Yu-Feng Hu

National Yang Ming University, T’ai-pei, Taipei, Taiwan

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Publications (123)464.43 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score is recommended by both American and European guidelines for stroke risk stratification in atrial fibrillation (AF), the treatment recommendations for a CHA2DS2-VASc score of 1 are less clear. This study aimed to investigate the risk of ischemic stroke in patients with a single additional stroke risk factor (i.e., CHA2DS2-VASc score = 1 [males] or 2 [females]) and the impact of different component risk factors. We used the National Health Insurance Research Database in Taiwan. Among 186,570 AF patients not on antiplatelet or anticoagulant therapy, we evaluated males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The clinical endpoint was the occurrence of ischemic stroke. Among 12,935 male AF patients with a CHA2DS2-VASc score of 1, 1,858 patients (14.4%) experienced ischemic stroke during follow-up (5.2 ± 4.3 years), with an annual stroke rate of 2.75%. Ischemic stroke risk ranged from 1.96%/year for men with vascular disease to 3.50%/year for those 65 to 74 years of age. For 7,900 females with AF and a CHA2DS2-VASc score of 2, 14.9% experienced ischemic stroke for an annual stroke rate of 2.55%. Ischemic stroke risk increased from 1.91%/year for women with hypertension to 3.34%/year for those 65 to 74 years of age. Not all risk factors in CHA2DS2-VASc score carry an equal risk, with age 65 to 74 years associated with the highest stroke rate. Oral anticoagulation should be considered for AF patients with 1 additional stroke risk factor given their high risk of ischemic stroke. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 02/2015; 65(7):635-642. · 15.34 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is the most common cardiac arrhythmia. However, the development of preventative therapies for AF has been disappointing. The infiltration of immune cells and proteins that mediate the inflammatory response in cardiac tissue and circulatory processes is associated with AF. Furthermore, the presence of inflammation in the heart or systemic circulation can predict the onset of AF and recurrence in the general population, as well as in patients after cardiac surgery, cardioversion, and catheter ablation. Mediators of the inflammatory response can alter atrial electrophysiology and structural substrates, thereby leading to increased vulnerability to AF. Inflammation also modulates calcium homeostasis and connexins, which are associated with triggers of AF and heterogeneous atrial conduction. Myolysis, cardiomyocyte apoptosis, and the activation of fibrotic pathways via fibroblasts, transforming growth factor-β and matrix metalloproteases are also mediated by inflammatory pathways, which can all contribute to structural remodelling of the atria. The development of thromboembolism, a detrimental complication of AF, is also associated with inflammatory activity. Understanding the complex pathophysiological processes and dynamic changes of AF-associated inflammation might help to identify specific anti-inflammatory strategies for the prevention of AF.
    Nature Reviews Cardiology 01/2015; · 10.40 Impact Factor
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    ABSTRACT: Noncompliant patients might be at risk of thromboembolism because of the short half-life and rapid offset of dabigatran etexilate. The assessment and management of dabigatran noncompliance should be optimized. A total of 150 nonvalvular atrial fibrillation patients receiving dabigatran were prospectively enrolled and followed for drug compliance and persistence. Noncompliance was identified by questionnaires and interviews. The hemoclot thrombin inhibitor (HTI) assay was used for monitoring the plasma dabigatran levels. Sixteen patients were noncompliant (10.7%). None of the clinical characteristics were significantly relevant to noncompliance after multivariate analysis. The dabigatran plasma level based on HTI was the only independent predictor of noncompliance (odds ratio: 0.97 per ng/mL, P = 0.003). The prothrombin time (PT), international normalized ratio of PT (INR [PT]), and activated partial thromboplastin time did not differ between compliant and noncompliant patients. During the follow-up, the persistent prescription of dabigatran was noted in 75% of noncompliant patients without improvement in compliance. The drug discontinuation rate was higher in the noncompliant than compliant patients (6.7% vs. 25%, P = 0.035). None of the patients in either group received warfarin after discontinuing dabigatran. The assessment and management of dabigatran noncompliance is generally ignored in clinical practice. The measurement of dabigatran plasma levels by HTI could be a reliable and simple method to identify noncompliant patients. ©2015 Wiley Periodicals, Inc.
    Pacing and Clinical Electrophysiology 01/2015; · 1.75 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is prevalent in end-stage renal disease (ESRD) patients and negatively impacts patient outcomes. We explored the incidence and risk factors for new-onset AF among patients with ESRD undergoing renal replacement therapy, without a prior history of AF, retrieved from Taiwan's National Health Insurance Research Database (NHIRD). For each of 134,901 patients with ESRD, one age- and gender-matched control and one similarly matched patient with chronic kidney disease (CKD), a total of 404,703 patients, were selected from the NHIRD. The study endpoint was the occurrence of new-onset AF and patients were followed an average of 5.1 years. The incidence rates of AF were 12.1, 7.3, and 5.0 per 1000 person-years for ESRD, CKD, and control patients, respectively. Among patients with ESRD, age, hypertension, heart failure, coronary artery disease, peripheral arterial occlusive disease, and chronic obstructive pulmonary disease were significant risk factors for new-onset AF. Thus, patients with ESRD had a significantly higher risk of new-onset AF. The presence of multiple risk factors was associated with a higher possibility of AF occurrence.Kidney International advance online publication, 14 January 2015; doi:10.1038/ki.2014.393.
    Kidney international. 01/2015;
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    ABSTRACT: Multiform premature ventricular complexes (PVCs) are common electrocardiographic abnormalities in patients with structurally normal hearts. However, the prognostic value of these complexes remains unclear. This study aimed to clarify the role of PVC polymorphism in predicting adverse outcomes. We examined the database for 24-hour electrocardiography monitoring between January 1, 2002 and December 31, 2004. We analyzed 3351 individuals with apparently normal hearts. Kaplan-Meier curves and multivariate Cox proportional hazards models were employed to estimate the effect of multiform PVC and uniform PVC on the number of incident adverse events. Average follow-up time was 10±1years. Patients with multiform PVC were older and had a higher prevalence of comorbidities. In multivariate analysis, patients with multiform PVC had an increased incidence of mortality (hazard ratio [HR]: 1.642, 95% confidence interval [CI]: 1.327-2.031), hospitalization (HR: 1.196, 95% CI: 1.059-1.350), cardiovascular hospitalization (HR: 1.289, 95% CI: 1.030-1.613), new-onset heart failure (HF; HR: 1.456, 95% CI: 1.062-1.997), transient ischemic accident (HR: 1.411, 95% CI 1.063-1.873), and new-onset atrial fibrillation (AF; HR: 1.546, 95% CI: 1.058-2.258) compared to the group without PVC. Patients with multiform PVC had a higher rate of mortality (HR: 1.231, 95% CI: 1.033-1.468) and all cause-hospitalization (HR: 1.147, 95% CI: 1.025-1.283) compared with patients with uniform PVC. The presence of multiform PVC was associated with a higher incidence of mortality, hospitalization, transient ischemic attack, new-onset AF, and new-onset HF independent of other clinical risk factors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 11/2014; 180C:80-85. · 6.18 Impact Factor
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    ABSTRACT: A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.
    Journal of the American College of Cardiology 10/2014; 64(16):1658-65. · 15.34 Impact Factor
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    ABSTRACT: Background Digoxin and related cardiac glycoside have been used for almost 100 years in atrial fibrillation (AF). However, recent 2 analyses of the “AFFIRM” trial showed non-consistent results about the risk of mortality associated with digoxin use. The goal of the present study is to investigate the relationship between digoxin and the risk of ischemic stroke and mortality in Asians. Methods This study used the “National Health Insurance Research Database” in Taiwan. A total of 4,781 AF patients who did not receive any antithrombotic therapy were selected as the study population. Among the study population, 829 subjects (17.3%) received the digoxin treatment. The risks of ischemic stroke and mortality of patients with or without digoxin use were compared. Results The use of digoxin was associated with an increased risk of clinical events with an adjusted hazard ratio of 1.41 (95% CI =1.17-1.70) for ischemic stroke and 1.21 (95% CI =1.01-1.44) for all-cause mortality. In the subgroup analysis based on the coexistence with heart failure or not, digoxin was a risk factor of adverse events for patients without heart failure, but not for those with heart failure (interaction p<0.001 for either endpoint). Among AF patients without heart failure, the use of beta-blockers was associated with better survival with an adjusted hazard ratio of 0.48 (95% CI = 0.34-0.68). Conclusions Digoxin should be avoided for AF patients without heart failure since it was associated with an increased risk of clinical events. Beta-blockers may be a better choice for controlling ventricular rate.
    The Canadian journal of cardiology 10/2014; · 3.12 Impact Factor
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    ABSTRACT: The risk of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF) having a CHA2DS2-VASc score of 0 (for males) or 1 (for females) has not been previously investigated.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2014; · 4.56 Impact Factor
  • International Journal of Cardiology 08/2014; · 6.18 Impact Factor
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    ABSTRACT: The characteristics of endocardial electrograms needed to detect the overlying abnormal epicardial substrates in arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia remain unclear. The current study investigated which of the endocardial electrogram characteristics could predict the overlying abnormal epicardial substrates.
    Journal of Cardiovascular Electrophysiology 07/2014; · 2.88 Impact Factor
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    ABSTRACT: Background:Although the link between sleep-disordered breathing (SDB) and atrial fibrillation (AF) has been reported, a population-based longitudinal cohort study was lacking. The goal of the present study was to investigate the AF risk carried by SDB, using the National Health Insurance Research Database in Taiwan.Methods and Results:From 2000 to 2001, a total of 579,521 patients who had no history of cardiac arrhythmias or significant comorbidities were identified. Among them, 4,082 subjects with the diagnosis of SDB were selected as the study group, and the remaining 575,439 subjects constituted the control group. The study endpoint was the occurrence of new-onset AF. During a follow-up of 9.2±2.0 years, there were 4,023 patients (0.7%) experiencing new-onset AF. The occurrence rate of AF was higher in patients with SDB compared to those without it (1.3% vs. 0.7%, P<0.001). The AF incidences were 1.38 and 0.76 per 1,000 person-years for patients with and without SDB, respectively. After anadjustment for age and sex, SDB was a significant risk factor of AF with a hazard ratio of 1.536. The AF risk increased with increasing clinical severity of SDB, represented by the requirement of continuous positive airway pressure use.Conclusions:SDB itself, without the coexistence of other systemic diseases, was a risk factor of AF.
    Circulation Journal 07/2014; · 3.69 Impact Factor
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    ABSTRACT: Renal dysfunction is a significant risk factor of ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence amongst AF patients with end-stage renal disease (ESRD) are unclear.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; · 4.56 Impact Factor
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    ABSTRACT: Radiofrequency catheter ablation (RFCA) is an effective therapeutic strategy in eliminating drug-refractory idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT VAs). It remains unclear what factors influence early and late VA recurrences after ablation.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; · 4.56 Impact Factor
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    ABSTRACT: Pericardial fat (PCF) may induce local inflammation and subsequent structural remodeling of the left atrium (LA). However, the adverse effects of PCF on LA are difficult to be evaluated and quantified. The atrial electromechanical interval determined by transthoracic echocardiogram was shown to be a convenient parameter which can reflect the process of LA remodeling. The goal of the present study was to investigate the association between the electromechanical interval and PCF.
    PLoS ONE 05/2014; 9(5):e97472. · 3.53 Impact Factor
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    ABSTRACT: Signal averaged electrocardiogram (SAECG) is a specific and non-invasive tool useful for arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis. However, its role in risk stratification of patients with ARVC remains largely undefined. Sixty-four patients fulfilling Task Force ARVC criteria (mean age: 47±14years-old, 56% male, 50% definite ARVC) were enrolled. The baseline demographic, electrocardiographic, structural, and electrophysiological characteristics were collected. Patients with SAECG fulfilling all 3 Task Force criteria (3+ SAECG) were categorized into group 1, and those fulfilled 2 or less criterion were categorized into group 2. The study endpoints were unstable ventricular arrhythmia (VA), device detectable sustained fast VA (cycle lengths <240ms) and cardiovascular death. During a mean follow-up of 21±20months, 15 primary endpoints including 12 unstable VAs and 3 device-detected fast VAs were met. One patient died of electrical storm, and one patient underwent heart transplantation. The presence of 3+ SAECG predicted malignant events in all patients with definite and non-definite ARVC (p<0.01, OR=30.5, 95% CI=2.5-373.7) and in patients with definite ARVC alone (p=0.03, OR=11.1, 95% CI=1.3-93.9). Patients diagnosed with non-definite ARVC without 3+ SAECG were free from malignant events. SAECG fulfilling all 3 Task Force criteria was an independent risk predictor of malignant events in ARVC patients. SAECG may play a valuable role in ARVC risk stratification.
    International journal of cardiology 04/2014; · 6.18 Impact Factor
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    ABSTRACT: Background A new risk model, the R2CHADS2 score, was proposed to be a powerful scoring scheme in predicting stroke or systemic embolism in atrial fibrillation (AF). The goal of the present study is to validate the usefulness of R2CHADS2 score among AF patients after catheter ablations. We also aimed to compare the accuracies of the CHA2DS2-VASc and R2CHADS2 scores for risk stratifications of thromboembolic (TE) events after ablation procedures. Methods We enrolled a total of 526 patients with AF who underwent catheter ablation. The clinical endpoint was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during the post-ablation follow-up. Results During a follow-up of 37.5+21.3 months, 14 patients (2.7%) experienced TE events. The R2CHADS2 score was an independent predictor of TE events in the multivariate analysis. Patients with a R2CHADS2 score of > 2 had a higher event rate compared to those with a score of 0 or 1 (0.5% versus 7.7%). The areas under the ROC curves of CHA2DS2-VASc and R2CHADS2 scores in predicting TE events were 0.832 and 0.872, respectively. The difference between these 2 curves did not reach statistical significance (p value = 0.338). In addition, the R2CHADS2 score did not improve net stroke risk reclassification over the CHA2DS2-VASc score (net reclassification improvement = -0.9%, p value = 0.948). Conclusions The R2CHADS2 and CHA2DS2-VASc scores could be used to predict TE events for AF patients receiving catheter ablations. The predictive accuracies of both scores were similar in this relatively small-sized cohort undergoing ablation.
    The Canadian journal of cardiology 04/2014; · 3.12 Impact Factor
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    ABSTRACT: Background: The impact of renal dysfunction has been investigated in patients with non-valvular atrial fibrillation (AF). The aim of this study was to assess its additive prognostic value in low thromboembolic risk AF patients with CHA2DS2-VASc score 0-1. Methods and Results: A total of 617 non-valvular AF patients were enrolled and baseline serum creatinine was measured. Estimated glomerular filtration rate and estimated clearance of creatinine were calculated using the Modification of Diet in Renal Disease equation and Cockcroft-Gault formula, respectively. The primary endpoint was cardiovascular death and systemic thromboembolic events, including acute ischemic stroke, transient ischemic attack, and peripheral artery embolism. Of these, 338 individuals had clinical CHA2DS2-VASc score 0-1. Among these individuals, 23 patients had impaired renal function. During the follow-up period of 53.6±32.1 months, the annual composite outcome rate in AF patients with CHA2DS2-VASc score 0-1 was 0.40%/year. As compared with patients with preserved renal function, the annual composite outcome rate was significantly higher in patients with impaired renal function (2.92%/year vs. 0.21%/year, P<0.001). Moreover, on multivariate Cox regression analysis, renal dysfunction was the only risk predictor in these low-risk patients. Conclusions: Impaired renal function has an additive prognostic value for thromboembolic events and cardiovascular mortality in low-risk AF patients with CHA2DS2-VASc score 0-1.
    Circulation Journal 02/2014; · 3.69 Impact Factor
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    ABSTRACT: Background Renal dysfunction is a significant risk factor of ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence amongst AF patients with end-stage renal disease (ESRD) are unclear. Objective The goal of the present study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AF patients with ESRD. Methods A total of 10,999 AF patients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan’s National Health Insurance Research Database. The study endpoint was occurrence of ischemic stroke. Results The median (IQR) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During the follow-up, 1,217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores were both significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (p<0.001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (p<0.0001). Among 1,409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years. Conclusions The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis, and was superior to CHADS2. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high risk patients remains to be defined.
    Heart Rhythm. 01/2014;
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    ABSTRACT: Background Radiofrequency catheter ablation (RFCA) is an effective therapeutic strategy in eliminating drug-refractory idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT VAs). It remains unclear what factors influence early and late VA recurrences after ablation. Objectives The aim of our study was to elucidate the differences between early and late recurrences after acute successful RFCA of RVOT VAs in a long-term follow-up. Methods A total of 220 patients with acute successful RFCA of RVOT VAs were enrolled. Detailed clinical characteristics and assessments by non-invasive and invasive electrophysiological studies were explored to predict the overall, early (≤ 1 year), and late VA recurrences (>1 year). Results During a mean follow-up of 34.15±33.74 months, 45 of the 220 patients (20.5%) documented recurrence of RVOT VAs after initial RFCA. Of them, 26 (57.8%) recurrent VA showed similar morphology, and 19 (42.2%) were different. Patients with recurrent VAs were associated with higher incidence of hypertension, higher systolic BP, identification of foci by pacemapping alone, shorter earliest activation time, more RF pulses required, and VA originating from anterior free wall. Multivariate analysis demonstrated that mapping strategy and shorter earliest activation time preceding VA were associated with early recurrences (P<0.001, HR:2.26, 95% CI: 1.49~3.42; P=0.008, HR:0.91, 95% CI: 0.85~0.98, respectively), whereas hypertension was associated with late recurrence (P=0.001, HR:3.48, 95% CI: 1.34~9.07). Conclusion RFCA is an effective strategy in elimination of RVOT VAs. However, early and late recurrences occur commonly. Patients with early and late VA recurrences demonstrated non-uniform patterns of clinical characteristics and electrophysiological properties.
    Heart Rhythm. 01/2014;
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    ABSTRACT: It is unclear whether atrial fibrillation (AF) adversely influences the clinical course of patients with hepatocellular carcinoma (HCC). During the period from January 1, 2001 to December 31, 2010, 476 patients (mean ± SD age 60.3 ± 12.9 years) diagnosed with HCC were retrospectively enrolled in our study. The HCC stage, treatment, baseline characteristics, underlying cardiovascular diseases, and corresponding drug treatment were systematically reviewed. The primary endpoint was death from any cause. AF was associated with a significantly reduced survival time in patients with HCC (AF vs. non-AF patients mean ± SD survival time 470.1 ± 89.6 days vs. 1161.2 ± 32.6 days, log-rank p < 0.001; probability of survival 0.20, 95% confidence interval 0.10-0.38, p < 0.001). After adjustment for gender and age, AF was still associated with poorer survival times (hazard ratio 4.131, 95% confidence interval 2.134-5.733, p < 0.001). The causes of death among 22 patients with both HCC and AF included 11 cases of hepatic failure, four cases of ruptured tumor, and two cases of bleeding from esophageal varices. None of these patients with AF used warfarin. Seven bleeding events related to HCC were noted, but none of these patients developed a major thromboembolism. The mean ± SD follow-up period was 645 ± 468 days. Patients with HCC had a significantly reduced survival time with the comorbidity of AF. Tumor rupture was relatively common among patients with both HCC and AF. The anticoagulation treatment of AF in patients with HCC deviated from the current guidelines without an increase in thromboembolic events.
    Journal of the Chinese Medical Association 12/2013; · 0.75 Impact Factor

Publication Stats

918 Citations
464.43 Total Impact Points

Institutions

  • 2007–2015
    • National Yang Ming University
      • • School of Medicine
      • • Institute of Clinical Medicine
      T’ai-pei, Taipei, Taiwan
  • 2007–2014
    • Taipei Veterans General Hospital
      • Cardiology Division
      T’ai-pei, Taipei, Taiwan
  • 2013
    • Mackay Memorial Hospital
      • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
  • 2009
    • Taipei Medical University
      • Division of Cardiology
      T’ai-pei, Taipei, Taiwan
  • 2008
    • Taichung Veterans General Hospital
      臺中市, Taiwan, Taiwan