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Ngan HT, Chan KY, Wong CK, Un KC, Sze SY, Shea P, Lam CC, Lam YM, Tam CC, Lau CP, Tse HF. Temporary Atrioventricular Sequential Conduction System Pacing in Patients With Acute Conduction Abnormalities and Cardiogenic Shock. JACC Clin Electrophysiol 2023; 9:1998-2000. [PMID: 37498245 DOI: 10.1016/j.jacep.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/28/2023]
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Chan KYE, Tai-Leung Chan D, Lam CCS, Shu-Yue Sze M, Un KC, Tam CCF, Lam YM, Wong CK. First-in-Human Undermining Iatrogenic Coronary Obstruction With Radiofrequency Needle (UNICORN) Procedure During Valve-in-Valve Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2022; 15:928-931. [PMID: 36268707 DOI: 10.1161/circinterventions.122.012399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kwong-Yue Eric Chan
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
| | - Daniel Tai-Leung Chan
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong SAR, China (D.T.-L.C.)
| | - Cheung-Chi Simon Lam
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
| | - Michael Shu-Yue Sze
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
| | - Ka-Chun Un
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
| | - Chor-Cheung Frankie Tam
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
| | - Yui-Ming Lam
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
| | - Chun-Ka Wong
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (K.-Y.E.C., C.-C.S.L., M.S.-Y.S., K.-C.U., C.-C.F.T., Y.-M.L., C.-K.W.)
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Chen Y, Chan YH, Wu MZ, Yu YJ, Lam YM, Sit KY, Chan DTL, Ho CKL, Ho LM, Lau CP, Au WK, Tse HF, Yiu KH. Prevalence and Prognostic Importance of Massive Tricuspid Regurgitation in Patients Undergoing Tricuspid Annuloplasty With Concomitant Left-Sided Valve Surgery: A Study on Rheumatic Valvular Heart Disease. Front Cardiovasc Med 2022; 9:686208. [PMID: 35155624 PMCID: PMC8829045 DOI: 10.3389/fcvm.2022.686208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background The presence of tricuspid regurgitation (TR) is very common in patients with concomitant left-sided valve disease. Recent studies have advocated an additional grading of massive TR that is beyond severe. The present study sought to characterize the spectrum of TR in patients undergoing tricuspid annuloplasty (TA) and to evaluate the prognostic value of TR severity for post-operative outcome following TA. Methods A total of 176 patients who underwent TA with combined left-sided valve surgery, secondary to rheumatic valvular heart disease, were prospectively evaluated. The severity of TR was quantified by effective regurgitant orifice area (EROA) using the proximal isovelocity surface area method. Patients were categorized as having non-massive TR (EROA < 0.6 cm2) or massive TR (EROA ≥ 0.6 cm2). Adverse outcome was defined as all-cause mortality or heart failure requiring hospital admission following TA. Results A total of 55 (31%) patients were considered to have massive TR. Patients with massive TR had a greater right ventricular dimension but a smaller left ventricular dimension compared with those with non-massive TR. After a median follow-up of 39 months, 35 adverse events occurred. Cox-regression analysis showed that both continuous EROA and dichotomized EROA (massive vs. non-massive TR) were independently associated with adverse events even after multivariable adjustment. Further, Harrell C index demonstrated that the addition of massive TR provided better discrimination ability of a prediction model to known prognosticators following TA. Conclusions Massive TR is common and up to 31% of study population had massive TR. Massive TR was associated with adverse outcome in patients undergoing TA. Classification of the severity of TR by quantitative measures and identification of massive TR in patients with concomitant left-sided valve disease are essential when considering the optimal timing of corrective surgery.
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Affiliation(s)
- Yan Chen
- Department of Ultrasound, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Yu-Juan Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Yui-Ming Lam
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Ko-Yung Sit
- Department of Cardiothoracic Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Daniel Tai-Leung Chan
- Department of Cardiothoracic Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Cally Ka-Lai Ho
- Department of Cardiothoracic Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chu-Pak Lau
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Wing-Kuk Au
- Department of Cardiothoracic Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
- *Correspondence: Kai-Hang Yiu
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Chen Y, Chan YH, Wu MZ, Yu YJ, Ren QW, Lam YM, Seto WK, Yuen MF, Chan ACY, Lau CP, Tse HF, Yiu KH. Prognostic value and reversibility of liver stiffness in patients undergoing tricuspid annuloplasty. Eur Heart J Cardiovasc Imaging 2021; 23:551-559. [PMID: 33826731 DOI: 10.1093/ehjci/jeab059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/20/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Liver stiffness (LS) assessed by transient elastography is associated with adverse events in patients with heart failure. However, the predictive value of LS for adverse outcome is uncertain in patients undergoing tricuspid annuloplasty (TA). This study sought to evaluate the prognostic value and reversibility of LS in patients undergoing TA during left-sided valve surgery. METHODS AND RESULTS A total of 158 patients who underwent TA were prospectively evaluated. Patients were divided into three groups according to tertile of LS. Adverse outcome was defined as heart failure that required hospital admission or all-cause mortality following TA. The median LS was 13.9 (inter-quartile range 8.1-22.3) kPa and independently correlated positively with tricuspid regurgitation (TR) severity, inferior vena cava diameter and negatively with tricuspid annular plane systolic excursion. During a median follow-up of 31 months, 49 adverse events occurred. Multivariable Cox regression analysis revealed that LS was an independent predictor of adverse events. Significant improvement in LS at 1-year post-TA (13.1-7.8 kPa, P < 0.01) was noted only in patients who had no adverse events, not in those who experienced heart failure (17.1-14.2 kPa, P = 0.87) and seems to be linked to an absence of TR recurrence. CONCLUSIONS This study demonstrated that LS is predictive of adverse outcome and is reversible in patients undergoing TA without TR recurrence at 1 year. These findings suggest that assessing LS, an integrative correlate of right heart condition, may aid the pre-operative risk assessment of candidate for heart surgery including TA.
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Affiliation(s)
- Yan Chen
- Department of Ultrasound, Shenzhen Hospital, Southern Medical University, Shen Zhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yu-Juan Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yui-Ming Lam
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wai-Kay Seto
- Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Man-Fung Yuen
- Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Albert Chi-Yan Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chu-Pak Lau
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Duchamp M, Hu H, Lam YM, Dunin-Borkowski RE, Boothroyd CB. STEM electron beam-induced current measurements of organic-inorganic perovskite solar cells. Ultramicroscopy 2020; 217:113047. [PMID: 32623204 DOI: 10.1016/j.ultramic.2020.113047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 03/27/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
We describe a new approach for preparing organic-inorganic perovskite solar cells for electron beam-induced current (EBIC) measurements in plan-view geometry. This method substantially reduces sample preparation artefacts, provides good electrical contact and keeps the preparation steps as close as possible to those for real devices. Our EBIC images were acquired simultaneously with annular dark-field scanning transmission electron microscopy images using a home-made highly sensitive EBIC amplifier. High-angle annular dark-field images and energy dispersive X-ray maps were recorded from the same area immediately afterwards. This allowed the EBIC contrast to be correlated with regions containing N and a deficiency of O. The EBIC contrast was also found to be similar to secondary electron contrast recorded with a scanning electron microscope. By identifying the generation and absorption electron processes, we determine that EBIC cannot be separated from the secondary electron and absorbed currents. This means that careful analysis needs to be performed before conclusions can be made on the origin of the current measured across p-n or p-i-n junctions.
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Affiliation(s)
- M Duchamp
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Technological University, Singapore 639798, Singapore; Ernst Ruska-Centre for Microscopy and Spectroscopy with Electrons (ER-C), Forschungszentrum Jülich, Jülich, 52425, Germany.
| | - H Hu
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Technological University, Singapore 639798, Singapore
| | - Y M Lam
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Technological University, Singapore 639798, Singapore
| | - R E Dunin-Borkowski
- Ernst Ruska-Centre for Microscopy and Spectroscopy with Electrons (ER-C), Forschungszentrum Jülich, Jülich, 52425, Germany
| | - C B Boothroyd
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Technological University, Singapore 639798, Singapore; Ernst Ruska-Centre for Microscopy and Spectroscopy with Electrons (ER-C), Forschungszentrum Jülich, Jülich, 52425, Germany
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Tam CCF, Cheung KS, Lam S, Wong A, Yung A, Sze M, Lam YM, Chan C, Tsang TC, Tsui M, Tse HF, Siu CW. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ Cardiovasc Qual Outcomes 2020; 13:e006631. [PMID: 32182131 PMCID: PMC7147280 DOI: 10.1161/circoutcomes.120.006631] [Citation(s) in RCA: 517] [Impact Index Per Article: 129.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Chor-Cheung Frankie Tam
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Kent-Shek Cheung
- Department of Accident and Emergency Department (K.-S.C., T.-C.T., M.T.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Simon Lam
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Anthony Wong
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Arthur Yung
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Michael Sze
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Yui-Ming Lam
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Carmen Chan
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Tat-Chi Tsang
- Department of Accident and Emergency Department (K.-S.C., T.-C.T., M.T.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Matthew Tsui
- Department of Accident and Emergency Department (K.-S.C., T.-C.T., M.T.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine (C.-C.F.T., S.L., A.W., A.Y., M.S., Y.-M.L., C.C., H.-F.T., C.-W.S.), Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
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Leung SL, Ho MK, Lam YM, Chow HY, So YH, Leung YC. PEGylated recombinant human arginase as a drug for breast cancer. Hong Kong Med J 2019; 25 Suppl 9:28-31. [PMID: 31889032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- S L Leung
- Department of Applied Biology and Chemical Technology, and Lo Ka Chung Centre for Natural Anti-Cancer Drug Development, The Hong Kong Polytechnic University
| | - M K Ho
- Department of Applied Biology and Chemical Technology, and Lo Ka Chung Centre for Natural Anti-Cancer Drug Development, The Hong Kong Polytechnic University
| | - Y M Lam
- Department of Applied Biology and Chemical Technology, and Lo Ka Chung Centre for Natural Anti-Cancer Drug Development, The Hong Kong Polytechnic University
| | - H Y Chow
- Department of Applied Biology and Chemical Technology, and Lo Ka Chung Centre for Natural Anti-Cancer Drug Development, The Hong Kong Polytechnic University
| | - Y H So
- Department of Applied Biology and Chemical Technology, and Lo Ka Chung Centre for Natural Anti-Cancer Drug Development, The Hong Kong Polytechnic University
| | - Y C Leung
- Department of Applied Biology and Chemical Technology, and Lo Ka Chung Centre for Natural Anti-Cancer Drug Development, The Hong Kong Polytechnic University
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Fang J, Wong A, Eric Chan KY, Yung A, Shea C, Un T, Sze M, Lam YM, Tse HF, Kelvin Chan KW, Simon Lam CC, Tam CC. TCT-645 The Importance of Coronary Revascularization and Guideline-Directed Medical Therapy (GDMT) in Elderly With Non–ST Elevation Acute Coronary Syndrome (NSTE-ACS). J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wu MZ, Chen Y, Au WK, Chan D, Sit KY, Ho KL, Ho LM, Lam YM, Lau CP, Chan TM, Tse HF, Yiu KH. Predictive value of acute kidney injury for major adverse cardiovascular events following tricuspid annuloplasty: A comparison of three consensus criteria. J Cardiol 2018; 72:247-254. [DOI: 10.1016/j.jjcc.2018.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/18/2017] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
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Lee SWL, Tam FC, Chan KK, Lam SC, Kong SL, Shea CP, Wong MK, Wong AY, Yung AS, Zhang LW, Lam YM, Mintz GS, Costa RA, Stoll HP, Maehara A. Establishment of healing profile and neointimal transformation in the new polymer-free biolimus A9-coated coronary stent by longitudinal sequential optical coherence tomography assessments: the EGO-BIOFREEDOM study. EUROINTERVENTION 2018; 14:780-788. [DOI: 10.4244/eij-d-18-00061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chen Y, Au WK, Chan D, Sit KY, Zhen Z, Ho KL, Wong D, Ho LM, Yap D, Lam YM, Lau CP, Tse HF, Chan TM, Yiu KH. Clinical Benefit of Valvular Surgery in Patients with Chronic Kidney Disease. Int Heart J 2018; 59:759-765. [DOI: 10.1536/ihj.17-460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/18/2022]
Affiliation(s)
- Yan Chen
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital
| | - Wing-Kuk Au
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital
| | - Daniel Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital
| | - Ko-Yung Sit
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital
| | - Zhe Zhen
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Kar-Lai Ho
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital
| | - Debbie Wong
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Lai-Ming Ho
- School of Public Health, University of Hong Kong
| | - Desmond Yap
- Divsion of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Yui-Ming Lam
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Chu-Pak Lau
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Tak-Mao Chan
- Divsion of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital
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Chen Y, Liu YX, Seto WK, Wu MZ, Yu YJ, Lam YM, Au WK, Chan D, Sit KY, Ho LM, Tse HF, Yiu KH. Prognostic Value of Hepatorenal Function By Modified Model for End-stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty. J Am Heart Assoc 2018; 7:JAHA.118.009020. [PMID: 30006492 PMCID: PMC6064836 DOI: 10.1161/jaha.118.009020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Model for End-stage Liver Disease excluding international normalized ratio (MELD-XI) score and the modified MELD score with albumin replacing international normalized ratio (MELD-Albumin) score, which reflect both liver and renal function, have been reported as predictors of adverse events in liver and heart disease. Nonetheless, their prognostic value in patients undergoing tricuspid annuloplasty has not been addressed. METHODS AND RESULTS A total of 394 patients who underwent tricuspid annuloplasty were evaluated. Baseline clinical, laboratory, and echocardiographic parameters were recorded. Adverse outcome was defined as the occurrence of heart failure requiring admission or all-cause mortality. Patients who underwent tricuspid annuloplasty had a high prevalence of preoperative hepatorenal dysfunction that was more common in patients with severe tricuspid regurgitation than those with mild to moderate tricuspid regurgitation. The MELD-XI and MELD-Albumin scores were excellent predictors of 1-year adverse outcome (area under the curve: 0.69 and 0.75, respectively). Kaplan-Meier survival curve demonstrated that a high score on MELD-XI (≥12.0) and MELD-Albumin (≥10.7) was associated with an increased risk of adverse events. During a median follow-up of 40 months, both MELD-XI and MELD-Albumin scores were significantly associated with adverse outcome, even after adjusting for potential confounding factors. Significant improvement of hepatorenal function at 1 year postoperation was noted only in patients who had no adverse events, not in those who experienced an adverse outcome. CONCLUSIONS Both MELD-XI score and MELD-Albumin score can provide useful information to predict adverse outcome in patients undergoing tricuspid annuloplasty. The present study supports monitoring of modified MELD score to improve preoperative risk stratification of these patients.
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Affiliation(s)
- Yan Chen
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China.,Division of Cardiology, Department of Medicine, University of Hong Kong Shenzhen Hospital, Hong Kong, China
| | - Ying-Xian Liu
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Wai-Kay Seto
- Division of Gastroenterology and hepatology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Yu-Juan Yu
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Yui-Ming Lam
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Wing-Kuk Au
- Department of Surgery, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Daniel Chan
- Department of Surgery, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Ko-Yung Sit
- Department of Surgery, University of Hong Kong Queen Mary Hospital, Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, University of Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China.,Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, University of Hong Kong Queen Mary Hospital, Hong Kong, China .,Division of Cardiology, Department of Medicine, University of Hong Kong Shenzhen Hospital, Hong Kong, China.,Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, China
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13
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Lee SWL, Tam FCC, Lam SCC, Kong SL, Shea CP, Chan KKW, Wong MKL, Chan MPH, Wong AYT, Yung ASY, Lam YM, Zhang LW, Wu KKY, Mintz GS, Maehara A. The OCT-ORION Study: A Randomized Optical Coherence Tomography Study Comparing Resolute Integrity to Biomatrix Drug-Eluting Stent on the Degree of Early Stent Healing and Late Lumen Loss. Circ Cardiovasc Interv 2018; 11:e006034. [PMID: 29654119 DOI: 10.1161/circinterventions.117.006034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Durable polymers used in drug-eluting stents are considered a potential cause of hypersensitivity inflammatory response adversely affecting stent healing. Using a sequential follow-up with optical coherence tomography, we compared the differences in healing profiles of 2 drug-eluting stents with a biodegradable or durable polymer. METHODS AND RESULTS Sixty patients with multivessel disease were prospectively enrolled to receive both study stents, which were randomly assigned to 2 individual vessels, a Resolute Integrity zotarolimus-eluting stent with a durable BioLinx polymer and a BioMatrix NeoFlex Biolimus A9-eluting stent with a biodegradable polylactic acid polymer. Optical coherence tomography was performed at baseline, then in 5 randomly assigned monthly groups at 2 to 6 months, and at 9 months in all patients. The primary end point was the difference in optical coherence tomography strut coverage at 9 months. Key secondary end points included angiographic late lumen loss and composite major adverse cardiac events (cardiac death, myocardial infarction, target lesion revascularization, and definite or probable stent thrombosis) at 9 months. Resolute Integrity zotarolimus-eluting stent showed significantly better strut coverage than BioMatrix NeoFlex Biolimus A9-eluting stent at 2 to 6 months (P<0.001) and less variance of percent coverage at 9 months, 99.7% (interquartile range, 99.1-100) versus 99.6% (interquartile range, 96.8-99.9; difference, 0.10; 95% confidence interval, 0.00-1.05; P<0.001). No significant difference was observed in major adverse cardiac events or angiographic end points. CONCLUSIONS Despite having a durable polymer, Resolute Integrity zotarolimus-eluting stent exhibited better strut coverage than BioMatrix NeoFlex Biolimus A9-eluting stent having a biodegradable polymer; both showed similar antiproliferative efficacy. This novel, longitudinal, sequential optical coherence tomography protocol using each patient as own control could achieve conclusive results in small sample size. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01742507.
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Affiliation(s)
- Stephen W L Lee
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.).
| | - Frankie C C Tam
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Simon C C Lam
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Shun-Ling Kong
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Catherine P Shea
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Kelvin K W Chan
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Michael K L Wong
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Michael P H Chan
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Anthony Y T Wong
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Arthur S Y Yung
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Yui-Ming Lam
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Lei-Wei Zhang
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Karl K Y Wu
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Gary S Mintz
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Akiko Maehara
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
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14
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Yiu KH, Chen Y, Liu JH, Lin Q, Liu M, Wu M, Wang R, Zhen Z, Zou Y, Lam YM, Ng MY, Lau CP, Tse HF. Burden and contributing factors associated with tricuspid regurgitation: a hospital-based study. Hosp Pract (1995) 2017; 45:209-214. [PMID: 28952403 DOI: 10.1080/21548331.2017.1384688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Tricuspid regurgitation (TR) is common in patients referred for cardiac assessment. Nonetheless, current estimates of its prevalence and contributing factors are limited. The aim of the present study was to evaluate the prevalence and demographics of TR in patients referred for echocardiography assessment at two University-affiliated hospitals. METHODS A total of 6711 consecutive Chinese patients were recruited as part of the Chinese Valvular Heart Disease Study (CVATS). RESULTS The most common valvular lesion was TR (54.7%), followed by mitral regurgitation (44.7%) and aortic regurgitation (26.5%). Clinically significant (moderate or severe) TR was identified in 8.4% with the proportion increased from 3.9% amongst those aged <51 to 15.9% in those aged ≥81. Multivariable adjustment demonstrated that significant TR was associated with age, congenital heart disease, chronic obstructive pulmonary disease, left-sided valvular heart disease (VHD), impaired left ventricular ejection fraction <50%, atrial fibrillation and pulmonary hypertension. CONCLUSIONS Among all types of VHD, TR was the most common and was identified in over half of the subjects and clinically significant in 8.4%. These unique data provide contemporary clinical and epidemiological characteristics of TR in a large cohort of patients referred for cardiac assessment and confirm the increased burden of TR in the aged population.
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Affiliation(s)
- Kai-Hang Yiu
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
- b Division of Cardiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Yan Chen
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
- b Division of Cardiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Ju-Hua Liu
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
| | - Qingshan Lin
- c Division of Radiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Mingya Liu
- b Division of Cardiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Min Wu
- b Division of Cardiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Run Wang
- b Division of Cardiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Zhe Zhen
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
| | - Yuan Zou
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
| | - Yui-Ming Lam
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
| | - Ming-Yen Ng
- c Division of Radiology, Department of Medicine , The University of Hong Kong Shenzhen Hospital , Shenzhen , China
| | - Chu-Pak Lau
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
| | - Hung-Fat Tse
- a Division of Cardiology Department of Medicine , The University of Hong Kong, Queen Mary Hospital , Hong Kong , China
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15
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Chen Y, Liu JH, Chan D, Sit KY, Wong CK, Ho KL, Ho LM, Zhen Z, Lam YM, Lau CP, Au WK, Tse HF, Yiu KH. Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty. J Am Heart Assoc 2016; 5:JAHA.116.003353. [PMID: 27451465 PMCID: PMC5015373 DOI: 10.1161/jaha.116.003353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Tricuspid annuloplasty is increasingly performed during left heart valve surgery, but the long‐term clinical outcome postoperatively is not satisfactory. The aim of this study was to determine whether residual pulmonary hypertension (PHT) contributes to the adverse outcome. Methods and Results One‐hundred thirty‐seven patients (age 61±11 years; men, 30%) who underwent tricuspid annuloplasty during left‐side valve surgery were enrolled. The mean pulmonary artery systolic pressure before surgery was 49±13 mm Hg and 32±15 mm Hg following surgery. Patients were divided into 3 groups according to postoperative pulmonary artery systolic pressure: no residual PHT (n=78, 57%), mild residual PHT (n=43, 31%), or significant residual PHT (n=16, 12%). A preoperative larger right ventricular (RV) geometry and tricuspid valve tethering area were associated with mild or significant residual PHT. A total of 24 adverse events (20 heart failures and 4 cardiovascular deaths) occurred during a median follow‐up of 25 months. Kaplan–Meier survival curve demonstrated that patients with significant residual PHT had the highest percentage of adverse events followed by those with mild residual PHT. Patients with no residual PHT had a very low risk of adverse events. Multivariable Cox regression analysis revealed that both mild (hazard ratio=4.94; 95% CI =1.34–18.16; P=0.02) and significant residual PHT (hazard ratio=8.67; 95% CI =2.43–30.98; P<0.01) were independent factors associated with adverse events. Conclusions The present study demonstrated that 43% of patients who underwent tricuspid annuloplasty had residual PHT. The presence of mild or significant residual PHT was associated with adverse events in these patients.
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Affiliation(s)
- Yan Chen
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
| | - Ju-Hua Liu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
| | - Daniel Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Ko-Yung Sit
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Chun-Ka Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
| | - Kar-Lai Ho
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, China
| | - Zhe Zhen
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
| | - Yui-Ming Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
| | - Chu-Pak Lau
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
| | - Wing-Kok Au
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Hong Kong, China
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16
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Abstract
Pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE) is uncommon but is associated with poor survival. This study aimed to examine the long-term effects of bosentan, a dual endothelin-1 receptor antagonist, on symptomatology, haemodynamics and quality of life measures in SLE patients with symptomatic PAH. Four local patients had been followed up prospectively with pre-defined protocol during 12-months of bosentan treatment. Six minute walk distance (6MWD), NYHA functional class, Borg Dyspnoea Index (BDI) and SF-36 were measured at 0, 3, 6, 9 and 12 months. Systolic pulmonary arterial pressure (PAP) was measured by transthoracic echocardiography at zero, six and 12 months. Clinical parameters were analysed, pooling data from other SLE patients reported in the literature ( n = 4). Bosentan was found to result in significant improvement in 6MWD compared to baseline [+24.8 m, +26.2 m, +54 m and +62.7 m at three ( P = 0.001), six ( P = 0.001), nine ( P = 0.24) and 12 ( P = 0.01) months respectively]. A differential effect was found with greater response in patients with lower exercise capacity. This was accompanied by decrease in NYHA functional class, BDI, transient or sustained drop in systolic PAP and mild improvement in SF-36 domains including mental health, vitality, social function and general health. Significantly deranged liver function was found in one patient. Lupus (2007) 16, 279—285.
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Affiliation(s)
- M Y Mok
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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17
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Mirbagheri N, Engberg S, Crovetto A, Simonsen SB, Hansen O, Lam YM, Schou J. Synthesis of ligand-free CZTS nanoparticles via a facile hot injection route. Nanotechnology 2016; 27:185603. [PMID: 27005863 DOI: 10.1088/0957-4484/27/18/185603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Single-phase, ligand-free Cu2ZnSnS4 (CZTS) nanoparticles that can be dispersed in polar solvents are desirable for thin film solar cell fabrication, since water can be used as the solvent for the nanoparticle ink. In this work, ligand-free nanoparticles were synthesized using a simple hot injection method and the precursor concentration in the reaction medium was tuned to control the final product. The as-synthesized nanoparticles were characterized using various techniques, and were found to have a near-stoichiometric composition and a phase-pure kesterite crystal structure. No secondary phases were detected with Raman spectroscopy or scanning transmission electron microscopy energy dispersive x-ray spectroscopy. Furthermore, high resolution transmission electron microscopy showed large-sized nanoparticles with an average diameter of 23 nm ± 11 nm. This approach avoids all organic materials and toxic solvents that otherwise could hinder grain growth and limit the deposition techniques. In addition the synthesis route presented here results in nanoparticles of a large size compared to other ligand-free CZTS nanoparticles, due to the high boiling point of the solvents selected. Large particle size in CZTS nanoparticle solar cells may lead to a promising device performance. The results obtained demonstrate the suitability of the synthesized nanoparticles for application in low cost thin film solar cells.
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Affiliation(s)
- N Mirbagheri
- DTU Fotonik, Department of Photonics Engineering, Technical University of Denmark, DK-4000 Roskilde, Denmark
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18
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Yiu KH, Wong A, Pu L, Chiang MF, Sit KY, Chan D, Lee HY, Lam YM, Chen Y, Siu CW, Lau CP, Au WK, Tse HF. Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty. Circulation 2014; 129:87-92. [DOI: 10.1161/circulationaha.113.003811] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 11/16/2022]
Abstract
Background—
Patients who undergo tricuspid annuloplasty during left-side heart valve surgery have a poor postoperative clinical outcome. However, preoperative right ventricular (RV) echocardiography parameters that predict adverse events in these patients are poorly understood.
Methods and Results—
We studied 74 patients (age, 58±10 years; men, 27%) with significant tricuspid regurgitation who consequently underwent tricuspid annuloplasty during left-side heart valve surgery. A total of 26 adverse events (22 heart failures and 4 cardiovascular deaths) occurred during a median follow-up of 26 months. RV midcavity diameter (hazard ratio=2.44; 95% confidence interval=1.48–4.02;
P
<0.01), RV longitudinal dimension (hazard ratio=1.64; 95% confidence interval=1.10–2.45;
P
=0.02), and tricuspid valve tethering area (hazard ratio=3.25; 95% confidence interval=1.71–6.19;
P
<0.01) were independently associated with adverse events after adjustment for age and New York Heart Association class III/IV. Receiver-operator characteristic curve analysis demonstrated that RV midcavity diameter (area under the curve=0.74;
P
<0.01) and tricuspid valve tethering area (area under the curve=0.70;
P
=0.04) were most associated with adverse events at the 1-year follow-up. The presence of either a large RV midcavity diameter or tricuspid valve tethering area was predictive of adverse outcome at 1 year after tricuspid annuloplasty.
Conclusions—
The present study demonstrates that RV geometry dimensions, namely RV midcavity diameter and tricuspid valve tethering area, are important preoperative measures associated with adverse events in patients undergoing tricuspid annuloplasty.
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Affiliation(s)
- Kai-Hang Yiu
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Arthur Wong
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Lijun Pu
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Man-Fung Chiang
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Ko-Yung Sit
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Daniel Chan
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Hou-Yee Lee
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Yui-Ming Lam
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Yan Chen
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Chung-Wah Siu
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Chu-Pak Lau
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Wing-Kok Au
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
| | - Hung-Fat Tse
- From the Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.)
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Chan RHW, Chan PH, Chan KKW, Lam SCC, Hai JJ, Wong MKL, Tam FCC, Lam L, Chan CWS, Lam YM, Siu DCW, Tse HF, Lee SWL. The CEPHEUS Pan-Asian survey: high low-density lipoprotein cholesterol goal attainment rate among hypercholesterolaemic patients undergoing lipid-lowering treatment in a Hong Kong regional centre. Hong Kong Med J 2012; 18:395-406. [PMID: 23018067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES. To evaluate attainment of low-density lipoprotein cholesterol goals among hypercholesterolaemic patients undergoing lipid-lowering drug treatment in Hong Kong and to identify potential determinants of treatment outcomes. DESIGN. Cross-sectional observational study. SETTING. A single site in Hong Kong, as part of the CEPHEUS Pan-Asian survey. PATIENTS. Subjects with hypercholesterolaemia aged 18 years or above, who had been on lipid-lowering drug treatment for at least 3 months with no dose adjustment for at least 6 weeks. RESULTS. A total of 561 such patients (mean age, 65.3; standard deviation, 9.7 years) were evaluated. Most had major cardiovascular risk factors; 534 (95.2%) of 561 patients had coronary heart disease and 534 (95.4%) of 560 patients had low-density lipoprotein cholesterol goals set at lower than 70 mg/dL. In all, 465 (82.9%) patients attained their respective low-density lipoprotein cholesterol goals. Among 75 patients who had coronary heart disease or equivalent risk, and multiple risk factors with a 10-year coronary heart disease risk of over 20%, 62 (82.7%) attained their respective low-density lipoprotein cholesterol goals. Significant predictors of low-density lipoprotein cholesterol goal attainment included the patient's baseline lipid profile (total cholesterol and low-density lipoprotein cholesterol levels), blood pressure, and drugs (statin/non-statin) used for treatment. CONCLUSIONS. Hypercholesterolaemic patients undergoing lipid-lowering drug treatment in the present Hong Kong study were able to achieve a very high attainment rate for the low-density lipoprotein cholesterol goal, despite the fact that most of them had major cardiovascular risk factors.
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Affiliation(s)
- Raymond H W Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
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Shea YF, Lee CH, Gill H, Chow WS, Lam YM, Luk HM, Lam STS, Chu LW. Delayed diagnosis of 22q11.2 deletion syndrome in an adult Chinese lady. Chin Med J (Engl) 2012; 125:2945-2947. [PMID: 22932096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We report a 32 year-old Chinese lady with history of tetralogy of Fallot, presented to us with chest pain due to hypocalcemia secondary to hypoparathyroidism. With her dysmorphic facial features and intellectual disability 22q11.2 deletion was suspected and confirmed by genetic study. Clinicians should consider the diagnosis of DiGeorge syndrome in adult patient with past medical history of congenital heart disease, facial dysmorphism, intellectual disability and primary hypoparathyroidism.
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Affiliation(s)
- Yat-Fung Shea
- Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China.
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21
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Tang DJ, Lam YM, Lam CH, Chu SL, Bruzzone R, Nal B. Mutational analysis of H5N1 hemagglutinins: identification of molecular determinants for efficient packaging into pseudotyped lentiviral particles. BMC Proc 2011. [DOI: 10.1186/1753-6561-5-s1-p69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Stolen CM, Lam YM, Siu CW, Lau CP, Parker JA, Hauser TH, Tse HF. Pacing to reduce refractory angina in patients with severe coronary artery disease: a crossover pilot trial. J Cardiovasc Transl Res 2011; 5:84-91. [PMID: 22038623 DOI: 10.1007/s12265-011-9326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/12/2011] [Indexed: 11/27/2022]
Abstract
Biventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onset of symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8 ± 0.4 vs. 1.2 ± 0.7 per week, P = 0.03) and amount of nitroglycerin used (0.2 ± 0.1 vs. 1.0 ± 0.7 per week, P = 0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427 ± 65 vs. 408 ± 64 s, P = 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9 ± 3.5 vs. 12.0 ± 4.0, P = 0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P > 0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings.
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Ho HH, Siu CW, Lam YM, Lee HY, Tse HF. A rare case of severe aortic stenosis with preserved ejection fraction and normal transvalvular gradient. Int J Cardiol 2011; 149:e127-8. [PMID: 19608291 DOI: 10.1016/j.ijcard.2009.06.041] [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] [Received: 06/15/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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Tang DJ, Lam YM, Lam CH, Chu SL, Bruzzone R, Nal B. Mutational analysis of H5N1 hemagglutinins: identification of molecular determinants for efficient packaging into pseudotyped lentiviral particles. BMC Proc 2011. [PMCID: PMC3019497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- DJ Tang
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - YM Lam
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - CH Lam
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - SL Chu
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - R Bruzzone
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - B Nal
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
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Chan ZCY, Chan TS, Lam YM, Lau LM, Li KK, Tam WH. HPV vaccination in Hong Kong: implications for medical education. Asian Pac J Cancer Prev 2011; 12:1095-1099. [PMID: 21790258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To explore the experience and attitudes of physicians in clinics, and to facilitate physicians' promotion of HPV vaccination. DATA SOURCES Primary data collected from conducting semi-structural in-depth interviews from May to June 2010 with 12 physicians in one district in Hong Kong to understand their experience of providing HPV vaccines, the difficulties in promoting HPV vaccines, and their attitudes towards HPV vaccination. STUDY DESIGN Physicians identified 4 categories of factors related to their experiences of and attitudes to providing HPV vaccination: (a) background information on HPV vaccination provided by physicians, (b) factors influencing women to receive vaccination, (c) physicians' recommendations to the public on HPV vaccines, and (d) physicians' perspectives on HPV vaccine promotion. CONCLUSIONS Our findings show that public knowledge on HPV and cervical cancer is insufficient and the role of government in vaccine promotion is unclear. Promotion strategies such as physicians' recommendation, financial assistance and health education provided by the government will influence HPV vaccination and its promotion.
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Affiliation(s)
- Zenobia C Y Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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Lee SWL, Ho HH, Kong SL, Lam YM, Siu CW, Miu KM, Lam L, Chan HW. Long term clinical outcomes after deployment of femoral vascular closure devices in coronary angiography and percutaneous coronary intervention. Catheter Cardiovasc Interv 2010; 75:345-8. [PMID: 19937775 DOI: 10.1002/ccd.22294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/10/2022]
Abstract
BACKGROUND We evaluated the long term clinical outcomes of femoral vascular closure devices following its deployment in coronary angiography and percutaneous coronary intervention (PCI) procedures. METHODS From June 2000 to September 2004, 265 patients who received femoral vascular closure devices after coronary angiography and PCIs were enrolled into the study. Patients' medical records were reviewed and vascular complications within 1 year of follow-up period were recorded. Rutherford's categories of claudication were used to quantify different degrees of claudication and leg ischaemia. Duplex ultrasonography of both femoral arteries (using the nonaccessed site as control) was performed at 1 year after deployment of vascular closure devices. Vessel diameter and flow velocities for both common femoral arteries were obtained. RESULTS There was no occurrence of late vascular complications like arteriovenous fistula, pseudoaneurysm, surgical repair of access site complications, late groin bleeding and infection. By Rutherford categories of claudication, 99.2% of patients had grade 0 claudication while the remaining 0.8% was in grade 1. By arterial Duplex ultrasonography, the peak systolic velocity of the accessed femoral artery (predominantly right side) was nonsignificantly higher, 94.9 + or - 26.0 cm/s when compared to 91.5 + or - 24.8 cm/s in the control site (P = 0.12). As for vessel diameter, no significant difference was found in the mean end-diastolic vessel diameter 8.8 + or - 1.3 mm (puncture site) versus 8.7 + or - 4.4 mm (control site) (P = 0.72). CONCLUSION We found that the use of femoral closure devices was safe and it was not associated with any adverse long term vascular complications.
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Affiliation(s)
- Stephen Wai-Luen Lee
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong, China.
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Fan KYY, Chan CWS, Cheng LC, Ko RLY, Lam YM, Jim MH, Au TWK, Ho CKL, Wang EP, Chau EMC, Chow WH. Isolated left ventricular non-compaction: an unusual indication for heart transplantation. Hong Kong Med J 2009; 15:378-380. [PMID: 19801696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report a patient with isolated left ventricular non-compaction diagnosed by echocardiography and cardiac magnetic resonance imaging. She developed refractory congestive heart failure and subsequently underwent successful heart transplantation. This type of cardiomyopathy is thought to be caused by the arrest of normal embryogenesis of the endocardium and myocardium. The spectrum of clinical, radiological, and pathological abnormalities is discussed.
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Jim MH, Lam YM, Siu CW, Chan RHW. Traumatic ventricular septal defect. Asian Cardiovasc Thorac Ann 2008; 16:436. [PMID: 18812359 DOI: 10.1177/021849230801600521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Man-Hong Jim
- Cardiac Medical Unit, The Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong, China.
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Xi LF, Lam YM. Synthesis and characterization of CdSe nanorods using a novel microemulsion method at moderate temperature. J Colloid Interface Sci 2007; 316:771-8. [PMID: 17850812 DOI: 10.1016/j.jcis.2007.07.067] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 07/25/2007] [Accepted: 07/26/2007] [Indexed: 11/22/2022]
Abstract
CdSe nanoparticles have been successfully synthesized using a novel microemulsion method at moderate temperature. It is found that with a combination of the surfactant AOT and hydrazine hydrate, it is possible to control the morphology of the nanoparticles. The hydrazine hydrate acts as both a reducing agent and a templating agent that favors the formation of a rodlike structure. The composition, morphology and optical properties of the CdSe nanoparticles were investigated using powder X-ray diffraction (XRD), transmission electron microscopy (TEM), ultraviolet-visible (UV-vis) absorption spectroscopy, photoluminescence (PL) spectroscopy, energy dispersive X-ray spectroscopy (EDX) and Fourier transform infrared (FT-IR) spectroscopy. The nucleation and growth mechanism for this system is also proposed based on a time-dependent study. This synthesis route provides a moderate temperature (100 degrees C) method for synthesizing rodlike CdSe, hence reducing the possibility of oxidation of this chalcogenide compound.
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Affiliation(s)
- L F Xi
- Department of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
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Hwang YY, Fan K, Lam YM, Chan WS, Cheung S, Wang EP, Au WY. Primary cardiac lymphoma presenting with right heart mass and bradycardia. Ann Hematol 2007; 86:685-6. [PMID: 17453210 DOI: 10.1007/s00277-007-0285-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 03/05/2007] [Indexed: 11/26/2022]
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Zhang Y, Lam YM. Controlled synthesis and association behavior of graft Pluronic in aqueous solutions. J Colloid Interface Sci 2007; 306:398-404. [PMID: 17161416 DOI: 10.1016/j.jcis.2006.10.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 10/26/2006] [Accepted: 10/27/2006] [Indexed: 11/19/2022]
Abstract
Poly(vinyl pyrrolidone) (PVP) was grafted onto Pluronic F127 (PEO-PPO-PEO) to produce novel amphiphilic PVP-g-F127 graft copolymers. A controlled synthesis method was used to graft PVP onto different parts of F127. Two types of graft polymers were obtained: one has PVP grafted onto the PEO part of F127 and the other has PVP grafted onto the PPO part of F127. The association behavior of the two modified polymers was examined using differential scanning calorimetry, surface tension measurements, and dynamic light scattering.
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Affiliation(s)
- Y Zhang
- School of Material Science and Engineering, Nanyang Technological University, Nanyang Drive, 639798 Singapore
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Abstract
Surface tension (ST) measurements were carried out on various binary mixtures of the "normal" surfactants, such as nonionic surfactant, hexaethylene glycol mono-n-dodecyl ether(C12EO6), and cationic surfactant, tetradecyltrimethylammonium bromide (TTAB), and polymeric copolymer, Pluronic F127, F127(PPO)-g-PVP, and F127(PEO)-g-PVP. In all cases mixed micellar aggregates were formed and critical micellar concentrations of binary mixtures containing different mole fractions of the surfactants were measured using surface tension measurement. In the region where mixed micelles are formed, the interaction of two "normal" surfactants and three "polymeric" nonionic surfactants showed synergistic behavior and the results were analyzed using a interaction parameter, beta, which characterized the interaction in the mixed micelle and introduced by a regular solution theory. The regular solution theory can be applied to describe the interaction between TTAB and C12EO6, and graft polymeric surfactants systems. The results discussed in this paper indicated that regular solution theory has broader extent of application.
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Affiliation(s)
- Y Zhang
- School of Materials Science and Engineering, Nanyang Technological University, NTU-SME, N4.1-B2-03, Nanyang Drive, Singapore 639798
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Lau KCH, Yiu KKH, Lee KL, Ko RLY, Lam YM, Lam L, Lee SWL. A case of takotsubo cardiomyopathy: transient left ventricular apical ballooning. Hong Kong Med J 2006; 12:388-90. [PMID: 17028361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
A 78-year-old woman was admitted to hospital with central chest pain and the electrocardiographic and cardiac marker changes typical of acute anterior myocardial infarction. Coronary angiography revealed normal epicardial coronary arteries, and left ventriculography showed apical akinesis as well as basal hyperkinesis. This is a case of transient left ventricular apical ballooning or takotsubo cardiomyopathy, possibly attributable to catecholamine-mediated myocardial stunning.
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Affiliation(s)
- K C H Lau
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Zhang Y, Lam YM, Tan WS. Poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide)-g-poly(vinylpyrrolidone): association behavior in aqueous solution and interaction with anionic surfactants. J Colloid Interface Sci 2006; 285:74-9. [PMID: 15797398 DOI: 10.1016/j.jcis.2004.12.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 12/03/2004] [Indexed: 10/25/2022]
Abstract
In this work, we aimed to study the association and interaction behavior of poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) block copolymers grafted with poly(vinylpyrrolidone). Critical micellization concentrations were determined using fluorescent probes (pyrene) and critical micellization temperatures characterizing temperature-dependent transitions from monomers to multimolecular micelles were measured. The thermal responsiveness of the copolymer is not affected by the grafting. The hydrodynamic radius of the graft copolymer micelles is found to be greater than that of the original copolymer micelles. The graft copolymer is found to form anisotropic aggregates. The structure of the graft copolymer micelles is less disrupted by the anionic surfactant sodium dodecyl sulfate, compared to the ungraft copolymer.
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Affiliation(s)
- Y Zhang
- School of Material Engineering, Nanyang Technological University, NTU-SME, N4.1-B2-03, Nanyang Drive, Singapore 639798
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Jim MH, Siu CW, Ho HH, Miu R, Lam YM, Lam L, Chan RHW, Lee SWL. Anomalous origin of right coronary artery from the left coronary sinus: incidence, characteristics, and a systematic approach for rapid diagnosis. J Interv Cardiol 2005; 18:101-6. [PMID: 15882155 DOI: 10.1111/j.1540-8183.2005.04046.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Twenty-three patients were found to have anomalous origin of right coronary artery from the left coronary sinus (LCS) from January 2000 to October 2003. The mean age was 58.6+/-14.3 years with male predominance (56.5%). Cardiovascular risk factors were found in 18 (78.3%) patients while coronary artery disease was seen in 13 (56.5%) patients. Among the coronary artery disease patients, the left anterior descending artery was the most commonly involved, followed by the right coronary artery and the left circumflex artery. Right coronary artery dominance was seen in 19 (82.6%) patients. The anomalous right coronary artery originates within the left coronary sinus in 17 (73.9%) patients while from the left aortic wall above the sinus in 6 (26.1%) patients only. Congenital heart disease and acquired valvular heart disease were the most common associated conditions. The author will share his experience and suggest a four-step approach of early recognition and selection of the anomalous right coronary artery ostium. Using the suggested strategy, most of the anomalous right coronary artery could be opacified with a left amplatz 1 catheter. Aortogram was needed only in 47.8% of cases.
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Affiliation(s)
- Man-Hong Jim
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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Siu CW, Tse HF, Lee K, Lam YM, Chan HW, Yung C, Lau CP. A rapid ultrasonic cardiac output monitor method for optimization of Ventriculo-ventricular Interval (VVI) in cardiac resynchronization therapy. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.262] [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: 11/30/2022]
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Tse KC, Ooi GC, Wu A, Ho PL, Ip SK, Jim MH, Lam YM, Fan YW, Tso WK, Tsang KW. Multiple brain abscesses in a patient with bilateral pulmonary arteriovenous malformations and immunoglobulin deficiency. Postgrad Med J 2004; 79:597-9. [PMID: 14612606 PMCID: PMC1742854 DOI: 10.1136/pmj.79.936.597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 34 year old Chinese man presented with grand mal seizures complicating multiple brain abscesses caused by mixed oral flora. Because of persistent hypoxaemia contrast spiral thoracic computed tomography was done, which revealed bilateral pulmonary arteriovenous malformations (PAVMs). Concomitant IgA and IgG subclass deficiency was also found. The combination of these two conditions appears to have predisposed this patient to presumably paradoxical septic embolism. The patient's cerebral condition responded to postoperative antibiotic treatment and he eventually received selective coil embolisation of right lower lobe PAVMs, which relieved his hypoxaemia and dyspnoea.
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Affiliation(s)
- K-C Tse
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Wong WM, Ho JC, Ooi GC, Mok T, Chan J, Hung IF, Ng W, Lam YM, Tam WO, Wong BCY, Wong PC, Ho PL, Lai CL, Lam WK, Lam SK, Tsang KW. Temporal patterns of hepatic dysfunction and disease severity in patients with SARS. JAMA 2003; 290:2663-5. [PMID: 14645306 DOI: 10.1001/jama.290.20.2663] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MRS, Lau CP. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002; 105:438-45. [PMID: 11815425 DOI: 10.1161/hc0402.102623] [Citation(s) in RCA: 734] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biventricular pacing has been proposed to improve symptoms and exercise capacity in patients with advanced heart failure and wide electrocardiographic wave complexes. This study investigated the effect of biventricular pacing on reverse remodeling and the underlying mechanisms. METHODS AND RESULTS Twenty-five patients with NYHA class III to IV heart failure and electrocardiographic wave complex duration >140 ms receiving biventricular pacing therapy were assessed serially up to 3 months after pacing and when pacing was withheld for 4 weeks. Tissue Doppler echocardiography was performed using a 6-basal, 6-mid segmental model to assess the time to peak sustained systolic contraction (T(S)). There was significant improvement of ejection fraction, dP/dt, and myocardial performance index; decrease in mitral regurgitation, left ventricular (LV) end-diastolic (205+/-68 versus 168+/-67 mL, P<0.01) and end-systolic volume (162+/-54 versus 122+/-42 mL, P<0.01); and improved 6-minute hall-walk distance and quality of life score after pacing for 3 months. The mechanisms of benefits were as follows: (1) improved LV synchrony, as evident by homogeneous delay of T(S) to a timing close to the latest (usually the lateral) segment abolishing the intersegmental difference in T(S) and decreasing the standard deviation of T(S) within the left ventricle (37.7+/-10.9 versus 29.3+/-8.3 ms, P<0.05); (2) improved interventricular synchrony; and (3) shortened isovolumic contraction time (122+/-57 versus 82+/-36 ms, P<0.05) but increased diastolic filling time. These benefits are pacing dependent, because withholding the pacing resulted in varying speeds in the loss of cardiac improvements. CONCLUSIONS Biventricular pacing reverses LV remodeling and improves cardiac function. Improvement of LV mechanical synchrony seems to be the predominant mechanism.
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Affiliation(s)
- Cheuk-Man Yu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong.
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Tse HF, Lam YM, Lau CP, Cheung BM, Kumana CR. Comparison of digoxin versus low-dose amiodarone for ventricular rate control in patients with chronic atrial fibrillation. Clin Exp Pharmacol Physiol 2001; 28:446-50. [PMID: 11380520 DOI: 10.1046/j.1440-1681.2001.03454.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Rapid ventricular rate (VR) and rhythm irregularity during atrial fibrillation (AF) impair cardiac performance. Although digoxin has been widely used in patients with AF, its efficacy for the control of VR and rhythm irregularity is unsatisfactory. Whether low-dose amiodarone is more effective remains unclear. 2. We randomized 16 patients (13 male, three female; mean (+/-SD) age 63 +/- 9 years) with chronic AF to receive either digoxin or amiodarone for 24 weeks. At baseline and at 12 and 24 weeks follow up, Holter monitor recording and cardiopulmonary exercise test were performed to assess VR and rhythm irregularity control and exercise capacity. 3. Seven and nine patients received digoxin and amiodarone, respectively. After 12 and 24 weeks treatment, both digoxin and amiodarone significantly decreased the mean ambulatory VR and the VR during peak exercise compared with baseline (all P < 0.05). At 24 weeks, there were no significant differences between digoxin and amiodarone in the percentage reduction in VR during ambulatory (27 +/- 13 vs. 25 +/- 12%, respectively; P = 0.8) and peak exercise (13 +/- 12 vs. 12 +/- 10%%, respectively; P = 0.6). 4. The rhythm irregularity, as measured by SD of RR intervals and the root mean square of the SD of RR intervals, and the exercise capacity, as measured by exercise workload, maximal oxygen consumption (VO2), minute ventilation, ventilatory equivalent and oxygen pulse, were not significantly changed after treatment with digoxin or amiodarone (all P > 0.05). 5. Quality of life, determined by SF-36 questionnaire, and AF symptomatology, as measured by the AF Symptom Checklist, were also not significantly changed after treatment with digoxin or amiodarone (all P > 0.05). 6. In conclusion, digoxin and low-dose amiodarone had similar efficacy in the control of VR during ambulatory activity and exercise. However, both were less efficacious during exercise and did not significantly affect rhythm irregularity, exercise capacity, quality of life and AF symptomatology in patients with chronic AF.
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Affiliation(s)
- H F Tse
- Division of Cardiology, Department of Medicine and the Institute of Cardiovascular Science and Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Tse HF, Lam YM, Lau CP, Cheung BM, Kumana CR. Comparison Of Digoxin Versus Low-Dose Amiodarone For Ventricular Rate Control In Patients With Chronic Atrial Fibrillation. Clin Exp Pharmacol Physiol 2001. [DOI: 10.1046/j.1440-1681.2001.3454.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
A 37-year-old woman presented with persistent hypotension and noncardiogenic pulmonary edema after massive nifedipine overdose. Judicious use of continuous and prolonged high-dose IV calcium infusion was administered to provide sustained increases in serum ionic calcium level (approximately 2 mmol/L) and was able to improve the hemodynamic status without any major adverse reaction.
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Affiliation(s)
- Y M Lam
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Abstract
Case reports and case series have identified putative risk factors for the development of bilateral massive adrenal hemorrhage (BMAH) in humans. The anatomy and physiology of the adrenal gland allow development of a model to fit the pathophysiology behind these risk factors. Until now, these risk factors were not systematically tested using analytical epidemiologic studies. A case-control study was undertaken using sources of cases and controls from multiple teaching hospitals in Ontario, Canada. The results of multivariate logistic regression indicated that thrombocytopenia (odds ratio [OR] = 14.6, 95% confidence intervals [CI] = 3.0-70.1, p < 0.001), heparin exposure of any route or type beyond 3 days (4-6 days: OR = 17.0, CI = 1.9-154.6; > 6 days: OR = 33.5, CI = 4.3-262.6; p < 0.001), and sepsis (OR = 6.3, CI = 1.2-32.2, p = 0.019) were most strongly and independently associated with development of BMAH. Another weaker positive association included invasive radiologic procedure (OR = 4.4, CI = 0.9-22.1, p = 0.055). Neither major surgery or duration of hospitalization were independent risk factors. Although coronary artery disease and possibly diabetes and hypertension appeared to be markers for lower risk of BMAH, this may be a result of bias introduced by using hospital controls ("Berkson bias"), as the effect was not explained by a protective effect of vasoactive medications. Thus, a picture of the high-risk patient should include a patient who has been treated with heparin (any route or type) beyond 3 days and has had thrombocytopenia (not necessarily induced by heparin) during the course of an illness. If the setting includes unexplained abdominal, chest, or back pain; fever; confusion; hypotension or shock; abrupt anemia; or electrolyte disorders, clinicians should not hesitate to cover empirically with lifesaving glucocorticoids while awaiting results of confirmatory tests.
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Affiliation(s)
- K A Kovacs
- Department of Medicine, Queen's University, Kingston, Ontario, Canada, K7L 3N6.
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Tse HF, Lam YM, Yiu M. Images in cardiology: Three dimensional reconstruction of femoral pseudoaneurysm using contrast enhanced axial CT angiography. Heart 2000; 84:581. [PMID: 11083729 PMCID: PMC1729512 DOI: 10.1136/heart.84.6.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lau CP, Yu CM, Chau E, Fan K, Tse HF, Lee K, Tang MO, Wan SH, Law TC, Lee PY, Lam YM, Hill MR. Reversal of left ventricular remodeling by synchronous biventricular pacing in heart failure. Pacing Clin Electrophysiol 2000; 23:1722-5. [PMID: 11139909 DOI: 10.1111/j.1540-8159.2000.tb07004.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Synchronous biventricular pacing is a new nonpharmacological supplemental treatment of advanced heart failure associated with electromechanical conduction delay. However, the role of pacing on left ventricular remodeling is unknown. Eleven patients with New York Heart Association Class III to IV heart failure, a left ventricular ejection fraction < 35%, and a QRS duration > or = 140 ms received a biventricular dual chamber pacemaker. Serial echocardiography, 6-minute hall walk, and Minnesota Living with Heart Failure quality-of-life (QOL) questionnaire were performed before and after up to 3 months of pacing. At 3 months there was a significant increase in fractional shortening (P < 0.001), ejection fraction (P < 0.001), and cardiac output (P < 0.05). The left ventricular end-diastolic volume (245 +/- 70 vs 185 +/- 37 mL, P < 0.05), end-systolic volume (209 +/- 69 vs 140 +/- 44 mL P < 0.05), and mitral regurgitation were reduced (P < 0.05), and diastolic filling time was lengthened (P < 0.05). There were also improvements in heart failure symptoms, an increase in 6-minute walk distance, and a decrease in QOL scores. Synchronous biventricular pacing for 3 months was associated with hemodynamic improvements, reversal of left ventricular remodeling, and increase in left ventricular systolic function, and a decrease in secondary mitral regurgitation.
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Affiliation(s)
- C P Lau
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Harvey PJ, Keightley AM, Lam YM, Cameron C, Lillicrap D. A single nucleotide polymorphism at nucleotide -1793 in the von Willebrand factor (VWF) regulatory region is associated with plasma VWF:Ag levels. Br J Haematol 2000; 109:349-53. [PMID: 10848823 DOI: 10.1046/j.1365-2141.2000.02000.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
von Willebrand Factor (VWF) is a large multimeric glycoprotein involved in the transport and protection of factor VIII and in mediating platelet-subendothelium and platelet-platelet interactions. We have documented the presence of a single nucleotide polymorphism (SNP) at nucleotide (nt) -1793 (G 0.36 or C 0.64) in the VWF 5'-flanking sequence. This polymorphism is in strong linkage disequilibrium with the previously reported SNPs at nts -1234, -1185 and -1051 and, like this other group of polymorphisms, shows a significant association with plasma VWF levels. This association is more marked in subjects who are more than 40 years of age. Further, circumstantial evidence to support a role for the -1793 sequence in regulating VWF expression comes from our demonstration of differential binding of endothelial cell nuclear proteins, including the transcription factor NFkappaB, by this sequence. In summary, the association of the -1793 SNP with plasma VWF levels provides additional evidence for the role of the VWF regulatory region between nts -1793 and -1051 in controlling VWF expression.
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Affiliation(s)
- P J Harvey
- Departments of Pathology and Community Health and Epidemiology, Queen's University, 99 University Avenue, Kingston, Ontario K7L 3N6, Canada
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Keightley AM, Lam YM, Brady JN, Cameron CL, Lillicrap D. Variation at the von Willebrand factor (vWF) gene locus is associated with plasma vWF:Ag levels: identification of three novel single nucleotide polymorphisms in the vWF gene promoter. Blood 1999; 93:4277-83. [PMID: 10361125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Both genetic and environmental factors contribute to the normal population variability of plasma von Willebrand Factor (vWF) levels, however, regulatory mechanisms at the vWF gene locus itself have not yet been identified. We have investigated the association between polymorphic variation in the 5'-regulatory region of the vWF gene and levels of plasma vWF:Ag in a study of 261 group O blood donors. Three novel single nucleotide polymorphisms (SNPs) were identified in the vWF promoter: C/T at -1234, A/G at -1185, and G/A at -1051. These SNPs had identical allele frequencies of 0.36 for the -1234C, -1185A, and -1051G alleles and 0.64 for the -1234T, -1185G, and -1051A alleles and were in strong linkage disequilibrium. In fact, these polymorphisms segregated as two distinct haplotypes: -1234C/-1185A/-1051G (haplotype 1) and -1234T/-1185G/-1051A (haplotype 2) with 12.6% of subjects homozygous for haplotype 1, 40. 6% homozygous for haplotype 2, and 42.5% of subjects heterozygous for both haplotypes. Only 4.3% of individuals had other genotypes. A significant association between promoter genotype and level of plasma vWF:Ag was established (analysis of covariance [ANCOVA], P =. 008; Kruskal-Wallis test, P =.006); individuals with the CC/AA/GG genotype had the highest mean vWF:Ag levels (0.962 U/mL), intermediate values of vWF:Ag (0.867 U/mL) were observed for heterozygotes (CT/AG/GA), and those with the TT/GG/AA genotype had the lowest mean plasma vWF:Ag levels (0.776 U/mL). Interestingly, when the sample was subgrouped according to age, the significant association between promoter genotype and plasma vWF:Ag level was accentuated in subjects > 40 years of age (analysis of variance [ANOVA], P =.003; Kruskal-Wallis test, P =.001), but was not maintained for subjects </= 40 years of age (ANOVA, P >.4; Kruskal-Wallis test, P >.4). In the former subgroup, mean levels of plasma vWF:Ag for subjects with the CC/AA/GG, CT/AG/GA, and TT/GG/AA genotypes were 1.075, 0.954, and 0.794 U/mL, respectively. By searching a transcription factor binding site profile database, these polymorphic sequences were predicted to interact with several transcription factors expressed in endothelial cells, including Sp1, GATA-2, c-Ets, and NFkappaB. Furthermore, the binding sites at the -1234 and -1051 SNPs appeared to indicate allelic preferences for some of these proteins. Electrophoretic mobility shift assays (EMSAs) performed with recombinant human NFkappaB p50 showed preferential binding of the -1234T allele (confirmed by supershift EMSAs), and EMSAs using bovine aortic endothelial cell (BAEC) nuclear extracts produced specific binding of a nuclear protein to the -1051A allele, but not the -1051G allele. These findings suggest that circulating levels of vWF:Ag may be determined, at least in part, by polymorphic variation in the promoter region of the vWF gene, and that this association may be mediated by differential binding of nuclear proteins involved in the regulation of vWF gene expression.
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Affiliation(s)
- A M Keightley
- Departments of Pathology and Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Abstract
Recent studies have demonstrated the potential application of computed tomography (CT) in research into bone density. Clinical studies of bone density using CT commonly employ a dipotassium phosphate phantom to calibrate measurements of mineral density. Designed for in vivo studies, the use of this phantom requires that bones be scanned while immersed in and permeated by fluids or soft tissues similar to water in X-ray attenuation coefficient. However, this condition may not always be met in anthropological applications, which often involve rare and fragile specimens. This study compares mineral density values calculated for a sample of bones scanned-at the same sites-in air and in water. The results indicate that, when scanned in air, the mineral density of trabecular bone is dramatically underestimated, while that of cortical bone is slightly overestimated. We present a linear regression equation to correct this error but recommend that, when possible, researchers calculate their own regressions based on their specific scanning conditions.
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Affiliation(s)
- X Chen
- Department of Anatomical Sciences, State University of New York, Stony Brook 11794-8081, USA.
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Abstract
OBJECTIVE To determine the extent of omeprazole prescribing in the senior population of Ontario over a 1-year period; the variation in omeprazole prescribing for this population according to age group, gender, and geographic region: and the extent of inappropriate prescribing of omeprazole for this population. DESIGN Retrospective drug utilization review of prescription drug insurance claims. DATA SOURCE The Ontario Drug Benefit (ODB) program claims database. OUTCOME MEASURES The following outcomes were measured: the proportion of seniors in Ontario who received a prescription for omeprazole from April 1, 1992 to March 31, 1993: effects of age group, gender, and geographic region of residence on omeprazole prescribing; and the extent of inappropriate omeprazole prescribing according to the ODB criteria for use. Prescribing of omeprazole was defined as inappropriate if a first-line antiulcer drug (i.e., histamine2-receptor antagonist) was not prescribed within 1-6 months of the first prescription claim for omeprazole. RESULTS A total of 29,936 seniors in Ontario received omeprazole from April 1, 1992 to March 31, 1993 (2.53 recipients per 100 eligible population). The age-gender group most frequently prescribed omeprazole was women 65-74 years, followed by women and men 75 years or older, and then men 65-74 years. Omeprazole prescribing varied widely among the 48 provincial counties (range of 1.66 recipients per 100 eligible population to 4.52 recipients per 100 population, p < 0.001). There was no evidence of a clustering effect in omeprazole prescribing at the county level. Prescribing of omeprazole was considered to be inappropriate for 80.5% of recipients. CONCLUSIONS This study demonstrated the ineffectiveness of the ODB limited-use program in controlling omeprazole prescribing. Further study should be done to examine determinants of variation in prescribing by geographic region.
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Campling BG, Young LC, Baer KA, Lam YM, Deeley RG, Cole SP, Gerlach JH. Expression of the MRP and MDR1 multidrug resistance genes in small cell lung cancer. Clin Cancer Res 1997; 3:115-22. [PMID: 9815546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Acquired multidrug resistance is a major obstacle to a cure for small cell lung cancer (SCLC). Overexpression of the MDR1 gene occurs infrequently in multidrug-resistant SCLC cell lines. The multidrug resistance protein (MRP) can confer multidrug resistance, but its role in clinically acquired drug resistance is unknown. The purpose of this study was to measure expression of MRP and MDR1 mRNA in cell lines and clinical samples from SCLC patients and to correlate the results with drug sensitivity profiles. Twenty-three SCLC cell lines and 10 tumor samples from SCLC patients were examined. Samples expressing MRP and MDR1 were identified by reverse transcription-PCR, and levels of MRP mRNA in the cell lines were measured by quantitative reverse transcription-PCR. One of 23 cell lines (4%) expressed MDR1 mRNA, whereas MRP expression was detected in 19 of 23 cell lines (83%). There was a significant correlation between doxorubicin resistance and MRP expression levels (r = 0.422; P = 0.045). Of the 10 clinical samples, 3 expressed only MRP, 2 expressed only MDR1, and 4 expressed both drug resistance genes. In summary, MRP is frequently expressed in clinical samples and cell lines from SCLC patients, and the levels correlate with doxorubicin resistance in unselected SCLC cell lines. Expression of MDR1 can be detected in clinical samples of SCLC but is rarely found in cell lines from drug-resistant patients. These multidrug resistance proteins may contribute to the multifactorial problem of clinically acquired drug resistance in SCLC.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/metabolism
- Drug Resistance, Multiple/genetics
- Drug Resistance, Neoplasm/genetics
- Drug Screening Assays, Antitumor
- Gene Expression
- Genes, MDR/genetics
- Humans
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Multidrug Resistance-Associated Protein 2
- RNA, Messenger/metabolism
- Tumor Cells, Cultured
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Affiliation(s)
- B G Campling
- Cancer Research Laboratory, Department of Oncology, Queen's University, Kingston, Ontario, K7L 3N6 Canada
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