Alex Pui-Wai Lee

Alex Pui-Wai Lee
The Chinese University of Hong Kong | CUHK · Department of Medicine and Therapeutics

MD MBChB (Hons) FACC FESC FRCP (Edin) FHKCP FHKAM (Medicine)

About

224
Publications
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Introduction
Prof. Lee is an academic cardiologist and physician-scientist. He specialises in cardiac imaging with particular interest in echocardiography. His main research interests are heart valve disease, heart failure, advanced techniques in echocardiography (3D, strain, and contrast), and the application of cardiac imaging in guiding valvular surgery and structural heart intervention. He is particularly keen in collaborating with engineers to innovate diagnostic and therapeutic strategies for cardiovas
Additional affiliations
November 2011 - present
The Chinese University of Hong Kong
Position
  • Professor (Assistant)

Publications

Publications (224)
Article
Full-text available
Objectives: This study aimed to assess the hypothesis that mitral annular disjunction (MAD) is associated with abnormal annular dynamics due to decoupling of annular-ventricular function. Background: MAD, defined as a separation between the atrial wall-mitral valve (MV) junction and left ventricular (LV) attachment, is a structural abnormality o...
Article
Full-text available
Background: Few data exist on the relation of the 3-dimensional morphology of mitral valve and degree of mitral regurgitation (MR) in mitral valve prolapse. Methods and results: Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 112 subjects, including 36 patients with mitral valve prolapse and significa...
Article
Full-text available
Recurrent functional mitral regurgitation (MR) has been reported after mitral valve repair with annuloplasty in patients with dilated cardiomyopathy, but the mechanism is not understood completely. The authors sought to identify abnormalities of the mitral valve and left ventricle that are associated with recurrent MR after mitral annuloplasty. In...
Article
Full-text available
A 78-year-old woman with atrial fibrillation and contraindication to oral anticoagulation because of high bleeding risk was referred for catheter-based left atrial appendage (LAA) occlusion. Preprocedural transesophageal echocardiography (TEE) using the biplane mode showed an LAA with double-lobed anatomy with a dominant posterior lobe (p) and an a...
Article
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Article
Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are associated with accelerated atherosclerosis driven by chronic Inflammation. We have previously reported that cumulative inflammatory burden, as reflected by cumulative averages of repeated measures of erythrocyte sedimentation rate (ca-ESR), was associated with increased arteria...
Article
Full-text available
Transcatheter edge-to-edge repair (TEER) therapy is recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for selected patients with symptomatic severe or moderate-severe mitral regurgitation (MR). Echocardiography, in particular transesophageal echocardiography (TEE), plays a critical role in procedural...
Article
Background Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional transesophageal echocardiography (3D-TEE) is more accurate than the two-dimensional (2D) modality for evaluation of the complex anatomy of LAA. However, 3D-TEE analysis of LAA is challenging and highly expe...
Poster
Full-text available
Background: Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Traditionally treated with anticoagulation by Warfarin, it is unclear if non-vitamin K oral anticoagulants (NOAC) are comparably efficacious and safe. Such data is also scarce in Asian patients. Purpose: To compare the clinical efficacy and safety of...
Article
Full-text available
Analysis of the cardiac vortex has been used for a deeper understanding of the pathophysiology in heart diseases. However, physiological changes of the cardiac vortex with normal aging are incompletely defined. Vector flow mapping (VFM) is a novel echocardiographic technique based on Doppler and speckle tracking for analysis of the cardiac vortex....
Article
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of shortness of breath and/or exercise intolerance secondary to elevated left ventricular filling pressures at rest or with exertion either as a result of primary diastolic dysfunction (primary HFpEF) or secondary to specific underlying causes (secondary HFpEF). In second...
Article
Background Real-time three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used in clinic for fast 3D analysis of cardiac anatomy and function. However, 3D TEE still suffers from the limited field of view (FoV). It is challenging to adopt conventional multi-view fusion methods to 3D TEE images because feature-based regis...
Article
Background: Deep-learning (DL) has been applied for automatic left ventricle (LV) ejection fraction (EF) measurement, but the diagnostic performance was rarely evaluated for various phenotypes of heart disease. This study aims to evaluate a new DL algorithm for automated LVEF measurement using two-dimensional echocardiography (2DE) images collecte...
Article
Full-text available
Background Psoriatic arthritis (PsA) is associated with accelerated atherosclerosis due to underlying inflammation. Whether inflammatory burden and drugs used to suppress inflammation over time are associated with cardiovascular (CV) events remains unclear. Objectives This study aims to examine the time-varying effect of C-reactive protein (CRP) l...
Article
Background Calprotectin is a member of S100 leukocyte. Serum calprotectin is a sensitive biomarker of disease activity in patients with psoriatic arthritis (PsA). While various CV risk score only shown modest correlation with augmented CV risk in patient with PsA, whether calprotectin could play an addition role remains uncertain. Objectives To el...
Article
Background Functional mitral regurgitation (FMR) is common in patients with myocardial infarction or dilated cardiomyopathy, and portends a poor prognosis despite guideline-directed medical therapy (GDMT). Surgical or transcatheter mitral repair for FMR from recent randomized clinical trials showed disappointing or conflicting results. Aims To pro...
Article
Full-text available
Aims Psoriatic arthritis (PsA) is associated with accelerated atherosclerosis due to underlying inflammation. Whether inflammatory burden and drugs used to suppress inflammation over time are associated with cardiovascular (CV) events remained unclear. This study aims to examine the time-varying effect of C-reactive protein (CRP) levels and the use...
Preprint
Full-text available
This paper presents a novel algorithm that registers a collection of mono-modal 3D images in a simultaneous fashion, named as Direct Simultaneous Registration (DSR). The algorithm optimizes global poses of local frames directly based on the intensities of images (without extracting features from the images). To obtain the optimal result, we start w...
Article
Full-text available
Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured p...
Article
Full-text available
3D direct planimetry is increasingly used in clinical practice as a rapid way to measure the mitral valve area (MVA) in patients with rheumatic mitral stenosis (MS) who underwent three-dimensional transesophageal echocardiography (3D-TEE). However, data on its accuracy and reliability are scarce. This study aimed to compare the MVA measurements obt...
Chapter
Using imaging data of human anatomy, 3D printing technology can be used for computer reconstruction. The data are the input for a 3D printer, and a structural model is constructed, which is convenient for direct visual inspection and operation [1]. Through more than twenty years of development, outstanding progress has been made in oral, maxillofac...
Chapter
Cardiomyopathy is a disease which involves heart tissue and is characterized by abnormal heart structure, heart failure, and arrhythmia, with great heterogeneity and diversity [1]. Cardiomyopathy can be classified into primary cardiomyopathy and secondary cardiomyopathy, and primary cardiomyopathy can be further classified into three types accordin...
Chapter
The coronary artery, which divides into the left coronary artery and the right coronary artery, is the first branch of the ascending aorta. The left coronary artery is a short trunk that originates from the left aortic sinus. It passes through the beginning of the pulmonary artery and the left atrial appendage and travels 3–5 mm along the coronary...
Chapter
The left atrial appendage (LAA) is a narrow, tubular, blind-ended structure extending anterolaterally from the main body of the left atrium (LA). The LAA is located above the LV, on the left side of the pulmonary artery and ascending aorta, between the left superior pulmonary vein and the mitral annulus. With prominent muscular ridges, the LAA has...
Chapter
3D printing materials are an important factor in the development of 3D printing technique in the cardiovascular field; however, the type and quality of materials for 3D printing remain a challenge. At present, polymeric materials and biomaterials are the ones mainly applied in the 3D printing cardiovascular field [1]. Of them, polymeric materials a...
Book
This book offers readers a comprehensive introduction to the techniques and application of 3D printing in cardiovascular medicine. To do so, it addresses the history, concepts, and methods of 3D printing, choice of printing materials for clinical purposes, personalized planning of cardiac surgery and transcatheter interventions with patient-specifi...
Article
Introduction: The genetic mutation IVS4+919G>A commonly found among Chinese is associated with later-onset cardiac variant of Fabry disease (FD). Patients with left ventricular hypertrophy (LVH) may be screened for FD by measuring plasma α-galactosidase activity. Objective: The aim of our study is to determine the prevalence of FD among Chinese LVH...
Article
Background Atherosclerosis is an important medical problem of modern society. High environmental tobacco smoke in casino is associated with an accelerated atherogenic process. We have previously shown vitamin B12 and C supplementation improves vascular reactivity and may be beneficial in vascular protection.Objective To evaluate the impact of vitam...
Article
Fabry Disease (FD) is a systemic disorder that can result in cardiovascular, renal, and neu- rovascular disease leading to reduced life expectancy. FD should be considered in the dif- ferential of all patients with unexplained left ventricular hypertrophy (LVH). We therefore performed a prospective screening study in Edmonton and Hong Kong using Dr...
Article
Background: Patients with hypertension may develop thoracic aortic aneurysm (TAA) that can be asymptomatic but potentially life-threatening. We sought to assess the prevalence of asymptomatic TAA among hypertensive patients with a point-of-care screening program using pocket-size mobile echocardiographic (PME) devices. Methods: We prospectively...
Article
Full-text available
Objectives: This study aimed to assess the performance of carotid ultrasound (US) parameters alone or in combination with Framingham Risk Score (FRS) in discriminating patients with psoriatic arthritis (PsA) with and without coronary artery disease (CAD). Methods: Ninety-one patients with PsA (56 males; age: 50±11 years, disease duration: 9.4±9....
Article
Objective To examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis. Methods A cohort analysis was performed in patients with PsA who had been followed...
Article
Full-text available
Objectives: Transcatheter aortic valve implantation is a recognized treatment for patients with severe aortic stenosis at all risk groups. However, permanent pacemaker rates remain high for self expandable transcatheter valves and permanent pacemaker implantation has been associated with increased morbidity. In this analysis we aim to evaluate sho...
Article
The term atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease, typically in the setting of long-standing atrial fibrillation. Recent evidence suggests that atrial functional mitr...
Poster
Full-text available
Background: Heart failure with reduced ejection fraction (HFrEF) is associated with structural and functional changes of the left ventricle. Analysis of intracardiac vortex flow by vector flow mapping (VFM) is a novel technique which may shed new light on the pathophysiology of HFrEF. This study aimed to compare the intracardiac vortex between HFrE...
Article
Background While carotid ultrasound (US) has been advocated for cardiovascular (CV) risk screening in patients with rheumatoid arthritis as various traditional scores underestimate CV risk, whether subclinical carotid atherosclerosis (SCA) is associated with coronary atherosclerosis on coronary computed tomography angiography (CCTA) in patients wit...
Article
Objectives Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance.DesignObservational study.SettingWe tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevale...
Article
Objective: PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the va...
Article
Full-text available
Echocardiography is a key evaluation tool for the diagnosis, prognosis, and guidance of interventional management of numerous cardiovascular conditions, including ischaemia, heart failure, and structural heart diseases. Recent technological advancements have also seen the exploration of artificial intelligence, intracardiac vortex imaging, and thre...
Article
The commonly used left atrial appendage (LAA) occlusion (LAAO) devices, Watchman (Boston Scientific, Marlborough, MA, USA) and Amulet (Abbott, Plymouth, Minnesota, USA), both rely on oversizing for stabilization. Therefore, occluding large LAA (ostium >=31mm for Watchman or landing zone >=31mm for Amulet) are not possible. LAmbre (Lifetech Scientif...
Article
Funding Acknowledgements CUHK Direct Grant, CUHK Lui Che Woo Institute of Innovative Medicine, Food and Health Bureau of HKSAR (EF); Hong Kong Jockey Club Charities Trust (JW) Background/Introduction 6-min walk distance (6MWD) can indicate frailty extent, cardiac dysfunction, and heart failure (HF) trajectory. Association of 6MWD with diastolic dys...
Article
Background Patients with hypertension may develop thoracic aortic aneurysm (TAA) that can be asymptomatic but potentially life-threatening. We sought to assess the prevalence of asymptomatic TAA among hypertensive patients and define the effectiveness of a TAA point-of-care screening program using pocket-size mobile echocardiographic (PME) devices....
Article
Three-dimensional (3D) printing refers to the process by which physical objects are built by depositing materials in layers based on a specific digital design. It was initially used in manufacture industry. Inspired by the technology, clinicians have recently attempted to integrate 3D printing into medical applications. One of the medical specialti...
Article
Background Brugada syndrome (BrS) is an inherited ion channelopathy that may predispose affected individuals to atrial cardiomyopathy. We tested the hypothesis that BrS patients have higher degrees of atrial electrophysiological abnormalities compared to controls, and these can be reflected by changes in P-wave parameters determined on the electroc...
Article
Full-text available
Background Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and L...
Article
Background: Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. Accurate device sizing is crucial for optimal outcome. Patient-specific LAA models can be created using three-dimensional (3D) printing from 3D transesophageal echocardiographic (TEE) images, allowing i...
Conference Paper
According to the Hospital Authority’s Statistical Report 2015–2016, heart failure (HF) was the leading cause of admission in Cardiology. The total number of HF admissions have increased by 14% in 10 years. Moreover, increasing frequency of acute decompensated HF has resulted in higher rates of hospitalisation and mortality. It is recognised that th...
Conference Paper
Fabry disease (FD) is an X-linked inherited lysosomal storage disorder that results from mutations in the α-galactosidase A gene (GLA), leading to deficient alpha-galactosidase A (α-GalA) activity and subsequent accumulation of globotriaosylceramide (Gb3) in a variety of tissues.¹ The estimated prevalence of classic FD in males ranges from 1:8000 t...
Article
Although reported failure rates of the Watchman device are low, the ballshaped device is not suitable for shallow and multilobed left atrial appendages (LAAs). The LAmbre device is available in two configurations - standard (cover 4-6 mm larger in diameter than the umbrella) and special (cover 12- 14 mm larger than the umbrella) - which allows the...
Article
Aims: We aimed to compare long-term "real-world" outcomes of three left atrial appendage occlusion (LAAO) devices for stroke prevention in a Chinese population with non-valvular atrial fibrillation (NVAF). Methods and results: Consecutive patients who underwent LAAO from June 2009 to October 2016 at a university-affiliated hospital were retrospe...
Article
Objective To test the utility of the FRAIL questionnaire as a screening tool for heart failure. Design Cross sectional study. Setting Chinese older people in Hong Kong. Participants Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two non...
Article
Background Carbohydrate antigen-125 (CA125) is an ovarian cancer marker, but recent work has examined its role in risk stratification in heart failure. A recent meta-analysis examined its prognostic value in heart failure generally. However, there has been no systematic evaluation of its role specifically in acute heart failure (AHF). Methods PubM...
Article
A 72-year-old woman with severe mitral and tricuspid regurgitation secondary to chronic atrial fibrillation presented with refractory heart failure despite optimal medical treatment. She was considered inoperable, and thus underwent transcatheter edge-to-edge repair of both valves using the MitraClip system as a compassionate use.
Article
Full-text available
Objectives We aimed to investigate the effects of achieving minimal disease activity (MDA) on the progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA). Methods 101 consecutive PsA patients were recruited for this prospective cohort study. All patients received protocolized treatment targeting...
Article
Full-text available
Background: Atrial fibrillation (AF) can result in atrial functional mitral regurgitation (MR), but the mechanism remains controversial. Few data about the relationship between the 3-dimensional morphology of the MV and the degree of MR in AF exist. Methods: Real-time 3-dimensional transesophageal echocardiography (3D-TEE) of the MV was acquired...
Article
Background In patients with remarkably enlarged cardiac chambers and history of implantation of older types of mitral valve prosthesis, the considerations for reoperative tricuspid valve surgery are not limited to the risks of sternal reentry but also include the dilemma of whether to carry out prophylactic replacement of the normal functioning but...
Article
This study aims to define the clinical history and significance of mitral leaflet (ML) adaptation in ischemic mitral regurgitation (IMR). Mitral regurgitation (MR) (leaking of left heart valve) frequently complicates myocardial infarction (MI) (heart attack) and is associated with doubled mortality and morbidity. Unfortunately, its mechanism is inc...