue of the competition between magnetic order and Kondo entanglement and, more generally, the interplay among different channels of interactions in correlated electron systems. Here, by using angle-resolved photoemission spectroscopy, we present the detailed electronic structure of USb_{2} and observe two different kinds of nearly flat bands in the antiferromagnetic state of USb_{2}. Polarization-dependent measurements show that these electronic states are derived from 5f orbitals with different characters; in addition, further temperature-dependent measurements reveal that one of them is driven by the Kondo correlations between the 5f electrons and conduction electrons, while the other reflects the dominant role of the magnetic order. Our results on the low-energy electronic excitations of USb_{2} implicate orbital selectivity as an important new ingredient for the competition between Kondo correlations and magnetic order and, by extension, in the rich landscape of quantum phases for strongly correlated f electron systems.
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Affiliation(s)
- Q Y Chen
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - X B Luo
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - D H Xie
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - M L Li
- Institute of Applied Physics and Computational Mathematics, Beijing 100088, China
| | - X Y Ji
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - R Zhou
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Y B Huang
- Shanghai Institute of Applied Physics, CAS, Shanghai, 201204, China
| | - W Zhang
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - W Feng
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Y Zhang
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - L Huang
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Q Q Hao
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Q Liu
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - X G Zhu
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Y Liu
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - P Zhang
- Institute of Applied Physics and Computational Mathematics, Beijing 100088, China
| | - X C Lai
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Q Si
- Department of Physics and Astronomy and Rice Center for Quantum Materials, Rice University, Houston, Texas 77005, USA
| | - S Y Tan
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
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Tan SY. [Paying attention to the prevention and treatment of hepatic injury induced by anti-tuberculosis drugs]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 42:326-329. [PMID: 31137107 DOI: 10.3760/cma.j.issn.1001-0939.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Minhas A, Dewey M, Vavere AL, Tanami Y, Ostovaneh MR, Laule M, Rochitte CE, Niinuma H, Kofoed KF, Geleijns J, Hoe J, Chen MY, Kitagawa K, Nomura C, Clouse ME, Rybicki FJ, Tan SY, Paul N, Matheson M, Cox C, Rief M, Maier P, Feger S, Plotkin M, Schönenberger E. Patient Preferences for Coronary CT Angiography with Stress Perfusion, SPECT, or Invasive Coronary Angiography. Radiology 2019; 291:340-348. [PMID: 30888934 DOI: 10.1148/radiol.2019181409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Patient preference is pivotal for widespread adoption of tests in clinical practice. Patient preferences for invasive versus other noninvasive tests for coronary artery disease are not known. Purpose To compare patient acceptance and preferences for noninvasive and invasive cardiac imaging in North and South America, Asia, and Europe. Materials and Methods This was a prospective 16-center trial in 381 study participants undergoing coronary CT angiography with stress perfusion, SPECT, and invasive coronary angiography (ICA). Patient preferences were collected by using a previously validated questionnaire translated into eight languages. Responses were converted to ordinal scales and were modeled with generalized linear mixed models. Results In patients in whom at least one test was associated with pain, CT and SPECT showed reduced median pain levels, reported on 0-100 visual analog scales, from 20 for ICA (interquartile range [IQR], 4-50) to 6 for CT (IQR, 0-27.5) and 5 for SPECT (IQR, 0-25) (P < .001). Patients from Asia reported significantly more pain than patients from other continents for ICA (median, 25; IQR, 10-50; P = .01), CT (median, 10; IQR, 0-30; P = .02), and SPECT (median, 7; IQR, 0-28; P = .03). Satisfaction with preparation differed by continent and test (P = .01), with patients from Asia reporting generally lower ratings. Patients from North America had greater percentages of "very high" or "high" satisfaction than patients from other continents for ICA (96% vs 82%, respectively; P < .001) and SPECT (95% vs 79%, respectively; P = .04) but not for CT (89% vs 86%, respectively; P = .70). Among all patients, CT was preferred by 54% of patients, compared with 18% for SPECT and 28% for ICA (P < .001). Conclusion For cardiac imaging, patients generally favored CT angiography with stress perfusion, while study participants from Asia generally reported lowest satisfaction. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Woodard and Nguyen in this issue.
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Affiliation(s)
- Anum Minhas
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Marc Dewey
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Andrea L Vavere
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Yutaka Tanami
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Mohammad R Ostovaneh
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Michael Laule
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Carlos E Rochitte
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Hiroyuki Niinuma
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Klaus F Kofoed
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Jacob Geleijns
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - John Hoe
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Marcus Y Chen
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Kakuya Kitagawa
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Cesar Nomura
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Melvin E Clouse
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Frank J Rybicki
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Swee Yaw Tan
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Narinder Paul
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Matthew Matheson
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Christopher Cox
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Matthias Rief
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Pia Maier
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Sarah Feger
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Michail Plotkin
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Eva Schönenberger
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
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Wang Y, Huang W, Koh N, Huang Z, Baskaran L, Tan SY. ADDING CORONARY CALCIUM SCORE TO EXERCISE TREADMILL TEST: AN ALTERNATIVE TO BETTER RISK STRATIFY PATIENTS WITH SYMPTOMATIC CHEST PAIN AT AN OUTPATIENT SETTING. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30679-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Meng HJ, Wang J, Fang YM, Shen DM, Mao L, Kuang HB, Qin HJ, Lai XM, Tan SY. [Signaling pathway of M2-type polarization induced by Mycobacterium tuberculosis-specific peptide E7 in monocyte-macrophages]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 41:954-958. [PMID: 30522193 DOI: 10.3760/cma.j.issn.1001-0939.2018.12.011] [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] [Indexed: 11/05/2022]
Abstract
Objective: To explore the signal pathway of M2-type polarization induced by Mycobacterium tuberculosis (MTB)-specific peptide E7. Methods: Monocyte-macrophages were divided into blank control group, M1 positive stimulus group [co-stimulated with lipopolysaccharide and gamma interferon (IFN-γ)], M2 positive group(co-stimulated with IL-4 and IL-13), and E7 experimental group (with MTB-specificity polypeptide E7 stimulated). The expression of M1 type markers CD(16), IL-6, TNF-α and M2 type markers CD(163), CD(206), IL-10 were detected at 12, 18, 24 and 36 h. Furthermore, peroxisome proliferators-activated receptors-γ (PPAR-γ) blocker was used in the blank control group, M2-positive stimulus group and E7 experimental stimulus group. T test was used to compare the expression of PPAR-γ and CD(163) before and after the addition of blockers. Results: Compared with the positive control group and the blank control group, the expression of TNF-α in the E7 experimental group gradually reached the peak when macrophages were stimulated for 18 h(the relative expression was 20.02), and then the expression of TNF-α gradually decreased and the expression of CD(163) increased. The expression of CD(163) peaked at 24 h (the relative expression was 2.44). After adding the inhibitor, the expression of PPAR-γ in E7 stimulation group was lower than before blocking (before blocking 0.94±0.06, after blocking 0.69±0.09, P=0.028). CD(163) expression level was significantly lower than that before blocking (before blocking 3.95±0.61, after blocking 2.87±0.20, P=0.047). Conclusion: The MTB-specific peptide E7 induced differentiation of macrophages into M2 type, a process that may be involving PPAR-γ in just another kinase-signal transducer and activator of transcription pathway.
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Affiliation(s)
- H J Meng
- Guangzhou Medical University, Guangzhou 511436, China
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Tan SY, Turner J, Kerin-Ayres K, Butler S, Deguchi C, Khatri S, Mo C, Warby A, Cunningham I, Malalasekera A, Dhillon HM, Vardy JL. Health concerns of cancer survivors after primary anti-cancer treatment. Support Care Cancer 2019; 27:3739-3747. [PMID: 30710242 DOI: 10.1007/s00520-019-04664-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/17/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Cancer survivors experience significant health concerns compared to the general population. Sydney Survivorship Clinic (SSC) is a multi-disciplinary clinic aiming to help survivors treated with curative intent manage side effects, and establish a healthy lifestyle. Here, we determine the health concerns of survivors post-primary treatment. METHODS Survivors completed questionnaires assessing symptoms, quality of life (QOL), distress, diet, and exercise before attending SSC, and a satisfaction survey after. Body mass index (BMI), clinical findings and recommendations were reviewed. Descriptive statistical methods were used. RESULTS Overall, 410 new patients attended SSC between September 2013 and April 2018, with 385 survivors included in analysis: median age 57 years (range 18-86); 69% female; 43% breast, 31% colorectal and 19% haematological cancers. Median time from diagnosis, 12 months. Common symptoms of at least moderate severity: fatigue (45%), insomnia (37%), pain (34%), anxiety (31%) and with 56% having > 5 moderate-severe symptoms. Overall, 45% scored distress ≥ 4/10 and 62% were rated by clinical psychologist as having 'fear of cancer recurrence'. Compared to population mean of 50, mean global QOL T-score was 47.2, with physical and emotional well-being domains most affected. Average BMI was 28.2 kg/m2 (range 17.0-59.1); 61% overweight/obese. Only 31% met aerobic exercise guidelines. Overall, 98% 'agreed'/'completely agreed' attending the SSC was worthwhile, and 99% would recommend it to others. CONCLUSION Distress, fear of cancer recurrence, fatigue, obesity and sedentary lifestyle are common in cancer survivors attending SSC and may best be addressed in a multi-disciplinary Survivorship Clinic to minimise longer-term effects. This model is well-rated by survivors.
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Affiliation(s)
- S Y Tan
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - J Turner
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia.,Centre for Medical Psychology and Evidence-Based Decision-making, University of Sydney, Sydney, Australia
| | - K Kerin-Ayres
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - S Butler
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - C Deguchi
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - S Khatri
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - C Mo
- Centre for Medical Psychology and Evidence-Based Decision-making, University of Sydney, Sydney, Australia
| | - A Warby
- Centre for Medical Psychology and Evidence-Based Decision-making, University of Sydney, Sydney, Australia
| | - I Cunningham
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia
| | - A Malalasekera
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - H M Dhillon
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia. .,Centre for Medical Psychology and Evidence-Based Decision-making, University of Sydney, Sydney, Australia.
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Zhang JM, Shuang D, Baskaran L, Wu W, Teo SK, Huang W, Gobeawan L, Allen JC, Tan RS, Su X, Ismail NB, Wan M, Su B, Zou H, Low R, Zhao X, Chi Y, Zhou J, Su Y, Lomarda AM, Chin CY, Fam JM, Keng FYJ, Wong ASL, Tan JWC, Yeo KK, Wong PEH, Chin CT, Ho KW, Yap J, Kassab GS, Chua T, Koh TH, Tan SY, Lim ST, Zhong L. Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions. Int J Cardiol 2018; 267:208-214. [DOI: 10.1016/j.ijcard.2018.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/16/2018] [Accepted: 04/05/2018] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW We review recent epidemiological and clinical studies investigating the consumption of tree nuts and peanuts and cardiovascular disease (CVD) mortality as well as CVD risk factors. RECENT FINDINGS A greater consumption of tree nuts and peanuts is associated with a reduced risk of CVD mortality, as well as lower CVD events. Furthermore, risk factors associated with the development of CVD such as dyslipidemia, impaired vascular function, and hypertension are improved with regular tree nut and peanut consumption through a range of mechanism associated with their nutrient-rich profiles. There is weak inconsistent evidence for an effect of nut consumption on inflammation. There is emerging evidence that consuming tree nuts reduces the incidence of non-alcoholic fatty liver disease (NAFLD) and promotes diversity of gut microbiota, which in turn may improve CVD outcomes. Evidence for CVD prevention is strong for some varieties of tree nuts, particularly walnuts, and length of supplementation and dose are important factors for consideration with recommendations.
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Affiliation(s)
- A M Coates
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campu, North Terrace, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - A M Hill
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campu, North Terrace, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - S Y Tan
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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Heng SY, Ho JS, Cheah FK, Siang Jin TC, Jih FKY, Baskaran L, Saffari SE, Tan SY. SPECTRUM OF CORONARY ARTERY CALCIUM (CAC) ACCORDING TO AGE, GENDER, RACE IN A MULTI-ETHNIC ASIAN POPULATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32221-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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42
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Gabriel Tan HJ, Ho JS, Yan YY, Mohamed HMS, Baskaran L, Lye WK, Cheah FK, Chua T, Tan SY. INCIDENCE OF LUNG CANCER AMONG SOLITARY PULMONARY NODULES INCIDENTALLY DETECTED ON CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAM IN A MULTIETHNIC POPULATION: DO WE INCORPORATE FLEISCHNER GUIDELINES 2017 INTO LOCAL PRACTICE? J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32126-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan SY, Strazzulla LC, Li X, Park JJ, Lee SJ, Kim CC. Association of clinicopathological features of melanoma with total naevus count and a history of dysplastic naevi: a cross-sectional retrospective study within an academic centre. Clin Exp Dermatol 2018; 43:566-572. [PMID: 29450912 DOI: 10.1111/ced.13393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND High naevus count (HNC) (≥ 50 naevi) and presence of dysplastic naevi (DN) are risk factors for malignant melanoma (MM); however, MMs also occur in patients with low naevus count (LNC) (< 50 naevi) and in patients without DN. Little is known about differences between MMs in these groups. AIM To characterize the clinicopathological differences between MMs in patients with HNC and those in patients with LNC, with or without biopsy-proven DN. METHODS This was a cross-sectional retrospective chart review of 281 patients with MM seen between April 2013 and March 2014 at an academic pigmented lesion clinic (Boston, MA, USA). RESULTS Patients with LNC MMs were diagnosed at an older age (51 vs. 41 years, P < 0.001, OR = 0.95, 95% CI 0.93-0.97), with more aggressive MM features, including greater Breslow thickness (1.1 vs. 0.8 mm, P = 0.01), more mitoses (2 vs. 1 mitoses/mm2 , P < 0.001), lower rate of superficial spreading subtype (58 vs. 78%, P < 0.01, OR = 2.57, 95% CI 1.31-5.03) and higher MM stage (P < 0.001), compared to patients with HNC. Patients with DN had similar trends as those in patients with HNC described above, and in addition, were more likely to have a truncal MM (55 vs. 39%, P < 0.01, OR = 1.97, 95% CI 1.22-3.18) with less ulceration (13 vs. 29%, P < 0.01, OR = 0.36, 95% CI 0.19-0.71). Patients without DN were more likely to have a history of a non-MM skin cancer (32 vs. 19%, P = 0.01, OR = 0.49, 95% CI 0.28-0.85) and an amelanotic MM (33 vs 21%, P = 0.03, OR = 0.55, 95% CI 0.31-0.96). CONCLUSIONS Patients with LNC may develop MMs with more aggressive features at an older age than patients with HNC. A history of biopsy-proven DN reveals distinct MM differences compared to patients without DN.
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Affiliation(s)
- S Y Tan
- Harvard Medical School, Boston, MA, USA
| | - L C Strazzulla
- New York University School of Medicine, New York, NY, USA
| | - X Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard School of Public Health, Boston, MA, USA
| | - J J Park
- Department of Dermatology, Stony Brook School of Medicine, New York, NY, USA
| | - S J Lee
- Harvard Medical School, Boston, MA, USA.,Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - C C Kim
- Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Chen QY, Xu DF, Niu XH, Peng R, Xu HC, Wen CHP, Liu X, Shu L, Tan SY, Lai XC, Zhang YJ, Lee H, Strocov VN, Bisti F, Dudin P, Zhu JX, Yuan HQ, Kirchner S, Feng DL. Band Dependent Interlayer f-Electron Hybridization in CeRhIn_{5}. Phys Rev Lett 2018; 120:066403. [PMID: 29481263 DOI: 10.1103/physrevlett.120.066403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 01/02/2018] [Indexed: 06/08/2023]
Abstract
A key issue in heavy fermion research is how subtle changes in the hybridization between the 4f (5f) and conduction electrons can result in fundamentally different ground states. CeRhIn_{5} stands out as a particularly notable example: when replacing Rh with either Co or Ir, antiferromagnetism gives way to superconductivity. In this photoemission study of CeRhIn_{5}, we demonstrate that the use of resonant angle-resolved photoemission spectroscopy with polarized light allows us to extract detailed information on the 4f crystal field states and details on the 4f and conduction electron hybridization, which together determine the ground state. We directly observe weakly dispersive Kondo resonances of f electrons and identify two of the three Ce 4f_{5/2}^{1} crystal-electric-field levels and band-dependent hybridization, which signals that the hybridization occurs primarily between the Ce 4f states in the CeIn_{3} layer and two more three-dimensional bands composed of the Rh 4d and In 5p orbitals in the RhIn_{2} layer. Our results allow us to connect the properties observed at elevated temperatures with the unusual low-temperature properties of this enigmatic heavy fermion compound.
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Affiliation(s)
- Q Y Chen
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - D F Xu
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - X H Niu
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - R Peng
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - H C Xu
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - C H P Wen
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - X Liu
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - L Shu
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
| | - S Y Tan
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - X C Lai
- Science and Technology on Surface Physics and Chemistry Laboratory, Mianyang 621908, China
| | - Y J Zhang
- Center for Correlated Matter, Zhejiang University, Hangzhou 310058, China
- Department of Physics, Zhejiang University, Hangzhou 310027, China
| | - H Lee
- Center for Correlated Matter, Zhejiang University, Hangzhou 310058, China
| | - V N Strocov
- Swiss Light Source, Paul Scherrer Institute, CH-5232 Villigen, Switzerland
| | - F Bisti
- Swiss Light Source, Paul Scherrer Institute, CH-5232 Villigen, Switzerland
| | - P Dudin
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
| | - J-X Zhu
- Theoretical Division and Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - H Q Yuan
- Center for Correlated Matter, Zhejiang University, Hangzhou 310058, China
- Department of Physics, Zhejiang University, Hangzhou 310027, China
- Collaborative Innovation Center of Advanced Microstructures, Nanjing 210093, China
| | - S Kirchner
- Center for Correlated Matter, Zhejiang University, Hangzhou 310058, China
| | - D L Feng
- State Key Laboratory of Surface Physics and Department of Physics, Fudan University, Shanghai 200433, China
- Collaborative Innovation Center of Advanced Microstructures, Nanjing 210093, China
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Lim WK, Davila S, Teo JX, Yang C, Pua CJ, Blöcker C, Lim JQ, Ching J, Yap JJL, Tan SY, Sahlén A, Chin CWL, Teh BT, Rozen SG, Cook SA, Yeo KK, Tan P. Beyond fitness tracking: The use of consumer-grade wearable data from normal volunteers in cardiovascular and lipidomics research. PLoS Biol 2018; 16:e2004285. [PMID: 29485983 PMCID: PMC5828350 DOI: 10.1371/journal.pbio.2004285] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022] Open
Abstract
The use of consumer-grade wearables for purposes beyond fitness tracking has not been comprehensively explored. We generated and analyzed multidimensional data from 233 normal volunteers, integrating wearable data, lifestyle questionnaires, cardiac imaging, sphingolipid profiling, and multiple clinical-grade cardiovascular and metabolic disease markers. We show that subjects can be stratified into distinct clusters based on daily activity patterns and that these clusters are marked by distinct demographic and behavioral patterns. While resting heart rates (RHRs) performed better than step counts in being associated with cardiovascular and metabolic disease markers, step counts identified relationships between physical activity and cardiac remodeling, suggesting that wearable data may play a role in reducing overdiagnosis of cardiac hypertrophy or dilatation in active individuals. Wearable-derived activity levels can be used to identify known and novel activity-modulated sphingolipids that are in turn associated with insulin sensitivity. Our findings demonstrate the potential for wearables in biomedical research and personalized health.
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Affiliation(s)
- Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore
| | - Sonia Davila
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
| | - Jing Xian Teo
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
| | - Chengxi Yang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Chee Jian Pua
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | | | - Jing Quan Lim
- Lymphoma Genomic Translational Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
| | | | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Anders Sahlén
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Bin Tean Teh
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Steven G. Rozen
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Stuart Alexander Cook
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- National Heart and Lung Institute, Imperial College London, United Kingdom
- MRC Clinical Sciences Centre, Imperial College London, United Kingdom
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
- Biomedical Research Council, Agency for Science, Technology and Research, Singapore
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Tan FC, Yap J, Allen JC, Tan O, Tan SY, Matchar DB, Chua TS. Triaging Primary Care Patients Referred for Chest Pain to Specialist Cardiology Centres: Efficacy of an Optimised Protocol. Ann Acad Med Singap 2018; 47:56-62. [PMID: 29549371] [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: 06/08/2023]
Abstract
INTRODUCTION Patients referred for chest pain from primary care have increased, along with demand for outpatient cardiology consultations. We evaluated 'Triage Protocol' that implements standardised diagnostic testing prior to patients' first cardiology consultation. MATERIALS AND METHODS Under the 'Triage Protocol', patients referred for chest pain were pretriaged using a standardised algorithm and subsequently referred for relevant functional diagnostic cardiology tests before their initial cardiology consultation. At the initial cardiology consultation scheduled by the primary care provider, test results were reviewed. A total of 522 triage patients (mean age 55 ± 13, male 53%) were frequency-matched by age, gender and risk cohort to 289 control patients (mean age: 56 ± 11, male: 52%). Pretest risk of coronary artery disease was defined according to a Modified Duke Clinical Score (MDCS) as low (<10), intermediate (10-20) and high (>20). The primary outcome was time from referral to diagnosis (days). Secondary outcomes were total visits, discharge rate at first consultation, patient cost and adverse cardiac outcomes. RESULTS The 'Triage Protocol' resulted in shorter times from referral to diagnosis (46 vs 131 days; P <0.0001) and fewer total visits (2.4 vs 3.0; P <0.0001). However, triage patients in low-risk groups experienced higher costs due to increased testing (S$421 vs S$357, P = 0.003). Adverse cardiac event rates under the 'Triage Protocol' indicated no compromise to patient safety (triage vs control: 0.57% vs 0.35%; P = 1.000). CONCLUSION By implementing diagnostic cardiac testing prior to patients' first specialist consultation, the 'Triage Protocol' expedited diagnosis and reduced subsequent visits across all risk groups in ambulatory chest pain patients.
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Affiliation(s)
- Francine Cl Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Meng HJ, Tan SY, Lai XM. [Advances in signal pathway of macrophage polarization in tuberculosis]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:859-862. [PMID: 29320835 DOI: 10.3760/cma.j.issn.1001-0939.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Soon JL, Ho KW, Ewe SH, Blanke P, Chao TT, Tan SY, Lim ST, Sin YK. Asia's First Transapical Transcatheter Mitral Valve-in-Ring Implantation. Ann Acad Med Singap 2017; 46:327-328. [PMID: 28920135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jia Lin Soon
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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Tan SJJ, Allen JC, Tan SY. Determination of ideal target exercise heart rate for cardiac patients suitable for rehabilitation. Clin Cardiol 2017; 40:1008-1012. [PMID: 28683177 DOI: 10.1002/clc.22758] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Exercise prescription for patients with cardiovascular disease remains a challenge. The concept of exercising at an intensity equivalent to one's anaerobic threshold has been well studied and highly recommended in the fitness industry for other populations. For this concept to be applicable to patients with cardiovascular disease, the level and intensity of activity must not trigger myocardial ischemia. HYPOTHESIS We hypothesized that the heart rate at ventilatory anaerobic threshold (HRVAT ) will not exceed heart rate at ischemic threshold (HRIT ) (ie, HRVAT ≤ HRIT in a majority [>50%] of patients). METHODS In this retrospective pilot study, 19 patients, mean age at baseline of 45.0 ± 15.6 years, who had positive cardiopulmonary exercise stress testing were included. Heart rate at ventilatory anaerobic threshold (VAT) was derived from a computer-analyzed V-slope method. The ischemic threshold (IT) was determined from electrocardiogram. The exercise test parameters at VAT in relation to IT were examined. RESULTS Heart rate at VAT preceded heart rate at IT in 89.5% of patients. On average, achievement of VAT preceded IT relative to workload (119.5 ± 49.6 vs 132.6 ± 47.5; P < 0.01), heart rate (121.2 ± 15.9 vs 133.3 ± 17.5; P < 0.01), oxygen consumption (19.3 ± 4.9 vs 20.8 ± 3.7; P < 0.01), and respiratory exchange ratio (0.96 ± 0.10 vs 1.01 ± 0.07; P < 0.01). CONCLUSIONS Greater than 50% of patients met the criteria of HRVAT ≤ HRIT ; therefore, we propose that anaerobic threshold is a suitable target aerobic exercise heart rate for all patients with cardiovascular diseases indicated for cardiopulmonary rehabilitation.
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Affiliation(s)
| | - John Carson Allen
- Duke-National University of Singapore Medical School, Singapore.,Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
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50
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Tan XW, Zheng Q, Shi L, Gao F, Allen JC, Coenen A, Baumann S, Schoepf UJ, Kassab GS, Lim ST, Wong ASL, Tan JWC, Yeo KK, Chin CT, Ho KW, Tan SY, Chua TSJ, Chan ESY, Tan RS, Zhong L. Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis. Int J Cardiol 2017; 236:100-106. [DOI: 10.1016/j.ijcard.2017.02.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/19/2017] [Accepted: 02/15/2017] [Indexed: 12/13/2022]
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