Vincent Chow

Publications (13)62.54 Total impact

• Source

  Available from: Austin Chin Chwan Ng

  Article: Fluctuation of Serum Sodium and Its Impact on Short and Long-Term Mortality following Acute Pulmonary Embolism

  Austin Chin Chwan Ng, Vincent Chow, Andy Sze Chiang Yong, Tommy Chung, Leonard Kritharides
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  ABSTRACT: Background: Baseline hyponatremia predicts acute mortality following pulmonary embolism (PE). The natural history of serum sodium levels after PE and the relevance to acute and long-term mortality after the PE is unknown.
  PLoS ONE 04/2013; 8(4):e61966. · 4.09 Impact Factor
• Article: Fluctuation of Serum Sodium and Its Impact on Short and Long-Term Mortality following Acute Pulmonary Embolism.

  Austin Chin Chwan Ng, Vincent Chow, Andy Sze Chiang Yong, Tommy Chung, Leonard Kritharides
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  ABSTRACT: Baseline hyponatremia predicts acute mortality following pulmonary embolism (PE). The natural history of serum sodium levels after PE and the relevance to acute and long-term mortality after the PE is unknown. Clinical details of all patients (n = 1023) admitted to a tertiary institution from 2000-2007 with acute PE were retrieved retrospectively. Serum sodium results from days 1, 3-4, 5-6, and 7 of admission were pre-specified and recorded. We excluded 250 patients without day-1 sodium or had <1 subsequent sodium assessment, leaving 773 patients as the studied cohort. There were 605 patients with normonatremia (sodium≥135 mmol/L throughout admission), 57 with corrected hyponatremia (day-1 sodium<135 mmol/L, then normalized), 54 with acquired hyponatremia and 57 with persistent hyponatremia. Patients' outcomes were tracked from a state-wide death registry and analyses performed using multivariate-regression modelling. Mean (±standard deviation) day-1 sodium was 138.2±4.3 mmol/L. Total mortality (mean follow-up 3.6±2.5 years) was 38.8% (in-hospital mortality 3.2%). There was no survival difference between studied (n = 773) and excluded (n = 250) patients. Day-1 sodium (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.83-0.95, p = 0.001) predicted in-hospital death. Relative to normonatremia, corrected hyponatremia increased the risk of in-hospital death 3.6-fold (95% CI 1.20-10.9, p = 0.02) and persistent hyponatremia increased the risk 5.6-fold (95% CI 2.08-15.0, p = 0.001). Patients with either persisting or acquired hyponatremia had worse long-term survival than those who had corrected hyponatremia or had been normonatremic throughout (aHR 1.47, 95% CI 1.06-2.03, p = 0.02). Sodium fluctuations after acute PE predict acute and long-term outcome. Factors mediating the correction of hyponatremia following acute PE warrant further investigation.
  PLoS ONE 01/2013; 8(4):e61966. · 4.09 Impact Factor
• Article: Prognostic Impact of the Charlson Comorbidity Index on Mortality following Acute Pulmonary Embolism.

  Austin Chin Chwan Ng, Vincent Chow, Andy Sze Chiang Yong, Tommy Chung, Leonard Kritharides
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  ABSTRACT: Objectives: It was the aim of this study to determine the prognostic significance of the Charlson Comorbidity Index (CCI) following acute pulmonary embolism (PE) and assess the prognosis of patients without comorbidities (defined as a CCI score of 0). Methods: Outcomes of 1,023 consecutive patients admitted with confirmed PE were tracked after a median of 3.7 years (25-75th interquartile range 1.5-6.1 years). All were assigned a non-age-adjusted CCI score. Results: The median CCI score was 1.0 (interquartile range 0.0-3.0). Three hundred and fifty-one (34%) patients had a CCI score of 0. Only 1 (0.3%) of 31 in-hospital deaths occurred in patients with a CCI score of 0. Long-term mortality for these patients was similar to the population-derived age- and sex-matched mortality rate, and was significantly better than for those with a CCI score ≥1 (12.5 vs. 47.5%; p < 0.0001 adjusted for age and sex). In multivariate analysis, CCI (per 1-score increase) independently predicted in-hospital (hazard ratio 1.27, 95% confidence interval 1.09-1.49; p = 0.003) and post-discharge (hazard ratio 1.35, 95% confidence interval 1.29-1.42; p < 0.0001) death. The c statistics for the multivariate prediction models for in-hospital (incorporating CCI score and serum sodium level) and post-discharge death (age, CCI score, hyperlipidemia, serum sodium and hemoglobin) were 0.738 and 0.788, respectively (both p < 0.0001). Conclusion: The CCI can be incorporated into risk models, with good discriminatory power, for predicting in-hospital and long-term outcomes following acute PE. Patients with a CCI score of 0 have a favorable long-term outcome following acute PE.
  Respiration 11/2012; · 2.26 Impact Factor
• Article: Persistent left superior vena cava draining into the left atrium: an elderly man with hypoxia, cyanosis, and paradoxical shunting post-myocardial infarction.

  Vincent Chow, Joseph Trieu, John Yiannikas
  European Heart Journal 03/2012; 33(18):2370. · 10.48 Impact Factor
• Article: Cardiac troponin-T and the prediction of acute and long-term mortality after acute pulmonary embolism.

  Austin Chin Chwan Ng, Andy Sze Chiang Yong, Vincent Chow, Tommy Chung, Saul Benedict Freedman, Leonard Kritharides
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  ABSTRACT: BACKGROUND: Although cardiac troponin elevation during acute pulmonary embolism (PE) predicts in-hospital death, its long-term prognostic significance, and the role of troponin-T concentration in this prediction, is unknown. Moreover, its use in acute PE in elderly populations with multiple comorbidities is not well described. METHODS: Consecutive patients presenting with confirmed PE to a tertiary hospital between 2000 and 2007 with troponin-T measured were identified retrospectively and their outcomes tracked from a state-wide death registry. RESULTS: There were 577 patients, (47% male) with a mean age (±standard deviation) of 70.1±15.2years, of whom 19 died during index admission. Of the 558 patients who survived to discharge, 186 patients died during a mean follow-up of 3.8±2.4years. There were 187 (32%) patients with elevated troponin-T (≥0.01μg/L). Troponin-T concentration was significantly and independently associated with in-hospital and long-term mortality whether analyzed as a continuous or categorical variable (p<0.001). However, different cut-points were required to optimally predict in-hospital and post-discharge long-term mortality in multivariate analysis. Troponin-T≥0.01μg/L was not an independent predictor of in-hospital or post-discharge survival. A cut-point of troponin-T≥0.03μg/L was required to independently predict in-hospital death (p=0.03), and troponin-T≥0.1μg/L was required to independently predict long-term mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001). CONCLUSIONS: Troponin-T elevation during acute PE shows a concentration-dependent relationship with acute and long-term outcome. Concentrations of troponin-T well above the threshold for detection may be required to independently contribute to prediction of outcome in elderly populations with acute PE.
  International journal of cardiology 08/2011; · 7.08 Impact Factor
• Article: Management and outcomes of patients with acute coronary syndromes in Australia and New Zealand, 2000-2007.

  Bernadette Aliprandi-Costa, Isuru Ranasinghe, Vincent Chow, Shruti Kapila, Craig Juergens, Gerard Devlin, John Elliott, Jeff Lefkowitz, David B Brieger
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  ABSTRACT: To describe temporal trends in the use of evidence-based medical therapies and management of patients with acute coronary syndromes (ACS) in Australia and New Zealand. Our analysis of the Australian and New Zealand cohort of the Global Registry of Acute Coronary Events (GRACE) included patients with ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation ACS (NSTEACS) enrolled continuously between January 2000 and December 2007 from 11 metropolitan and rural centres in Australia and New Zealand. 5615 patients were included in this analysis (1723 with STEMI; 3892 with NSTEACS). During 2000-2007 there was an increase in the use of statin therapy, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and thienopyridines (P < 0.0001 for each). Among patients with STEMI, there was an increase in emergency revascularisation with PCI (from 11% to 27% [P < 0.0001]), and inhospital coronary angiography (from 61% to 76% [P < 0.0001]). Among patients with NSTEACS, there was an increase in revascularisation with PCI (from 20% to 25% [P = 0.004]). Heart failure rates declined substantially among STEMI and NSTEACS patients (from 21% to 12% [P = 0.0002], and from 13% to 4% [P < 0.0001], respectively) as did rates of hospital readmission for ischaemic heart disease at 6 months (from 23% to 9% [P = 0.0001], and from 24% to 15% [P = 0.0001], respectively). From 2000 to 2007 in Australia and New Zealand, there was a fall in inhospital events and 6-month readmissions among patients admitted with ACS. This showed an association with improved uptake of guideline-recommended medical and interventional therapies. These data suggest an overall improvement in the quality of care offered to contemporary ACS patients in Australia and New Zealand.
  The Medical journal of Australia 08/2011; 195(3):116-21. · 2.81 Impact Factor
• Article: Caseous calcification associated with left ventricular noncompaction: a multimodality diagnostic approach.

  Vincent Chow, Lloyd Ridley, Andrew Sindone, Leonard Kritharides
  International journal of cardiology 07/2011; 155(2):e29-31. · 7.08 Impact Factor
• Article: Risk stratification in the setting of non-ST elevation acute coronary syndromes 1999-2007.

  Isuru Ranasinghe, Bernadette Alprandi-Costa, Vincent Chow, John M Elliott, Jonathon Waites, John T Counsell, Jose Lopéz-Sendón, Alvaro Avezum, Shaun G Goodman, Christopher B Granger, David Brieger
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  ABSTRACT: It is unclear if clinician risk stratification has changed with time. The aim of this study was to assess the temporal change in the concordance between patient presenting risk and the intensity of evidence-based therapies received for non-ST-segment elevation acute coronary syndromes over a 9-year period. Data from 3,562 patients with non-ST-segment elevation acute coronary syndromes enrolled in the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE) from 1999 to 2007 were analyzed. Patients were stratified to risk groups on the basis of the GRACE risk score for in-hospital mortality. Main outcome measures included in-hospital use of widely accepted evidence-based medications, investigations, and procedures. Invasive management was consistently higher in low-risk patients than in intermediate- or high-risk patients (coronary angiography 66.7% vs 63.5% vs 35.3%, p <0.001; percutaneous coronary intervention 31.1% vs 22.0% vs 12.9%, p <0.001). Absolute rates of angiography and percutaneous coronary intervention in the high-risk group remained 24% and 15% lower compared to the low-risk group in the most recent time period (2005 to 2007). In-hospital use of thienopyridine, low-molecular weight heparin, and glycoprotein IIb/IIIa inhibitors showed a similar inverse relation with risk. Prescription of aspirin, β blockers, statins, and angiotensin receptor blockers was inversely related to risk before 2004, although this inverse relation was no longer present in the most recent time period (2005 to 2007). Only in-hospital use of unfractionated heparin showed use concordant with patient risk status. In conclusion, despite an overall increase in the uptake of evidence-based therapies, most investigations and treatments are not targeted on the basis of patient risk. Clinician risk stratification remains suboptimal compared to objective measures of patient risk.
  The American journal of cardiology 06/2011; 108(5):617-24. · 3.58 Impact Factor
• Article: Thrombus in transit within a patent foramen ovale: an argument for consideration of prophylactic closure?

  Vincent Chow, William Wang, Michael Wilson, John Yiannikas
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  ABSTRACT: Recurrent pulmonary embolism (PE) in prothrombotic patients with patent foramen ovale (PFO) is not considered a setting for elective PFO closure. We describe a 35-year-old woman with known PFO, recurrent PE on warfarin, and Klippel-Trenaunay syndrome-a condition with predisposition for thromboembolism-who suffered concurrent saddle PE and devastating stroke with further impending paradoxical embolus across the PFO. Optimal management in patients with biatrial thromboembolus caught in transit across PFO is challenging. Patients with recurrent PE, prothrombotic states, and PFO should be considered for PFO closure. Prompt diagnosis of impending paradoxical embolus with echocardiography and consideration of surgical removal and PFO closure are critical.
  Journal of Clinical Ultrasound 04/2011; 40(2):115-8. · 0.81 Impact Factor
• Article: Long-term cardiovascular and noncardiovascular mortality of 1023 patients with confirmed acute pulmonary embolism.

  Austin Chin Chwan Ng, Tommy Chung, Andy Sze Chiang Yong, Helen Siu Ping Wong, Vincent Chow, David Stephen Celermajer, Leonard Kritharides
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  ABSTRACT: There are currently no guidelines advising long-term surveillance of patients following an acute pulmonary embolism (PE), because long-term outcome studies are rare. We investigated the long-term cardiovascular and all-cause mortality of a large patient cohort with confirmed PE in relation to baseline cardiovascular disease (CVD). Clinical details of all patients presenting with acute PE to a tertiary hospital were retrieved from medical records, and their survival tracked from a statewide death registry. There were 1023 (45% males) patients admitted with confirmed PE from 2000 to 2007. During a mean follow-up of 3.8±2.6 years, 363 patients died (35.5%), of whom only 31 (3.0%) died in-hospital during the index PE admission. The 3-month, 6-month, 1-year, 3-year, and 5-year cumulative mortality rates were 8.3%, 11.1%, 16.3%, 26.7%, and 31.6% respectively. Annual mortality did not improve over the 7-year period. The postdischarge mortality of 8.5%/patient-year was 2.5-fold that of an age- and sex-matched general population, being 12.6-fold in the youngest quintile (<55 years) and 1.9-fold in the oldest quintile (≥83 years). Patients with known CVD at baseline had 2.2-fold greater all-cause mortality than those without CVD, and this effect, although at a lower level of risk, remained significant after multivariate analysis. Of the 332 deaths occurring postdischarge, 40% were attributed to cardiovascular causes. In a contemporary adult population, PE is associated with a substantially increased long-term mortality, of which nearly half is cardiovascular. Our study highlights the urgent need to develop long-term surveillance strategies in this population.
  Circulation Cardiovascular Quality and Outcomes 01/2011; 4(1):122-8. · 4.91 Impact Factor
• Article: Peri-procedural anticoagulation and the incidence of haematoma formation after permanent pacemaker implantation in the elderly.

  Vincent Chow, Isuru Ranasinghe, Jerrett Lau, Hughina Stowe, Paul Bannon, Nick Hendel, Leonard Kritharides
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  ABSTRACT: Haematoma formation is a recognised complication after permanent pacemaker (PPM) implantation. The contribution of peri-procedural anticoagulation to the risk of haematoma formation is unclear. The records of 518 consecutive patients, mean age 76.9±9.8 years, receiving their first PPM (2004-2007) in a single tertiary referral centre were reviewed. Follow-up was complete for 506 patients (97.7%) up to six weeks. Haematomas were diagnosed clinically, and further subdivided according to the need for evacuation. There were 27 instances of haematoma formation in 25 patients (4.9%) with 19 requiring drainage or evacuation. Twenty-one of the 25 patients who developed a haematoma had stopped warfarin and received bridging therapeutic anticoagulation pre- and post-PPM. The incidence of haematoma was significantly greater in those receiving peri-operative therapeutic anticoagulation (26.9% vs 0.9%, p<0.001), but was unaffected by the use of anti-platelet therapy. Most haematomas developed in patients whose heparin was recommenced within 24 hours of implantation. The development of haematoma post-PPM increased median hospital stay significantly (p<0.001). The main indication for anticoagulation in these patients was atrial fibrillation (79.5%) and most of these patients had a low to intermediate risk of peri-procedural thromboembolic events. Peri-operative therapeutic anticoagulation is associated with more than 25-fold increase in haematoma formation post-pacemaker implantation. The risk-benefit ratio of therapeutic anticoagulation should be carefully considered, particularly in patients with a low risk of thromboembolic events.
  Heart Lung &amp Circulation 12/2010; 19(12):706-12. · 1.20 Impact Factor
• Article: Embolisation of a non-culprit coronary artery complicating thrombus aspiration in acute myocardial infarction: the "drag and drop" effect of the thrombus aspiration catheter.

  Isuru Ranasinghe, Vincent Chow, David Brieger, Leonard Kritharides
  International journal of cardiology 10/2010; 145(3):616-8. · 7.08 Impact Factor
• Article: Coexisting vasospastic angina and undiagnosed Brugada syndrome resulting in cardiac arrest.

  Vincent Chow, Isuru Ranasinghe, John Yiannikas
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  ABSTRACT: The coexistence of Brugada Syndrome and resting vasospastic angina resulting in cardiac arrest is rare. We describe a 64 year-old man presenting with cardiac arrest and vasospastic angina with diagnostic criteria of symptomatic Brugada Syndrome. Recognition of the coexistence of these potentially fatal conditions has important therapeutic implications when using calcium channel antagonists and may shed light on the mechanisms of coronary spasm. A common pathogenesis, such as a common underlying channelopathy, may explain its coexistence with Brugada Syndrome.
  International journal of cardiology 12/2009; 150(2):e73-6. · 7.08 Impact Factor