ORCID Profile
0000-0003-3986-1951
Current Organisations
Center for Medical Excellence, Faculty of Medicine, Chiang Mai University
,
Chiang Mai University Faculty of Medicine
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Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.EJRAD.2009.03.010
Abstract: The accurate measurement of myocardial salvage is critical to the ongoing refinement of reperfusion strategies in acute myocardial infarction (AMI). Cardiac magnetic resonance imaging (CMR) can define the area at risk in AMI by the presence of myocardial oedema, identified by high signal intensity on T(2)-weighted imaging with a short inversion time inversion-recovery (STIR) sequence. In addition, myocardial necrosis can be identified with CMR delayed contrast enhanced imaging. In this prospective study we examined the relationship of acute oedema and necrosis with impaired microvascular reperfusion. We also evaluated acute oedema as a marker of the area at risk in AMI, for the purposes of documenting myocardial salvage. CMR was performed on 15 patients with (AMI), within 24h of successful percutaneous coronary intervention (PCI). Left ventricular (LV) systolic dysfunction was defined by a systolic thickening <40% (severe <20%). Microvascular reperfusion was evaluated during the acute phase of contrast wash-in. CMR was repeated 3 months post-PCI to evaluate recovery of LV function and final infarct size. Myocardial salvage was defined as the percentage of the area at risk that was not infarcted on follow up CMR. There was a significant correlation between impaired microvascular reperfusion and the extent of segmental oedema (R=0.363, P 0.5). The extent of myocardial salvage correlated with recovery of systolic function (R=0.241, P<0.05), which was strongest in LV segments with severely reduced systolic function (R=0.422, P<0.01). In acutely reperfused AMI, oedema can be used to identify the area at risk for the purpose of calculating myocardial salvage. The correlation between myocardial oedema and reperfusion status suggests a pathological role of acute oedema in the impairment of microvascular reperfusion.
Publisher: Mary Ann Liebert Inc
Date: 07-2019
Abstract: The rise of cardiac troponin post-percutaneous coronary intervention (PCI) is associated with a high risk of long-term cardiovascular events. Previous studies have shown that curcuminoids decreased myocardial injury post-coronary bypass graft surgery through anti-oxidant and anti-inflammatory effects. We sought to examine whether curcuminoids could prevent PCI-related myocardial injury. One-hundred enrolled patients receiving elective PCI were randomized to obtain curcuminoids or placebo 4 g/day at least 1 day before and after the scheduled PCI. Cardiac troponin-T and 12-lead electrocardiogram were evaluated before PCI and at 24 and 48 h post-PCI. The definitions of PCI-related myocardial injury and myocardial infarction were in line with the third universal definition of myocardial infarction. Baseline characteristics of patients and procedures did not differ between the curcuminoids and placebo groups. The mean age was 63.9 ± 10.8 years. The incidence of PCI-related myocardial injury was not different between curcuminoids and placebo groups (32% vs. 38%,
Publisher: Portland Press Ltd.
Date: 02-02-2018
DOI: 10.1042/BSR20171266
Abstract: Early detection of iron overload cardiomyopathy is an important strategy for decreasing the mortality rate of patients with transfusion-dependent thalassemia (TDT). Although cardiac magnetic resonance (CMR) T2* is effective in detecting cardiac iron deposition, it is costly and not generally available. We investigated whether heart rate variability (HRV) can be used as a screening method of iron overload cardiomyopathy in TDT patients. HRV, evaluated by 24-h Holter monitoring, non-transferrin bound iron (NTBI), serum ferritin, left ventricular (LV) ejection fraction (LVEF), and CMR-T2* were determined. Patients with a cardiac iron overload condition had a significantly higher low frequency/high frequency (LF/HF) ratio than patients without a cardiac iron overload condition. Log-serum ferritin (r = −0.41, P=0.008), serum NTBI (r = −0.313, P=0.029), and LF/HF ratio (r = −0.286, P=0.043) showed a significant correlation with CMR-T2*, however only the LF/HF ratio was significantly correlated with LVEF (r = −0.264, P=0.043). These significant correlations between HRV and CMR-T2* and LVEF in TDT confirmed the beneficial role of HRV as a potential early screening tool of cardiac iron overload in thalassemia patients, especially in a medical center in which CMR T2* is not available. A larger number of TDT patients with cardiac iron overload are needed to confirm this finding.
Publisher: American Medical Association (AMA)
Date: 23-10-2013
Abstract: Among nontraditional cardiovascular risk factors, recent influenzalike infection is associated with fatal and nonfatal atherothrombotic events. To determine if influenza vaccination is associated with prevention of cardiovascular events. A systematic review and meta-analysis of MEDLINE (1946-August 2013), EMBASE (1947-August 2013), and the Cochrane Library Central Register of Controlled Trials (inception-August 2013) for randomized clinical trials (RCTs) comparing influenza vaccine vs placebo or control in patients at high risk of cardiovascular disease, reporting cardiovascular outcomes either as efficacy or safety events. Two investigators extracted data independently on trial design, baseline characteristics, outcomes, and safety events from published manuscripts and unpublished supplemental data. High-quality studies were considered those that described an appropriate method of randomization, allocation concealment, blinding, and completeness of follow-up. Random-effects Mantel-Haenszel risk ratios (RRs) and 95% CIs were derived for composite cardiovascular events, cardiovascular mortality, all-cause mortality, and in idual cardiovascular events. Analyses were stratified by subgroups of patients with and without a history of acute coronary syndrome (ACS) within 1 year of randomization. Five published and 1 unpublished randomized clinical trials of 6735 patients (mean age, 67 years 51.3% women 36.2% with a cardiac history mean follow-up time, 7.9 months) were included. Influenza vaccine was associated with a lower risk of composite cardiovascular events (2.9% vs 4.7% RR, 0.64 [95% CI, 0.48-0.86], P = .003) in published trials. A treatment interaction was detected between patients with (RR, 0.45 [95% CI, 0.32-0.63]) and without (RR, 0.94 [95% CI, 0.55-1.61]) recent ACS (P for interaction = .02). Results were similar with the addition of unpublished data. In a meta-analysis of RCTs, the use of influenza vaccine was associated with a lower risk of major adverse cardiovascular events. The greatest treatment effect was seen among the highest-risk patients with more active coronary disease. A large, adequately powered, multicenter trial is warranted to address these findings and assess in idual cardiovascular end points.
Publisher: Wiley
Date: 23-03-2006
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.HRTLNG.2018.09.009
Abstract: Little is known regarding the relationship between medication adherence and quality of life in heart failure patients. We therefore aimed to examine the nature of relationship between medication adherence and quality of life. A prospective, cross-sectional study of chronic heart failure patients with reduced ejection fraction was performed at a tertiary-care, university hospital in Thailand. Quality of life and medication adherence were assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Relationship of MLHFQ and MMAS-8 were examined using Spearman's correlation coefficient and multiple regression analysis for covariates adjustment. Among 180 patients, 38.3%, 50.0% and 11.7% were found to have high, medium and poor adherence, respectively. For quality of life, the overall median score on the MLHFQ was relatively low. A positive relationship was identified between medication adherence and quality of life. After covariate adjustment, medication adherence was found to have the strongest relationship with quality of life, compared to other covariates. Medication adherence has a small and positive relationship with quality of life among heart failure patients.
Publisher: International Scientific Information, Inc.
Date: 26-05-2019
DOI: 10.12659/AJCR.915415
Publisher: Informa UK Limited
Date: 2018
Publisher: American Geophysical Union (AGU)
Date: 12-2008
DOI: 10.1029/2007TC002186
Publisher: Springer Science and Business Media LLC
Date: 08-11-2016
Publisher: Oxford University Press (OUP)
Date: 03-2008
Abstract: A second procedure for recurrent atrial fibrillation (AF) may be associated with the need for a different positioning of the puncture site and may increase the difficulty and complications. This study investigated whether the transseptal puncture site changed and whether the difficult punctures increased in the patients who received a repeat ablation procedure for recurrent AF. Twenty-nine AF patients (52 +/- 12 years old, 20 males) underwent catheter ablation for a recurrence of AF. Compared with the first procedure, the height between the transseptal puncture site and coronary sinus ostium was higher in the second procedure during both the atrial end-systolic phase (38.0 +/- 4.7 vs. 34.8 +/- 5.3 mm, P = 0.036), and end-diastolic phase (43.0 +/- 4.8 vs. 39.1 +/- 5.4 mm, P = 0.004) in the 30 degrees right anterior oblique view. No significant change in the vertical atrial diameter was noted between the first and second procedures. A higher incidence of a difficult puncture was noted during the second procedure than in the first procedure (28 vs. 7%, P = 0.014). All those difficult punctures were overcome by using a large-curved transseptal needle. No differences of age, gender, AF duration, interval between first and second procedures, procedure time of the first procedure, and left atrial anteroposterior diameter were noted between easy and difficult transseptal punctures during the second procedure. The incidence of a difficult puncture was higher in the second procedure compared with the first procedure. The transseptal puncture site moved higher in the second procedure. Chronic scarring over the previous transseptal site is a reasonable hypothesis to explain the observations. The difficult punctures experienced during the second procedure might be overcome by changing the needle curve from a small curve to a large curve design.
Publisher: Elsevier BV
Date: 08-2017
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.LFS.2007.02.029
Abstract: Inflammation and abnormal calcium homeostasis play important roles in atrial fibrillation. Tumor necrosis factor-alpha (TNFalpha), a proinflammatory cytokine, can induce cardiac arrhythmias. Pulmonary veins (PVs) are critical in initiating paroxysmal atrial fibrillation. This study was designed to investigate whether TNFalpha may change the calcium handling and arrhythmogenic activity of PV cardiomyocytes. We used whole-cell patch cl and indo-1 fluorimetric ratio technique to investigate the action potentials, ionic currents and intracellular calcium in isolated rabbit single PV cardiomyocytes with and without (control) incubation with TNFalpha (25 ng/ml) for 7-10 h. The expression of sarcoplasmic reticulum ATPase in the control and TNFalpha-treated PV cardiomyocytes was evaluated by confocal micrographs and Western blot. We found that the spontaneous beating rates were similar between the control (n=45) and TNFalpha-treated (n=28) PV cardiomyocytes. Compared with the control PV cardiomyocytes, the TNFalpha-treated PV cardiomyocytes had significantly a larger litude of the delayed afterdepolarizations (6.0+/-1.7 vs. 2.6+/-0.8 mV, P<0.05), smaller L-type calcium currents, larger transient inward currents, larger Na(+)-Ca(2+) exchanger currents, a smaller intracellular calcium transient, smaller sarcoplasmic reticulum calcium content, larger diastolic intracellular calcium, a longer decay portion of the calcium transient (Tau), and a decreased sarcoplasmic reticulum ATPase expression. In conclusion, TNFalpha can increase the PV arrhythmogenicity and induce an abnormal calcium homeostasis, thereby causing inflammation-related atrial fibrillation.
Publisher: Wiley
Date: 21-04-2014
DOI: 10.1111/ANEC.12162
Publisher: Public Library of Science (PLoS)
Date: 17-06-2015
Publisher: Wiley
Date: 04-2019
DOI: 10.1002/EJHF.1459
Abstract: Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87-0.99 per 0.1 unit adherence level increase P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94-0.99 per 0.1 unit adherence level increase P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9-1.02 CV: SHR 0.98, 95% CI 0.96-1.01 and HF: SHR 0.99, 95% CI 0.96-1.02 per 0.1 unit change in adherence score P = 0.52, P = 0.2, and P = 0.4, respectively). These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines.
Publisher: Wiley
Date: 30-01-2006
DOI: 10.1111/J.1540-8167.2006.00353.X
Abstract: The anatomic proximity between the esophagus and the coronary sinus (CS) might render the esophagus vulnerable to thermal injury during ablation. Therefore, we investigated the anatomic relationship between the esophagus and the CS in patients with atrial fibrillation (AF). Thirty patients (25 males, mean age = 54 +/- 11 years) with drug-refractory paroxysmal AF were included. Sixteen-slice multidetector computed tomography was performed to depict the course of the esophagus and relationship to the CS. The esophagus was in direct contact with the CS in 57% (17/30) of patients (group 1). The mean length of the contact was 6.1 +/- 3.4 mm. In the remaining 13 patients, the esophagus did not come in direct contact with the CS (group 2). The shortest distance between the esophagus and the CS was 4.0 +/- 2.6 mm. The CS diameter (9.4 +/- 1.8 vs 8.5 +/- 2.4 mm, P = 0.15), esophagus width (18.6 +/- 1.6 vs 18.6 +/- 1.7 mm, P = 0.87), anteroposterior diameter of the left atrium (35.9 +/- 3.8 vs 35.0 +/- 3.3 mm, P = 0.58), thickness of the anterior wall of the esophagus (2.9 +/- 0.6 vs 2.9 +/- 0.6 mm, P = 0.97), and shortest distance from the esophagus to the CS ostium (19.3 +/- 5.4 vs 25.0 +/- 6.2 mm, P = 0.02) and to the great cardiac vein (8.5 +/- 5.3 vs 12.1 +/- 6.9 mm, P = 0.10) were compared between the two groups. In 57% of our patients, the esophagus was in direct contact with the CS, and a significantly shorter distance between the esophagus and the CS ostium was noted in these patients. It is important to prevent esophageal damage when applying energy within the CS.
Publisher: Wiley
Date: 08-05-2019
DOI: 10.1002/PDS.4781
Abstract: This study aimed to describe incidence, risk factors, and outcomes of warfarin-associated major bleeding (WAMB) in Thai patients. A nested case-control study was conducted in a cohort of adult patients receiving ≥6 months of warfarin therapy who were prospectively followed up at a tertiary care hospital in Thailand during January 2011 to December 2014. Logistic regression was used to identify risk factors associated with WAMB. The area under the receiver operating characteristic (AUROC) curve was used to assess the performance of the HAS-BLED score to predict WAMB in patients with non-valvular atrial fibrillation (NVAF). Among 1604 patients (2972 patient-year of follow-up), there were 93 major bleeding that occurred in 76 patients. The incidence of WAMB was 3.13 events per 100 patient-year. Time in therapeutic range (TTR) of <60% (RR: 3.62, 95% CI: 1.94-6.73, P < 0.001), mechanical valve replacement at mitral position (RR 3.43, 95% CI: 1.92-6.16, P < 0.001) cancer (RR: 2.84, 95% CI: 1.11-7.29, P = 0.029), and age ≥ 65 years (RR: 2.37, 95% CI: 1.20-4.67, P = 0.012) were independent risk factors for WAMB. There were 17 fatalities and 12 cases of disabilities from WAMB. Mean cost of WAMB was 45 341.54 THB/event. An exploratory analysis suggested that HASBLED score demonstrated an excellent discriminatory capacity to predict WAMB among NVAF patients (AUROC of 0.91, 95% CI: 0.85-0.97, P < 0.001). WAMB in Thai population is common and associated with high rate of morbidity and mortality. Improvement in anticoagulation control is clearly needed.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Wiley
Date: 23-06-2009
DOI: 10.1111/J.1540-8167.2008.01411.X
Abstract: The left atrial (LA) substrate plays an important role in the maintenance of atrial fibrillation (AF). However, little is known about the acute effect of circumferential pulmonary vein isolation (CPVI). This study was to investigate the acute change of LA activation, voltage and P wave in surface electrocardiogram (ECG) after CPVI. Electroanatomic mapping (NavX) was performed in 50 patients with AF (mean age = 54 +/- 10 years, 36 males) who underwent only CPVI. The mean peak-to-peak bipolar voltage and total activation time of LA were obtained during sinus rhythm before and immediately after CPVI. The average duration and litude of P waves in 12-lead ECG were also analyzed before and after CPVI. Change in the earliest LA breakthrough sites could cause decreased LA total activation time. Downward shift in the breakthrough site was inversely proportional to the proximity of the breakthrough site to the radiofrequency lesions. A shortening of P-wave duration and decrease in voltage after CPVI were observed after CPVI. Patients with recurrent AF had less voltage reduction in the atrial wall 1 cm from the circumferential PV lesions compared with those without recurrent AF (60.1 +/- 11.7% vs 74.1 +/- 6.6%, P = 0.002). Reduction of voltage < or = 64.4% in this area after CPVI is related with recurrent AF. CPVI could result in acute change of LA substrate, involving LA activation and voltage. Less reduction of voltage in the atrial wall adjacent to the circumferential PV lesions after CPVI may be associated to the recurrence of AF.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2015
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.HRTHM.2009.02.019
Abstract: The regional distribution of the low-voltage zones (LVZs) may relate to the maintenance of atrial arrhythmias in the right atrium (RA). The purpose of this study was to investigate the RA substrate characteristics in different types of atrial arrhythmias originating from RA and left atrium (LA). Forty-five patients (35 men, age = 62 +/- 15 years) with RA atypical atrial flutter (n = 15, group 1), RA atrial fibrillation (AF n = 15, no PV initiating foci, group 2), and LA AF (n = 1 5, no RA arrhythmias, group 3) referred for three-dimensional EnSite mapping were included. Voltage and activation maps were visualized. The mean voltage of the RA was lower in group 2, and compared with group 3, a voltage reduction during atrial pacing was evident in groups 1 and 2. The fixed LVZs (independent of the rhythm) were mostly located along the lower crista terminalis (CT). A functional extension of the LVZ was located on the CT in 84% of patients, sinus venosa in 18%, and free-wall region in 27%, forming the borders of the slow conduction isthmus for the reentrant circuits. The number of slow conduction isthmuses was 1.3 +/- 0.9, 2.2 +/- 1.0, and 0.87 +/- 0.74, for the groups 1-3 patients, respectively (P <.05). Radiofrequency ablation connecting the LVZs successfully eliminated those isthmuses. The long-term follow-up revealed that 66% of the patients remained in sinus rhythm. Single and multiple slow conduction isthmuses bordered by the fixed and functional LVZs were critical for the reentrant circuits in the RA. The conduction isthmuses could be identified by their substrate characteristics and ablated successfully.
Publisher: International Scientific Information, Inc.
Date: 08-01-2021
DOI: 10.12659/AJCR.928969
Publisher: Springer Science and Business Media LLC
Date: 24-11-2020
DOI: 10.1186/S12933-020-01176-4
Abstract: Metformin has been shown to have various cardiovascular benefits beyond its antihyperglycemic effects, including a reduction in stroke, heart failure, myocardial infarction, cardiovascular death, and all-cause mortality. However, the roles of metformin in cardiac arrhythmias are still unclear. It has been shown that metformin was associated with decreased incidence of atrial fibrillation in diabetic patients with and without myocardial infarction. This could be due to the effects of metformin on preventing the structural and electrical remodeling of left atrium via attenuating intracellular reactive oxygen species, activating 5′ adenosine monophosphate-activated protein kinase, improving calcium homeostasis, attenuating inflammation, increasing connexin-43 gap junction expression, and restoring small conductance calcium-activated potassium channels current. For ventricular arrhythmias, in vivo reports demonstrated that activation of 5′ adenosine monophosphate-activated protein kinase and phosphorylated connexin-43 by metformin played a key role in ischemic ventricular arrhythmias reduction. However, metformin failed to show anti-ventricular arrhythmia benefits in clinical trials. In this review, in vitro and in vivo reports regarding the effects of metformin on both atrial arrhythmias and ventricular arrhythmias are comprehensively summarized and presented. Consistent and controversial findings from clinical trials are also summarized and discussed. Due to limited numbers of reports, further studies are needed to elucidate the mechanisms and effects of metformin on cardiac arrhythmias. Furthermore, randomized controlled trials are needed to clarify effects of metformin on cardiac arrhythmias in human.
Publisher: Wiley
Date: 10-11-2006
DOI: 10.1111/J.1540-8167.2006.00655.X
Abstract: The left atrial appendage (LAA) has been proven to be the most important site of thrombus formation in patients with atrial fibrillation (AF). However, the information regarding the morphometric alteration of the LAA related to the outcome of AF ablation is still lacking. Thus, we evaluated the long-term changes of the LAA morphology in patients undergoing catheter ablation of AF using magnetic resonance angiography (MRA). Group 1 included 15 controls without any AF history. Group 2 included 40 patients with drug-refractory paroxysmal AF. They were ided into two subgroups: group 2a included 30 patients without AF recurrence after pulmonary vein (PV) ablation. Group 2b included 10 patients with late recurrence of AF. The LAA morphology before and after (20 +/- 11 months) ablation was evaluated by three-dimensional MRA. The group 2 patients had a larger baseline LAA size (including the LAA orifice, neck, and length) and less eccentric LAA orifice and neck. After the AF ablation, there was a significant reduction in the LAA size in the group 2a patients, and the morphology of the LAA neck became more eccentric during the follow-up period. In group 2b, the LAA size increased and no significant change in the eccentricity of the orifice and neck could be noted. The morphometric remodeling of the LAA in the AF patients could be reversed after a successful ablation of the AF. Progressive dilation of the LAA was noted in the patients with AF recurrence. These structural changes in the LAA may play a role in reducing the potential risk of cerebrovascular accidents.
Publisher: BMJ
Date: 06-2016
Publisher: Wiley
Date: 03-05-2007
DOI: 10.1111/J.1540-8167.2007.00823.X
Abstract: Some conflicting results of the efficacy of the inducibility test used in the catheter ablation of atrial fibrillation (AF) have been reported. The aim of this study was to investigate the inducibility and efficacy of circumferential ablation with pulmonary vein isolation (PVI) in patients with paroxysmal AF and its relationship to the atrial substrate. This study consisted of 88 patients with paroxysmal AF who underwent catheter ablation. Electroanatomic mapping using a NavX system was performed and the biatrial voltage was obtained during sinus rhythm. After successful circumferential ablation with PVI, an inducibility test was performed to determine the requirement for creating left atrial (LA) ablation line. After procedure, patients with inducible AF had a higher recurrence rate than did those with noninducibility of AF (55% vs 18%, P = 0.02). The patients with inducible AF after the PVI had a lower biatrial voltage than did those with negative inducibility. The patients with inducible AF after the final procedure who had a recurrence had a lower LA voltage (1.3 +/- 0.4 vs 1.8 +/- 0.4 mV, P = 0.02) and longer LA total activation time (99 +/- 18 vs 88 +/- 13 msec, P = 0.02) than did those with noninducible AF and no recurrence. None of the patients had occurrence of LA flutter during the follow-up. After a single procedure of circumferential ablation with PVI and noninducibility, 82% patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.
Publisher: Wiley
Date: 29-12-2008
DOI: 10.1111/J.1540-8167.2008.01269.X
Abstract: The characteristics of cavotricuspid isthmus (CTI) in patients with atrial fibrillation (AF) and flutter that may predict recurrence of flutter is not known. We aimed to investigate the CTI characteristics in patients who underwent a second ablation procedure for recurrent AF after previous combined pulmonary vein (PV) and CTI ablation. Among 196 consecutive patients with drug-refractory symptomatic AF who underwent PV isolation and CTI ablation with bidirectional isthmus block, 49 patients (age 50 +/- 12 years, 43 males) had recurrent AF and received a second procedure 291 +/- 241 days after the first procedure. Right atrial angiography for the evaluation of the CTI morphology, and the biatrial contact bipolar electrograms were obtained before both procedures. In the second procedure, 11 (group 1) of the 49 patients demonstrated recovered CTI conduction. Compared with the patients without CTI conduction (group 2, n = 38), group 1 patients had a higher frequency of a pouch-type anatomy (82% vs 13%, P < 0.001), longer CTI (34.0 +/- 8.6 vs 25.5 +/- 7.5 mm, P = 0.01), longer ablation time, and larger number of radiofrequency applications furthermore, the preablation bipolar voltage decreased along both the CTI and ablation line in group 2, whereas it remained similar in group 1 in the second procedure. A high (22%) percentage of CTIs exhibited recurrent conduction in the long-term follow-up. The CTIs with recurrent conduction had a higher incidence of a pouch and longer length compared with those without recurrent conduction.
Publisher: Informa UK Limited
Date: 06-2015
DOI: 10.3109/03630269.2015.1043059
Abstract: Iron overload cardiomyopathy remains the major cause of death in β-thalassemia (β-thal). Conventional routine screening parameters such as serum ferritin and echocardiogram (ECG) do not permit early detection of this condition. Although non-transferrin-bound iron (NTBI) is a reliable indicator for iron overload, it is still not universally available. Recently, heart rate variability (HRV), representing cardiac autonomic function, was found to be depressed in thalassemia patients. We hypothesized that HRV can be used for early detection of iron overload cardiomyopathy. Fifty patients (aged 29 ± 11 years 31 females and 19 males) with β-thal were enrolled. The 24-hour Holter monitoring for HRV, serum ferritin, NTBI, hematological values and ECG were performed for each patient. Of the 50 patients, 29 carried β-thal major (β-TM). Non-transferrin-bound iron was weakly correlated to all time-domain HRV parameters. Low- and high-frequency domain HRV parameters were also inversely weakly correlated with NTBI. Neither HRV nor NTBI was correlated with serum ferritin. With its weak but significant correlation with NTBI, HRV may be considered to be used as a potential indicator of an iron overload condition and an early marker of cardiac involvement in patients with β-thal.
Publisher: Wiley
Date: 14-11-2007
DOI: 10.1111/J.1540-8167.2007.01012.X
Abstract: The features of multiple catheter ablation procedures for paroxysmal atrial fibrillation (AF) are unknown. We aimed to investigate the electrophysiologic characteristics and the clinical outcomes in the patients with AF who received more than two ablation procedures. The study consisted of 15 consecutive patients (age 48 +/- 14 years, 10 males) who had undergone three to five (3.3 +/- 0.6) catheter ablation procedures for recurrent paroxysmal AF. Ten patients had pulmonary vein (PV)-AF and one had AF originating from both PVs and the superior vena cava (SVC) in the first ablation procedure. All of them exhibited PV reconnection during the recurrent episodes. Four of the 15 patients had AF originating from non-PV foci (three from the SVC, one from the crista terminalis) in the first procedure, and two had AF recurrences due to recovered conduction from the SVC. In all patients with PV-AF recurrences, repeated PV isolation procedures could effectively eliminate the AF. The incidence of the need for additional LA linear ablation lesions was higher comparing between the first procedure and in the following ablation procedures (18% vs. 71%, P = 0.02). During a follow-up of 1.7 +/- 1.1 years, 73% of the patients remained in sinus rhythm without any antiarrhythmic drugs after the final procedure. Recovered PV connection was the major cause of the AF recurrences despite undergoing multiple catheter ablation procedures. It is advisable to inspect all PVs during the AF recurrence. Repeated PV isolation plus left atrial linear ablations could effectively eliminate the AF with satisfactory outcomes.
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.EJPHAR.2007.05.066
Abstract: The autonomic nervous system and calcium regulation play important roles in the pathophysiology of atrial fibrillation. Calmodulin regulates the calcium homeostasis and may mediate the proarrhythmic effects of autonomic nervous agents. The purpose of this study was to compare the effects of beta- and alpha-adrenoceptor agonists on the pulmonary vein electrical activity and evaluate whether calmodulin kinase II inhibitors may change the effects of the adrenoceptor agonists on the pulmonary vein arrhythmogenesis. Conventional microelectrodes were used to record the action potentials in isolated rabbit pulmonary vein tissue specimens before and after the administration of isoproterenol, phenylephrine and KN-93 (a calmodulin kinase II inhibitor). In the tissue preparation, isoproterenol (0, 0.1, 3 microM) increased the beating rates (1.5+/-0.2, 1.6+/-0.2, 2.3+/-0.3 Hz, n=10, P<0.001) with the genesis of early afterdepolarizations (EADs, 0%, 40%, 50%, P<0.05) and increased the litude of the delayed afterdepolarizations (DADs, 0.6+/-0.3, 1.7+/-0.4, 3.9+/-1.0 mV, P<0.05). Phenylephrine (0, 1, 10 microM) also increased the beating rates (1.4+/-0.2, 1.6+/-0.2, 1.9+/-0.2 Hz, n=12, P<0.001), incidence of EADs (0%, 8%, 50%, P<0.05) and litude of the DADs (0.4+/-0.2, 1.2+/-0.4, 2.6+/-0.8 mV, P<0.05). KN-93 did not change the pulmonary vein beating rates or action potential duration. However, in the presence of KN-93 (1 microM), isoproterenol (3 microM) and phenylephrine (10 microM) did not induce any EADs or DADs in the pulmonary veins. In conclusion, calmodulin kinase II inhibition may prevent adrenergic induced pulmonary vein arrhythmogenesis.
Publisher: Massachusetts Medical Society
Date: 25-07-2013
Publisher: Springer Science and Business Media LLC
Date: 12-10-2017
DOI: 10.1007/S00296-017-3846-7
Abstract: Inception cohort study regarding the causes of death and risk factors for mortality in patients with early systemic sclerosis (SSc), especially diffuse SSc (dcSSc) has not been well elucidated. Therefore, the aim of our study was to determine the causes of death, survival rates, and risk factors for mortality in Thai patients with early SSc of whom the majority belonged to the dcSSc subset. We used an inception cohort of early-SSc patients seen between January 2010 and August 2014. All patients were evaluated for clinical and laboratory data at the study entry and then every 6 months. A total of 115 patients (68 female, 91 dcSSc) were enrolled. The mean ± SD age at onset, duration of disease, and duration of follow-up were 52.5 ± 8.5 years, 12.3 ± 9.2 months, and 27.5 ± 16.4 months, respectively. During the follow-up, 11(9.6%) SSc patients died. The mortality rate was 4.17 per 100 person-years (95% CI 2.31, 7.53). The leading cause of SSc-related death was dilated cardiomyopathy (27.2%). Infection was the most common cause of non-SSc-related death (18.2%). Survival rates at 1, 2, 3, and 4 years after the study entry were 93, 91, 88, and 88%, respectively. In the multivariate Cox regression analysis, ESR ≥ 40 mm/h [HR 8.65 (95% CI 1.66,45.17)], hemoglobin < 10 mg/dL [HR 4.57 (95% CI 1.14,18.34)], and mRSS [HR 1.09 (95% CI 1.03,1.15)] were independent risk factors for mortality. Our data suggest that dilated cardiomyopathy was the most common SSc-related cause of death in Thai patients with early SSc, of whom majority was dcSSc subset. Elevated ESR, anemia, and increased mRSS predicted poor outcome.
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1540-8167.2008.01182.X
Abstract: The success rate of achieving electrical isolation by circumferential pulmonary vein ablation (CPVA) varies from 32% to 88%. We carried out ablation at the pulmonary vein carina to evaluate the elimination rates of the pulmonary vein potentials (PVPs) after one round of CPVA had failed to eliminate all the PVPs in the patients with atrial fibrillation (AF). Ninety-seven patients (75 males mean age: 50 +/- 12 years 15 with persistent AF and 82 with paroxysmal AF) who underwent catheter ablation were analyzed. All patients underwent one round of CPVA with PVP elimination as the endpoint. The electrophysiology tracings were then analyzed to look for the presence of any gaps that were subsequently targeted by radiofrequency ablation. The patients in whom the PVPs still persisted underwent ablation at the pulmonary vein carina and the success rate of the PVP elimination was studied. The patients were followed up for a mean duration of 12.9 +/- 8.2 months. One hundred ninety-four ipsilateral pulmonary veins in 97 patients were subjected to CPVA with successful elimination of the PVPs in 110 ipsilateral pulmonary veins (success rate of 56.7%). A carina ablation was carried out in the remaining 84 ipsilateral pulmonary vein pairs harboring PVPs. Elimination of the PVPs was achieved in all the remaining ipsilateral pulmonary veins after the carina ablation. Considering the limited efficacy of CPVA in eliminating the PVPs, pulmonary vein carina ablation is advisable to substantially increase the PVP elimination rate.
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/HEARTASIA-2019-011201
Abstract: The benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK. We randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at L ang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke). One hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054). The delayed coronary intervention ( hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention. NCT02131103 .
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Springer Science and Business Media LLC
Date: 03-04-2019
DOI: 10.1007/S10840-019-00541-Y
Abstract: Patients who are post-implantation of cardiac rhythm management devices (CRMDs) are commonly instructed to restrict ipsilateral arm movement to reduce risk of lead dislodgement. This immobilization practice increases risk of shoulder-related pain leading to limited shoulder function. We aimed to assess effect of pendulum exercise on shoulder function in patients after CRMD implantation. This study was a prospective, randomized, open-blinded end point study conducted with 200 patients undergoing CRMD implantation. They were randomized into two groups, standard care (control) and pendulum exercise (experimental) groups. The shoulder function was assessed using QuickDASH-TH scores and measurement of the range of motion (ROM) of shoulder abduction and flexion before and 1 month after implantation. Baseline characteristics did not differ between the two groups. The lower incidence of shoulder ROM reduction after CRMD implantation was demonstrated in the pendulum exercise group compared to the control group in both flexion (16.8% vs. 40.4%, P < 0.001) and abduction (9.9% vs. 32.3%, P < 0.001). A lower disability of shoulder function after implantation assessed by QuickDASH-TH scores was also noted in the exercise group compared to control (15.2 ± 16.4 vs. 23.4 ± 18.1, P = 0.001). Two patients in the control group and one in the exercise group had atrial lead dislodgement on the day following the procedure. Early pendulum exercise with ipsilateral arm after CRMD implantation was safe and resulted in lower incidence of limited shoulder ROM and less disability of shoulder function compared to control group. The study was registered in clinicaltrials.in.th , and the identification number is TCTR20180612003.
Publisher: MDPI AG
Date: 25-11-2022
DOI: 10.3390/JCM11236954
Abstract: Background: Acute pulmonary embolism (APE) is a common condition with increasing worldwide incidence. However, the clinical characteristics, risk factors, and clinical outcomes of APE in the Asian population especially in the Thai population are still limited. Therefore, the objective of this study was to identify the clinical characteristics, risk factors, and clinical outcomes of APE in the Asian population. Methods: A cross-sectional study was conducted on patients diagnosed with APE at Chiang Mai University Hospital, Thailand during 2011–2020. Results: During the study period, 696 patients confirmed the diagnosis of APE with a mean age of 57.7 ± 15.7 years and 41.1% males. APE was suspected in 468 of 696 patients (67.2%), while 228 patients (32.8%) had incidental PE. Active malignancy during treatment was found in 388 (55.7%). Dyspnea, cough, and chest pain were the most common presenting symptoms. Respiratory failure was found in 129 patients (18.6%). The thirty-day all-cause mortality rate was 19.1%. PE-related mortality was 5.6%. Most PE-related mortality was high-risk PE. Conclusion: APE was not uncommon in the Asian population. Active cancer, especially lung cancer was the most common risk factors. High-risk and intermediate-high-risk PE were associated with high mortality. Risk stratification and prompt management are warranted to improve outcomes.
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.JACC.2006.03.045
Abstract: The purpose of this study was to investigate the relationship between the abnormal substrate and peak negative voltage (PNV) in the right atrium (RA) with atypical flutter. The impact of a local abnormally low voltage electrogram on the local activation pattern and velocity of atrial flutter (AFL) remains unclear. Twelve patients with clinically documented AFL were included to undergo noncontact mapping of the RA. The atrial substrate was characterized by the: 1) activation mapping 2) high-density voltage mapping and 3) conduction velocity along the flutter re-entrant circuit. The normalized PNV (i.e., the relative ratio to the maximal PNV) in each virtual electrode recording was used to produce the voltage maps of the entire chamber. The protected isthmus was bordered by low voltage zones. Atypical AFL of the RA was induced by atrial pacing in 12 patients, including 10 upper loop re-entry and 2 RA free wall re-entry flutter. These protected isthmuses were located near the crista terminalis. The mean width of the protected isthmus was 1.7 +/- 0.3 cm and mean voltage at the isthmus was -0.91 +/- 0.39 mV. The conduction velocities within these paths were significantly slower than outside the path (0.30 +/- 0.18 m/s vs. 1.14 +/- 0.41 m/s, respectively p = 0.004). The ratiometric PNV of 37.6% of the maximal PNV had the best cut-off value to predict slow conduction, with a high sensitivity (92.3%) and specificity (85.7%). Characterization of the RA substrate in terms of the unipolar PNV is an effective predictor of the slow conduction path within the critical isthmus of the re-entrant circuit.
Publisher: Wiley
Date: 06-03-2007
DOI: 10.1111/J.1540-8167.2007.00781.X
Abstract: Aging increases atrial fibrillation (AF) vulnerability. The left atrium (LA) is important for the generation of AF. However, the effect of aging on the electrophysiological properties of the LA in general, on the specific LA sites, and of possible accentuation of regional differences between the LA sites with aging is not clear. The purpose of this study was to evaluate the effects of aging on the LA electrophysiological heterogeneity and ouabain-induced arrhythmogenicity. We used conventional microelectrodes to record the action potentials (APs) in isolated young (age, 3 months) and aged (age, 3 years) rabbit LA posterior wall (LAPW) and LA appendage (LAA) tissue specimens before and after the administration of ouabain. Young LAPWs (n = 10) had larger AP litudes than young LAAs (n = 10, P < 0.05), and aged LAPWs (n = 9) had longer AP durations than aged LAAs (n = 9, P < 0.05). Ouabain (1 microM) induced a higher incidence (80% vs 30%, P < 0.05) of delayed afterdepolarizations (DADs) and spontaneous activity (60% vs 10%, P < 0.05) in the young LAPWs than in the young LAAs. Compared with the young group, the aged LAs had a higher incidence of DADs with a less negative resting membrane potential and smaller maximum upstroke velocity. After the ouabain (1 microM) administration, the aged LAPWs had a greater shortening of the AP duration. Ouabain-induced spontaneous activity was similar between the young and aged groups. Aging enhanced the LA regional electrical heterogeneity and LAPW arrhythmogenesis.
Publisher: Hindawi Limited
Date: 24-01-2018
DOI: 10.1111/JCPT.12667
Abstract: Digoxin is commonly prescribed for heart failure patients with reduced ejection fraction (HFrEF) and patients with atrial fibrillation (AF). Due to digoxin's narrow therapeutic range, monitoring the serum digoxin concentration (SDC) is important. However, the SDC measurement is not widely available. Equations using clinical parameters can be employed to estimate the SDC but have never been studied in the Thai population. Therefore, we conducted this study to evaluate the correlation between the measured SDC and predicted digoxin level using 2 commonly used equations: the Konishi equation and the Koup and Jusko equation. This report describes prospective, cross-sectional study conducted at Chiang Mai University. One hundred and fourteen patients were recruited in the study. All of the patients were diagnosed as having HFrEF, AF or both and had been receiving digoxin for at least 4 weeks. The SDC of each patient was measured at steady state and assigned to one of 3 groups according to the classifications of the Digitalis Investigation Group (DIG) trial: in the therapeutic range, over the therapeutic range and in the suboptimal range. There were significant correlations between the measured and predicted SDCs using both the Konishi equation and the Koup and Jusko equation, which had correlation coefficients (R) of 0.69 and 0.31 (P < .05 for both), respectively. The percentages of patients with measured SDCs in the therapeutic range, over the therapeutic range and in the suboptimal range were 27.2%, 9.6% and 63.2%, respectively. The sensitivity and specificity of the Konishi equation in predicting SDCs in the over the therapeutic range were 72.73% (95% Confidence interval (CI): 39.03%-93.98%) and 80.58% (95% CI: 71.62%-87.72%), respectively. Of the 5 patients (4.4%) who were rehospitalized, 2 patients (0.01%) were readmitted due to acute decompensated heart failure (ADHF). One of the patients had an SDC that was over the therapeutic range. None of the readmitted patients had ventricular arrhythmia. The Konishi equation yielded better predictions of the SDC, especially in the subgroup of HFrEF patients. Furthermore, the prediction of SDCs in the over the therapeutic range using this equation was superior to that of the Koup and Jusko equation. With further validation in a larger population, this equation should facilitate the detection of patients who are over the therapeutic range in clinical practice.
Publisher: MDPI AG
Date: 19-10-2021
DOI: 10.3390/RS13204186
Abstract: Altimetric performance of Global Navigation Satellite System - Reflectometry (GNSS-R) instruments depends on receiver’s bandwidth and signal-to-noise ratio (SNR). The altimetric delay is usually computed from the time difference between the peak of the direct signal waveform and the maximum of the derivative of the reflected signal waveform. Dual-frequency data gathered by the airborne Microwave Interferometric Reflectometer (MIR) in the Bass Strait, between Australia and Tasmania, suggest that this approach is only valid for flat surfaces and large bandwidth receivers. This work analyses different methods to compute the altimetric observables using GNSS-R. A proposed novel method, the Peak-to-Minimum of the 3rd Derivative (P-Min3D) for narrow-band codes (e.g., L1 C/A), and the Peak-to-Half Power (P-HP) for large bandwidth codes (e.g., L5 or E5a codes) show improved performance when using real data. Both methods are also compared to the Peak-to-Peak (P-P) and Peak-to-Maximum of the 1st Derivative (P-Max1D) methods. The key difference between these methods is the determination of the delay position in the reflected signal waveform in order to compute the altimetric observable. Airborne experimental results comparing the different methods, bands and GNSS-R processing techniques show that centimeter level accuracy can be achieved.
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-051987
Abstract: The burden of atrial fibrillation (AF) in Thailand is high and associated with increased morbidity, mortality and healthcare costs. Vitamin K antagonists (eg, warfarin), commonly used for stroke prevention in patients with AF in Thailand, are effective but are often suboptimally controlled. We aim to evaluate the impact of an SAMe-TT 2 R 2 score-guided strategy and educational intervention compared to usual care on anticoagulation control expressed by the time in therapeutic range (TTR) at 12 months, in anticoagulant-naïve Thai patients with AF. Multicentre, open-label, parallel-group, randomised controlled trial conducted in Thailand among adult patients (age: 18 years) with AF who are anticoagulant naïve. Patients will be randomised to one of two groups an SAMe-TT 2 R 2 score-guided strategy with educational intervention and usual care versus usual care alone. The planned follow-up period is 12 months. The primary outcome is TTR at 12 months. Secondary outcomes include: (1) TTR at 6 months (2) thromboembolic and bleeding events at 12 months (3) composite major adverse cardiovascular events at 12 months (4) change in patients’ knowledge of AF between baseline and 6 months and 12 months (5) cost effectiveness (6) quality of life at baseline, 6 months and 12 months using EQ-5D-5L (Thai version) and (7) patient satisfaction erceptions of the TREAT intervention. An embedded qualitative study will assess patient perceptions of the TREAT intervention. The study has been approved by the Ethical Review Committee, Ministry of Public Health of Thailand, and registered in the Thai Clinical Trials Registry. The results of this trial will be submitted for publication in a peer-reviewed journal. Participants will be informed via a link to a preview of the publication. A lay summary will also be provided to all participants prior to publication. TCTR20180711003.
Publisher: Informa UK Limited
Date: 12-05-2015
Publisher: American Physiological Society
Date: 04-2008
DOI: 10.1152/AJPHEART.01078.2007
Abstract: The RhoA-Rho kinase (ROCK) signaling pathway has an important role in cardiovascular diseases. However, the effect of Rho kinase inhibition on pressure overload-induced cardiac hypertrophy (POH) and associated diastolic dysfunction has not been evaluated. This study examined the effect of a selective ROCK inhibitor (GSK-576371) in a POH model, induced by suprarenal abdominal aortic constriction. POH rats were ided into the following four groups: 1 (GSK 1, n = 9) or 3 (GSK 3, n = 10) mg/kg bid GSK-576371, 1 mg·kg −1 ·day −1 ramipril ( n = 10) or vehicle ( n = 11) treatment for 4 wk. Sham animals ( n = 11) underwent surgery without banding. Echocardiograms were performed before surgery and posttreatment, and hemodynamic data were obtained at completion of the study. Echocardiography showed an increase in relative wall thickness of the left ventricle (LV) following POH + vehicle treatment compared with sham animals. This was attenuated by both doses of GSK-576371 and ramipril. Vehicle treatment demonstrated abnormal diastolic parameters, including mitral valve (MV) inflow E wave deceleration time, isovolumic relaxation time, and MV annular velocity, which were dose dependently restored toward sham values by GSK-576371. LV end diastolic pressure was increased following POH + vehicle treatment compared with sham (6.9 ± 0.7 vs. 3.2 ± 0.7 mmHg, P = 0.008) and was reduced with GSK 3 and ramipril treatment (1.7 ± 0.7, P 0.01 and 2.9 ± 0.6 mmHg, P 0.01, respectively). Collagen I deposition in the LV was increased following POH + vehicle treatment (32.2% P 0.01) compared with sham animals and was significantly attenuated with GSK 1 (21.7% P 0.05), GSK 3 (23.8% P 0.01), and ramipril (35.5% P 0.01) treatment. These results suggest that ROCK inhibition improves LV geometry and reduces collagen deposition accompanied by improved diastolic function in POH.
Publisher: Frontiers Media SA
Date: 19-11-2018
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.THROMRES.2019.11.012
Abstract: Novel oral anticoagulants (NOACs) and warfarin care bundles (e.g. genotyping, patient self-testing or self-management) are alternatives to usual warfarin care for stroke prevention in patients with atrial fibrillation (AF). We aim to evaluate the cost-effectiveness of NOACs and warfarin care bundles in patients with AF in a middle-income country, Thailand. A Markov model was used to evaluate the economic and treatment outcomes of warfarin care bundles and NOACs compared with usual warfarin care. Cost-effectiveness was assessed from a societal perspective over a lifetime horizon with 3% discount rate in a hypothetical cohort of 65-year-old atrial fibrillation patients. Input parameters were derived from published literature, meta-analysis and local data when available. The outcome measure was incremental cost per quality-adjusted life years (QALY) gained (ICER). Using USD5104 as the threshold of willingness-to-pay per QALY, patient's self-management of warfarin was cost-effective when compared to usual warfarin care, with an ICER of USD1395/QALY from societal perspective. All NOACs were not cost-effective in Thailand, with ICER ranging from USD8678 to USD14,247/QALY. When compared to the next most effective intervention, patient's self-testing and genotype-guided warfarin dosing were dominated. In the cost-effectiveness acceptability curve, patient's self-management had the highest probability of being cost-effective in Thailand, approximately 78%. Results were robust over a range of inputs in sensitivity analyses. In Thailand, NOACs were unlikely to be cost-effective at current prices. Conversely, patient's self-management is a highly cost-effective intervention and may be considered for adoption in developing regions with resource-limited healthcare systems.
Publisher: Informa UK Limited
Date: 04-2015
DOI: 10.2147/TCRM.S78745
Publisher: Springer Science and Business Media LLC
Date: 05-01-2017
Publisher: Springer Science and Business Media LLC
Date: 23-07-2020
Publisher: MDPI AG
Date: 24-04-2023
Abstract: The Event Horizon Telescope (EHT) has led to the first images of a supermassive black hole, revealing the central compact objects in the elliptical galaxy M87 and the Milky Way. Proposed upgrades to this array through the next-generation EHT (ngEHT) program would sharply improve the angular resolution, dynamic range, and temporal coverage of the existing EHT observations. These improvements will uniquely enable a wealth of transformative new discoveries related to black hole science, extending from event-horizon-scale studies of strong gravity to studies of explosive transients to the cosmological growth and influence of supermassive black holes. Here, we present the key science goals for the ngEHT and their associated instrument requirements, both of which have been formulated through a multi-year international effort involving hundreds of scientists worldwide.
Publisher: Medknow
Date: 09-2017
Publisher: American College of Physicians
Date: 15-11-2011
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.CMPB.2016.03.015
Abstract: Heart failure due to iron-overload cardiomyopathy is one of the main causes of mortality. The cardiomyopathy is reversible if intensive iron chelation treatment is done in time, but the diagnosis is often delayed because the cardiac iron deposition is unpredictable and the symptoms are lately detected. There are many ways to assess iron-overload. However, the widely used and approved method is by using MRI which is performed by calculating the T2* (T2-star). In order to compute the T2* value, the region of interest (ROI) is manually selected by an expert which may require considerable time and skills. The aim of this work is hence to develop the cardiac T2* measurement by using region growing algorithm for automatically segmenting the ROI in cardiac MR images. Mathematical morphologies are also used to reduce some errors. Thirty MR images with free-breathing and respiratory-trigger technique were used in this work. The segmentation algorithm yields good results when compared with the manual segmentation performed by two experts. The averages of positive predictive value, the sensitivity, the Hausdorff distance, and the Dice similarity coefficient are 0.76, 0.84, 7.78 pixels, and 0.80 when compared with the two experts' opinions. The T2* values were carried out based on the automatically segmented ROI's. The mean difference of T2* values between the proposed technique and the experts' opinion is about 1.40ms. The results demonstrate the accuracy of the proposed method in T2* value estimation. Some previous methods were implemented for comparisons. The results show that the proposed method yields better segmentation and T2* value estimation performances.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.PEPTIDES.2010.04.026
Abstract: Urotensin II (UII) is a potential mediator in the pathogenesis of cardiovascular disease, and inhibition of its actions at the urotensin receptor (UT) has been shown to improve cardiac function and structural changes of the myocardium in a model of myocardial infarction. In this study we utilized a model of pressure-overload hypertrophy induced by abdominal aortic constriction (AAC) which resulted in hypertrophy, increased fibrosis and impaired diastolic and systolic function. These changes were associated with a 4-fold increase in UII protein expression in the myocardium. Treatment of animals with a selective UT (SB-657510) antagonist for 20 weeks at a dose of 1500 ppm did not improve cardiac function as assessed by echocardiography and pressure-volume loop analysis, nor did it inhibit left ventricular hypertrophy or fibrosis. We hypothesize that other neurohumoral pathways may have a greater involvement in the pathogenesis of this model. Targeting the UII system appears to be insufficient to observe a beneficial outcome.
Publisher: Informa UK Limited
Date: 2015
DOI: 10.2147/TCRM.S75608
Publisher: American Physiological Society
Date: 02-2010
DOI: 10.1152/AJPHEART.00942.2009
Abstract: The vasoactive peptide urotensin-II (U-II) is likely to play a key causal role in cardiac remodeling that ultimately leads to heart failure. Its contribution, specifically to the development of diastolic dysfunction and the downstream intracellular signaling, however, remains unresolved. This study interrogates the effect of chronic U-II infusion in normal rats on cardiac structure and function. The contribution of Rho kinase (ROCK) signaling to these pathophysiological changes is evaluated in cell culture studies. Chronic high-dose U-II infusion over 4 wk significantly impaired diastolic function in rats on echocardiography-derived Doppler indexes, including E-wave deceleration time (vehicle 56.7 ± 3.3 ms, U-II 118.0 ± 21.5 ms P 0.01) and mitral valve annulus peak early/late diastolic tissue velocity (vehicle 2.01 ± 0.19 ms, U-II 1.04 ± 0.25 ms P 0.01). A lower dose of U-II infusion (1 nmol·kg −1 ·h −1 ) yielded comparable changes. Diastolic dysfunction was accompanied by molecular [significant increases in procollagen-α 1 (I) gene expression on real-time PCR] and morphological (increases in total collagen, P 0.05, and collagen type-I protein deposition, P 0.001) evidence of left ventricular (LV) fibrosis following high-dose U-II infusion. The ROCK inhibitor GSK-576371 (10 −7 to 10 −5 M) elicited concentration-dependent inhibition of U-II (10 −7 M)-stimulated cardiac fibroblast collagen synthesis and cardiac myocyte protein synthesis. Chronic U-II infusion causes diastolic dysfunction, caused by fibrosis of the LV. The in vitro data suggest that this may be in part occurring via a ROCK-dependent pathway.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.HLC.2008.03.085
Abstract: Cardiac magnetic resonance imaging (CMR) has evolved as a major diagnostic tool to evaluate arrhythmogenic right ventricular dysplasia (ARVD). However, there is a lack of consensus in the interpretation of findings such as fatty infiltration or myocardial fibrosis. We examined the diagnostic utility of these two features in the diagnosis of ARVD. We performed fast imaging employing steady-state acquisition cine imaging, T(1)-weighted black blood imaging with and without fat suppression and post-contrast delayed enhancement on a 1.5-T scanner to evaluate ventricular function and morphology, fatty infiltration and regional myocardial fibrosis in 52 subjects with suspected ARVD. Eight subjects met the international diagnostic criteria for ARVD. Right ventricle (RV) delayed hyper-enhancement was found in 7 of 8 (88%) ARVD subjects compared to 6 of 44 (14%) subjects without ARVD (p<0.001). Fatty infiltration was only identified in 1 ARVD patient, and 1 non-ARVD patient. On multiple logistic regression analysis RV enhancement remained an independent predictor for the diagnosis of ARVD (p<0.05). RV delayed enhancement is common in patients with ARVD, whereas detection of fatty infiltration of the right ventricle was rare in our patient population. The inclusion of RV fibrosis on CMR as a feature of ARVD may improve the diagnostic accuracy of this condition.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.IJCARD.2005.11.106
Abstract: Calcium (Ca2+) plays an important role as a messenger in the excitation-contraction coupling process of the myocardium. It is stored in the sarcoplasmic reticulum (SR) and released via a calcium release channel called the ryanodine receptor. Cardiac ryanodine receptor (RyR2) controls Ca2+ release, which is essential for cardiac contractility. There are several molecules which bind and regulate the function of RyR2 including calstabin2, calmodulin, protein kinase A (PKA), phosphatase, sorcin and calsequestrin. Alteration of RyR2 and associated molecules can cause functional and/or structural changes of the heart, leading to heart failure and sudden cardiac death. In this review, the alteration of RyR2 and its regulatory proteins, and its roles in heart failure and sudden cardiac death, are discussed. Evidence of a possible novel therapy targeting RyR2 and its associated regulatory proteins, currently proposed by investigators, is also included in this article.
Publisher: Radcliffe Group Ltd
Date: 09-05-2021
DOI: 10.15420/ECR.2021.36
Abstract: The prevalence of dyslipidaemia has been increasing in the Asia-Pacific region and this is attributed to dietary changes and decreasing physical activity. While there has been substantial progress in dyslipidaemia therapy, its management in the region is hindered by limitations in awareness, adherence and healthcare costs. The Asian Pacific Society of Cardiology (APSC) developed these consensus recommendations to address the need for a unified approach to managing dyslipidaemia. These recommendations are intended to guide general cardiologists and internists in the assessment and treatment of dyslipidaemia and are hoped to pave the way for improving screening, early diagnosis and treatment. The APSC expert panel reviewed and appraised the evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. The resulting consensus recommendations tackle contemporary issues in the management of dyslipidaemia, familial hypercholesterolaemia and lipoprotein(a) in the Asia-Pacific region.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.BIOPHA.2018.10.138
Abstract: Low density lipoprotein cholesterol (LDL-C) is a well-established risk factor for cardiovascular disease. Although there are several developed lipid lowering drugs such as statins and fenofibrates, many patients do not achieve an adequate response. Recently, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been developed as a new therapeutic strategy for cholesterol regulation. PCSK9 binds to low density lipoprotein receptors (LDLR) and initiates LDLR degradation, elevating LDL-C. Therefore, PCSK9 inhibition could exert beneficial effects on cardiovascular disease outcomes. This review comprehensively summarizes and discusses the effects of PCSK9 inhibitors on lipid metabolism and cardiovascular function comparatively with current lipid lowering drugs. This review also details essential information regarding the cardiovascular benefits of PCSK9 inhibition which could encourage further clinical studies.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.HRTHM.2008.05.009
Abstract: Data detailing the age-related difference in the atrial substrate for formation of typical atrial flutter (AFL) are sparse. The purpose of this study was to characterize the difference in the right atrial substrate related to aging using noncontact mapping of the right atrium. A total of 54 patients (23 young [ or=60 years 74 +/- 6 years]) with typical AFL who underwent three-dimensional noncontact mapping of typical AFL were enrolled in the study. The atrial substrate was characterized according to (1) regional wavefront activation mapping, (2) regional conduction velocity, and (3) regional voltage distribution by dynamic substrate mapping. During activation mapping of the crista terminalis, two activation patterns were observed: (1) around the upper end of the crista terminalis (67%) and (2) through a gap in the crista terminalis. The presence of a crista terminalis gap was associated with a high incidence of induced atypical AFL/atrial fibrillation (P <.001). The conduction velocities of the medial cavotricuspid isthmus were slower in the old group than in the young group. In regional activation mapping of the AFL, the location of the slowest conduction shifted from the lateral cavotricuspid isthmus (71%) in the young group to the medial cavotricuspid isthmus (40%) in the old group. More cases with a low-voltage zone (<or=30% peak negative voltage) extending to the medial side of the cavotricuspid isthmus occurred in the old group than in the young group (55% vs 17%, P = .012). The atrial substrate responsible for formation of typical AFL differed between young and old patient groups.
Publisher: Wiley
Date: 09-06-2013
DOI: 10.1111/ANEC.12064
Publisher: MDPI AG
Date: 29-05-2020
DOI: 10.3390/RS12111759
Abstract: As compared to GPS L1C/A signals, L5/E5a Global Navigation Satellite System-Reflectometry (GNSS-R) improves the spatial resolution due to the narrower auto-correlation function. Furthermore, the larger transmitted power (+3 dB), and correlation gain (+10 dB) allow the reception of weaker reflected signals. If directive antennas are used, very short incoherent integration times are enough to achieve good signal-to-noise ratios, allowing the reception of multiple specular reflection points without the blurring induced by long incoherent integration times. This study presents for the first time experimental evidence of the wind and swell waves signatures in the GNSS-R waveforms, and it performs a statistical analysis, a time-domain analysis, and a frequency-domain analysis for a unique data set of waveforms collected by the UPC MIR instrument during a series of flights over the Bass Strait, Australia.
Publisher: Wiley
Date: 19-08-2010
DOI: 10.1111/J.1365-2362.2010.02343.X
Abstract: Despite its proposed cardioprotective effect, the role of plasma urocortin in acute myocardial infarction (AMI) remains unknown. We investigated plasma profile of urocortin in AMI patients and evaluated its long-term prognostic performance. Sixty-six AMI patients and 21 healthy subjects were included in this study. Blood s les for urocortin were collected on days 0 (onset), 1, 3 and 5 and at 3 and 6 months. Primary endpoint was mortality within 1 year of follow-up. Secondary endpoint was combined death and nonfatal adverse cardiac events (i.e. myocardial reinfarction, urgent revascularization or hospitalization due to heart failure) within 1 year. During follow-up at 1 year, 38 (57·6%) patients were alive without cardiac events, nine (13·6%) had nonfatal cardiac events and 17 (25·8%) died. Plasma urocortin in AMI patients were increased on days 0, 1, 3 and 5 (P<0·05 vs. control). The receiver-operating characteristic curve showed an area under curve (AUC) of day 0 urocortin to be 0·750 with 95% confidence interval (CI) of 0·619-0·881 (P=0·004), whereas AUC of NT-proBNP was 0·857 (95% CI, 0·722-0·992 P=0·003). Sensitivity values for predicting the mortality of urocortin NT-proBNP and a combined urocortin and NT-proBNP were 0·81 (95% CI, 0·54-0·95), 0·86 (95% CI, 0·42-0·99) and 1·0 (95% CI, 0·56-1·0), respectively. Plasma urocortin level is elevated in AMI patients for 5 days from onset. High plasma urocortin within 24 h after the onset is associated with increased mortality. Combined urocortin and NT-proBNP enhance prognostic performance in AMI patients.
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1016/J.HRTHM.2007.12.009
Abstract: Temporal variation in complex fractionated atrial electrograms (CFAEs) exists during atrial fibrillation (AF). This study sought to quantify the variation in CFAEs using a fractionation interval (FI) algorithm and to define the shortest optimal recording duration required to consistently characterize the magnitude of the fractionation. Twenty-seven patients undergoing AF mapping in the left atrium were studied. The FI and frequency analysis were performed at each mapped site for recording durations of 1 to 8 seconds. The magnitude of the fractionation was quantified by the FI algorithm, which calculated the mean interval between multiple, discrete deflections during AF. The results from each duration were statistically compared with the maximal-duration recording, as a standard. The FI values were compared with the dominant frequency values obtained from the associated frequency spectra. The FIs obtained from recording durations between 5 and 8 seconds had a smaller variation in the FI (P < .05) and, for those sites with a FI 5 seconds harbored higher dominant frequency values than those with shorter recording durations (8.1 +/- 2.5 Hz vs. 6.8 +/- 0.98 Hz, P < .05). The CFAE sites with continuous fractionation were located within the pulmonary veins and their ostia in 77% of patients with paroxysmal AF, and in only 29% of patients with nonparoxysmal AF (P or =5 seconds at each site to obtain a consistent fractionation. Sites with the shortest FIs consistently identified sites with the fastest electrogram activity throughout the entire left atrium and pulmonary veins.
Publisher: Elsevier BV
Date: 02-2007
Publisher: Ivyspring International Publisher
Date: 2020
DOI: 10.7150/IJMS.45795
Publisher: Wiley
Date: 24-04-2008
Publisher: Springer Science and Business Media LLC
Date: 03-08-2020
DOI: 10.1186/S12882-020-01990-8
Abstract: Cardiorenal syndrome (CRS), a serious condition with high morbidity and mortality, is characterized by the coexistence of cardiac abnormality and renal dysfunction. There is limited information about CRS in association thalassemia. This study aimed to investigate the prevalence of CRS in thalassemia patients and also associated risk factors. Thalassemia patients who attended the out-patient clinic of a tertiary care university hospital from October 2016 to September 2017 were enrolled onto this cross-sectional study. Clinical and laboratory findings from 2 consecutive visits, 3 months apart, were assessed. The criteria for diagnosis of CRS was based on a system proposed by Ronco and McCullough. Cardiac abnormalities are assessed by clinical presentation, establishment of acute or chronic heart failure using definitions from 2016 ESC guidelines or from structural abnormalities shown in an echocardiogram. Renal dysfunction was defined as chronic kidney disease according to the 2012 KDIGO guidelines. Out of 90 thalassemia patients, 25 (27.8%) had CRS. The multivariable analysis showed a significant association between CRS and extramedullary hematopoiesis (EMH) (odds ratio (OR) 20.55, p = 0.016) thalassemia type [β 0 /β E vs β 0 /β 0 thalassemia (OR 0.005, p = 0.002)] pulmonary hypertension (OR 178.1, p = 0.001) elevated serum NT-proBNP (OR 1.028, p = 0.022), and elevated 24-h urine magnesium (OR 1.913, p = 0.016). There was no association found between CRS and frequency of blood transfusion, serum ferritin, liver iron concentration, cardiac T2*, type of iron chelating agents, or urine neutrophil gelatinase-associated lipocalin level. CRS is relatively common in thalassemia patients. Its occurrence is associated with laboratory parameters which are easily measured in clinical practice.
Publisher: Wiley
Date: 13-04-2019
DOI: 10.1111/BCP.13903
Publisher: Wiley
Date: 31-03-2007
DOI: 10.1111/J.1540-8167.2007.00803.X
Abstract: The optimal recording technique of the electrogram voltage for detecting abnormal atrial tissue remains unclear. The aim of this study was to compare the impact of various recording techniques on the electrogram voltage after the delivery of ablation therapy in the human right atrium (RA). Noncontact mapping was performed in 27 patients with typical atrial flutter (mean age = 63 +/- 16, males = 20). Noncontact unipolar and bipolar electrograms were obtained before and after cavotricuspid isthmus (CTI) linear ablation. All unipolar electrograms were acquired with both wide-band filtering (0.5-300 Hz) and narrow-band filtering (32-300 Hz). The unipolar voltage measurements included both the peak-to-peak voltage and peak-negative voltage (PNV) for both filter settings. A comparison of the electrogram voltage along the ablation line before and after the ablation demonstrated a greater reduction in the unipolar PNV with wide-band filtering (70 +/- 24%) than in any of the other recording modalities (P = 0.03). It was the most sensitive and specific recording technique to predict conduction block (cut-off Value 0.35 mV sensitivity = 94.4% and specificity = 80%). A comparison of the electrogram voltage between the ablated atrial myocardium and nearby nonablated myocardium showed that the unipolar PNV with the wide-band filtering remained the most sensitive method to detect the acute ablative tissue injury, whereas the peak-to-peak bipolar voltage was the most specific method. The noncontact unipolar electrogram using the PNV with wide-band filter settings (0.5-300 Hz) provided the most sensitive recording technique for detecting acute ablative tissue injury.
Publisher: Wiley
Date: 18-10-2007
DOI: 10.1111/J.1540-8167.2007.00924.X
Abstract: Noncontact mapping (NCM) can record virtual unipolar electrograms (Egs) from multiple sites simultaneously therefore, it has the potential to perform simultaneous frequency mapping during atrial fibrillation (AF). The aim of this study was to validate the frequency spectra of the noncontact unipolar Egs in both atria. This study enrolled 12 patients (age = 61 +/- 16 years) with paroxysmal or persistent AF who underwent catheter ablation guided by NCM. Noncontact and contact unipolar Egs were recorded simultaneously. The cross-correlation of the Eg morphology, activation time difference of the time-domain signals, and resultant frequency spectra were compared via dominant frequency (DF) and magnitude-squared coherence (MSC). A total of 159 sites were analyzed during AF. The variables that independently predicted a higher correlation between the contact and noncontact electrogram morphology were a smaller activation timing difference P < 0.01), smaller distance of the mapping sites to the array center (P = 0.01), and higher atrial voltage (P = 0.03). However, the average MSC of the frequency band within the physiologic range of AF (2 to 15 Hz) was only affected by the activation timing difference (P = 0.002). The DF value between the contact and noncontact unipolar signals correlated well with each other throughout the right atria and left atria in 94% of the mapping sites (r = 0.87, P < 0.001). The accuracy of the noncontact unipolar Eg morphology decreased when the mapping sites harbored a smaller atrial voltage and longer distance to the array center. The DF difference between the contact and noncontact unipolar Eg was not affected by the distance to the array center.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2022
Publisher: Future Medicine Ltd
Date: 09-2012
DOI: 10.2217/EBO.11.284
Publisher: Springer Science and Business Media LLC
Date: 09-01-2020
DOI: 10.1186/S12872-019-01311-4
Abstract: Ischemic cardiomyopathy is a high-cost, resource-intensive public health burden that is associated with a 1-year mortality rate of about 16% in western population. Different in patient ethnicity and pattern of practice may impact the clinical outcome. We aim to determine 1-year mortality and to identify factors that significantly predicts 1-year mortality of Thai patients with ischemic cardiomyopathy. This prospective multicenter registry enrolled consecutive Thai patients that were diagnosed with ischemic cardiomyopathy at 9 institutions located across Thailand. Patients with left ventricular function 40% and one of the following criteria were included: 1) presence of epicardial coronary stenoses 75% in the left main or proximal left anterior descending artery or coronary angiography, and/or two major epicardial coronary stenoses 2) prior myocardial infarction 3) prior revascularization by coronary artery bypass graft or percutaneous coronary intervention or, 4) magnetic resonance imaging pattern compatible with ischemic cardiomyopathy. Baseline clinical characteristics, coronary and echocardiographic data were recorded. The 1-year clinical outcome was pre-specified. Four hundred and nineteen patients were enrolled. Thirty-nine patients (9.9%) had died at 1 year, with 27 experiencing cardiovascular death, and 12 experiencing non-cardiovascular death. A comparison between patients who were alive and patients who were dead at 1 year revealed lower baseline left ventricular ejection fraction (LVEF) (26.7 ± 7.6% vs 30.2 ± 7.8% p = 0.021), higher left ventricular end-diastolic volume (LVEDV) (185.8 ± 73.2 ml vs 155.6 ± 64.2 ml p = 0.014), shorter mitral valve deceleration time (142.9 ± 57.5 ml vs 182.4 ± 85.7 ml p = 0.041), and lower use of statins (94.7% vs 99.7% p = 0.029) among deceased patients. Patients receiving guideline-recommended β-blockers had lower mortality than patients receiving non-guideline-recommended β-blockers (8.1% vs 18.2% p = 0.05). The results of this study revealed a 9.9% 1-year mortality rate among Thai ischemic cardiomyopathy patients. Doppler echocardiographic parameters significantly associated with 1-year mortality were LVEF, LVEDV, mitral E velocity, and mitral valve deceleration time. The use of non-guideline-recommended β-blockers rather than guideline recommended β-blockers were associated with increased with 1-year mortality. Guidelines recommended β-blockers should be preferred. Thai Clinical Trials Registry TCTR20190722002. Registered 22 July 2019. “Retrospectively registered”.
Publisher: Springer Science and Business Media LLC
Date: 24-10-2019
DOI: 10.1007/S00018-019-03340-W
Abstract: Breast cancer is the most frequently occurring cancer among women worldwide. Human epidermal growth factor receptor 2 (HER2 or ErbB2) is overexpressed in between 20 and 25% of invasive breast cancers and is associated with poor prognosis. Trastuzumab, an anti-ErbB2 monoclonal antibody, reduces cancer recurrence and mortality in HER2-positive breast cancer patients, but unexpectedly induces cardiac dysfunction, especially when used in combination with anthracycline-based chemotherapy. Novel approved ErbB2-targeting drugs, including lapatinib, pertuzumab, and trastuzumab-emtansine, also potentially cause cardiotoxicity, although early clinical studies demonstrate their cardiac safety profile. Unfortunately, the mechanism involved in causing the cardiotoxicity is still not completely understood. In addition, the use of preventive interventions against trastuzumab-induced cardiac dysfunction, including angiotensin-converting enzyme inhibitors and beta-blockers, remain controversial. Thus, this review aims to summarize and discuss the evidence currently available from in vitro, in vivo, and clinical studies regarding the mechanism and potential interventions associated with the cardiotoxicity of ErbB2-targeted drugs.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.AMJCARD.2012.02.043
Abstract: It is well established that myocardial infarction (MI) associated with coronary artery bypass grafting (CABG) predicts a poor outcome. Nevertheless, cardioprotective therapies to limit myocardial injury after CABG are lacking. Previous studies have shown that curcuminoids decrease proinflammatory cytokines during cardiopulmonary bypass surgery and decrease the occurrence of cardiomyocytic apoptosis after cardiac ischemia/reperfusion injury in animal models. We aimed to evaluate whether curcuminoids prevent MI after CABG compared to placebo. The 121 consecutive patients undergoing CABG were randomly allocated to receive placebo or curcuminoids 4 g/day beginning 3 days before the scheduled surgery and continued until 5 days after surgery. The primary end point was incidence of in-hospital MI. The secondary end point was the effect of curcuminoids on C-reactive protein, plasma malondialdehyde, and N-terminal pro-B-type natriuretic peptide levels. Baseline characteristics were comparable between the curcuminoid and placebo groups. Mean age was 61 ± 9 years. On-pump CABG procedures were performed in 51.2% of patients. Incidence of in-hospital MI was decreased from 30.0% in the placebo group to 13.1% in the curcuminoid group (adjusted hazard ratio 0.35, 0.13 to 0.95, p = 0.038). Postoperative C-reactive protein, malondialdehyde, and N-terminal pro-B-type natriuretic peptide levels were also lower in the curcuminoid than in the placebo group. In conclusion, we demonstrated that curcuminoids significantly decreased MI associated with CABG. The antioxidant and anti-inflammatory effects of curcuminoids may account for their cardioprotective effects shown in this study.
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.IJCARD.2009.01.073
Abstract: Curcumin (diferuloylmethane) is a polyphenol responsible for the yellow color of the curry spice turmeric. It has been used in a variety of diseases in traditional medicine. Modern scientific research has demonstrated its anti-inflammatory, anti-oxidant, anti-carcinogenic, anti-thrombotic, and cardiovascular protective effects. In this review, we focused mainly on the effects of curcumin on the cardiovascular system. The antioxidant effects of curcumin have been shown to attenuate adriamycin-induced cardiotoxicity and may prevent diabetic cardiovascular complications. The anti-thrombotic, anti-proliferative, and anti-inflammatory effects of curcumin and the effect of curcumin in decreasing the serum cholesterol level may protect against the pathological changes occurring with atherosclerosis. The p300-HAT inhibitory effects of curcumin have been demonstrated to ameliorate the development of cardiac hypertrophy and heart failure in animal models. The inflammatory effects of curcumin may have the possibility of preventing atrial arrhythmias and the possible effect of curcumin for correcting the Ca(2+) homeostasis may play a role in the prevention of some ventricular arrhythmias. The preclinical studies from animal to clinical data in human are discussed.
Publisher: MDPI AG
Date: 07-10-2022
DOI: 10.3390/HEALTHCARE10101959
Abstract: In iduals with metabolic risks are at high risk of cognitive impairment. We aimed to investigate whether the Thai Cardiovascular Risk (TCVR) score can be used to predict mild cognitive impairment (MCI) in Thai adults with metabolic risks. The study was conducted using secondary data of patients with metabolic risks from Maharaj Nakorn Chiang Mai Hospital. MCI was indicated by an MoCA score of less than 25. Six different TCVR models were used with various combinations of ten different variables for predicting the risk of MCI. The area under the receiver operator characteristic curve (AuROC) and Hosmer–Lemeshow goodness of fit tests were used for determining discriminative performance and model calibration. The sensitivity of the discriminative performance was further evaluated by stratifying by age and gender. From a total of 421 participants, 348 participants had MCI. All six TCVR models showed a similar AuROC, varying between 0.58 and 0.61. The anthropometric-based model showed the best risk prediction performance in the older age group (AuROC 0.69). The laboratory-based model provided the highest discriminative performance for the younger age group (AuROC 0.60). There is potential for the development of an MCI risk model based on values from routine cardiovascular risk assessments among patients with metabolic risks.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.IJCARD.2016.09.044
Abstract: It has been shown that I This study was a prospective randomized, double blind, placebo-controlled study. Ivabradine, 5mg twice a day (n=21), or placebo (n=11) was administered for 1month to adult patients with non-paroxysmal AF, in addition to standard therapy. The primary end point was the change in mean ventricular rate between baseline and 1month, as assessed by 24-hour Holter. The baseline characteristics did not differ between ivabradine and placebo groups (mean age was 59.7±13.3years, male 62.5%). Mean 24-hour ventricular rate at baseline was comparable between 2 groups. We found that ivabradine significantly decreased mean ventricular rate from 86.0±10.9beats/min to 79.2±9.6beats/min (p<0.001). In contrast, no significant change in ventricular rate was observed in placebo group (84.3±11.2 vs. 82.9±9.9beats/min, p=0.469). The effect of ivabradine on rate reduction was significantly greater than placebo (6.9±6.3 vs. 1.4±6.0beats/min, p=0.024). No drug-related adverse effects were observed in both groups. We demonstrated that ivabradine significantly decreased ventricular rate during AF compared to placebo. Therefore, ivabradine can be a potential treatment to improve ventricular control in patients with non-paroxysmal AF. Due to the small s le size, larger studies are needed to confirm this effect of ivabradine.
Publisher: Oxford University Press (OUP)
Date: 25-07-2022
Publisher: Wiley
Date: 25-07-2006
DOI: 10.1111/J.1540-8167.2006.00549.X
Abstract: The left atrium (LA) ablation in different regions, including LA appendage (LAA), LA roof, and LA septum, has recently been proposed to improve the success rate of treating patients with atrial fibrillation (AF). The purpose of this study was to investigate the anatomy of LAA, LA roof, and LA septum, using computed tomography (CT). Multidetector CT scan was used to depict the LA in 47 patients with drug-refractory paroxysmal AF (39 males, age = 50 +/- 12 years) and 49 control subjects (34 males, age = 54 +/- 11 years). The area of LAA orifice, neck, and the length of roof line were greater in AF group than in control subjects. Three types of LAA locations and two types of LAA ridges were observed. Higher incidence of inferior LAA was noted in AF patients. The different morphologies of LA roof were described. Roof pouches were revealed in 15% of AF and 14% of controls. Moreover, we found septal ridge in 32% of AF and 23% of controls. Considerable variations of LAA and LA roof morphologies were demonstrated. Peculiar structures, including roof pouches and septal ridges, were delineated by CT imaging. These findings were important for determining the strategy of AF ablation and avoiding the procedure-related complications.
Publisher: Wiley
Date: 29-04-2019
DOI: 10.1002/EJHF.1467
Publisher: American Physiological Society
Date: 10-2009
Abstract: The influence of circulating urotensin II (UII) on liver disease and portal hypertension is unknown. We aimed to evaluate whether UII executes a pathogenetic role in the development of hepatic fibrosis and portal hypertension. UII was administered by continuous infusion over 4 wk in 20 healthy rats ided into three treatment groups, controls (saline, n = 7), low dose (UII, 1 nmol·kg −1 ·h −1 , n = 8), and high dose (UII, 3 nmol·kg −1 ·h −1 , n = 5). Hemodynamic parameters and morphometric quantification of fibrosis were assessed, and profibrotic cytokines and fibrosis markers were assayed in hepatic tissue. UII induced a significant dose-dependent increase in portal venous pressure (5.8 ± 0.4, 6.4 ± 0.3, and 7.6 ± 0.7, respectively, P = 0.03). High-dose UII infusion was associated with an increase in hepatic transcript for transforming growth factor-β ( P 0.05) and platelet-derived growth factor-β ( P = 0.06). Liver tissue hydroxyproline was elevated in the high-dose group ( P 0.05). No systemic hemodynamic alterations were noted. We concluded that UII infusion elevates portal pressure and induces hepatic fibrosis in normal rats. This response may be mediated via induction of fibrogenic cytokines. These findings have pathophysiological implications in human liver disease where increased plasma UII levels have been observed.
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.HRTHM.2007.06.023
Abstract: Aging and pulmonary veins (PVs) play a critical role in the pathophysiology of atrial fibrillation. Abnormal Ca(2+) regulation and ryanodine receptors are known to contribute to PV arrhythmogenesis. The purpose of this study was to investigate whether aging alters PV electrophysiology, Ca(2+) regulation proteins, and responses to rapamycin, FK-506, ryanodine, and ouabain. Conventional microelectrodes were used to record action potential and contractility in isolated PV tissue s les in 15 young (age 3 months) and 16 aged (age 3 years) rabbits before and after drug administration. Expression of sarcoplasmic reticulum Ca(2+) ATPase (SERCA2a), ryanodine receptor, and Na(+)/Ca(2+) exchanger was evaluated by western blot. Aged PVs had larger litude of delayed afterdepolarizations, greater depolarized resting membrane potential, longer action potential duration, and higher incidence of action potential alternans and contractile alternans with increased expression of Na(+)/Ca(2+) exchanger and ryanodine receptor and decreased expression of SERCA2a. Rapamycin (1,10,100 nM), FK-506 (0.01, 0.1, 1 microM), ryanodine (0.1, 1 microM), and ouabain (0.1, 1 microM) concentration-dependently increased PV spontaneous rates and the incidence of delayed afterdepolarizations in young and aged PVs. Compared with results in young PVs, rapamycin and FK-506 in aged PVs increased PV spontaneous rates to a greater extent and exhibited a larger delayed afterdepolarization litude. In PVs without spontaneous activity, rapamycin and FK-506 induced spontaneous activity only in aged PVs, but ryanodine and ouabain induced spontaneous activity in both young and aged PVs. Aging increases PV arrhythmogenesis via abnormal Ca(2+) regulation. These findings support the concept that ryanodine receptor dysfunction may result in high PV arrhythmogenesis and aging-related arrhythmogenic vulnerability.
Publisher: Wiley
Date: 06-2009
DOI: 10.1111/J.1540-8167.2008.01393.X
Abstract: The efficacy of ablation of complex fractionated atrial electrograms (CFEs) in the single ablation procedure for nonparoxysmal atrial fibrillation (AF) patients is not well demonstrated. The aim of this study was to compare the ablation strategies of pulmonary vein isolation (PVI) plus linear ablation with and without additional ablation ofCFEs in these patients. Consecutive 60 patients (49 +/- 11 years old, 50 male, 10 female) with nonparoxysmal AF underwent catheter ablation guided by a NavX mapping system. A stepwise approach included a circumferential PVI and left atrial (LA) linear ablation followed by either the additional ablation of continuous CFEs in the LA/coronary sinus (the first 30 patients) or not (the second 30 patients), detected by an automatic algorithm. There was no difference in the baseline characteristics between the two groups. Complete PVI eliminated some continuous CFEs and altered the distribution of CFEs. Following PVI and linear ablation,the remaining continuous CFEs were identified in 7.9 +/-10% mapping sites of the LA and CS, and were ablated successfully with a procedural AF termination rate of 53%. With a follow-up of 19 +/-11 months, a Kaplan-Meier analysis showed that the patients with additional ablation of the CFEs had a higher rate of sinus rhythm maintenance. Multivariate analysis showed the single procedure success could be predicted by the procedural AF termination and the additional ablation of continuous CFEs in the LA/CS. Ablation of continuous CFEs after PVI and LA linear ablation had a better long-term efficacy based on the results of single-ablation procedure.
Publisher: Wiley
Date: 26-04-2020
DOI: 10.1111/JCMM.15305
Publisher: Informa UK Limited
Date: 03-2009
Abstract: Atrial fibrillation (AF) and heart failure are the two modern epidemics of cardiovascular disease. They are commonly encountered together and either condition predisposes to the other. Patients with both AF and heart failure carry a poor prognosis therefore, the management of this group of patients should be addressed aggressively. In the context of AF management in patients with heart failure, the pharmacologic rhythm control strategy is not superior to the rate control strategy. Due to the adverse effects of anti-arrhythmic agents, the rate control should be considered as a primary approach. The long-term data regarding the efficacy and safety of catheter-based ablation therapy in the patients with heart failure are limited hence, the catheter ablation of AF should be reserved for the patients for whom the drug therapy is inadequate or undesirable. Ultimately, the patient's symptoms and the tolerance for the particular treatment should be taken into account for the management of AF in patients with heart failure.
Publisher: Informa UK Limited
Date: 03-2016
DOI: 10.2147/TCRM.S96016
Publisher: Wiley
Date: 21-09-2007
Publisher: Wiley
Date: 11-2006
DOI: 10.1111/J.1540-8167.2006.00647.X
Abstract: Radiofrequency ablation (RFA) of typical AFL is sometimes difficult because of the poor electroanatomic approach to the cavotricuspid isthmus (CTI). The aim of this study was to correlate the anatomy of the CTI between contact mapping (NavX) and right atrial angiography (RAG), and to investigate the impact of the electroanatomic characteristics of the CTI on the RFA of typical atrial flutter (AFL). One hundred patients with typical AFL undergoing RFA were studied. The image-guided group consisted of 50 consecutive patients with the guidance of NavX. NavX geometry and RAG were performed to investigate the morphology of the CTI. The bipolar voltages of the CTI were collected during sinus rhythm by a NavX. The control group consisted of 50 consecutive patients with the guidance of conventional fluoroscopy. There was a good correlation between the angiography and NavX for the anatomy of the CTI. The pouch type had a longer length of CTI than the flat type (33.4 +/- 5.0 vs 22.6 +/- 8.4 mm, P < 0.0001) and deeper depth than the concave type (6.5 +/- 2.2 vs 3.7 +/- 0.8 mm, P < 0.0001) on the angiography. The pouch-type CTI had a longer ablation time and larger pulses of RFA than the other two types. The control group had a longer ablation time, fluoroscopy time, and larger pulses of RFA than image-guided group. The 3-D mapping system provided a good reconstruction of CTI, which may help in the RFA in patients with a complex anatomy of the CTI.
Publisher: MDPI AG
Date: 26-01-2021
Abstract: Despite advances in our knowledge and attempts to improve therapies, β-thalassemia remains a prevalent disorder with increased risk for the development of cardiomyopathy. Using an untargeted discovery-based lipidomic workflow, we uncovered that transfusion-dependent thalassemia (TDT) patients had a unique circulating lipidomic signature consisting of 387 lipid features, allowing their significant discrimination from healthy controls (Q-value 0.01). In particular, TDT patients had elevated triacylglycerols and long-chain acylcarnitines, albeit lower ether phospholipids or plasmalogens, sphingomyelins, and cholesterol esters, reminiscent of that previously characterized in cardiometabolic diseases resulting from mitochondrial and peroxisomal dysfunction. Discriminating lipid (sub)classes correlated differentially with clinical parameters, reflecting blood (ether phospholipids) and iron (cholesterol ester) status or heart function (triacylglycerols). We also tested 15 potential serum biomarkers related to cardiometabolic disease and found that both lipocalin-2 and, for the first time, endocan-1 levels were significantly elevated in TDT patients and showed a strong correlation with blood parameters and three ether diacylglycerophosphatidylcholine species. In conclusion, this study identifies new characteristics of TDT patients which may have relevance in developing biomarkers and therapeutics.
Publisher: IOP Publishing
Date: 30-06-2008
Publisher: Geological Society of America
Date: 2008
DOI: 10.1130/G25294A.1
Publisher: Oxford University Press (OUP)
Date: 10-06-2017
Abstract: The long-term outcomes of radiofrequency catheter ablation (RFCA) in patients with Wolff-Parkinson-White syndrome (WPW) remain unclear. We investigated the impact of RFCA on the long-term risk of coronary events and mortality in WPW patients. We conducted a prospective cohort study utilizing the Taiwan National Health Insurance Research Database. Between 2000 and 2003, WPW patients with no prior coronary artery disease (CAD) history, aged over 18 years, who underwent RFCA were identified. WPW patients without RFCA were matched with propensity-score 1:4 matching for confounding coronary risk factors. The study outcomes were total mortality and coronary events. A total of 1524 matched non-ablated WPW patients (Group 1) and 381 ablated WPW patients (Group 2) were included. After a mean follow-up of 9.6 ± 2.9 and 10.3 ± 1.9 years, respectively, ablation group demonstrated a lower incidence of mortality compared with non-ablation group (17 vs. 26/1000 person-years, P < 0.001 adjusted HR: 0.57, 95% CI: 0.44-0.7). However, ablation group had a higher incidence of coronary events compared with non-ablation group (47 vs. 82/1000 person-years, P < 0.001 adjusted HR: 1.69, 95% CI: 1.4-2.04). The ablation-treated WPW patients had lower risk of total mortality but higher risk of coronary events than non-ablated WPW patients during the long-term follow-up. Coronary artery injury produced by RFCA may account for the increased risk of coronary events. Therefore, the ablation strategies to avoid coronary artery injury should be implemented.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.IJCARD.2019.01.107
Abstract: Cardiac troponin is a sensitive and specific biomarker for acute myocardial injury and has been used in the diagnosis of acute coronary syndromes, and has emerged as a tool for identifying high risk in iduals for primary preventive therapy. Recent evidence has emerged indicating that high-sensitivity cardiac troponin assays, which allow robust detection of very low troponin concentrations, could detect subclinical injury in asymptomatic patients. On 24 March 2018, a group of cardiologists from the Asia Pacific region convened to review the data and discuss the potential utility of high-sensitivity troponin I (hsTnI) in the risk assessment of cardiovascular disease in the general population. The group recognized the immense burden of cardiovascular disease in the Asia-Pacific region, and the limitations of current risk stratification strategies. Data demonstrates that cardiac biomarkers like hsTnI could improve risk stratification, and thresholds for hsTnI in cardiovascular disease risk classification have been developed in Caucasian populations but not validated in Asian populations. There is an urgent need to improve cardiovascular risk assessment in the Asia Pacific general population, validate the Asian threshold of high risk and prove the utility of targeting these high-risk in iduals for primary preventive strategies.
Publisher: Future Medicine Ltd
Date: 05-2012
DOI: 10.2217/FCA.12.1
Publisher: Baishideng Publishing Group Inc.
Date: 2011
Publisher: Frontiers Media SA
Date: 22-05-2019
Publisher: Springer Science and Business Media LLC
Date: 18-07-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-02-2019
Abstract: Using data from the GARFIELD ‐ AF (Global Anticoagulant Registry in the FIELD –Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( CKD ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( AF ). GARFIELD ‐ AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe CKD , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia) 10.9% (n=3613) had moderate‐to‐severe CKD , 16.9% (n=5595) mild CKD , and 72.1% (n=23 816) no CKD . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA 2 DS 2 ‐ VAS c score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe CKD were independent risk factors for all‐cause mortality. Moderate‐to‐severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe CKD on mortality was significantly greater in patients from Asia than the rest of the world ( P =0.001). In GARFIELD ‐ AF , moderate‐to‐severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe CKD on mortality was even greater in patients from Asia than the rest of the world. URL : www.clinicaltrials.gov . Unique identifier: NCT 01090362.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.IJCARD.2016.02.146
Abstract: Recent studies have suggested that dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) may be associated with increased risk of heart failure (HF), but evidence was inconclusive. We aimed to determine the effects of DPP-4 inhibitors on risk of HF. An extensive search in PubMed, EMBASE, CINAHL, IPA, Cochrane, ClinicalTrial.gov and the manufacturers' websites for randomized controlled trials (RCT) of all DPP-4 inhibitors was performed up to June 2015. All RCTs comparing DPP-4 inhibitors to any comparators with minimum follow-up of 12 weeks were included. The primary outcome was the occurrence of HF. A total of 54 studies with 74,737 participants were included for analysis. Overall, DPP-4 inhibitors were not associated with an increased risk of HF compared to comparators (relative risk (RR) 1.106 95% CI 0.995-1.228 p=0.062). When analyzed in idually, saxagliptin was significantly associated with the increased risk of HF (RR 1.215 95% CI, 1.028-1.437 p=0.022), while others were not. Age ≥ 6 5 years, diabetes duration of ≥ 10 years and BMI ≥ 30 kg/m(2) were associated with an increased risk of HF among patients using saxagliptin. Our meta-analysis suggested a differential effect of each DPP-4 inhibitor on the risk of HF. Use of saxagliptin significantly increases the risk of HF by 21% especially among patients with high CV risk while no signals were detected with other agents. This information should be taken into consideration when prescribing DDP-4 inhibitors.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.JACC.2007.05.026
Abstract: We sought to investigate the imaging of the left atrial (LA) muscular bundle and the relationship between the bundle and inducibility of tachyarrhythmia after pulmonary vein isolation (PVI). Noninducibility is used as a clinical end point of atrial substrate ablation after PVI. However, little is known about the role of the LA muscular bundles in tachyarrhythmia after PVI. Forty-three consecutive patients with paroxysmal atrial fibrillation who underwent catheter ablation were included. Bi-atrial isochronal mapping was performed with the NavX system (St. Jude Medical Inc., St. Paul, Minnesota) during sinus rhythm. After 4 PVI, inducible organized LA flutter with or without transforming to atrial fibrillation (AF) (LA flutter/AF) was ablated with additional lines at the roof and/or mitral isthmus. The existence of bilateral muscular bundles was an independent predictor of LA flutter/AF after PVI (p = 0.02). Patients with LA flutter/AF after PVI had a greater index of the double potentials (5.4 +/- 3.4% vs. 2.8 +/- 1.8%, p = 0.006) and interpotential interval (33 +/- 5 ms vs. 29 +/- 4 ms, p = 0.02) than without LA flutter/AF. The muscular bundles were identified in 28% patients using 16-slice multidetector computed tomography, which were identical to the isochrone map. Patients with noninducible LA flutter/AF after PVI plus the additional linear ablation had a lower recurrence rate as compared with the patients without it (19% vs. 75%, p = 0.02). Left atrial muscular bundles may provide a conduction block line and barrier, which is important for the formation of LA flutter/AF after PVI. The noninducibility of LA flutter/AF achieved after additional linear ablation may contribute to a better outcome in RF ablation of paroxysmal atrial fibrillation.
Publisher: Wiley
Date: 30-07-2007
DOI: 10.1111/J.1540-8167.2007.00915.X
Abstract: Atrio-bronchial fistula (ABF) can be a rare but potentially lethal complication following the catheter ablation of atrial fibrillation (AF). Understanding the extent of the contact between the bronchial tree and pulmonary veins (PVs) is critical to avoid this complication. We investigated the anatomic relationship between the four PVs and bronchial tree using multi-detector computed tomography (MDCT) images. Seventy patients with drug refractory AF were included. They underwent 16-slice MDCT before the ablation. The spatial relationship between the bronchus and PVs was demonstrated by the multi-planar images. The bronchus was in direct contact with four PVs in the vast majority of patients. The mean distances between the bronchus and the ostia of right superior, left superior, right inferior, and left inferior PV were 7.1 +/- 5.5, 3.5 +/- 4.8, 12.3 +/- 5.6, and 17.9 +/- 6.8 mm, respectively. Patients were categorized into two groups: Group I: proximal contact ( 5 mm from the PV ostium). For the right superior pulmonary vein (RSPV), the Group I patients were associated with thinner connective tissue between them (P = 0.001), a larger RSPV (17.2 +/- 2.2 vs 15.5 +/- 2.1 mm, P < 0.001), and right inferior pulmonary vein (RIPV) diameter (15.9 +/- 1.9 vs 14.6 +/- 1.6 mm, P < 0.01). For the left superior pulmonary vein (LSPV), the Group I patients were associated with an older age (P = 0.02). Isolation of the superior PVs may carry the potential risk of bronchial damage. The clinical or anatomic characteristics associated with the proximal contact between the bronchi and superior PVs can provide useful information to prevent this complication.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.BCMD.2012.12.002
Abstract: Cardiac damage remains a major cause of mortality among patients with thalassemia major. The detection of a lower cardiac magnetic resonance T2* (CMR-T2*) signal has been suggested as a powerful predictor of the subsequent development of heart failure. However, the lack of worldwide availability of CMR-T2* facilities prevents its widespread use for follow-up evaluations of cardiac function in thalassemia major patients, warranting the need to assess the utility of other possible procedures. In this setting, the determination of left ventricular ejection fraction (LVEF) offers an accurate and reproducible method for heart function evaluation. These findings suggest a reduction in LVEF≥7%, over time, determined by 2-D echocardiography, may be considered a strong predictive tool for the detection of thalassemia major patients with increased risk of cardiac death. The reduction of LVEF≥7% had higher (84.76%) predictive value. Finally, Kaplan-Meier survival curves of thalassemia major patients with LVEF≥7% showed a statistically significant decreased probability of survival for heart disease (p=0.0022). However, because of limitations related to the study design, such findings should be confirmed in a large long-term prospective clinical trial.
Publisher: Wiley
Date: 09-09-2020
DOI: 10.1111/BCP.14535
Publisher: Wiley
Date: 14-05-2007
DOI: 10.1111/J.1540-8167.2007.00848.X
Abstract: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV-left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 +/- 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 +/- 11 years old, 24 males) who underwent circumferential ablation with PV-LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV-LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV-AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20% vs. 0%, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Circumferential ablation of AF with PV-LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure.
Publisher: Elsevier BV
Date: 05-2008
Publisher: Oxford University Press (OUP)
Date: 02-02-2011
Abstract: Influenza infection has been shown to accentuate the progression of atherosclerosis and precipitate the occurrence of acute coronary syndrome (ACS). However, the protective effects of the influenza vaccine on cardiovascular events are still inconclusive. The study was a prospective randomized open with blinded endpoint (PROBE) study. The 439 patients who had been admitted due to ACS within 8 weeks were enrolled and randomly allocated to receive inactivated influenza vaccine in the vaccine group and no treatment in the control group. All patients were treated with the standard therapy including revascularization according to primary cardiologists. The primary endpoint, which was the combined major cardiovascular events, including death, hospitalization from ACS, hospitalization from heart failure, and hospitalization from stroke, occurred less frequently in the vaccine group than the control group [9.5 vs. 19.3%, unadjusted HR 0.70 (0.57-0.86), P = 0.004]. There was no significant difference in the incidence of cardiovascular death between the vaccine and control groups [2.3 vs. 5.5%, unadjusted HR 0.39 (0.14-1.12), P = 0.088]. The influenza vaccine reduced major cardiovascular events in patients with ACS. Therefore, it should be encouraged as a secondary prevention in this group of patients.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.IJCARD.2016.07.256
Abstract: A gap in the knowledge on the status of heart failure (HF) in Asia versus other regions led to the creation of a working group of Asian experts from 9 countries or regions (Hong Kong, Indonesia, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam). Each expert sought the best available data from local publications, registries, or clinical practice. The prevalence of HF in Asia was generally similar to global values (1% to 3%), but with some outliers. There were substantial variations in healthcare spending, and the average cost of HF hospitalization varied from 813 US$ in Indonesia to nearly 9000 US$ in South Korea. Comorbidities were frequent, particularly hypertension, diabetes mellitus, and dyslipidemia. Modifiable risk factors such as smoking were alarmingly common in some countries. Asian HF patients spent between 5 and 12.5days in hospital, and 3% to 15% were readmitted for HF by 30days. The pharmacological treatment of Asian patients generally followed international guidelines, including renin-angiotensin-aldosterone system inhibitors (61% to 90%), diuretics (76% to 99%), beta-blockers (32% to 78%), and digoxin (19% to 53%), with some room for improvement in terms of life-saving therapies. Our review supports implementation of a more comprehensive and organized approach to HF care in Asia.
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.HRTHM.2008.11.013
Abstract: Termination of atrial fibrillation (AF) can be achieved by catheter ablation. It has been used as one of the procedural endpoints for AF ablation. The purpose of this study was to investigate the factors that predict AF termination and the association with long-term outcomes. Eighty-five consecutive AF patients (33 paroxysmal, 52 nonparoxysmal) underwent three-dimensional mapping and catheter ablation. A stepwise ablation approach included circumferential pulmonary vein (PV) isolation and left atrial (LA) linear ablation, followed by LA and right atrial (RA) electrogram-based (complex fractionated atrial electrogram) ablation. Clinical and electrophysiologic characteristics were assessed to evaluate the predictors of acute AF termination. In univariate analysis, a diagnosis of paroxysmal AF, shorter AF history, absence of history of heart failure, smaller LA diameter, longer postablation coronary sinus cycle length, lower LA and RA mean dominant frequencies, lower RA max dominant frequency, and higher LA voltage were related to acute termination of AF during ablation. Multivariate analysis showed that smaller LA diameter and lower preablation mean RA dominant frequency were independent predictors of AF termination. Multivariate analysis also showed that larger LA diameter and the presence of RA non-PV ectopy during the index procedure could predict late recurrence during long-term (13 +/- 8 months) follow-up. LA size and RA non-PV drivers are important for acute termination of AF and for long-term success. Careful selection of patients, extensive RA mapping, and LA ablation may enhance long-term ablation efficacy.
Publisher: Wiley
Date: 19-12-2006
DOI: 10.1111/J.1540-8167.2007.00719.X
Abstract: Atrial substrate properties have been demonstrated to be related to atrial arrhythmias. This study investigated whether the atrial substrate exhibits progressive remodeling in patients with recurrence of atrial fibrillation (AF) after catheter ablation. Fifteen consecutive AF patients (52 +/- 12 years old, 12 males) underwent the same mapping technique (NavX, St. Jude Medical, Minnetonka, MN, USA) and same ablation technique for primary AF and recurrence of AF (170 +/- 66 days after the first procedure). The bipolar mean peak-to-peak voltage (PPV) of the global left atrium during sinus rhythm significantly decreased in the second procedure (2.25 +/- 0.62 vs. 1.79 +/- 0.60 mV, P = 0.008). Also, the percentage of the surface area of the low voltage zone (LVZ less than 0.5 mV) in the left atrium increased from 6 +/- 4% to 13 +/- 6% (P = 0.001) in the second procedure. There was no significant change in the right atrial bipolar mean PPV or surface area of the LVZ in the second procedure. Atrial substrate remodeling with a progressive decrease in the left atrial voltage was demonstrated in patients with recurrent AF.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/4097471
Abstract: Introduction . The prognosis of acute coronary syndrome (ACS) patients has been improved with several treatments such as antithrombotics, beta-blockers, and angiotensin-converting enzyme inhibitors (ACEI) as well as coronary revascularization. Influenza vaccination has been shown to reduce adverse outcomes in ACS, but no information exists regarding the interaction of other treatments. Methods . This study included 439 ACS patients from Phrommintikul et al. A single dose of inactivated influenza vaccine was given by intramuscular injection in the vaccination group. The cardiovascular outcomes were described as major cardiovascular events (MACEs) which included mortality, hospitalization due to ACS, and hospitalization due to heart failure (HF). The stratified and multivariable Cox’s regression analysis was performed. Results . The stratified Cox’s analysis by influenza vaccination for each cardiovascular outcome and discrimination of hazard ratios showed that beta-blockers had an interaction with influenza vaccination. Moreover, the multivariable hazard ratios disclosed that influenza vaccine is associated with a significant reduction of hospitalization due to HF in patients who received beta-blockers (HR = 0.05, 95% CI = 0.004–0.71, P = 0.027 ), after being adjusted for prognostic indicators (sex, dyslipidemia, serum creatinine, and left ventricular ejection fraction). Conclusions . The influenza vaccine was shown to significantly modify the effect of beta-blockers in ACS patients and to reduce the hospitalization due to HF. However, further study of a larger population and benefits to HF patients should be investigated.
Publisher: Springer Science and Business Media LLC
Date: 18-08-2023
Publisher: Springer Science and Business Media LLC
Date: 25-08-2018
Publisher: MDPI AG
Date: 10-02-2023
Abstract: We present a case for significantly enhancing the utility and efficiency of the ngEHT by incorporating an additional 86 GHz observing band. In contrast to 230 or 345 GHz, weather conditions at the ngEHT sites are reliably good enough for 86 GHz to enable year-round observations. Multi-frequency imaging that incorporates 86 GHz observations would sufficiently augment the (u,v) coverage at 230 and 345 GHz to permit detection of the M87 jet structure without requiring EHT stations to join the array. The general calibration and sensitivity of the ngEHT would also be enhanced by leveraging frequency phase transfer techniques, whereby simultaneous observations at 86 GHz and higher-frequency bands have the potential to increase the effective coherence times from a few seconds to tens of minutes. When observation at the higher frequencies is not possible, there are opportunities for standalone 86 GHz science, such as studies of black hole jets and spectral lines. Finally, the addition of 86 GHz capabilities to the ngEHT would enable it to integrate into a community of other VLBI facilities—such as the GMVA and ngVLA—that are expected to operate at 86 GHz but not at the higher ngEHT observing frequencies.
Publisher: Medical Association of Thailand
Date: 15-10-2020
DOI: 10.35755/JMEDASSOCTHAI.2020.10.11529
Abstract: Background: A substantial number of patients with non-valvular atrial fibrillation (NVAF) and a CHA₂DS₂-VASc score of 0 (i.e., low-risk group) use oral anticoagulants (OACs). Objective: To investigate the rate and reasons for OAC use in Thai patients with NVAF and having a CHA₂DS₂-VASc score of 0. Materials and Methods: A nationwide observational multicenter registry of patients with NVAF was set up in Thailand. The patients’ demographic and clinical data were recorded on a case record form and then entered into a web-based data collection and management system. Results: One hundred seventy-six patients with NVAF and a CHA₂DS₂-VASc score of 0 were included. The average age was 53.9±8.2 years old, and all patients were male. Forty-six (26.1%) of the patients received OACs. NVAF patients receiving OACs had a longer duration of AF, more persistent and permanent AF, and mild left ventricular dysfunction. NVAF patients not receiving OACs were significantly more likely to be taking antiplatelet drugs. The reasons for using OACs in patients with a CHA₂DS₂-VASc score of 0 included thrombus in the left atrial appendage, post-AF ablation, planned cardioversion, hypertrophic cardiomyopathy, hyperthyroidism, and endomyocardial fibrosis. Physicians or patients preferred OAC use despite having a CHA₂DS₂-VASc score of 0 in 24 patients (52.2%). The use of OACs did not decrease clinical events, but it increased the bleeding risk. Conclusion: Among Thai NVAF patients with CHA₂DS₂-VASc score of 0, OAC was used in 26.1%. Some stroke risk factors were identified but were not included in the current risk scoring tool. Keywords: Oral anticoagulant, Outcomes, Non-valvular atrial fibrillation, CHA₂DS₂-VASc score, Thailand
Publisher: Public Library of Science (PLoS)
Date: 13-10-2016
Publisher: Springer Science and Business Media LLC
Date: 08-03-2018
DOI: 10.1007/S00784-018-2402-5
Abstract: The present study is to investigate the salivary gland function of metabolic syndrome (MetS) patients, as indicated by salivary flow rate, amylase activity, and salivary oxidative stress, by measuring MDA level. One hundred and eighty-one MetS patients from Maharaj Nakorn Chiang Mai Hospital were enrolled onto this study. The metabolic parameters of each patient were collected and evaluated. Unstimulated saliva was also collected for 5 min. Salivary gland functions, including salivary flow rate, amylase activity, and salivary MDA levels, were investigated. High levels of triglycerides, high-density lipoprotein, blood pressure, and waist circumference in MetS patients did not show a correlation with altered salivary gland function. However, a decrease in salivary flow rate was observed in MetS patients with hyperglycemia. In addition, decreased amylase activity was found in MetS patients with obesity (BMI ≥ 23 kg/m These findings suggest that obesity and hyperglycemia in MetS patients were associated with the impairment of salivary glands. Treatment with a DPP-IV inhibitor was found to exert beneficial effects on the salivary gland. This study demonstrated the impairment of salivary glands of MetS patients and the beneficial effect of DPP-IV inhibitor treatment in the salivary glands.
Publisher: Oxford University Press (OUP)
Date: 03-03-2008
Abstract: Fibrillatory waves observed in the surface electrograms may be a direct reflection of the electrophysiologic mechanism of the atrial fibrillation (AF). This study compared the fibrillatory waves in the surface ECG and the in idual intracardiac mapping sites in different types of paroxysmal AF. Thirty patients with paroxysmal AF originating from the pulmonary veins (PVs) or superior vena cava (SVC) were enrolled. Frequency analysis was performed on the intracardiac electrograms recorded from various mapping sites in both atria sequentially with simultaneous surface electrogram recordings. The SVC-AF patients had a trend toward a higher DF in ECG lead V1 when compared with the PV-AF patients (7.35 +/- 2.09 vs. 5.89 +/- 0.79 Hz, P = 0.018). The mean dominant frequency (DF) of the LA mapping sites in the PV-AF patients was higher than that in the SVC-AF patients (7.06 +/- 0.66 vs. 6.13 +/- 0.96 Hz, P = 0.009), whereas the mean DF of the RA mapping sites was similar between the two groups (5.84 +/- 0.80 vs. 6.26 +/- 1.11 Hz, P = NS). The intra-class correlation coefficient (ICC) between the mean DF of the RA sites and V1 was higher (r = 0.21, P = 0.02) when compared with the mean DF of the LA sites (r = -0.007, P > 0.05). Furthermore, the maximal ICC was observed in the anterolateral RA free wall (r = 0.84, P < 0.001) and not the other anatomic sites of the RA and LA. The fibrillatory activity observed in ECG lead V1 correlated primarily with the activity of the anterolateral RA free wall and thus may be useful for detecting the AF source if it is close to that area.
Publisher: International Scientific Information, Inc.
Date: 18-12-2019
DOI: 10.12659/AJCR.918838
Publisher: Springer Science and Business Media LLC
Date: 26-03-2018
DOI: 10.1038/S41598-018-23550-9
Abstract: Increased fibroblast growth factor 21 (FGF21) levels have been found in patients with metabolic syndrome (MetS). MetS is also associated with cognitive decline. However, the correlation between FGF21 and cognitive decline in elderly and nonelderly MetS patients has not been investigated. 116 non-elderly patients (age years old) and 96 elderly patients (≥65 years old) with MetS were enrolled. Blood s les for FGF21 were collected from all participants after 12-hour fasting. Cognitive function was assessed using the Montreal cognitive assessment (MoCA) test. The MoCA score was negatively associated with age and was different among different levels of education in these MetS patients. In the non-elderly group, body mass index (BMI) showed positively correlated with MoCA score while, FGF21 level and HbA1C were negatively associated with the MoCA score in non-elderly MetS patients. BMI was the only factor which showed a negative correlation with the MoCA score in elderly MetS patients. This study demonstrated that FGF21 level was independently associated with cognitive impairment in non-elderly patients but not in elderly patients. The possible role of FGF21 level in cognitive impairment in non-elderly should be confirmed in a prospective study.
Publisher: Springer Science and Business Media LLC
Date: 08-12-2020
DOI: 10.1038/S41598-020-78551-4
Abstract: Cognitive impairment is commonly found in the elderly population. Evidence suggests that mitochondrial function in lymphocytes are potential biomarkers in the progression of neurodegeneration, as peripheral mitochondrial function is associated with mild cognitive impairment (MCI) in the elderly population. Therefore, we hypothesize that impaired mitochondrial ATP production and oxidative stress in peripheral blood mononuclear cells (PBMCs) are associated with cognitive impairment in the elderly population. Data were collected from 897 participants from the EGAT (The Electricity Generating Authority of Thailand) cohort. The participants were classified to be in the normal cognition group (n = 428) or mild cognitive impairment group (n = 469), according to their MoCA score. The association of mitochondrial function and cognitive status was analyzed by binary logistic regression analysis. MCI participants had higher age, systolic blood pressure, waist/hip ratio, and lower plasma high- and low-density lipoprotein cholesterol levels, when compared to the normal cognition group. In addition, estimated glomerular filtration rate were lower in the MCI group than those in the normal cognition group. Collectively, MCI is associated with mitochondrial dysfunction in PBMCs as indicated by decreasing mitochondrial ATP production, increasing proton leak, and oxidative stress, in the elderly population, independently of the possible confounding factors in this study.
Publisher: Wiley
Date: 29-11-2006
DOI: 10.1111/J.1540-8167.2006.00301.X
Abstract: Acquired pulmonary vein (PV) stenosis is a well-known complication following catheter ablation of atrial fibrillation (AF). However, the details of congenital PV stenosis have not been reported in patients who underwent catheter ablation of AF. A total of 178 patients (110 men, age: 54 +/- 11 years) with drug-refractory AF received MRA or multidetector CT (MDCT) before ablation for delineation of PV morphologies. Five PVs in 5 patients (2.8%) showed at least 50% stenosis before ablation. We demonstrated two types of preexisting PV stenosis. Type I is the external compression of PV by the descending aorta, observed in LIPV of the three patients. Type II is the focal narrowing of PV, observed in RSPV of the two patients. Preexisting stenosis of PV may be a consequence of congenital focal narrowing or external compression by the adjacent structures. Detection of this condition by 3D CT or MRA before catheter ablation can provide information for planning of ablation strategy and prevent misdiagnosis of ablation-related PV stenosis.
Publisher: Japanese Circulation Society
Date: 25-06-2020
Publisher: Wiley
Date: 20-12-2007
DOI: 10.1111/J.1540-8167.2007.01065.X
Abstract: Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF. Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females mean age 47 +/- 18 years) with both PSVT and AF were ided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 +/- 3 vs. 41 +/- 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2. The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome.
Publisher: MDPI AG
Date: 21-08-2022
DOI: 10.3390/PHARMACEUTICS14081744
Abstract: Low-dose rivaroxaban has been used in Asian patients with direct oral anticoagulants (DOACs) eligible for atrial fibrillation (AF). However, there are few pharmacokinetic (PK) data in Thai patients to support precise dosing. This study aimed to develop a population PK model and determine the optimal rivaroxaban doses in Thai patients. A total of 240 Anti-Xa levels of rivaroxaban from 60 Thai patients were analyzed. A population PK model was established using the nonlinear mixed-effect modeling approach. Monte Carlo simulations were used to predict drug exposures at a steady state for various dosages. Proportions of patients having rivaroxaban exposure within typical exposure ranges were determined. A one-compartment model with first-order absorption best described the data. Creatinine clearance (CrCl) and body weight significantly affected CL/F and V/F, respectively. Regardless of body weight, a higher proportion of patients with CrCl 50 mL/min receiving the 10-mg once-daily dose had rivaroxaban exposures within the typical exposure ranges. In contrast, a higher proportion of patients with CrCl ≥ 50 mL/min receiving the 15-mg once-daily dose had rivaroxaban exposures within the typical exposure ranges. The study’s findings suggested that low-dose rivaroxaban would be better suited for Thai patients and suggested adjusting the medication’s dose in accordance with renal function.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Japanese Circulation Society
Date: 24-01-2020
Publisher: Elsevier BV
Date: 10-2018
Publisher: BMJ
Date: 15-05-2006
Publisher: Wiley
Date: 23-03-2009
DOI: 10.1111/J.1540-8167.2008.01358.X
Abstract: Atrial tachycardia (AT), including focal and reentrant AT, can occur after circumferential pulmonary vein isolation (CPVI). The aim of this study was to investigate the electrophysiological characteristics of induced AT and its clinical outcome. In our series of 160 patients with paroxysmal atrial fibrillation (AF), 45 ATs were induced by high-current burst pacing after CPVI in 26 patients. All induced ATs were mapped using a three-dimensional (3D) mapping system. Noninducibility was the endpoint of the ablation of the AT. Gap-related AT was considered if the AT was related to the CPVI lesions. A 16-slice multidetector computed tomography scan was performed in all patients to correlate the anatomical structure with electroanatomical mapping. Thirty-five (78%) reentrant ATs and 10 (22%) focal ATs were identified. Of those, 34 were gap-related ATs (24 reentrant and 10 focal ATs). Reentrant AT had more gaps in the left atrial appendage ridge than did focal AT (39.6% vs 0%, P = 0.02). Focal AT had a higher incidence of gap in the PV carina compared with reentrant AT (80% vs 10%, P < 0.001). Reentrant ATs were mostly terminated during the ablation creating the mitral and roof lines with crossing of the gaps. During a mean follow-up of 21 +/- 8 months, only one patient (0.6%) with induced mitral reentry had a recurrent AT. The location of the AT gap may be related with the complex anatomy of the LA. The induced ATs after CPVI can be eliminated by catheter ablation.
Publisher: Wiley
Date: 11-2009
Publisher: SAGE Publications
Date: 2017
Abstract: There were some reports of peripheral artery occlusive disease (PAOD) associated with nilotinib usage in chronic myeloid leukemia (CML). These complications in other tyrosine kinase inhibitors are revealed as unknown. We determined the prevalence of PAOD in patients with CML as compared with matched-control population by cross-sectional case-control study. Peripheral artery occlusive disease was screened by ankle-brachial index (ABI). In total, 78 CML and 156 matched-control patients were included. The median age was 55 years. In all, 61 (78.2%) were on imatinib and 13 (16.7%) were on nilotinib, whereas 4 patients (5.2%) were on dasatinib. Prevalence of low ABI ( .9) was 9.0%, and nilotinib users had the highest prevalence of low ABI of 30.7%. All cases with low ABI were not shown to be clinically overt of PAOD. There were well-balanced characteristics between cases of CML and matched control except in higher levels of hypercholesterolemia in the control. Interestingly, CML had more amounts of pathologic ABI than the control (odds ratio: 2.09, 95% confidence interval: 0.71-6.21), and diagnosis of diabetes found it to be independent of the risk of PAOD. Peripheral artery occlusive disease was higher among patients with CML than the control, especially in patients who had diabetes.
Publisher: Mary Ann Liebert Inc
Date: 06-2019
Publisher: SAGE Publications
Date: 28-05-2020
Abstract: Fixed-dose 2.5 mg of fondaparinux subcutaneous injection once daily has been recommended in treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) irrespective of body weight (BW). However, data on anti–factor Xa (anti-FXa) activity of fondaparinux are scarce in low-BW patients. We aimed to assess anti-FXa activity of fondaparinux in low-BW patients (BW 50 kg) compared with normal-BW patients (BW ≥ 50 kg) who presented with NSTE-ACS. This is a prospective cohort study of patients with NSTE-ACS receiving fondaparinux. Anti-FXa activity was measured 4 hours after 2.5 mg subcutaneous injection of fondaparinux after the first 2 doses. Among 87 enrolled patients, 18 (21%) had BW kg. Patients in the low-BW group were older and had lower creatinine clearance. Median duration of fondaparinux therapy was 3 (IQR 2-4) days. Anti-FXa activity after the first dose of fondaparinux was similar between the low-BW and normal-BW groups (0.40 ± 0.15 vs 0.40 ± 0.17 mg/L, P = 0.914). However, anti-FXa activity after the second dose of fondaparinux was significantly higher in the low-BW group as compared with the normal-BW group (0.53 ± 0.10 vs 0.44 ± 0.16 mg/L, P = 0.011). Multivariate analysis showed that BW was the only independent factor that inversely correlated with anti-FXa activity. There was only 1 bleeding event during hospitalization in the normal-BW group and none in the low-BW group. Anti-FXa activity of the second dose of fondaparinux was higher in low-BW patients but still within the expected range.
Publisher: Wiley
Date: 22-11-2020
DOI: 10.1002/CPT.2090
Publisher: Springer Science and Business Media LLC
Date: 22-06-2020
DOI: 10.1038/S41598-020-67078-3
Abstract: Metabolic syndrome (MetS) has become a worldwide health issue. Recent studies reveal that the human gut microbiota exerts a significant role in the pathogenesis of this disease. While drug treatments may greatly improve metabolic symptoms, little is known about the gut microbiota composition of these treated MetS patients. This study aimed to characterize the gut microbiota composition of treated-MetS patients and analyse the possibility of using gut microbiota as an indicator of metabolic conditions. 16S rRNA metagenomic sequencing approach was used to profile gut microbiota of 111 treated MetS patients from The Cohort of patients at a high Risk of Cardiovascular Events (CORE)-Thailand registry. Our results show that the gut microbiota profiles of MetS patients are erse across in iduals, but can be classified based on their similarity into three groups or enterotypes. We also showed several associations between species abundance and metabolic parameters that are enterotype specific. These findings suggest that information on the gut microbiota can be useful for assessing treatment options for MetS patients. In addition, any correlations between species abundance and human properties are likely specific to each microbial community.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-01-2020
Abstract: Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF %) versus preserved EF (≥50%). The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged years with symptomatic HF were recruited (mean age: 61.6±13.3 years 27% women 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4% P .001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. URL : www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.
Publisher: Wiley
Date: 25-10-2007
DOI: 10.1111/J.1540-8167.2007.00982.X
Abstract: The atrial substrate is the determinant of occurrence and maintenance of atrial fibrillation (AF), which can induce remodeling of atrial function and structure. This study investigated the relationship between the left atrial (LA) substrate properties and LA mechanical function. Forty-four consecutive patients (50.3 +/- 10.7 years old, 33 men) who presented with sinus rhythm during echocardiographic study before receiving catheter ablation for AF were enrolled. The LA diameter, LA volume, ratio of early and late transmitral filling flow velocities (E/A), LA appendage flow velocity, and transmitral velocity-time integral (VTI) were measured by the echocardiography. The LA empty fraction (LAEF), which was obtained via iding the difference between maximal and minimal LA volume by maximal LA volume, was calculated as a parameter of the global LA contractile function. The LA global contact voltage mapping (NavX system) was performed before pulmonary vein isolation. Mean LA voltage and LA low voltage zone index (LVZ index, area with voltage < 0.5 mV, ided by total LA surface area) showed significant correlation with LA diameter and volume, but only the LA LVZ index showed significant correlation with A-wave velocity, transmitral A-wave VTI, and LAEF (r =-0.340, -0.411, -0.426 P = 0.024, 0.006, 0.005, respectively). We ided the LA LVZ index into three groups ( 20%). The LAEF got worse and the transmitral A-wave VTI percentage ( ided by transmitral VTI) decreased as LA LVZ index increased. The LA substrate properties showed close correlation with LA size, but only the LA LVZ index correlated with the LA mechanical function.
Publisher: Wiley
Date: 03-2007
Publisher: MDPI AG
Date: 04-04-2023
Abstract: An influenza vaccination is recommended for patients with diabetes mellitus (DM) or ischemic heart disease (IHD) to prevent cardiovascular events, but the vaccination coverage remains low. This cross-sectional study sought to investigate vaccination coverage, knowledge level on influenza and factors associated with influenza vaccination in patients with DM or IHD treated at a tertiary hospital in northern Thailand. Patients were interviewed from August to October 2017. Of 150 patients interviewed (51.3% women, mean age of 66.7 ± 8.3 years, 35.3% DM, 35.3% IHD, 29.3% DM and IHD), 45.3% (68/150) were vaccinated against influenza. The mean knowledge score was 9.68 ± 1.35 (total: 11) and did not differ between those receiving the immunization and those who did not (p = 0.056). Two factors remained significantly associated with their vaccination after multivariable logistic regression analysis: knowing their right to receive free vaccinations (adjusted OR 2.32, 95% CI: 1.06–5.10, p-value: 0.035), and needing to be vaccinated (adjusted OR 3.50, 95% CI: 1.51–8.12, p-value: 0.003). Overall, the vaccine coverage was low less than one-half of patients received the influenza vaccine, but their knowledge level was high. Possessing the right and having a need were two factors associated with vaccination. Such factors should be carefully considered to encourage patients with DM and IDH to receive the influenza vaccination.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/OPENHRT-2019-001133
Abstract: In Thailand, due to limited availability of percutaneous coronary intervention (PCI)-capable hospitals, a number of patients with ST-elevation myocardial infarction (STEMI) after fibrinolytic therapy underwent the delayed coronary intervention (24 hours to 2 weeks). Existing tool such as the Global Registry of Acute Coronary Event (GRACE) to define patients at high risk of cardiovascular outcomes has been used widely, except for patients who had the delayed coronary intervention. We, therefore, evaluated the cardiovascular outcomes of STEMI patients who underwent the delayed coronary intervention. We retrospectively analysed the data from the PCI-capable hospital (Maharaj Nakorn Chiang Mai Hospital) STEMI registry during the period 2007–2012. Patients who received fibrinolytic treatment (SK) and underwent the delayed coronary intervention were included. The outcomes of the study were 30-day and 6-month composite cardiovascular outcomes (including death, re-hospitalised with acute coronary syndrome, re-hospitalised with heart failure and stroke). Of all 341 patients included, 229 (67.2%) patients were in the low GRACE score group ( points) and 112 (32.8%) patients in the intermediate-high GRACE score group (≥126 points). At 30 days, the composite cardiovascular outcome occurred in 2.2% (n=5) in the low GRACE score group and 11.6% (n=13) in the intermediate-high GRACE score group (p value=0.001). At 6 months, the composite cardiovascular outcomes occurred in 3.9% (n=9) in the low GRACE score group and 13.4% (n=15) in the intermediate-high GRACE score group (p value=0.003). The area under the receiver operating characteristic curve of GRACE score for 6-month composite cardiovascular outcomes was 0.746 (95% CI 0.698 to 0.793). Intermediate-high GRACE risk STEMI patients after fibrinolytic therapy in limited PCI-capable hospital who underwent the delayed coronary intervention increased 30-day and 6-month cardiovascular outcomes compared with the low GRACE risk patients. In limited available PCI-capable hospital, GRACE risk score can be helpful in guiding the cardiologists to select a proper time for coronary intervention in post-fibrinolytic STEMI patients.
Publisher: Wiley
Date: 12-2007
DOI: 10.1111/J.1540-8159.2007.00899.X
Abstract: The anatomical differences with age may raise difficulty in determining the proper positioning of the transseptal puncture site in the therapeutic left heart catheterization. This study investigated whether age affects the fluoroscopy-guided transseptal puncture in the catheter ablation of atrial fibrillation. Fifty patients (52 +/- 12 years, 35 men) who underwent ablation for paroxysmal ersistent atrial fibrillation were included. The patients were ided into two groups according to their age (cut-point 50 y/o): young group (n = 20) and old group (n = 30). In the 30 degrees right anterior oblique view (RAO), the width between the transseptal puncture site and coronary sinus ostium (H (N-CSO)) was longer in old-age group (14.4 +/- 9.4 vs 10.9 +/- 10.4 mm, P = 0.034). In the 60 degrees left anterior oblique view (LAO) view, the angle of the direction of the transseptal needle (N-angle) was less in the old-age group (56.0 +/- 10.0 degrees vs 58.4 +/- 9.8 degrees , P = 0.041). The ratio of the transseptal puncture site-coronary sinus ostium (CSO) distance over the distance between the superior vena cava-right atrial junction and CSO (V(N-CSO)/V(J-CSO)) was significantly higher in the old-age group (0.73 +/- 0.12 vs 0.63 +/- 0.2, P = 0.009). The transseptal puncture site in the RAO view moved higher and more posterior and the transseptal puncture angle in the LAO view decreased with age. These findings highlight the influence of age on the atrial anatomy and transseptal puncture site.
Publisher: Informa UK Limited
Date: 10-2020
DOI: 10.2147/CEOR.S268553
Publisher: Wiley
Date: 29-06-2017
DOI: 10.1111/JOIC.12403
Abstract: Warfarin discontinuation with heparin bridging is a common practice in patients receiving warfarin prior to elective coronary angiography (CAG). The uninterrupted warfarin strategy has been suggested to be alternative option for patients with high thromboembolic risk. Therefore, we aimed to assess the safety of elective transfemoral CAG during uninterrupted warfarin therapy compared to heparin bridging. This study was a randomized open-label design with blinded event evaluation. The 110 consecutive patients (age ≥ 18 years) receiving warfarin before the planned transfemoral CAG were randomly assigned to either heparin bridging or uninterrupted warfarin with targeted INR (2.0-3.0). The primary outcome was the incidence of major vascular access site complications. The baseline characteristics were comparable between two groups (mean age was 60.1 ± 7.8 years, 49 males). The mean INR on the day of CAG of heparin bridging and uninterrupted warfarin groups was 1.2 ± 0.3 and 2.2 ± 0.5 (P < 0.001). The major vascular access site complications occurred in 3 of 55 (5.5%) heparin-bridging patients and in none of 55 uninterrupted warfarin patients (P = 0.243). The total vascular access site complications occurred in 6 (10.9%) heparin-bridging and one (1.8%) uninterrupted warfarin patients (P = 0.113). No patient developed either other bleeding or thromboembolic events during 7 days after CAG. We demonstrated that an uninterrupted warfarin strategy did not increase vascular access site complications in patients undergoing transfemoral CAG compared to heparin bridging therapy. Due to the safety and the ease of uninterrupted warfarin strategy, this approach should be encouraged in patients receiving long-term warfarin who undergo elective transfemoral CAG.
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1016/S0828-282X(07)70818-8
Abstract: Acute myocardial infarction (AMI) is currently one of the most important health problems in many countries around the world. Following AMI, many cytokines and proteolytic enzymes are released. Among these, matrix metalloproteinases (MMPs) are important proteolytic enzymes that lead to degradation of the extracellular matrix and to changes in cardiomyocytes in both infarcted and noninfarcted myocardium. This process is known as cardiac remodelling. It has been demonstrated that more than one type of MMP is present in the circulation after cardiomyocyte injury. A number of studies have demonstrated the correlations between these MMP levels and the severity of a coronary lesion, the progression of left ventricular dimension and the survival rate following AMI in both animal and human studies. MMPs have also been proposed as a possible novel prognostic indicator for myocardial infarction patients. Although the use of MMP inhibitors to improve cardiac outcome in AMI patients has been investigated, discrepancies in the results from those studies indicate that further research is still needed to warrant their beneficial effects. In the present review article, the roles of MMPs as prognostic indicators, as well as the factors influencing MMP expression, are discussed. Current findings on the role of MMP inhibitors in cardiac remodelling and the prognosis after AMI in both animal models and clinical studies are also examined.
Publisher: Oxford University Press (OUP)
Date: 06-2006
DOI: 10.1016/J.CARDIORES.2006.02.026
Abstract: Pulmonary veins (PVs) are the most important focus for generation of atrial fibrillation. The Na(+)/Ca(2+) exchange (NCX) current is important in PV electrical activity and cardiac glycosides-induced arrhythmias. The purpose of this study was to investigate whether KB-R7943, a NCX current blocker with preferential inhibition of the Ca(2+) influx, may alter PV electrophysiological characteristics and reduce glycoside-induced arrhythmogenicity. Conventional microelectrodes were used to record the effects of KB-R7943 on action potentials and contractility in isolated rabbit PV tissue specimens with and without administration of ouabain. The ionic currents and intracellular calcium were studied in isolated single cardiomyocytes before and after KB-R7943 by the whole-cell patch cl and indo-1 fluorimetric ratio techniques. KB-R7943 (0, 3, 10, 30 microM) concentration-dependently prolonged APD(50) and APD(90) and decreased the PV firing rates (2.3 +/- 1.2 Hz, 2.1 +/- 1.2 Hz, 1.9 +/- 0.9 Hz, 1.7 +/- 1.1 Hz, n = 7, p < 0.05) and incidences of delayed afterdepolarizations (DADs). KB-R7943 (3, 30 microM) decreased transient inward currents, Ca(2+) transient and sarcoplasmic reticulum Ca(2+) content. Ouabain (0, 0.1, 1 microM) concentration-dependently increased the PV firing rates and DADs in PVs with spontaneous activity (n = 7) and induced nonsustained spontaneous activity (1 microM) in the PVs without spontaneous activity (n = 14). However, in the presence of KB-R7943 (30 microM), ouabain (1 microM) did not increase the PV firing rates or induce spontaneous activity in the PVs without spontaneous activity (n = 7). KB-R7943 reduces the PV arrhythmogenic activity and prevents the ouabain-induced arrhythmogenicity. Our findings support the role of the NCX current in the PV electrical activity.
Publisher: Wiley
Date: 20-12-2007
DOI: 10.1111/J.1540-8167.2007.01057.X
Abstract: Smoking is a major risk factor for cardiovascular disease. The impact of smoking on the right and left atrial substrates is unknown. This study included 88 patients (age 50 +/- 13 years, M/F = 71/17) who underwent four pulmonary veins isolation (PVI) for paroxysmal atrial fibrillation (AF). The mean voltage and total activation time of the in idual atria were obtained by using a NavX mapping system, and were compared between the patients with and without a previous smoking history. The dose effect was evaluated by the smoking intensity-duration, defined as the number of packs per day plus how many years they had been smoking. The right atrial (RA) mean voltage was lower in the patients with a previous history of smoking than in those without a history of smoking (1.92 +/- 0.49 vs 2.17 +/- 0.56 mV, P < 0.05). The left atrial (LA) mean voltage was similar between the two groups (1.73 +/- 0.67 vs 1.82 +/- 0.48 mV, P = 0.488). Further, the total activation time of the RA was longer in the patients with a previous history of smoking than in those without a history of smoking, but not so for the LA. Furthermore, the voltage reduction in the RA was related to the smoking intensity-duration (Pearson's correlation, r = 0.650, P < 0.001). In patients with atrial fibrillation, the RA mean voltage and total activation time were significantly correlated to smoking and had a dose-dependent effect.
Publisher: IEEE
Date: 11-2015
Publisher: Springer Science and Business Media LLC
Date: 05-04-2019
DOI: 10.1007/S11136-019-02171-3
Abstract: The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF). This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥ 65 years) patients with NVAF. Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72 ± 0.26 vs. 0.84 ± 0.20 p < 0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p = 0.006) and taking warfarin (p = 0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p < 0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p < 0.001). Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.
Publisher: Wiley
Date: 12-2005
Publisher: Wiley
Date: 18-10-2007
DOI: 10.1111/J.1540-8167.2007.00941.X
Abstract: The atrial substrate plays an important role in the maintenance of atrial fibrillation (AF). Further investigation of the biatrial substrate may be helpful for understanding the mechanism of AF. The aim of this study was to investigate the properties of right and left atrial (RA and LA) substrate in AF patients and their impact on the catheter ablation. Biatrial electroanatomic mapping using a three-dimensional mapping system (NavX) was performed in 117 consecutive patients with paroxysmal (n = 99) and persistent (n = 18) AF. The biatrial voltage and total activation time (TAT) were obtained during sinus rhythm. The LA had a lower voltage (1.6 +/- 0.5 vs 2.0 +/- 0.6 mV, P < 0.001) than the RA. The TAT correlated with the voltage (r = -0.65, P < 0.001). The patients with persistent AF had a lower atrial voltage, higher coefficient of variance for the LA voltage, longer LA TAT, and more extensive scar than those with paroxysmal. The patients with recurrent AF after catheter ablation had a lower LA voltage and higher incidence of LA scarring than those without recurrence. A scar located in the low anteroseptal or low posterior wall of LA was related to recurrence of AF. LA scarring was the independent predictor of AF recurrence after catheter ablation. The LA voltage was lower than the RA, and the atrial voltage correlated with the TAT. Electroanatomical remodeling of the atria could be crucial to the maintenance of AF. The LA substrate properties may play an important role in the recurrence of AF after catheter ablation of AF.
Publisher: Wiley
Date: 22-08-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2009
DOI: 10.1161/CIRCEP.108.812024
Abstract: Background— There is a paucity of data regarding the mechanism of maintaining atrial fibrillation (AF) after pulmonary vein isolation (PVI) in patients with AF. The aim of this study was to examine the impact of circumferential PVI on the left atrial (LA) substrate characteristics. Methods and Results— Seventy-two AF patients (age, 53�11 years) underwent mapping and catheter ablation using an NavX system. The biatrial characteristics such as the complex fractionated atrial electrograms (CFEs based on fractionated intervals) and frequency analysis (based on dominant frequencies) were mapped before and after PVI. PVI with electric isolation was performed in all patients. In the 45 patients who did not respond to PVI, the continuous CFEs ( seconds, 18�18% and 12�17% of the LA sites, before and after PVI, respectively, P =0.02), degree of LA fractionation (mean fractionated interval: 75.6�14.3 msec versus 87.3�16.7 msec, P =0.001), and mean LA dominant frequencies (6.92�0.88 Hz versus 6.58�0.91 Hz, P =0.001) decreased after PVI. Complete PVI altered the distribution of the CFEs toward the LA anteroseptum, mitral annulus, and LA appendage regions. A persistent presence of continuous CFEs in the vicinity of the dominant frequencies sites (observed in 53% patients) correlated with a higher procedural AF termination rate for the CFE ablation (63% versus 23%, P .05). Conclusions— Complete PVI eliminated some CFEs in the LA and altered the distribution of the CFEs. The persistent presence of CFEs before and after PVI in the vicinity of the high frequency sites is important for AF maintenance after PVI.
Publisher: Public Library of Science (PLoS)
Date: 24-02-2023
DOI: 10.1371/JOURNAL.PONE.0282344
Abstract: Autonomic disturbance is common in end-stage kidney disease (ESKD). Heart rate variability (HRV) is a useful tool to assess autonomic function. We aimed to evaluate the predictive value of HRV on all-cause mortality and explore the proper timing of HRV assessment. This prospective cohort study enrolled 163 ESKD on hemodialysis patients from April-December 2018. HRV measurements were recorded ten minutes before hemodialysis, four hours during hemodialysis, and ten minutes after hemodialysis. Clinical parameters and all-cause mortality were recorded. Cox-proportional hazard regression was used for statistical analysis. After a median follow up of 40 months, 37 (22.7%) patients died. Post-dialysis HRV parameters including higher very low frequency (VLF) (hazard ratio [HR], 0.881 95%confidence interval [CI], 0.828–0.937 p .001), higher normalized low frequency (nLF) (HR, 0.950 95%CI, 0.917–0.984 p = 0.005) and higher LF/HF ratio (HR, 0.232 95%CI, 0.087–0.619 p = 0.004) were the independent predictors associated with lower risk for all-cause mortality. Higher post-dialysis normalized high frequency (nHF) increased risk of mortality (HR, 1.051 95%CI, 1.015–1.089 p = 0.005). HRV parameters at pre-dialysis and during dialysis were not predictive for all-cause mortality. The area under receiver operating characteristic curve (AuROC) of VLF for survival was highest compared to other HRV parameters at post-dialysis period (AuROC 0.71 95% CI 0.62–0.79 p .001). In conclusion, post-dialysis HRV parameters predicted all-cause mortaliy in ESKD. VLF measured at post-dialysis exhibited best predictive value for survival in chronic hemodialysis patients.
Publisher: MDPI AG
Date: 22-02-2021
DOI: 10.3390/RS13040797
Abstract: Global Navigation Satellite System—Reflectometry (GNSS-R) has already proven its potential for retrieving a number of geophysical parameters, including soil moisture. However, single-pass GNSS-R soil moisture retrieval is still a challenge. This study presents a comparison of two different data sets acquired with the Microwave Interferometer Reflectometer (MIR), an airborne-based dual-band (L1/E1 and L5/E5a), multiconstellation (GPS and Galileo) GNSS-R instrument with two 19-element antenna arrays with four electronically steered beams each. The instrument was flown twice over the OzNet soil moisture monitoring network in southern New South Wales (Australia): the first flight was performed after a long period without rain, and the second one just after a rain event. In this work, the impact of surface roughness and vegetation attenuation in the reflectivity of the GNSS-R signal is assessed at both L1 and L5 bands. The work analyzes the reflectivity at different integration times, and finally, an artificial neural network is used to retrieve soil moisture from the reflectivity values. The algorithm is trained and compared to a 20-m resolution downscaled soil moisture estimate derived from SMOS soil moisture, Sentinel-2 normalized difference vegetation index (NDVI) data, and ECMWF Land Surface Temperature.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2013
DOI: 10.1007/S40266-013-0094-8
Abstract: Atrial fibrillation (AF) is the most common arrhythmia in older adults with a prevalence of 9 % in adults aged 80 years or older. AF patients have a five times greater risk of developing stroke than the general population. Using anticoagulants for stroke prevention in the elderly becomes a challenge because both stroke and bleeding complications increase with age. CHA₂DS₂-VASc and HAS-BLED scores are currently used as stroke and bleeding risk evaluations. When the HAS-BLED score is 3 or higher, caution and efforts to correct reversible risk factors are advised. Regardless of the HAS-BLED score, warfarin or novel oral anticoagulants are a IIa recommendation for CHA₂DS₂-VASc of 1, except for a score of 1 for females, and a IA recommendation for the score of 2 or higher. Aspirin is no longer recommended for AF thromboprophylaxis. In an elderly patient, lenient rate control is preferred over rhythm control owing to fewer adverse drugs effects and hospitalizations. When rhythm control is needed, dronedarone is a new antiarrhythmic drug that can be considered in patients who have paroxysmal AF and no history of heart failure. Although less efficacious than amiodarone, dronedarone has a fewer thyroid, neurologic, dermatologic, and ocular side effects than amiodarone.
Publisher: Elsevier BV
Date: 05-2007
Publisher: Wiley
Date: 10-11-2006
DOI: 10.1111/J.1540-8167.2006.00645.X
Abstract: Left atrial (LA) isthmus ablation was reported to improve the success rate of catheter ablation of paroxysmal atrial fibrillation (AF). LA isthmus ablation could also cure a subset of LA flutter. Therefore, understanding the anatomy of the LA isthmus is important for performing the ablation effectively. Group I included 45 patients (40 male, mean age = 50 +/- 13 years) with paroxysmal AF who underwent catheter ablation. Group II included 45 patients (37 male, mean age = 54 +/- 10 years) without a history of AF. They underwent a 16-slice multidetector computed tomography (MDCT) scan to delineate the LA structures before the ablation procedure. The average length of the LA isthmus was longer in group I than in group II (lateral isthmus: 3.30 +/- 0.68 vs 2.71 +/- 0.60 cm, P < 0.001 medial isthmus: 5.12 +/- 0.94 vs 4.45 +/- 0.63 cm, P < 0.001), and morphological patterns of lateral and medial isthmus were similar between groups. In addition, the average depth of lateral isthmus was similar between groups (0.62 +/- 0.32 vs 0.55 +/- 0.33 cm, P = 0.41), but the average depth of medial isthmus was larger in group I than in group II (0.60 +/- 0.32 vs 0.44 +/- 0.25 cm, P = 0.01). The medial isthmus had more ridges, as compared to the lateral isthmus (13% vs 0%, P = 0.026). Furthermore, the distances between esophagus and lateral isthmus were longer in group I than in group II (at the middle of isthmus and mitral annulus level: 21.0 +/- 4.8 vs 18.4 +/- 6.0 mm, P < 0.001 and 37.1 +/- 5.7 vs 29.6 +/- 8.1 mm, P < 0.001, respectively). The LA isthmus was longer in the AF patients. The morphology of the isthmus was variable. Compared with the lateral isthmus, the medial isthmus was longer and had more ridges. A peculiar configuration of the isthmus provided by CT images could influence the ablation strategy.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/4370834
Abstract: Background . An increase in the mean platelet volume (MPV) has been proposed as a novel prognostic indicator in critically ill patients. Objective . We conducted a systematic review and meta-analysis to determine whether there is an association between MPV and mortality in critically ill patients. Methods . We did electronic search in Medline, Scopus, and Embase up to November 2015. Results . Eleven observational studies, involving 3724 patients, were included. The values of initial MPV in nonsurvivors and survivors were not different, with the mean difference with 95% confident interval (95% CI) being 0.17 (95% CI: −0.04, 0.38 p = 0.112 ). However, after small s le studies were excluded in sensitivity analysis, the pooling mean difference of MPV was 0.32 (95% CI: 0.04, 0.60 p = 0.03 ). In addition, the MPV was observed to be significantly higher in nonsurvivor groups after the third day of admission. On the subgroup analysis, although patient types (sepsis or mixed ICU) and study type (prospective or retrospective study) did not show any significant difference between groups, the difference of MPV was significantly difference on the unit which had mortality up to 30%. Conclusions . Initial values of MPV might not be used as a prognostic marker of mortality in critically ill patients. Subsequent values of MPV after the 3rd day and the lower mortality rate unit might be useful. However, the heterogeneity between studies is high.
Publisher: Elsevier BV
Date: 11-2008
DOI: 10.1016/J.JACC.2008.06.049
Abstract: The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI). Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis. We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T(1) mapping sequence was used to calculate the post-contrast myocardial T(1) time as an index of diffuse fibrosis regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation. Post-contrast myocardial T(1) times correlated histologically with fibrosis (R = -0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 +/- 17 ms vs. 564 +/- 23 ms, p < 0.0001). The T(1) time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 +/- 22 ms vs. 564 +/- 23 ms, p < 0.0001). The post-contrast myocardial T(1) time shortened as diastolic function worsened (562 +/- 24 ms in normal diastolic function vs. 423 +/- 33 ms in impaired diastolic function vs. 368 +/- 20 ms in restrictive function, p < 0.001). Contrast-enhanced CMRI T(1) mapping identifies changes in myocardial T(1) times in heart failure, which appear to reflect diffuse fibrosis.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.HRTHM.2015.06.004
Abstract: Hyperthyroidism is a known reversible cause of atrial fibrillation (AF). However, some patients remain in AF despite restoration of euthyroid status. The purpose of this study was to compare the electrophysiologic characteristics and long-term ablation outcome in AF patients with and without history of hyperthyroidism. The study enrolled 717 consecutive patients with AF who underwent first AF ablation, which involved pulmonary vein (PV) isolation in paroxysmal AF and additional substrate modification in nonparoxysmal AF patients. Eighty-four patients (12%) with hyperthyroidism history were compared to those without. Euthyroid status was achieved for ≥3 months before ablation in hyperthyroid patients. Patients with hyperthyroid history were associated with older age, more female gender, lower mean right atrial voltage, higher number of PV ectopic foci (1.3 ± 0.4 vs 1.0 ± 0.2, P < .01), and higher prevalence of non-PV foci (42% vs 23%, P < .01). Ectopic foci from ligament of Marshall were demonstrated more often in hyperthyroid patients (7.1% vs 1.6%, P < .01) in whom alcohol ablations were required. After propensity score matching for potential covariates, history of hyperthyroidism was an independent predictor of AF recurrence after single procedure (hazard ratio 2.07, 95% confidence interval 1.27-3.38). AF recurrence rates after multiple procedures were not different between patients with and those without hyperthyroid history. Patients with hyperthyroid history had a significantly higher number of PV ectopies and higher prevalence of non-PV ectopic foci compared to euthyroid patients, which resulted in a higher AF recurrence rate after a single procedure.
Publisher: MDPI AG
Date: 09-04-2020
DOI: 10.3390/RS12071208
Abstract: As opposed to monostatic radars where incoherent backscattering dominates, in bistatic radars, such as Global Navigation Satellite Systems Reflectometry (GNSS-R), the forward scattered signals exhibit both an incoherent and a coherent component. Current models assume that either one or the other are dominant, and the calibration and geophysical parameter retrieval (e.g., wind speed, soil moisture, etc.) are developed accordingly. Even the presence of the coherent component of a GNSS reflected signal itself has been a matter of discussion in the last years. In this work, a method developed to separate the leakage of the direct signal in the reflected one is applied to a data set of GNSS-R signals collected over the ocean by the Microwave Interferometer Reflectometer (MIR) instrument, an airborne dual-band (L1/E1 and L5/E5a), multi-constellation (GPS and Galileo) GNSS-R instrument with two 19-elements antenna arrays with 4 beam-steered each. The presented results demonstrate the feasibility of the proposed technique to untangle the coherent and incoherent components from the total power waveform in GNSS reflected signals. This technique allows the processing of these components separately, which increases the calibration accuracy (as today both are mixed and processed together), allowing higher resolution applications since the spatial resolution of the coherent component is determined by the size of the first Fresnel zone (300–500 meters from a LEO satellite), and not by the size of the glistening zone (25 km from a LEO satellite). The identification of the coherent component enhances also the location of the specular reflection point by determining the peak maximum from this coherent component rather than the point of maximum derivative of the incoherent one, which is normally noisy and it is blurred by all the glistening zone contributions.
Location: Thailand
No related grants have been discovered for Arintaya Phrommintikul.