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Coronary Artery Disease: HELP
Articles by Philip En Hou Wong
Based on 12 articles published since 2008

Between 2008 and 2019, P. Wong wrote the following 12 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Editorial Biodegradable vascular scaffold: is optimal expansion the key to minimising flow disturbances and risk of adverse events? 2015

Foin, Nicolas / Torii, Ryo / Mattesini, Alessio / Wong, Philip / Di Mario, Carlo. ·National Heart Centre Singapore, Singapore. ·EuroIntervention · Pubmed #25420789.

ABSTRACT: -- No abstract --

2 Review Bioresorbable stents: Current and upcoming bioresorbable technologies. 2017

Ang, Hui Ying / Bulluck, Heerajnarain / Wong, Philip / Venkatraman, Subbu S / Huang, Yingying / Foin, Nicolas. ·National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore. · School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore. · School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore. Electronic address: yingyinghuang@ntu.edu.sg. · National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; DUKE-NUS Medical School, 8 College Road, 169857, Singapore. Electronic address: nicolas.foin@gmail.com. ·Int J Cardiol · Pubmed #27912202.

ABSTRACT: Bioresorbable scaffolds (BRS) represent a novel horizon in interventional cardiology for the treatment of coronary artery disease. The technology was introduced to overcome limitations of current metallic drug-eluting stents such as late in-stent restenosis and permanently caging the vessel. The concept of the BRS is to provide temporal support to the vessel during healing before being degraded and resorbed by the body, promoting restoration of the vessel vasomotion. Currently, there are several BRS that are under development or already commercially available. Although several reviews have elegantly covered progress of current clinical programs and newer scaffold technologies, little is available currently to describe the mechanistic differences between biomaterials used in current and newer bioresorbable technologies. This aim of this review is to discuss the status of the different BRS technologies and materials currently under investigation, explore the newer strategies being adopted to improve material mechanical properties and optimize BRS degradation and summarize the performance of BRS in the clinical setting so far.

3 Article Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions. 2018

Zhang, Jun-Mei / Shuang, Dongsi / Baskaran, Lohendran / Wu, Weijun / Teo, Soo-Kng / Huang, Weimin / Gobeawan, Like / Allen, John Carson / Tan, Ru San / Su, Xi / Ismail, Nasrul Bin / Wan, Min / Su, Boyang / Zou, Hua / Low, Ris / Zhao, Xiaodan / Chi, Yanling / Zhou, Jiayin / Su, Yi / Lomarda, Aileen Mae / Chin, Chee Yang / Fam, Jiang Ming / Keng, Felix Yung Jih / Wong, Aaron Sung Lung / Tan, Jack Wei Chieh / Yeo, Khung Keong / Wong, Philip En Hou / Chin, Chee Tang / Ho, Kay Woon / Yap, Jonathan / Kassab, Ghassan S / Chua, Terrance / Koh, Tian Hai / Tan, Swee Yaw / Lim, Soo Teik / Zhong, Liang. ·National Heart Center Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, 8 College Rd, 169857, Singapore. · Wuhan Asia Heart Hospital, 753 Jinghan Dadao, Wuhan 138632, Hubei, China. · National Heart Center Singapore, 5 Hospital Drive, 169609, Singapore. · National Heart Center Singapore, 5 Hospital Drive, 169609, Singapore; Nanchang University, Nanchang 330031, Jiangxi, China. · Institute of High Performance Computing, Agency for Science, Technology and Research, 138632, Singapore. · Institute for Infocomm Research, Agency for Science, Technology and Research, 138632, Singapore. · Duke-NUS Medical School, 8 College Rd, 169857, Singapore. · California Medical Innovations Institute, San Diego, CA 92121, USA. · National Heart Center Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, 8 College Rd, 169857, Singapore. Electronic address: lim.soo.teik@singhealth.com.sg. · National Heart Center Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, 8 College Rd, 169857, Singapore. Electronic address: zhong.liang@nhcs.com.sg. ·Int J Cardiol · Pubmed #29685695.

ABSTRACT: BACKGROUND: Computed tomography coronary angiography (CTCA) image analysis enables plaque characterization and non-invasive fractional flow reserve (FFR) calculation. We analyzed various parameters derived from CTCA images and evaluated their associations with ischemia. METHODS: 49 (61 lesions) patients underwent CTCA and invasive FFR. Lesions with diameter stenosis (DS) ≥ 50% were considered obstructive. CTCA image processing incorporating analytical and numerical methods were used to quantify anatomical parameters of lesion length (LL) and minimum lumen area (MLA); plaque characteristic parameters of plaque volume, low attenuation plaque (LAP) volume, dense calcium volume (DCV), normalized plaque volume (NP Vol), plaque burden, eccentricity index and napkin-ring (NR) sign; and hemodynamic parameters of resistance index, stenosis flow reserve (SFR) and FFR RESULTS: Plaque burden and plaque volume were inversely related to FFR. Multivariable logistic regression analysis identified the best anatomical, plaque and hemodynamic predictors, respectively, as DS (≥50% vs <50%; OR: 8.0; 95% CI: 1.6-39.4), normalized plaque volume (NP Vol) (≥4.3 vs <4.3; OR: 3.9; 95% CI: 1.1-14.0) and NR Sign (0 vs 1; OR: 13.6; 95% CI: 1.3-146.1), and FFR CONCLUSION: Normalized plaque volume, napkin-ring derived from plaque analysis, and FFR

4 Article Stenosis detection and quantification on cardiac CTCA using panoramic MIP of coronary arteries. 2017

Chi, Y / Huang, W / Zhou, J / Toe, K K / Zhang, J-M / Wong, P / Lim, S T / Tan, R S / Zhong, L. · ·Conf Proc IEEE Eng Med Biol Soc · Pubmed #29060821.

ABSTRACT: In this work, we proposed to demonstrate the entire 3D coronary tree using panoramic maximum intensity projection (MIP) of coronary arteries, and to detect and quantify coronary stenosis from computed tomography coronary angiography (CTCA). The performance of the proposed method was assessed in comparison with invasive coronary angiography (ICA) as reference standard. Six anonymized CTCA datasets were tested. MIP method achieved a sensitivity of 82% and a specificity of 95% for the stenosis detection with a good reproducibility (i.e. Cohen's kappa coefficient of 0.74 for the intra-rater agreement, and 0.45 for the inter-raters agreement). In stenosis quantification, three image options are provided. The original density images resulted in an accuracy of 0.85. The edge map images resulted in an accuracy of 0.79. The image combination had a better accuracy of 0.89 than any single image option. In conclusion, the panoramic MIP provided fast and accurate way for the stenosis detection and quantification. It may be helpful to assist the radiologist in identifying the location of the greatest narrowing in clinical practice.

5 Article Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. 2017

Shen, Jiayun / Wong, Ka-Tak / Cheng, Isaac T / Shang, Qing / Li, Edmund K / Wong, Priscilla / Kun, Emily W / Law, Mei Yan / Yip, Ronald / Yim, Isaac / Ying, Shirley / Li, Martin / Li, Tena K / Wong, Chun-Kwok / Zhu, Tracy Y / Lee, Jack Jock-Wai / Chang, Mimi / Lee, Alex Pui-Wai / Tam, Lai-Shan. ·Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong. · Department of Diagnostic and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong. · Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong. · Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong. · Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong. · Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong. · Department of Chemical Pathology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong. · Bone Quality and Health Center of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong. · Division of Biostatistics, The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong. ·Ann Rheum Dis · Pubmed #28052860.

ABSTRACT: OBJECTIVES: To evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA). METHODS: Ninety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison. RESULTS: Patients with PsA and controls were matched in age, gender and traditional CV risk factors (all p>0.2). The prevalence of overall plaque (54(60%)/84(35%), p<0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p<0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p<0.001) and combined MP/NCP (46(51%)/62(26%), p<0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p<0.001), while obstructive plaques (>50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p<0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p<0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001). CONCLUSIONS: Patients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA. TRIAL REGISTRATION NUMBER: NCT02232321.

6 Article Optimization of coronary optical coherence tomography imaging using the attenuation-compensated technique: a validation study. 2017

Teo, Jing Chun / Foin, Nicolas / Otsuka, Fumiyuki / Bulluck, Heerajnarain / Fam, Jiang Ming / Wong, Philip / Low, Fatt Hoe / Leo, Hwa Liang / Mari, Jean-Martial / Joner, Michael / Girard, Michael J A / Virmani, Renu. ·National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609. · Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore. · CV Path Institute, Gaithersburg, MD, USA. · National Cerebral and Cardiovascular Center, Osaka, Japan. · Department of Cardiology, National University Heart Center, Singapore. · University of French Polynesia, French Polynesia. · Singapore Eye Research Institute Singapore National Eye Centre, Singapore. ·Eur Heart J Cardiovasc Imaging · Pubmed #27469587.

ABSTRACT: Aim: To optimize conventional coronary optical coherence tomography (OCT) images using the attenuation-compensated technique to improve identification of plaques and the external elastic lamina (EEL) contour. Methods and Results: The attenuation-compensated technique was optimized via manipulating contrast exponent C, and compression exponent N, to achieve an optimal contrast and signal-to-noise ratio (SNR). This was applied to 60 human coronary lesions (38 native and 22 stented) ex vivo conventional coronary OCT images acquired from heart autopsies of 10 patients and matching histology was available as reference. Three independent reviewers assessed the conventional and attenuation-compensated OCT images blindly for plaque characteristics and EEL detection. Conventional OCT and compensated OCT assessment were compared against histology. Using an optimized algorithm, the attenuation-compensated OCT images had a 2-fold improvement in contrast between different tissues in both stented and non-stented epicardial coronaries (P < 0.05). Overall sensitivity and specificity for plaque classification increased from 84 to 89% and from 92 to 94%, respectively, with substantial agreement among the three reviewers (Fleiss' Kappa k, 0.72 and 0.71, respectively). Furthermore, operators were 2.5 times more likely to identify the EEL contour in the attenuation-compensated OCT images (k = 0.72) than in the conventional OCT images (k = 0.36). Conclusion: The attenuation-compensated technique can be retrospectively applied to conventional OCT images and improves the detection of plaque characteristics and the EEL contour. This approach could complement conventional OCT imaging in the evaluation of plaque characteristics and quantify plaque burden in the clinical setting.

7 Article Current bioresorbable scaffold technologies for treatment of coronary artery diseases: Do polymer and Magnesium platforms differ? 2016

Foin, Nicolas / Ng, Jaryl / Wong, Philip / Di Mario, Carlo. ·National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore. Electronic address: nicolas.foin@gmail.com. · National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore. · BRU, Royal Brompton Hospital NHS Trust, Imperial College London, United Kingdom. ·Int J Cardiol · Pubmed #27552572.

ABSTRACT: -- No abstract --

8 Article Early coverage of drug-eluting stents analysed by optical coherence tomography: evidence of the impact of stent apposition and strut characteristics on the neointimal healing process. 2016

Lee, Renick / Foin, Nicolas / Ng, Jaryl / Allen, John / Soh, Nicole / Ang, Ivy / Shim, Winston / Torii, Ryo / Wong, Philip. ·National Heart Centre Singapore, Singapore. ·EuroIntervention · Pubmed #27497360.

ABSTRACT: AIMS: Previous studies have associated issues such as incomplete stent apposition with delayed healing and adverse events (stent thrombosis). The aim of this study was to evaluate the impact of strut apposition and stent type on the progression of stent strut coverage. METHODS AND RESULTS: We evaluated in vivo in porcine models the follow-up response and coverage characteristics of well-apposed and malapposed segments of drug-eluting stents (DES) (CYPHER, PROMUS Element and Orsiro) and the Absorb bioresorbable vascular scaffold (BVS) by optical coherence tomography (OCT) sequentially, at baseline, and at one week and four weeks of follow-up. Supporting results were provided by histological analysis performed at four-week follow-up and computer simulation describing the shear characteristics around apposed and non-apposed struts. A total of 325 cross-sections containing 3,166 struts were analysed. The extent of malapposition decreased over time as a result of neointimal healing (from 7.1% at baseline to 0% at four weeks; p=0.03). At one week, 13.6% of struts in well-apposed segments were still uncovered versus 19.2% of struts in malapposed cross-sections and 77.8% of NASB struts (p<0.01). At four-week follow-up, 3.1% of struts were uncovered in well-apposed cross-sections vs. 1.6% in malapposed cross-sections and 35.7% of NASB struts (p<0.01). A comparison of the apposed segments revealed that the thin-strut Orsiro had only 1.3% of uncovered struts at one week while PROMUS Element, CYPHER and BVS had 6.6%, 48.4% and 16.2% of struts still uncovered, respectively. CONCLUSIONS: This study shows that early coverage is influenced by stent apposition as well as platform strut characteristics (stent type). At four weeks, NASB struts remained a focus of delayed endothelialisation.

9 Article Intravascular Assessment of Arterial Disease Using Compensated OCT in Comparison With Histology. 2016

Lee, Renick / Foin, Nicolas / Otsuka, Fumiyuki / Wong, Philip / Mari, Jean-Martial / Joner, Michael / Girard, Michael J A / Virmani, Renu. · ·JACC Cardiovasc Imaging · Pubmed #25797128.

ABSTRACT: -- No abstract --

10 Article Very late metallic stent malapposition and in-stent restenosis treated with a bioresorbable scaffold: a novel alternative for an old problem. 2015

Foin, Nicolas / Lee, Renick / Wong, Philip / Low, Adrian F. ·National Heart Centre Singapore, Singapore. ·EuroIntervention · Pubmed #26298237.

ABSTRACT: -- No abstract --

11 Article Incomplete stent apposition causes high shear flow disturbances and delay in neointimal coverage as a function of strut to wall detachment distance: implications for the management of incomplete stent apposition. 2014

Foin, Nicolas / Gutiérrez-Chico, Juan Luis / Nakatani, Shimpei / Torii, Ryo / Bourantas, Christos V / Sen, Sayan / Nijjer, Sukhjinder / Petraco, Ricardo / Kousera, Chrysa / Ghione, Matteo / Onuma, Yoshinobu / Garcia-Garcia, Hector M / Francis, Darrel P / Wong, Philip / Di Mario, Carlo / Davies, Justin E / Serruys, Patrick W. ·From the International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom (N.F., S.S., S.N., R.P., C.K., D.P.F., J.E.D., P.W.S.) · National Heart Centre Singapore, Singapore (N.F., P.W.) · ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands (J.L.G.-C., S.N., C.V.B., Y.O., H.M.G.-G., P.W.S.) · Ludwig-Maximilian Universität, München, Germany (J.L.G.-C.) · Department of Mechanical Engineering, University College London, London, United Kingdom (R.T.) · NIHR, BRU, Royal Brompton and Harefield NHS Trust, London, United Kingdom (M.G., C.D.M.) · and Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.). ·Circ Cardiovasc Interv · Pubmed #24642998.

ABSTRACT: BACKGROUND: Lack of re-endothelialization and neointimal coverage on stent struts has been put forward as the main underlying mechanism leading to late stent thrombosis. Incomplete stent apposition (ISA) has been observed frequently in patients with very late stent thrombosis after drug eluting stent implantation, suggesting a role of ISA in the pathogenesis of this adverse event. The aim of this study was to evaluate the impact of different degrees of ISA severity on abnormal shear rate and healing response with coverage, because of its potential implications for stent optimization in clinical practice. METHODS AND RESULTS: We characterized flow profile and shear distribution in different cases of ISA with increasing strut-wall detachment distance (ranging from 100 to 500 μm). Protruding strut and strut malapposed with moderate detachment (ISA detachment distance <100 μm) have minimal disturbance to blood flow as compared with floating strut that has more significant ISA distance. In vivo impact on strut coverage was assessed retrospectively using optical coherence tomography evaluation on 72 stents (48 patients) sequentially at baseline and after 6-month follow-up. Analysis of coverage revealed an important impact of baseline strut-wall ISA distance on the risk of incomplete strut coverage at follow-up. Malapposed segments with an ISA detachment <100 μm at baseline showed complete strut coverage at follow-up, whereas segments with a maximal ISA detachment distance of 100 to 300 μm and >300 μm had 6.1% and 15.7% of their struts still uncovered at follow-up, respectively (P<0.001). CONCLUSIONS: Flow disturbances and risk of delayed strut coverage both increase with ISA detachment distance. Insights from this study are important for understanding malapposition as a quantitative, rather than binary phenomenon (present or absent) and to define the threshold of ISA detachment that might benefit from optimization during stent implantation.

12 Article Impact on service provision for non-invasive cardiac imaging following NICE recommendations: an observational study. 2011

Garg, Pankaj / Ashrafi, Reza / Feeney, Laura / Lagan, Jakub / Wong, Peter / Rodrigues, Erwin / Davis, Gershan. ·Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool, UK. ·Postgrad Med J · Pubmed #21406591.

ABSTRACT: BACKGROUND: Chest pain or discomfort due to angina can have a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. The National Institute for Health and Clinical Excellence (NICE) published 'Chest pain of recent onset' guidelines in March 2010. These guidelines appraise the role of newer non-invasive modalities in cardiac imaging in the prompt and cost-effective diagnosis of coronary artery disease. OBJECTIVE: To study the service requirement for non-invasive cardiac imaging in patients with stable chest pain using current NICE guidance. DESIGN: Single-centre, 6-month (January 2010 to June 2010) observational study. SETTING: Rapid access chest pain clinics in a large university teaching hospital providing secondary care cardiology services. METHODS: Clinic letters were used to ascertain the type of chest pain and cardiovascular risk factors. The resting 12-lead ECG was examined for any ischaemic changes. Patients were then retrospectively allocated to an assessment pathway based on NICE guidance for the evaluation of stable chest pain. Pretest likelihood of coronary artery disease was calculated using Pryor et al's table as published by NICE. Depending on the calculated pretest probability, their NICE-suggested investigation was determined. This included no further investigations, cardiac CT, functional imaging or invasive angiography. RESULTS: 500 patients were seen in rapid access chest pain clinics, 65 of which did not meet the referral criteria of having chest pain. On the basis of previous practice, 52% of patients were likely to have an exercise tolerance test. According to current NICE guidance as applied to our cohort of patients, 128 (30%) would have required functional imaging, 119 (27%) no further investigation, 95 (22%) cardiac CT, and 93 (21%) invasive angiography. CONCLUSION: Functional imaging and then cardiac CT are the main investigations required in the assessment of patients with stable chest pain.