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Ng P, Yeo TC. Carney Complex with Left Atrial Myxoma - A Vasculitis Mimicker. Acta Cardiol Sin 2024; 40:133-136. [PMID: 38264069 PMCID: PMC10801423 DOI: 10.6515/acs.202401_40(1).20231108a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Perryn Ng
- National University Heart Centre, Singapore, Singapore
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2
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Chew NW, Chong B, Kuo SM, Jayabaskaran J, Cai M, Zheng H, Goh R, Kong G, Chin YH, Imran SS, Liang M, Lim P, Yong TH, Liew BW, Chia PL, Ho HH, Foo D, Khoo D, Huang Z, Chua T, Tan JWC, Yeo KK, Hausenloy D, Sim HW, Kua J, Chan KH, Loh PH, Lim TW, Low AF, Chai P, Lee CH, Yeo TC, Yip J, Tan HC, Mamas MA, Nicholls SJ, Chan MY. Trends and predictions of metabolic risk factors for acute myocardial infarction: findings from a multiethnic nationwide cohort. Lancet Reg Health West Pac 2023; 37:100803. [PMID: 37693863 PMCID: PMC10485675 DOI: 10.1016/j.lanwpc.2023.100803] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 05/14/2023] [Indexed: 09/12/2023]
Abstract
Background Understanding the trajectories of metabolic risk factors for acute myocardial infarction (AMI) is necessary for healthcare policymaking. We estimated future projections of the incidence of metabolic diseases in a multi-ethnic population with AMI. Methods The incidence and mortality contributed by metabolic risk factors in the population with AMI (diabetes mellitus [T2DM], hypertension, hyperlipidemia, overweight/obesity, active/previous smokers) were projected up to year 2050, using linear and Poisson regression models based on the Singapore Myocardial Infarction Registry from 2007 to 2018. Forecast analysis was stratified based on age, sex and ethnicity. Findings From 2025 to 2050, the incidence of AMI is predicted to rise by 194.4% from 482 to 1418 per 100,000 population. The largest percentage increase in metabolic risk factors within the population with AMI is projected to be overweight/obesity (880.0% increase), followed by hypertension (248.7% increase), T2DM (215.7% increase), hyperlipidemia (205.0% increase), and active/previous smoking (164.8% increase). The number of AMI-related deaths is expected to increase by 294.7% in individuals with overweight/obesity, while mortality is predicted to decrease by 11.7% in hyperlipidemia, 29.9% in hypertension, 32.7% in T2DM and 49.6% in active/previous smokers, from 2025 to 2050. Compared with Chinese individuals, Indian and Malay individuals bear a disproportionate burden of overweight/obesity incidence and AMI-related mortality. Interpretation The incidence of AMI is projected to continue rising in the coming decades. Overweight/obesity will emerge as fastest-growing metabolic risk factor and the leading risk factor for AMI-related mortality. Funding This research was supported by the NUHS Seed Fund (NUHSRO/2022/058/RO5+6/Seed-Mar/03) and National Medical Research Council Research Training Fellowship (MOH-001131). The SMIR is a national, ministry-funded registry run by the National Registry of Diseases Office and funded by the Ministry of Health, Singapore.
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Affiliation(s)
- Nicholas W.S. Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Si Min Kuo
- Policy, Research and Surveillance Division, Health Promotion Board, Singapore
| | | | - Mingshi Cai
- Policy, Research and Surveillance Division, Health Promotion Board, Singapore
| | | | - Rachel Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | - Zijuan Huang
- Department of Cardiology, National Heart Centre, Singapore
| | - Terrance Chua
- Department of Cardiology, National Heart Centre, Singapore
| | | | | | - Derek Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Hui Wen Sim
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Jieli Kua
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Koo Hui Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Poay Huan Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Toon Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Ping Chai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Chi Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Tiong Cheng Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - James Yip
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Mamas A. Mamas
- Institute of Population Health, University of Manchester, Manchester, UK
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Stephen J. Nicholls
- Victorian Heart Institute, Melbourne, Australia
- Monash Heart, Monash Health, Melbourne, Australia
| | - Mark Y. Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
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3
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Li T, Yeo S, Sari NY, Ngiam N, Lee CH, Lim TW, Yeo WT, Seow SC, Lim YC, Yeo TC, Yip JWL, Poh KK, Kong WK, Lin W, Sia CH, Wong RCC. VALIDATION OF RISK STRATIFICATION MODELS FOR SUDDEN CARDIAC DEATH IN MULTI-ETHNIC ASIAN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00512-0] [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: 03/06/2023]
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4
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Sari NY, Li T, Yeo S, Ngiam N, Lee RCH, Lee E, Yeo TC, Yip JWL, Poh KK, Kong WK, Lim YC, Lin W, Sia CH, Wong RCC. ASSOCIATION OF LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN AND CARDIOVASCULAR OUTCOMES IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01186-5] [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: 03/06/2023]
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Lim J, Chin YH, Kong G, Ng CH, Goh R, Chong B, Chaoxing L, Kong WK, Poh KK, Foo RSY, Chai P, Yeo TC, Low A, Chan MY, Richards M, Loh PH, Chew N. HEPATIC STEATOSIS AND ADVANCED HEPATIC FIBROSIS ARE INDEPENDENT PREDICTORS OF LONG-TERM MORTALITY IN ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02136-8] [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: 03/06/2023]
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6
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Yeo TC, Goh FQ, Teo YN, Sia CH. Approach to bradyarrhythmias: A proposed algorithm. Ann Acad Med Singap 2023; 52:96-99. [PMID: 36880821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Bradyarrhythmias are commonly encountered in clinical practice. While there are several electrocardiographic criteria and algorithms for tachyarrhythmias, there is no algorithm for bradyarrhythmias to the best of our knowledge. In this article, we propose a diagnostic algorithm that uses simple concepts: (1) the presence or absence of P waves, (2) the relationship between the number of P waves and QRS complexes, and (3) the regularity of time intervals (PP, PR and RR intervals). We believe this straightforward, stepwise method provides a structured and thorough approach to the wide differential diagnosis of bradyarrhythmias, and in doing so, reduces misdiagnosis and mismanagement.
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Affiliation(s)
- Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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Teoh SE, Tan EWX, Teo YN, Basker G, Teo YH, Chai P, Wong RCC, Yip JWL, Kuntjoro I, Lim YH, Poh KK, Yeo TC, Kong WKF, Sia CH. Effects of medical therapy, transcatheter intervention, and surgery on outcomes of patients with functional mitral regurgitation: a systematic review and network meta-analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.072] [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): Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme.
Background
Functional mitral regurgitation (FMR) is the most common valvular heart disease worldwide. Despite recent major trials, the relative efficacy between medical therapy, transcatheter intervention, and surgery for the treatment of FMR remains poorly understood.
Purpose
We performed a systematic review and network meta-analysis of all published randomised controlled trials (RCTs) and observational studies to compare the efficacy between medical therapy, transcatheter intervention, and surgery on the clinical outcomes of patients with FMR.
Methods
Four electronic databases (PubMed, EMBASE, SCOPUS, and the Cochrane Library) were searched from inception to March 13, 2022, for studies reporting clinical outcomes in patients with FMR and comparing the efficacy between either medical therapy, transcatheter intervention, or surgery. Frequentist network meta-analysis models were utilised to summarise the studies. This study was registered in the International Prospective Register of Systematic Reviews.
Results
10 articles were included in the analysis, comprising a combined cohort of 1,981 patients. Network meta-analysis demonstrated that compared to medical therapy, transcatheter intervention achieved a lower relative risk in the composites of all-cause mortality (risk ratio [RR]: 0.43; 95% confidence interval [CI] 0.22-0.82) and mitral regurgitation (MR) severity grade ≥3+ (RR: 0.06; 95% CI 0.01-0.42). Compared to surgery, transcatheter intervention achieved a lower relative risk in the composites of cardiovascular death (RR: 0.36; 95% CI 0.17-0.75) and MR severity grade ≥3+ (RR: 0.25; 95% CI 0.09-0.70) and higher relative risk in the composite of heart failure hospitalisation (RR: 2.94; 95% CI 1.26-6.82). Compared to medical therapy, surgery achieved a higher relative risk in the composite of cardiovascular death (RR: 2.54; 95% CI 1.18-5.47) and lower relative risks in the composites of all-cause mortality (RR: 0.56; 95% CI 0.34-0.91) and heart failure hospitalisation (RR: 0.28; 95% CI 0.13-0.61).
Conclusion
Medical therapy, transcatheter intervention, and surgery in patients with FMR displayed differing effects on the various clinical outcomes. Further head-to-head trials are required to better understand the optimal treatment modality in this population.
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Affiliation(s)
- S E Teoh
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - E W X Tan
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - Y N Teo
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - G Basker
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - Y H Teo
- National University of Singapore, Department of Medicine , Singapore , Singapore
| | - P Chai
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - R C C Wong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - J W L Yip
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - Y H Lim
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
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Low CHX, Ong JSP, Li TYW, Ho JSY, Sharma VK, Tan BYQ, Seow SC, Yeo LLL, Yeo TC, Chai P, Chan MYY, Sia CH. Sex-based comparisons of clinical characteristics and outcomes of patients with embolic stroke of undetermined source with implantable loop recorders. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.085] [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: None.
Introduction
Embolic strokes of undetermined source (ESUS) constitute a significant proportion of all ischemic strokes, but sex-based comparisons of clinical characteristics and outcomes of ESUS patients have not been well explored. As such, we aimed to examine how sex influences outcomes of ESUS patients.
Methods
Retrospective cohort study performed on consecutive ESUS patients with an implanted ILR between December 2013 to September 2021. We obtained information on the patients’ characteristics, treatments, and outcomes from the electronic medical records. Cox regression was used to investigate whether sex was independently associated with outcomes.
Results
There were 176 patients included in this study. The mean duration of follow-up was 1254 ± 724 days. Mean age was 60.8 ± 12.0 and 47 (26.7%) of patients were female. On univariable Cox regression analysis for subsequent atrial fibrillation (AF) on implantable loop recorder (ILR), patients with subsequent AF on ILR were more likely to be female (HR 2.19, 95% CI 1.04–4.63, p = 0.040), older (HR 1.07, 95% CI 1.03–1.12, p = 0.001), have a lower glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97– 0.99, p = 0.004), and have previous percutaneous coronary intervention (PCI) (HR 2.60, 95% CI 1.05–6.46, p = 0.039). On multivariable Cox regression, after adjustment for age, eGFR and previous PCI status, female sex remained independently associated with the development of subsequent AF on ILR. Female sex was not associated with other outcomes including mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.
Conclusions
In this cohort of ESUS patients with ILR implantation, female sex was independently associated with a higher risk of development of AF on ILR. However, female sex was not a predictor of mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.
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Affiliation(s)
- C H X Low
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - J S P Ong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - T Y W Li
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - J S Y Ho
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - V K Sharma
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - B Y Q Tan
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - S C Seow
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - L L L Yeo
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - P Chai
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - M Y Y Chan
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
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Sari NY, Li TYW, Yeo S, Ngiam NJH, Lee CH, Evangelista LKM, Lee ECY, Yeo TC, Yip JWL, Poh KK, Kong WKF, Lin WQ, Lim YC, Sia CH, Wong RCC. Association of left atrial ejection fraction and cardiovascular outcomes in Asian patients with hypertrophic cardiomyopathy. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.076] [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 University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme
Background
The optimal method of risk stratification of hypertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM.
Methods
This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization.
Results
The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness >30mm, significant left ventricular outflow tract (LVOT) gradient of > 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p<0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively].
Conclusion
LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.
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Affiliation(s)
- N Y Sari
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T Y W Li
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - S Yeo
- National University of Singapore, Cardiology , Singapore , Singapore
| | - N J H Ngiam
- National University Health System, Medicine , Singapore , Singapore
| | - C H Lee
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - L K M Evangelista
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - E C Y Lee
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - J W L Yip
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W Q Lin
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - Y C Lim
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - R C C Wong
- National University Heart Centre, Cardiology , Singapore , Singapore
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Zheng Y, Li TYW, Goh FQ, Ong JSP, Low CHX, Ho JSY, Chan MY, Seow SC, Kong WKF, Poh KK, Wong RCC, Yeo TC, Yeo LLL, Tan BYQ, Sia CH. Abnormal left atrial strain is associated with eventual diagnosis of atrial fibrillation in patients with embolic stroke of undetermined source. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.002] [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: None.
Background
Patients with embolic stroke of undetermined source (ESUS) have no immediate attributable cause despite initial evaluation. Occult paroxysmal atrial fibrillation (pAF) diagnosed on prolonged electrocardiographic monitoring may be subsequently found in 20% of patients initially classified as ESUS [1]. Anatomic and functional alterations of left atrium (LA) are known to predict pAF in the general population [2]. Recent studies have suggested that LA dysfunction is linked to the risk of development of pAF in stroke patients and may precede LA enlargement [1]. LA strain analysis may be helpful to predict the development of pAF as it can detect subclinical functional impairment [2]. The aim of this study was to analyse whether LA strain can be a marker for the development of new-onset AF in patients with ESUS and sinus rhythm.
Methods
Our single-centre observational cohort study examined 157 patients hospitalised for ESUS in our tertiary hospital between October 2014 and October 2017 who underwent AF monitoring with an implantable loop recorder (ILR). These patients were followed up for occurrence of new-onset pAF and recurrence of ischaemic stroke. All patients underwent transthoracic echocardiography (TTE) during index hospitalisation as part of the workup for ESUS. Echocardiographic images were obtained and analysed post-hoc for two-dimensional (2D) speckle tracing deformation parameters. These LA strain parameters were analysed against the primary outcome of AF detection and secondary outcome of recurrent ischaemic stroke.
Results
A total of 157 ESUS patients, with a mean age of 61.0 (±11.6) years, were followed up for a median duration of 3.5 (interquartile range 3.29) years. ILR monitoring detected AF in 27 patients (17.2%). 27 patients developed recurrent ischaemic strokes. Of the 27 patients with newly diagnosed AF on ILR, 24 (88.9%) were commenced on oral anticoagulation; the remaining 3 patients were not on anticoagulation due to high bleeding risk and frailty.
Patients who had newly diagnosed AF had more impaired left atrial reservoir strain (LASr; 23.5% ± 10.3%, P = 0.042) and left atrial conduit strain (LAScd; -10.5% ± 5.3%, P = 0.003) compared with patients who remained in sinus rhythm. Multivariable logistic regression analysis adjusting for age, sex, hypertension, hyperlipidaemia, diabetes mellitus and left ventricular ejection fraction (LVEF) showed that LAScd was associated with occult AF (adjusted odds ratio [aOR] = 1.110, 95% CI, 1.019-1.209, P = 0.017) and the composite outcome of AF and recurrent ischaemic stroke (OR = 1.069, 95% CI, 1.014-1.138, P = 0.038). Abnormal LAScd was significantly associated with occult AF even when stratified by normal LA volume index (LAVI) (OR = 2.672, 95% CI, 1.035-8.548, P = 0.048) and high LAVI (OR = 1.713, 95% CI, 1.023-2.869, P = 0.041).
Conclusion
Impaired left atrial strain was associated with occult AF detection in patients with ESUS undergoing ILR monitoring.
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Affiliation(s)
- Y Zheng
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T Y W Li
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - F Q Goh
- National University Health System, Medicine , Singapore , Singapore
| | - J S P Ong
- National University of Singapore, Medicine , Singapore , Singapore
| | - C H X Low
- National University of Singapore, Medicine , Singapore , Singapore
| | - J S Y Ho
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - S C Seow
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - R C C Wong
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - L L L Yeo
- National University Health System, Medicine , Singapore , Singapore
| | - B Y Q Tan
- National University Health System, Medicine , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Cardiology , Singapore , Singapore
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Teo YN, Basker G, Teoh SE, Tan EWX, Teo YH, Chai P, Wong RCC, Yip JWL, Kuntjoro I, Lim Y, Poh KK, Yeo TC, Kong WKF, Sia CH. Natural history of functional mitral regurgitation: a systematic review and individual patient data meta-analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.071] [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): Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme.
Background
Functional mitral regurgitation (FMR) precipitates a vicious cycle of left ventricular volume overload and remodelling, leading to perpetual worsening of FMR and left ventricular dysfunction, with a resultant poor prognosis. However, there is a lack of conclusive data on the natural progression of FMR in patients who do not undergo valvular intervention.
Purpose
We performed a one-stage meta-analysis on reconstructed individual patient data (IPD) to elucidate the natural history of FMR.
Methods
Four databases (PubMed, Embase, Scopus, Cochrane) were searched for randomised controlled trials or cohorts, published from inception to March 13, 2022, reporting clinical outcomes in patients with FMR not receiving valvular intervention. IPD meta-analysis, as the gold standard approach for evidence synthesis, was performed with reconstructed IPD obtained from the survival curves reported in the included studies. Pooled survival estimates were derived. Quality assessment of included studies was conducted using the Cochrane risk-of-bias tool and Newcastle Ottawa Scale. This study was registered on the International Prospective Register of Systematic Reviews.
Results
A total of five studies were included, comprising a total cohort of 691 patients with FMR who did not undergo valvular intervention. The mean age of the cohort was 72.4 years (95% CI 67.6 to 77.1) and the proportion of males was 61.1% (95% CI 43.8 to 76.0). All-cause mortality was analysed over a follow-up duration of five years, while hospitalisation for heart failure, cardiovascular death, and the composite of all-cause mortality and hospitalisation for heart failure were analysed over a follow-up duration of three years. The probability of survival of patients with FMR without intervention was 79.4% (95% CI 76.2 to 82.3), 50.9% (95% CI 46.6 to 55.1), and 39.6% (95% CI 33.1 to 46.0) at one, three, and five years respectively. The probability of survival free from the composite of all-cause mortality and hospitalisation for heart failure was 51.3% (95% CI 46.8 to 55.6) and 12.0% (95% CI 8.9 to 15.7) at one year and three years respectively. The probability of survival free from hospitalisation for heart failure was 58.3% (95% CI 54.0 to 62.3) and 19.7% (95% CI 16.0 to 23.7) at one and three years respectively. The probability of survival free from cardiovascular death was 75.4% (95% CI 68.9 to 80.8) and 45.6% (95% CI 29.1 to 60.7) at one and three years respectively. All included studies were of low to moderate risk of bias.
Conclusion
FMR in the absence of valvular intervention is associated with poor survival and cardiovascular outcomes. Further research should focus on the role of interventions to mitigate its poor prognosis.
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Affiliation(s)
- Y N Teo
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - G Basker
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - S E Teoh
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - E W X Tan
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - Y H Teo
- National University of Singapore, Department of Medicine , Singapore , Singapore
| | - P Chai
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - R C C Wong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - J W L Yip
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - Y Lim
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
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12
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Goh FQ, Sia CH, Tan BYQ, Yeo LLL, Sharma VK, Chew NWS, Li TYW, Ngiam JN, Yeo TC, Kong WKF, Poh KK. Characteristics and outcomes of aortic stenosis patients with and without stroke. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.069] [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): Sia CH was supported by the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme
Background
Aortic stenosis (AS) is related to several atherosclerosis risk factors and is associated with an increased risk of ischaemic stroke. Some reports suggest that aortic valve calcification may predispose to embolic stroke although this is not well-studied. The literature is also sparse regarding individual stroke subtypes and predictors of stroke in AS.
Purpose
We aimed to 1) Describe rates of ischaemic stroke in AS including specific stroke subtypes; 2) Compare clinical and echocardiographic characteristics of patients with AS who subsequently developed ischaemic stroke versus those who did not, and 3) Identify independent variables associated with subsequent stroke in AS.
Methods
Patients with AS were recruited from an echocardiography database from September 2011 to December 2015 at a single tertiary centre. The primary study endpoint was acute ischaemic stroke. Clinical characteristics and echocardiographic parameters were compared between patients who suffered a stroke after AS diagnosis and those who did not. Multivariable Cox regression analysis was used to identify factors associated with subsequent stroke.
Results
A total of 703 patients with AS were studied, with a median follow-up duration of 3.0 (IQR 0.5, 5.0) years. Twenty-two patients (3.1%) developed stroke following AS diagnosis (large vessel, 18.2%; cardioembolic, 50.0%; small vessel, 18.2%; other determined ischaemic stroke, 13.6%). These patients had a greater prevalence of previous stroke or transient ischaemic attack (TIA) (50.0%) compared to patients who did not develop subsequent stroke (20.9%), p<0.001. Patients with AS who developed subsequent stroke also more commonly had atrial fibrillation at the time of indexed echocardiography (40.0%) compared to their counterparts who did not develop stroke (13.5%), p=0.004 (Table 1). Other cardiovascular risk factors and traditional echocardiographic parameters of AS severity were similar between the 2 groups. Degenerative calcified aortic valve was not associated with the development of all types of ischaemic stroke or cardioembolic stroke. AS severity was also not associated with development of stroke. Multivariable Cox regression analysis found previous stroke or TIA (HR 8.00, 95% CI 2.70–23.58, p<0.001) and atrial fibrillation at time of echocardiography (HR 8.81, 95% CI 1.34–10.80, p=0.012) to be independent predictors of subsequent stroke in AS. The key findings of our study are summarised in Figure 1.
Conclusions
Cardioembolic stroke is the most common stroke subtype in patients with AS. Previous history of stroke or TIA and atrial fibrillation at time of diagnostic echocardiography are independent predictors of subsequent stroke in AS. Calcified aortic valve was not found to be a risk factor for all types of ischaemic stroke or cardioembolic stroke.
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Affiliation(s)
- F Q Goh
- National University Hospital, Department of Medicine , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - B Y Q Tan
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - L L L Yeo
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - V K Sharma
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - N W S Chew
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - T Y W Li
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - J N Ngiam
- National University Hospital, Division of Infectious Diseases, Department of Medicine , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
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13
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Soh YHR, Teo YN, Teo YH, Djohan AH, Ho SYJ, Sukmawati I, Chan KA, Sim HW, Yeo TC, Tan HC, Chan YYM, Sia CH. Real-world comparison of intracoronary imaging and fractional flow reserve measurements on outcomes of semi-urgent and elective percutaneous coronary intervention in a multi-ethnic asian population. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.054] [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: None.
Background
Intracoronary imaging and fractional flow reserve measurements (FFR) are helpful in optimisation of percutaneous coronary intervention (PCI) for patients with stable coronary artery disease, but their comparative efficacy is not well described. Furthermore, few studies involve Asian patients in a real-world context.
Purpose
This study aims to compare the use of intracoronary imaging and fractional flow reserve measurements on the outcomes of semi-urgent and elective PCI in a multi-ethnic Asian population.
Methods
This was a retrospective database study of patients who underwent semi-urgent and elective PCI from 1st Jan 2014 to 31st Dec 2015 at a tertiary academic centre. The patients were split into 2 groups – imaging-guided (IG) consisting of intravascular ultrasound guided PCI or optical coherence tomography guided PCI and physiology-guided (PG) which included FFR-guided PCI. Patients who underwent both IG PCI and PG PCI were excluded. Incidence rates of major adverse cardiovascular events (MACE) (Subsequent myocardial infarction, congestive cardiac failure, all-cause mortality) and major adverse cardiovascular and cerebrovascular events (MACCE) (Subsequent myocardial infarction, congestive cardiac failure, stroke or transient ischemic attack and all-cause mortality) were compared between the two groups. One-to-one propensity score matching (PSM) was performed to control for potential bias.
Results
Of 1,732 patients studied, the median age was 61.0 years (IQR 53.0 to 68.0) and 336 were female (19.4%). There were 266 patients (15.4%) in IG and 186 (10.7%) in PG. The patients were followed up for 33 ±37 months. A total of 133 pairs were matched. In the unmatched cohort, there was no statistical difference between the IG and PG group in the incidence of MACE (24.2% vs 15.5%, p= 0.099) and MACCE (26.6% vs 17.7%, p= 0.112). Baseline and procedural characteristics were balanced between the IG and PG groups. In the matched cohort, the incidence rates of MACE (11.3% vs 7.5%, p= 0.383) and MACCE (15.8% vs 12.8%, p=0.596) did not differ significantly between the two groups.
Conclusion
In a real-world multi-ethnic Asian registry of semi-urgent and elective PCI patients, there was no difference in outcomes whether patients underwent the use of intracoronary imaging or fractional flow reserve measurements during PCI.
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Affiliation(s)
- Y H R Soh
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - Y N Teo
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - Y H Teo
- National University of Singapore, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - A H Djohan
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - S Y J Ho
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - I Sukmawati
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - K A Chan
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - H W Sim
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - H C Tan
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - Y Y M Chan
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Cardiology , Singapore , Singapore
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14
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Ngiam JN, Goh W, Sim MY, Chhabra S, Liong TS, Chew NWS, Chai P, Yeo TC, Cross GB, Tambyah PA, Sia CH. 300. Trends in electrocardiographic and cardiovascular manifestations of patients hospitalized with COVID-19. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported amongst hospitalised patients with COVID-19 in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. As such, we sought to examine the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised for COVID-19 infection.
Methods
We examined the first 1781 consecutive hospitalised patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the population based on those who had an abnormal electrocardiogram (ECG) and those who had a normal ECG, comparing the baseline characteristics and outcomes between the 2 groups. Cardiovascular complications such as acute myocardial infarction, stroke, pulmonary embolism, myocarditis and mortality were also examined over time.
Results
Of the 261 (14.7%) patients presenting with abnormal ECG, they were more likely to be symptomatic with complaints of breathlessness, palpitations and chest pain. Sinus tachycardia was the most common arrhythmia. Troponin I levels (41.6±264.3 vs 97.0±482.9, p=0.047) and C-reactive protein levels (20.1±50.7 vs 13.9±24.1 µmol/L, p=0.003) were significantly higher amongst those with abnormal ECGs at presentation, with a higher prevalence of myocarditis (1.9% vs 0.5%, p=0.021), pulmonary embolism (1.9% vs 0.3%, p=0.009) and acute myocardial infarction (1.1% vs 0.1%, p=0.025). Over time, there was a trend towards a higher proportion of hospitalised patients with cardiovascular complications.
Baseline characteristics of hospitalised patients with COVID-19, with or without abnormal ECG at presentation
Changes in percentage of hospitalised patients with COVID-19, experiencing cardiovascular events (acute myocardial infarction, stroke, myocarditis, pulmonary embolism and death) over time
Conclusion
A baseline ECG at presentation is a simple test that provides valuable information on potential cardiovascular complications in the context of COVID-19. Although the prevalence of abnormal ECGs is relatively low, it appears to be increasing over time amongst hospitalised patients with COVID-19.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | - Wilson Goh
- National University Health System , Singapore, Not Applicable , Singapore
| | - Meng Ying Sim
- National University Health System , Singapore, Not Applicable , Singapore
| | - Srishti Chhabra
- National University Health System , Singapore, Not Applicable , Singapore
| | - Tze Sian Liong
- National University Health System , Singapore, Not Applicable , Singapore
| | - Nicholas W S Chew
- National University Health System , Singapore, Not Applicable , Singapore
| | - Ping Chai
- National University Health System Singapore , Singapore, Not Applicable , Singapore
| | - Tiong Cheng Yeo
- National University Health System Singapore , Singapore, Not Applicable , Singapore
| | - Gail Brenda Cross
- National University Health System , Singapore, Not Applicable , Singapore
| | | | - Ching Hui Sia
- National University Health System , Singapore, Not Applicable , Singapore
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15
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Chong CZ, Cherian R, Ng P, Yeo TC, Ling LH, Soo WM, Wong RCC, Tambyah PA, Kong WKF, Tay ELW. Clinical outcomes of severe tricuspid valve infective endocarditis related to intravenous drug abuse - a case series. Acta Cardiol 2022; 77:884-889. [PMID: 34517788 DOI: 10.1080/00015385.2021.1976448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Right-sided infective endocarditis (IE) related to intravenous drug use (IVDU) can follow an acute fulminant course. However, there is limited information on its longer-term clinical outcomes. AIM AND METHODS We assessed a cohort of consecutive patients who presented with IVDU complicated by severe tricuspid valve regurgitation to determine their presentation, treatment, and long-term outcomes. In this study, severe tricuspid regurgitation (TR) was defined by the European Association of Cardiovascular Imaging criteria at initial presentation to the hospital. RESULTS Thirty-three patients with a mean age of 35 ± 18 years (72% males) presented with IVDU associated with severe TR. At the initial presentation, 15 patients were in septic shock and required inotropes. 26 patients had septic pulmonary emboli; 10 patients had associated metastatic systemic sites of infection of which 5 patients had central nervous system (CNS) involvement. Three patients were in disseminated intravascular coagulation (DIC) and 1 patient had multi-organ failure (MOF), but not requiring dialysis or mechanical ventilation. Most patients had large tricuspid valve vegetations of >20mm. Eleven patients underwent surgery with 18% perioperative mortality. The Median follow-up was 6.4 years (0.5-11.4). Recurrent IE occurred in one-third of patients, the overall incidence of heart failure and Atrial fibrillation (AF) on follow-up was low in all 3 groups. Five-year survival was 94%. CONCLUSION Acute severe TR following associated endocarditis IVDU results in a fulminant initial presentation, but a longer-term prognosis is good with surgical and medical treatment.
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Affiliation(s)
- Cheryl Zhiya Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Robin Cherian
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Perryn Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Tiong Cheng Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Lieng Hsi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Wern Miin Soo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Raymond Ching Chiew Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Paul Anantharajah Tambyah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
| | - William Kok-Fai Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Edgar Lik Wui Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
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16
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Chew NWS, Ng CH, Kong G, Tan D, Lim WH, Kofidis T, Yip J, Loh PH, Chan KH, Low A, Lee CH, Yeo TC, Tan HC, Chan MY. Reconstructed meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting for left main disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results.
Objectives
We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes.
Methods
The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups.
Results
Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p<0.001) at 5 years.
Conclusion
This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - D Tan
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - T Kofidis
- National University Heart Centre , Singapore , Singapore
| | - J Yip
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
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17
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Chew NWS, Zhang A, Koh S, Ong JL, Kong G, Lim O, Kuntjoro I, Kong W, Low A, Lee CH, Chan MY, Yeo TC, Tan HC, Poh KK, Loh PH. Higher long-term mortality in patients with concomitant acute coronary syndrome and aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and acute coronary syndrome (ACS) share similar cardiovascular risk factors, and their concomitant presentation is increasing in incidence with the aging population. Yet literature regarding the prognosis of patients with concomitant ACS and AS remains scarce.
Methods
This retrospective cohort study examined consecutive patients presenting with ACS (ST-segment elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and concomitant AS between 1 January 2011 and 31 March 2021 in a tertiary hospital. The cohort was divided into mild, moderate and severe AS based on index echocardiogram. The primary outcome was all-cause mortality. Kaplan-Meier curves were constructed to compare all-cause mortality among the three groups of patients, based on ACS type and left ventricular ejection fraction (LVEF). Multivariable Cox regression was performed to identify independent predictors of all-cause mortality.
Results
Of a total of 563 patients, 264 had mild (46.9%), 193 moderate (34.3%) and 106 severe AS (18.8%). The mean follow-up duration was 2.5 (± 2.4) years. Majority of patients (72.5%) presented with NSTEMI. Patients with moderate and severe AS had higher rates of all-cause mortality compared to those with mild AS (49.7% vs. 51.4% vs. 35.6% respectively, p=0.002). Concomitant moderate (HR 1.439, 95% CI 1.012–2.048, p=0.043) and severe AS (HR 1.844, 95% CI 1.159–2.933, p=0.010) were independent predictors of all-cause mortality after adjusting for age, gender, LVEF, ACS type, chronic kidney disease, diabetes, hypertension, coronary artery bypass grafting and aortic valve replacement as a time-dependent variable. The Kaplan-Meier curves demonstrated excess mortality in moderate and severe AS, compared to the mild AS group (p<0.001), with similar survival trends observed in the STEMI and the NSTEMI groups, as well as those with preserved LVEF.
Conclusion
Regardless of the ACS presentation type, long-term excess mortality in those with concomitant moderate or severe AS was observed. The adverse prognosis typically observed in patients with concomitant severe AS, in the setting of ACS, extends to patients with moderate AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Heart Centre , Singapore , Singapore
| | - S Koh
- National University Heart Centre , Singapore , Singapore
| | - J L Ong
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - O Lim
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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18
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Ho JSY, Soh RYH, Djohan AH, Sim HW, Loh PH, Yeo TC, Tan HC, Chan MY, Sia CH. Association of body mass index with long-term outcomes after elective and semi-urgent percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While obesity is associated with cardiovascular mortality and morbidity, patients with higher body mass index (BMI) may have better outcomes post-percutaneous coronary intervention (PCI). This “obesity paradox” is controversial and needs clarification.
Purpose
We aimed to investigate the relationship between BMI and outcomes post-PCI in an Asian cohort.
Methods
A retrospective cohort study was performed on consecutive patients who underwent semi-urgent PCI for non-ST elevation myocardial infraction or unstable angina, and elective PCI for stable angina from January 2014 to December 2015 in a tertiary centre. Patients were underweight (BMI <18.5), normal weight (BMI 18.5–22.9), overweight (BMI 23–24.9), pre-obese (BMI 25–29.9) or obese (BMI ≥30), according to the WHO Asian classification. The primary endpoint was all-cause mortality. The secondary outcomes were subsequent events of stroke or transient ischemic attack, myocardial infarction (MI) and congestive cardiac failure (CCF).
Results
1,610 patients were followed up for 3.71 (±0.97) years, 19.7% were female and mean age was 62.1 years (Table 1). BMI showed a U-shaped relationship with the incidence of death (p<0.001), MI (p=0.005), and CCF (p<0.001) (Figure 1A), which was also shown on Kaplan Meier analysis (Figures 1B-E). With reference to normal weight patients on multivariable Cox analysis, overweight (adjusted HR 0.64, 95% CI 0.42–0.97) and pre-obese (adjusted HR 0.55, 95% CI 0.38–0.80) patients had lower mortality. Underweight patients had higher risk (adjusted HR 2.12, 95% CI 1.01–4.46), while pre-obese patients had lower risk of MI (adjusted HR 0.56, 95% CI 0.34–0.92) compared to normal weight patients. Underweight and obese patients had higher risk of CCF (underweight: adjusted HR 3.05, 95% CI 1.45–6.42; obese: adjusted HR 1.86, 95% CI 1.03–3.35) compared to normal weight patients.
Conclusion
Patients at the lower and upper extremes of BMI demonstrated higher risk of mortality, MI and CCF post-PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J S Y Ho
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - R Y H Soh
- National University Heart Centre , Singapore , Singapore
| | - A H Djohan
- National University Heart Centre , Singapore , Singapore
| | - H W Sim
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - C H Sia
- National University Heart Centre , Singapore , Singapore
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19
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Goh FQ, Sim JJL, Ling RR, Neo VSQ, Ng EST, Leow AST, Tan BYQ, Kong WKF, Sharma VK, Poh KK, Wong RC, Yeo LLL, Chai P, Yeo TC, Sia CH. Clinical characteristics, echocardiographic features and long-term outcomes of patients with ischaemic versus non-ischaemic left ventricular thrombus. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular thrombus (LVT) may develop in patients following myocardial infarction (MI), as well as in ischaemic and non-ischaemic cardiomyopathies, and may result in acute ischaemic stroke. Smaller studies comparing LVT associated with ischaemic and non-ischaemic aetiologies only reported 1-year outcomes or focused on specific subpopulations. We aimed to compare the clinical and echocardiographic characteristics and longer-term outcomes in a large population of patients with ischaemic versus non-ischaemic LVT.
Methods
This was a retrospective study of 552 consecutive patients with echocardiographically-identified LVT from March 2011 to January 2021 at a tertiary centre. Ischaemic LVT included LVT associated with MI and ischaemic cardiomyopathy. Non-ischaemic LVT included cases without evidence of ischaemia. Echocardiographic images were interpreted by trained cardiologists. We studied thrombus resolution as well as 5-year rates of ischaemic stroke and all-cause mortality.
Results
Of the 552 patients, mean age was 59.9 years and 84.4% were male. 492 patients had ischaemic LVT and 60 patients had non-ischaemic LVT. Ischaemic LVT was associated with older age (60.4 versus 55.3 years), male sex (86.8% versus 65.0%), smoking (49.2% versus 25.0%) and hyperlipidaemia (54.3% versus 28.3%). Left ventricular ejection fraction (LVEF) was lower in non-ischaemic LVT (28.9% versus 31.9%). LVEF ≤35% was associated with increased mortality in ischaemic LVT (HR 2.11, 95% CI 1.32–3.38). Rates of thrombus resolution, stroke and all-cause mortality were similar in the 2 groups. Anticoagulation was associated with a lower risk of stroke in ischaemic LVT (HR 0.32, 95% CI 0.16–0.66) and lower mortality in both ischaemic (HR 0.44, 95% CI 0.26–0.72) and non-ischaemic LVT (HR 0.14, 95% CI 0.03–0.61).
Conclusion
Patients with ischaemic LVT were more often older, male, smokers and had cardiovascular co-morbidities compared to those with non-ischaemic LVT. Thrombus resolution, stroke and all-cause mortality rates were similar in both groups. Anticoagulation was associated with lower mortality but this needs to be investigated in future prospective studies.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CHS was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Faculty Scheme
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Affiliation(s)
- F Q Goh
- National University Hospital , Singapore , Singapore
| | - J J L Sim
- National University of Singapore, Department of Medicine, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - R R Ling
- National University of Singapore, Department of Medicine, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - V S Q Neo
- National University of Singapore, Department of Medicine, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - E S T Ng
- National University of Singapore, Department of Medicine, Yong Loo Lin School of Medicine , Singapore , Singapore
| | - A S T Leow
- National University Hospital , Singapore , Singapore
| | - B Y Q Tan
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre , Singapore , Singapore
| | - V K Sharma
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R C Wong
- National University Heart Centre , Singapore , Singapore
| | - L L L Yeo
- National University Hospital, Division of Neurology, Department of Medicine , Singapore , Singapore
| | - P Chai
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - C H Sia
- National University Heart Centre , Singapore , Singapore
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20
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Chew N, Zhang A, Kong G, Lee KL, Ng CH, Chong B, Ngiam N, Loh PH, Kuntjoro I, Wong R, Kong W, Yeo TC, Poh KK. Prognostically distinct phenotypes of metabolic health beyond obesity in aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Whilst current evidence are in favour of metabolic health and non-obesity in the reduction of incident cardiovascular disease, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease occurs. This study examined the prognosis of patients with significant aortic stenosis (AS) based on the presence of metabolic health and obesity.
Methods
This retrospective cohort on consecutive patients presenting with moderate-to-severe AS to a tertiary hospital between 2010 and 2015. Patients were allocated into 4 groups based on obesity and metabolic health: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to Program Adult Treatment Panel III criteria. The primary outcome was all-cause mortality. Cox regression examined independent associations between mortality and metabolic phenotypes, adjusting for aortic valve area, ejection fraction, age, sex, chronic kidney disease and AVR as a time-dependent covariate.
Results
Of 727 patients, the majority (51.6%) were MUNO, followed by MUO (32.7%), MHNO (11.4%), and MHO (4.3%). MHNO had the highest mortality (43.0%), followed by the MUNO (37.5%), MUO (30.0%) and MHO (6.9%) groups (p=0.001). Compared to MHNO, MHO (HR 0.159, 95% CI 0.038–0.668, p=0.012) and MUO (HR 0.614, 95% CI 0.403–0.937, p=0.024) were independently associated with lower all-cause mortality rates, after adjusting for confounders. In obese patients, metabolic health had favourable survival compared to metabolically unhealthy (p=0.015), but this protective impact of metabolic health was not observed in overweight or normal weight individuals. Obesity had favourable survival compared to overweight and normal weight, in both metabolically health (p=0.002) and unhealthy (p=0.007) patients,
Conclusion
MHO patients with AS have the most favourable prognosis whilst the seemingly healthy MHNO group had the worst survival. There should be a paradigm shift towards prioritising metabolic health rather than weight reduction in patients with significant AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Health System , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - K L Lee
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - B Chong
- National University of Singapore , Singapore , Singapore
| | - N Ngiam
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - R Wong
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
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21
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Hecht S, Butcher SC, Pio SM, Kong WKF, Singh GK, Ng ACT, Perry R, Poh KK, Almeida AG, González A, Shen M, Yeo TC, Shanks M, Popescu BA, Gay LG, Fijałkowski M, Liang M, Tay E, Marsan NA, Selvanayagam J, Pinto F, Zamorano JL, Evangelista A, Delgado V, Bax JJ, Pibarot P. Impact of Left Ventricular Ejection Fraction on Clinical Outcomes in Bicuspid Aortic Valve Disease. J Am Coll Cardiol 2022; 80:1071-1084. [PMID: 36075677 DOI: 10.1016/j.jacc.2022.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The prognostic impact of left ventricular ejection fraction (LVEF) in patients with bicuspid aortic valve (BAV) disease has not been previously studied. OBJECTIVES The purpose of this study was to determine the prognostic impact of LVEF in BAV patients according to the type of aortic valve dysfunction. METHODS We retrospectively analyzed the data collected in 2,672 patients included in an international registry of patients with BAV. Patients were classified according to the type of aortic valve dysfunction: isolated aortic stenosis (AS) (n = 749), isolated aortic regurgitation (AR) (n = 554), mixed aortic valve disease (MAVD) (n = 190), or no significant aortic valve dysfunction (n = 1,179; excluded from this analysis). The study population was divided according to LVEF strata to investigate its impact on clinical outcomes. RESULTS The risk of all-cause mortality and the composite endpoint of aortic valve replacement or repair (AVR) and all-cause mortality increased when LVEF was <60% in the whole cohort as well as in the AS and AR groups, and when LVEF was <55% in MAVD group. In multivariable analysis, LVEF strata were significantly associated with increased rate of mortality (LVEF 50%-59%: HR: 1.83 [95% CI: 1.09-3.07]; P = 0.022; LVEF 30%-49%: HR: 1.97 [95% CI: 1.13-3.41]; P = 0.016; LVEF <30%: HR: 4.20 [95% CI: 2.01-8.75]; P < 0.001; vs LVEF 60%-70%, reference group). CONCLUSIONS In BAV patients, the risk of adverse clinical outcomes increases significantly when the LVEF is <60%. These findings suggest that LVEF cutoff values proposed in the guidelines to indicate intervention should be raised from 50% to 60% in AS or AR and 55% in MAVD.
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Affiliation(s)
- Sébastien Hecht
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Ariana González
- Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Mylène Shen
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr C. C. Iliescu," Bucharest, Romania
| | - Laura Galian Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michael Liang
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joseph Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Fausto Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Jose L Zamorano
- Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
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22
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Ng P, Cherian R, Chan SP, Soo WM, Kong W, Poh KK, Wong R, Yeo TC, Ling LH, Tay E. Severe Functional Tricuspid Valve Regurgitation: Predictors of Mortality After Initial Diagnosis. Heart Lung Circ 2022; 31:1234-1240. [PMID: 35667972 DOI: 10.1016/j.hlc.2022.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Severe functional tricuspid regurgitation (fTR) is associated with adverse clinical outcomes and remains under-treated. There is recent interest in this disease due to emerging tricuspid valve therapies. However, the timing and selection of patients who may benefit from treatment is uncertain. Risk factors associated with mortality after diagnosis of severe fTR may help guide treatment. AIM We studied patients with severe fTR to assess predictors of mortality. METHODS We retrospectively identified consecutive patients who had severe fTR diagnosed on transthoracic echocardiography in a single academic tertiary hospital. These were categorised into atrial fibrillation (AF)- and non-AF-related groups. Patient characteristics and echocardiographic parameters were collected. We then analysed the collected parameters on their impact on occurrence of mortality and also on the time to mortality. RESULTS A total of 635 patients with severe fTR were studied (41.6 % male, mean age of 68.6±15.4 years). There were 130 (20.5%) in the AF-related group and 505 (79.5%) in the non-AF related-group. Median follow-up duration was 774 days, during which 154 (24.3%) deaths occurred within the first year. Older age on diagnosis, reduced left ventricular ejection fraction (LVEF) (<50%), high pulmonary systolic pressure (PASP) (>50 mmHg) and a prior history of heart failure admissions were associated with occurrence of mortality. Older age on diagnosis, reduced LVEF, and high PASP were also found to be associated with time to mortality. CONCLUSIONS For patients diagnosed with severe fTR, advanced age on diagnosis, prior heart failure admission, LVEF <50%, and PASP >50 mmHg are associated with mortality. These factors could form the basis of future studies that determine the timing and decision to intervene in patients with severe fTR.
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Affiliation(s)
- Perryn Ng
- National University Heart Centre, Singapore.
| | | | | | | | | | | | | | | | | | - Edgar Tay
- National University Heart Centre, Singapore
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23
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Ng PLF, Lim YC, Evangelista LKM, Wong RCC, Chai P, Sia CH, Loi HY, Yeo TC, Lin W. Utility and pitfalls of the electrocardiogram in the evaluation of cardiac amyloidosis. Ann Noninvasive Electrocardiol 2022; 27:e12967. [PMID: 35567784 PMCID: PMC9296797 DOI: 10.1111/anec.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cardiac amyloidosis is a protein misfolding disorder involving deposition of amyloid fibril proteins in the heart. The associated fibrosis of the conduction tissue results in conduction abnormalities and arrhythmias. "Classical" electrocardiogram (ECG) findings in cardiac amyloidosis include that of low voltage complexes with increased left ventricular wall thickness on echocardiography. However, this "classical" finding is neither sensitive nor specific. As cardiac amyloidosis is associated with a generally poor prognosis, the need for early recognition of this disease is important given the availability of new treatment options. In this review, we highlight 3 cases of patients with cardiac amyloidosis. Although presenting with typical clinical signs and symptoms, ECG for all 3 patients was not consistent with the classical findings described. They underwent further diagnostic tests which clinched the diagnosis of cardiac amyloidosis, allowing patients to receive targeted treatment. Through the review of the literature, we will highlight the different ECG patterns in patients with different types of cardiac amyloidosis and clinical scenarios, as well as the pitfalls of using ECG to identify the condition. Lastly, we also emphasize the current paradigms in diagnosing cardiac amyloidosis through the non-invasive methods of echocardiography, cardiac magnetic resonance imaging, and nuclear technetium-pyrophosphate imaging. CONCLUSIONS Electrocardiogram is often the first investigation used in evaluating many cardiac disorders, including cardiac amyloidosis. However, classical features of cardiac amyloidosis on ECG are often not present. A keen understanding on the ECG features of cardiac amyloidosis and knowledge of the diagnostic workflow is important to diagnose this condition.
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Affiliation(s)
- Perryn Lin Fei Ng
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yoke Ching Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Raymond Ching Chiew Wong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 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
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hoi Yin Loi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Weiqin Lin
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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24
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Ng LFP, Tay E, Chan SP, Soo WM, Kong WKF, Poh KK, Wong RCC, Yeo TC, Ling LH, Cherian R. PREDICTORS OF MORTALITY FOR SEVERE ATRIAL FIBRILLATION-RELATED FUNCTIONAL TRICUSPID REGURGITATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02682-1] [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: 11/27/2022]
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25
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Djohan AH, Evangelista LKM, Sia CH, Lin W, Chan KH, Ching LY, Chan MY, Cherian R, Wong RCC, Lee RCH, Tung BWL, Ng ZY, Tan HC, Yeo TC, Chai P, Low A, Loh PH. ASSOCIATION BETWEEN CLINICAL CHARACTERISTICS AND THE DEVELOPMENT OF CARDIOGENIC SHOCK IN ASIAN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02155-6] [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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26
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Ho YJ, WS WS N, Mai A, Ng CH, Kong G, Lim Y, Kuntjuro I, Kong WKF, Chan KH, Yee Y, Chan M, Low A, Lee CH, Yeo TC, Yip JWL, Tan HC, Poh KK, Loh PH. PROGNOSTIC OUTCOMES OF PATIENTS WITH CONCOMITANT ACUTE CORONARY SYNDROME AND AORTIC STENOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02703-6] [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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27
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Teo YN, Teo YH, Syn NL, Yoong CSY, Cheong AJY, Wee CF, Lim YC, Lee CH, Yeo TC, Chai P, Wong RCC, Lim W, Sia CH. COMPARING SGLT2 INHIBITORS AGAINST SACUBITRIL/VALSARTAN IN HEART FAILURE: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04458-8] [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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28
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Butcher SC, Pio SM, Kong WKF, Singh GK, Ng ACT, Perry R, Sia CH, Poh KK, Almeida AG, González A, Shen M, Yeo TC, Shanks M, Popescu BA, Galian Gay L, Fijałkowski M, Liang M, Tay E, Ajmone Marsan N, Selvanayagam J, Pinto F, Zamorano JL, Pibarot P, Evangelista A, Bax JJ, Delgado V. Left ventricular remodelling in bicuspid aortic valve disease. Eur Heart J Cardiovasc Imaging 2021; 23:1669-1679. [PMID: 34966913 DOI: 10.1093/ehjci/jeab284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (≥moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. METHODS AND RESULTS In this international, multicentre BAV registry, 1345 patients [51.0 (37.0-63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m2 in males and >95 g/m2 in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) ≤0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT ≤0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m2, 95% confidence interval (CI) 1.00-1.17, P = 0.046] and AR (HR 1.19 per 25 g/m2, 95% CI 1.11-1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06-2.23, P = 0.024; HR 1.68, 95% CI 1.17-2.42, P = 0.005; HR 1.59, 95% CI 1.03-2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35-4.60, P = 0.004 and HR 3.05, 95% CI 1.71-5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. CONCLUSIONS LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, 197 Wellington St, Perth WA 6000, Australia
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Dr, Bedford Park SA 5042, Adelaide, Australia
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Ariana González
- Department of Cardiology, Hospital Universitario Ramón y Cajal, M-607, 9, 100, 28034 Madrid, Spain
| | - Mylène Shen
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Laura Galian Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Michael Liang
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore.,Department of Cardiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Edgar Tay
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Joseph Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Dr, Bedford Park SA 5042, Adelaide, Australia
| | - Fausto Pinto
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Jose L Zamorano
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Philippe Pibarot
- Department of Cardiology, Hospital Universitario Ramón y Cajal, M-607, 9, 100, 28034 Madrid, Spain
| | - Arturo Evangelista
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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See RM, Teo YN, Teo YH, Syn NL, Yip ASY, Leong S, Wee CF, Cheong AJY, Lee CH, Chan MYY, Yeo TC, Wong RCC, Chang P, Hong CC, Chai P, Sia CH. Effects of Sodium-Glucose Cotransporter 2 on Amputation Events: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. Pharmacology 2021; 107:123-130. [PMID: 34942623 DOI: 10.1159/000520903] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly utilized in the treatment of diabetes mellitus as well as therapeutic extra-glycemic effects. However, there are still concerns over complications such as amputation events, given the results from the Canagliflozin Cardiovascular Assessment Study (CANVAS) trial. Hence, we conducted a systematic review and meta-analysis of randomized-controlled trials to investigate the effect of SGLT2 inhibitors on amputation events. METHODS Four electronic databases (PubMed, Embase, Cochrane, and SCOPUS) were searched on November 21, 2020, for articles published from January 1, 2000, up to November 21, 2020, for studies that examined the effect of SGLT2 inhibitors on amputation events. Random-effect pair-wise meta-analysis for hazard ratios and fixed-effect Peto odds ratio meta-analysis were utilized to summarize the studies. RESULTS A total of 15 randomized-controlled trials were included with a combined cohort of 63,716 patients. We demonstrated that there was no significant difference in amputation events across different types of SGLT2 inhibitors, different baseline populations, and different duration of SGLT2 inhibitor use. DISCUSSION/CONCLUSIONS In this meta-analysis, SGLT2 inhibitors were not associated with a significant difference in amputation events.
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Affiliation(s)
- Ray Meng See
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alicia Swee Yan Yip
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shariel Leong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Caitlin Fern Wee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex Jia Yang Cheong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Tiong Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Raymond C C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Peter Chang
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Choon Chiet Hong
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
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Li TYW, Ngiam JN, Chew NWS, Tham SM, Lim ZY, Cen S, Lim SL, Cherian R, Wong RCC, Chai P, Yeo TC, Tambyah PA, Santosa A, Cross GB, Sia CH. Low incidence of cardiac complications from COVID-19 and its treatment among hospitalised patients in Singapore. Ann Acad Med Singap 2021; 50:490-493. [PMID: 34195758 DOI: 10.47102/annals-acadmedsg.202122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Tony Yi Wei Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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31
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Chew N, Ngiam N, Cheong C, Kong G, Sia CH, Kuntjoro I, Wen R, Kong W, Tay E, Yeo TC, Poh KK. THE ETHNIC GAP IN CLINICAL OUTCOMES OF SIGNIFICANT AORTIC STENOSIS IN THE ASIAN POPULATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03070-9] [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: 11/16/2022]
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32
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Sim HW, Zheng H, Richards AM, Chen RW, Sahlen A, Yeo KK, Tan JW, Chua T, Tan HC, Yeo TC, Ho HH, Liew BW, Foo LL, Lee CH, Hausenloy DJ, Chan MY. Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization. Sci Rep 2020; 10:15184. [PMID: 32938986 PMCID: PMC7495427 DOI: 10.1038/s41598-020-72232-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. A total of 15,073 patients with AMI who underwent inhospital coronary revascularization from January 2007 to December 2013 were analyzed. At 12 months, BB was significantly associated with a lower incidence of major adverse cardiovascular events (MACE, adjusted HR 0.80, 95% CI 0.70–0.93) and all-cause mortality (adjusted HR 0.69, 95% CI 0.55–0.88), while ACEI/ARB was significantly associated with lower all-cause mortality (adjusted HR 0.80, 95% CI 0.66–0.98) and heart failure (HF) hospitalization (adjusted HR 0.80, 95% CI 0.68–0.95). Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57–0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40–0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48–0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. In conclusion, in AMI managed with revascularization, both BB and ACEI/ARB were associated with a lower incidence of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the lowest incidence of all-cause mortality and HF hospitalization.
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Affiliation(s)
- Hui Wen Sim
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Department of Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Huili Zheng
- Health Promotion Board, National Registry of Disease Office, 3 Second Hospital Ave, Singapore, 168937, Singapore
| | - A Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,Cardiovascular Research Institute, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ruth W Chen
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Anders Sahlen
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore.,Karolinska Institutet, Stockholm, Sweden
| | - Khung-Keong Yeo
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Jack W Tan
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Hee Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Boon-Wah Liew
- Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Ling Li Foo
- Health Promotion Board, National Registry of Disease Office, 3 Second Hospital Ave, Singapore, 168937, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,Cardiovascular Research Institute, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Derek J Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore.,Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.,The Hatter Cardiovascular Institute, University College London, London, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore. .,Cardiovascular Research Institute, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Kuntjoro I, Tay E, Hon J, Yip J, Kong W, Poh KK, Yeo TC, Tan HC, Caleb MG, Luo N, Wang P. Cost-Effectiveness of Transcatheter Aortic Valve Implantation in Intermediate and Low Risk Severe Aortic Stenosis Patients in Singapore. Ann Acad Med Singap 2020; 49:423-433. [PMID: 33000105] [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: 06/11/2023]
Abstract
INTRODUCTION Singapore has the world's second most efficient healthcare system while costing less than 5% GDP. It remains unclear whether transcatheter aortic valve implantation (TAVI) is cost-effective for treating intermediate-low risk severe aortic stenosis (AS) patients in a highly efficient healthcare system. MATERIALS AND METHODS A two-phase economic model combining decision tree and Markov model was developed to assess the costs, effectiveness, and the incremental cost-effectiveness ratio (ICER) of transfemoral (TF) TAVI versus surgical aortic valve replacement (SAVR) in intermediate-low risk patients over an 8-year time horizon. Mortality and complications rates were based on PARTNER 2 trial cohort A and Singapore life table. Costs were mainly retrieved from Singapore National University Health System database. Health utility data were obtained from Singapore population based on the EuroQol-5D (EQ-5D). A variety of sensitivity analyses were conducted. RESULTS In base case scenario, the incremental effectiveness of TF-TAVI versus SAVR was 0.19 QALYs. The ICER of TF-TAVI was S$33,833/QALY. When time horizon was reduced to 5 years, the ICER was S$60,825/QALY; when event rates from the propensity analysis was used, the ICER was S$21,732/QALY and S$44,598/QALY over 8-year and 5-year time horizons, respectively. At a willingness to pay threshold of S$73,167/QALY, TF-TAVI had a 98.19% probability of being cost-effective after 100,000 simulations. The model was the most sensitive to the costs of TF-TAVI procedure. CONCLUSION TF-TAVI is a highly cost-effective option compared to SAVR for intermediate-low risk severe AS patients from a Singapore healthcare system perspective. Increased procedure experience, reduction in device cost, and technology advance may have further increased the cost-effectiveness of TF-TAVI per scenario analysis.
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Affiliation(s)
- Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre, Singapore
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Poh KK, Lee PSS, Djohan AH, Galupo MJ, Songco GG, Yeo TC, Tan HC, Richards AM, Ye L. Transplantation of Endothelial Progenitor Cells in Obese Diabetic Rats Following Myocardial Infarction: Role of Thymosin Beta-4. Cells 2020; 9:cells9040949. [PMID: 32290541 PMCID: PMC7226991 DOI: 10.3390/cells9040949] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022] Open
Abstract
Endothelial progenitor cells (EPCs) are bone-marrow derived cells that are critical in the maintenance of endothelial wall integrity and protection of ischemic myocardium through the formation of new blood vessels (vasculogenesis) or proliferation of pre-existing vasculature (angiogenesis). Diabetes mellitus (DM) and the metabolic syndrome are commonly associated with ischemic heart disease through its pathological effects on the endothelium and consequent endothelial dysfunction. Thymosin-β4 (Tβ4) which expressed in the embryonic heart is critical in epicardial and coronary artery formation. In this study, we explored the effects of Tβ4 treatment on diabetic EPCs in vitro and intramyocardial injection of Tβ4-treated and non-Tβ4 treated EPCs following acute myocardial infarction (MI) of diabetic rats in vivo. It was found that 10 ng/mL Tβ4 increased migration, tubule formation, and angiogenic factor secretion of diabetic EPCs in vitro. In vivo, although implantation of Tβ4 treated diabetic EPCs significantly increased capillary density and attracted more c-Kit positive progenitor cells into the infarcted hearts as compared with implantation of non-Tβ4 treated diabetic EPCs, the significantly improved left ventricular ejection fraction was only found in the rats which received non-Tβ4 treated EPCs. The data suggests that a low dose Tβ4 increases diabetic EPC migration, tubule formation, and angiogenic factor secretion. However, it did not improve the effects of EPCs on left ventricular pump function in diabetic rats with MI.
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Affiliation(s)
- Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Poay Sian Sabrina Lee
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Andie Hartanto Djohan
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
| | - Mary Joyce Galupo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
| | - Geronica Gorospe Songco
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Arthur Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (K.K.P.); (P.S.S.L.); (A.H.D.); (M.J.G.); (G.G.S.); (T.C.Y.); (H.C.T.); (A.M.R.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore 169609, Singapore
- Correspondence:
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Leow AST, Sia CH, Tan BYQ, Kaur R, Sim HW, Yeo TC, Chan MYY, Richards MA, Tay ELW, Loh JPY. P263 Characterisation of patients with acute myocardial infarction complicated by left ventricular thrombus. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.087] [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
None
Background/Introduction
Left ventricular (LV) thrombus is a widely recognized complication of acute myocardial infarction (AMI). Limited data are available from South East Asian patients with this post-infarction complication nor on whether patients with non-ST segment elevation myocardial infarction (NSTEMI) or STEMI with associated LV thrombosis exhibit differing clinical characteristics and/or outcomes. Left Ventricular Ejection Fraction (LVEF) ≤ 40% is a recognized predictor of LV thrombus formation, but there is limited data on LV thrombus patients with EF > 40% or in NSTEMI patients.
Purpose
This study aims to investigate and compare the clinical characteristics, treatment and outcomes of post-AMI patients with LV thrombus formation, with a particular emphasis on those with EF ≤ 40% and in NSTEMI patients.
Methods
Among 5829 consecutive echocardiogram results containing the keyword "thrombus" from August 2006 to September 2017, we identified 289 post-AMI patients with acute LV thrombus formation. Demographics, treatment and outcome measures were analysed.
Results
Cardiovascular risk factors such as dyslipidaemia (54.0%) and hypertension (50.5%) were commonly present in post-AMI patients with LV thrombus. Mean LVEF was 33.0 ± 10.4%. The majority (68.0%) of patients received triple therapy and 59.5% achieved thrombus resolution. NSTEMI patients had greater number of co-morbidities including heart failure (p < 0.01), documented history of ischaemic heart disease preceding the AMI leading to thrombus formation (p < 0.01) and lower LVEF (28.3 ± 9.3% vs. 34.8 ± 10.3% , p < 0.01) compared with STEMI cases. On multivariate analysis, having a lower EF was a significant independent predictor of stroke (HR 0.96, 95% CI 0.93-1.00, p = 0.03) and all-cause mortality (HR 0.95, 95% CI 0.92-0.99, p < 0.01). The categories of STEMI and NSTEMI did not predict thrombus resolution, stroke events or all-cause mortality after adjustment.
Conclusion(s)
Post-AMI LV thrombus patients with NSTEMI and STEMI differed in terms of their co-morbidities in their demographics and co-morbidities but it was a lower EF that was associated with an increased risk of stroke and all-cause mortality. Further studies on this topic are required.
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Affiliation(s)
- A S T Leow
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C H Sia
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - B Y Q Tan
- National University Hospital, Department of Medicine, Singapore, Singapore
| | - R Kaur
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - H W Sim
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - T C Yeo
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - M Y Y Chan
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - M A Richards
- National University Health System, Cardiovascular Research Institute, Singapore, Singapore
| | - E L W Tay
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - J P Y Loh
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
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Kong WKF, Vollema EM, Prevedello F, Perry R, Ng ACT, Poh KK, Almeida AG, González A, Shen M, Yeo TC, Shanks M, Popescu BA, Galian Gay L, Fijałkowski M, Liang M, Chen RW, Ajmone Marsan N, Selvanayagam J, Pinto F, Zamorano JL, Pibarot P, Evangelista A, Delgado V, Bax JJ. Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2019; 21:759-767. [DOI: 10.1093/ehjci/jez252] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Received: 09/14/2019] [Accepted: 10/08/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
Aims
In patients with bicuspid aortic valve (BAV) and preserved left ventricular (LV) ejection fraction (EF), the frequency of impaired LV global longitudinal strain (GLS) and its prognostic implications are unknown. The present study evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF.
Methods and results
Five hundred and thirteen patients (68% men; mean age 44 ± 18 years) with BAV and preserved LVEF (>50%) were divided into five groups according to the type of BAV dysfunction: (i) normal function BAV, (ii) mild aortic stenosis (AS) or aortic regurgitation (AR), (iii) ≥moderate isolated AS, (iv) ≥moderate isolated AR, and (v) ≥moderate mixed AS and AR. LV systolic dysfunction based on 2D speckle-tracking echocardiography was defined as a cut-off value of LVGLS (−13.6%). The primary outcome was aortic valve intervention or all-cause mortality. The proportion of patients with LVGLS ≤−13.6% was the highest in the normal BAV group (97%) and the lowest in the group with moderate and severe mixed AS and AR (79%). During a median follow-up of 10 years, 210 (41%) patients underwent aortic valve replacement and 17 (3%) died. Patients with preserved LV systolic function (LVGLS ≤ −13.6%) had significantly better event-free survival compared to those with impaired LV systolic function (LVGLS > −13.6%). LVGLS was independently associated with increased risk of events (mainly aortic valve replacement): hazard ratio 1.09; P < 0.001.
Conclusion
Impaired LVGLS in BAV with preserved LVEF is not infrequent and was independently associated with increased risk of events (mainly aortic valve replacement events).
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Affiliation(s)
- William K F Kong
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Francesca Prevedello
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Australia
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Portugal
| | - Ariana González
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mylène Shen
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy “Carol Davila”—Euroecolab, Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
| | - Laura Galian Gay
- Department of Cardiology, Hospital Universitari Vall d’Hebrón, Barcelona, Spain
| | | | - Michael Liang
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Ruth W Chen
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Joseph Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia
| | - Fausto Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Portugal
| | - Jose L Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d’Hebrón, Barcelona, Spain
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Chew N, Ngiam N, Tan BYQ, Sim HW, Kong WKF, Tay ELW, Yeo TC, Poh KK. P910An Asian perspective on left ventricular outflow tract cut-offs and the resulting discrepancy in severity grading of aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0506] [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
Objectives
Inconsistencies in grading of aortic stenosis (AS) severity have been reported based on measurement of left ventricular outflow tract diameter (LVOTd), but this remains to be studied in an Asian population. We investigated consistency of grading AS severity at various LVOTd, and subsequently postulated alternative cut-offs for more consistent grading of AS severity.
Methods
350 consecutive patients with index echocardiographic diagnosis of severe AS were divided them into three groups based on LVOTd: “small” (<20mm), “average” (20–22mm), “large” (>22mm). In each group, the consistency of flow-dependent (transaortic mean pressure gradient (MG)) and flow-independent parameters (AVA) were used for classification of AS severity.
Results
Of 350 patients, 51.7% had small LVOTd, while 30.8% and 17.5% had average and large LVOTd respectively. Consistent grading by LVOTd based on AVA and MG, was seen in 33.7% of patients with small, 47.6% with average, 57.7% with large LVOTd. When the hypothetical AVA cut-off of 0.9cm2 was used, consistent grading improved to 38.0% in small, 56.5% in average and 70% in large LVOTd. At an AVA cut-off of 0.8cm2, there was further incremental improvement in the small LVOTd group to 54.1% (p<0.05).
Table 1. Consistent grading by LVOTd based on current guidelines Small LVOTd (<20mm, n=181) Average LVOTd (20–22mm, n=108) Large LVOTd (>22mm, n=61) Consistent grading AVA < cut-off MG >40 Consistency (%) Consistent grading AVA < cut-off MG >40 Consistency (%) Consistent grading AVA < cut-off MG >40 Consistency (%) n=61 33.7 n=51 47.6 n=35 57.7 n=69 38 n=61 56.5 n=43 70* n=98 54.1*+ n=70 65.1* n=43 70.8* *p-value <0.05 when compared with AVA cut-off 0.8cm2 for each LVOTd category; +p-value <0.05 when compared with AVA cut-off 0.9cm2 for each LVOTd category.
Figure 1
Conclusion
Current severe AS guidelines are most consistent with those in the large LVOTd group. However, the majority of the study's Asian population is in the small LVOTd group, which is the group most susceptible to discrepancy in AS grading. Improved consistency in echocardiographic grading may be attained with a lower AVA cut-off in this Asian cohort.
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Affiliation(s)
- N Chew
- National University Heart Centre, Singapore, Singapore
| | - N Ngiam
- National University Heart Centre, Singapore, Singapore
| | - B Y Q Tan
- National University Heart Centre, Singapore, Singapore
| | - H W Sim
- National University Heart Centre, Singapore, Singapore
| | - W K F Kong
- National University Heart Centre, Singapore, Singapore
| | - E L W Tay
- National University Heart Centre, Singapore, Singapore
| | - T C Yeo
- National University Heart Centre, Singapore, Singapore
| | - K K Poh
- National University Heart Centre, Singapore, Singapore
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Ngiam N, Chew N, Sim HW, Tan YQB, Sia CH, Kong WKF, Yeo TC, Poh KK. P3366Increased left ventricular remodelling index in paradoxical low-flow severe aortic stenosis with preserved left ventricular ejection fraction compared to normal-flow. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0242] [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: 11/15/2022] Open
Abstract
Abstract
Background
Left Ventricular Remodelling Index (LVRI) has been demonstrated to be able to reliably discriminate between an athlete's heart and pathological LV remodelling. Patients with paradoxical low-flow severe aortic stenosis (LF AS) despite preserved left ventricular ejection fraction (LVEF) are a distinct group from normal-flow (NF) with poorer prognosis, more concentric hypertrophy and smaller LV cavities.
Purpose
We compared LVRI in LF compared to NF AS and examined clinical outcomes.
Methods
We studied consecutive patients with index echocardiographic diagnosis of severe AS (aortic valve area<1cm2) with preserved LVEF (>50%). LVRI was determined by the ratio of LV mass to the end-diastolic volume.
Results
Of the 450 patients studied, 149 (33.1%) were LF. There were no significant differences in baseline clinical profile of patients between LF and NF. LVRI was significantly higher in patients with LF compared to NF (2.27±0.68 vs 1.85±0.53 g/ml, p<0.001). Patients with high LVRI (>1.56 g/ml) had poorer clinical outcomes in terms of mortality (log-rank 9.18, p=0.002) and admissions for cardiac failure (log-rank 7.61, p=0.006).
Low-flow (n=149) Normal-flow (n=301) Mean difference/Odds Ratio (95% CI) p-value Age (years) 73.5 (±12.8) 71.0 (±13.1) 2.5 (−0.1 to 5.1) 0.053 Body Mass Index (g/m2) 24.6 (±5.6) 24.7 (±5.3) −0.1 (−1.2 to 1.1) 0.877 Gender (male) 49 (32.9%) 125 (41.5%) 0.7 (0.5 to 1.1) 0.076 Hypertension 100 (67.1%) 195 (64.8%) 1.1 (0.7 to 1.7) 0.624 Diabetes 57 (38.3%) 100 (33.2%) 1.2 (0.8 to 1.9) 0.295 Hyperlipidaemia 79 (53.0%) 147 (49.0%) 1.2 (0.8 to 1.7) 0.425 End-diastolic volume (ml) 72.3 (±18.9) 112.6 (±26.3) −40.2 (−44.9 to −35.5) <0.001 Left ventricular ejection fraction (%) 66.0 (±7.9) 67.4 (±7.1) −1.4 (−2.9 to 0.2) 0.077 Left ventricular mass index (g/m2) 99.7 (±33.0) 126.8 (±37.4) −27.2 (−34.8 to −19.6) <0.001 Transaortic mean pressure gradient (mmHg) 32.2 (±17.4) 37.1 (±19.9) −4.9 (−8.6 to −1.1) 0.011 Aortic valve area (cm2) 0.78 (±0.16) 0.79 (±0.17) 0.1 (−0.2 to 0.1) 0.635 Stroke volume index (ml/m2) 28.6 (±5.6) 46.9 (±9.8) −18.3 (−20.0 to −16.6) <0.001 Left ventricular remodelling index (LVRI, g/ml) 2.27 (±0.68) 1.85 (±0.53) 0.42 (0.31 to 0.54) <0.001
LVRI in LF versus NF AS
Conclusion
Pathological LV remodelling as evidenced by increased LVRI was more common in LF compared to NF AS. Patients with increased LVRI also had worse clinical outcomes.
Acknowledgement/Funding
None
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Affiliation(s)
- N Ngiam
- National University Health System, Internal Medicine, Singapore, Singapore
| | - N Chew
- National University Health System, Internal Medicine, Singapore, Singapore
| | - H W Sim
- National University Health System, Internal Medicine, Singapore, Singapore
| | - Y Q B Tan
- National University Health System, Internal Medicine, Singapore, Singapore
| | - C H Sia
- National University Health System, Internal Medicine, Singapore, Singapore
| | - W K F Kong
- National University Health System, Internal Medicine, Singapore, Singapore
| | - T C Yeo
- National University Health System, Internal Medicine, Singapore, Singapore
| | - K K Poh
- National University Health System, Internal Medicine, Singapore, Singapore
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Teng M, Zhao YJ, Khoo AL, Yeo TC, Yong QW, Lim BP. Impact of coconut oil consumption on cardiovascular health: a systematic review and meta-analysis. Nutr Rev 2019; 78:249-259. [DOI: 10.1093/nutrit/nuz074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/17/2019] [Indexed: 12/19/2022] Open
Abstract
AbstractContextCoconut oil is rich in medium-chain fatty acids and has been claimed to have numerous health benefits.ObjectiveThis review aimed to examine the evidence surrounding coconut oil consumption and its impact on cardiovascular health.Data SourcesA systematic literature search of the PubMed, Embase, the Cochrane Library, and CINAHL databases, up to May 2019, was performed.Data ExtractionStudy characteristics including study design, population, intervention, comparator, outcome, and source of funding were summarized.Data AnalysisMeta-analyses included 12 studies to provide estimates of effects. Subgroup analyses were performed to account for any differences in the study-level characteristics. When compared with plant oils and animal oils, coconut oil was found to significantly increase high-density lipoprotein cholesterol (HDL-C) by 0.57 mg/dL (95%CI, 0.40–0.74 mg/dL; I2 = 6.7%) and 0.33 mg/dL (0.01–0.65 mg/dL; I2 = 0%), respectively. Coconut oil significantly raised low-density lipoprotein cholesterol (LDL-C) by 0.26 mg/dL (0.09–0.43 mg/dL; I2 = 59.7%) compared with plant oils and lowered LDL-C (−0.37 mg/dL; −0.69 to −0.05 mg/dL; I2 = 48.1%) compared with animal oils. No significant effects on triglyceride were observed. Better lipid profiles were demonstrated with the virgin form of coconut oil.ConclusionCompared with animal oils, coconut oil demonstrated a better lipid profile n comparison with plant oils, coconut oil significantly increased HDL-C and LDL-C.
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Affiliation(s)
- Monica Teng
- M. Teng, Y.J. Zhao, A.L. Khoo, and B.P. Lim are with the Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Ying Jiao Zhao
- M. Teng, Y.J. Zhao, A.L. Khoo, and B.P. Lim are with the Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Ai Leng Khoo
- M. Teng, Y.J. Zhao, A.L. Khoo, and B.P. Lim are with the Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Tiong Cheng Yeo
- T.C. Yeo is with the Department of Cardiology, National University Heart Centre, Singapore
- T.C. Yeo is with the Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Quek Wei Yong
- Q.W. Yong is with the Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Boon Peng Lim
- M. Teng, Y.J. Zhao, A.L. Khoo, and B.P. Lim are with the Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
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Kong WK, Vollema E, Prevedello F, Ng A, Perry R, Poh KK, Yeo TC, Shanks M, Popescu B, Fijalkowski M, Liang M, Chen WX, Marsan N, Selvanayagam J, Pinto F, Pibarot P, Evangelista-Masip A, Delgado V, Bax JJ. INFECTIVE ENDOCARDITIS IN PATIENTS WITH BICUSPID AORTIC VALVE: CLINICAL CHARACTERISTICS, COMPLICATIONS, AND PROGNOSIS OF A MULTI-CENTER INTERNATIONAL OBSERVATIONAL STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32567-7] [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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41
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Tay LWE, Yip WLJ, Low TT, Yip CLW, Kong KFW, Yeo TC, Tan HC, Quereshi SA, Quek SC. Percutaneous pulmonary valve implantation as an alternative to repeat open-heart surgery for patients with pulmonary outflow obstruction: a reality in Singapore. Singapore Med J 2018; 60:260-264. [PMID: 30488081 DOI: 10.11622/smedj.2018141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right ventricle to pulmonary artery (RV-PA) conduits have been used for the surgical repair of congenital heart defects. These conduits frequently become stenosed or develop insufficiency with time, necessitating reoperations. Percutanous pulmonary valve implantation (PPVI) can delay the need for repeated surgeries in patients with congenital heart defects and degenerated RV-PA conduits. We presented our first experience with PPVI and described in detail the procedural methods and the considerations that are needed for this intervention to be successful. Immediate and short-term clinical outcomes of our patients were reported. Good haemodynamic results were obtained, both angiographically and on echocardiography. PPVI provides an excellent alternative to repeat open-heart surgery for patients with congenital heart defects and degenerated RV-PA conduits. This represents a paradigm shift in the management of congenital heart disease, which is traditionally managed by open-heart surgery.
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Affiliation(s)
- Lik Wui Edgar Tay
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Wei Luen James Yip
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ting Ting Low
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Chin Ling William Yip
- Department of Pediatrics, National University of Singapore, Singapore.,Department of Paediatric Cardiology, Gleneagles Hospital, Singapore
| | | | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | | | - Swee Chye Quek
- Department of Pediatrics, National University of Singapore, Singapore
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42
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Ng P, Tay E, Chan SP, Ling LH, Yeo TC, Wong R, Poh KK, Kong W, Cherian R. 5321Severe functional tricuspid valve regurgitation: predictors of mortality at 1 and 2 years and heart failure admission. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Ng
- National University Heart Centre, Singapore, Singapore
| | - E Tay
- National University Heart Centre, Singapore, Singapore
| | - S P Chan
- National University Heart Centre, Singapore, Singapore
| | - L H Ling
- National University Heart Centre, Singapore, Singapore
| | - T C Yeo
- National University Heart Centre, Singapore, Singapore
| | - R Wong
- National University Heart Centre, Singapore, Singapore
| | - K K Poh
- National University Heart Centre, Singapore, Singapore
| | - W Kong
- National University Heart Centre, Singapore, Singapore
| | - R Cherian
- National University Heart Centre, Singapore, Singapore
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43
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Tan E, Chan SP, Krishnan SK, Tan HC, Yeo TC, Low A, Lee RCH, Loh JPY, Loh PH, Tay ELW, Chan KH, Richards AM, Chan MY. P4619Accelerated accrural of ischaemic events after stopping dual antiplatelet therapy at 12 months in a real-world acute myocardial infarction cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Tan
- National University Heart Centre, Singapore, Singapore
| | - S P Chan
- National University of Singapore, Singapore, Singapore
| | - S K Krishnan
- National University Heart Centre, Singapore, Singapore
| | - H C Tan
- National University Heart Centre, Singapore, Singapore
| | - T C Yeo
- National University Heart Centre, Singapore, Singapore
| | - A Low
- National University Heart Centre, Singapore, Singapore
| | - R C H Lee
- National University Heart Centre, Singapore, Singapore
| | - J P Y Loh
- National University Heart Centre, Singapore, Singapore
| | - P H Loh
- National University Heart Centre, Singapore, Singapore
| | - E L W Tay
- National University Heart Centre, Singapore, Singapore
| | - K H Chan
- National University Heart Centre, Singapore, Singapore
| | - A M Richards
- National University Heart Centre, Singapore, Singapore
| | - M Y Chan
- National University Heart Centre, Singapore, Singapore
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44
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Teng M, Zhao YJ, Khoo AL, Ananthakrishna R, Yeo TC, Lim BP, Chan MY, Loh JP. Cost-effectiveness analysis of biodegradable polymer versus durable polymer drug-eluting stents incorporating real-world evidence. Cardiovasc Ther 2018; 36:e12442. [PMID: 29873191 DOI: 10.1111/1755-5922.12442] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/28/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022] Open
Abstract
AIM Compared with second-generation durable polymer drug-eluting stents (DP-DES), the cost-effectiveness of biodegradable polymer drug-eluting stents (BP-DES) remains unclear in the real-world setting. We assessed the cost-effectiveness of BP-DES in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS We developed a decision-analytic model to compare the cost-effectiveness of BP-DES to DP-DES over 1 year and 5 years from healthcare payer perspective. Relative treatment effects during the first year post-PCI were obtained from a real-world population analysis while clinical event risks in the subsequent 4 years were derived from a meta-analysis of published studies. RESULTS At 1 year, based on the clinical data analysis of 497 propensity-score matched pairs of patients, BP-DES were associated with an incremental cost-effectiveness ratio (ICER) of USD20 503 per quality-adjusted life-year (QALY) gained. At 5 years, BP-DES yielded an ICER of USD4062 per QALY gained. At the willingness-to-pay threshold of USD50 400 (one gross domestic product per capita in Singapore in 2015), BP-DES were cost-effective. Sensitivity analysis showed that the cost of stents had a significant impact on the cost-effectiveness of BP-DES. Threshold analysis demonstrated that if the cost difference between BP-DES and DP-DES exceeded USD493, BP-DES would not be cost-effective in patients with 1 year of follow-up. CONCLUSIONS Biodegradable polymer drug-eluting stents were cost-effective compared with DP-DES in patients with coronary artery disease at 1 year and 5 years after PCI. It is worth noting that the cost of stents had a significant impact on the findings.
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Affiliation(s)
- Monica Teng
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Ying Jiao Zhao
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Ai Leng Khoo
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Rajiv Ananthakrishna
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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45
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Ngiam N, Chew N, Teng R, Kochav JD, Kochav S, Tay E, Yeo TC, Poh KK. COMPARING THE IMPACT OF CONCOMITANT SIGNIFICANT MITRAL REGURGITATION ON THE ECHOCARDIOGRAPHIC PROFILE OF PATIENTS WITH LOW-FLOW VERSUS NORMAL-FLOW SEVERE AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32096-5] [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: 11/29/2022]
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46
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Zhao YJ, Teng M, Khoo AL, Ananthakrishna R, Yeo TC, Lim BP, Loh JP, Chan MY. A propensity score-matched comparison of biodegradable polymer vs second-generation durable polymer drug-eluting stents in a real-world population. Cardiovasc Ther 2018; 36. [PMID: 29316284 DOI: 10.1111/1755-5922.12319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS The safety and efficacy of BP-DES compared to second-generation DP-DES remain unclear in the real-world setting. We compared the clinical outcomes of biodegradable polymer drug-eluting stents (BP-DES) with second-generation durable polymer drug-eluting stents (DP-DES) in an all-comer percutaneous coronary intervention (PCI) registry. METHODS/RESULTS The study included a cohort of 1065 patients treated with either BP-DES or DP-DES from January 2009 through October 2015. Propensity score matching was performed to account for potential confounders and produced 497 matched pairs of patients. The primary endpoint was target lesion failure (TLF) at one-year follow-up. The rates of TLF were comparable between BP-DES and DP-DES (8.7% vs 9.1%, P = .823) at 1 year. The rates of stent thrombosis at 30 days (0.4% vs 0.4%, P = 1.00) and 1 year (0.8% vs 0.8%, P = 1.00) did not differ between BP-DES and DP-DES. There were no significant differences in other clinical outcomes including target vessel failure (8.9% vs 9.5%, P = .741), in-stent restenosis (1.8% vs 1.0%, P = .282), and cardiac death (6.4% vs 7.4%, P = .533) at 1 year. Multivariate cox regression analysis showed that the risk of TLF at one-year did not differ significantly between BP-DES and DP-DES (hazard ratio 0.94, P = .763). CONCLUSIONS Efficacy and safety of BP-DES were not better than DP-DES at one-year follow-up.
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Affiliation(s)
- Ying Jiao Zhao
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Monica Teng
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Ai Leng Khoo
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Rajiv Ananthakrishna
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore
| | - Joshua P Loh
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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47
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Wai SH, Kyu K, Galupo MJ, Songco GG, Kong WKF, Lee CH, Yeo TC, Poh KK. Assessment of left atrial appendage function by transthoracic pulsed Doppler echocardiography: Comparing against transesophageal interrogation and predicting echocardiographic risk factors for stroke. Echocardiography 2017; 34:1478-1485. [DOI: 10.1111/echo.13659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shin Hnin Wai
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
- Faculty of Medicine; Nursing and Health Sciences; Monash University; Clayton VIC Australia
| | - Kyu Kyu
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
| | - Mary Joyce Galupo
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
| | - Geronica G. Songco
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
| | - William K. F. Kong
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Chi Hang Lee
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Kian Keong Poh
- Department of Cardiology; National University Heart Center Singapore; National University Health System; Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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48
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Goh SSN, Sia CH, Ngiam NJ, Tan BYQ, Lee PS, Tay ELW, Kong WKF, Yeo TC, Poh KK. Effect of Renin-Angiotensin Blockers on Left Ventricular Remodeling in Severe Aortic Stenosis. Am J Cardiol 2017; 119:1839-1845. [PMID: 28390678 DOI: 10.1016/j.amjcard.2017.02.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 11/19/2022]
Abstract
Studies have shown that medical therapy with renin-angiotensin blockers (RABs) may benefit patients with aortic stenosis (AS). However, its use and efficacy remains controversial, including in patients with low flow (LF) with preserved left ventricular ejection fraction (LVEF). We examined the effects of RAB use on LV remodeling in patients with severe AS with preserved LVEF, analyzing the differential effects in patients with LF compared with normal flow (NF). This is a retrospective study of 428 consecutive subjects from 2005 to 2014 with echocardiographic diagnosis of severe AS and preserved LVEF. Clinical and echocardiographic parameters were systematically collected and analyzed. Two hundred forty-two (57%) patients had LF. Sixty-four LF patients (26%) were treated with RAB. Patients on RAB treatment had a higher incidence of hyperlipidemia (69% vs 44%) and diabetes mellitus (53% vs 34%). Severity of AS in terms of valve area, transvalvular mean pressure gradient, and aortic valve resistance were similar between both groups as was the degree of LV diastolic function. The RAB group demonstrated significantly lower LV mass index with a correspondingly lower incidence of concentric LV hypertrophy. Regardless of the duration of RAB therapy, patients had increased odds of having a preserved LV mass index compared with those without RAB therapy. In conclusion, RAB therapy may be associated with less LV pathological remodeling and have a role in delaying patients from developing cardiovascular complications of AS.
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Affiliation(s)
- Serene Si-Ning Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Nicholas Jinghao Ngiam
- Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Poay Sian Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - William Kok-Fai Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Tiong Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Kian-Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
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Kong WKF, Regeer MV, Ng ACT, McCormack L, Poh KK, Yeo TC, Shanks M, Parent S, Enache R, Popescu BA, Yip JW, Ma L, Kamperidis V, van der Velde ET, Mertens B, Ajmone Marsan N, Delgado V, Bax JJ. Sex Differences in Phenotypes of Bicuspid Aortic Valve and Aortopathy: Insights From a Large Multicenter, International Registry. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005155. [PMID: 28251911 DOI: 10.1161/circimaging.116.005155] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 03/14/2016] [Accepted: 12/29/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND This large multicenter, international bicuspid aortic valve (BAV) registry aimed to define the sex differences in prevalence, valve morphology, dysfunction (aortic stenosis/regurgitation), aortopathy, and complications (endocarditis and aortic dissection). METHODS AND RESULTS Demographic, clinical, and echocardiographic data at first presentation of 1992 patients with BAV (71.5% men) were retrospectively analyzed. BAV morphology and valve function were assessed; aortopathy configuration was defined as isolated dilatation of the sinus of Valsalva or sinotubular junction, isolated dilatation of the ascending aorta distal to the sinotubular junction, or diffuse dilatation of the aortic root and ascending aorta. New cases of endocarditis and aortic dissection were recorded. There were no significant sex differences regarding BAV morphology and frequency of normal valve function. When presenting with moderate/severe aortic valve dysfunction, men had more frequent aortic regurgitation than women (33.8% versus 22.2%, P<0.001), whereas women were more likely to have aortic stenosis (34.5% versus 44.1%, P<0.001). Men had more frequently isolated dilatation of the sinus of Valsalva or sinotubular junction (14.2% versus 6.7%, P<0.001) and diffuse dilatation of the aortic root and ascending aorta (16.2% versus 7.3%, P<0.001) than women. Endocarditis (4.5% versus 2.5%, P=0.037) and aortic dissections (0.5% versus 0%, P<0.001) occurred more frequently in men. CONCLUSIONS Although there is a male predominance among patients with BAV, men with BAV had more frequently moderate/severe aortic regurgitation at first presentation compared with women, whereas women presented more often with moderate/severe aortic stenosis compared with men. Furthermore, men had more frequent aortopathy than women.
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Affiliation(s)
- William K F Kong
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Madelien V Regeer
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Arnold C T Ng
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Louise McCormack
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Kian Keong Poh
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Tiong Cheng Yeo
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Miriam Shanks
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Sarah Parent
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Roxana Enache
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Bogdan A Popescu
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - James W Yip
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Lawrence Ma
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Vasileios Kamperidis
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Enno T van der Velde
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Bart Mertens
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Nina Ajmone Marsan
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Victoria Delgado
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.)
| | - Jeroen J Bax
- From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
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Kong WKF, Delgado V, Poh KK, Regeer MV, Ng ACT, McCormack L, Yeo TC, Shanks M, Parent S, Enache R, Popescu BA, Liang M, Yip JW, Ma LCW, Kamperidis V, van Rosendael PJ, van der Velde ET, Ajmone Marsan N, Bax JJ. Prognostic Implications of Raphe in Bicuspid Aortic Valve Anatomy. JAMA Cardiol 2017; 2:285-292. [DOI: 10.1001/jamacardio.2016.5228] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- William K. F. Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands2Department of Cardiology, National University Heart Center, National University Health System, Singapore
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Center, National University Health System, Singapore3Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Madelien V. Regeer
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arnold C. T. Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Queensland, Australia
| | - Louise McCormack
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Queensland, Australia
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Center, National University Health System, Singapore3Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Alberta, Canada
| | - Sarah Parent
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Alberta, Canada
| | - Roxana Enache
- University of Medicine and Pharmacy “Carol Davila”–Euroecolab, Institute of Cardiovascular Diseases “Prof Dr C. C. Iliescu,” Bucharest, Romania
| | - Bogdan A. Popescu
- University of Medicine and Pharmacy “Carol Davila”–Euroecolab, Institute of Cardiovascular Diseases “Prof Dr C. C. Iliescu,” Bucharest, Romania
| | - Michael Liang
- Department of Cardiology, National University Heart Center, National University Health System, Singapore7Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - James W. Yip
- Department of Cardiology, National University Heart Center, National University Health System, Singapore3Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lawrence C. W. Ma
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Queensland, Australia
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands8Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | | | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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