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Sim DKL, Mittal S, Zhang J, Hung CL, Azman WAW, Choi JO, Yingchoncharoen T, De Lara ACF, Ito H, Ashraf T, Yiu KH, Krittayaphong R. Expert recommendations for the management of iron deficiency in patients with heart failure in Asia. Int J Cardiol 2024; 403:131890. [PMID: 38382854 DOI: 10.1016/j.ijcard.2024.131890] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Iron deficiency is a common comorbidity in heart failure (HF) and is independently associated with a worse quality-of-life and exercise capacity, as well as increased risk of hospitalization, regardless of anemia status. Although international guidelines have provided recommendations for the management of iron deficiency in patients with HF, guidelines in Asia are less established, and practical use of guidelines for management of iron deficiency is limited in the region. METHODS A panel comprising cardiologists from China, Hong Kong, India, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, and Thailand convened to share insights and provide guidance for the optimal management of iron deficiency in patients with HF, tailored for the Asian community. RESULTS Expert opinions were provided for the screening, diagnosis, treatment and monitoring of iron deficiency in patients with HF. It was recommended that all patients with HF with reduced ejection fraction should be screened for iron deficiency, and iron-deficient patients should be treated with intravenous iron. Monitoring of iron levels in patients with HF should be carried out once or twice yearly. Barriers to the management of iron deficiency in patients with HF in the region include low awareness of iron deficiency amongst general physicians, lack of reimbursement for screening and treatment, and lack of proper facilities for administration of intravenous iron. CONCLUSIONS These recommendations provide a structured approach to the management of iron deficiency in patients with HF in Asia.
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Affiliation(s)
| | - Sanjay Mittal
- Department of Clinical and Preventive Cardiology, Heart Institute, Mendanta - The Medicity, India
| | - Jian Zhang
- Heart Failure Centre, Fuwai Hospital, China
| | - Chung-Lieh Hung
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan; Division of Cardiology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | | | - Aileen Cynthia F De Lara
- Department of Medical Education and Research, Faculty of Medicine and Surgery, University of Santo Tomas, Philippines
| | - Hiroshi Ito
- Department of General Internal Medicine, Kawasaki Medical School, Japan
| | - Tariq Ashraf
- National Institute of Cardiovascular Disease, Pakistan
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, China
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Thailand
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2
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Cheang I, Zhu X, Huang JY, Tse YK, Li HL, Ren QW, Wu MZ, Chan YH, Xu X, Tse HF, Gue Y, Lip GYH, Li X, Yiu KH. Prediabetes is associated with increased cardiac events in patients with cancer who are prescribed anthracyclines. Cancer 2024. [PMID: 38662418 DOI: 10.1002/cncr.35322] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Prediabetes, which is a precedent of overt diabetes, is a known risk factor for adverse cardiovascular outcomes. Its impact on adverse cardiovascular outcomes in patients with cancer who are prescribed anthracycline-containing chemotherapy (ACT) is uncertain. The objective of this study was to evaluate the association of prediabetes with cardiovascular events in patients with cancer who are prescribed ACT. METHODS The authors identified patients with cancer who received ACT from 2000 to 2019 from Clinical Data Analysis Reporting System of Hong Kong. Patients were divided into diabetes, prediabetes, and normoglycemia groups based on their baseline glycemic profile. The Primary outcome, a major adverse cardiovascular event (MACE), was the composite event of hospitalization for heart failure and cardiovascular death. RESULTS Among 12,649 patients at baseline, 3997 had prediabetes, and 5622 had diabetes. Over median follow-up of 8.7 years, the incidence of MACE was 211 (7.0%) in the normoglycemia group, 358 (9.0%) in the prediabetes group, and 728 (12.9%) in the diabetes group. Compared with normoglycemia, prediabetes (adjusted hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.01-1.43) and diabetes (adjusted HR, 1.46; 95% CI, 1.24-1.70) were associated with an increased risk of MACE. In the prediabetes group, 475 patients (18%) progressed to overt diabetes and exhibited a greater risk of MACE (adjusted HR, 1.76; 95% CI, 1.31-2.36) compared with patients who remained prediabetic. CONCLUSIONS In patients with cancer who received ACT, those who had prediabetes at baseline and those who progressed to diabetes at follow-up had an increased risk of MACE. The optimization of cardiovascular risk factor management, including prediabetes, should be considered in patients with cancer who are treated before and during ACT to reduce cardiovascular risk. PLAIN LANGUAGE SUMMARY Patients with cancer who have preexisting diabetes have a higher risk of cardiovascular events, and prediabetes is often overlooked. In this study of 12,649 patients with cancer identified in the Clinical Data Analysis Reporting System of Hong Kong who were receiving treatment with anthracycline drugs, prediabetes was correlated with increased deaths from cardiovascular disease and/or hospitalizations for heart failure. Patients who progressed from prediabetes to diabetes within 2 years had an increased risk of combined hospitalization for heart failure and death from cardiovascular disease. These findings indicate the importance of paying greater attention to cardiovascular risk factors, including how prediabetes is managed, in patients who have cancer and are receiving chemotherapy with anthracyclines, emphasizing the need for surveillance, follow-up strategies, and consideration of prediabetes management in cancer care.
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Affiliation(s)
- Iokfai Cheang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xu Zhu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hang-Long Li
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xin Xu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ying Gue
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Xinli Li
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Fong FW, Hwang S, Xu Y, Hui WHA, Leung KHG, Lin L, Ho SY, Tang HS, Kwan CT, Ng PP, Hai JSH, Kwok FYJ, Sze HF, Fong AHT, Wan EYF, Lai YTA, Leung ST, Chan HL, Chan WSC, Cheung SCW, Lee CYJ, Yiu KH, Pennell DJ, Mohiaddin RH, Yan AT, Ng MY. Prognostic Utility of Left Atrial Strain From MRI Feature Tracking in Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study. AJR Am J Roentgenol 2024:1-14. [PMID: 38323782 DOI: 10.2214/ajr.23.30357] [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: 02/08/2024]
Abstract
BACKGROUND. MRI-based prognostic evaluation in patients with dilated cardiomyopathy (DCM) has historically used markers of late gadolinium enhancement (LGE) and feature tracking (FT)-derived left ventricular global longitudinal strain (LVGLS). Early data indicate that FT-derived left atrial strain (LAS) parameters, including reservoir, conduit, and booster, may also have prognostic roles in such patients. OBJECTIVE. The purpose of our study was to evaluate the prognostic utility of LAS parameters, derived from MRI FT, in patients with ischemic or nonischemic DCM, including in comparison with the traditional parameters of LGE and LVGLS. METHODS. This retrospective study included 811 patients with ischemic or nonischemic DCM (median age, 60 years; 640 men, 171 women) who underwent cardiac MRI at any of five centers. FT-derived LAS parameters and LVGLS were measured using two- and four-chamber cine images. LGE percentage was quantified. Patients were assessed for a composite outcome of all-cause mortality or heart failure hospitalization. Multivariable Cox regression analyses including demographic characteristics, cardiovascular risk factors, medications used, and a wide range of cardiac MRI parameters were performed. Kaplan-Meier analyses with log-rank tests were also performed. RESULTS. A total of 419 patients experienced the composite outcome. Patients who did, versus those who did not, experience the composite outcome had larger LVGLS (-6.7% vs -8.3%, respectively; p < .001) as well as a smaller LAS reservoir (13.3% vs 19.3%, p < .001), LAS conduit (4.7% vs 8.0%, p < .001), and LAS booster (8.1% vs 10.3%, p < .001) but no significant difference in LGE (10.1% vs 11.3%, p = .51). In multivariable Cox regression analyses, significant independent predictors of the composite outcome included LAS reservoir (HR = 0.96, p < .001) and LAS conduit (HR = 0.91, p < .001). LAS booster and LGE were not significant independent predictors in the models. LVGLS was a significant independent predictor only in a model that initially included LAS booster but not the other LAS parameters. In Kaplan-Meier analysis, all three LAS parameters were significantly associated with the composite outcome (p < .001). CONCLUSION. In this multicenter study, LAS reservoir and LAS conduit were significant independent prognostic markers in patients with ischemic or nonischemic DCM, showing greater prognostic utility than the currently applied markers of LVGLS and LGE. CLINICAL IMPACT. FT-derived LAS analysis provides incremental prognostic information in patients with DCM.
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Affiliation(s)
- Fai Wang Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Subin Hwang
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Yueyi Xu
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | | | - Kwan Ho Gordon Leung
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Lu Lin
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
- Department of Medical Imaging, Peking Union Medical College, Beijing, China
| | - Shui Yan Ho
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Pan Pan Ng
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Jojo Siu Han Hai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Fung Yu James Kwok
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Ho Fung Sze
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Ambrose Ho Tung Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
| | - Eric Yuk Fai Wan
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR
| | - Yee Tak Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
- Department of Radiology, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong SAR
| | - Siu Ting Leung
- Imaging and Intervention Radiology Centre, CUHK Medical Centre, Hong Kong SAR
| | - Hiu Lam Chan
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | | | | | - Chun Yin Jonan Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Kai-Hang Yiu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Dudley J Pennell
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Raad H Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew T Yan
- Departments of Medicine and Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong SAR
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Wang H, Li Y, Chai K, Long Z, Yang Z, Du M, Wang S, Zhan S, Liu Y, Wan Y, Wang F, Yin P, Li W, Liao Y, Dong Y, Li X, Zhou J, Yiu KH, Zhou M, Huo Y, Yang J. Mortality in patients admitted to hospital with heart failure in China: a nationwide Cardiovascular Association Database-Heart Failure Centre Registry cohort study. Lancet Glob Health 2024; 12:e611-e622. [PMID: 38485428 DOI: 10.1016/s2214-109x(23)00605-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND China has the largest burden of heart failure worldwide. However, large-scale studies on heart failure mortality are scarce. We aimed to investigate mortality and identify risk factors for mortality among patients with heart failure in China. METHODS This prospective cohort study used data from the China Cardiovascular Association (CCA) Database-Heart Failure Centre Registry, which were linked to the National Mortality Registration Information Management System by the Chinese Centre for Disease Control and Prevention. We included patients enrolled from Jan 1, 2017, to Dec 31, 2021, across 572 CCA Database-Heart Failure Centre certified hospitals in 31 provinces of mainland China. Eligible patients were aged 18 years or older (younger than 100 years) with a principal discharge diagnosis of heart failure based on Chinese heart failure guidelines. All-cause mortality at 30 days, 1 year, and 3 years for patients with heart failure were calculated and the causes of death were recorded. Multivariable analysis was used to analyse factors associated with all-cause mortality and cardiovascular mortality. This study was registered with the Chinese Clinical Trial Registry, ChiCTR2200066305. FINDINGS Of the 327 477 patients in the registry, 230 637 eligible adults with heart failure were included in our analyses. Participant mean age was 69·3 years (SD 13·2), 94 693 (41·1%) participants were female, and 135 944 (58·9%) were male. The median follow-up time was 531 days (IQR 251-883). Post-discharge all-cause mortality of patients with heart failure at 30 days was 2·4% (95% CI 2·3-2·5), at 1 year was 13·7% (13·5-13·9), and at 3 years was 28·2% (27·7-28·6). Cardiovascular death accounted for 32 906 (71·5%) of 46 006 all-cause deaths. Patients with heart failure with reduced ejection fraction had the highest all-cause mortality. A lower guideline adherence score was independently associated with the increase of all-cause and cardiovascular mortality. INTERPRETATION In China, mortality for patients with heart failure is still high, especially in patients with reduced ejection fraction. Our findings suggest that guideline-directed medical therapy needs to be improved. FUNDING National High Level Hospital Clinical Research Funding, the Capital's Funds for Health Improvement and Research, and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Hua Wang
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingying Li
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ke Chai
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Long
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Zhikai Yang
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Minghui Du
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yujia Liu
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhao Wan
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Yin
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Weimin Li
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhua Liao
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yugang Dong
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinli Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai-Hang Yiu
- Cardiology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Maigeng Zhou
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China.
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
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5
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Lin L, Kwan CT, Yap PM, Fung SY, Tang HS, Tse WWV, Kwan CNF, Chow YHP, Yiu NC, Lee YP, Fong AHT, Ren QW, Wu MZ, Lee KCK, Leung CY, Li A, Montero D, Vardhanabhuti V, Hai J, Siu CW, Tse H, Pennell DJ, Mohiaddin R, Senior R, Yiu KH, Ng MY. Diagnostic Performance of Cardiovascular Magnetic Resonance Phase Contrast Analysis to Identify Heart Failure With Preserved Ejection Fraction. J Thorac Imaging 2024:00005382-990000000-00126. [PMID: 38465896 DOI: 10.1097/rti.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Lu Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
- Department of Diagnostic Radiology, School of Clinical Medicine
| | - Chi Ting Kwan
- Department of Diagnostic Radiology, School of Clinical Medicine
| | - Pui Min Yap
- Department of Diagnostic Radiology, School of Clinical Medicine
| | - Sau Yung Fung
- Department of Diagnostic Radiology, School of Clinical Medicine
| | - Hok Shing Tang
- Department of Diagnostic Radiology, School of Clinical Medicine
| | | | | | | | - Nga Ching Yiu
- Department of Diagnostic Radiology, School of Clinical Medicine
| | - Yung Pok Lee
- Department of Diagnostic Radiology, School of Clinical Medicine
| | | | - Qing-Wen Ren
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Mei-Zhen Wu
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Ka Chun Kevin Lee
- Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Wan Chai
| | - Chun Yu Leung
- Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan O
| | - Andrew Li
- Department of Medicine and Therapeutics, United Christian Hospital, Kwun Tong
| | - David Montero
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), Pokfulam, Hong Kong SAR, China
| | - Varut Vardhanabhuti
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - JoJo Hai
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Chung-Wah Siu
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - HungFat Tse
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Dudley John Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Cale Street, London
| | - Raad Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Cale Street, London
| | - Roxy Senior
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Cale Street, London
- Department of Cardiology, Northwick Park Hospital, Harrow
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK
| | - Kai-Hang Yiu
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Futian, Shenzhen, Guangdong, China
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6
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Ren QW, Katherine Teng TH, Tse YK, Wei Tsang CT, Yu SY, Wu MZ, Li XL, Hung D, Tse HF, Lam CS, Yiu KH. Statins and risks of dementia among patients with heart failure: a population-based retrospective cohort study in Hong Kong. Lancet Reg Health West Pac 2024; 44:101006. [PMID: 38298909 PMCID: PMC10827582 DOI: 10.1016/j.lanwpc.2023.101006] [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] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
Background Heart failure (HF) and dementia frequently co-exist with shared pathological mechanisms and risk factors. Our study aims to investigate the association between statin therapy and the risks of dementia and its subtypes among patients with HF. Methods The Hong Kong Clinical Data Analysis and Reporting System database was interrogated to identify patients with incident HF diagnosis from 2004 to 2018, using ICD 9/ICD 10 codes. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between statin users (N = 54,004) and non-users (N = 50,291). The primary outcomes were incident all-cause dementia, including subtypes of Alzheimer's disease, vascular dementia, and unspecified dementia. Cox proportional-hazard model with competing risk regression was performed to estimate the sub-distribution hazards ratio (SHR) with corresponding 95% confidence intervals (CI) of the risks of all-cause dementia and its subtypes that are associated with statin use. Findings Of all eligible patients with HF (N = 104,295), the mean age was 74.2 ± 13.6 years old and 52,511 (50.3%) were male. Over a median follow-up of 9.9 years (interquartile range [IQR]: 6.4-13.0), 10,031 (9.6%) patients were diagnosed with dementia, among which Alzheimer's disease (N = 2250), vascular dementia (N = 1831), and unspecified dementia (N = 5950) were quantified separately. After IPTW, statin use was associated with a 20% lower risk of incident dementia compared with non-use (multivariable-adjusted SHR 0.80, 95% CI 0.76-0.84). Stratified by subtypes of dementia, statin use was associated with a 28% lower risk of Alzheimer's disease (SHR 0.72, 95% CI 0.63-0.82), 18% lower risk of vascular dementia (SHR 0.82, 95% CI 0.70-0.95), and a 20% lower risk of unspecified dementia (SHR 0.80, 95% CI 0.75-0.85). Interpretation In patients with HF, statin use was associated with a significantly lower risk of all-cause dementia and its subtypes, including Alzheimer's disease, vascular dementia, and unspecified dementia. Both randomized trials and experimental studies to validate the potential neuroprotective effect of statin are warranted. Funding No funding was provided for this study.
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Affiliation(s)
- Qing-wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Center Singapore, Singapore
- Duke-NUS Medical School, Singapore
- School of Allied Health, University of Western Australia, Australia
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Christopher Tze Wei Tsang
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Si-Yeung Yu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Xin-li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Denise Hung
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Carolyn S.P. Lam
- National Heart Center Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Wu MZ, Teng THK, Tsang CTW, Chan YH, Lee CH, Ren QW, Huang JY, Cheang IF, Tse YK, Li XL, Xu X, Tse HF, Lam CSP, Yiu KH. Risk of hyperkalaemia in patients with type 2 diabetes mellitus prescribed with SGLT2 versus DPP-4 inhibitors. Eur Heart J Cardiovasc Pharmacother 2024; 10:45-52. [PMID: 37942588 DOI: 10.1093/ehjcvp/pvad081] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
AIMS To investigate the risk of hyperkalaemia in new users of sodium-glucose cotransporter 2 (SGLT2) inhibitors vs. dipeptidyl peptidase-4 (DPP-4) inhibitors among patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS Patients with T2DM who commenced treatment with an SGLT2 or a DPP-4 inhibitor between 2015 and 2019 were collected. A multivariable Cox proportional hazards analysis was applied to compare the risk of central laboratory-determined severe hyperkalaemia, hyperkalaemia, hypokalaemia (serum potassium ≥6.0, ≥5.5, and <3.5 mmol/L, respectively), and initiation of a potassium binder in patients newly prescribed an SGLT2 or a DPP-4 inhibitor. A total of 28 599 patients (mean age 60 ± 11 years, 60.9% male) were included after 1:2 propensity score matching, of whom 10 586 were new users of SGLT2 inhibitors and 18 013 of DPP-4 inhibitors. During a 2-year follow-up, severe hyperkalaemia developed in 122 SGLT2 inhibitor users and 325 DPP-4 inhibitor users. Use of SGLT2 inhibitors was associated with a 29% reduction in incident severe hyperkalaemia [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58-0.88] compared with DPP-4 inhibitors. Risk of hyperkalaemia (HR 0.81, 95% CI 0.71-0.92) and prescription of a potassium binder (HR 0.74, 95% CI 0.67-0.82) were likewise decreased with SGLT2 inhibitors compared with DPP-4 inhibitors. Occurrence of incident hypokalaemia was nonetheless similar between those prescribed an SGLT2 inhibitor and those prescribed a DPP-4 inhibitor (HR 0.90, 95% CI 0.81-1.01). CONCLUSION Our study provides real-world evidence that compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with lower risk of hyperkalaemia and did not increase the incidence of hypokalaemia in patients with T2DM.
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Affiliation(s)
- Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, 169609, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, 169857, Singapore
- School of Allied Health, University of Western Australia, Perth, 6009, Australia
| | - Christopher Tze-Wei Tsang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Chi-Ho Lee
- Division of Endocrinology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Iok-Fai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, 210029, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, 210029, China
| | - Xin Xu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, 169609, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, 169857, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, 9713, The Netherlands
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
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Ng MY, Tam CH, Lee YP, Fong HTA, Wong CK, Ng WKC, Yeung MHY, Ling WHI, Tsao S, Wan EYF, Ferreira V, Yan AT, Siu CW, Yiu KH, Hung IFN. Post-COVID-19 vaccination myocarditis: a prospective cohort study pre and post vaccination using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:74. [PMID: 38057820 DOI: 10.1186/s12968-023-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Concerns about COVID-19 vaccination induced myocarditis or subclinical myocarditis persists in some populations. Cardiac magnetic resonance imaging (CMR) has been used to detect signs of COVID-19 vaccination induced myocarditis. This study aims to: (i) characterise myocardial tissue, function, size before and after COVID-19 vaccination, (ii) determine if there is imaging evidence of subclinical myocardial inflammation or injury after vaccination using CMR. METHODS Subjects aged ≥ 12yrs old without prior COVID-19 or COVID-19 vaccination underwent two CMR examinations: first, ≤ 14 days before the first COVID-19 vaccination and a second time ≤ 14 days after the second COVID-19 vaccination. Biventricular indices, ejection fraction (EF), global longitudinal strain (GLS), late gadolinium enhancement (LGE), left ventricular (LV) myocardial native T1, T2, extracellular volume (ECV) quantification, lactate dehydrogenase (LDH), white cell count (WCC), C-reactive protein (CRP), NT-proBNP, troponin-T, electrocardiogram (ECG), and 6-min walk test were assessed in a blinded fashion. RESULTS 67 subjects were included. First and second CMR examinations were performed a median of 4 days before the first vaccination (interquartile range 1-8 days) and 5 days (interquartile range 3-6 days) after the second vaccination respectively. No significant change in global native T1, T2, ECV, LV EF, right ventricular EF, LV GLS, LGE, ECG, LDH, troponin-T and 6-min walk test was demonstrated after COVID-19 vaccination. There was a significant WCC decrease (6.51 ± 1.49 vs 5.98 ± 1.65, p = 0.003) and CRP increase (0.40 ± 0.22 vs 0.50 ± 0.29, p = 0.004). CONCLUSION This study found no imaging, biochemical or ECG evidence of myocardial injury or inflammation post COVID-19 vaccination, thus providing some reassurance that COVID-19 vaccinations do not typically cause subclinical myocarditis.
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Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China.
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen, China.
| | - Cheuk Hang Tam
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Yung Pok Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Kei Carol Ng
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Wood-Hay Ian Ling
- Grantham Hospital, 125 Wong Chuk Hang Rd, Aberdeen, Hong Kong SAR, China
| | - Sabrina Tsao
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford BHF Centre of Research Excellence, Oxford Centre for Clinical Magnetic Resonance Research, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew T Yan
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Chung Wah Siu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Cai S, Chang J, Su M, Wei Y, Sun H, Chen C, Yiu KH. miR-455-5p promotes pathological cardiac remodeling via suppression of PRMT1-mediated Notch signaling pathway. Cell Mol Life Sci 2023; 80:359. [PMID: 37951845 PMCID: PMC10640488 DOI: 10.1007/s00018-023-04987-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023]
Abstract
Pathological cardiac remodeling plays an essential role in the progression of cardiovascular diseases, and numerous microRNAs have been reported to participate in pathological cardiac remodeling. However, the potential role of microRNA-455-5p (miR-455-5p) in this process remains to be elucidated. In the present study, we focused on clarifying the function and searching the direct target of miR-455-5p, as well as exploring its underlying mechanisms in pathological cardiac remodeling. We found that overexpression of miR-455-5p by transfection of miR-455-5p mimic in vitro or tail vain injection of miR-455-5p agomir in vivo provoked cardiac remodeling, whereas genetic knockdown of miR-455-5p attenuated the isoprenaline-induced cardiac remodeling. Besides, miR-455-5p directly targeted to 3'-untranslated region of protein arginine methyltransferase 1 (PRMT1) and subsequently downregulated PRMT1 level. Furthermore, we found that PRMT1 protected against cardiac hypertrophy and fibrosis in vitro. Mechanistically, miR-455-5p induced cardiac remodeling by downregulating PRMT1-induced asymmetric di-methylation on R1748, R1750, R1751 and R1752 of Notch1, resulting in suppression of recruitment of Presenilin, Notch1 cleavage, NICD releasing and Notch signaling pathway. Finally, circulating miR-455-5p was positively correlated with parameters of left ventricular wall thickening. Taken together, miR-455-5p plays a provocative role in cardiac remodeling via inactivation of the PRMT1-mediated Notch signaling pathway, suggesting miR-455-5p/PRMT1/Notch1 signaling axis as potential therapeutic targets for pathological cardiac remodeling.
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Affiliation(s)
- Sidong Cai
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Junlei Chang
- Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Mengqi Su
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yinxia Wei
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Haoran Sun
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Cong Chen
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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Rao J, Mou X, Mo Y, Bei HP, Wang L, Tang CY, Yiu KH, Yang Z, Zhao X. Gas station in blood vessels: An endothelium mimicking, self-sustainable nitric oxide fueling stent coating for prevention of thrombosis and restenosis. Biomaterials 2023; 302:122311. [PMID: 37677916 DOI: 10.1016/j.biomaterials.2023.122311] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Stenting is the primary treatment for vascular obstruction-related cardiovascular diseases, but it inevitably causes endothelial injury which may lead to severe thrombosis and restenosis. Maintaining nitric oxide (NO, a vasoactive mediator) production and grafting endothelial glycocalyx such as heparin (Hep) onto the surface of cardiovascular stents could effectively reconstruct the damaged endothelium. However, insufficient endogenous NO donors may impede NO catalytic generation and fail to sustain cardiovascular homeostasis. Here, a dopamine-copper (DA-Cu) network-based coating armed with NO precursor L-arginine (Arg) and Hep (DA-Cu-Arg-Hep) is prepared using an organic solvent-free dipping technique to form a nanometer-thin coating onto the cardiovascular stents. The DA-Cu network adheres tightly to the surface of stents and confers excellent NO catalytic activity in the presence of endogenous NO donors. The immobilized Arg functions as a NO fuel to generate NO via endothelial nitric oxide synthase (eNOS), while Hep works as eNOS booster to increase the level of eNOS to decompose Arg into NO, ensuring a sufficient supply of NO even when endogenous donors are insufficient. The synergistic interaction between Cu and Arg is analogous to a gas station to fuel NO production to compensate for the insufficient endogenous NO donor in vivo. Consequently, it promotes the reconstruction of natural endothelium, inhibits smooth muscle cell (SMC) migration, and suppresses cascading platelet adhesion, preventing stent thrombosis and restenosis. We anticipate that our DA-Cu-Arg-Hep coating will improve the quality of life of cardiovascular patients through improved surgical follow-up, increased safety, and decreased medication, as well as revitalize the stenting industry through durable designs.
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Affiliation(s)
- Jingdong Rao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Xiaohui Mou
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong 523000, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou, Guangdong, China
| | - Yongyi Mo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ho-Pan Bei
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Li Wang
- Department of Civil Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong Island, Hong Kong SAR, China
| | - Chuyang Y Tang
- Department of Civil Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong Island, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong Island, Hong Kong SAR, China
| | - Zhilu Yang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong 523000, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou, Guangdong, China.
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China; Department of Applied Biology and Chemical Technology, the Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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Tse YK, Li HL, Ren QW, Huang JY, Wu MZ, Leung CKL, Yu SY, Hung D, Tse HF, Flachskampf FA, Yiu KH. Morphological and functional types of tricuspid regurgitation: prognostic value in patients undergoing tricuspid annuloplasty during left-sided valvular surgery. Clin Res Cardiol 2023; 112:1463-1474. [PMID: 37540240 DOI: 10.1007/s00392-023-02265-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The nonuniform benefit of tricuspid annuloplasty may be explained by the proportionality of tricuspid regurgitation (TR) severity to right ventricular (RV) area. The purpose of this study was to delineate distinct morphological phenotypes of functional TR and investigate their prognostic implications in patients undergoing tricuspid annuloplasty during left-sided valvular surgery. METHODS The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area (RVDA) were retrospectively assessed in 290 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from penalized splines and maximally selected rank statistics, patients were stratified into proportionate (EROA/RVDA ratio ≤ 1.74) and disproportionate TR (EROA/RVDA ratio > 1.74). RESULTS Overall, 59 (20%) and 231 (80%) patients had proportionate and disproportionate TR, respectively. Compared to those with proportionate TR, patients with disproportionate TR were older, had a higher prevalence of atrial fibrillation, lower pulmonary pressures, more impaired RV function, and larger tricuspid leaflet tenting area. Over a median follow-up of 4.1 years, 79 adverse events (47 heart failure hospitalizations and 32 deaths) occurred. Patients with disproportionate TR had higher rates of adverse events than those with proportionate TR (32% vs 10%; P = 0.001) and were independently associated with poor outcomes on multivariate analysis. TR proportionality outperformed guideline-based classification of TR severity in outcome prediction and provided incremental prognostic value to both the EuroSCORE II and STS score (incremental χ2 = 6.757 and 9.094 respectively; both P < 0.05). CONCLUSIONS Disproportionate TR is strongly associated with adverse prognosis and may aid patient selection and risk stratification for tricuspid annuloplasty with left-sided valvular surgery.
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Affiliation(s)
- Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Calvin Ka-Lam Leung
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Denise Hung
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Frank A Flachskampf
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Kwan CT, Ching OHS, Yap PM, Fung SY, Tang HS, Tse WWV, Kwan CNF, Chow YHP, Yiu NC, Lee YP, Lau JWK, Fong AHT, Ren QW, Wu MZ, Wan EYF, Lee KCK, Leung CY, Li A, Montero D, Vardhanabhuti V, Hai JSH, Siu CW, Tse HF, Zingan V, Zhao X, Wang H, Pennell DJ, Mohiaddin R, Senior R, Yiu KH, Ng MY. Intraventricular 4D flow cardiovascular magnetic resonance for assessing patients with heart failure with preserved ejection fraction: a pilot study. Int J Cardiovasc Imaging 2023; 39:2015-2027. [PMID: 37380904 DOI: 10.1007/s10554-023-02909-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. Intraventricular four-dimensional flow (4D flow) phase-contrast cardiovascular magnetic resonance (CMR) can assess different components of left ventricular (LV) flow including direct flow, delayed ejection, retained inflow and residual volume. This could be utilised to identify HFpEF. This study investigated if intraventricular 4D flow CMR could differentiate HFpEF patients from non-HFpEF and asymptomatic controls. Suspected HFpEF patients and asymptomatic controls were recruited prospectively. HFpEF patients were confirmed using European Society of Cardiology (ESC) 2021 expert recommendations. Non-HFpEF patients were diagnosed if suspected HFpEF patients did not fulfil ESC 2021 criteria. LV direct flow, delayed ejection, retained inflow and residual volume were obtained from 4D flow CMR images. Receiver operating characteristic (ROC) curves were plotted. 63 subjects (25 HFpEF patients, 22 non-HFpEF patients and 16 asymptomatic controls) were included in this study. 46% were male, mean age 69.8 ± 9.1 years. CMR 4D flow derived LV direct flow and residual volume could differentiate HFpEF vs combined group of non-HFpEF and asymptomatic controls (p < 0.001 for both) as well as HFpEF vs non-HFpEF patients (p = 0.021 and p = 0.005, respectively). Among the 4 parameters, direct flow had the largest area under curve (AUC) of 0.781 when comparing HFpEF vs combined group of non-HFpEF and asymptomatic controls, while residual volume had the largest AUC of 0.740 when comparing HFpEF and non-HFpEF patients. CMR 4D flow derived LV direct flow and residual volume show promise in differentiating HFpEF patients from non-HFpEF patients.
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Affiliation(s)
- Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - On Hang Samuel Ching
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pui Min Yap
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sau Yung Fung
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wan Wai Vivian Tse
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Cheuk Nam Felix Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yin Hay Phoebe Chow
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Nga Ching Yiu
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yung Pok Lee
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jessica Wing Ka Lau
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ambrose Ho Tung Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka Chun Kevin Lee
- Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Wan Chai, Hong Kong
| | - Chun Yu Leung
- Department of Medicine, Tseung Kwan O Hospital, Hong Hau, Hong Kong
| | - Andrew Li
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong
| | - David Montero
- School of Public Health, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jojo Siu Han Hai
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Xiaoxi Zhao
- Circle Cardiovascular Imaging Inc, Calgary, Canada
| | | | - Dudley John Pennell
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raad Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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Leung CKL, Lam LY, Li KY, Feng Y, Cao G, Wu M, Wang R, Wu MZ, Ren QW, Yu SY, Tse YK, Li HL, Yu SY, Tse HF, Xu B, Yiu KH. Clinical Value of Computational Angiography-derived Fractional Flow Reserve in Stable Coronary Artery Disease. J Cardiovasc Transl Res 2023; 16:1166-1176. [PMID: 36991293 DOI: 10.1007/s12265-023-10381-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Abstract
The utilization of FFR remains low. Our study evaluated the per-vessel prognostic value of computational pressure-flow dynamics-derived FFR (caFFR) among patients with stable coronary artery disease. A total of 3329 vessels from 1308 patients were included and analysed. They were stratified into ischaemic (caFFR ≤ 0.8) and non-ischaemic (caFFR > 0.8) cohorts, and the associations between PCI and outcomes were evaluated. The third cohort comprised all included vessels, and the associations between treatment adherent-to-caFFR (PCI in vessels with caFFR ≤ 0.8 and no PCI in vessels with caFFR > 0.8) and outcomes were evaluated. The primary outcome was VOCE, defined as a composite of vessel-related cardiovascular mortality, non-fatal myocardial infarction, and repeat revascularization. PCI was associated with a lower 3-year risk of VOCE in the ischaemic cohort (HR, 0.44; 95% CI, 0.26-0.74; P = 0.002) but not in the non-ischaemic cohort. The risk of VOCE was lower in the adherent-to-caFFR group (n = 2649) (HR, 0.69; 95% CI, 0.48-0.98; P = 0.039). A novel index that uses coronary angiography images to estimate FFR may have substantial clinical value in guiding management among patients with stable coronary artery disease.
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Affiliation(s)
- Calvin Ka-Lam Leung
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Lok-Yee Lam
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Kwan-Yu Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Yundi Feng
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
| | - Gaozhen Cao
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Min Wu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Run Wang
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Shuk-Yin Yu
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China
| | - Bo Xu
- National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China.
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China.
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Ng PY, Ng AKY, Ip A, Yiu KH. The authors reply. Crit Care Med 2023; 51:e186-e187. [PMID: 37589525 DOI: 10.1097/ccm.0000000000005946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Pauline Yeung Ng
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - Andrew Kei-Yan Ng
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - April Ip
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
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15
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Ng PY, Ng AKY, Ip A, Wu MZ, Guo R, Yiu KH. Risk of ICU Admission and Related Mortality in Patients With Sodium-Glucose Cotransporter 2 Inhibitors and Dipeptidyl Peptidase-4 Inhibitors: A Territory-Wide Retrospective Cohort Study. Crit Care Med 2023; 51:1074-1085. [PMID: 37026864 PMCID: PMC10335740 DOI: 10.1097/ccm.0000000000005869] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVES The benefit of sodium-glucose cotransporter 2 (SGLT2) inhibitors in reducing the occurrence rate of adverse cardiac and renal outcomes in patients with type 2 diabetes has been well described in randomized trials. Whether this benefit extends to patients at the most severe end of the disease spectrum requiring admission to the ICU remains to be examined. DESIGN Retrospective observational study. SETTING Data were obtained from a territory-wide clinical registry in Hong Kong (Clinical Data Analysis and Reporting System). PATIENTS All adult patients (age ≥ 18 yr) with type 2 diabetes and newly prescribed SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors between January 1, 2015, and December 31, 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After 1:2 propensity score matching, a total of 27,972 patients (10,308 SGLT2 inhibitors vs 17,664 DPP-4 inhibitors) were included in the final analysis. The mean age was 59 ± 11 years, and 17,416 (62.3%) were male. The median follow-up period was 2.9 years. The use of SGLT2 inhibitors was associated with decreased ICU admission (286 [2.8%] vs 645 [3.7%]; hazard ratio [HR], 0.79; 95% CI, 0.69-0.91; p = 0.001) and lower risks of all-cause mortality (315 [3.1%] vs 1,327 [7.5%]; HR, 0.44; 95% CI, 0.38-0.49; p < 0.001), compared with DPP-4 inhibitors. The severity of illness upon ICU admission by Acute Physiology and Chronic Health Evaluation IV-predicted risk of death was also lower in SGLT2 inhibitors users. Admissions and mortality due to sepsis were lower in SGLT2 inhibitor users compared with DPP-4 inhibitor users (admissions for sepsis: 45 [0.4%] vs 134 [0.8%]; p = 0.001 and mortality: 59 [0.6%] vs 414 [2.3%]; p < 0.001, respectively). CONCLUSIONS In patients with type 2 diabetes, SGLT2 inhibitors were independently associated with lower rates of ICU admission and all-cause mortality across various disease categories.
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Affiliation(s)
- Pauline Yeung Ng
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - Andrew Kei-Yan Ng
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - April Ip
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mei-Zhen Wu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
| | - Ran Guo
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Kai-Hang Yiu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
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16
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Ng MY, Vardhanabhuti V, Yiu KH, Hai SH. Cardiac magnetic resonance assessment of heart failure with preserved ejection fraction: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 4:22-25. [PMID: 37690803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- M Y Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - V Vardhanabhuti
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - K H Yiu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S H Hai
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Cai S, Huang F, Wang R, Wu M, Liu M, Peng Y, Cao G, Li Y, Liu S, Lu J, Su M, Wei Y, Yiu KH, Chen C. Habitual physical activity improves outcomes among patients with myocardial infarction. Front Cardiovasc Med 2023; 10:1174466. [PMID: 37378408 PMCID: PMC10291190 DOI: 10.3389/fcvm.2023.1174466] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose This study evaluates the association between habitual physical activity (HPA) and the outcomes of patients with myocardial infarction (MI). Methods Patients newly diagnosed with MI were divided into two groups based on whether they engaged in HPA, defined as an aerobic activity with a duration of no less than 150 min/week, before the index admission. The primary outcomes included major adverse cardiovascular events (MACEs), cardiovascular (CV) mortality, and cardiac readmission rate 1 year following the index date of admission. A binary logistic regression model was applied to analyze whether HPA was independently associated with 1-year MACEs, 1-year CV mortality, and 1-year cardiac readmission rate. Results Among the 1,266 patients (mean age 63.4 years, 72% male), 571 (45%) engaged in HPA, and 695 (55%) did not engage in HPA before MI. Patients who participated in HPA were independently associated with a lower Killip class upon admission (OR = 0.48: 95% CI, 0.32-0.71, p < 0.001) and a lower prevalence of 1-year MACEs (OR = 0.74: 95% CI, 0.56-0.98, p = 0.038) and 1-year CV mortality (OR = 0.50: 95% CI, 0.28-0.88, p = 0.017) than those who did not participate in HPA. HPA was not associated with cardiac-related readmission (OR = 0.87: 95% CI, 0.64-1.17, p = 0.35). Conclusions HPA before MI was independently associated with a lower Killip class upon admission, 1-year MACEs, and 1-year CV mortality rate.
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Affiliation(s)
- Sidong Cai
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fangmei Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Run Wang
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Min Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mingya Liu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yufen Peng
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Gaozhen Cao
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yapin Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shuhong Liu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jiena Lu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mengqi Su
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yinxia Wei
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Cong Chen
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Tang HS, Kwan CT, He J, Ng PP, Hai SHJ, Kwok FYJ, Sze HF, So MH, Lo HY, Fong HTA, Wan EYF, Lee CH, Yu EYT, Lai YTA, Lee CYJ, Leung ST, Chan HL, Tse HF, Pennell DJ, Mohiaddin RH, Senior R, Yan AT, Yiu KH, Ng MY. Prognostic Utility of Cardiac MRI Myocardial Strain Parameters in Patients With Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study. AJR Am J Roentgenol 2023; 220:524-538. [PMID: 36321987 DOI: 10.2214/ajr.22.28415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND. Prior small single-center studies have yielded conflicting results regarding the prognostic significance of myocardial strain parameters derived from feature tracking (FT) on cardiac MRI in patients with dilated cardiomyopathy (DCM). OBJECTIVE. The purpose of this study was to evaluate the prognostic utility of FT parameters on cardiac MRI in patients with ischemic and nonischemic DCM and to determine the optimal strain parameter for outcome prediction. METHODS. This retrospective study included 471 patients (median age, 61 years; 365 men, 106 women) with ischemic (n = 233) or nonischemic (n = 238) DCM and left ventricular (LV) ejection fraction (EF) less than 50% who underwent cardiac MRI at any of four centers from January 2011 to December 2019. Cardiac MRI parameters were determined by manual contouring. In addition, software-based FT was used to calculate six myocardial strain parameters (LV and right ventricular [RV] global radial strain, global circumferential strain, and global longitudinal strain [GLS]). Late gadolinium enhancement (LGE) was also evaluated. Patients were assessed for a composite outcome of all-cause mortality and/or heart-failure hospitalization. Cox regression models were used to determine associations between strain parameters and the composite outcome. RESULTS. Mean LV EF was 27.5% and mean LV GLS was -6.9%. The median follow-up period was 1328 days. The composite outcome occurred in 220 patients (125 deaths, 95 heart-failure hospitalizations). All six myocardial strain parameters were significant independent predictors of the composite outcome (hazard ratio [HR] = 0.92-1.16; all p < .05). In multivariable models that included age, corrected LV and RV end-diastolic volume, LV and RV EF, and presence of LGE, the only strain parameter that was a significant independent predictor of the composite outcome was LV GLS (HR = 1.13, p = .006); LV EF and presence of LGE were not independent predictors of the composite outcome in the models (p > .05). A LV GLS threshold of -6.8% had sensitivity of 62.6% and specificity of 62.6% in predicting the composite outcome rate at 4.0 years. CONCLUSION. LV GLS, derived from FT on cardiac MRI, is a significant independent predictor of adverse outcomes in patients with DCM. CLINICAL IMPACT. This study strengthens the body of evidence supporting the clinical implementation of FT when performing cardiac MRI in patients with DCM.
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Affiliation(s)
- Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Jianlong He
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Pan Pan Ng
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Siu Han Jojo Hai
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
| | - Fung Yu James Kwok
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Ho Fung Sze
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Man Hon So
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Hong Yip Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR
| | - Chi-Ho Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR
| | - Yee Tak Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Chun Yin Jonan Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Siu Ting Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
- Imaging and Intervention Radiology Centre, CUHK Medical Centre, Hong Kong SAR
| | - Hiu Lam Chan
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Hung Fat Tse
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Dudley J Pennell
- Department of Cardiovascular Magnetic Resonance, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Raad H Mohiaddin
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Roxy Senior
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kai-Hang Yiu
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Diaz-Canestro C, Ng HF, Yiu KH, Montero D. Reduced lean body mass: a potential modifiable contributor to the pathophysiology of heart failure. Eur Heart J 2023; 44:1386-1388. [PMID: 36924205 DOI: 10.1093/eurheartj/ehad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Candela Diaz-Canestro
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.,Department of Medicine, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Hung-Fat Ng
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China.,Department of Medicine, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China.,Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China.,Center for Translational Stem Cell Biology, 17 Science Park W Ave, Science Park, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China.,Department of Medicine, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China.,Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - David Montero
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.,School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China.,Libin Cardiovascular Institute of Alberta, University of Calgary, 1403-29th Street NW, Calgary, AB T2N 2T9, Canada
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20
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Ye X, Huang C, Yan VKC, Kang W, Fan M, Tsang GKC, Ho CMY, Lip GYH, Yiu KH, Tse HF, Ma T, Qin X, Chui CSL, Lai FTT, Wong CKH, Wan EYF, Li X, Lee CK, Hung IFN, Wong ICK, Chan EW. Sex-based differences in risk of ischemic stroke or systemic embolism after BNT162b2 or CoronaVac COVID-19 vaccination in patients with atrial fibrillation: A self-controlled case series and nested case-control study. Eur Heart J Cardiovasc Pharmacother 2023:7077540. [PMID: 36918200 PMCID: PMC10385083 DOI: 10.1093/ehjcvp/pvad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
AIMS Patients with atrial fibrillation (AF) have a higher risk of ischemic stroke or systemic embolism with a greater risk for female patients. This study aims to evaluate the risk of ischemic stroke or systemic embolism and bleeding following COVID-19 vaccination in patients with AF and the sex differences. METHODS AND RESULTS Self-controlled case series (SCCS) analysis was conducted to evaluate the risk of ischemic stroke or systemic embolism and bleeding following BNT162b2 or CoronaVac in patients with AF, using the territory-wide electronic medical records from the Hospital Authority and vaccination records from the Department of Health in Hong Kong. Patients with a primary diagnosis of ischemic stroke or systemic embolism or bleeding in the inpatient setting between February 23, 2021 and March 31, 2022 were included. A nested case-control analysis was also conducted with each case randomly matched with ten controls according to sex, age, Charlson comorbidity index and date of hospital admission. Conditional Poisson regression was used in the SCCS analysis and conditional logistic regression was used in nested case-control analysis to assess the risks and all analyses were stratified by sex and type of vaccines. Among 51 158 patients with AF, we identified an increased risk of ischemic stroke or systemic embolism after the first dose of BNT162b2 in SCCS analysis during 0-13 days (incidence rate ratio 6.60[95% CI 1.51-28.77]) and 14-27 days (6.53[95% CI 1.31-32.51]), and nested case-control analysis during 0-13 days (adjusted odds ratio 6.21 [95% CI 1.14-33.91]) and 14-27 days (5.52 [95% CI 1.12-27.26]) only in female patients. The increased risk in female patients following the first dose of CoronaVac was only detected during 0-13 days (3.88 [95% CI 1.67-9.03]) in the nested case-control analysis. No increased risk of ischemic stroke or systemic embolism was identified in male patients and no increased risk of bleeding was detected in all patients with AF for both vaccines. An increased risk of ischemic stroke or systemic embolism after COVID-19 was also observed in both females (17.42 [95% CI 5.08-59.73]) and males (6.63 [95% CI 2.02-21.79]). CONCLUSIONS The risk of ischemic stroke or systemic embolism after COVID-19 vaccination was only increased in female patients with AF. However, as the risk after COVID-19 was even higher, proactive uptake of COVID-19 vaccines is recommended to prevent the potential severe outcomes after infection.
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Affiliation(s)
- Xuxiao Ye
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Caige Huang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent K C Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wei Kang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gigi K C Tsang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Clarissa M Y Ho
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.,Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.,Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Tiantian Ma
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Xiwen Qin
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.,School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T T Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.,Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cheuk Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong SAR, China
| | - Ivan F N Hung
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.,Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.,Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China.,Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
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21
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Ng MY, Kwan CT, Yap PM, Fung SY, Tang HS, Tse WWV, Kwan CNF, Chow YHP, Yiu NC, Lee YP, Fong AHT, Hwang S, Fong ZFW, Ren QW, Wu MZ, Wan EYF, Lee KCK, Leung CY, Li A, Montero D, Vardhanabhuti V, Hai JSH, Siu CW, Tse HF, Pennell DJ, Mohiaddin R, Senior R, Yiu KH. Diagnostic Accuracy of Cardiovascular Magnetic Resonance Strain Analysis and Atrial Size to Identify Heart Failure with Preserved Ejection Fraction. European Heart Journal Open 2023; 3:oead021. [PMID: 36992915 PMCID: PMC10041670 DOI: 10.1093/ehjopen/oead021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
Abstract
Aims
Heart failure with preserved ejection fraction (HFpEF) continues to be a diagnostic challenge. CMR atrial measurements, feature-tracking (CMR-FT), tagging have long been suggested to diagnose HFpEF and potentially complement echocardiography especially when echocardiography is indeterminate. Data supporting the use of atrial measurements, CMR-FT or tagging is absent. Our aim is to conduct a prospective case-control study assessing the diagnostic accuracy of CMR atrial volume/area, CMR-FT, and tagging to diagnose HFpEF amongst patients suspected of having HFpEF.
Methods & Results
121 suspected HFpEF patients were prospectively recruited from four centres. Patients underwent echocardiography, CMR, NT-proBNP measurements within 24 hours to diagnose HFpEF. Patients without HFpEF diagnosis underwent catheter pressure measurements or stress echocardiography to confirm HFpEF or non-HFpEF. Area under the curve (AUC) were determined by comparing HFpEF with non-HFpEF patients. 53 HFpEF (median age 78yrs, interquartile range 74-82yrs) and 38 non-HFpEF (median age 70yrs, interquartile range 64-76yrs). CMR left atrial (LA) reservoir strain (ResS), LA area indexed (LAAi) and LA volume indexed (LAVi) had the highest diagnostic accuracy (AUCs 0.803, 0.815 and 0.776 respectively).
LA ResS, LAAi and LAVi had significantly better diagnostic accuracy than CMR-FT left ventricle (LV)/right ventricle (RV) parameters and tagging (p < 0.01). Tagging circumferential and radial strain had poor diagnostic accuracy (AUC 0.644 and 0.541 respectively).
Conclusion
CMR LA ResS, LAAi and LAVi have the highest diagnostic accuracy to identify HFpEF patients from non-HFpEF patients amongst clinically suspected HFpEF patients. CMR-FT LV/RV parameters and tagging had low diagnostic accuracy to diagnose HFpEF.
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Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong
| | - Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong
| | - Pui Min Yap
- Department of Diagnostic Radiology, The University of Hong Kong
| | - Sau Yung Fung
- Department of Diagnostic Radiology, The University of Hong Kong
| | - Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong
| | | | | | | | - Nga Ching Yiu
- Department of Diagnostic Radiology, The University of Hong Kong
| | - Yung Pok Lee
- Department of Diagnostic Radiology, The University of Hong Kong
| | | | - Subin Hwang
- Department of Diagnostic Radiology, The University of Hong Kong
| | | | - Qing-Wen Ren
- Department of Medicine, The University of Hong Kong
| | - Mei-Zhen Wu
- Department of Medicine, The University of Hong Kong
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong , Hong Kong
| | - Ka Chun Kevin Lee
- Department of Medicine, Ruttonjee Hospital and Tang Shiu Kin Hospitals , Hong Kong
| | - Chun Yu Leung
- Department of Medicine, Tseung Kwan O Hospital , Hong Kong
| | - Andrew Li
- Department of Medicine, United Christian Hospital , Hong Kong
| | - David Montero
- School of Public Health, Faculty of Medicine, The University of Hong Kong , Hong Kong
| | | | | | | | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong
| | - Dudley John Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
- National Heart and Lung Institute, Imperial College , London , United Kingdom
| | - Raad Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
- National Heart and Lung Institute, Imperial College , London , United Kingdom
| | - Roxy Senior
- National Heart and Lung Institute, Imperial College , London , United Kingdom
- Department of Cardiology, Northwick Park Hospital , Harrow , United Kingdom
- Cardiology, Royal Brompton Hospital , London , United Kingdom
| | - Kai-Hang Yiu
- Department of Medicine, The University of Hong Kong
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22
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Zheng J, Zhou R, Zhang Y, Su K, Chen H, Li F, Hukportie DN, Niu F, Yiu KH, Wu X. Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study. Chest 2023; 163:610-623. [PMID: 36372304 DOI: 10.1016/j.chest.2022.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/14/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) findings are a heterogeneous condition characterized by a normal FEV1 to FVC ratio with underlying impairment of pulmonary function. Data relating to the association of baseline and trajectories of PRISm findings with diverse cardiovascular outcomes are sparse. RESEARCH QUESTION How do baseline and trajectories of PRISm findings impact subsequent cardiovascular events? STUDY DESIGN AND METHODS In the UK Biobank cohort study, we included participants free of cardiovascular disease (CVD) with spirometry (FEV1 and FVC values) at baseline (2006-2010). Participants with baseline spirometry and follow-up spirometry (2014-2020) were included in the lung function trajectory analysis. Cox proportional hazards multivariate regression was performed to evaluate the outcomes of major adverse cardiovascular events (MACEs), incident myocardial infarction (MI), stroke, heart failure (HF), and CVD mortality in association with lung function. RESULTS For baseline analysis (329,954 participants), the multivariate adjusted hazard ratios (HRs) for participants had PRISm findings (vs normal spirometry findings) were 1.26 (95% CI, 1.17-1.35) for MACE, 1.12 (95% CI, 1.01-1.25) for MI, 1.88 (95% CI, 1.72-2.05) for HF, 1.26 (95% CI, 1.13-1.40) for stroke, and 1.55 (95% CI, 1.37-1.76) for CVD mortality, respectively. A total of 22,781 participants underwent follow-up spirometry after an average of 8.9 years. Trajectory analysis showed that persistent PRISm findings (HR, 1.96; 95% CI, 1.24-3.09) and airflow obstruction (HR, 1.43; 95% CI, 1.00-2.04) was associated with a higher incidence of MACE vs consistently normal lung function. Compared with persistent PRISm findings, changing from PRISm to normal spirometry findings was associated with a lower incidence of MACE (HR, 0.42; 95% CI, 0.19-0.99). INTERPRETATION Individuals with baseline or persistent PRISm findings were at a higher risk of diverse cardiovascular outcomes even after adjusting for a wide range of confounding factors. However, individuals who transitioned from PRISm to normal findings showed a similar cardiovascular risk as those with normal lung function.
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Affiliation(s)
- Jiazhen Zheng
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangdong, China; Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong SAR, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR, China
| | - Kelei Su
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Haowen Chen
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Furong Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Guangdong, China
| | - Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Fangbing Niu
- Department of Tuberculosis, Hebei Chest Hospital, Hebei, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, Guangdong, China; Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Island, Hong Kong, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China.
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23
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Wu MZ, Teng THK, Tay WT, Ren QW, Tromp J, Ouwerkerk W, Chandramouli C, Huang JY, Chan YH, Teramoto K, Yu SY, Lawson C, Li HL, Tse YK, Li XL, Hung D, Tse HF, Lam CSP, Yiu KH. Chronic kidney disease begets heart failure and vice versa: temporal associations between heart failure events in relation to incident chronic kidney disease in type 2 diabetes. Diabetes Obes Metab 2023; 25:707-715. [PMID: 36346045 DOI: 10.1111/dom.14916] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
AIM To investigate the interplay of incident chronic kidney disease (CKD) and/or heart failure (HF) and their associations with prognosis in a large, population-based cohort with type 2 diabetes (T2DM). METHODS Patients aged ≥18 years with new-onset T2DM, without renal disease or HF at baseline, were identified from the territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up until December 31, 2020 for incident CKD and/or HF and all-cause mortality. RESULTS Among 102 488 patients (median age 66 years, 45.7% women, median follow-up 7.5 years), new-onset CKD occurred in 14 798 patients (14.4%), in whom 21.7% had HF. In contrast, among 9258 patients (9.0%) with new-onset HF, 34.6% had CKD. The median time from baseline to incident CKD or HF (4.4 vs. 4.1 years) did not differ. However, the median (interquartile range) time until incident HF after CKD diagnosis was 1.7 (0.5-3.6) years and was 1.2 (0.2-3.4) years for incident CKD after HF diagnosis (P < 0.001). The crude incidence of CKD was higher than that of HF: 17.6 (95% confidence interval [CI] 17.3-17.9) vs. 10.6 (95% CI 10.4-10.9)/1000 person-years, respectively, but incident HF was associated with a higher adjusted-mortality than incident CKD. The presence of either condition (vs. CKD/HF-free status) was associated with a three-fold hazard of death, whereas concomitant HF and CKD conferred a six to seven-fold adjusted hazard of mortality. CONCLUSION Cardiorenal complications are common and are associated with high mortality risk among patients with new-onset T2DM. Close surveillance of these dual complications is crucial to reduce the burden of disease.
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Affiliation(s)
- Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, Singapore
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Wan-Ting Tay
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jasper Tromp
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Chanchal Chandramouli
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, Singapore
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kanako Teramoto
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Claire Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, UK
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xin-Li Li
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Denise Hung
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, Singapore
- University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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24
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Xu Y, Yiu KH, Lee WN. Fast and Robust Clutter Filtering in Ultrafast Echocardiography. Ultrasound Med Biol 2023; 49:441-453. [PMID: 36372594 DOI: 10.1016/j.ultrasmedbio.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Singular value decomposition (SVD)-based filters have become the norm for clutter filtering in ultrasound blood flow applications but are computationally expensive and susceptible to large and fast tissue motion. Randomized SVD (rSVD) has later been shown to successfully accelerate filtering of in vivo stationary tissues. However, little is known about its performance on ultrafast echocardiography, which produces thousands of frames to assess complex myocardial deformation and blood dynamics. Neither has its inherently robust randomized scheme been proven in any ultrasound blood flow imaging methods. This study thus proposed to employ rSVD as a fast and robust clutter filter for ultrafast echocardiograms prior to power Doppler analysis. Ultrafast echocardiograms of nine normal human hearts were acquired in vivo by our cascaded synthetic aperture imaging method. One subject was additionally scanned under four different sonographic signal-to-noise ratio (SNR) levels. Contrast ratio (CR) and contrast-to-noise ratio (CNR) of in vivo power Doppler images obtained from filtered ultrafast echocardiograms were calculated, and their mean and standard deviation within a cardiac cycle represented temporal average and variation of contrast resolution, respectively. Our in vivo results showed that rSVD accelerated clutter filtering by 12-fold and provided significantly better local contrast (mean CNR values: p < 0.001) while being equally effective (mean CR values: p = 0.20) compared with full-SVD. rSVD yielded smaller standard deviations of CR (1.32 dB vs. 5.49 dB) and CNR (1.27 dB vs. 5.49 dB) than full-SVD in the lowest SNR scenario, thus substantiating its superior robustness. Our findings suggest using rSVD in ultrafast echocardiographic blood dynamics analysis.
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Affiliation(s)
- Yue Xu
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Cardiology Division, University of Hong Kong, Shenzhen Hospital, Hong Kong, China; Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Wei-Ning Lee
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong, China; Biomedical Engineering Programme, University of Hong Kong, Hong Kong, China.
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25
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Teng THK, Tay WT, Ouwerkerk W, Tromp J, Richards AM, Gamble G, Greene SJ, Yiu KH, Poppe K, Ling LH, Lund M, Sim D, Devlin G, Loh SY, Troughton R, Ren QW, Jaufeerally F, Lee SGS, Tan RS, Soon DKN, Leong G, Ong HY, Yeo DPS, Lam CSP, Doughty RN. Titration of medications and outcomes in multi-ethnic heart failure cohorts (with reduced ejection fraction) from Singapore and New Zealand. ESC Heart Fail 2023; 10:1280-1293. [PMID: 36722315 PMCID: PMC10053276 DOI: 10.1002/ehf2.14275] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS We investigated titration patterns of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs) and beta-blockers, quality of life (QoL) over 6 months, and associated 1 year outcome [all-cause mortality/heart failure (HF) hospitalization] in a real-world population with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Participants with HFrEF (left ventricular ejection fraction <40%) from a prospective multi-centre study were examined for use and dose [relative to guideline-recommended maintenance dose (GRD)] of ACEis/ARBs and beta-blockers at baseline and 6 months. 'Stay low' was defined as <50% GRD at both time points, 'stay high' as ≥50% GRD, and 'up-titrate' and 'down-titrate' as dose trajectories. Among 1110 patients (mean age 63 ± 13 years, 16% women, 26% New York Heart Association Class III/IV), 714 (64%) were multi-ethnic Asians from Singapore and 396 were from New Zealand (mainly European ethnicity). Baseline use of either ACEis/ARBs or beta-blockers was high (87%). Loop diuretic was prescribed in >80% of patients, mineralocorticoid receptor antagonist in about half of patients, and statins in >90% of patients. At baseline, only 11% and 9% received 100% GRD for each drug class, respectively, with about half (47%) achieving ≥50% GRD for ACEis/ARBs or beta-blockers. At 6 months, a large majority remained in the 'stay low' category, one third remained in 'stay high', whereas 10-16% up-titrated and 4-6% down-titrated. Patients with lower (vs. higher) N-terminal pro-beta-type natriuretic peptide levels were more likely to be up-titrated or be in 'stay high' for ACEis/ARBs and beta-blockers (P = 0.002). Ischaemic aetiology, prior HF hospitalization, and enrolment in Singapore (vs. New Zealand) were independently associated with higher odds of 'staying low' (all P < 0.005) for prescribed doses of ACEis/ARBs and beta-blockers. Adjusted for inverse probability weighting, ≥100% GRD for ACEis/ARBs [hazard ratio (HR) = 0.42; 95% confidence interval (CI) 0.24-0.73] and ≥50% GRD for beta-blockers (HR = 0.58; 95% CI 0.37-0.90) (vs. Nil) were associated with lower hazards for 1 year composite outcome. Country of enrolment did not modify the associations of dose categories with 1 year composite outcome. Higher medication doses were associated with greater improvements in QoL. CONCLUSIONS Although HF medication use at baseline was high, most patients did not have these medications up-titrated over 6 months. Multiple clinical factors were associated with changes in medication dosages. Further research is urgently needed to investigate the causes of lack of up-titration of HF therapy (and its frequency), which could inform strategies for timely up-titration of HF therapy based on clinical and biochemical parameters.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | | | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Jasper Tromp
- Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - A Mark Richards
- National University Heart Centre, Singapore.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Greg Gamble
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Katrina Poppe
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | | | - David Sim
- National Heart Centre Singapore, Singapore
| | - Gerard Devlin
- School of Medicine, University of Auckland, Auckland, New Zealand.,Tairāwhiti District Health Board, Gisborne, New Zealand
| | | | | | - Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | - Ru San Tan
- National Heart Centre Singapore, Singapore
| | | | | | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob N Doughty
- School of Medicine, University of Auckland, Auckland, New Zealand
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26
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Yu SY, Li HL, Tse YK, Li X, Ren QW, Wu MZ, Wong PF, Tse HF, Lip GYH, Yiu KH. Pre-admission and In-Hospital Statin Use is Associated With Reduced Short-Term Mortality in Infective Endocarditis. Mayo Clin Proc 2023; 98:252-265. [PMID: 36114025 DOI: 10.1016/j.mayocp.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/11/2022] [Accepted: 06/02/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate for potential protective effects of statin use among patients with infective endocarditis (IE) with consideration for underlying diseases and bacterial culture - variables which have prognostic implications and show considerable geographic variation yet are unappreciated in previous pharmacoepidemiological studies. PATIENTS AND METHODS Patients diagnosed with IE between January 1, 1996, and December 31, 2019, were identified. We estimated the effect on mortality of pre-admission statin use (≥90 cumulative days of use before index date) and in-hospital use (use beginning within 2 days of admission), compared with nonusers and discontinued users, respectively, through propensity score analytics. RESULTS Of 6700 IE patients (mean age, 58.0 years; 63.3% male [n=4251]), 776 patients had pre-admission statin use, with 626 continuing statin use following admission (in-hospital users). Pre-admission statin users had a 31% lower risk of 1-year mortality (HR, 0.69; 95% CI, 0.58 to 0.82) compared with nonusers. In-hospital users had a 48% lower risk of 1-year mortality (HR, 0.52; 95% CI, 0.34 to 0.78) compared with discontinued users. Subgroup analyses showed significant protective effects of statin use for patients with varying causative agents, underlying diseases, and with or without prosthetic valves. Results were consistent across different statins, and were dose-dependent. CONCLUSION In patients with IE, pre-admission and in-hospital use of statin, when compared with statin nonusers and discontinued users, respectively, were associated with a lower risk of 1-year mortality.
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Affiliation(s)
- Si-Yeung Yu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xue Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Pui-Fai Wong
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Ren QW, Katherine Teng TH, Tse YK, Tay WT, Li HL, Tromp J, Yu SY, Hung D, Wu MZ, Chen C, Yuk Yuen JK, Huang JY, Ouwerkerk W, Li XL, Teramoto K, Chandramouli C, Tse HF, Lam CSP, Yiu KH. Incidence, Clinical Correlates, and Prognostic Impact of Dementia in Heart Failure: A Population-Based Cohort Study. JACC Asia 2023; 3:108-119. [PMID: 36873768 PMCID: PMC9982209 DOI: 10.1016/j.jacasi.2022.09.016] [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] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/05/2023]
Abstract
Background Heart failure (HF) may increase the risk of dementia via shared risk factors. Objectives The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF. Methods The previously territory-wide database was interrogated to identify eligible patients with HF (N = 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Cox/competing risk regression models where appropriate. Results Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 [IQR: 1.2-10.2] years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI: 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimer's disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included: older age (≥75 years, subdistribution hazard ratio [SHR]: 2.22), female sex (SHR: 1.31), Parkinson's disease (SHR: 1.28), peripheral vascular disease (SHR: 1.46), stroke (SHR: 1.24), anemia (SHR: 1.11), and hypertension (SHR: 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR: 4.51; P < 0.001). Conclusions New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.
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Affiliation(s)
- Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | - Hang-Long Li
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Si-Yeung Yu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Denise Hung
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jia-Yi Huang
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Tse YK, Ren QW, Wu MZ, Huang JY, Leung CKL, Li HL, Yiu KH. Statin use after valvular heart surgery is associated with a decreased risk of prosthetic valve endocarditis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Sanming Project of Medicine in Shenzhen, China;
HKU-SZH Fund for Shenzhen Key Medical Discipline
Background
Prosthetic valve endocarditis (PVE) is a rare but serious complication following valvular heart surgery for which preventive strategies remain unknown. Recent epidemiological evidence suggests that statins may reduce the risk of infections and infection-related complications.
Purpose
We aim to assess the association between statin use and the risk of prosthetic valve endocarditis in patients undergoing valvular heart surgery.
Methods
In all patients undergoing valvular heart surgery in Hong Kong between 2010 and 2021, statin use was ascertained by ≥14-day consecutive filled prescriptions after surgery. Stepwise Poisson regression was applied to identify predictors of PVE. Baseline characteristics between statin nonusers (N = 1400) with statin users (N = 976) were balanced using the inverse probability of treatment weighting. Cox proportional-hazard models with competing risk regression were further performed to estimate the risk of PVE and cardiovascular mortality associated with statin use.
Results
Our study included 2376 patients; the mean age was 57.8±14.2 years, and 54.4% were males. Over a median follow-up of 5.5 years (interquartile range 2.8-8.6), PVE occurred in 93 patients (6.75 [95% CI 5.51-8.26] PVE events per 1000 person-years). PVE was associated with New York Heart Association Class (Relative Risk [RR] 1.22, 95% Confidence Interval [CI] 1.01-1.45; P = 0.035), prior infective endocarditis (RR 8.64, 95% CI 5.58-13.19; P < 0.001), and aortic valve replacement (RR 1.67, 95% CI 1.11-2.53; P = 0.014).
Compared with non-use, statin use was associated with a 47% lower risk of PVE incidence (multivariable-adjusted subdistribution hazard ratio [SHR] 0.53, 95% CI 0.33-0.83; P = 0.006) (Figure 1). This inverse association with the risk of PVE was duration dependent, with an adjusted SHR of 0.60 (95% CI 0.47-0.73; P < 0.001) per year of statin use. Results were consistent across subgroups of sex (male vs female), the number of valvular procedures (single vs multiple), and prosthesis type (mechanical vs biological), but not in groups aged ≤60 years or with prior infective endocarditis (Figure 2). Statin use was associated with a 45% decreased risk of cardiovascular death (SHR 0.55, 95% CI 0.36-0.84; P = 0.006).
Conclusions
In patients undergoing valvular surgery, post-operative statin use is associated with a lower risk of PVE. These results provide new avenues for preventing PVE and hence valve failure.
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Affiliation(s)
- Y K Tse
- The University of Hong Kong , Hong Kong , Hong Kong
| | - Q W Ren
- The University of Hong Kong , Hong Kong , Hong Kong
| | - M Z Wu
- The University of Hong Kong , Hong Kong , Hong Kong
| | - J Y Huang
- The University of Hong Kong , Hong Kong , Hong Kong
| | - C K L Leung
- The University of Hong Kong , Hong Kong , Hong Kong
| | - H L Li
- The University of Hong Kong , Hong Kong , Hong Kong
| | - K H Yiu
- The University of Hong Kong , Hong Kong , Hong Kong
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Xu X, Ren QW, Yiu KH. HbA1c variability is associated with adverse outcomes in heart failure patients with and without diabetes. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Glycemic control is an important clinical issue in the management of patients with heart failure (HF). Variability of Glycated hemoglobin A1c (HbA1c) has been proven to be a predictor of cardiovascular events. However, previous studies mainly focused on general population and patients with coronary artery disease, while less is known about the effect of long-term HbA1c variability on clinical outcomes in HF patients.
Purpose
To evaluate the association of HbA1c variability and the risk of all-cause mortality and rehospitalization in patients with HF irrespective of their diabetic status.
Methods
By using the data from the well-validated Clinical Data Analysis Reporting System (CDARS), HF patients from 2003-2020 who had more than 3 times HbA1c measurements after the diagnosis of HF were included (N=65950, mean age was 66.5±12.0 years and 39409 (52.9%) were male). Average successive variability (ASV) ( average absolute difference between successive values), standard deviation (SD) of HbA1c were calculated. Hazard ratio (HR) of all-cause mortality and HF rehospitalization were estimated using competing risk regression with Cox proportional-hazard model.
Results
During a median follow-up of 7.2 years, 52446 (79.5%) patients developed HF rehospitalization and 34508 (52.3%) died. After adjusting for confounders, each unit change of HbA1c ASV or SD was significantly associated with higher risk of all-cause mortality, as well as higher risk of HF-rehospitalization (Figure 1). Among the study population, 48673 (73.8%) was diabetic while the remaining 17277 (26.2%) were non-diabetic. Interestingly, HbA1c variability had a stronger impact to non-diabetic compared to diabetic patients (P for interaction <0.001) in predicting all-cause mortality and HF rehospitalization (Table 1).
Conclusion
In patients with HF, a greater HbA1c variability was associated with an increased risk of HF rehospitalization and all-cause mortality. Such effect was stronger in non-diabetic compared with diabetic. HbA1c variability, irrespective of baseline diabetic status, should be evaluated in HF patients for better risk-stratification.
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Affiliation(s)
- X Xu
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
| | - Q W Ren
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
| | - K H Yiu
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
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Hung D, Tse YK, Ren QW, Huang JY, Yiu KH. Prognostic value of longitudinal assessment of inflammatory and nutritional status in patients undergoing valvular heart surgery. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Novel strategies to improve the long-term risk stratification of valvular surgery are urgently needed as a result of the increasing prevalence of valvular heart diseases globally.
Purpose
This study aimed to evaluate the prognostic implications of longitudinal assessment of inflammatory and nutritional status in patients undergoing valvular surgery.
Methods
1046 patients who underwent valvular surgery were stratified into three groups based on their inflammatory (neutrophil-to-lymphocyte ratio [NLR]) and nutritional status (prognostic nutritional index [PNI]): without inflammation and malnutrition (normal), inflammation or malnutrition alone (mild), and concomitant inflammation and malnutrition (severe). Optimal NLR and PNI thresholds for predicting all-cause mortality were determined using receiver-operating characteristic analysis. The endpoints were all-cause mortality, cardiovascular death and adverse events (composite of death and heart failure [HF] hospitalization).
Results
Over a median follow-up of 4.3 years (IQR: 2.6 to 6.4 years), 139 (13.3%) deaths and 148 (14.1%) HF hospitalizations occurred. Based on the optimal cut-off of NLR >4.06 (inflammation) and PNI <45.8 (malnutrition), 714 (68.3%), 214 (20.5%) and 118 (11.3%) patients were categorized into normal, mild and severe groups respectively. Compared with patients without inflammation and malnutrition, those with concomitant inflammation and malnutrition before surgery had the highest risk of all-cause mortality (hazard ratio [HR] 5.60, 95% confidence interval [CI] 3.66-8.57), cardiovascular death (subdistribution HR [SHR] 5.19, 95% CI 2.33-11.60) and adverse events (HR 3.14, 95% CI 2.25-4.38) (p<0.001 for all), adjusted for demographics, cardiovascular risk factors and diseases, medications, valvular surgeries and EuroSCORE II. Discriminatory improvement for predicting all-cause mortality was observed when baseline NLR and PNI were added to EuroSCORE II (C-statistic 0.77 vs 0.73, p=0.04; continuous net reclassification improvement [cNRI] 0.24, 95% CI 0.12-0.36, p=0.004; integrated discrimination improvement [IDI] 0.04, 95% CI 0.01-0.08, p=0.004) and STS score (C-statistic 0.78 vs 0.73, p=0.03; cNRI 0.16, 95% CI 0.06-0.32, p=0.002; IDI 0.02, 95% CI 0.000-0.049, p=0.048) respectively. 1 year following surgery (n=740), those with persistent concomitant inflammation and malnutrition experienced the highest risk of all-cause mortality (HR 8.82, 95% CI 4.21-18.49), cardiovascular death (SHR 12.63, 95% CI 3.85-41.39) and adverse events (HR 5.83, 95% CI 3.16-10.76) than those without (p<0.001 for all).
Conclusion
Concomitant inflammation and malnutrition is common and is strongly associated with mortality and HF in patients undergoing valvular surgery. Beyond conventional risk scores, assessments of inflammatory and nutritional status using NLR and PNI before and after surgery may provide additional prognostic value for long-term outcomes following valvular surgery.
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Affiliation(s)
- D Hung
- The University of Hong Kong , Hong Kong , Hong Kong
| | - Y K Tse
- The University of Hong Kong , Hong Kong , Hong Kong
| | - Q W Ren
- The University of Hong Kong , Hong Kong , Hong Kong
| | - J Y Huang
- The University of Hong Kong , Hong Kong , Hong Kong
| | - K H Yiu
- The University of Hong Kong , Hong Kong , Hong Kong
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Cheang IF, Li XL, Yiu KH. Pre-diabetes is associated with increases cardiac event in cancer patients treated with anthracyclines. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University of Hong Kong, Queen Mary Hospital
Objective
To evaluate the association between pre-diabetes and cardiovascular events in patients treated with anthracyclines containing chemotherapy (ACT).
Methods
Patients treated with ACT between 2000 and 2019 were divided into diabetes, pre-diabetes, and normoglycemia groups based on the baseline glycemic status. Primary outcome was the major adverse cardiovascular composite events (MACE) of heart failure hospitalization and cardiovascular death. Kaplan-Meier, multivariable COX regression, and Fine and Gray model analysis were applied.
Results
Among 12649 patients treated with ACT, 3997 (31.6%, median age 61 years old) had pre-diabetes and 5622 (44.45%, median age 67 years old) had diabetes at baseline. Over a median follow-up of 8.7 years, the incidence of MACE was 211 (7.0%) in normoglycemia group, 358 (9.0%) in pre-diabetes group, and 728 (12.9%) in diabetes group. Compared with normoglycemia group, both pre-diabetes (adjusted HR=1.20, 95%CI 1.01-1.43) and diabetes (adjusted HR=1.46, 95% CI 1.24-1.70) were significantly associated with an increased risk of MACE. Further analysis showed that there were 475 (18%) progressed to overt diabetes in the pre-diabetes group after 2 years of the index date and were at greater risk of MACE (Adjusted HR=1.76, 95% CI 1.31-2.36).
Conclusions
Pre-diabetes was significantly associated with an increased risk of MACE in patients treated with ACTs. Among, those who progressed to diabetes after 2 years demonstrated an increased risk of MACE. Findings support that pre-diabetes as a risk factor for cardiovascular events might optimize management.
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Affiliation(s)
- I F Cheang
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - X L Li
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - K H Yiu
- Queen Mary Hospital, Department of Medicine , Hong Kong , Hong Kong
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Wu MZ, Ren QW, Huang JY, Tse YK, Yu SY, Cheang LF, Li HL, Chan YH, Tse HF, Yiu KH. Comparison of risk of hyperkalemia between SGLT2 inhibitors and DPP4-inhibitors in patients with type 2 diabetes. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Hyperkalemia is a common complication and increases the risk of cardiac arrhythmias and mortality in patients with type 2 diabetes (T2DM), especially in those with diabetic nephropathy. We investigated the risk of hyperkalemia in patients initiated on SGLT2 inhibitors versus DPP-4 inhibitors among patients with T2DM.
Methods
This study included patients with T2DM who initiated on SGLT2 inhibitors or DPP-4 inhibitors between January 01, 2015 and December 31, 2019 from a territory-wide clinical registry in Hong Kong (Clinical Data Analysis and Reporting System [CDARS]). A multivariable cox proportional hazards analysis, adjusting for key confounders, was used to compare the risk of central laboratory-determined hyperkalemia (serum potassium ≥6.0mmol/L) and hypokalemia (serum potassium <3.5mmol/L), respectively, between SGLT2 inhibitors and DPP-4 inhibitors.
Results
10193 new users of SGLT2 inhibitors were matched to 17305 new users of DPP-4 inhibitors. During the 2-year follow-up, there were 104 hyperkalemia events (incident rate [IR] = 5.17 per 1000 person-years) among SGLT2 inhibitors and 306 events (IR = 9.09 per 1000 person-years) among DPP-4 inhibitors, of which SGLT2 inhibitors were associated with a lower risk of incident hyperkalemia (Adjusted HR: 0.66 [95%CI 0.53-0.83], p<0.001), compared to DPP-4 inhibitors. The incident hypokalemia was similar between SGLT2 inhibitors and DPP-4 inhibitors (Adjusted HR: 0.91 [95%CI 0.81-1.03], P=0.13).
Conclusion
SGLT2 inhibitors reduced incident hyperkalemia, but without increasing incident hypokalemia compared to DPP-4 inhibitors.
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Affiliation(s)
- M Z Wu
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
| | - Q W Ren
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
| | - J Y Huang
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
| | - Y K Tse
- the University of Hong Kong , Hong Kong , China
| | - S Y Yu
- the University of Hong Kong , Hong Kong , China
| | - L F Cheang
- the University of Hong Kong , Hong Kong , China
| | - H L Li
- the University of Hong Kong , Hong Kong , China
| | - Y H Chan
- the University of Hong Kong , Hong Kong , China
| | - H F Tse
- the University of Hong Kong , Hong Kong , China
| | - K H Yiu
- University of Hong Kong-Shenzhen Hospital , Shenzhen , China
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Ren QW, Tse YK, Yiu KH. Association between triglyceride and all-cause mortality and cardiovascular outcomes in heart failure patients: a territory-wide study in Hong Kong. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objectives
To determine the association between levels of triglyceride (TG) and all-cause mortality and cardiovascular outcomes. To evaluate the concentration of TG associated with the lower range and lowest risk of adverse outcomes in heart failure (HF) patients.
Methods
Using a previously validated territory-wide clinical information registry, all eligible patients with HF (N=147 396) from 1996 to 2020 were enrolled. Levels of time-weighted TG associated with risk of mortality were evaluated on a continuous scale using restricted cubic spline curves and by categories of TG with Cox proportional hazards regression model. The primary outcomes were all-cause mortality and cardiovascular death (CVD). Secondary outcomes include cause-specific mortality and incident cardiovascular events.
Results
Among 147 396 HF patients, the mean age was 70.0±12.5 years and 73 571 (49.9%) were male. The association between levels of time-weighted TG and the risk of all-cause mortality was J-shaped, with low and high levels associated with an increased risk of all-cause mortality, CVD and cause-specific mortality. Compared with individuals with levels of TG between 1.14 to 2.85 mmol/L, the multivariable-adjusted hazard ratio (HR) for all-cause mortality was 1.39 (95% confidence interval [CI] 1.35 to 1.44) for individuals with TG concentrations of less than 0.71 mmol/L and 1.97 (95% CI, 1.67 to 2.32) for TG concentrations of more than 5.60 mmol/L. The concentration of TG associated with the lowest risk of all-cause mortality was 1.84 mmol/L. Similar results were seen in males and females, in patients with or without lipid-lowering treatment, and for cardiovascular events.
Conclusion
In the HF population, low and high levels of TG were associated with an increased risk of all-cause mortality and cardiovascular outcomes. The lowest risk of all-cause mortality was found at a TG concentration of 1.84 mmol/L.
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Affiliation(s)
- Q W Ren
- The University of Hong Kong , Hong Kong , China
| | - Y K Tse
- The University of Hong Kong , Hong Kong , China
| | - K H Yiu
- The University of Hong Kong , Hong Kong , China
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Huang JY, Tse YK, Li HL, Chen C, Zhao CT, Liu MY, Wu MZ, Ren QW, Yu SY, Hung D, Li XL, Tse HF, Lip GYH, Yiu KH. Prediabetes Is Associated With Increased Risk of Heart Failure Among Patients With Atrial Fibrillation. Diabetes Care 2023; 46:190-196. [PMID: 36251385 DOI: 10.2337/dc22-1188] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the association between prediabetes and heart failure (HF) and the association of HF with changes in glycemic status. RESEARCH DESIGN AND METHODS Patients newly diagnosed with atrial fibrillation (AF) between 2015 and 2018 were divided into three groups (normoglycemia, prediabetes, and type 2 diabetes) according to their baseline glycemic status. The primary outcome was incident HF. The Fine and Gray competing risks model was applied, with death defined as the competing event. RESULTS Among 17,943 patients with AF (mean age 75.5 years, 47% female), 3,711 (20.7%) had prediabetes, and 10,127 (56.4%) had diabetes at baseline. Over a median follow-up of 4.7 years, HF developed in 518 (14%) patients with normoglycemia, 646 (15.7%) with prediabetes, and 1,795 (17.7%) with diabetes. Prediabetes was associated with an increased risk of HF compared with normoglycemia (subdistribution hazard ratio [SHR] 1.12, 95% CI 1.03-1.22). In patients with prediabetes at baseline, 403 (11.1%) progressed to diabetes, and 311 (8.6%) reversed to normoglycemia at 2 years. Compared with remaining prediabetic, progression to diabetes was associated with an increased risk of HF (SHR 1.50, 95% CI 1.13-1.97), whereas reversion to normoglycemia was associated with a decreased risk (SHR 0.61, 95% CI 0.42-0.94). CONCLUSIONS Prediabetes was associated with an increased risk of HF in patients with AF. Compared with patients who remained prediabetic, those who progressed to diabetes at 2 years experienced an increased risk of HF, whereas those who reversed to normoglycemia incurred a lower risk of HF.
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Affiliation(s)
- Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Cong Chen
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
| | - Chun-Ting Zhao
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
| | - Ming-Ya Liu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Denise Hung
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xin-Li Li
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, U.K
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Hong Kong, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Li HL, Tse YK, Chandramouli C, Hon NWL, Cheung CL, Lam LY, Wu M, Huang JY, Yu SY, Leung KL, Fei Y, Feng Q, Ren Q, Cheung BMY, Tse HF, Verma S, Lam CSP, Yiu KH. Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Pneumonia and Septic Shock. J Clin Endocrinol Metab 2022; 107:3442-3451. [PMID: 36181458 PMCID: PMC9693836 DOI: 10.1210/clinem/dgac558] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Individuals with type 2 diabetes mellitus (DM) have an increased risk of pneumonia and septic shock. Traditional glucose-lowering drugs have recently been found to be associated with a higher risk of infections. It remains unclear whether sodium-glucose cotransporter 2 inhibitors (SGLT2is), which have pleiotropic/anti-inflammatory effects, may reduce the risk of pneumonia and septic shock in DM. METHODS MEDLINE, Embase, and ClinicalTrials.gov were searched from inception up to May 19, 2022, for randomized, placebo-controlled trials of SGLT2i that included patients with DM and reported outcomes of interest (pneumonia and/or septic shock). Study selection, data extraction, and quality assessment (using the Cochrane Risk of Bias Assessment Tool) were conducted by independent authors. A fixed-effects model was used to pool the relative risk (RRs) and 95% CI across trials. RESULTS Out of 4568 citations, 26 trials with a total of 59 264 patients (1.9% developed pneumonia and 0.2% developed septic shock) were included. Compared with placebo, SGLT2is significantly reduced the risk of pneumonia (pooled RR 0.87, 95% CI 0.78-0.98) and septic shock (pooled RR 0.65, 95% CI 0.44-0.95). There was no significant heterogeneity of effect size among trials. Subgroup analyses according to the type of SGLT2i used, baseline comorbidities, glycemic control, duration of DM, and trial follow-up showed consistent results without evidence of significant treatment-by-subgroup heterogeneity (all Pheterogeneity > .10). CONCLUSION Among DM patients, SGLT2is reduced the risk of pneumonia and septic shock compared with placebo. Our findings should be viewed as hypothesis generating, with concepts requiring validation in future studies.
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Affiliation(s)
- Hang-Long Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore 169609, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Nicole Wing-Lam Hon
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
| | - Lok-Yee Lam
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Meizhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Ka-Lam Leung
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Yue Fei
- Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Qi Feng
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Qingwen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Bernard M Y Cheung
- Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore 169609, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
- University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Kai-Hang Yiu
- Correspondence: Kai-Hang Yiu, MD, Division of Cardiology, Department of Medicine, The University of Hong Kong, Room 1929B/K1931, Block K, Queen Mary Hospital, Hong Kong 999077, China.
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Cheang I, Zhu X, Lu X, Yue X, Tang Y, Gao R, Liao S, Yao W, Zhou Y, Zhang H, Yiu KH, Li X. Associations of Inflammation with Risk of Cardiovascular and All-Cause Mortality in Adults with Hypertension: An Inflammatory Prognostic Scoring System. J Inflamm Res 2022; 15:6125-6136. [PMID: 36386589 PMCID: PMC9653039 DOI: 10.2147/jir.s384977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/22/2022] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Inflammation is one of the major pathways in the progression of hypertension (HTN), and the related inflammatory markers have demonstrated certain predictive values. The current study aimed to integrate these markers to construct an inflammatory prognostic scoring (IPS) system and to assess the prognostic values of IPS in patients with HTN. METHODS A total of 9846 adult participants with HTN from NHANES 1999-2010 were enrolled and followed up. Demographic characteristics and the related laboratory results for the 12 inflammatory markers were collected. LASSO-COX regression, Kaplan-Meier, restricted cubic spline COX regression (RCS), receiver operator characteristic curve (ROC), and random survival forests (RSF) analysis were applied to explore the values of individual and IPS parameters. RESULTS At the census date of follow-up, 2387 (24.2%) were identified as all-cause deaths and 484 (4.9%) as cardiovascular deaths. All inflammatory markers showed certain prognostic values. Then, based on the LAASO analysis, LDH, ALP, LYM, NLR, MLR, SIRI, and RDW were included in the construction of the IPS system. The higher IPS had significantly worse long-term prognosis in Kaplan-Meier analysis (p log-rank <0.001). Also, IPS remained an independent prognosticator compared to the lowest quartile (All p for trend <0.001), and the ROC showed satisfactory values in the long-term prognosis of both cardiovascular and all-cause mortality. RCS further showed a linear association of IPS with cardiovascular mortality and all-cause mortality (p for non-linearity >0.05). Two different algorithms of RSF, variable importance and minimal depth, to evaluate the prognostic importance showed that IPS was the best in survival prediction. CONCLUSION Our results highlight that a higher IPS (system integrating the inflammatory markers) was associated with the increased risk of cardiovascular and all-cause mortality in patients with HTN, suggesting that IPS is a useful method for risk stratification in HTN.
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Affiliation(s)
- Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, 999077, People’s Republic of China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Xinyi Lu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Xin Yue
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Yuan Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, People’s Republic of China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, 999077, People’s Republic of China
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, 518000, People’s Republic of China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
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Ye X, Huang C, Wei Y, Li ST, Yan VK, Yiu KH, Tse HF, Ma T, Qin X, Chui CS, Lai FT, Li X, Wan EY, Wong CK, Wong IC, Chan EW. Safety of BNT162b2 or CoronaVac COVID-19 vaccines in patients with heart failure: A self-controlled case series study. The Lancet Regional Health - Western Pacific 2022; 30:100630. [PMCID: PMC9638810 DOI: 10.1016/j.lanwpc.2022.100630] [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] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
Background COVID-19 vaccines are important for patients with heart failure (HF) to prevent severe outcomes but the safety concerns could lead to vaccine hesitancy. This study aimed to investigate the safety of two COVID-19 vaccines, BNT162b2 and CoronaVac, in patients with HF. Methods We conducted a self-controlled case series analysis using the data from the Hong Kong Hospital Authority and the Department of Health. The primary outcome was hospitalization for HF and the secondary outcomes were major adverse cardiovascular events (MACE) and all hospitalization. We identified patients with a history of HF before February 23, 2021 and developed the outcome event between February 23, 2021 and March 31, 2022 in Hong Kong. Incidence rate ratios (IRR) were estimated using conditional Poisson regression to evaluate the risks following the first three doses of BNT162b2 or CoronaVac. Findings We identified 32,490 patients with HF, of which 3035 were vaccinated and had a hospitalization for HF during the observation period (BNT162b2 = 755; CoronaVac = 2280). There were no increased risks during the 0–13 days (IRR 0.64 [95% confidence interval 0.33–1.26]; 0.94 [0.50–1.78]; 0.82 [0.17–3.98]) and 14–27 days (0.73 [0.35–1.52]; 0.95 [0.49–1.84]; 0.60 [0.06–5.76]) after the first, second and third doses of BNT162b2. No increased risks were observed for CoronaVac during the 0–13 days (IRR 0.60 [0.41–0.88]; 0.71 [0.45–1.12]; 1.64 [0.40–6.77]) and 14–27 days (0.91 [0.63–1.32]; 0.79 [0.46–1.35]; 1.71 [0.44–6.62]) after the first, second and third doses. We also found no increased risk of MACE or all hospitalization after vaccination. Interpretation Our results showed no increased risk of hospitalization for HF, MACE or all hospitalization after receiving BNT162b2 or CoronaVac vaccines in patients with HF. Funding The project was funded by a Research Grant from the 10.13039/501100005407Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref. No. COVID19F01). F.T.T.L. (Francisco T.T. Lai) and I.C.K.W. (Ian C.K. Wong)'s posts were partly funded by the D24H; hence this work was partly supported by AIR@InnoHK administered by Innovation and Technology Commission.
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Affiliation(s)
- Xuxiao Ye
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Caige Huang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Silvia T.H. Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent K.C. Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Tiantian Ma
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Xiwen Qin
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Celine S.L. Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T.T. Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y.F. Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos K.H. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C.K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
- Corresponding author. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy General Office, L02-56 2/F Laboratory Block LKS, Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam Hong Kong SAR, China.
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
- Corresponding author. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy General Office, L02-56 2/F Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam Hong Kong SAR, China.
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Lee CH, Wu MZ, Lui DTW, Fong CHY, Ren QW, Yu SY, Yuen MMA, Chow WS, Huang JY, Xu A, Yiu KH, Lam KSL. Prospective associations of circulating thrombospondin-2 level with heart failure hospitalization, left ventricular remodeling and diastolic function in type 2 diabetes. Cardiovasc Diabetol 2022; 21:231. [PMID: 36335340 PMCID: PMC9637303 DOI: 10.1186/s12933-022-01646-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Circulating thrombospondin-2 (TSP2) levels were associated with the development of heart failure (HF) in recent studies. However, these studies included only a minority of patients with type 2 diabetes, which is associated with an increased HF risk. As hyperglycemia induces TSP2 expression and its tissue expression increases in type 2 diabetes, we investigated the prospective association of circulating TSP2 with incident HF hospitalization (HHF), and its associations with longitudinal changes of echocardiographic parameters in type 2 diabetes. Methods Baseline serum TSP2 levels were measured in 4949 patients with type 2 diabetes to determine its association with incident HHF using multivariable Cox regression analysis. In the echocardiographic study, baseline serum TSP2 levels were measured in another 146 patients with type 2 diabetes but without cardiovascular diseases who underwent detailed transthoracic echocardiography at baseline and after 1 year. Results Over a median follow-up of 7.8 years, 330 of 4949 patients (6.7%) developed incident HHF. Baseline serum TSP2 levels were independently associated with the development of HHF (HR 1.31, 95%CI 1.06–1.62, p = 0.014) after adjustments for baseline conventional cardiovascular risk factors, atrial fibrillation, estimated glomerular filtration rate, albuminuria and high-sensitivity C-reactive protein level, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, loop-diuretics, aspirin, insulin, metformin and sodium-glucose co-transporter 2 inhibitors. Moreover, baseline serum TSP2 levels were independently associated with increase in average E/e’ and left atrial volume index (p = 0.04 and < 0.01, respectively). Conclusion Serum TSP2 levels were independently associated with both incident HHF and deterioration in diastolic function in type 2 diabetes. Trial registration Not Applicable Supplementary information The online version contains supplementary material available at 10.1186/s12933-022-01646-x.
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Tsui L, Tse YK, Yu SY, Li HL, Ren QW, Wu MZ, Yu SY, Tse HF, Yiu KH. Peak atrial longitudinal strain as an independent predictor of composite endpoint in patients received aortic valve replacement for severe aortic stenosis: a prospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Severe aortic stenosis (AS) is the primary valvular heart disease, treatable only by aortic valve replacement (AVR). The prognostic value of pre-operative left atrial (LA) function on post-AVR clinical outcomes is uncertain. The study aims to evaluate the prognostic value of pre-operative peak atrial longitudinal strain (PALS) as a surrogate of LA function on post AVR all-cause mortality and heart failure hospitalisation.
Methods
Patients aged 18 years old or above with severe AS were recruited and assessed using speckle-tracking echocardiography pre-operatively. Severe AS was defined according to 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. PALS was measured. Based on the median value of PALS, patients were stratified into PALS <15.94% and PALS >15.94%. Patients with underlying pre-operative atrial fibrillation, other moderate to severe valvular heart diseases and cancers were excluded. Patients were followed up until death, heart failure hospitalisation or end of the study. The primary outcome is a composite endpoint of all-cause mortality and heart failure hospitalisation. The association of PALS with the composite endpoint was evaluated by Cox Proportional Hazards analysis.
Results
A total of 128 patients (mean age 65.32±9.42 years, 56.3% male) were prospectively analyzed. Patients were followed up for a mean period of 3.9±2.4 years. A total of 65 of 128 patients (50.8%) belonged to PALS<15.94%. During the study period, 23 patients developed the adverse events. A lower pre-operative PALS, both as a continuous or a categorical variable, were associated with a higher unadjusted risk of adverse events (Continuous; HR, 0.93; 95% CI 0.88–0.98; p=0.011; PALS <15.94%; HR, 4.94; 95% CI, 1.67–14.58; p=0.004).
Conclusion
The study demonstrated a lower pre-operative PALS is associated with all-cause mortality and heart failure admission in patients with severe AS undergoing AVR. Evaluation of LA function by assessing speckle tracking derived PALS may aid in prognostication for patients undergoing AVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Tsui
- The University of Hong Kong , Hong Kong , Hong Kong
| | - Y K Tse
- The University of Hong Kong , Hong Kong , Hong Kong
| | - S Y Yu
- The University of Hong Kong , Hong Kong , Hong Kong
| | - H L Li
- The University of Hong Kong , Hong Kong , Hong Kong
| | - Q W Ren
- The University of Hong Kong , Hong Kong , Hong Kong
| | - M Z Wu
- The University of Hong Kong , Hong Kong , Hong Kong
| | - S Y Yu
- The University of Hong Kong , Hong Kong , Hong Kong
| | - H F Tse
- The University of Hong Kong , Hong Kong , Hong Kong
| | - K H Yiu
- The University of Hong Kong , Hong Kong , Hong Kong
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Wu MZ, Chandramouli C, Wong PF, Chan YH, Li HL, Yu SY, Tse YK, Ren QW, Yu SY, Tse HF, Lam CSP, Yiu KH. Risk of sepsis and pneumonia in patients initiated on SGLT2 inhibitors and DPP-4 inhibitors. Diabetes Metab 2022; 48:101367. [PMID: 35753654 DOI: 10.1016/j.diabet.2022.101367] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022]
Abstract
AIM The organ protective effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors may be beneficial against infectious complications. This real-world study aims to compare the risk of pneumonia and sepsis between SGLT2 inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors in patients with type 2 diabetes. METHODS Using a territory-wide clinical registry in Hong Kong (Clinical Data Analysis and Reporting System [CDARS]), we included patients initiated on SGLT2 inhibitors or DPP-4 inhibitors between January 01, 2015 and December 31, 2019 through 1:2 propensity score matching. The primary outcomes were incident events of pneumonia, sepsis and the related mortality. Cox proportional hazards analysis was used to compare the risk of incident pneumonia and sepsis for SGLT2 inhibitors versus DPP-4 inhibitors. RESULTS After propensity score matching, 10,706 new users of SGLT2 inhibitors and 18,281 new users of DPP-4 inhibitors were included. The mean age of all eligible subjects were 60 years (SD 11.07) and 61.1% were male. There were 309 pneumonia events [incidence rate per 1000 person-years (IR) = 11.38] among SGLT2 inhibitors users and 961 events (IR = 20.45) among DPP-4 inhibitors users, with lower risk of pneumonia among SGLT2 inhibitors users (adjusted HR 0.63 [95%CI 0.55-0.72], p<0.001). Similarly, SGLT2 inhibitors users had lower incidence of sepsis [164 (IR=6.00) vs. 610 (IR=12.88) events] as well as associated risk of incident sepsis (HR 0.52 [95% CI 0.44-0.62], p<0.001), compared to DPP-4 inhibitors users. Outcome analyses showed that SGLT2 inhibitors were associated with lower risk of pneumonia-related death (HR 0.41 [95%CI 0.29-0.58], p<0.001), sepsis-related death (HR 0.39 [95%CI 0.18-0.84], p<0.05), and infection-related death (HR 0.43 [95%CI 0.32-0.57], p<0.001), compared to DPP-4 inhibitors users. Results were consistent when stratified by age, sex, pre-existing cardiovascular disease, and type of SGLT2 inhibitors. CONCLUSION We provide real-world evidence that irrespective of age, sex, prior-existing cardiovascular disease, or type of SGLT2 inhibitors used, patients with type 2 diabetes initiated on SGLT2 inhibitors have lower incidence of pneumonia and sepsis as well as mortality risk associated with pneumonia, sepsis, and infectious diseases, compared with those initiated on DPP-4 inhibitors.
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Affiliation(s)
- Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, the University of Hong Kong-Shenzhen Hospital, Shen Zhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | - Pui-Fai Wong
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Shuk-Yin Yu
- Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, the University of Hong Kong-Shenzhen Hospital, Shen Zhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore; University Medical Center Groningen, Groningen, Netherlands; Duke-NUS Medical School, Singapore, Singapore.
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, the University of Hong Kong-Shenzhen Hospital, Shen Zhen, China; Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Yiu KH, Seto WK, Yuen MF, Tse HF. Reversibility of liver stiffness after tricuspid annuloplasty: a case-control study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:8-11. [PMID: 35701222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- K H Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - W K Seto
- Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - M F Yuen
- Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - H F Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
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Huang J, Lip YHG, Wu MZ, Ren QW, Tse HF, Yiu KH. Pre-diabetes increases the risk of heart failure among patients with nonvalvular atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Heart failure (HF) is common in patients with nonvalvular atrial fibrillation (NVAF) which is associated with excess morbidity and mortality. Notably, the presence of diabetes increases risk of HF in patients with NVAF. The association between pre-diabetes and risk of HF was nonetheless unexplored in this population.
Purpose
The present study aimed to evaluate whether pre-diabetes was associated with an increased risk of HF in patients with NVAF.
Methods
Using a previously validated territory-wide electronic health record database, patients with newly diagnosed NVAF from 2010 to 2018 were included to evaluate for risk of HF upon competing risk regression with Cox proportional-hazard model adjustment. Patients were divided into 3 groups according to their baseline glycemic status: (1) type 2 diabetes, (2) pre-diabetes, and (3) normoglycemia. In the pre-diabetes group, the subsequent risk of HF was further evaluated according to the changes of glycemic status at two years following index date.
Results
Among 65,994 NVAF patients (mean age 75.7 years, 48.5% female), 27,706 (42.0%) were normoglycemic, 10,926 (16.6%) had pre-diabetes, and 27,312 (41.4%) had diabetes at baseline. Over a median follow-up of 7.1 years, 7,203 (26%) normoglycemic patients, 3,168 (29%) pre-diabetic patients, and 8,745 (32%) diabetic patients developed HF (Log rank test, P<0.001). Pre-diabetes was associated with an increased risk of HF compared with normoglycemic patients (subdistribution Hazard Ratio (SHR) = 1.09, 95% confidence interval (CI): 1.04-1.14) and diabetes conferred the highest risk amongst three groups (SHR=1.19, 95%CI: 1.15-1.24). In patients with pre-diabetes at baseline, 873 (8.0%) progressed to diabetes and 1204 (11%) resolved to normoglycemia at 2 years. Compared to those who remained pre-diabetic, patients who progressed to diabetes had a higher risk of HF (SHR = 1.23, 95% CI :1.05-1.44), whereas those who resolved to normoglycemia incurred a lower risk (SHR = 0.80, 95% CI :0.68-0.94).
Conclusion(s)
Pre-diabetes was independently associated with an increased risk of HF in patients with NVAF. Pre-diabetic patients who progressed to diabetes at 2 years experienced an increased risk of HF, whereas those who resolved to normoglycemia reduced risk of HF, as compared to those who remained pre-diabetic. These findings highlight the importance of strict blood glucose control in reducing the risk of HF in patients with atrial fibrillation.
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Affiliation(s)
- J Huang
- The University of Hong Kong, Hong Kong, Hong Kong
| | - YHG Lip
- The University of Hong Kong, Hong Kong, Hong Kong
| | - MZ Wu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - QW Ren
- The University of Hong Kong, Hong Kong, Hong Kong
| | - HF Tse
- The University of Hong Kong, Hong Kong, Hong Kong
| | - KH Yiu
- The University of Hong Kong, Hong Kong, Hong Kong
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Li HL, Tromp J, Teramoto K, Tse YK, Yu SY, Lam LY, Li KY, Wu MZ, Ren QW, Wong PF, Cheung CL, To KKW, Tse HF, Lam CSP, Yiu KH. Temporal trends and patterns of infective endocarditis in a Chinese population: A territory-wide study in Hong Kong (2002–2019). The Lancet Regional Health - Western Pacific 2022; 22:100417. [PMID: 35257120 PMCID: PMC8897627 DOI: 10.1016/j.lanwpc.2022.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The characteristics of infective endocarditis (IE) in Asians are poorly understood. Therefore, we aim to describe the epidemiological trends and clinical features of IE in Hong Kong. Methods All patients with incident IE from 2002–2019 in a territory-wide clinical database in Hong Kong were identified. We studied the age- and sex-adjusted and one-year mortality of IE between 2002 and 2019 and identified significant contributors to 1-year all-cause death using the attributable fraction. We used propensity score and inverse propensity of treatment weighting to study the association of surgery with mortality. Findings A total of 5139 patients (60.4 ± 18.2years, 37% women) were included. The overall incidence of IE was 4.9 per 100,000 person-year, which did not change over time (P = 0.17). Patients in 2019 were older and more comorbid than those in 2002. The one-year crude mortality rate was 30% in 2002, which did not change significantly over time (P = 0.10). Between 2002 and 2019, the rate of surgery increased and was associated with a 51% risk reduction in 1-year all-cause mortality (Hazard Ratio 0.49 [0.28–0.87], P = 0.015). Advanced age (attributable fraction 19%) and comorbidities (attributable fraction 15%) were significant contributors to death. Interpretation The incidence of IE in Hong Kong did not change between 2002 and 2019. Patients with IE in 2019 were older and had more comorbidities than those in 2002. Mortality of IE remains persistently high in Hong Kong. Together, these data can guide public health strategies to improve the outcomes of patients with IE. Funding This work was supported by Sanming Project of Medicine in Shenzhen, China [No. SZSM201911020] and HKU-SZH Fund for Shenzhen Key Medical Discipline [No. SZXK2020081].
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Yu YJ, Tse YK, Yu SY, Lam LY, Li KY, Chen Y, Wu MZ, Ren QW, Yu SY, Wong PF, Tse HF, Yiu KH. Prognostic value of MELD-XI and MELD-Albumin scores in double valve replacement. Cardiology Plus 2022. [DOI: 10.1097/cp9.0000000000000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Chung HY, Lau CS, Tse HF, Yiu KH. Osteogenic Circulating Endothelial Progenitor Cells are Associated with Vascular Aging of the Large Arteries in Rheumatoid Arthritis. Clin Interv Aging 2022; 17:287-294. [PMID: 35321150 PMCID: PMC8937309 DOI: 10.2147/cia.s337118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aim Rheumatoid arthritis is associated with both abnormal bone metabolism and accelerated vascular aging but a mechanistic link was lacking. This study aims to investigate the role of osteocalcin (OCN)-expressing circulating endothelial progenitor cells (EPCs) in vascular aging, as determined by arterial calcifications in rheumatoid arthritis. Methods We performed flow cytometry studies in 145 consecutive patients with rheumatoid arthritis to determine osteogenic circulating levels of OCN-positive (OCN+) CD34+KDR+ and OCN+CD34+ versus conventional early EPC CD34+CD133+KDR+. Total calcium load of the thoracic aorta (ascending plus descending) and the carotid arteries were assessed by non-contrast computed tomography (CT) and contrast CT angiography. Results Osteogenic EPCs OCN+CD34+KDR+ (P = 0.002) and OCN+CD34+ (P = 0.001), together with clinical parameters of age, history of hypertension, systolic blood pressure, serum levels of triglycerides, HbA1c and creatinine, use of leflunomide and brachial-ankle pulse-wave velocity (all P < 0.05), were associated with the clustered presence of aortic and carotid calcification. Multivariable analyses revealed that circulating OCN+CD34+KDR+ (B = 14.4 [95% CI 4.0 to 24.8], P = 0.007) and OCN+CD34+ (B = 9.6 [95% CI 4.9 to 14.3], P < 0.001) remained independently associated with increased aortic calcium load. OCN+CD34+ EPC (B = 0.8 [95% CI 0.1 to 1.5], P = 0.023), but not OCN+CD34+KDR+ EPC (B = 1.2 [95% CI −0.2 to 2.6], P = 0.09), was further independently associated with carotid calcium load. In comparison, conventional early EPC CD34+CD133+KDR+ had no significant association with aortic or carotid calcium load (P = 0.46 and 0.88, respectively). Conclusion Circulating level of osteogenic EPC is associated with increased vascular aging in terms of calcification of the large arteries in patients with rheumatoid arthritis. The findings may suggest a role of the bone-vascular axis underlying vascular aging in rheumatic diseases. Further research is needed to characterize the mechanistic links and basis of these observations.
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Affiliation(s)
- Yap-Hang Chan
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Michael Cheong Ngai
- Division of Hematology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Yan Chen
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Yu-Juan Yu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Zhe Zhen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Kevin Lai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Ho-Yin Chung
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Chak-Sing Lau
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
- Correspondence: Kai-Hang Yiu, Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, 518053, Guangdong, People’s Republic of China, Tel +852 22553633, Fax +852 28186304, Email
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Stephanie YK, Li HL, Wu MZ, Ren QW, Yiu KH. Impact of proportionality of tricuspid regurgitation on outcome after tricuspid annuloplasty. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Sanming Project of Medicine in Shenzhen, China [No. SZSM201911020]; HKU-SZH Fund for Shenzhen Key Medical Discipline [No. SZXK2020081]
Background
Patients with secondary tricuspid regurgitation (TR) benefit differentially from tricuspid annuloplasty. We hypothesized that TR severity may be proportional or disproportional to right ventricular (RV) remodeling and investigated the prognostic implication of this novel framework.
Methods
The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area (RVDA) and tricuspid annular plane systolic excursion (TAPSE) were retrospectively assessed in 307 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from cubic splines and maximally selected rank statistics, patients were stratified into 3 groups: proportionate TR (Group 1: EROA/RVDA ≤1.70 and EROA/TAPSE ≤3.42), disproportionate TR to RV size (Group 2: EROA/RVDA >1.70 and EROA/TAPSE ≤3.42), and disproportionate TR to RV size and function (Group 3: EROA/RVDA >1.70 and EROA/TAPSE >3.42).
Results
Overall, 77 (25%), 126 (41%), and 104 (34%) patients were classified into Group 1, 2, and 3, respectively. Compared with those with proportionate TR (Group 1), patients with disproportionate TR (Group 2 and 3) had a higher prevalence of atrial fibrillation and smaller left ventricular end-diastolic and end-systolic volumes. During a median (interquartile range) follow-up of 4.1 (2.5-6.2) years, 81 adverse events (49 HF hospitalizations and 32 deaths) occurred. Patients with disproportionate TR (Group 2 and 3) had higher rates of adverse events than those with proportionate TR (22% and 44% versus 9%; P = 0.018 and P < 0.001, respectively) and were independently associated with poor outcomes on multivariate analysis. TR proportionality outperformed guideline-based prediction algorithm comprising EROA and RV assessment in outcome prediction (C-statistic 0.70 versus 0.62, p = 0.015; likelihood ratio test <0.001).
Conclusion
Disproportionate TR is independently associated with poor prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV size and function may aid patient selection and risk stratification for tricuspid annuloplasty. Abstract Figure.
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Affiliation(s)
- YK Stephanie
- Hongkong University of Shenzhen Hospital, Shenzhen, China
| | - HL Li
- The University of Hong Kong, Hong Kong, Hong Kong
| | - MZ Wu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - QW Ren
- The University of Hong Kong, Hong Kong, Hong Kong
| | - KH Yiu
- The University of Hong Kong, Hong Kong, Hong Kong
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47
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Stephanie YK, Li HL, Ren QW, Wu MZ, Yiu KH. Prognostic implications of the proportionality of tricuspid regurgitation in tricuspid annuloplasty. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.102] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with secondary tricuspid regurgitation (TR) represent a heterogeneous group that benefits differentially from tricuspid annuloplasty. We hypothesized that TR severity may be proportional or disproportional to right ventricular (RV) remodeling and investigated the prognostic implications of this novel paradigm.
Methods
The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area (RVDA) and tricuspid annular plane systolic excursion (TAPSE) were retrospectively assessed in 307 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from cubic splines and maximally selected rank statistics, patients were stratified into 3 groups: proportionate TR (Group 1: EROA/RVDA ≤1.68 and EROA/TAPSE ≤3.42), disproportionate TR to RV size (Group 2: EROA/RVDA >1.68 and EROA/TAPSE ≤3.42), and disproportionate TR to RV size and function (Group 3: EROA/RVDA >1.68 and EROA/TAPSE >3.42).
Results
Overall, 72 (23%), 127 (41%), and 108 (35%) patients were classified into Group 1, 2, and 3, respectively. Compared with those with proportionate TR (Group 1), patients with disproportionate TR (Group 2 and 3) had a higher prevalence of atrial fibrillation, moderate to severe aortic stenosis, and smaller left ventricular end-diastolic and end-systolic volumes. During a median (interquartile range) follow-up of 4.3 (2.6-6.3) years, 74 adverse events (42 HF hospitalizations and 32 deaths) occurred. Patients with disproportionate TR (Group 2 and 3) had higher rates of adverse events than those with proportionate TR (21% and 38% versus 8%; P = 0.010 and P < 0.001, respectively; Figure) and were independently associated with poor outcomes on multivariate analysis. Importantly, this novel framework outperformed the TR grading system recommended by current guidelines, which was unable to effectively stratify prognosis in this population (Hazard Ratio for severe versus moderate TR 1.42; 95% CI 0.84-2.38; P = 0.194).
Conclusion
Disproportionate TR is independently associated with poor prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV size and function may aid patient selection and risk stratification for tricuspid annuloplasty. Abstract Figure.
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Affiliation(s)
- Y K Stephanie
- Hongkong University of Shenzhen Hospital, Shenzhen, China
| | - H L Li
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Q W Ren
- The University of Hong Kong, Hong Kong, Hong Kong
| | - M Z Wu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - K H Yiu
- The University of Hong Kong, Hong Kong, Hong Kong
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Hon NWL, Wu MZ, Yu SY, Wong PF, Tse YK, Li HL, Tsui LH, Yu SY, Yiu KH. Role of prenatal cardiovascular magnetic resonance imaging in determining pregnancy risk in repaired Tetralogy of Fallot patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.163] [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
Funding Acknowledgements
Type of funding sources: None.
Addressing pregnancy risks poses as a new challenge among women with repaired tetralogy of Fallot (TOF). The high-output state of pregnancy may predispose women to late complications of repaired TOF. However, guidelines regarding antenatal and or perinatal cardiovascular assessment has not been outlined. Noninvasive modalities such as cardiac magnetic resonance imaging (CMR) that do not require the utilization of ionizing radiation are feasible methods of assessment. Risk stratification of baseline CMR parameters has been sparsely investigated among repaired TOF cohorts. This study aims to identify baseline CMR parameters that may predict adverse outcomes of pregnancy among women with repaired TOF.
Sixty-five successful pregnancies were recorded from a cohort of 105 pregnant episodes. Patients with CMR studies performed within 5 years prior to delivery events were included. Adverse clinical outcomes of interest included arrhythmia, heart failure admissions, gestational hypertension, pre-eclampsia toxemia and all-cause mortality. Baseline CMR parameters regarding ventricular mechanics such as left and right ventricular end-diastolic and end-systolic volumes, left and right ventricular ejection fractions and pulmonary regurgitant fraction were measured, and their association with adverse clinical outcomes were evaluated using an independent-samples t-test.
Within all 65 successful pregnancies, 26 baseline CMR images were obtained and included in this study. The mean maternal age was 29.7 ± 6.7 years old with a mean birth weight of 2.91 ± 0.49 kg at a mean gestational age of 38.4 ± 2.0 weeks. There was a total of 12 patients with adverse clinical outcome: 5 patients with heart failure hospitalizations, 4 patients with gestational hypertension, 4 patients with arrhythmia and 2 patients with pre-eclampsia toxemia.
Assessment of baseline CMR parameters of ventricular mechanics revealed that increased left ventricular end-diastolic volumes (LVEDV) (144.7mL/m2 ± 4.9; P = 0.011), left ventricular end-systolic volumes (LVESV) (65.1mL/m2 ± 9.4; P = 0.004), right ventricular end-diastolic volumes (RVEDV) (235.2 ± 29.0; P = 0.021) and right ventricular end-systolic volumes (RVESV) (122.2mL/m2 ± 38.1; P = 0.033) were associated with an increased incidence of arrhythmia during pregnancy. Nonetheless, there was no significant association between baseline ventricular mechanics with heart failure, gestational hypertension, and pre-eclampsia toxemia.
Baseline assessment of cardiac magnetic resonance imaging among pregnant TOF women revealed that larger left and right ventricular volumes were associated with arrythmia development during pregnancy. Further studies with larger cohort sizes evaluating the role of antenatal and perinatal cardiovascular imaging assessment using CMR in predicting the risks of cardiovascular complications during pregnancy are warranted.
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Affiliation(s)
- N W L Hon
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - M Z Wu
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - S Y Yu
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - P F Wong
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - Y K Tse
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - H L Li
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - L H Tsui
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - S Y Yu
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
| | - K H Yiu
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China, Hong Kong, Hong Kong
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Ren QW, Teng THK, Wang T, Tse YK, Wong PF, Li HL, Yu SY, Wu MZ, Li XL, Tse HF, Lam CSP, Yiu KH. Incidence, clinical correlates and associated outcomes of dementia in heart failure: a population-based cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.046] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Dementia, in the setting of heart failure (HF), portends poorer outcomes and poses great challenges in its clinical management.
Purpose
We investigated the incidence, types, clinical correlates, and the prognostic impact of dementia in a population-based cohort of patients with HF. Further, we examined the interactions of age and sex, and education status with dementia incidence.
Methods
The previously validated Hong Kong Clinical Data Analysis Reporting System (CDARS), a territory-wide database was interrogated to identify patients with HF (N= 202,121) from 1995 to 2018. Associations of clinical correlates with incident dementia and its risk with all-cause mortality were assessed using competing risk/multivariable Cox regression models where appropriate.
Results
Among a total cohort aged ≥18 years with HF (mean age: 75.3 ± 13.0 years, 51.3% women), new-onset dementia occurred in 22,145 (11.0%) over a median follow-up of 5.5 years. Alzheimer’s disease occurred in 27.0%; vascular dementia (18.1%) and unspecified dementia (in 55.1%). Age-standardized rate of dementia incidence in women was 1297 (95%CI, 1276-1318) (vs. 744, 95%CI, 723-765) per 10000 population in men. Other independent predictors of dementia include: Increasing age (HR 1.08), Female sex (HR 1.19), Nil/< primary (vs tertiary) education (HR 1.29), Parkinson’s disease (HR 1.73), head injury (HR 1.37), peripheral vascular disease (HR 1.31), stroke (HR 1.29), depression (HR 1.18), alcohol intake (HR1.17), anaemia (HR 1.14), hypertension (HR 1.08), among other common comorbidities in HF (Figure 1A).
Notably, a significant interaction (p < 0.001) between age and sex on dementia incidence was observed, such that women in all age groups were observed to have higher sHR compared to men (Figure 1B). After accounting for competing risk, dementia was not associated with adjusted hazard of all-cause mortality.
Conclusions
Female sex, lower socioeconomic status, increasing age and common comorbidities were associated with higher hazards of incident dementia. Abstract Figure 1A and Figure 1B
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Affiliation(s)
- Q W Ren
- The University of Hong Kong, Hong Kong, China
| | - T H K Teng
- National Heart Centre Singapore, Singapore, Singapore
| | - T Wang
- National Heart Centre Singapore, Singapore, Singapore
| | - Y K Tse
- The University of Hong Kong, Hong Kong, China
| | - P F Wong
- The University of Hong Kong, Hong Kong, China
| | - H L Li
- The University of Hong Kong, Hong Kong, China
| | - S Y Yu
- The University of Hong Kong, Hong Kong, China
| | - M Z Wu
- The University of Hong Kong, Hong Kong, China
| | - X L Li
- Nanjing Medical University, Nanjing, China
| | - H F Tse
- The University of Hong Kong, Hong Kong, China
| | - C S P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - K H Yiu
- The University of Hong Kong, Hong Kong, China
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50
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Tsui L, Yiu KH, Tse HF, Lam LY, Leung CKL, Yu ASY, Wu MZ, Ren QW, Wong PF, Tse YK, Yu SSY, Li HL, Hon WL. Prognostic value of pre-operative left atrial strain on composite endpoint in patients received aortic valve replacement for severe aortic stenosis: a retrospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objective
Severe aortic stenosis (AS) is the most common primary valvular heart disease, treatable only by aortic valve replacement (AVR). Current literatures have shown that severe AS may precede atrial dysfunction which predicts adverse outcomes. However, predictive value of pre-operative left atrial (LA) function on post-AVR clinical outcomes is uncertain. The study aims to evaluate the prognostic value of pre-operative LA strain on post AVR all-cause mortality and heart failure.
Methods
Patients aged 18 years old or above with severe AS were recruited and assessed using speckle-tracking echocardiography pre-operatively. Severe AS was defined according to 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Peak Atrial Longitudinal Strain (PALS) was measured as a surrogate of LA function. Patients with underlying pre-operative atrial fibrillation and other severe valvular heart diseases were excluded. High PALS was defined as PALS higher than 15.94%. Patients were followed up until death or end of the study. The primary endpoint is a composite endpoint of all-cause mortality and heart failure during hospitalisation. The association of LA function with composite endpoint of all-cause mortality and heart failure was evaluated by Cox Proportional Hazards analysis.
Results
A total of 128 patients (mean age 65.3.9 ± 9.4 years, 56.3% male) were analysed. Patients were followed up for a mean period of 3.9 ± 2.4years. A total of 65 of 128 patients (50.8%) belonged to low PALS group. During the study period, 23 patients developed events on the composite endpoint. Among those with composite endpoint, low PALS group accounted for 18 (78.3%) patients and high PALS group accounted for 5 (21.7%) patients. Higher PALS was independently associated with lower risk of composite endpoint of all-cause mortality and heart failure (HR, 0.33; 95% CI 0.117-0.916, p = 0.03) after adjustment for EuroSCORE II.
Conclusion
Higher PALS, a surrogate of LA function, is associated with a lower risk of composite endpoints of mortality and heart failure in patients with severe AS undergoing AVR, independent of EuroSCORE II. Evaluation of LA function by assessing speckle tracking derived PALS may aid in prognostication for patients undergoing AVR.
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Affiliation(s)
- L Tsui
- The University of Hong Kong, Hong Kong, Hong Kong
| | - K H Yiu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - H F Tse
- The University of Hong Kong, Hong Kong, Hong Kong
| | - L Y Lam
- The University of Hong Kong, Hong Kong, Hong Kong
| | - C K L Leung
- The University of Hong Kong, Hong Kong, Hong Kong
| | - A S Y Yu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - M Z Wu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Q W Ren
- The University of Hong Kong, Hong Kong, Hong Kong
| | - P F Wong
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Y K Tse
- The University of Hong Kong, Hong Kong, Hong Kong
| | - S S Y Yu
- The University of Hong Kong, Hong Kong, Hong Kong
| | - H L Li
- The University of Hong Kong, Hong Kong, Hong Kong
| | - W L Hon
- The University of Hong Kong, Hong Kong, Hong Kong
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