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Wu XF, Sun TT, Lin JL, Guo WL, Li XY, Hong C. [Pulmonary artery stenting in chronic thromboembolic pulmonary hypertension: a report of 2 cases]. Zhonghua Jie He He Hu Xi Za Zhi 2024; 47:228-232. [PMID: 38448172 DOI: 10.3760/cma.j.cn112147-20230921-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a pulmonary vascular disease characterized by an insidious onset, progressive deterioration, and poor prognosis. It is distinguished by the thrombotic organization within the pulmonary arteries, leading to vascular stenosis or occlusion. This results in a progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure. In recent years, balloon pulmonary angioplasty (BPA) has emerged as an effective treatment option for patients ineligible for pulmonary endarterectomy (PEA). However, the use of stents in patients with suboptimal balloon dilation remains controversial. This article describes two cases of chronic thromboembolic pulmonary hypertension (CTEPH) in which balloon angioplasty yielded unsatisfactory results, subsequently leading to stent placement. Following stent implantation, there was improved blood flow, significant reduction in pulmonary arterial pressure, and notable alleviation of patient symptoms. One-year follow-up showed no recurrence of stenosis within the stent, suggesting potential guidance for the use of pulmonary artery stenting as a treatment modality for CTEPH. This report provided new insights into the therapeutic approach for CTEPH.
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Affiliation(s)
- X F Wu
- Guangzhou Institute of Respiratory Health (National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine), The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - T T Sun
- Guangzhou Institute of Respiratory Health (National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine), The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - J L Lin
- Department of Radiology and Interventianl, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - W L Guo
- Guangzhou Institute of Respiratory Health (National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine), The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - X Y Li
- Guangzhou Institute of Respiratory Health (National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine), The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - C Hong
- Guangzhou Institute of Respiratory Health (National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine), The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
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2
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Lin JL, Wu CY, Hou LK, Huang Y, Xie HK, Wu W, Zhang LP. [Clinicopathological and molecular genetic features of primary pulmonary epithelial- myoepithelial carcinoma]. Zhonghua Bing Li Xue Za Zhi 2023; 52:715-717. [PMID: 37408403 DOI: 10.3760/cma.j.cn112151-20230323-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- J L Lin
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - C Y Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - L K Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Y Huang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - H K Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - W Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - L P Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Wu YK(A, Yu CC, Lin JL. A Rare Cause of Recurrent Cardiogenic Shock and Flash Pulmonary Edema-Concealed Atrial Lead Dysfunction. Acta Cardiol Sin 2023; 39:488-491. [PMID: 37229335 PMCID: PMC10203716 DOI: 10.6515/acs.202305_39(3).20230129a] [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] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/29/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Yuan-Kun (Aden) Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
| | - Chih-Chieh Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei
| | - Jiunn-Lee Lin
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei
- Cardiovascular Center, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan
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Chiang CE, Hung CL, Wu YW, Lin TH, Ueng KC, Sung SH, Wu CK, Chao TH, Lin HJ, Lin YH, Huang JL, Chen MYC, Lin PL, Chao TF, Cheng HM, Liu ME, Wang TD, Yeh HI, Li YH, Liu PY, Yin WH, Hsieh IC, Wang CC, Chen CH, Chu PH, Lin SJ, Yeh SJ, Lin JL, Hwang JJ, Hung HF, Chen WJ, Hou CJY. 2023 Consensus of Taiwan Society of Cardiology on the Pharmacological Treatment of Chronic Heart Failure. Acta Cardiol Sin 2023; 39:361-390. [PMID: 37229331 PMCID: PMC10203721 DOI: 10.6515/acs.202305_39(3).20230301a] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 05/27/2023]
Abstract
The prevalence of heart failure is increasing, causing a tremendous burden on health care systems around the world. Although mortality rate of heart failure has been significantly reduced by several effective agents in the past 3 decades, yet it remains high in observational studies. More recently, several new classes of drugs emerged with significant efficacy in reducing mortality and hospitalization in chronic heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). To integrate these effective therapies and prioritize them in the management of Asian patients, Taiwan Society of Cardiology has recently appointed a working group to formulate a consensus of pharmacological treatment in patients with chronic heart failure. Based on most updated information, this consensus provides rationales for prioritization, rapid sequencing, and in-hospital initiation of both foundational and additional therapies for patients with chronic heart failure.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
- Institute of Biomedical Sciences, MacKay Medical College
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Kwo-Chang Ueng
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Hung-Ju Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
- National Taiwan University College of Medicine, Taipei
| | - Jin-Long Huang
- Department of Medical Education, Taichung Veterans General Hospital
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung
| | - Michael Yu Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University
| | - Hao-Min Cheng
- Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University School of Medicine
- Division of Faculty Development, Taipei Veterans General Hospital
| | - Ming-En Liu
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital
| | - Hung-I Yeh
- Departments of Internal Medicine and Medical Research, MacKay Memorial Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Ping-Yen Liu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Hsian Yin
- School of Medicine, National Yang Ming Chiao Tung University
- Heart Center, Cheng-Hsin General Hospital, Taipei
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Chun-Chieh Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Chen-Huan Chen
- School of Medicine, National Yang Ming Chiao Tung University
- Department of Medical Education, Taipei Veterans General Hospital, Taipei
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Shing-Jong Lin
- Taipei Heart Institute, Taipei Medical University
- Department of Medical Research, Taipei Veterans General Hospital, Taipei
| | - San-Jou Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
- Shuan Ho Hospital, Taipei Medical University, New Taipei City
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Huei-Fong Hung
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan
| | - Charles Jia-Yin Hou
- Department of Medicine, MacKay Medical College, New Taipei City
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
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Ma C, Lin JL, Bai R, Sun Y, Nam GB, Stewart J, Wieloch M, Zhu J. Effect of Dronedarone in the Treatment of Atrial Fibrillation in the Asian Population: Post Hoc Analysis of the ATHENA Trial. Clin Ther 2022; 44:1203-1213. [PMID: 35927094 DOI: 10.1016/j.clinthera.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/05/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Limited data are available on the impact of dronedarone treatment in Asian patients with atrial fibrillation (AF) or atrial flutter (AFL). This post hoc analysis evaluated the efficacy and safety of dronedarone compared with placebo in populations from Asian and non-Asian regions randomized in the ATHENA trial (A Placebo-Controlled, Double-blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of CV Hospitalization or Death From Any Cause in Patients With AF/AFL). METHODS Time to first hospitalization for cardiovascular events or death from any cause (primary outcome) and time to first AF/AFL event recurrence (secondary outcome) were analyzed by Kaplan-Meier curves and Cox proportional hazards regression. FINDINGS The risk of experiencing the primary composite outcome was significantly lower in the dronedarone-treated patients in both the Asian (hazard ratio = 0.541; 95% CI, 0.320-0.914]) and non-Asian (hazard ratio = 0.768; 95% CI, 0.696-0.848) populations than in the placebo-treated patients. The median time to the first AF/AFL event recurrence was longer in the dronedarone-treated population than in the placebo-treated populations: 183 vs 92 days (P = 0.165) in the Asian population and 534 vs 196 days (P < 0.001) in the non-Asian population. Treatment-emergent adverse events in Asian (81.2% vs 78.4%) and non-Asian (71.4% vs 68.7%) populations and serious treatment-emergent adverse events in Asian (14.3% vs 15.7%) and non-Asian (20.3% vs 21.5%) patients were comparable in patients taking dronedarone compared with those taking placebo. IMPLICATION Efficacy and tolerability of dronedarone were consistent in the Asian population compared with the non-Asian population in the ATHENA trial. These finding may aid Asian health care professionals to select the appropriate first-line treatment for Asian patients with AF/AFL.
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Affiliation(s)
- Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing
| | - Jiunn-Lee Lin
- Taipei Heart Institute, Taipei Medical University, Taipei
| | - Rong Bai
- Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing
| | - Yihong Sun
- China-Japan Friendship Hospital, Beijing
| | | | | | - Mattias Wieloch
- Sanofi, Paris; Center for Thrombosis and Haemostasis, Lund University, Malmö.
| | - Jun Zhu
- Emergency and Critical Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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Yan XY, Lin JL, Tian RH, Weng XQ, Wang L, Zou ZK, Li XH, Lin XD, Chen G, Hu D. [Multicenter retrospective study of 38 cases with fumarate hydratase deficiency uterine leiomyoma]. Zhonghua Fu Chan Ke Za Zhi 2022; 57:435-441. [PMID: 35775251 DOI: 10.3760/cma.j.cn112141-20220312-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma. Methods: The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results: (1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P<0.05). Conclusions: FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.
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Affiliation(s)
- X Y Yan
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - J L Lin
- Department of Pathology, the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350003, China
| | - R H Tian
- Department of Pathology, Xiamen Maternal and Child Health Hospital, Xiamen 361003, China
| | - X Q Weng
- Department of Pathology, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355099, China
| | - L Wang
- Department of Pathology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China
| | - Z K Zou
- Department of Pathology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou 363008, China
| | - X H Li
- Department of Pathology, Nanping First Hospital Affiliated to Fujian Medical University, Nanping 353023, China
| | - X D Lin
- Laboratory of Radiobiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - G Chen
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - D Hu
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
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Wei Y, Lin JL, Chen G, Pei LJ. [A cohort study of association between sleep duration and cognitive impairment in the elderly aged 65 years and older in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:359-365. [PMID: 35345291 DOI: 10.3760/cma.j.cn112338-20210410-00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the effect of sleep duration on the risk of cognitive impairment in the elderly in China. Methods: Baseline data of 9 679 elderly individuals with intact cognition were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2005, and followed up was conducted until 2018. Cox proportional hazards model was used to analyze the association between different sleep durations and the risk for cognitive impairment in the elderly. Results: Compared with elderly with sleep duration of 6 hours per day, those with sleep duration less than 5 hours had increased risk for cognitive impairment by 30% (HR=1.30, 95%CI: 1.05-1.62), and those with sleep durations of 7 hours, 8 hours and more than 9 hours had increased risk for cognitive impairment by 34% (HR=1.34,95%CI: 1.09-1.64), 40% (HR=1.40,95%CI: 1.17-1.69) and 43% (HR=1.43,95%CI: 1.19-1.70), respectively. Trend test showed that the risk of cognitive impairment increased with the extension of sleep duration (>6 h), and there was a dose-response relationship (P<0.001). However, self-rated sleep quality was not associated with the risk for cognitive impairment in the elderly. Conclusions: The shorter and longer sleep duration were associated an increased risk of cognitive impairment in the elderly aged ≥65 years in China, suggesting that optimizing sleep duration might delay the occurrence of cognitive impairment.
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Affiliation(s)
- Y Wei
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - J L Lin
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - G Chen
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - L J Pei
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
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Liang L, Wu CY, Zhang LP, Hou LK, Dong ZW, Wu W, Lin JL, Huang Y, Xie HK. [Clinicopathological and genetic characteristics of bronchial sialadenoma papilliferum: report of four cases]. Zhonghua Bing Li Xue Za Zhi 2022; 51:212-217. [PMID: 35249284 DOI: 10.3760/cma.j.cn112151-20210727-00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To investigate the clinicopathological, immunophenotypic, and molecular genetic features of bronchial sialadenoma papilliferum (BSP). Methods: Four cases of BSP collected at the Shanghai Pulmonary Hospital from May 2018 to June 2021 were retrieved and analyzed. These cases were evaluated for their clinical, histological, immunohistochemical (IHC) and genomic features. The patients were followed up and relevant literature was reviewed. Results: All four patients were male, aged from 55 to 75 years (mean 62 years), with tumor diameter of 6 to 21 mm (mean 13.5 mm), and lesions were located in the left lower lobe (n=2), right lower lobe (n=1), and trachea (n=1). They were characterized by a combination of surface exophytic endobronchial papillary proliferation and an endophytic two-cell layered ductal structure. IHC staining showed that CK7 and EMA were strongly positive in ductal epithelium; p63, p40, CK5/6 were positive in ductal and papillary basal cells; SOX10 was positive in ductal epithelium and basal cells; S-100 was positive in basal cells and ductal epithelium in two cases. Next generation sequencing showed that two cases harbored BRAF V600E mutation. Conclusions: BSP is an extremely rare primary lung tumor arising from the salivary gland under bronchial mucosa. The primary treatment choice of this tumor is complete surgical resection. The diagnosis and differential diagnosis of this tumor depend on classic histomorphologic and IHC features, and BRAF V600E gene mutation can be detected.
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Affiliation(s)
- L Liang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - C Y Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - L P Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - L K Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Z W Dong
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - W Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - J L Lin
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Y Huang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - H K Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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9
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Chang SN, Lin JW, Wang YC, Wu CK, Cheng JJ, Hwang JJ, Lin JL, Chiang FT, Chen YS, Hsu RB, Chen W, Chen JJ, Lien WP. The Sequential Change in Left Ventricular Function among Various Cardiovascular Diseases: A 12-Year Study. J Pers Med 2022; 12:jpm12030415. [PMID: 35330415 PMCID: PMC8950536 DOI: 10.3390/jpm12030415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This 12-year study aimed to compare the longitudinal change in left ventricular diastolic dysfunction (LVDD) between healthy elderly, coronary artery disease (CAD), and hypertension (HTN) patients. Methods: From 2008 to 2020, 1476 patients were included, and 3181 echocardiography examinations were conducted. Finally, 130 participants (36 healthy elderly (79.39 ± 9.51 years old), 51 with CAD (68.31 ± 12.09 years old), and 43 with HTN (68.31 ± 12.09 years old)) with more than a 10-year follow-up period were included in the final analysis. Results: The change in diastolic function was different among these subjects according to the integrated score index (elderly vs. HTN, p = 0.01; CAD vs. HTN, p = 0.01), septal E/e′ ratio (elderly vs. HTN, p < 0.001; CAD vs. HTN, p = 0.01), lateral E/e′ ratio (elderly vs. HTN, p < 0.001; CAD vs. HTN, p < 0.001), and NYHA functional class (elderly vs. HTN, p = 0.03; CAD vs. HTN, p < 0.001). Additionally, per one-year increase in age, the integrated score index increased 0.2 in the healthy elderly, 0.15 in the CAD, and 0.06 in the HTN patients (all p < 0.05). Conclusion: Under aggressive treatment, diastolic function was relatively preserved in HTN subjects with aging in comparison with elderly and CAD subjects.
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Affiliation(s)
- Sheng-Nan Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin City 640, Taiwan; (S.-N.C.); (J.-W.L.)
| | - Jou-Wei Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin City 640, Taiwan; (S.-N.C.); (J.-W.L.)
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
| | - Jun-Jack Cheng
- Division of Cardiology, Shin-Kong Wu-Ho Su Memorial Hospital, Taipei City 111, Taiwan;
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
- Division of Cardiology, Department of Internal Medicine, Fu-Jen Catholic University Hospital, Fu-Jen Catholic University, New Taipei City 243, Taiwan
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-S.C.); (R.-B.H.)
| | - Ron-Bin Hsu
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-S.C.); (R.-B.H.)
| | | | - Jin-Jer Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
| | - Wen-Pin Lien
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City 100, Taiwan; (Y.-C.W.); (C.-K.W.); (J.-J.H.); (J.-L.L.); (F.-T.C.); (J.-J.C.)
- Correspondence: ; Tel.: +886-2-23562668; Fax: +886-2-82317099
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Liu YH, Lin JL. EARLY PREDICTION OF SURVIVAL TO DISCHARGE AND NEUROLOGICAL OUTCOME IN PATIENTS WITH NON-TRAUMATIC SUDDEN CARDIAC ARREST AFTER RETURN OF SPONTANEOUS CIRCULATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Lin JL, Wei Y, Chen G, Lin SQ, Pei LJ. [A cohort study on the influence of the chronic diseases on falls among middle-aged and older Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:218-226. [PMID: 35184488 DOI: 10.3760/cma.j.cn112338-20210506-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To analyze the influence of chronic diseases on falls among middle-aged and older Chinese. Methods: Baseline data of 13 670 middle-aged and older adults recruited from China Health and Retirement Longitudinal Study (CHARLS) in 2011 were used and followed up to 2018, among those were 7 443 (54.45%) middle-aged people aged 45-59 and 6 227 (45.55%) older adults aged 60 and above. The Cox proportional hazards model was used to analyze the effects of different types, the number of chronic diseases and the interaction between chronic illness and other factors on the fall risk of middle-aged and older people. Results: After adjusting for confounding factors, respiratory diseases increased the risk of falls by 21% (HR=1.21, 95%CI:1.02-1.45), and arthritis increased the risk of falls by 27% (HR=1.27,95%CI: 1.12-1.43) in the group aged 45-59, kidney disease increased the risk of falls by 26% (HR=1.26, 95%CI: 1.03-1.53) in the group aged 60 and above. A linear dose-response relationship between the number of chronic diseases and fall risk (χ2=133.61, P<0.001) was found in all the age groups. The interaction between having chronic diseases and the factors of females (HR=1.64, 95%CI: 1.43-1.89), impaired activities of daily living (ADL) (HR=1.66, 95%CI: 1.39-1.99), and having a fall history (HR=2.58, 95%CI: 2.24-2.97) increased the risk of falls. Conclusions: There is a positive linear relationship between the number of chronic diseases and the fall risk among Chinese aged 45 and above. The female middle-aged and elderly patients with chronic diseases and the middle-aged and elderly patients with impaired ADL or a history of falls are the high-risk groups for falls that need to be focused on intervention. The window of fall injury prevention should be moved forward to the middle-aged stage in time.
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Affiliation(s)
- J L Lin
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - Y Wei
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - G Chen
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - S Q Lin
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - L J Pei
- Institute of Population Research/Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
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12
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Wei Y, Lin JL, Chen G, Pei LJ. [Association between sleep duration and cognitive impairment in Chinese people aged 65 years and older]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:2138-2142. [PMID: 34954977 DOI: 10.3760/cma.j.cn112338-20201106-01313] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the association between sleep duration and cognitive impairment in older adults in China. Methods: The data was from 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). According to the Chinese version of Mini-mental State Examination (CMMSE), 7 111 subjects aged 65 and above were divided into cognitive impaired group and cognitive intact group. Multiple logistic regression analysis was conducted to investigate the association between sleep duration and the risk of cognitive impairment after adjusting the potential confounding factors. Result: The score of cognitive function showed an inverted U-shape distribution with sleep duration. After adjusting for demographic, socioeconomic factors, lifestyle and health status, the OR were 1.21(95%CI: 0.90-1.64) and 1.41(95%CI: 1.06-1.86) in groups that sleep 8 h and ≥9 h per day respectively, compared with sleep 7 h group. Trend test showed that the risk of cognitive impairment in the elderly increased with the extension of sleep duration, and there was a dose-response relationship (trend P=0.017), while no association was observed between short sleep duration (<7 h) and cognitive function. Conclusion: Longer sleep duration was found to be associated with higher risk of cognitive impairment in the Chinese aged 65 years and older.
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Affiliation(s)
- Y Wei
- Institute of Population Research, Peking University; Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - J L Lin
- Institute of Population Research, Peking University; Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - G Chen
- Institute of Population Research, Peking University; Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
| | - L J Pei
- Institute of Population Research, Peking University; Chinese Center for Population Health and Development, Peking University, Beijing 100871, China
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13
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Lin JL, Chen PS, Li YH. Less statin associated adverse events after initiation of pitavastatin compared with atorvastatin and rosuvastatin. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Statin associated adverse events (SAAEs), including hepatitis, myopathy and new onset diabetes mellitus (NODM), are major reasons that prevent the use of statins. We compared the risk of SAAEs among the commonly used statins to see if SAAEs were similar among the statins.
Methods
We retrieved data from the Taiwan National Health Insurance Research Database. From January 2013 to December 2017, all statin-treated patients without diabetes at baseline were enrolled. We classified eligible patients into pitavastatin (2–4mg/day), moderate-intensity statin (MIS [atorvastatin 10–20 mg/day or rosuvastatin 5–10 mg/day]), and high-intensity statin group (HIS [atorvastatin ≥40 mg/day and rosuvastatin ≥20mg/day]). The study endpoint is a composite of safety events, including hepatitis, myopathy, and NODM. All patients were followed-up for at least one year until December 2018. We used propensity score to balance the baseline differences between the 3 statin groups (N=50935 in each group).
Results
After a mean follow up time of 3.08 years, the safety events occurred in 5014 patients in pitavastatin group (9.84%), 5542 in MIS group (10.88%), and 5343 in HIS group (10.49%). Multivariate Cox proportional hazards model showed that MIS and HIS statins were associated with a higher risk of safety events compared with pitavastatin (adjusted hazard ratio [aHR] 1.122, 95% confidence interval [CI] 1.08–1.17 for MIS and aHR 1.056, 95% CI 1.02–1.10 for HIS). Most events were NODM, with 4818 events in pitavastatin (9.46%), 5284 in MIS (10.37%), and 5113 in HIS group (10.04%). Multivariate Cox proportional hazard analysis showed higher risk of NODM in MIS (adjusted HR 1.111, 95% CI 1.07–1.16) and HIS (aHR 1.050, 95% CI 1.01–1.10) compared with pitavastatin. Time-varying HR analysis showed increased risk of NODM with use of all these statins for more than 1 year compared with non-statin users.
Conclusions
Pitavastatin was associated with a lower risk of SAAEs, especially NODM, compared with atorvastatin and rosuvastatin.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Orient EuroPharma Co., Ltd.
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Affiliation(s)
- J L Lin
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - P S Chen
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Y H Li
- National Cheng Kung University Hospital, Tainan, Taiwan
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14
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Huang PS, Cheng JF, Ko WC, Chang SH, Lin TT, Chen JJ, Chiu FC, Lin LY, Lai LP, Lin JL, Tsai CT. Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study. Sci Rep 2021; 11:18250. [PMID: 34521870 PMCID: PMC8440502 DOI: 10.1038/s41598-021-95975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/31/2021] [Indexed: 02/08/2023] Open
Abstract
There has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study (TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p < 0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia-Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.
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Affiliation(s)
- Pang-Shuo Huang
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC ,grid.412094.a0000 0004 0572 7815Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Fang Cheng
- grid.454740.6Division of Cardiology, Department of Internal Medicine, Ministry of Health and Welfare Pingtung Hospital, Pintung County, Taiwan, ROC ,grid.412094.a0000 0004 0572 7815Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Ko
- grid.413535.50000 0004 0627 9786Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Shu-Hsuan Chang
- grid.415323.20000 0004 0639 3300Division of Cardiology, Department of Internal Medicine, Mennonite Christian Hospital, Hualien, Taiwan, ROC
| | - Tin-Tse Lin
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan, ROC
| | - Jien-Jiun Chen
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC
| | - Fu-Chun Chiu
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC
| | - Lian-Yu Lin
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital , Taipei City, 100 Taiwan, ROC ,grid.412094.a0000 0004 0572 7815Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ping Lai
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital , Taipei City, 100 Taiwan, ROC ,grid.412094.a0000 0004 0572 7815Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital , Taipei City, 100 Taiwan, ROC ,grid.412094.a0000 0004 0572 7815Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan ,grid.412955.e0000 0004 0419 7197Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chia-Ti Tsai
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital , Taipei City, 100 Taiwan, ROC ,grid.412094.a0000 0004 0572 7815Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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15
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Ho LT, Chen JLY, Chan HM, Huang YC, Su MY, Kuo SH, Chang YC, Lin JL, Chen WJ, Lee WJ, Lin LY. First Asian population study of stereotactic body radiation therapy for ventricular arrhythmias. Sci Rep 2021; 11:10360. [PMID: 33990651 PMCID: PMC8121933 DOI: 10.1038/s41598-021-89857-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/20/2020] [Accepted: 04/22/2021] [Indexed: 12/31/2022] Open
Abstract
We report the first Asian series on stereotactic body radiation (SBRT) for refractory ventricular arrhythmia (VA) in Taiwanese patients. Three-dimensional electroanatomic maps, delayed-enhancement magnetic resonance imaging (DE-MRI), and dual-energy computed tomography (CT) were used to identify scar substrates. The main target volume was treated with a single radiation dose of 25 Gy and the margin volume received 20 Gy using simultaneous integrated boost delivered by the Varian TrueBeam system. Efficacy was assessed according to VA events recorded by an implantable cardioverter-defibrillator (ICD) or a 24-h Holter recorder. Pre- and post-radiation therapy imaging studies were performed. From February 2019 to December 2019, seven patients (six men, one woman; mean age, 55 years) were enrolled and treated. One patient died of hepatic failure. In the remaining six patients, at a median follow-up of 14.5 months, the VA burden and ICD shocks significantly decreased (only one patient with one ICD shock after treatment). Increased intensity on DE-MRI might be associated with a lower risk for VA recurrence, whereas dual-energy CT had lower detection sensitivity. No acute or minimal late adverse events occurred. In patients with refractory VA, SBRT is associated with a marked reduction in VA burden and ICD shocks, and DE-MRI might be useful for monitoring treatment effects.
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Affiliation(s)
- Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Jenny Ling-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Hsing-Min Chan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Yu-Cheng Huang
- Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Yeun-Chung Chang
- Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Jiunn-Lee Lin
- Cardiovascular Center, Taipei Medical University Shuang Ho Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Wen-Jeng Lee
- Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan. .,Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.
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16
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Pham VT, Lin C, Tran TT, M Su MY, Lin YK, Nien CT, I Tseng WY, Lin JL, Lo MT, Lin LY. Predicting ventricular tachyarrhythmia in patients with systolic heart failure based on texture features of the gray zone from contrast-enhanced magnetic resonance imaging. J Cardiol 2020; 76:601-609. [PMID: 32675026 DOI: 10.1016/j.jjcc.2020.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous research showed that gray zone detected by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging could help identify high-risk patients. In this study, we investigated whether LGE-CMR gray zone heterogeneity measured by image texture features could predict cardiovascular events in patients with heart failure (HF). METHOD This is a retrospective cohort study. Patients with systolic HF undergoing CMR imaging were enrolled. Cine and LGE images were analyzed to derive left ventricular (LV) function and scar characteristics. Entropy and uniformity of gray zones were derived by texture analysis. RESULTS A total of 82 systolic HF patients were enrolled. After a median 1021 (25%-75% quartiles, 205-2066) days of follow-up, the entropy (0.60 ± 0.260 vs. 0.87 ± 0.28, p = 0.013) was significantly increased while the uniformity (0.68 ± 0.14 vs. 0.53±0.15, p = 0.016) was significantly decreased in patients with ventricular tachycardia or ventricular fibrillation (VT/VF). The percentage of core scar (21.9 ± 10.6 vs. 30.6 ± 10.4, p = 0.029) was higher in cardiac mortality group than survival group while the uniformity (0.55 ± 0.17 vs. 0.67 ± 0.14, p = 0.018) was lower in cardiac mortality group than survival group. A multivariate Cox regression model showed that higher percentage of gray zone area (HR = 8.805, 1.620-47.84, p = 0.045), higher entropy (>0.85) (HR = 1.391, 1.092-1.772, p = 0.024) and lower uniformity (≦0.54) (HR = 0.535, 0.340-0.842, p = 0.022) were associated with VT/VF attacks. Also, higher percentage of gray zone area (HR = 5.716, 1.379-23.68, p = 0.017), core scar zone (HR = 1.939, 1.056-3.561, p = 0.025), entropy (>0.85) (HR = 1.434, 1.076-1.911, p = 0.008) and lower uniformity (≦0.54) (HR = 0.513, 0.296-0.888, p = 0.009) were associated with cardiac mortality during follow-up. CONCLUSIONS Gray zone heterogeneity by texture analysis method could provide additional prognostic value to traditional LGE-CMR substrate analysis method.
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Affiliation(s)
- Van-Truong Pham
- School of Electrical Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam; Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
| | - Thi-Thao Tran
- School of Electrical Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam; Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Mao-Yuan M Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Kuang Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan; Department of Medicine, Taiwan Landseed Hospital, Taoyuan, Taiwan
| | - Chun-Tung Nien
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan; Department of Medicine, Taiwan Landseed Hospital, Taoyuan, Taiwan
| | - Wen-Yih I Tseng
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Center for Optoelectronic Biomedicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
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Jimmy Juang JM, Liu YB, Julius Chen CY, Yu QY, Chattopadhyay A, Lin LY, Chen WJ, Yu CC, Huang HC, Ho LT, Lai LP, Hwang JJ, Lin TT, Liao MT, Chen JJ, Sherri Yeh SF, Chuang JY, Yang DH, Lin JL, Lu TP, Chuang EY, Ackerman MJ. Validation and Disease Risk Assessment of Previously Reported Genome-Wide Genetic Variants Associated With Brugada Syndrome: SADS-TW BrS Registry. Circ Genom Precis Med 2020; 13:e002797. [PMID: 32490690 PMCID: PMC7439932 DOI: 10.1161/circgen.119.002797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is an oligogenic arrhythmic disease with increased risk of sudden cardiac arrest. Several BrS or ECG traits-related single-nucleotide polymorphisms (SNPs) were identified through previous genome-wide association studies in white patients. We aimed to validate these SNPs in BrS patients in the Taiwanese population, assessing the cumulative effect of risk alleles and the BrS-polygenic risk score in predicting cardiac events. METHODS We genotyped 190 unrelated BrS patients using the TWB Array, and Taiwan Biobank was used as controls. SNPs not included in the array were imputed by IMPUTE2. Cox proportional hazards model was used to evaluate the associations between each particular SNP, the collective BrS-polygenic risk score, and clinical outcomes. RESULTS Of the 88 previously reported SNPs, 22 were validated in Taiwanese BrS patients (P<0.05). Of the 22 SNPs, 2 (rs10428132 and rs9388451) were linked with susceptibility to BrS, 10 were SNPs previously reaching genome-wide significance, and 10 were SNPs associated with ECG traits. For the 3 most commonly reported SNPs, disease risk increased consistently with the number of risk alleles (odds ratio, 3.54; Ptrend=1.38×10-9 for 5 risk alleles versus 1). Similar patterns were observed in both SCN5A mutation+ (odds ratio, 3.66; Ptrend=0.049) and SCN5A mutation- (odds ratio, 3.75; Ptrend=8.54×10-9) subgroups. Furthermore, BrS patients without SCN5A mutations had more risk alleles than BrS patients with SCN5A mutations regardless of the range of polygenic risk scores. Three SNPs (rs4687718, rs7784776, and rs2968863) showed significant associations with the composite outcome (sudden cardiac arrest plus syncope, hazard ratio, 2.13, 1.48, and 0.41; P=0.02, 0.006, and 0.008, respectively). CONCLUSIONS Our findings suggested that some SNPs associated with BrS or ECG traits exist across multiple populations. The cumulative risk of the BrS-related SNPs is similar to that in white BrS patients, but it appears to correlate with the absence of SCN5A mutations.
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Affiliation(s)
- Jyh-Ming Jimmy Juang
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Yen-Bin Liu
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Ching-Yu Julius Chen
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Qi-You Yu
- Institute of Epidemiology and Preventive Medicine, Department of Public Health (Q.-Y.Y., A.C., T.-P.L.), National Taiwan University, Taipei
| | - Amrita Chattopadhyay
- Institute of Epidemiology and Preventive Medicine, Department of Public Health (Q.-Y.Y., A.C., T.-P.L.), National Taiwan University, Taipei
| | - Lian-Yu Lin
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Wen-Jone Chen
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Chih-Chien Yu
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Hui-Chun Huang
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Li-Ting Ho
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Ling-Ping Lai
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (J.-M.J.J., Y.-B.L., C.-Y.J.C., L.-Y.L., W.-J.C., C.-C.Y., H.-C.H., L.-T.H., L.-P.L.)
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch (J.-J.H., J.-J.C.)
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine (T.-T.L., M.-T.L.), National Taiwan University Hospital Hsin-Chu Branch, Taipei
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine (T.-T.L., M.-T.L.), National Taiwan University Hospital Hsin-Chu Branch, Taipei
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch (J.-J.H., J.-J.C.)
| | - Shih-Fan Sherri Yeh
- Department of Environmental and Occupational Medicine (S.-F.S.Y.), National Taiwan University Hospital Hsin-Chu Branch, Taipei
| | - Jing-Yuan Chuang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung (J.-Y.C.)
| | - Dun-Hui Yang
- Department of Radiology, Tainan Municipal Hospital (D.-H.Y.)
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan (J.-L.L.)
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, Department of Public Health (Q.-Y.Y., A.C., T.-P.L.), National Taiwan University, Taipei
| | - Eric Y Chuang
- Graduate Institute of Biomedical Electronics and Bioinformatics (E.Y.C.), National Taiwan University, Taipei
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), Molecular Pharmacology and Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN (M.J.A.)
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18
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He J, Zhou WJ, Shi J, Lin JL, Zhang BQ, Sun ZH. [Analysis of genotypes, EEG and phenotypes of tuberous sclerosis complex patients]. Zhonghua Yi Xue Za Zhi 2020; 100:136-140. [PMID: 31937054 DOI: 10.3760/cma.j.issn.0376-2491.2020.02.011] [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] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Tuberous sclerosis complex (TSC) is a multi-system disease with TSC1 and TSC2 genes as the pathogenic genes. The purpose of our study was to analyze the gene mutation in patients with TSC with epilepsy as the main clinical manifestation. The relationship between genotype and phenotype, scalp EEG in patients was analyzed. Methods: The peripheral blood was extracted from 43 patients and their families. TSC gene was detected by second-generation sequencing. Long-term video EEG monitoring and MRI examination were performed to determine the onset area, seizure type and location of nodules. Results: 39 patients had TSC gene mutation, 4 patients did not detect the gene mutation.11 had TSC1 mutations and 28 had TSC2 mutations. 22 mutations were de novo. Patients with TSC2 mutations had earlier seizure and more nodules than patients with TSC1 mutations, but no significant difference in intelligence and spasm were observed. 28 patients had focal origin of scalp EEG, of which 85.7% of TSC2 mutations patients had focal origin. Conclusions: Patients of TSC2 mutations always has an early onset age. Although MRI shows multiple nodules, the onset of EEG is mainly focal origin.
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Affiliation(s)
- J He
- Department of Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing 100049, China
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19
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Yeh CH, Juan CH, Yeh HM, Wang CY, Young HWV, Lin JL, Lin C, Lin LY, Lo MT. The critical role of respiratory sinus arrhythmia on temporal cardiac dynamics. J Appl Physiol (1985) 2019; 127:1733-1741. [PMID: 31647722 DOI: 10.1152/japplphysiol.00262.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Temporal cardiac properties provide alternative information in analyzing heart rate variability (HRV), which may be disregarded by the standard HRV analyses. Patients with congestive heart failure (CHF) are known to have distinct temporal features from the healthy individuals. However, the underlying mechanism leading to the variation remains unclear. Whether or not these parameters can finely classify the severity for CHF patients is uncertain as well. In this work, an electrocardiogram was monitored in advanced CHF patients using 24-h Holter in four conditions, including baseline, one and three months after atenolol therapy, and healthy individuals. Slope and area under the curve (AUC) of multiscale entropy (MSE) curve over short (scales 1-5) and long (scales 6-20) scales, and detrended fluctuation analysis (DFA) scaling exponents at short (4-11 beats) and intermediate (>11 beats) window sizes were calculated. The results show that short-time scale MSE-derived parameters (slope: -0.08 ± 0.10, -0.03 ± 0.10, 0.02 ± 0.06, 0.08 ± 0.06; AUC: 4.03 ± 2.11, 4.69 ± 1.28, 4.73 ± 0.94, and 6.17 ± 1.23) and short-time scale DFA exponent (0.79 ± 0.16, 0.95 ± 0.22, 1.11 ± 0.19, and 1.35 ± 0.20) can hierarchically classify all four conditions. More importantly, simulated R-R intervals with different fractions and amplitude of respiratory sinus arrhythmia (RSA) components were examined to validate our hypothesis regarding the essentiality of RSA in the improvement of cardiovascular function, and its tight association with unpredictability and fractal property of HRV, which is in line with our hypothesis that RSA contributes significantly to the generation of the unpredictability and fractal behavior of HR dynamics.NEW & NOTEWORTHY Temporal cardiac properties provide useful diagnostic parameters for patients with congestive heart failure (CHF). Our study hierarchically classified CHF patients with β-blocker treatment by using multiscale entropy and detrended fluctuation analysis. Also, we provided the evidence to validate the critical role of respiratory sinus arrhythmia in the fractal properties of heart rate variability.
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Affiliation(s)
- Chien-Hung Yeh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Chung-Hau Juan
- Department of Biomedical Sciences, National Central University, Taoyuan, Taiwan.,Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Huei-Ming Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yen Wang
- Department of Biomedical Sciences, National Central University, Taoyuan, Taiwan
| | - Hsu-Wen Vincent Young
- Department of Biomedical Sciences, National Central University, Taoyuan, Taiwan.,Department of Applied Mathematics, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences, National Central University, Taoyuan, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences, National Central University, Taoyuan, Taiwan
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20
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Chiang JY, Fu CM, Lin YC, Ku BW, Hsu SU, Wu CK, Lin LY, Lin JL, Chiang FT, Juang JM. P1880Entropy-based algorithm for atrial fibrillation detection using photoplethysomgraphic signal recorded by a smart watch. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most common arrhythmia, and its paroxysmal and short duration nature makes its detection challenging. The most important limitation of current smartwatches is that patients need to touch to the sensor of the watch to record signals when patients feel discomfort. We developed a wearable smart watch and evaluated its accuracy to differentiate AF from sinus rhythm, which can continuously detecting heart rhythm without hand touching the device.
Methods and results
A wearable smart watch with PPG sensor and electrocardiogram (ECG) recording function was used for signal acquisition. A total 399 patients with a mean age of 67 years old were enrolled in the study, of whom 237 (81.5%) were male, and 101 have been diagnosed with AF. Pulse wave extracted from the green light spectrum of the signal and ECG were recorded for about 10 minutes for each patient. Pulse-to-pulse intervals (PPI) were automatically identified. All ECG signals were verified by two cardiologists. The correlation between R-to-R interval on ECG and PPI were excellent, with a correlation coefficient R >0.99 (p<0.05). An entropy-based algorithm which combined Shannon entropy of successive difference of PPI and sample entropy of PPI was used to discriminate between AF and sinus rhythm. This method had high sensitivity and specificity (96% and 98%, respectively), the area under receiver operating characteristic curve reached 0.98.
Conclusions
We developed an entropy-based algorithm for AF detection with PPG signal recorded by a wearable smart watch. This algorithm discriminates AF from sinus rhythm accurately. This advance in technology overcomes an important clinical obstacle and can increase the AF detection rate tremendously.
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Affiliation(s)
- J Y Chiang
- National Taiwan University Hospital, Internal medicine, Taipei, Taiwan
| | - C M Fu
- MediaTek Inc, Taipei, Taiwan
| | - Y C Lin
- MediaTek Inc, Taipei, Taiwan
| | - B W Ku
- MediaTek Inc, Taipei, Taiwan
| | - S U Hsu
- MediaTek Inc, Taipei, Taiwan
| | - C K Wu
- MediaTek Inc, Taipei, Taiwan
| | - L Y Lin
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
| | - J L Lin
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
| | - F T Chiang
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
| | - J M Juang
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
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21
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Juang JM, Chen CY, Liu YB, Lin LY, Ho LT, Huang HC, Lai LP, Hwang JJ, Wu CK, Lin TT, Yu CC, Lu TP, Chattopadhyay A, Yu QY, Lin JL. P1604Validating previously reported Brugada syndrome-associated common variants identified in caucasian population in the Han Chinese BrS cohort in Taiwan: SADS-BrS registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Brugada syndrome (BrS) is a sudden arrhythmic death. The prevalence of BrS is higher in the Southeast Asian populations than that in Caucasian patients. A previous genome-wide association study (GWAS) has reported 13 SNPs significantly associated with BrS. However, no study was performed to validate whether these SNPs are enriched in BrS patients in Han Chinese (HC).
Purpose
Evaluating the common variants previously reported in Caucasian BrS patients could be generalized to HC BrS patients in Taiwan
Methods
We genotyped 200 unrelated BrS patients using Affymetrix TWB Array (N=653,291 SNPs, a customized array for HC in Taiwan). The controls are obtained from the Taiwan Biobank (N ≈ 16,000) using the same array. An imputation workflow was shown in Figure 1. To confirm the accuracy of the imputed genotype of each variant, Sanger sequencing was performed in 10% of randomly selected cases.
Results
Among the 3 most important common variants (rs11708996 in SCN5A, rs10428132 in SCN10A and rs9388451 in HEY2/NCOA7) reported in the previous GWAS mainly conducted in Caucasian BrS patients, 2 of them (rs10428132 and rs9388451) were successfully replicated in the HC population in Taiwan (P<0.01). We also found that the differences of minor allele frequency (dMAF: the MAF of cases minus the MAF of controls) of the two variants were relatively smaller between the BrS cases and healthy controls in HC population compared with that in Caucasian populations (dMAF, rs9388451: 0.15 (Caucasian) vs −0.07 (HC); rs10428132: 0.28 (Caucasian) vs 0.11 (HC)). For the remaining 10 common variants reaching genome-wide significance (P=5×10–8) in Caucasian BrS patients, 9 of them were also significantly enriched in the HC BrS patients after the Bonferroni correction (P<0.05/12=0.0042). We next analyzed the variants identified in the previous GWAS on ECG traits (PR interval, QRS duration, QTc interval, and heart rate) in the Caucasian population. Among the reported 75 variants associated with ECG traits, 5 common variants (rs6798015 (PR), rs1760876 (QRS), rs6795970 (PR/QRS), rs2074238 (QTc) and rs314370 (heart rate)) were significant after Bonferroni correction (P<0.05/75=0.00066).
Figure 1
Conclusions
The preliminary results indicated that 85% of common variants of SCN10A and HEY2/NCOA7 previously reported in Caucasian BrS patients are replicated in BrS patients in the HC population but not the common variant of SCN5A (rs11708996). Furthermore, the common variants of SCN10A and HEY2/NCOA7 related to cardiac depolarization or repolarization may also contribute to the development of BrS.
Acknowledgement/Funding
NTUH 106-S3469, NTUH106-S3458 and NTUH 106-018
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Affiliation(s)
- J.-M Juang
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - C Y Chen
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - Y B Liu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - L Y Lin
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - L T Ho
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - H C Huang
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - L P Lai
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - J J Hwang
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - C K Wu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - T T Lin
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - C C Yu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - T P Lu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - A Chattopadhyay
- National Taiwan University, Bioinformatics and Biostatistics Core, Center of Genomic Medicine, Taipei, Taiwan
| | - Q Y Yu
- National Taiwan University, Bioinformatics and Biostatistics Core, Center of Genomic Medicine, Taipei, Taiwan
| | - J L Lin
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
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22
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Li YH, Chen JW, Lin TH, Wang YC, Wu CC, Yeh HI, Huang CC, Chang KC, Wu CK, Chen PW, Huang CW, Chen ZC, Chang WT, Huang WC, Wang CY, Lee MY, Chao AC, Fu WR, Tsai LK, Tang SC, Chan HL, Yang YC, Wu YW, Hwang JJ, Lin JL. A performance guide for major risk factors control in patients with atherosclerotic cardiovascular disease in Taiwan. J Formos Med Assoc 2019; 119:674-684. [PMID: 31113748 DOI: 10.1016/j.jfma.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/12/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease, cerebrovascular disease, and peripheral artery disease, carries a high morbidity and mortality. Risk factor control is especially important for patients with ASCVD to reduce recurrent cardiovascular events. Clinical guidelines have been developed by the Taiwan Society of Cardiology, Taiwan Society of Lipids and Atherosclerosis, and Diabetes Association of Republic of China (Taiwan) to assist health care professionals in Taiwan about the control of hypertension, hypercholesterolemia and diabetes mellitus. This article is to highlight the recommendations about blood pressure, cholesterol, and sugar control for ASCVD. Some medications that are beneficial for ASCVD were also reviewed. We hope the clinical outcomes of ASCVD can be improved in Taiwan through the implementation of these recommendations.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital and Institute of Pharmacology, National Yang Ming University, Taipei, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital, China Medical University College of Medicine and Hospital, Taichung, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-I Yeh
- Department of Internal Medicine and Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chin-Chou Huang
- Department of Medical Education, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Wei Huang
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Chun Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - A-Ching Chao
- Department of Neurology, Kaohsiung Medical University Hospital, Taiwan; Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ren Fu
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Lung Chan
- Department of Family Medicine, Mackay Memorial Hospital, Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Wen Wu
- Cardiology Division, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Juey-Jen Hwang
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin, Yun-Lin, Taiwan.
| | - Jiunn-Lee Lin
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
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23
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Chan NY, Mok NS, Yuen HC, Lin LY, Yu CC, Lin JL. Cryoablation with an 8-mm tip catheter in the treatment of atrioventricular nodal re-entrant tachycardia: results from a randomized controlled trial (CRYOABLATE). Europace 2018; 21:662-669. [DOI: 10.1093/europace/euy225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/18/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Rm 223, Block J, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Ngai-Shing Mok
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Rm 223, Block J, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Ho-Chuen Yuen
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Rm 223, Block J, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Chih-Chieh Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
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24
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Li YH, Wang YC, Wang YC, Liu JC, Lee CH, Chen CC, Hsieh IC, Kuo FY, Huang WC, Sung SH, Chiu CZ, Hsu JC, Jen SL, Hwang JJ, Lin JL. 2018 Guidelines of the Taiwan Society of Cardiology, Taiwan Society of Emergency Medicine and Taiwan Society of Cardiovascular Interventions for the management of non ST-segment elevation acute coronary syndrome. J Formos Med Assoc 2018; 117:766-790. [PMID: 30017533 DOI: 10.1016/j.jfma.2018.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
In Taiwan, the incidence of non-ST segment elevation acute coronary syndrome (NSTE-ACS) continues to increase in recent years. The purpose of this guideline is to help health care professionals in Taiwan to use adequate tests and treatments for management of NSTE-ACS. For rapid diagnosis, in addition to history and physical examination, 0/3 h rapid diagnosis protocol with high sensitivity cardiac troponin assay is recommended in this guideline. Dual antiplatelet and anticoagulation therapies are important parts in the initial treatment. Risk stratification should be performed to identify high risk patients for early coronary angiography. Through evaluation of the coronary anatomy and other clinical factors, the decision for coronary revascularization, either by percutaneous coronary intervention or coronary artery bypass grafting, should be decided by the heart team. The duration of dual antiplatelet therapy should be given for at least 12 months after discharge. Other secondary preventive medications are also recommended for long term use.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital and Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Han Lee
- Department of Internal Medicine and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Chun-Chi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng-You Kuo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Wei-Chun Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chiung-Zuan Chiu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Long Jen
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital and Taipei Medical University, New Taipei City, Taiwan.
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25
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Chiang CE, Lin SY, Lin TH, Wang TD, Yeh HI, Chen JF, Tsai CT, Hung YJ, Li YH, Liu PY, Chang KC, Wang KL, Chao TH, Shyu KG, Yang WS, Ueng KC, Chu PH, Yin WH, Wu YW, Cheng HM, Shin SJ, Huang CN, Chuang LM, Lin SJ, Yeh SJ, Sheu WHH, Lin JL. 2018 consensus of the Taiwan Society of Cardiology and the Diabetes Association of Republic of China (Taiwan) on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases. J Chin Med Assoc 2018; 81:189-222. [PMID: 29453020 DOI: 10.1016/j.jcma.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 11/29/2022] Open
Abstract
The global incidence and prevalence of type 2 diabetes have been escalating in recent decades. Patients with type 2 diabetes have an increased risk of atherosclerotic cardiovascular disease (ASCVD). About two-thirds of death in type 2 diabetes are due to ASCVD, including 40% from coronary heart disease (CHD), 15% from heart failure (HF), and 10% from stroke. The association between hyperglycemia and elevated CV risk has been demonstrated in multiple cohort studies. However, clinical trials of intensive glucose reduction did not significantly reduce macrovascular outcomes. It remains unclear whether the absence of demonstrable benefits is attributed to the inclusion of patients with far advanced ASCVD in whom a short treatment period is barely enough for CV protective effects to be shown, or complications associated with the treatment such as hypoglycemia hamper the beneficial effects to manifest, or simply glucose-lowering per se is ineffective. Since the US FDA issued a mandate in December 2008 that every new anti-diabetic agent requires rigorous assessments of its CV safety, there have been more than 200,000 patients enrolled in a number of randomized controlled trials (RCTs), and around half of them have been completed and published. The results of these CV outcome trials are important for clinicians in their clinical practice, and also provide an opportunity for academic society to formulate treatment guidelines or consensus to provide specific recommendations for glucose control in various CV diseases. The Taiwan Society of Cardiology (TSOC) and the Diabetes Association of Republic of China (DAROC), aiming to formulate a treatment consensus in type 2 diabetic patients with CVD, have appointed a jointed consensus group for the 2018 Consensus of TSOC/DAROC (Taiwan) on the Pharmacological Management of Patients with Type 2 Diabetes and CV Diseases. The consensus is comprised of 5 major parts: 1) Treatment of diabetes in patients with hypertension, 2) Treatment of diabetes in patients with CHD, 3) Treatment of diabetes in patients with stage 3 chronic kidney disease, 4) Treatment of diabetes in patients with a history of stroke, and 5) Treatment of diabetes in patients with HF. The members of the consensus group comprehensively reviewed all the evidence, mainly RCTs, and also included meta-analyses, cohort studies, and studies using claim data. The treatment targets of HbA1c were provided. The anti-diabetic agents were ranked according to their clinical evidence. The consensus is not mandatory. The final decision may need to be individualized and based on clinicians' discretion.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Hung-I Yeh
- Cardiovascular Center, MacKay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Jung-Fu Chen
- Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan, ROC
| | - Yi-Jen Hung
- Division of Endocrinology and Metabolism, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan, ROC
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Division of Cardiology, Internal Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan, ROC; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, ROC
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ting-Hsing Chao
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan, ROC
| | - Kou-Gi Shyu
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Wei-Shiung Yang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Kwo-Chang Ueng
- Department of Internal Medicine, School of Medicine, Chung-Shan Medical University (Hospital), Taichung, Taiwan, ROC
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan, ROC
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Yen-Wen Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, and Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shyi-Jang Shin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Division of Metabolism and Endocrinology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Chien-Ning Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shang Medical University Hospital, Taichung, Taiwan, ROC; Institute of Medicine, Chung Shang Medical University, Taichung, Taiwan, ROC
| | - Lee-Ming Chuang
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - San-Jou Yeh
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan, ROC
| | - Wayne Huey-Herng Sheu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; College of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Institute of Medical Technology, National Chung Hsing University, Taichung, Taiwan, ROC.
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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Chen CYJ, Juang JMJ, Chen YH, Wu IC, Hsu CC, Wu RC, Chen KC, Liaw WJ, Tsai TL, Lin LY, Hwang JJ, Ho LT, Yu CC, Lee JK, Wu CK, Yeh SFS, Yang DH, Chang IS, Lai LP, Chiang FT, Lin JL, Hsiung CA. Comparisons of clinical impacts on individuals with Brugada electrocardiographic patterns defined by ISHNE criteria or EHRA/HRS/APHRS criteria: a nationwide community-based study. Ann Med 2018; 50:7-15. [PMID: 28685636 DOI: 10.1080/07853890.2017.1353222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Identifying Brugada electrocardiographic pattern (BrP) early is crucial to prevent sudden cardiac death. Two different diagnostic criteria proposed by International Society for Holter and Noninvasive Electrocardiography (ISHNE) and Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society (HRS/EHRA/APHRS) were widely used in clinical practice. The difference in prevalence and prognosis of BrP by applying the two different criteria was never studied before. METHODS This study was prospectively conducted in a nationwide large-scale stratified random sampling community-based cohort (HALST) from Han Chinese population in Taiwan from December 2008 to December 2012. We compared the prevalence and prognosis of BrP defined by the two diagnostic criteria. RESULTS A total of 5214 adults were enrolled (2530 men) with mean age of 69.3 years. Four had spontaneous type 1 BrP (0.077%). By the HRS/EHRA/APHRS criteria, 68 individuals have type 2 BrP (1.30%) and 101 have type 3 BrP (1.94%) whereas by the ISHNE criteria, 46 individuals exhibited type 2 BrP (0.88%). When applying the ISHNE criteria, the number of individuals with BrP decreased by 71%. However, all-cause mortality and cardiovascular mortality were not different between individuals with or without BrP, irrespective of the criteria used. CONCLUSIONS The two different criteria may impact the diagnostic yield of individuals with BrP, but do not affect the prognosis of the individuals with BrP. Key messages Comparing with the use of HRS/EHRA/APHRS criteria, the number of individuals with Brugada ECG patterns was decreased by 71% when applying the ISHNE criteria. The prognosis of individuals with Brugada ECG patterns defined by 2012 ISHNE or 2013 HRS/EHRA/APHRS criteria were not different.
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Affiliation(s)
- Ching-Yu Julius Chen
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Jyh-Ming Jimmy Juang
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Ying-Hsiang Chen
- b Institute of Population Health Sciences , National Health Research Institutes , Zhunan , Taiwan
| | - I-Chien Wu
- b Institute of Population Health Sciences , National Health Research Institutes , Zhunan , Taiwan
| | - Chih-Cheng Hsu
- b Institute of Population Health Sciences , National Health Research Institutes , Zhunan , Taiwan
| | - Ray-Chin Wu
- b Institute of Population Health Sciences , National Health Research Institutes , Zhunan , Taiwan
| | - Kwo-Ching Chen
- c Department of Family Medicine , Hope Doctors Hospital , Miaoli , Taiwan
| | - Wen-Jin Liaw
- d Department of Family Medicine , Yee Zen General Hospital , Taoyuan , Taiwan
| | - Tsung-Lung Tsai
- e Department of Internal Medicine, Ministry of Health and Welfare , Puzi Hospital , Puzi , Taiwan
| | - Lian-Yu Lin
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Juey-Jen Hwang
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Li-Ting Ho
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Chih-Chien Yu
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Jen-Kuang Lee
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Cho-Kai Wu
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Shih-Fan Sherri Yeh
- f Department of Environmental and Occupational Medicine , National Taiwan University Hospital , Taipei , Taiwan
| | - Dun-Hui Yang
- g Department of Radiology , Tainan Municipal Hospital , Tainan , Taiwan
| | - I-Shou Chang
- h National Institute of Cancer Research , National Health Research Institutes , Zhunan , Taiwan
| | - Ling-Ping Lai
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Fu-Tien Chiang
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Jiunn-Lee Lin
- a Cardiovascular Center and Division of Cardiology, Department of Internal Medicine , National Taiwan University Hospital, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Chao Agnes Hsiung
- b Institute of Population Health Sciences , National Health Research Institutes , Zhunan , Taiwan
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Huang CY, Yang YH, Lin LY, Tsai CT, Hwang JJ, Chen PC, Lin JL. Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy. Heart 2018; 104:1276-1283. [PMID: 29371376 DOI: 10.1136/heartjnl-2017-312573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/15/2017] [Revised: 01/01/2018] [Accepted: 01/03/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM. METHODS We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence. RESULTS Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment. CONCLUSION In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.
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Affiliation(s)
- Chen-Yu Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Tsai CT, Kuo MW, Lin JL, Yu AL, Yu J. RETRACTED: Deficiency of a novel gene, Yulink, predisposes to heart failure and ventricular arrhythmia. FASEB J 2018:fj201700932RR. [PMID: 29401584 DOI: 10.1096/fj.201700932rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Heart failure is a major cardiovascular disease and is associated with significant morbidity and mortality. Sudden cardiac death (SCD) in heart failure is a disastrous cardiovascular phenomenon. However, few studies have examined the genetic background that determines susceptibility to heart failure and SCD. We found that deficiency of a newly identified gene, Yulink, promoted cardiac alternans in zebrafish cardiomyocytes, and genetic knockdown (KD) resulted in pericardial edema, decreased cardiac output, and premature ventricular contractions. Yulink KD morphants exhibited irregular action potentials, slower Ca2+ reuptake, and alternans of Ca2+ transients and action potential duration, which are hallmarks for SCD susceptibility in heart failure. Similarly, KD of Yulink in mouse cardiomyocytes disrupted Ca2+ reuptake, reduced the expression of cardiac Serca2, and resulted in a reduction in peroxisome proliferator-activated receptor (PPAR)γ activity. Expression of Serca2 was up-regulated by PPARγ agonists and down-regulated by PPARγ-short hairpin RNA KD, suggesting that Yulink regulates Serca2 expression through PPARγ. Finally, Yulink and Serca2 were down-regulated in ventricular samples of hearts from patients with heart failure due to dilated cardiomyopathy. Our results highlight the interaction of Yulink with PPARγ in regulating Serca2 expression and suggest a mechanistic role of the Yulink in the development of human heart failure and SCD.-Tsai, C.-T., Kuo, M.-W., Lin, J.-L., Yu, A. L., Yu, J. Deficiency of a novel gene, Yulink, predisposes to heart failure and ventricular arrhythmia.
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Affiliation(s)
- Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Wei Kuo
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Alice L Yu
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Pediatrics, University of California, San Diego, California, USA
| | - John Yu
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
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Chang HY, Wang CC, Wei J, Chang CY, Chuang YC, Huang CL, Chong E, Lin JL, Mar GY, Chan KC, Kuo JY, Wang JH, Chen ZC, Tseng WK, Cherng WJ, Yin WH. Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry. J Chin Med Assoc 2017; 80:750-757. [PMID: 29033112 DOI: 10.1016/j.jcma.2017.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/14/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. METHODS A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. RESULTS At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at ≥50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with ≥50% of the target dose, and highest in those who received 0 or 1 class of medications. CONCLUSION The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines.
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Affiliation(s)
- Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Chieh Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Chong-Yi Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Yi-Cheng Chuang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | | | - Eric Chong
- Division of Cardiology, Jurong Health Pte Ltd, Singapore
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Guang-Yuan Mar
- Division of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Kuei-Chuan Chan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Ji-Hung Wang
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC
| | - Zhih-Cherng Chen
- Division of Cardiovascular Medicine, Chimei Medical Center, Tainan, Taiwan, ROC
| | - Wei-Kung Tseng
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, ROC
| | - Wen-Jin Cherng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Lin JL, Lin WC, Liu JK, Surampalli RY, Zhang TC, Kao CM. Aerobic Biodegradation of OCDD by P. Mendocina NSYSU: Effectiveness and Gene Inducement Studies. Water Environ Res 2017; 89:2113-2121. [PMID: 29166993 DOI: 10.2175/106143017x15054988926415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The goals of this study were to assess the effectiveness of (1) enhancing octachlorinated dibenzo-p-dioxin (OCDD) biodegradation under aerobic conditions by Pseudomonas mendocina NSYSU (P. Mendocina NSYSU) with the addition of lecithin, and (2) inducing OCDD ring-cleavage genes by pentachlorophenol (PCP) and OCDD addition. P. Mendocina NSYSU could biodegrade OCDD via aerobic cometabolism and lecithin was used as a primary substrate. Approximately 74 and 67% of OCDD biodegradation was observed after 60 days of incubation with lecithin and glucose supplement, respectively. Lecithin was also used as the solubilization additive resulting in OCDD solubilization and enhanced bioavailability of OCDD to P. Mendocina NSYSU. Two intradiol and extradiol ring-cleavage dioxygenase genes (Pmen_0474 and Pmen_2526) were identified from gene analyses. Gene concentration was significantly enhanced after the inducement by PCP and OCDD. Higher gene inducement efficiency was obtained using PCP as the inducer, and Pmen_2526 played a more important role in OCDD biodegradation.
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Huang CY, Lin TT, Yang YH, Lin LY, Tsai CT, Hwang JJ, Chen PC, Lin JL. Effect of statin therapy on the prevention of new-onset acute coronary syndrome in patients with rheumatoid arthritis. Int J Cardiol 2017; 253:1-6. [PMID: 29174015 DOI: 10.1016/j.ijcard.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/30/2017] [Revised: 10/20/2017] [Accepted: 11/03/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study is to investigate whether statin therapy can reduce new-onset acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). METHODS We used a database from the Registry for Catastrophic Illness from the National Health Research Institute (NHRI) in Taiwan. All RA patients aged 18 or older, diagnosed between 1995 and 2013, without previous cardiovascular events were included. We divided participants into quartiles according to the accumulated statin equivalent dosage and tertiles of period of days of statin treatment to examine the possible dose-response effect. To avoid confounding effects, a 1:4 propensity score matching and Cox's proportional hazard regression models were applied to estimate the hazard ratios for ACS events in patients with and without statin use. RESULTS Total 49,227 patients were included and PS matching identified 5483 patients receiving statins and 21,932 who did not. RA patients treated with statins had lower incidence of first ACS event (IRR 0.779, 95% CI: 0.654-0.927, p=0.005) after PS matching. Statin therapy is associated with reduced risk of new ACS before PS matching (HR=0.847, 95% CI: 0.737-0.973, p=0.019) and the beneficial effect is correlated with accumulated dose and therapy duration (HRs from Q1 to Q4 are 1.215, 0.825, 0.716 and 0.611, p<0.001 for trend; HRs from T1 to T3 are 1.100, 0.841 and 0.611, p<0.001 for trend). These results remained robust after propensity matching. Comparison between 6 different statins, rosuvastatin seems to be associated with better outcome on ACS primary prevention after excluding participants taking more than one kind of statin. CONCLUSIONS Our study demonstrated that statin therapy is associated with lower event rate of new-onset ACS in RA patients and the beneficial effect is dose-responsive.
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Affiliation(s)
- Chen-Yu Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ting-Tse Lin
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Liu CW, Liao PC, Chen KC, Hsu JC, Tu CM, Wu YW, Li AH, Ke SR, Lin JL. SYNTAX Score of Infarct-Related Artery Other Than the Number of Coronary Balloon Inflations and Deflations as an Independent Predictor of Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction. Acta Cardiol Sin 2017; 33:362-376. [PMID: 29033507 DOI: 10.6515/acs20161130a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although remote ischemic post-conditioning (RIPC) has been shown to prevent contrast-induced acute kidney injury (CIAKI) in patients with acute coronary syndrome, its efficacy in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. We examined the relationship among balloon inflations and deflations (BID) times, SYNTAX score of infarction-related artery (SI), periprocedural complications, and CIAKI in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). METHODS Patients with STEMI undergoing pPCI with Mehran risk score (MRS) ≥ 5 were enrolled between February 2007 and September 2012. The study end point was the development of CIAKI. RESULTS Of 206 patients, the median age was 65 years [interquartile range (IQR): 55-77] with 72.8% male and Mehran risk score (MRS) 8 (IQR: 6-12). Receiver operating characteristic curve showed that BID times > 9 times or SI > 10 was the best cut-off associated with CIAKI. In univariate analysis, significant association with CIAKI existed in BID > 9 times [odds ratio (OR): 3.106, 95% confidence interval (CI): 1.284-7.513, p = 0.012] and SI > 10 (OR: 3.909, 95% CI: 1.570-9.735, p = 0.003). Other variables associated with CIAKI included creatinine, hemoglobin, angiotensin converting enzyme inhibitor or angiotensin receptor blocker use at discharge. In multivariate analysis, SI > 10 remained an independent predictor of CIAKI in different adjustment model, even on top of MRS (adjusted OR: 3.498, 95% CI: 1.086-11.268, p = 0.036). CONCLUSIONS Vascular complexity of infarct-related artery rather than higher BID times (> 9) was the major determinant of the development of CIAKI after pPCI in STEMI patients.
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Affiliation(s)
- Cheng-Wei Liu
- Department of Internal Medicine, Tri-Service General Hospital, Songshan Branch, National Defense Medical Center, Taipei
| | - Pen-Chih Liao
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Chin Chen
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Ming Tu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Chihlee University of Technology
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Departments of Internal Medicine.,Departments of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ai-Hsien Li
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shin-Rong Ke
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Chen YL, Cheng CL, Huang JL, Yang NI, Chang HC, Chang KC, Sung SH, Shyu KG, Wang CC, Yin WH, Lin JL, Chen SM. Mortality prediction using CHADS2/CHA2DS2-VASc/R2CHADS2 scores in systolic heart failure patients with or without atrial fibrillation. Medicine (Baltimore) 2017; 96:e8338. [PMID: 29069008 PMCID: PMC5671841 DOI: 10.1097/md.0000000000008338] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The CHADS2, CHA2DS2-VASc, and R2CHADS2 scores are well-known predictors of stroke caused by atrial fibrillation (AF), but no studies have evaluated their use for stratifying all-cause mortality risk in patients discharged for systolic heart failure (SHF) with or without AF.This study analyzed data in the Taiwan Society of Cardiology-heart failure with reduced ejection fraction (TSOC-HFrEF) registry. These data were obtained by a prospective, multicenter, observational survey of patients treated at 21 medical centers in Taiwan after hospitalization for acute, pre-existing or new onset SHF from May, 2013 to October, 2014. During 1 year follow-up, 198 patients were lost follow-up, and final 1311 (86.8%) patients were included for further analysis. During the follow-up period, 250 (19%) patients died. Multivariate analysis revealed that body mass index, thyroid disorder, valvular surgery history, chronic kidney disease (CKD), and scores for CHADS2, CHA2DS2-VASc, and R2CHADS2 were significant independent predictors of mortality in the overall population of SHF patients (all P < .05) The c-indexes showed that CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were significantly associated with mortality in SHF patients with or without AF (all P < 005). However, R2CHADS2 had significantly higher accuracy in predicting mortality in all SHF patients compared with CHADS2 and CHA2DS2-VASc (DeLong test, P < .0001), especially in SHF without AF (DeLong test, P = .0003).Scores for CHADS2, CHA2DS2-VASc, and R2CHADS2 can be used to predict 1-year all-cause mortality in SHF patients with or without AF. For predicting all-cause mortality in SHF patients, R2CHADS2 is more accurate than CHADS2 and CHA2DS2-VASc.
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Affiliation(s)
- Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
- Chang Gung University College of Medicine
| | - Ching-Lan Cheng
- Department of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Ning-I Yang
- Chang Gung University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
| | - Heng-Chia Chang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Kuan-Cheng Chang
- Graduate Institute of Biomedical Sciences, China Medical University
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung
| | | | - Kou-Gi Shyu
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Chun-Chieh Wang
- Chang Gung University College of Medicine
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | | | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
- Chang Gung University College of Medicine
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Wu CK, Tsai HY, Su MYM, Wu YF, Hwang JJ, Lin JL, Lin LY, Chen JJ. Evolutional change in epicardial fat and its correlation with myocardial diffuse fibrosis in heart failure patients. J Clin Lipidol 2017; 11:1421-1431. [PMID: 29050981 DOI: 10.1016/j.jacl.2017.08.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to characterize the characteristics of epicardial fat (EAT) in different stage heart failure (HF) patients and its relationship between cardiac fibrosis. BACKGROUND EAT is visceral adipose tissue that possesses inflammatory properties. Inflammation and obesity are associated with cardiac fibrosis, but the relationship between cardiac fibrosis and EAT is unknown. METHODS EAT volume was measured using cardiac magnetic resonance imaging (CMR) in 180 subjects: 58 patients with systolic HF, 63 patients with HF and preserved ejection fraction, and 59 patients without HF. CMR derived myocardial extracellular volume (ECV) was used for fibrosis quantification. RESULTS Patients with systolic HF had significantly more EAT compared with patients with HF and preserved ejection fraction or the control group (patients without HF) (indexed EAT volume [mL/m2], 27.0 [22.7-31.6] vs 25.6 [21.4-31.2] and 24.2 [21.0-27.6], P < .05). The adjusted EAT amount was associated with ECV completely independent of age, hypertension, diabetes, etiology of HF, left ventricular ejection fraction, CMR-late gadolinium enhancement (LGE), left ventricular mass index, and left ventricular end-diastolic volume index (correlation coefficient: 0.49; 95% confidence interval: 0.12-0.86, P < .01). Increased CMR ECV was more associated with EAT in those with advanced age, male sex, LGE on magnetic resonance imaging-LGE images, and less left ventricular end-diastolic volume index. CONCLUSIONS EAT volume is highly associated with CMR ECV independent of traditional risk factors and left ventricular mass or volume. Whether EAT plays a role in the long-term prognosis of HF requires future investigation.
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Affiliation(s)
- Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hao-Yuan Tsai
- Division of Cardiology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Mao-Yuan M Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Fan Wu
- Department of Family Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jien-Jiun Chen
- Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan.
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Chang SN, Chang SH, Yu CC, Wu CK, Lai LP, Chiang FT, Hwang JJ, Lin JL, Tsai CT. Renal Denervation Decreases Susceptibility to Arrhythmogenic Cardiac Alternans and Ventricular Arrhythmia in a Rat Model of Post-Myocardial Infarction Heart Failure. ACTA ACUST UNITED AC 2017; 2:184-193. [PMID: 30167565 PMCID: PMC6113543 DOI: 10.1016/j.jacbts.2017.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/21/2022]
Abstract
In systolic heart failure, decreased renal perfusion due to impaired cardiac pumping activates the renal nerves, which send a signal to the brain to call for help. The brain thus activates the neurohormonal system to increase organ perfusion, which may predispose the heart to ventricular arrhythmia. Chemical renal denervation with phenol cuts the signal sent to the brain and thus decreases the susceptibility to ventricular arrhythmia in rats with systolic heart failure.
Several studies have shown the beneficial effect of renal denervation (RDN) in the treatment of ventricular arrhythmia, especially in the setting of heart failure (HF). However, the underlying mechanism of antiarrhythmic effect of RDN is unknown. Arrhythmogenic cardiac alternans, particularly spatially discordant repolarization alternans, characterized by simultaneous prolongation and shortening of action potential duration (APD) in different myocardial regions, is central to the genesis of ventricular fibrillation in HF. Whether RDN decreases the susceptibility to arrhythmogenic cardiac alternans in HF has never been addressed before. The authors used a rat model of post-myocardial infarction HF and dual voltage-calcium optical mapping to investigate whether RDN could attenuate arrhythmogenic cardiac alternans that predisposes to ventricular arrhythmias, as well as the hemodynamic effect of RDN in HF. The HF rats had increased body weights, dilated hearts, and lower blood pressure. The HF rats also had longer ventricular APDs and a delay in the decay of the calcium transient, typical electrophysiological features of human HF. Susceptibility to calcium transient alternans, APD alternans, and spatially discordant APD alternans was increased in the HF hearts. RDN significantly attenuated a delay in the decay of the calcium transient, calcium transient and APD alternans, and importantly, the discordant APD alternans, and thereby decreased the incidence of induced ventricular arrhythmia in HF. RDN did not further decrease blood pressure in HF rats. In conclusion, RDN improves calcium cycling and prevents spatially discordant APD alternans and ventricular arrhythmia in HF. RDN does not aggravate hemodynamics in HF.
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Key Words
- APD, action potential duration
- APD-ALT, action potential duration alternans
- Ca-ALT, calcium transient alternans
- HF, heart failure
- MI, myocardial infarction
- PR, pacing rate
- RDN, renal denervation
- SCD, sudden cardiac death
- VF, ventricular fibrillation
- VT, ventricular tachycardia
- alternans
- arrhythmia mechanism
- heart failure
- renal denervation
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Affiliation(s)
- Sheng-Nan Chang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Shu-Hsuan Chang
- Division of Cardiology, Department of Internal Medicine, Camillians Saint Mary’s Hospital Luodong, Luodong, Taiwan
| | - Chih-Chieh Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ping Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Address for correspondence: Dr. Chia-Ti Tsai, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan.
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Chiang CE, Wu TJ, Ueng KC, Chao TF, Chang KC, Wang CC, Lin YJ, Yin WH, Kuo JY, Lin WS, Tsai CT, Liu YB, Lee KT, Lin LJ, Lin LY, Wang KL, Chen YJ, Chen MC, Cheng CC, Wen MS, Chen WJ, Chen JH, Lai WT, Chiou CW, Lin JL, Yeh SJ, Chen SA. 2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the management of atrial fibrillation. J Formos Med Assoc 2016; 115:893-952. [PMID: 27890386 DOI: 10.1016/j.jfma.2016.10.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [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: 06/16/2016] [Revised: 08/24/2016] [Accepted: 10/10/2016] [Indexed: 12/21/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia. Both the incidence and prevalence of AF are increasing, and the burden of AF is becoming huge. Many innovative advances have emerged in the past decade for the diagnosis and management of AF, including a new scoring system for the prediction of stroke and bleeding events, the introduction of non-vitamin K antagonist oral anticoagulants and their special benefits in Asians, new rhythm- and rate-control concepts, optimal endpoints of rate control, upstream therapy, life-style modification to prevent AF recurrence, and new ablation techniques. The Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology aimed to update the information and have appointed a jointed writing committee for new AF guidelines. The writing committee members comprehensively reviewed and summarized the literature, and completed the 2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the Management of Atrial Fibrillation. This guideline presents the details of the updated recommendations, along with their background and rationale, focusing on data unique for Asians. The guidelines are not mandatory, and members of the writing committee fully realize that treatment of AF should be individualized. The physician's decision remains most important in AF management.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center, Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
| | - Tsu-Juey Wu
- Cardiovascular Center, Department of Internal Medicine, Taichung Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Kwo-Chang Ueng
- Department of Internal Medicine, School of Medicine, Chung-Shan Medical University (Hospital), Taichung, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Wang
- Department of Internal Medicine, Section of Cardiology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Wei-Shiang Lin
- Division of Cardiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Kun-Tai Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Jen Lin
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Kang-Ling Wang
- General Clinical Research Center, Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Yi-Jen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Ming-Shien Wen
- Department of Internal Medicine, Section of Cardiology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Cardiology, Poh-Ai Hospital, Yilan, Taiwan
| | - Jyh-Hong Chen
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chuen-Wang Chiou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - San-Jou Yeh
- Department of Internal Medicine, Section of Cardiology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
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Chen JJ, Lin LY, Yang YH, Hwang JJ, Chen PC, Lin JL, Chi NH. On pump versus off pump coronary artery bypass grafting in patients with end-stage renal disease and coronary artery disease - A nation-wide, propensity score matched database analyses. Int J Cardiol 2016; 227:529-534. [PMID: 27836299 DOI: 10.1016/j.ijcard.2016.10.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/12/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The usage of on or off cardiopulmonary bypass in patients with coronary artery disease receiving coronary artery bypass grafting (CABG) surgery had been debated and had not yet been investigated thoroughly in patients with end-stage renal disease (ESRD). We aimed to study cardiovascular outcomes and total mortality in these patients by using our National Health Insurance (NHI) database. METHOD By using our NHI ESRD claim database, we searched ESRD patients aged more than 18years, who received CABG and divided them into on pump and off pump groups. Baseline characteristics and underlying comorbidities were identified from the database. Propensity score (PS) method was used to match all the potential confounders between patients. Outcomes including mortality, myocardial infarction, stroke and repeat revascularization within 30days, 1year and whole follow-up period were also obtained. RESULT A total of 134,410 ESRD patients were identified in the database. We included 341 patients and 543 patients who received off pump and on pump CABG respectively. The hazard ratios of different outcomes at 30days, 1year and a median of 745days after CABG did not show significant different between on, or off pump groups before and after PS match. CONCLUSION ESRD patients with CAD undergoing either on pump or off pump CABG surgery showed similar outcomes in 30days, 1year and whole follow-up period.
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Affiliation(s)
- Jien-Jiun Chen
- Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pau-Chung Chen
- Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Hsin Chi
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Xu JF, Lin JL, Qu JM. Bronchiectasis in China: Present Situations and Challenges. Pneumologie 2016. [DOI: 10.1055/s-0036-1592269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lin TT, Wu CC, Yang YH, Lin LY, Lin JL, Chen PC, Hwang JJ. Anti-Hyperglycemic Agents and New-Onset Acute Myocardial Infarction in Diabetic Patients with End-Stage Renal Disease Undergoing Dialysis. PLoS One 2016; 11:e0160436. [PMID: 27513562 PMCID: PMC4981426 DOI: 10.1371/journal.pone.0160436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Diabetes and chronic kidney disease (CKD) are a high-stakes combination for cardiovascular disease. Patients with decreased kidney function and end-stage renal disease (ESRD) have increased risk of hypoglycemia when attaining better glycemic control, leading to higher risk of myocardial infarction (MI). For these patients, which kinds of anti-hyperglycemic agents would be associated with higher risk of MI is not clear. METHODS We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Patients with diabetes and ESRD were selected as the study cohort. Propensity score adjustment and Cox's proportional hazards regression model were used to estimate the hazard ratios (HRs) for new-onset MI. RESULTS Among 15,161 patients, 39% received insulin, 40% received sulfonylureas, 18% received meglitinides and 3% received thiazolidinedione (TZD). After a median follow-up of 1,357 days, the incidence of MI was significant increase in patients taking sulfonylureas (HR = 1.523, 95% confidence interval [CI] = 1.331-1.744), meglitinides (HR = 1.251, 95% CI = 1.048-1.494) and TZD (HR = 1.515, 95% CI = 1.071-2.145) by using patients receiving insulin therapy as the reference group. The risk of MI remains higher in other three groups in subgroup analyses. CONCLUSIONS In conclusion, among diabetic patients with ESRD undergoing dialysis, the use of sulfonylureas, meglitinides and TZD are associated with higher risk of new-onset MI as compared with insulin.
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Affiliation(s)
- Ting-Tse Lin
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Institute of Biomedical Engineering, National Chiao-Tung University, Hsinchu, Taiwan
| | - Chih-Chen Wu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yao-Hsu Yang
- Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Wang HX, Zhang BQ, Lin JL, Song XC, Ruan J, Liu YO, He J, Sun ZH, Zhou WJ. [Functional mapping of the insular and opercular cortex: A study using SEEG electrical stimulation in epileptic patients]. Zhonghua Yi Xue Za Zhi 2016; 96:2347-51. [PMID: 27524194 DOI: 10.3760/cma.j.issn.0376-2491.2016.29.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Insular and opercular cortex is involved in complicated physiological function.Insular seizures involve extensive epileptic network, which results in the complex and diverse semiology.Electrical cortical stimulation(ECS) can explore the functional mapping and symptomatogenic zone. METHODS The clinical presurgical evaluation and ECS data of 20 patients whose electrode contacts were located in the insular and opercular were analyzed retrospectively.CT scan/3D MRI data fusion was performed in order to accurately identify and locate each contact and check the electrode trajectory by the MRI images performed after the electrodes were removed.ECS was applied between two contiguous contacts.Stimulation usually lasted for 5 s at 50 Hz(pulse width=0.3 ms). Depending on the area of stimulated cortex, the stimulation intensities ranged from 0.2 to 3.0 mA.The classification of the insular were anterior short gyrus, middle short gyrus, precentral gyrus, postcentral gyrus, posterior long gyrus and insular pole.The classification of the opercular were orbital, frontal, precentral, central, parietal and temporal opercular. RESULTS One hundred and six contacts were located in the insular and 51 responses were evoked (48.11%). Four hundred eighteen contacts were located in the insular and 132 responses were evoked (31.58%). We classified the principal responses as somatosensory, pain, auditory, oropharyngeal, speech disturbances and neurovegetative response.Somatosensory responses were mainly evoked in parietal opercular and postcentral gyrus, while pain response distributed sporadically.Auditory were only evoked in temporal opercular(transverse temporal gyri) and posterior long gyrus.Oropharyngeal symptoms were only evoked in central opercular.Speech disturbances were located in precentral and central opercular and neurovegetative responses were mainly evoked in insular pole and middle short gyrus. CONCLUSIONS These findings may indicate a functional specificity for the insular gyrus and opercular, which contribute to the understanding of anatomo-functional organization and the role in insular and opercular epileptic network.Moreover, it could optimize the implantation strategy for exploring these structures.
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Affiliation(s)
- H X Wang
- Epilepsy Center, Yuquan Hospital, Tsinghua University, Beijing 100049, China
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Wang CC, Chang HY, Yin WH, Wu YW, Chu PH, Wu CC, Hsu CH, Wen MS, Voon WC, Lin WS, Huang JL, Chen SM, Yang NI, Chang HC, Chang KC, Sung SH, Shyu KG, Lin JL, Mar GY, Chan KC, Kuo JY, Wang JH, Chen ZC, Tseng WK, Cherng WJ. TSOC-HFrEF Registry: A Registry of Hospitalized Patients with Decompensated Systolic Heart Failure: Description of Population and Management. Acta Cardiol Sin 2016; 32:400-11. [PMID: 27471353 DOI: 10.6515/acs20160704a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. METHODS The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed. RESULTS A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean age of 64 years (72% were male). Ischemic cardiomyopathy and dilated cardiomyopathy were diagnosed in 44% and 33% of patients, respectively. Coronary artery disease, hypertension, diabetes, and chronic renal insufficiency were the common comorbid conditions. Acute coronary syndrome, non-compliant to treatment, and concurrent infection were the major precipitating factors for acute decompensation. The median length of hospital stay was 8 days, and the in-hospital mortality rate was 2.4%. At discharge, 62% of patients were prescribed either angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, 60% were prescribed beta-blockers, and 49% were prescribed mineralocorticoid receptor antagonists. CONCLUSIONS The TSOC-HFrEF registry provided important insights into the current clinical characteristics and management of hospitalized decompensated systolic HF patients in Taiwan. One important observation was that adherence to guideline-directed medical therapy was suboptimal.
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Affiliation(s)
- Chun-Chieh Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | | | | | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern memorial Hospital, New Taipei City
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | - Chih-Cheng Wu
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu
| | - Chih-Hsin Hsu
- Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, and National Cheng Kung University Hospital, Tainan
| | - Ming-Shien Wen
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung
| | - Wei-Shiang Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Ning-I Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
| | - Heng-Chia Chang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine and Cardiovascular Research Laboratory, China Medical University Hospital, Taichung
| | | | - Kou-Gi Shyu
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Guang-Yuan Mar
- Division of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Kuei-Chuan Chan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Ji-Hung Wang
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien
| | - Zhih-Cherng Chen
- Division of Cardiovascular Medicine, Chimei Medical Center, Tainan
| | - Wei-Kung Tseng
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wen-Jin Cherng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
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Yu CC, Chia-Ti T, Chen PL, Wu CK, Chiu FC, Chiang FT, Chen PS, Chen CL, Lin LY, Juang JM, Ho LT, Lai LP, Yang WS, Lin JL. KCNN2 polymorphisms and cardiac tachyarrhythmias. Medicine (Baltimore) 2016; 95:e4312. [PMID: 27442679 PMCID: PMC5265796 DOI: 10.1097/md.0000000000004312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Potassium calcium-activated channel subfamily N member 2 (KCNN2) encodes an integral membrane protein that forms small-conductance calcium-activated potassium (SK) channels. Recent studies in animal models show that SK channels are important in atrial and ventricular repolarization and arrhythmogenesis. However, the importance of SK channels in human arrhythmia remains unclear. The purpose of the present study was to test the association between genetic polymorphism of the SK2 channel and the occurrence of cardiac tachyarrhythmias in humans. We enrolled 327 Han Chinese, including 72 with clinically significant ventricular tachyarrhythmias (VTa) who had a history of aborted sudden cardiac death (SCD) or unexplained syncope, 98 with a history of atrial fibrillation (AF), and 144 normal controls. We genotyped 12 representative tag single nucleotide polymorphisms (SNPs) across a 141-kb genetic region containing the KCNN2 gene; these captured the full haplotype information. The rs13184658 and rs10076582 variants of KCNN2 were associated with VTa in both the additive and dominant models (odds ratio [OR] 2.89, 95% confidence interval [CI] = 1.505-5.545, P = 0.001; and OR 2.55, 95% CI = 1.428-4.566, P = 0.002, respectively). After adjustment for potential risk factors, the association remained significant. The population attributable risks of these 2 variants of VTa were 17.3% and 10.6%, respectively. One variant (rs13184658) showed weak but significant association with AF in a dominant model (OR 1.91, CI = 1.025-3.570], P = 0.042). There was a significant association between the KCNN2 variants and clinically significant VTa. These findings suggest an association between KCNN2 and VTa; it also appears that KCNN2 variants may be adjunctive markers for risk stratification in patients susceptible to SCD.
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Affiliation(s)
- Chih-Chieh Yu
- Department of Internal Medicine, National Taiwan University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
| | - Tsai Chia-Ti
- Department of Internal Medicine, National Taiwan University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
| | - Pei-Lung Chen
- Department of Internal Medicine, National Taiwan University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
- Department of Medical Genetics, National Taiwan University Hospital
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei
| | - Cho-Kai Wu
- Department of Internal Medicine, National Taiwan University Hospital
| | - Fu-Chun Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Fu-Tien Chiang
- Department of Internal Medicine, National Taiwan University Hospital
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital
| | - Jyh-Ming Juang
- Department of Internal Medicine, National Taiwan University Hospital
| | - Li-Ting Ho
- Department of Internal Medicine, National Taiwan University Hospital
| | - Ling-Ping Lai
- Department of Internal Medicine, National Taiwan University Hospital
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei
- Correspondence: Jiunn-Lee Lin, Wei-Shiung Yang, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung San South Road, Taipei City 100, Taiwan (R.O.C.) (e-mail: , )
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University Hospital
- Correspondence: Jiunn-Lee Lin, Wei-Shiung Yang, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung San South Road, Taipei City 100, Taiwan (R.O.C.) (e-mail: , )
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Lin LY, Liao CW, Wang CH, Chi NH, Yu HY, Chou NK, Hwang JJ, Lin JL, Chiang FT, Chen YS. Effects of Additional Intra-aortic Balloon Counter-Pulsation Therapy to Cardiogenic Shock Patients Supported by Extra-corporeal Membranous Oxygenation. Sci Rep 2016; 6:23838. [PMID: 27032984 PMCID: PMC4817114 DOI: 10.1038/srep23838] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/16/2016] [Indexed: 12/15/2022] Open
Abstract
Extra-corporeal membranous oxygenation (ECMO) has been applied in patients with cardiopulmonary failure. One critical drawback of peripheral ECMO is an increase in left ventricular (LV) afterload which could be counterbalanced by the combination of intra-aortic balloon counter-pulsation (IABP) therapy. We hypothesized that an add-on therapy with IABP could improve outcomes in patients receiving ECMO support. We included patients (>18 years old) from 2002 to 2013 requiring ECMO support due to cardiogenic shock in a medical center. A total of 529 patients (227 ECMO alone and 302 combined IABP plus ECMO) were included. The mortality rates at 2 weeks (48.5 vs. 47.7%) after ECMO implantation were not different between the two groups (ECMO vs. combined group). After adjustment for propensity score and potential confounders, the odds ratios of outcomes within 14 days (combined group vs. ECMO) for poor LV systolic function, high preload, multi-organ failure and mortality were not different. The results remained similar for subgroup analysis. Compared with ECMO alone, combined IABP and ECMO treatment did not improve outcomes in patients with circulatory failure.
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Affiliation(s)
- Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Che-Wei Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chih-Hsien Wang
- Division of Cardiology, Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Nai-Hsin Chi
- Division of Cardiology, Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hsi-Yu Yu
- Division of Cardiology, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Nai-Kuan Chou
- Division of Cardiology, Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Division of Cardiology, Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Lin LY, Su MYM, Pham VT, Tran TT, Wang YH, Tseng WYI, Lo MT, Lin JL. Endocardial Remodeling in Heart Failure Patients with Impaired and Preserved Left Ventricular Systolic Function--A Magnetic Resonance Image Study. Sci Rep 2016; 6:20868. [PMID: 26876005 PMCID: PMC4753516 DOI: 10.1038/srep20868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/27/2015] [Accepted: 01/08/2016] [Indexed: 12/25/2022] Open
Abstract
Left ventricular (LV) trabeculation has been studied in certain forms of cardiomyopathy. However, the changes of LV endocardial trabeculation during the remodeling process leading to heart failure (HF) are unclear. Seventy-four patients with systolic heart failure (SHF), 65 with heart failure with preserved ejection fraction (HFpEF) and 61 without HF were prospectively enrolled. All subjects received magnetic resonance imaging (MRI) study including cine, T1 and late gadolinium enhancement (LGE) images. Trabecular-papillary muscle (TPM) mass, fractal dimension (FD) and extracellular volume (ECV) were derived. The results showed that TPM mass index was higher in patients with SHF than that in patients with HFpEF and non-HF. The TPM mass-LV mass ratio (TPMm/LVM) was higher in SHF group than that in HFpEF and non-HF. FD was not different among groups. The presence of LGE was inversely associated with TPM mass index and TPMm/LVM while the ECV were positively associated with TPMm/LVM. The FD was positively associated with LV chamber size. In conclusion, TPM increases in patients with SHF and are probably related to myocardial cell hypertrophy and fibrotic repair during remodeling. The FD increases with the dilatation of LV chamber but remain unchanged with the deterioration of LV function.
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Affiliation(s)
- Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan M Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Van-Truong Pham
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Chungli, Taiwan
| | - Thi-Thao Tran
- Department of Electrical Engineering, National Central University, Chungli, Taiwan
| | - Yung-Hung Wang
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Chungli, Taiwan
| | - Wen-Yih I Tseng
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Center for Optoelectronic Biomedicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Men-Tzung Lo
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Chungli, Taiwan
| | - Jiunn-Lee Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Lin LY, Wu CK, Juang JMJ, Wang YC, Su MYM, Lai LP, Hwang JJ, Chiang FT, Tseng WYI, Lin JL. Myocardial Regional Interstitial Fibrosis is Associated With Left Intra-Ventricular Dyssynchrony in Patients With Heart Failure: A Cardiovascular Magnetic Resonance Study. Sci Rep 2016; 6:20711. [PMID: 26846306 PMCID: PMC4742892 DOI: 10.1038/srep20711] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/01/2015] [Accepted: 01/11/2016] [Indexed: 01/04/2023] Open
Abstract
Left ventricular (LV) dyssynchrony is associated with poor prognosis in patients with heart failure (HF). The mechanisms leading to LV dyssynchrony are not fully elucidated. This study evaluates whether myocardium regional variation in interstitial fibrosis is associated with LV dyssynchrony. Forty-two patients with systolic heart failure (SHF), 76 patients with heart failure with preserved ejection fraction (HFpEF) and 20 patients without HF received cardiovascular magnetic resonance imaging (MRI) study. LV was divided into 18 segments by short-axis view. In each segment, regional extracellular volume fraction (ECV) and the time taken to reach minimum regional volume (Tmv) were derived. Intra-LV dyssynchrony were represented by maximum difference (Dysyn_max) and standard deviation (Dysyn_sd) of all Tmv. The results showed that among the covariates, only age (1.87, 95% CI: 0.61-3.13, p = 0.004) and ECV (3.77, 95% CI: 2.72-4.81, p < 0.001) were positively associated with Tmv. The results remained robust in certain subgroups. In conclusion, we demonstrated that LV myocardium regional variation in interstitial fibrosis is closely related to LV intra-ventricular dyssynchrony irrespective of the LV global function. These data might help explain the pathophysiology of LV dyssynchrony and it's underlying mechanisms leading to poor prognosis.
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Affiliation(s)
- Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jyh-Ming Jimmy Juang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Mao-Yuan Marine Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ping Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wen-Yih Issac Tseng
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Center for Optoelectronic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Juang JMJ, Chen CYJ, Chen YH, Wu IC, Hsu CC, Chen LN, Tang FC, Wang CC, Juan CC, Chiu HC, Lo HM, Chang IS, Hwang JJ, Lai LP, Chiang FT, Lin JL, Hsiung CA. Prevalence and prognosis of Brugada electrocardiogram patterns in an elderly Han Chinese population: a nation-wide community-based study (HALST cohort). Europace 2016; 17 Suppl 2:ii54-62. [DOI: 10.1093/europace/euv141] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chiang JY, Huang JW, Lin LY, Chang CH, Chu FY, Lin YH, Wu CK, Lee JK, Hwang JJ, Lin JL, Chiang FT. Detrended Fluctuation Analysis of Heart Rate Dynamics Is an Important Prognostic Factor in Patients with End-Stage Renal Disease Receiving Peritoneal Dialysis. PLoS One 2016; 11:e0147282. [PMID: 26828209 PMCID: PMC4734614 DOI: 10.1371/journal.pone.0147282] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 01/02/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with severe kidney function impairment often have autonomic dysfunction, which could be evaluated noninvasively by heart rate variability (HRV) analysis. Nonlinear HRV parameters such as detrended fluctuation analysis (DFA) has been demonstrated to be an important outcome predictor in patients with cardiovascular diseases. Whether cardiac autonomic dysfunction measured by DFA is also a useful prognostic factor in patients with end-stage renal disease (ESRD) receiving peritoneal dialysis (PD) remains unclear. The purpose of the present study was designed to test the hypothesis. MATERIALS AND METHODS Patients with ESRD receiving PD were included for the study. Twenty-four hour Holter monitor was obtained from each patient together with other important traditional prognostic makers such as underlying diseases, left ventricular ejection fraction (LVEF) and serum biochemistry profiles. Short-term (DFAα1) and long-term (DFAα2) DFA as well as other linear HRV parameters were calculated. RESULTS A total of 132 patients (62 men, 72 women) with a mean age of 53.7±12.5 years were recruited from July 2007 to March 2009. During a median follow-up period of around 34 months, eight cardiac and six non-cardiac deaths were observed. Competing risk analysis demonstrated that decreased DFAα1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFAα1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617-0.905). DFAα1≧ 0.95 was associated with lower cardiac mortality (Hazard ratio (HR) 0.062, 95% CI = 0.007-0.571, P = 0.014) and total mortality (HR = 0.109, 95% CI = 0.033-0.362, P = 0.0003). CONCLUSION Cardiac autonomic dysfunction evaluated by DFAα1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.
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Affiliation(s)
- Jiun-Yang Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Fang-Ying Chu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Juei-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Chung YW, Yang YH, Wu CK, Yu CC, Juang JMJ, Wang YC, Tsai CT, Lin LY, Lai LP, Hwang JJ, Chiang FT, Chen PC, Lin JL. Spironolactone is associated with reduced risk of new-onset atrial fibrillation in patients receiving renal replacement therapy. Int J Cardiol 2016; 202:962-6. [DOI: 10.1016/j.ijcard.2015.05.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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Lin TT, Chiang JY, Liao MT, Tsai CT, Hwang JJ, Chiang FT, Lin JL, Lin LY. Primary prevention of atrial fibrillation with beta-blockers in patients with end-stage renal disease undergoing dialysis. Sci Rep 2015; 5:17731. [PMID: 26643783 PMCID: PMC4672347 DOI: 10.1038/srep17731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/25/2015] [Accepted: 11/05/2015] [Indexed: 01/19/2023] Open
Abstract
Current evidence suggests that beta-blocker lower the risk of development of atrial fibrillation (AF) and in-hospital stroke after cardiac surgery. This study was to assess whether beta-blockers could decrease incidence of new-onset AF in patients with end stage renal disease (ESRD). We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score matching and Cox’s proportional hazards regression model were used to estimate hazard ratios (HRs) for new-onset AF. Among 100066 patients, 41.7% received beta-blockers. After a median follow-up of 1500 days, the incidence of new-onset AF significantly decreased in patients treated with beta-blockers (HR = 0.483, 95% confidence interval = 0.437-0.534). The prevention of new-onset AF was significantly better in patients taking longer duration of beta-blockers therapy (P for time trend <0.001). The AF prevention effect remains robust in subgroup analyses. In conclusion, beta-blockers seem effective in the primary prevention of AF in ESRD patients. Hence, beta-blockers may be the target about upstream treatment of AF.
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Affiliation(s)
- Ting-Tse Lin
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jiun-Yang Chiang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Juey Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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