Shih-Ann Chen

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

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Publications (499)1840.28 Total impact

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    ABSTRACT: Background: Influenza infection could activate systemic inflammatory responses and increase the sympathetic tone which play an important role in the pathogenesis of atrial fibrillation (AF). Objective: The goal of the present study was to investigate whether influenza infection was a risk factor of AF. We also aimed to study whether influenza vaccination could decrease the AF risk. Methods: From 2000-2010, a total of 11,374 patients with newly diagnosed AF were identified from the Taiwan National Health Insurance Research Database. On the same date of enrollment, 4 control patients (without AF) with matched age and sex were selected to be the control group for each study patient. The relationship between AF and influenza infection/ vaccination 1 year before the enrollment was analyzed. Results: Compared to patients without influenza infection nor vaccination (reference group, n=38,353), patients with influenza infection without vaccination (n=1,369) were associated with a significant higher risk of AF with an odds ratio of 1.182 (p=0.032) after the adjustment for baseline differences. The risk of AF was lower among patients receiving influenza vaccination without influenza infection (n=16,452) with an odds ratio of 0.881 (p<0.001). For patients who have received influenza vaccination and experienced influenza infection (n=696), the risk of AF was similar to that of the reference group (odds ratio=1.136, p=0.214). The lower risk of AF with vaccination was consistently observed in subgroup analyses. Conclusions: Influenza infection was significantly associated with the development of AF, with an 18% increase in the risk, which could be reduced through influenza vaccination.
    No preview · Article · Feb 2016 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Catheter ablation of atrial fibrillation (AF) has evolved over the past 20 years from being a novel, unproven procedure to a commonly performed procedure. Triggers are important for the initiation of AF and a suitable substrate is important for perpetuation of AF. Remodeling, including electrical and structural remodeling, is common in patients with persistent AF. Therefore, targeting the remodeled atrium is a critical issue during persistent AF ablation. However, ablation outcomes remain suboptimal despite aggressive substrate modification. Empirical linear ablation is not recommended because of the difficulty in achieving complete linear block and it is recommended only if macroreentry tachycardia develops during the procedure. Complex fractionated atrial electrogram (CFAE) ablation is recommended in the Heart Rhythm Society Consensus Document but efficacy has been limited in long-term follow-up studies. Rotor ablation is controversial. A combined approach using CFAE, similarity and phase mappings with rotor identification may be helpful in searching for AF sources and subsequent substrate ablation. Nevertheless, more prospective randomized studies are required to validate efficacy and safety.
    Preview · Article · Jan 2016 · Circulation Journal
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    ABSTRACT: Background: Atrial fibrillation (AF) can be associated with an increased risk of developing coronary artery disease (CAD) due to mechanisms of inflammation, endothelial dysfunction and adverse atrial remodelling. It is unclear if adverse coronary events can be further reduced after successful catheter ablation of AF. We hypothesise that AF ablation and sinus maintenance could reduce future adverse cardiac events in patients with underlying CAD. Methods: A total of 310 patients with drug-refractory paroxysmal AF and prior history of percutaneous coronary intervention (PCI) for underlying CAD were recruited in the retrospective case control study. Of these, 155 patients underwent AF ablation (the Ablation Group), while 155 patients received medical treatment (the Medical Group). All patients were followed up for major adverse cardiac events, including acute coronary syndrome requiring hospitalisation, stroke, pulmonary embolism and mortality. Results: The clinical characteristics were comparable between the two groups, except for higher antiarrhythmic drug use in the Medical Group. During a follow-up duration of 61±32 months, all-cause mortality (8.4% vs. 1.3%, p=0.004) and the overall major adverse events (47.7% vs. 12.3%, p<0.001) were significantly higher in the Medical Group than the Ablation Group. There were also more instances of stroke (10.3% vs. 3.2%, p=0.013) and acute coronary syndrome requiring hospitalisation (29% vs. 7.1%, p<0.001) in the Medical Group than the Ablation Group. Multivariate analysis confirmed that non-ablation was an independent risk factor for major adverse events (p<0.001, HR 3.4, 95% confidence interval 1.9-5.9). Conclusion: In PAF patients with established CAD who underwent PCI, catheter ablation could lead to fewer major adverse cardiac events compared to medical therapy.
    No preview · Article · Jan 2016 · Heart, Lung and Circulation
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    ABSTRACT: Atrial fibrillation (AF) is currently recognized as one of the most common cardiac arrhythmias worldwide, with the increasing prevalence that has been estimated to be as high as 9% among the elderly. Health-related quality of life (HRQoL) has become an important patient-centered health outcome measurement, but the impacts created by AF and other arrhythmias with similar symptoms, such as frequent atrial and ventricular premature contractions (APCs and VPCs, defined as ≥ 3 beats/5 minutes), have not been extensively evaluated. The Yilan Study is a population-based community health survey, which in part aims to evaluate the prevalence and impacts of these arrhythmias on the HRQoL in a community dwelling elderly population. A total of 1,732 citizens from the Yilan, Taiwan, aged 65 years or older (45.8% male) were enrolled and visited at their homes, where HRQoL was measured utilizing the Short Form-12 Health Survey. Each participant’s heart rhythm was recorded with an electrocardiographic monitor for 5 minutes. The results disclosed that the prevalence of AF of this aged population was 5.8%, similar to the mean global prevalence. Besides, the prevalence of frequent APCs and frequent VPCs in these elderly people were 7.1% and 5.5%, respectively. After multiple regression analysis, elderly people with AF had lower scores in the physical component of HRQoL, while those elderly people with frequent VPCs had lower scores in the mental component. Ultimately, these findings can provide additional useful and population-specific information about AF, and assist medical professionals in designing more effective strategies for cardiac arrhythmia treatments.
    Preview · Article · Jan 2016 · The Tohoku Journal of Experimental Medicine
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    ABSTRACT: Background: Hypokalemia and hyponatremia increase the occurrence of atrial fibrillation. Sinoatrial nodes (SANs) and pulmonary veins (PVs) play a critical role in the pathophysiology of atrial fibrillation. Objective: This study was to evaluate whether electrolyte disturbances with low concentrations of potassium ([K(+)]) or sodium ([Na(+)]) may modulate SAN and PV electrical activity and arrhythmogenesis, and investigate potential underlying mechanisms. Methods: Conventional microelectrodes were used to record the electrical activity in rabbit SAN and PV tissue preparations before and after perfusion with different low [K(+)] or [Na(+)], interacting with the Na(+)-Ca(2+) exchanger inhibitor (KB-R7943, 10 μM). Results: A low [K(+)] (3.5, 3, 2.5 and 2 mM) decreased beating rates in PV cardiomyocytes with genesis of delayed afterdepolarizations (DADs), burst firing, and increased diastolic tension. A low [K(+)] (3.5, 3, 2.5 and 2 mM) also decreased SAN beating rates with the genesis of DADs. A low [Na(+)] increased PV diastolic tension, DADs and burst firing, which was attenuated in the co-superfusion with low [K(+)] (2 mM). In contrast, a low [Na(+)] has little effect on SAN electrical activities. KB-R7943 (10 μM) reduced the occurrences of low [K(+)] (2 mM)- or low [Na(+)] (110 mM)-induced DAD and burst firing in both PVs and SANs. Conclusions: Low [K(+)] and low [Na(+)] differentially modulates SAN and PV electrical properties. Low [K(+)] or low [Na(+)]-induced slowing of SAN beating rate and genesis of PV burst firing may contribu te to the high occurrence of atrial fibrillation during hypokalemia or hyponatremia.
    No preview · Article · Dec 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Aims The detailed electrophysiological characteristics of patients with both atrioventricular nodal re-entrant tachycardia (AVNRT) and atrial flutter (AFL) have not been clarified. This study investigated the related electrophysiological differences in a large series of patients undergoing radiofrequency catheter ablation of AVNRT. Methods and results A total of 1063 clinically documented AVNRT patients underwent catheter ablation were enrolled. Before the slow pathway (SP) ablation, 61 patients (5.7%) had inducible sustained cavotricuspid isthmus (CTI)-dependent AFL (Group 1), and the others (94.3%) without inducible sustained CTI-dependent AFL were defined as Group 2. The electrophysiological characteristics of these two groups and effect of the SP ablation on the inducibility of AFL were assessed. In Group 1, 36 patients (59%) had inducible/sustained AFL after the ablation of AVNRT and required a CTI ablation. The Group 1 patients had more AVNRT with continuous atrioventricular (AV) node function curves (P < 0.001, odds ratio = 7.55 [3.70–16.7], multivariate regression), and a younger age (P = 0.02, odds ratio = 1.02 [1.003–1.03], multivariate regression) than Group 2. The other characteristics were comparable between the two groups. The long-term follow-up (64.9 ± 34.9 months) revealed that the recurrence of AFL/atrial fibrillation was similar between the two groups (P > 0.05). Conclusion Atrioventricular nodal re-entrant tachycardia patients with concomitant CTI-dependent AFL had more continuous AV node function curves. Forty-one per cent of these patients had non-inducible AFL after the SP ablation, indicating a slow conduction isthmus in the triangle of Koch area.
    No preview · Article · Nov 2015 · Europace
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    Chin-Yu Lin · Fa-Po Chung · Yenn-Jiang Lin · Shih-Ann Chen
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    ABSTRACT: We describe the case of a patient with severe hypertensive left ventricular hypertrophy and sustained hemodynamically unstable ventricular tachycardia (VT). Entrainment was demonstrated in the electrophysiological study. Activation mapping and pacemapping identified the location of the intramural reentrant VT with the exit site close to the epicardium. However, VT persisted after ablation at the epicardial exit site. Successful ablation was performed endocardially at the corresponding position.
    Preview · Article · Nov 2015 · Korean Circulation Journal
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    ABSTRACT: Background: The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods: Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results: Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/interpretation: The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.
    Full-text · Article · Oct 2015 · PLoS ONE
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    ABSTRACT: Background: Renal failure (RF) increases the risk of atrial fibrillation (AF), but arrhythmogenic mechanism is unclear. The present study investigated the electrophysiological effects of RF on AF trigger (pulmonary veins, PVs) and substrate (atria) and evaluated potential underlying mechanisms. Methods: Electrocardiographic, echocardiographic, and biochemical studies were conducted in rabbits with and without antibiotic-induced mild (creatinine=1.5-6.0mg/dl) and advanced (creatinine>6.0mg/dl) RF. Conventional microelectrode techniques, western blotting, and histological examinations were performed using the isolated rabbit PV, left atrium (LA), right atrium (RA) and sinoatrial node (SAN). Results: Advanced RF rabbits (n=18) had a higher incidence (33.3% vs. 11.1% and 0%, p<0.05) of atrial arrhythmia than mild RF (n=18) and control (n=18) rabbits. Advanced RF rabbits exhibited faster PV spontaneous activities, longer action potential duration (APD) in the LA, higher fibrosis in the LA, and slower SAN beating rates than control rabbits, but had a similar APD and fibrosis in the RA. Caffeine (1mM) increased advanced RF PV arrhythmogenesis, which is blocked by flecainide (10μM), or KB-R7943 (10μM). Moreover, advanced RF rabbits had a higher expression of the Na(+)/Ca(2+) exchanger, protein kinase A, phosphorylated ryanodine receptor (Serine 2808), and phosphorylated phospholamban (Serine 16) in PVs, and a higher expression of Cav 1.2 in the LA, and a lower expression of hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 in the SAN. Conclusions: Advanced RF increases atrial arrhythmia by modulating the distinctive electrophysiological characteristics of the PV, LA, and SAN.
    No preview · Article · Oct 2015 · International journal of cardiology
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    ABSTRACT: The clinical characteristics and prognostic value of early repolarization (ER) in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and symptomatic ventricular arrhythmias remain unclear. We investigated the prevalence, clinical features, and cardiovascular outcomes of patients with symptomatic ARVD/C and ER. A total of 59 consecutive ARVD/C patients hospitalized for catheter ablation, presenting with and without J-point elevations of ≥0.1mV in at least 2 inferior leads or lateral leads were enrolled. Clinical characteristics, electrophysiological study, substrate mapping, catheter ablation, and future clinical outcomes in a prospective patient registry were investigated. ER was observed in 38 patients (64.4%). Among these patients, ER was found in the inferior leads in 18 patients (47.4%), in the lateral leads in 2 patients (5.3%), and in both inferior and lateral leads in 18 patients (47.4%). Patients exhibiting ER were commonly men, had lower right ventricular ejection fraction, had higher incidence of clinical ventricular fibrillation or aborted sudden cardiac death, had more defibrillator implantations, had higher the need of epicardial ablation, and had more major criteria according to the task force criteria. Significant higher incidence of induced ventricular fibrillation and shorter tachycardia cycle length of induced ventricular tachycardia were found during procedure. The recurrence rate of ventricular arrhythmias did not differ between patients with and without ER after catheter ablation. A high prevalence of electrocardiographic ER was found among symptomatic ARVD/C patients undergoing catheter ablation. ER in 12-lead ECG is associated with an increased risk of clinical fatal ventricular arrhythmias. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Oct 2015 · International journal of cardiology
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    Preview · Article · Oct 2015
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    ABSTRACT: Atrial fibrillation (AF) is associated with cognitive decline and may contribute to an increased risk of dementia. The goal of the present study was to investigate whether statin use prevented non-vascular dementia in subjects with AF. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study group comprised 51,253 AF subjects aged ≥60years who had received statin treatment. For each study patient, four age- and sex-matched AF subjects without statin exposure were selected as the control group (n=205,012). The risk of non-vascular dementia was compared between the statin and control groups. During the follow-up period, 17,201 patients experienced non-vascular dementia. The annual incidence of non-vascular dementia was lower in the statin group than in the control group (1.89% vs. 2.20%; p<0.001). Statin use exhibited a protective effect on the occurrence of non-vascular dementia, with an adjusted hazard ratio (HR) of 0.832 (95% confidence interval=0.801-0.864). Among statin types, the use of rosuvastatin was associated with the largest risk reduction (adjusted HR=0.661). Statin exposure duration was related inversely to the risk of non-vascular dementia. In this large-scale nationwide cohort study, statin use was associated with a lower risk of non-vascular dementia in AF. Use of more potent statin and longer exposure time may be associated with greater benefits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Oct 2015 · International journal of cardiology
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    ABSTRACT: Background: Recent studies from Asia have suggested that the risk of ischemic stroke for patients with atrial fibrillation (AF) with a "low-risk" congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female (CHA2DS2-VASc) score of 0 (for males) or 1 (for females) might be higher than that for non-Asians. Objectives: This study hypothesized that the age threshold (65 years) used in the CHA2DS2-VASc system for initiating oral anticoagulants (OACs) might be lower in Taiwanese AF patients than in non-Asians. Methods: We used the National Health Insurance Research Database in Taiwan to study 186,570 nonanticoagulated AF patients. There were 9,416 males with a CHA2DS2-VASc score of 0 and 6,390 females with a CHA2DS2-VASc score of 1. Their risk of ischemic stroke was analyzed with stratification on the basis of age. Results: The annual risks of ischemic stroke for males (score 0) and females (score 1) were 1.15% and 1.12%, respectively, and continuously increased from younger to older age groups, with an increment in stroke risk evident for patients >50 years of age. At a cutoff of 50 years, patients could be further stratified into 2 subgroups with different stroke risks (>50 years of age: 1.78%/year; vs. <50 years of age: 0.53%/year). This observation was consistent for males (1.95%/year vs. 0.46%/year, respectively) and females (1.58%/year vs. 0.64%/year, respectively) with AF. In a subgroup analysis, the annual risks of ischemic stroke for males and females with AF 50 to 54 years of age were 1.47% and 1.07%, respectively. Conclusions: For Taiwanese patients 50 to 64 years of age, the annual stroke risk was 1.78%, which may exceed the threshold for OAC use for stroke prevention. The annual risk of ischemic stroke for AF patients <50 years of age was 0.53%, which was truly low-risk, and OACs could be omitted. Whether resetting the age threshold to 50 years could refine current clinical risk stratification for Asian AF patients deserves further study.
    No preview · Article · Sep 2015 · Journal of the American College of Cardiology
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    ABSTRACT: Background: -Current American and European guidelines emphasized the importance of rate control treatments in treating atrial fibrillation (AF) with a Class I recommendation, although data about the survival benefits of rate control are lacking. The goal of the present study was to investigate whether patients receiving rate control drugs had a better prognosis compared to those without rate-control treatment. Methods and results: -This study used the "National Health Insurance Research Database" in Taiwan. There were 43,879, 18,466 and 38,898 AF patients enrolled in the groups of beta-blockers (BBs), calcium channel blockers (CCBs) and digoxin, respectively. The reference group consisted of 168,678 subjects who did not receive any rate-control drug. The clinical endpoint was all-cause mortality. During a follow-up of 4.9±3.7 years, mortality occurred in 88,263 patients (32.7%). After the adjustment for the baseline differences, the risk of mortality was lower in patients receiving BBs (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.74-0.78) and CCBs (adjusted HR = 0.93, 95% CI = 0.90-0.96) compared to those who did not receive rate-control medications. On the contrary, the digoxin group had a higher risk of mortality with an adjusted HR of 1.12 (95% CI = 1.10-1.14). The results were consistently observed in subgroup analyses and among the cohorts after propensity matching. Conclusions: -In this nationwide AF cohort, the risk of mortality was lower for patients receiving rate-control treatments with BBs or CCBs, and the use of BBs was associated with a largest risk reduction. Digoxin use was associated with greater mortality. Prospective randomized trials are necessary to confirm these findings.
    No preview · Article · Sep 2015 · Circulation
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    ABSTRACT: The prognostic significance of premature atrial complex (PAC) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PACs and long-term outcome. We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF. The burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
    Preview · Article · Aug 2015 · Journal of the American Heart Association
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    ABSTRACT: Radiofrequency ablation of ventricular arrhythmias (VAs) originating from the continuum between the aortic sinus of Valsalva (ASV) and the left ventricular (LV) summit is a challenge. To investigate the electrocardiographic, electrophysiological, and anatomical characteristics of VAs and develop an algorithm for predicting the successful ablation site. We recruited 66 patients (mean age of 47±15 years old; 42 male patients) with symptomatic VAs originating from the continuum between the ASV and LV summit who underwent radiofrequency ablation. Patients were classified into 4 groups (group 1: ASV, n=20; group 2: subvalvular region, n=15; group 3: great cardiac vein/anterior interventricular vein [GCV/AIV], n=16; group 4: epicardium requiring pericardial access, n=15). The QRS morphological characteristics of the VAs were compared among the 4 groups. ECG analysis revealed that the aVL/aVR Q-wave ratio is useful in the prediction of successful ablation sites in the ASV, subvalvular area, GCV/AIV, and epicardium requiring pericardial access at cut-off values of ≤1.415, 1.416-1.535, 1.536-1.740, and >1.740, respectively. The aVL/aVR Q-wave ratio was well correlated to the distance between the successful ablation site and the LV summit tip. A distance of >18.9 mm and LV myocardial thickness of >9.1 mm predicted the need for the epicardial or GCV/AIV approaches. There were no major procedural complications. Eight (12.1%) patients developed VA recurrence during a mean follow-up of 15.9 months (9-24). The aVL/aVR Q-wave ratio is a useful parameter for predicting the successful ablation sites of VAs originating from the continuum between the ASV and LV summit. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Aug 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Heart failure (HF) affects cardiac metabolism and inflammation. Histone deacetylases (HDACs) play a critical role in cardiac pathophysiology. This study investigated whether HDAC inhibition can regulate HF by modifying cardiac inflammation and peroxisome proliferator-activated receptor (PPAR) isoforms. Echocardiography, electrocardiography, ELISA and Western blot were performed in rats with isoproterenol-induced HF, with and without orally administered MPT0E014 (a novel HDAC inhibitor, 50 mg/kg for 7 consecutive days). The left ventricles (LVs) of HF rats expressed significantly higher levels of HDAC1, HDAC2, HDAC3, HDAC4 and HDAC6 than the healthy LVs did. HF rats treated with MPT0E014 exhibited improved cardiac fraction shortening with reducing chamber size. The MPT0E014-treated HF LVs exhibited a smaller increase in the expression of interleukin (IL)-6, p22, SMAD2/3, extracellular signal-regulated kinase 1/2, PPAR isoforms and circulatory tumor growth factor-β1 than the untreated HF LVs did. Moreover, MPT0E014-treated HF LVs expressed less fibroblast growth factor receptor than untreated HF LVs did. HDAC inhibition can improve cardiac function and attenuate the effects of HF on cardiac metabolism and inflammation, which might contribute to the beneficial effects of HDAC inhibition in HF. © 2015 S. Karger AG, Basel.
    No preview · Article · Aug 2015 · Pharmacology
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    ABSTRACT: A prospective 1-year observational survey was designed to assess the management and control of atrial fibrillation (AF) in eight countries within the Asia-Pacific region. Patients (N = 2,604) with recently diagnosed AF or a history of AF ≤1 year were included. Clinicians chose the treatment strategy (rhythm or rate control) according to their standard practice and medical discretion. The primary endpoint was therapeutic success. At baseline, rhythm- and rate-control strategies were applied to 35.7% and 64.3% of patients, respectively. At 12 months, therapeutic success was 43.2% overall. Being assigned to rhythm-control strategy at baseline was associated with a higher therapeutic success (46.5% vs 41.4%; P = 0.0214) and a lower incidence of clinical outcomes (10.4% vs 17.1% P < 0.0001). Patients assigned to rate-control strategies at baseline had higher cardiovascular morbidities (history of heart failure or valvular heart disease). Cardiovascular outcomes may be less dependent on the choice of treatment strategy than cardiovascular comorbidities.
    Full-text · Article · Aug 2015 · Clinical Medicine Insights: Cardiology
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    ABSTRACT: Both American and European guidelines recommended the use of CHA2DS2-VASc score, rather than CHADS2, for stroke risk stratification in atrial fibrillation (AF). However, the CHA2DS2-VASc score has not been proved to be better than CHADS2 for Asians in a large-scale study. We aimed to compare the accuracies of CHADS2 and CHA2DS2-VASc scores in predicting ischemic stroke in Chinese. This study used the "National Health Insurance Research Database" in Taiwan. A total of 186,570 AF patients without antithrombotic therapies were selected as the study cohort. The clinical endpoint was occurrence of ischemic stroke. During the follow-up of 3.4+3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc score performed better than CHADS2 score in predicting ischemic stroke assessed by c-indexes (0.698 versus 0.659, p<0.0001). Among 25,286 patients with a CHADS2 score of 0, the CHA2DS2-VASc score ranged from 0-3 and the annual stroke rate ranged from 1.15% to 4.47%. Compared to patients with a CHA2DS2-VASc score of 0, the hazard ratio of ischemic stroke for patients with a CHA2DS2-VASc score of 3 was 3.998. Patients with a CHADS2 score of 0 were not necessarily 'low risk', and the annual stroke rate can be as high as 4.47% when they were further stratified by the CHA2DS2-VASc score. In contrast, patients with a CHA2DS2-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate around 1.15%. The same as Caucasians, the CHA2DS2-VASc score should be used for stroke risk stratification in Asians. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Aug 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Ventricular arrhythmia is the major cause of sudden cardiac death for patients with heart failure, including those receiving implantation of cardiac resynchronization therapy (CRT). The purpose of this study was to assess the value of myocardial perfusion SPECT (MPS) in predicting ventricular arrhythmia for patients with CRT. Fifty-one patients (35 males, mean age 64 ± 12 years) who had received CRT for at least 6 months were enrolled for resting gated MPS. Three main quantitative parameters of MPS, including extent of myocardial scar, left ventricular ejection fraction (LVEF) and LV dyssynchrony (phase SD), were generated by Emory Cardiac Toolbox. Using the recorded ventricular arrhythmia in the device, including ventricular tachycardia (VT) and ventricular fibrillation (VF), as the primary end point, the value of quantitative parameters of MPS in predicting the development of VT/VF was assessed. Twenty (39 %) of the 51 patients developed VT/VF during the follow-up (15.3 ± 12.7 months). The patients with VT/VF had significantly lower LVEF (24 ± 12 vs. 36 ± 17 %, p < 0.005), larger scar areas (36 ± 19 vs. 22 ± 12 %, p < 0.05) and larger phase SD (57° ± 20° vs. 43° ± 17°, p < 0.01). When categorizing the patients by the median values of LVEF, scar and phase SD, univariate regression analysis showed that lower LVEF (<29 %), larger scar (>23 %) and larger phase SD (>50°) were related to the development of VT/VF (p = 0.006, 0.011 and 0.064, respectively). However, only LVEF was marginally significant as an independent predictor of VT//VF on multivariate regression analysis (p = 0.0573). Survival analysis with Kaplan-Meier curves showed that the survival probability for VT/VF in those with LVEF >29 %, scar areas <23 % and phase SD < 50° was significantly better than in the others (HR 5.16, 95 % CI 1.20-22.16) by log-rank test (χ (2) = 5.9894, p = 0.014). Lower LVEF, larger scar and/or more dyssynchrony assessed by MPS were related to the development of ventricular arrhythmia for patients with CRT, and further defibrillator implantation may be considered for these patients.
    No preview · Article · Jul 2015 · Annals of Nuclear Medicine

Publication Stats

11k Citations
1,840.28 Total Impact Points

Institutions

  • 1993-2016
    • National Yang Ming University
      • • School of Medicine
      • • Institute of Clinical Medicine
      T’ai-pei, Taipei, Taiwan
  • 1992-2016
    • Taipei Veterans General Hospital
      • • Cardiology Division
      • • Department of Medicine
      T’ai-pei, Taipei, Taiwan
  • 2012
    • St George's, University of London
      Londinium, England, United Kingdom
  • 2011
    • Taichung Hospital
      臺中市, Taiwan, Taiwan
    • National Defense Medical Center
      T’ai-pei, Taipei, Taiwan
  • 2009
    • University of the Ryukyus
      • Faculty of Medicine
      Okinawa, Okinawa, Japan
  • 2007
    • Indiana University-Purdue University Indianapolis
      • Department of Medicine
      Indianapolis, IN, United States
  • 2004-2005
    • Fu Jen Catholic University
      • School of Medicine
      T’ai-pei, Taipei, Taiwan
    • Kuang Tien General Hospital
      臺中市, Taiwan, Taiwan
    • Chung Shan Medical University
      • Institute of Medicine
      Taichung, Taiwan, Taiwan
  • 2002
    • Wan Fang Hospital
      T’ai-pei, Taipei, Taiwan
  • 2000
    • Shin Kong Wu Ho-Su Memorial Hospital
      T’ai-pei, Taipei, Taiwan