Chi-Jen Chang

Chang Gung University, Hsin-chu-hsien, Taiwan, Taiwan

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Publications (46)106.93 Total impact

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    ABSTRACT: Dilated inferior vena cava (IVC) is prevalent among patients with heart failure (HF), but whether its presence predicts worsening renal function (WRF) or adverse outcomes is unclear. This cohort study analyzed patients with left ventricular ejection fraction <40 % and repeated hospitalizations (≥2 times) for HF between August 2009 and August 2011. The study endpoints were death and HF re-hospitalization. Among baseline parameters, IVC diameter was the most powerful predictor for the development of WRF (area under the curve = 0.795, cut-off value = 20.5 mm). During the 2-year follow-up, 36 patients (49 %) were re-hospitalized for HF and 14 patients (19 %) died. The event rates were significantly greater in the WRF group than in the non-WRF group (71 vs. 30 %, P < 0.001 for HF re-hospitalization; 29 vs. 10 %, P = 0.03 for death). In Cox regression model, the risk of combined end-points was increased in patients with aging, elevated blood urine nitrogen, IVC >21 mm, and WRF. When adjusted for confounding factors, IVC >21 mm [hazard ratio (HR) 3.73, 95 % confidence interval (CI) 1.66-8.34] and WRF (HR 2.68, 95 % CI 1.07-6.75) were significant predictors for adverse outcomes. In patients with advanced decompensated HF, dilated IVC (>21 mm) predicted the development of WRF and could be a predictor for adverse outcomes.
    No preview · Article · Jun 2014 · The International Journal of Cardiovascular Imaging
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    ABSTRACT: Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complication percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.
    Preview · Article · Sep 2013 · Journal of Geriatric Cardiology
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    ABSTRACT: Purpose: Large epidemiologic studies have associated gouty arthritis with the risk of coronary heart disease. However, there has been a lack of information regarding outcomes for patients who have gout attacks during hospitalization for acute myocardial infarction. Methods: We reviewed the data of 444 consecutive patients who were admitted to our hospital between 2005 and 2008 due to acute ST elevation myocardial infarction (STEMI). The clinical outcomes were compared between patients with gout attack and those without. Results: Of the 444, 48 patients with acute STEMI developed acute gouty arthritis during hospitalization. The multivariate analysis identified prior history of gout and estimated glomerular filtration rate as independent risk factors of gout attack for patients with acute STEMI (odds ratio [OR] 21.02, 95% CI 2.96–149.26, p=0.002; OR 0.92, 95% CI 0.86–0.99, p=0.035, respectively). The in-hospital mortality and duration of hospital stay did not differ significantly between the gouty group and the non-gouty group (controls). During a mean follow-up of 49±28 months, all-cause mortality and stroke were similar for both groups. Multivariate Cox regression showed that gout attack was an independent predictor for short- and long-term adverse non-fatal cardiac events (hazard ratio [HR] 1.88, 95% CI 1.09–3.24, p=0.024; HR 1.82, 95% CI 1.09–3.03, p=0.022, respectively). View this table:Enlarge table
    Preview · Article · Aug 2013 · Clinical Rheumatology
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    ABSTRACT: Impaired left ventricular (LV) strain is associated with an increased risk of cardiac events in asymptomatic severe aortic stenosis (AS). We aimed to evaluate the prognostic value of global LV strain in conservatively treated patients with symptomatic AS. This cohort study retrospectively reviewed symptomatic AS patients who were treated conservatively or surgically between July 2007 and April 2010. We measured their global longitudinal strain (GLS) and global circumferential strain (GCS). Clinical events were defined as readmission for heart failure or all-cause death for 2 years. GLS and GCS could predict a worse outcome in the conservatively treated group at cut-offs of =-16.5% (77% sensitivity and 67% specificity) and =-22.2% (92% sensitivity and 83% specificity), respectively. By univariate Cox regression analysis, age, logistic EuroSCORE, aortic valve area, GLS, and GCS were significant predictors. When adjusted for age, logistic EuroSCORE, and aortic valve area, impaired GLS and GCS were independently associated with a higher risk of clinical events. In conservatively treated patients with symptomatic AS, impaired GLS and GCS were associated with an increased risk of cardiac events during a 2-year follow-up. Global LV strain may help to define a higher risk subset; therefore, a larger and prospective observation study would be necessary.
    Full-text · Article · Jul 2013 · Journal of Cardiology
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    ABSTRACT: Objective: Previous investigations have revealed an association between the ABO locus/blood group and total cholesterol and inflammatory biomarker levels. We aimed to test the statistical association of ABO locus variants with lipid profiles and levels of thirteen inflammatory markers in a Taiwanese population. Methods and results: A sample population of 617 Taiwanese subjects was enrolled. Five ABO gene region polymorphisms were selected and genotyped. After adjusting for clinical covariates and inflammatory marker levels, the genetic-inferred ABO blood group genotypes were associated with sE-selectin level (P = 3.5 × 10(-36)). Significantly higher total and low-density lipoprotein cholesterol (LDL-C) levels were noted in individuals with blood group A (P = 7.2 × 10(-4) and P = 7.3 × 10(-4), respectively). Interestingly, after adjusting for sE-selectin level, significantly lower high-density lipoprotein cholesterol (HDL-C) level as well as higher triglyceride (TG) level and ratio of triglyceride to HDL-C (TG/HDL-C ratio) were noted in individuals with blood group A comparing to non-A individuals (P = 0.009, P = 0.004 and P = 0.001, respectively); these associations were also observed in the group A male subjects (P = 0.027, P = 0.001, and P = 0.002, respectively). Mediation analysis further revealed a suppression effect of sE-selectin level on the association between genetic-inferred ABO blood group genotypes and TG/HDL-C ratio in total participants (P = 1.18 × 10(-6)) and in males (P = 5.99 × 10(-5)). Conclusion: Genetic variants at the ABO locus independently affect sE-selectin level in Taiwanese subjects, while the association of ABO locus variants with TG/HDL-C ratio is suppressed by sE-selectin level in Taiwanese males. These results provided further evidence for the mechanism in the association of ABO blood groups with atherosclerotic cardiovascular diseases.
    No preview · Article · Apr 2013 · Atherosclerosis
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    ABSTRACT: Several strategies have been found to be associated with a significant reduction in door-to-balloon (D2B) time in the management of ST-segment elevation myocardial infarction (STEMI). The objective of this retrospective cohort study was to assess D2B time before and after specific hospital strategies, including a computerized provider order entry (CPOE), were implemented to reduce D2B time. Patients who presented to the emergency department within 12 h of STEMI were enrolled. Strategies adopted included: (1) electrocardiography during triage for patients with chest pain; (2) implementing a CPOE; (3) activating the catheterization laboratory by sending a cell phone notification via the computer system; (4) using an open real-time on-line STEMI registry; and (5) conducting a monthly meeting to review registration. A total of 134 patients were included in the study (preintervention, n = 69; postintervention, n = 65). Median D2B time improved from 83 to 63 min after the new strategies were implemented (P = 0.001). Median door-to-electrocardiogram (5-2 min) and door-to-laboratory time (60-41 min) also significantly improved (P < 0.001). The proportion of patients with a D2B time within 90 min increased from 59.4 % to 98.5 % (P < 0.001). In conclusion, our findings suggest that implementing specific strategies can substantially improve D2B time for patients with STEMI and increase the proportion of patients with D2B time less than 90 min.
    No preview · Article · Mar 2013 · Heart and Vessels
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    ABSTRACT: Caffeic acid phenethyl ester (CAPE) is an active component of propolis that exhibits cardioprotective and antiarrhythmic effects. The detailed mechanisms underlying these effects, however, are not entirely understood. The aim of this study was to elucidate the electromechanical effects of CAPE in guinea-pig cardiac preparations. Intracardiac electrograms, left ventricular (LV) pressure, and the anti-arrhythmic efficacy were determined using isolated hearts. Action potentials of papillary muscles were assessed with microelectrodes, Ca(2+) transients were measured by fluorescence, and ion fluxes were measured by patch-clamp techniques. In a perfused heart model, CAPE prolonged the atrio-ventricular conduction interval, the Wenckebach cycle length, and the refractory periods of the AV node and His-Purkinje system, while shortening the QT interval. CAPE reduced the occurrence of reperfusion-induced ventricular fibrillation and decreased LV pressure in isolated hearts. In papillary muscles, CAPE shortened the action potential duration and reduced both the maximum upstroke velocity and contractile force. In fura-2-loaded single ventricular myocytes, CAPE decreased cell shortening and the Ca(2+) transient amplitude. Patch-clamp experiments revealed that CAPE produced a use-dependent decrease in L-type Ca(2+) current (I(Ca,L)) (IC(50)=1.1μM) and Na(+) current (I(Na)) (IC(50)=0.43μM), caused a negative-shift of the voltage-dependent inactivation and a delay of recovery from inactivation. CAPE decreased the delayed outward K(+) current (I(K)) slightly, without affecting the inward rectifier K(+) current (I(K1)). These results suggest that the preferential inhibition of Ca(2+) inward and Na(+) inward currents by CAPE may induce major electromechanical alterations in guinea-pig cardiac preparations, which may underlie its antiarrhythmic action.
    No preview · Article · Feb 2013 · European journal of pharmacology
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    ABSTRACT: Background: Mutations in bone morphogenetic protein receptor type II (BMPR2) and activin-like kinase 1 (ALK1), have been implicated in the pathogenesis of heritable or idiopathic pulmonary arterial hypertension (HPAH/IPAH). However, there was still a lack of information regarding the underlying genetic factors in Taiwanese PAH patients. Methods: A total of 6 patients diagnosed with IPAH were enrolled in this study. The entire protein-coding region and intron/exon boundaries of the BMPR2 and ALK1 genes were amplified by polymerase chain reaction and analyzed by direct sequencing. Results: We identified 3 patients with BMPR2 heterozygous exonic mutations. One was a missense mutation, R491W. The second was a 2-base pair (bp) TG deletion at positions 1446 and 1447 relative to the translation start site. The third was a 2-bp CA deletion replaced by a single nucleotide T insertion at positions 991 and 992. The latter two mutations are novel and expected to result in frame shifts and premature termination. None of these 6 patients carried exonic mutations in the ALK1gene. Conclusion: A substantial portion of Taiwanese IPAH patients carry BMPR2 mutations. Since mutations in BMPR2 may be heritable and are associated with poor prognosis, genetic screening for BMPR2 mutations may be necessary for Taiwanese IPAH patients.
    Full-text · Article · Sep 2012 · Acta Cardiologica Sinica
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    ABSTRACT: We aimed to investigate the association between the ABO blood groups and the risk of coronary artery disease (CAD) and myocardial infartion (MI) in a young Taiwanese population. We retrospectively recruited 277 consecutive subjects (men younger than 45 years and women younger than 55 years) who underwent coronary angiography (136 with documented CAD and 129 without CAD) at our center, between 2005 and 2008. Their ABO blood groups were determined using standard agglutination techniques. Patients with CAD showed a significantly different blood group distribution (O, 30.1%; A, 39.7%; B, 26.5%; AB, 3.7%) than that shown by the controls (O, 42.6%; A, 24.0%; B, 27.1%; AB, 6.2%; p=0.032). Patients with blood group A had a greater risk of CAD and MI than those with non-A blood groups (OR=2.08, 95% CI=1.23-3.54; OR=2.21, 95% CI=1.19-4.09, respectively). After adjustment for common cardiovascular risk factors such as age, gender, hypertension, cigarette smoking, diabetes mellitus, body mass index, family history of CAD, and lipid profiles; blood group A remained significantly associated with an increased risk of CAD and MI (OR=2.61, 95% CI 1.11-6.14, p=0.028; OR=3.53, 95% CI=1.21-10.29, p=0.021, respectively). Our findings suggest that blood group A is an independent risk factor for CAD and MI in young people in Taiwan.
    No preview · Article · Jul 2012 · Internal Medicine
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    ABSTRACT: Background: The use of combined SYNTAX score and EuroSCORE to predict two-year cardiac mortality in de-novo left main coronary artery (LMCA) disease patients undergoing percutaneous coronary intervention (PCI) has been discussed. Whether the combination of these two parameters could also predict the clinical outcomes in de-novo LMCA patients undergoing bypass surgery remains unknown. Method: From April 2003 to June 2008, 86 patients with de-novo LMCA disease undergoing coronary artery bypass surgery (CABG) were studied. Patients were divided into three subgroups of global risk classification (GRC), low-risk group (n = 44), intermediate-risk group (n = 28), and high-risk group (n = 14) according to their SYNTAX score and EuroSCORE. The baseline characteristics were compared between different risk subgroups of GRC. The differences of clinical outcomes in terms of major cardiovascular and cerebrovascular events (MACCEs) between different risk subgroups of GRC were compared. Results: Compared with the low-risk group, the high-risk group showed a significantly higher proportion of myocardial infarction (50.0% vs. 18.2%), congestive heart failure (21.4% vs. 2.3%), and cardiogenic shock (7.1% vs. 0.0%; p = 0.02), higher SYNTAX score (48.7 ± 5.6 vs. 27.5 ± 6.8; p < 0.01), higher EuroSCORE (7.7 ± 1.9 vs. 2.7 ± 1.5; p < 0.01), a higher proportion of diabetes mellitus (85.7% vs. 43.2%; p = 0.02), prior stroke (28.6% vs. 4.6%; p = 0.03), and peripheral arterial occlusive disease (28.6% vs. 2.3%; p < 0.01), and lower ejection fraction (50.8 ± 17.4 vs. 66.5 ± 14.1, p < 0.01). Using multivariable Cox-regression proportional regression with the forward conditional method, the global risk classification (GRC) predicted long-term cumulative MACCEs (p < 0.01, HR: 4.45, 95% CI: 2.48-7.99). The Kaplan-Meier Curve with log-rank test displayed significant differences of long-term MACCEs (p < 0.01; c 2 = 39.08) between different subgroups of GRC. Conclusion: The new GRC system effectively predicts long-term MACCEs of de-novo LMCA disease patients undergoing CABG.
    Full-text · Article · Jun 2012 · Acta Cardiologica Sinica
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    ABSTRACT: A large-lumen guiding catheter is often used for complex percutaneous coronary intervention-particularly when a final kissing-balloon or 2-stent technique is required. However, catheter insertion is sometimes restricted by diseased vascular access sites or a tortuous vascular route.We report 2 cases in which a unique double guiding catheter technique was used to create a lumen of sufficient size for complex percutaneous coronary intervention. In each patient, two 6F guiding catheters were used concurrently to engage the ostium of 1 target vessel. In 1 patient, these catheters were used for the delivery of 2 balloons to complete kissing-balloon dilation after single-stent placement. In the other patient, the catheters were used to deliver 2 stents sequentially to their respective target lesions. The stents were then deployed simultaneously as kissing stents, followed by high-pressure kissing-balloon postdilation.
    Full-text · Article · Feb 2012 · Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
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    ABSTRACT: Background: There have been conflicting reports of the association between the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene, and the risk of venous thromboembolism (VTE). We sought to investigate the association between ACE I/D polymorphism, and the risk of VTE in a Chinese population living in Taiwan. Methods: 176 patients with VTE and 321 age and sex-matched controls were analyzed for the ACE I/D polymorphism by polymerase chain reaction. Results: The genotype distribution of the ACE I/D polymorphism was not statistically different between the VTE affected subjects and the group of unaffected subjects (p = 0.057). Notably, the frequency of ACE D allele in patients with VTE were significantly lower than that in the control group (28% vs. 35%, p = 0.018). After adjusting for age, gender, smoking, hypertension, diabetes and body mass index (BMI), the ACE D allele carriers remained significantly associated with a decreased risk of VTE. Further meta-analysis by pooling data from 15 studies revealed that neither the DD, nor the II genotype, was found to be associated with VTE (pooled unadjusted odds ratio were 1.167, 95% confidence intervals, 0.927-1.470, p = 0.189 for DD, and 1.085, 95% confidence intervals, 0.875-1.345 p = 0.460 for II). Conclusion: Our results suggest that the presence of the D allele may confer protection against the development of VTE in an ethnically Chinese population in Taiwan. Further meta-analysis did not support a relationship between the ACE I/D polymorphism and the risk of VTE.
    Full-text · Article · Dec 2011 · Acta Cardiologica Sinica
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    Chia-Pin Lin · Junko Honye · Chi-Jen Chang · Chi-Tai Kuo
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    ABSTRACT: Intravascular ultrasound (IVUS) employs a miniature ultrasound probe positioned at the tip of a coronary catheter to emit ultrasound signal which is reflected from surrounding tissue and then reconstructed into a real-time tomographic gray-scale image. IVUS directly images the vessel inside, allowing measurement of plaque morphology, distribution and exact vessel composition. Recent technical developments enable processing of the backscattered ultrasound radiofrequency signal underlying the gray-scale image. Therefore, IVUS can now provide more accurate measurement of tissue properties than traditional gray-scale images by different methods of tissue characterization. Thin-cap fibroatheroma by virtual histology was a proved risk factor for future cardiac events. Clinical trials disclosed significant improvement in patient outcome and reduced complications by IVUS-guided percutaneous coronary intervention (PCI), which can also provide more information in angiographic ambiguous lesions. 3-4 mm 2 for non-left main (LM) lesion or 5.9-7.5 mm 2 for LM lesion are considered the cut-off minimal lumen areas to identify significant stenosis. After stenting, in-stent minimal area ³ 90% of the average reference lumen area or ³ 100% of the lumen area of the reference segment with the lowest lumen area are IVUS-acceptable. In conclusion, IVUS is a powerful imaging modality which can provide more information before, during and after PCI to facilitate the procedure. Therefore, it should be used more widely in order to improve clinical outcomes and quality of our interventions.
    Full-text · Article · Mar 2011 · Acta Cardiologica Sinica
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    ABSTRACT: Although inflammation has been shown to play an important role in metabolic syndrome (MetS), the association between inflammatory marker gene polymorphisms and the risk of MetS has not been fully elucidated. This study was initiated to investigate the association between functional variants of inflammatory marker genes and the risk of MetS in Taiwanese adults. The sample population comprised 615 unrelated subjects, of which 22% had MetS. The single nucleotide polymorphisms rs5491 on the intercellular adhesive molecule 1 (ICAM1) gene and rs3091244 on C-reactive protein (CRP) were genotyped. The ICAM1 rs5491 polymorphism was significantly associated with the level of soluble intercellular adhesive molecule 1 (P < .001). Both the ICAM1 rs5491 and the CRP rs3091244 were shown to have significant association with MetS after adjustment for age, sex, smoking, and body mass index, but not after adjustment for levels of the respective serum marker. Independent associations between the combined ICAM1-CRP (rs5491 and rs3091244) genotypes and MetS were found by multivariate analysis (P = .005). In subgroup analysis, association of combined genotypes with insulin resistance and MetS mainly occurred in subjects with central obesity. In conclusion, inflammatory marker gene polymorphisms play an important role in modulating the risk of insulin resistance and MetS for subjects with central obesity. These findings will contribute toward a better understanding of the mechanism of association between inflammatory markers and the risk of developing atherosclerotic disease.
    No preview · Article · Dec 2010 · Metabolism: clinical and experimental
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    ABSTRACT: After being anastomosed with the artery, vein graft is exposed to abruptly increased hemodynamic stresses. These hemodynamic stresses may change the profile of endothelial gap junction expression as demonstrated in the artery, which may subsequently play active roles in physiological adaptation or pathophysiological changes of the vein grafts. We investigated the endothelial expression of gap junction in the venous vessels exposed to different hemodynamic stresses. Immunocytochemical analysis of the endothelial Cx expression was performed by observing the whole mounts of inferior vena cava (IVC) of aortocaval fistula (ACF) rats or IVC-banded ACF rats using confocal microscope. Immunocytochemical analysis demonstrated that in the endothelium of the native vein, the gap-junctional spot numbers (GJSNs) and the total gap-junctional areas (TGJAs) of Cx40 and Cx43 were lower than those of the thoracic aorta and that Cx37 was hardly detectable. In the IVCs of ACF rats, which were demonstrated to be exposed to a hemodynamic condition of high flow velocity and low pressure, the GJSNs and the TGJAs of all three Cxs were increased. In the IVCs of IVC-banded ACF rats, which were exposed to a hemodynamic condition of high pressure and low flow velocity, the GJSNs and the TGJAs of Cx37 increased markedly and those of Cx40 and Cx43 remained without significant changes. In conclusion, the endothelial expressions of gap junctions in the native veins were lower than those of the arteries. When exposed to different hemodynamic stresses, the gap junctions were expressed in specific patterns.
    Full-text · Article · Dec 2010 · Journal of Histochemistry and Cytochemistry
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    ABSTRACT: Background: The status of percutaneous coronary intervention (PCI) for the treatment of left main coronary artery (LMCA) disease remains undetermined, and relatively few data on Taiwanese population has been published. Method: Between March, 2003 and October, 2008, 121 patients with de-novo significant LMCA disease were included into this study. Eighty-seven patients received coronary artery bypass surgery (CABG) for LMCA disease, and 34 patients received PCI for LMCA disease. Significant LMCA disease was defined as at least > 50% stenosis of the left main coronary artery. The differences of clinical outcomes between the two treatment strategies were compared with respect to the in-hospital major adverse events rate and long-term major adverse cardiovascular and cerebrovascular events (MACCE) rate. Results: There were no significant differences in terms of baseline characteristics between the two groups. The overall all-cause mortality with MACCE was 32.2% in the CABG group, and 35.3% in the PCI group (p = 0.74). The overall mortality throughout the study period was 17.2% in the CABG group, and 5.9% in the PCI group (p = 0.09). The CABG group had significantly higher in-hospital major adverse event rates (27.6%) than the PCI group (8.8%) (p = 0.02) after adjustment of potential covariates. Long-term cumulative MACCE rates were 15% in the CABG group, and 32.4% in the PCI group, respectively (p = 0.02). The lower MACCE rate in the CABG group was mainly due to lower revascularization rate in the CABG group than in the PCI group (8.8% vs. 29.4%; p < 0.01). Conclusion: The CABG group conferred significantly higher in-hospital major adverse event rate but significantly lower long-term MACCE rate in patients with significant LMCA disease. The CABG group displayed numerically higher incidence of all-cause mortality throughout the study period. PCI could be considered an alternative option for patients with unprotected LMCA disease.
    Full-text · Article · Dec 2010 · Acta Cardiologica Sinica
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    ABSTRACT: Repeated puncture is a mechanical injury to the hemodialysis accesses. We systemically observed the vascular changes at the puncture segments of arteriovenous fistulas. The native arteriovenous fistulas in 104 patients on maintenance hemodialysis using the buttonhole technique for puncture were studied. We used the duplex scan to observe the intimal lesions, the maximal diameters at the arterial and venous puncture segments, and the references. Intimal lesions were found in 42% and 40% of the arterial and venous puncture segments, none of which resulted in significant luminal stenosis. The differences between diameters at the arterial or venous puncture segments and the corresponding references were significant (arterial, 11.07 +/- 4.45 vs 6.85 +/- 2.35 mm, P < .001; venous, 8.82 +/- 4.13 vs 5.54 +/- 2.22 mm, P < .001). All segments, except only three arterial and four venous puncture segments, were larger than the corresponding references. The degree of vascular dilatation, defined as the diameter difference between the puncture segments and the references calibrated by the reference diameter, were 64.1 +/- 49.6% at arterial puncture segments and 59.9 +/- 42.2% at venous segments. Multivariate analysis revealed that the patient age and the puncture duration were strongly correlated with the degree of vascular dilatation at both the arterial (P = .018 and .007, respectively) and venous puncture segments (P = .020 and .011, respectively). Puncture of arteriovenous fistula using a buttonhole technique resulted in a consistent vascular dilatation and moderately high incidence of intimal thickness, but no significant luminal stenosis was found.
    Preview · Article · Sep 2010 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
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    ABSTRACT: Mechanical discoordination as studied by magnetic resonance imaging has been shown to be a better predictor of left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) compared with mechanical dyssynchrony. This study assessed the value of acute recoordination derived from speckle-tracking echocardiography for predicting response to CRT compared with acute resynchronization. Thirty patients with heart failure scheduled for CRT were studied at baseline, immediately after CRT, and after 6 months of CRT. Acute recoordination after CRT was indexed by an acute reduction in radial discoordination index (RDI), defined as the ratio of average myocardial thinning to thickening during the ejection phase. CRT responders were defined as those patients whose LV end-systolic volume decreased by >or= 15% at the 6-month follow-up. Immediately after CRT, the responders (n = 18) demonstrated a significant reduction in RDI (P < .001), which was sustained at the 6-month follow-up (P < .001). The nonresponders, however, did not show a significant change in RDI after CRT. LV reverse remodeling at the 6-month follow-up was significantly correlated with acute recoordination (r = 0.75, P < .001) but weakly correlated with acute resynchronization (r = 0.43; P = .02). Receiver operating characteristic analysis revealed that acute recoordination provided the best separation for prediction of CRT responders compared with acute resynchronization, baseline dyssynchrony, or baseline discoordination. LV recoordination after CRT is an acute phenomenon and predicts response to CRT at 6-month follow-up better than resynchronization.
    No preview · Article · Apr 2010 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: Background: Pulmonary arterial hypertension (PAH) is a serious and often progressive disorder that results in right ventricular dysfunction and mortality. Brain natriuretic peptide (BNP) is a useful cardiac biomarker for left-side heart failure. Reports about serial plasma BNP levels in PAH are limited. The aim of this article is to report serial plasma BNP determination in 6 PAH patients, who received therapy based on one of the endothelin receptor antagonists, bosentan. Methods: Starting from September 2004 to September 2007, we enrolled 6 PAH patients (4 males, 2 females; mean age: 33 years) who received bosentan therapy. Four patients had been diagnosed with idiopathic pulmonary hypertension (IPAH) and two had PAH associated with systemic lupus erythematosus (SLE). All patients were in World Health Organization (WHO) functional class III. All the patients with IPAH received right-heart catheterization and acute vasoreactivity test with nitric oxide inhalation. Plasma BNP measurement, 6-min walk test, and echocardiographic evaluation of right ventricular function were performed regularly every 3 to 6 months and in case of clinical worsening. Results: There was no mortality for a mean follow-up period of 33 months. During the follow-up period, the BNP levels fluctuated. There was a decrease in plasma BNP after bosentan therapy. Right-heart catheterization, 6-min walk distance, and echocardiography results were also presented in this report. During follow-up, 3 IPAH patients received combination therapy due to disease progression, 2 patients developed pericardial effusion, and 2 patients had an elevation of plasma BNP level with deterioration of clinical conditions. Conclusion: There is an initial decrease in plasma BNP in PAH patients under treatment with oral bosentan. Serial measurement of plasma BNP may help clinical judgement and management in PAH.
    Full-text · Article · Sep 2009 · Acta Cardiologica Sinica
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    ABSTRACT: Percutaneous coronary intervention (PCI) is the preferred treatment modality for patients with acute coronary syndrome, but the "no-reflow" phenomenon, primarily caused by distal embolism, has hampered the effectiveness of PCI as regards reperfusion of the myocardium. Thrombus aspiration is sometimes used to reduce the incidence of distal embolism, but potentially the procedure may be complicated by upstream thrombus migration and systemic embolism. Two cases of systemic embolism during thrombus aspiration are presented. One patient had embolism of the cerebral artery and the other embolism of the left radial artery. It is suggested that a large-lumen guiding catheter with a deep-seated position and gentle injection of contrast medium should be used for thrombus aspiration.
    No preview · Article · Jul 2009 · Circulation Journal