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Coronary Artery Disease: HELP
Articles from Taiwan
Based on 475 articles published since 2008
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These are the 475 published articles about Coronary Artery Disease that originated from Taiwan during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19
1 Editorial Reliable and stable computer-aided diagnosis systems for images. 2016

Yang, Hsuan-Chia / Lu, Richard / Wu, Chieh-Chen / Li, Yu-Chuan Jack. ·Institute of Biomedical Informatics, National Yang-Ming University, Taiwan; Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan. · Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan. · Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan. · Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan; Chair, Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan. Electronic address: jack@tmu.edu.tw. ·Comput Methods Programs Biomed · Pubmed #27040839.

ABSTRACT: -- No abstract --

2 Review An evaluation of pitavastatin for the treatment of hypercholesterolemia. 2019

Chan, Paul / Shao, Li / Tomlinson, Brian / Zhang, Yuzhen / Liu, Zhong-Min. ·a Division of Cardiology, Department of Internal Medicine , Wan Fang Hospital, Taipei Medical University , Taipei City , Taiwan . · b The VIP Department , Shanghai East Hospital, Tongji University School of Medicine , Shanghai , China. · c Research Center for Translational Medicine , Shanghai East Hospital Affiliated to Tongji University School of Medicine , Shanghai , China. · d Department of Medicine & Therapeutics , The Chinese University of Hong Kong , Shatin , Hong Kong. · e Department of Cardiac Surgery , Shanghai East Hospital, Tongji University , Shanghai , China. ·Expert Opin Pharmacother · Pubmed #30482061.

ABSTRACT: INTRODUCTION: Statins are the first line of therapy to reduce low-density lipoprotein cholesterol (LDL-C) in order to decrease cardiovascular events. Pitavastatin is the latest statin to be introduced to the market. Areas covered: In this article, the authors review the efficacy, safety, and tolerability of pitavastatin. The authors also review a recent cardiovascular outcome study. Expert opinion: Pitavastatin produces dose-dependent reductions in LDL-C at lower doses than other statins. The maximum approved dose of 4 mg reduces LDL-C by about 40-49% in different patient groups and is equivalent to atorvastatin 20 mg in this effect. Pitavastatin undergoes minimal metabolism so drug-drug interactions are less likely than with many other statins, but it can interact with some drugs that inhibit drug transporters. Compared with other statins, it has been associated with greater increases in high-density lipoprotein cholesterol and it was found to be less likely to cause new onset diabetes. In a recent study in Japanese patients with stable coronary artery disease, pitavastatin 4 mg was more effective than pitavastatin 1 mg in reducing cardiovascular events. Therefore, the highest dose may be preferred in high-risk patients.

3 Review The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness. 2018

Yang, Tsung-Ju / Lin, Ming-Tai / Lu, Chun-Yi / Chen, Jong-Min / Lee, Ping-Ing / Huang, Li-Min / Wu, Mei-Hwan / Chang, Luan-Yin. ·Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan. · Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan. Electronic address: cylu@ntuh.gov.tw. · Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan. Electronic address: lychang@ntu.edu.tw. ·J Microbiol Immunol Infect · Pubmed #28927685.

ABSTRACT: OBJECTIVE: The use of corticosteroid in Kawasaki disease (KD) remains controversial among current guidelines. The objective of this study is to summarize the effectiveness and safety of corticosteroid to prevent coronary arterial lesions in Kawasaki disease, both as initial and rescue therapy. METHODS: The Medline, EMBASE, Google scholar, Cochrane Central Register of Controlled Trials databases, ClinicalTrials.gov, and Japanese Institutional Repositories Online were searched for studies up to 31 March 2017. Studies that compared incidence of coronary artery lesions between regimens with corticosteroid and regimen without it in a well-defined controlled group were included. The incidence of coronary artery lesion was analyzed by meta-analysis. RESULTS: Nineteen studies published between 1999 and 2016 fulfilled eligibility criteria. There were 3591 patients included for analysis. There was a significant reduction in incidence of coronary artery lesions with usage of corticosteroid with a pooled odds ratio of 0.72 (95% CI 0.57-0.92; p = 0.01) than that without usage of corticosteroid. In general, a greater effect was seen in the patient received corticosteroid as initial and adjuvant therapy with intravenous immune globulin (pooled odds ratio 0.39, 95% CI 0.21-0.73, p = 0.007) than those who received corticosteroid as rescue therapy. The risk reduction was statistically significant in Japanese groups (OR 0.56, 95% CI 0.42-0.75 in fixed effects model) but not significant in non-Japanese groups (OR 1.45, 95% CI 0.91-2.30 in fixed effects model). CONCLUSIONS: We demonstrated an overall reduction in incidence of coronary artery lesions with the use of corticosteroid as initial and adjuvant treatment for Kawasaki disease.

4 Review Preventing coronary artery lesions in Kawasaki disease. 2017

Kuo, Ho-Chang. ·Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: erickuo48@yahoo.com.tw. ·Biomed J · Pubmed #28651735.

ABSTRACT: A form of systemic vasculitis that affects mostly small and medium-sized vessels, Kawasaki disease (KD) is most commonly found in children under the age of 5 years old. Though its etiology is unknown, KD has been the most frequent acquired heart disease in developing countries. Its incidence has increased over recent decades in many centuries, including Japan, Korea, and China. The most severe complications of KD are coronary artery lesions (CAL), including dilation, fistula, aneurysm, arterial remodeling, stenosis, and occlusion. Aneurysm formation has been observed in 20-25% of KD patients that do not receive intravenous immunoglobulin (IVIG) treatment, and in 3-5% that do receive it. Coronary artery dilation has been found in about 30% of KD patients in the acute stage, although mostly in the transient form. Diminishing the occurrence and regression of CAL is a vital part of treating KD. In this review article, I demonstrate the clinical method to prevent CAL formation used at the Kawasaki Disease Center in Taiwan.

5 Review Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials. 2017

Chen, Yu-Chi / Tsai, Jen-Chen / Liou, Yiing-Mei / Chan, Paul. ·1 Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan. · 2 School of Nursing, National Yang-Ming University, Taipei, Taiwan. · 3 Institute of Community Care, Director of School Health Research Center, National Yang-Ming University, Taipei, Taiwan. · 4 Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. ·Eur J Cardiovasc Nurs · Pubmed #28565969.

ABSTRACT: BACKGROUND: Exercise interventions apparently reduce the risks of and prevent coronary artery disease (CAD). Developing an exercise intervention for patients with CAD is a rapidly expanding focus worldwide. The results of previous studies are inconsistent and difficult to interpret across various types of exercise programme. AIM: This study aimed to update prior systemic reviews and meta-analyses in order to determine the overall effects of endurance exercise training on patients with CAD. METHODS: The databases (PubMed, Medline, CINAHL, EMBASE and Cochrane Library) were searched for the interventions published between January 1, 2000, and May 31, 2015. Comprehensive meta-analysis software was used to evaluate the heterogeneity of the selected studies and to calculate mean differences (MDs) while considering effect size. RESULTS: A total of 18 studies with 1286 participants were included. Endurance exercise interventions at a moderate to high training intensity significantly reduced resting systolic blood pressure (MD: -3.8 mmHg, p = 0.01) and low-density lipoprotein cholesterol (MD: -5.5 mg/dL, p = 0.02), and increased high-density lipoprotein cholesterol (MD: 3.8 mg/dL, p < 0.001). There were also significant positive changes in peak oxygen consumption (MD: 3.47 mL/kg/min, p < 0.001) and left ventricular ejection fraction (MD: 2.6%, p = 0.03) after the interventions. Subgroup analysis results revealed that exercise interventions of 60-90 minutes per week with a programme duration of >12 weeks had beneficial effects on functional capacity, cardiac function and a number of cardiovascular risk factors. CONCLUSIONS: Endurance exercise training has a positive effect on major modifiable cardiovascular risk factors and functional capacity. Nurses can develop endurance exercise recommendations for incorporation into care plans of clinically stable CAD patients following an acute cardiac event or revascularisation procedure.

6 Review Coronary artery aneurysm after implantation of a bioresorbable vascular scaffold: Case report and literature review. 2017

Chua, Su-Kiat / Cheng, Jun-Jack. ·School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. · Department of General Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. · Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. · Medical College, Taipei Medical University, Taipei, Taiwan. ·Catheter Cardiovasc Interv · Pubmed #28164433.

ABSTRACT: A 55-year-old man underwent successful percutaneous coronary intervention for the middle left circumflex artery with a 3.5 × 28-mm bioresorbable vascular scaffold (BVS). At 18 months, follow-up coronary angiography showed ectatic change with aneurysm formation over the BVS. Optical coherence tomography revealed absence of strut continuity at the aneurysm site, in the middle of the BVS. A literature review identified nine patients with intrascaffold aneurysm, including the present patient, which developed 6-32 months after BVS implantation. Of these nine patients, four underwent percutaneous coronary intervention for chronic total occlusion. The pathogenesis of coronary artery aneurysm is multifactorial. Most patients receive no further intervention, but long-term dual antiplatelet therapy is sometimes prescribed in conjunction with regular follow-up. © 2017 Wiley Periodicals, Inc.

7 Review Review: The outcomes of different vessel diameter in patients receiving coronary artery stenting. 2016

Tsai, Ming-Lung / Chen, Chun-Chi / Chen, Dong-Yi / Yang, Chia-Hung / Hsieh, Ming-Jer / Lee, Cheng-Hung / Wang, Chao-Yung / Chang, Shang-Hung / Hsieh, I-Chang. ·Department of Cardiology, Chang Gung Memorial Hospital, Taipei, and College of Medicine, Chang Gung University, Taoyuan, Taiwan. · Department of Cardiology, Chang Gung Memorial Hospital, Taipei, and College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: hsiehic@ms28.hinet.net. ·Int J Cardiol · Pubmed #27665404.

ABSTRACT: Compared to bare metal stent (BMS) implantation, drug-eluting stents (DES) is significantly better in attenuating intimal hyperplasia and reducing the rate of revascularization. However, the requirement of prolonged dual antiplatelet therapy (DAPT) and the economic cost have been the major disadvantages of DES. Studies have shown that the use of DES in small vessels decrease revascularization rate, but the results in large vessels vary. Previous studies have shown that the extent of late loss is unrelated to vessel diameter, and that late loss is easily accommodated in large vessels, thus resulting in decreased clinical benefit of DES in this setting. No definite cut-off point value of the vessel size has yet been demonstrated. Series studies aimed at evaluating the clinical outcomes of DES versus BMS in large vessels, but their results have been controversial. In this review, we evaluate the latest studies on clinical outcomes for different vessel sizes and clinical conditions. Nonetheless, further large clinical trials are warranted to address the clinical results of newer stents in different size vessels, especially in large vessels.

8 Review Target Blood Pressure in Patients with Diabetes: Asian Perspective. 2016

Park, Sungha / Kario, Kazuomi / Park, Chang Gyu / Huang, Qi Fang / Cheng, Hao Min / Hoshide, Satoshi / Wang, Ji Guang / Chen, Chen Huan / Anonymous2590880. ·Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea. · Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan. kkario@jichi.ac.jp. · Division of Cardiology, Korea University College of Medicine, Seoul, Korea. · Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. · Department of Medical Education, Taipei Veterans General Hospital, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. · Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan. ·Yonsei Med J · Pubmed #27593856.

ABSTRACT: Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despite the significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjects enrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associated with a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130-140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated with an elevated risk for cardiovascular events. As the association between stroke and BP is stronger in Asians, compared to other ethnicities, consideration should be given for a target BP of 130/80 mm Hg in Asians.

9 Review Diagnostic Performance of Attenuation-Corrected Myocardial Perfusion Imaging for Coronary Artery Disease: A Systematic Review and Meta-Analysis. 2016

Huang, Jei-Yie / Huang, Chun-Kai / Yen, Ruoh-Fang / Wu, Hon-Yen / Tu, Yu-Kang / Cheng, Mei-Fang / Lu, Ching-Chu / Tzen, Kai-Yuan / Chien, Kuo-Liong / Wu, Yen-Wen. ·Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. · Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. · Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. · Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. · Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan klchien@ntu.edu.tw wuyw0502@gmail.com. · Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan klchien@ntu.edu.tw wuyw0502@gmail.com. · Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. · Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; and. · National Yang-Ming University School of Medicine, Taipei, Taiwan. ·J Nucl Med · Pubmed #27445295.

ABSTRACT: Myocardial perfusion imaging (MPI) with SPECT is a well-established tool for the diagnosis of coronary artery disease (CAD). However, soft-tissue attenuation is a common artifact that limits the diagnostic accuracy of MPI. The aim of this study was to determine whether attenuation correction (AC) improved the diagnostic performance of MPI, using coronary angiography as a reference standard. METHODS: MEDLINE and EMBASE were searched until March 2015 for studies evaluating AC MPI for the diagnosis of CAD. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. For each study, the sensitivity, specificity, and diagnostic odds ratio, along with 95% confidence intervals (CIs), were calculated to determine the diagnostic accuracy of AC versus non-attenuation-corrected (NAC) MPI. A bivariate mixed-effects model was applied for pooling the data. RESULTS: Of 201 articles, 17 studies (1,701 patients) were identified, including 5 studies that used CT AC, 12 studies that used radionuclide source AC (RAC), and 15 studies that reported NAC results. The pooled sensitivities across studies were 0.80 (95% CI, 0.64-0.91), 0.85 (95% CI, 0.81-0.88), 0.84 (95% CI, 0.79-0.88), and 0.80 (95% CI, 0.75-0.85) for CT AC, RAC, all AC, and NAC, respectively. The pooled specificities were 0.83 (95% CI, 0.71-0.91), 0.81 (95% CI, 0.73-0.86), 0.80 (95% CI, 0.74-0.85), and 0.68 (95% CI, 0.61-0.74). Both sensitivities and specificities resulted in a pooled diagnostic odds ratio of 20 (95% CI, 12-34), 24 (95% CI, 13-43), 22 (95% CI, 13-35), and 9 (7-11). Significant differences in specificity and diagnostic odds ratios were noted when AC (including CT AC, RAC, and all AC) was compared with NAC. CONCLUSION: The results from this study suggested that AC should be applied to MPI to improve the diagnosis of CAD, especially the specificity.

10 Review Interplay between CRP, Atherogenic LDL, and LOX-1 and Its Potential Role in the Pathogenesis of Atherosclerosis. 2016

Stancel, Nicole / Chen, Chih-Chieh / Ke, Liang-Yin / Chu, Chih-Sheng / Lu, Jonathan / Sawamura, Tatsuya / Chen, Chu-Huang. ·Department of Vascular and Medicinal Research, Texas Heart Institute, Houston, TX; · Center for Lipid Biosciences, Kaohsiung Medical University (KMU) Hospital, KMU, Kaohsiung, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan; · Center for Lipid Biosciences, Kaohsiung Medical University (KMU) Hospital, KMU, Kaohsiung, Taiwan; Lipid Science and Aging Research Center, KMU, Kaohsiung, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, KMU, Kaohsiung, Taiwan; · Center for Lipid Biosciences, Kaohsiung Medical University (KMU) Hospital, KMU, Kaohsiung, Taiwan; Department of Internal Medicine, KMU Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, KMU, Kaohsiung, Taiwan; · Department of Physiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan; cchen@texasheart.org t-sawamura@umin.ac.jp. · Department of Vascular and Medicinal Research, Texas Heart Institute, Houston, TX; Center for Lipid Biosciences, Kaohsiung Medical University (KMU) Hospital, KMU, Kaohsiung, Taiwan; Lipid Science and Aging Research Center, KMU, Kaohsiung, Taiwan; Cardiovascular Research Center, China Medical University (CMU) Hospital, CMU, Taichung, Taiwan; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Current affiliation: New York Heart Research Foundation, Mineola, NY. cchen@texasheart.org t-sawamura@umin.ac.jp. ·Clin Chem · Pubmed #26607724.

ABSTRACT: BACKGROUND: Studies have shown that the classic acute-phase protein C-reactive protein (CRP) has proinflammatory effects on vascular cells and may play a causal role in the pathogenesis of coronary artery disease. A growing body of evidence has suggested that interplay between CRP, lectin-like oxidized LDL receptor-1 (LOX-1), and atherogenic LDL may underlie the mechanism of endothelial dysfunction that leads to atherosclerosis. CONTENT: We review the biochemical evidence for an association of CRP, LOX-1, and either oxidized LDL (OxLDL) or electronegative L5 LDL with the pathogenesis of coronary artery disease. Artificially oxidized OxLDL has been studied extensively for its role in atherogenesis, as has electronegative L5 LDL, which is present at increased levels in patients with increased cardiovascular risks. OxLDL and L5 have been shown to stimulate human aortic endothelial cells to produce CRP, indicating that CRP is synthesized locally in the endothelium. The ligand-binding face (B-face) of CRP has been shown to bind the LOX-1 scavenger receptor and increase LOX-1 expression in endothelial cells, thereby promoting the uptake of OxLDL or L5 by LOX-1 into endothelial cells to induce endothelial dysfunction. SUMMARY: CRP and LOX-1 may form a positive feedback loop with OxLDL or L5 in atherogenesis, whereby increased levels of atherogenic LDL in patients with cardiovascular risks induce endothelial cells to express CRP, which may in turn increase the expression of LOX-1 to promote the uptake of atherogenic LDL into endothelial cells. Further research is needed to confirm a causal role for CRP in atherogenesis.

11 Review Inflammation and the pathogenesis of atrial fibrillation. 2015

Hu, Yu-Feng / Chen, Yi-Jen / Lin, Yenn-Jiang / Chen, Shih-Ann. ·Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Number 201, Section 2, Shipai Road, Beitou District, Taipei 11217, Taiwan, Republic of China. · Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Number 111, Section 3, Hsing-Long Road, Taipei 11696, Taiwan, Republic of China. ·Nat Rev Cardiol · Pubmed #25622848.

ABSTRACT: Atrial fibrillation (AF) is the most common cardiac arrhythmia. However, the development of preventative therapies for AF has been disappointing. The infiltration of immune cells and proteins that mediate the inflammatory response in cardiac tissue and circulatory processes is associated with AF. Furthermore, the presence of inflammation in the heart or systemic circulation can predict the onset of AF and recurrence in the general population, as well as in patients after cardiac surgery, cardioversion, and catheter ablation. Mediators of the inflammatory response can alter atrial electrophysiology and structural substrates, thereby leading to increased vulnerability to AF. Inflammation also modulates calcium homeostasis and connexins, which are associated with triggers of AF and heterogeneous atrial conduction. Myolysis, cardiomyocyte apoptosis, and the activation of fibrotic pathways via fibroblasts, transforming growth factor-β and matrix metalloproteases are also mediated by inflammatory pathways, which can all contribute to structural remodelling of the atria. The development of thromboembolism, a detrimental complication of AF, is also associated with inflammatory activity. Understanding the complex pathophysiological processes and dynamic changes of AF-associated inflammation might help to identify specific anti-inflammatory strategies for the prevention of AF.

12 Review What is the ultimate test that lowering lipoprotein(a) is beneficial for cardiovascular disease and aortic stenosis? 2014

Hung, Ming-Yow / Tsimikas, Sotirios. ·aDivision of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City bDepartment of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan cSchool of Medicine, University of California San Diego, La Jolla, California, USA. ·Curr Opin Lipidol · Pubmed #25340480.

ABSTRACT: PURPOSE OF REVIEW: Lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular disease (CVD) and calcific aortic valve stenosis. We review recent studies that highlight Lp(a) in CVD and calcific aortic valve stenosis and propose pathways to clinical registration of Lp(a)-lowering agents. RECENT FINDINGS: Over the last few years, almost irrefutable evidence has accumulated that Lp(a) is a causal, independent, genetic risk factor for CVD. Most recently, new data have emerged that elevated Lp(a) is causally associated with calcific aortic valve stenosis and the need for aortic valve replacement. Three levels of evidence to support these findings: epidemiological studies, Mendelian randomization studies and genetic association studies. A dedicated Lp(a)-lowering trial has not been performed to date. Emerging Lp(a)-lowering therapies with specific and potent lowering of Lp(a) are in phase II clinical trials and provide a tool to test the hypothesis that lowering Lp(a) plasma levels will lead to clinical benefit. SUMMARY: We provide a rationale for the potential clinical use of Lp(a)-lowering therapies in high-risk patients or patients with established CVD whose major risk factor is elevated Lp(a) levels and propose clinical studies and trials to demonstrate that lowering Lp(a) levels will effectively reduce the risk of calcific aortic valve stenosis and CVD.

13 Review Coronary artery spasm: review and update. 2014

Hung, Ming-Jui / Hu, Patrick / Hung, Ming-Yow. ·1. Department of Cardiology, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan; · 2. International Cardiovascular Institute, Las Vegas, Nevada, USA; ; 3. Department of Cardiology, Riverside Medical Clinic, Riverside, California, USA; · 4. Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; 5. Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; ; 6. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan. ·Int J Med Sci · Pubmed #25249785.

ABSTRACT: Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not β-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS.

14 Review The relation of location-specific epicardial adipose tissue thickness and obstructive coronary artery disease: systemic review and meta-analysis of observational studies. 2014

Wu, Fu-Zong / Chou, Kang-Ju / Huang, Yi-Luan / Wu, Ming-Ting. ·Department of Radiology, Section of Thoracic and Circulation Imaging, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. wu.mingting@gmail.com. ·BMC Cardiovasc Disord · Pubmed #24884458.

ABSTRACT: BACKGROUND: There is growing evidence about the importance of epicardial adiposity on cardiometabolic risk. However, the relation of location-specific epicardial adipose tissue (EAT) thickness to coronary atherosclerotic burden is still unclear. METHODS: This meta-analysis was used to study the relations between location-specific EAT thickness and obstructive coronary artery disease (CAD). A systemic literature search to identify eligible studies that met the inclusion criteria from the beginning until January 2014 was made. We conducted the meta-analysis of all included 10 published studies. Pre-specified subgroup analyses were performed according to ethnicity, body mass index, diagnostic tools for CAD, and measurement tool if presence of high heterogeneity between studies. Potential publication bias was also assessed. RESULTS: We identified ten observed studies with a total of 1625 subjects for planned comparison. With regard to the association between obstructive CAD and location-specific EAT thickness at the right ventricular free wall, caution is warranted. The pooled estimate showed that location-specific EAT thickness at the right ventricular free wall was significantly higher in the CAD group than non-CAD group (standardized mean difference (SMD): 0.70 mm, 95% CI: 0.26-1.13, P = 0.002), although heterogeneity was high (I2 = 93%). It should be clear that only the result of echocardiography-based studies showed a significant association (SMD: 0.98 mm, 95% CI: 0.43-1.53, P = 0.0005), and the result of all included CT-based studies showed a non-significant association (SMD: 0.06 mm, 95% CI: -0.12-0.25, P = 0.50). In the subgroup analysis, the "diagnostic tools for CAD" or "measurement tool of EAT thickness" are potential major sources of heterogeneity between studies. With regard to location-specific EAT thickness at the left atrioventricular (AV) groove, it was significantly higher in the CAD group than non-CAD group (SMD: 0.74 mm, 95% CI: 0.55-0.92, P <0.00001; I2 = 0%). CONCLUSION: Our meta-analysis suggests that significantly elevated location-specific EAT thickness at the left AV groove is associated with obstructive CAD. Based on the current evidence, the location-specific EAT thickness at the left AV groove appears to be a good predictor in obstructive CAD, especially in Asian populations. Furthermore well-designed studies are warranted because of the current limited number of studies.

15 Review A meta-analysis comparing SPECT with PET for the assessment of myocardial viability in patients with coronary artery disease. 2014

Tsai, Jui-Peng / Yun, Chun-Ho / Wu, Tung-Hsin / Yen, Chih-Hsuan / Hou, Charles Jia-Yin / Kuo, Jen-Yuan / Hung, Chung-Lieh. ·aDepartment of Biomedical Imaging and Radiological Sciences, National Yang Ming University bDepartment of Internal Medicine, Division of Cardiology cDepartment of Radiology, Mackay Memorial Hospital dMackay Medicine, Nursing and Management College, Taipei, Taiwan. ·Nucl Med Commun · Pubmed #24785009.

ABSTRACT: OBJECTIVE: The aim of this meta-analysis was to examine the diagnostic accuracy of single-photon emission computed tomography (SPECT) for the assessment of myocardial viability in patients with coronary artery disease as compared with PET. MATERIALS AND METHODS: The literature was searched using the following keywords: single-photon emission computed tomography, positron emission tomography, perfusion, viability, myocardial infarction. Studies involving patients with coronary artery disease, left ventricular dysfunction, or a history of myocardial infarction and that compared SPECT and PET for the assessment of myocardial viability were included in the analysis. RESULTS: Eight studies including 310 patients were included in the meta-analysis. The total number of myocardial segments analyzed was 3580. The sensitivity and specificity of SPECT for the eight studies ranged from 59 to 95% and from 79 to 100%, respectively. The pooled sensitivity of SPECT was 82% [95% confidence interval (CI): 81-84%]. The pooled specificity of SPECT was 88% (95% CI: 86-90%). For all studies, the pooled diagnostic odds ratio was 62.60 (95% CI: 19.29-203.15) and the area under the receiver-operating characteristic curve was 0.945, indicating that SPECT could accurately assess myocardial viability. CONCLUSION: The meta-analysis indicated that SPECT can accurately assess myocardial viability, as compared with PET, and supports the use of SPECT for the assessment of myocardial viability in patients with coronary artery disease.

16 Review Double right coronary artery and its clinical implications. 2014

Chien, Tsu-Ming / Chen, Chih-Wei / Chen, Huai-Min / Lee, Chee-Siong / Lin, Ching-Cheng / Chen, Ying-Fu. ·1 Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan. · 2 School of Medicine, Chung Shan Medical University, Taichung, Taiwan. · 3 Division of Cardiovascular Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan. · 4 Division of Cardiology, Kaohsiung Medical University, Kaohsiung, Taiwan. ·Cardiol Young · Pubmed #23458190.

ABSTRACT: Congenital anomalies of the coronary arteries are present in 0.2-1.4% of the general population. These anomalies represent one of the most confusing issues in the field of cardiology and challenges for interventional cardiologists and cardiac surgeons if the anomalies are unrecognised. Double right coronary artery is one of the rarest coronary arteries. Previously, the probability of developing atherosclerotic changes in patients with a double right coronary artery was considered to be equal to that in those without it. In reality, however, a high prevalence of atherosclerotic coronary artery disease was found in patients with a double right coronary artery originating from a single ostium after our comprehensive literature search through the PubMed database. Owing to the fact that double right coronary artery is both a congenital and potentially atherosclerotic coronary artery disease at diagnosis, coronary intervention or cardiac operation is more complicated than previously believed. Individuals with a double right coronary artery may be unaware of its presence until an accidental finding during coronary angiography or cardiac operation and are at risk for unsuspected complications of atherosclerotic coronary artery disease or during cardiac operation. Therefore, it is important to obtain information on the anatomic variants of this congenital coronary anomaly in patients who are undergoing either coronary intervention, aortic root operation or myocardial revascularisation. To our knowledge, this is the first comprehensive article to discuss the anomalies and their clinical implications.

17 Review Relation of body mass index to mortality among patients with percutaneous coronary intervention in the drug-eluting stent era: a systematic review and meta-analysis. 2013

Lin, Gen-Min / Li, Yi-Hwei / Lin, Chin-Lon / Wang, Ji-Hung / Han, Chih-Lu. ·Department of Public Health, Tzu-Chi University, Hualien, Taiwan; Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan. Electronic address: farmer507@yahoo.com.tw. ·Int J Cardiol · Pubmed #23890878.

ABSTRACT: -- No abstract --

18 Review Recent advances in the treatment of Kawasaki disease. 2011

Weng, Ken-Pen / Ou, Shan-F / Lin, Chu-Chuan / Hsieh, Kai-Sheng. ·Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. ·J Chin Med Assoc · Pubmed #22100015.

ABSTRACT: Kawasaki disease (KD) is acute systemic vasculitis that occurs mainly in infants and children under 5 years of age. The etiology of KD remains unknown. KD is liable to be complicated by coronary artery lesions (CALs), which develop in approximately 15-25% of untreated KD children and in approximately 5% of KD children after intravenous immunoglobulin (IVIG) therapy. A single high dose of IVIG (2 g/kg) is the gold standard therapy in the acute stage of KD. However, approximately 8--38% of children are unresponsive to initial IVIG treatment and at increased risk for CAL development. Anti-inflammatory high doses of aspirin are recommended in conjunction with IVIG, but our study demonstrated that there is no evidence of efficacy in preventing CAL development. The usefulness of steroids in initial therapy for KD or treatment of IVIG-resistant patients is not well established. Other immunosuppressive therapies, including infliximab, have been used in the treatment of refractory KD, but merit additional investigation. Subclinical atherosclerosis may develop early in KD patients, which makes early initiation of therapy to improve chronic inflammation an important issue. Future multicenter studies may help to define the optimal management of KD patients.

19 Review The clinical implications of blood adiponectin in cardiometabolic disorders. 2009

Chang, Lin-Chau / Huang, Kuo-Chin / Wu, Yen-Wen / Kao, Hsien-Li / Chen, Chi-Ling / Lai, Ling-Ping / Hwang, Juey-Jen / Yang, Wei-Shiung. ·Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. ·J Formos Med Assoc · Pubmed #19443289.

ABSTRACT: Adipose tissue is now accepted by the scientific and medical community to be a genuine endocrine organ, in addition to its classical role as an energy store. Adiponectin is one of the many adipocytokines that are secreted almost exclusively by adipose tissue. Alteration in blood adiponectin concentrations has been linked to many human diseases in numerous cross-sectional and prospective studies. In this review, we describe briefly the biological effects of adiponectin as revealed by basic scientific investigations. We also summarize the principles of blood adiponectin assays. Overall, lower blood adiponectin concentration is found in subjects with obesity, type 2 diabetes mellitus, dyslipidemia, and hypertension. These medical conditions are components of the metabolic syndrome and major risk factors for accelerated atherosclerosis. Plasma adiponectin levels are also expected to be lower in subjects with cardiovascular diseases, such as coronary artery disease, ischemic stroke and peripheral artery disease. Congestive heart failure (CHF) and cardiac arrhythmia are common end points in cardiovascular diseases. Surprisingly, higher blood adiponectin levels are frequently reported to predict mortality associated with CHF. Few human data regarding adiponectin and cardiac arrhythmia are available. Higher blood adiponectin level has been documented only in atrial fibrillation. We also summarize data on the role of the high molecular weight (HMW) isoforms of adiponectin and the effects of clinical treatment on the levels of total or HMW adiponectin. Whether adiponectin is a risk marker or a risk factor for the diseases reviewed in this article, and in many other human diseases, and their detailed pathogenic links awaits further investigation.

20 Clinical Trial Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials. 2018

Campos, Carlos M / Caixeta, Adriano / Franken, Marcelo / Bartorelli, Antonio L / Whitbourn, Robert J / Wu, Chiung-Jen / Li Paul Kao, Hsien / Rosli, Mohd Ali / Carrie, Didier / De Bruyne, Bernard / Stone, Gregg W / Serruys, Patrick W / Abizaid, Alexandre / Anonymous3471055. ·Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia. · Department of Cardiology, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Taiwan. · Department of Cardiology, National Taiwan University Hospital, Taipei, Taiwan. · Department of Cardiology, Institute Jantung Negara, Kuala Lumpur, Malaysia. · Department of Cardiology, Hôpital de Rangueil CHU, Toulouse, France. · Department of Cardiology, Cardiovascular Center Aalst, Belgium. · Department of Interventional Cardiology, Columbia University Medical Center, New York. · Cardiovascular Research Foundation, New York. · International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom. · Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. ·Catheter Cardiovasc Interv · Pubmed #28471086.

ABSTRACT: OBJECTIVES: to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. METHODS: The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). RESULTS: After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. CONCLUSION: In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.

21 Clinical Trial Detecting Triple-Vessel Disease with Cadmium Zinc Telluride-Based Single-Photon Emission Computed Tomography Using the Intensity Signal-to-Noise Ratio between Rest and Stress Studies. 2017

Fang, Yu-Hua Dean / Su, Tzu-Pei / Chang, Chi-Jen / Ho, Kung-Chu / Su, May / Yen, Tzu-Chen. ·Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan. · Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. · Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan. · Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan. · Center for Advanced Molecular Imaging and Translation & Cyclotron Center, Chang Gung Memorial Hospital, Linkou, Taiwan. ·Contrast Media Mol Imaging · Pubmed #29114176.

ABSTRACT: The purpose of this study was to investigate if a novel parameter, the stress-to-rest ratio of the signal-to-noise ratio (RSNR) obtained with a cadmium zinc telluride (CZT) SPECT scanner, could be used to distinguish triple-vessel disease (TVD) patients.

22 Clinical Trial Genetic and Pharmacologic Inactivation of ANGPTL3 and Cardiovascular Disease. 2017

Dewey, Frederick E / Gusarova, Viktoria / Dunbar, Richard L / O'Dushlaine, Colm / Schurmann, Claudia / Gottesman, Omri / McCarthy, Shane / Van Hout, Cristopher V / Bruse, Shannon / Dansky, Hayes M / Leader, Joseph B / Murray, Michael F / Ritchie, Marylyn D / Kirchner, H Lester / Habegger, Lukas / Lopez, Alex / Penn, John / Zhao, An / Shao, Weiping / Stahl, Neil / Murphy, Andrew J / Hamon, Sara / Bouzelmat, Aurelie / Zhang, Rick / Shumel, Brad / Pordy, Robert / Gipe, Daniel / Herman, Gary A / Sheu, Wayne H H / Lee, I-Te / Liang, Kae-Woei / Guo, Xiuqing / Rotter, Jerome I / Chen, Yii-Der I / Kraus, William E / Shah, Svati H / Damrauer, Scott / Small, Aeron / Rader, Daniel J / Wulff, Anders Berg / Nordestgaard, Børge G / Tybjærg-Hansen, Anne / van den Hoek, Anita M / Princen, Hans M G / Ledbetter, David H / Carey, David J / Overton, John D / Reid, Jeffrey G / Sasiela, William J / Banerjee, Poulabi / Shuldiner, Alan R / Borecki, Ingrid B / Teslovich, Tanya M / Yancopoulos, George D / Mellis, Scott J / Gromada, Jesper / Baras, Aris. ·From Regeneron Genetics Center (F.E.D., C.O., C.S., O.G., S.M., C.V.V.H., S.B., L.H., A.L., J.P., N.S., A.J.M., J.D.O., J.G.R., A.R.S., I.B.B., T.M.T., G.D.Y., S.J.M., A. Baras) and Regeneron Pharmaceuticals (V.G., H.M.D., A.Z., W.S., N.S., A.J.M., S.H., A. Bouzelmat, R.Z., B.S., R.P., D.G., G.A.H., W.J.S., P.B., G.D.Y., S.J.M., J.G.) Tarrytown, NY · the Department of Medicine, Division of Translational Medicine and Human Genetics (R.L.D.), and Departments of Surgery (S.D.) and Genetics and Medicine (A.S., D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, and Geisinger Health System, Danville (J.B.L., M.F.M., M.D.R., H.L.K., D.H.L., D.J.C.) - both in Pennsylvania · the Division of Endocrinology and Metabolism, Department of Internal Medicine (W.H.H.S., I.-T.L.) and Cardiovascular Center (K.-W.L.), Taichung Veterans General Hospital, Institute of Medical Technology, National Chung-Hsing University (W.H.H.S.), School of Medicine, Chung Shan Medical University (I.-T.L.), and the Department of Medicine, China Medical University (K.-W.L.), Taichung, and School of Medicine, National Yang-Ming University (W.H.H.S., I.-T.L., K.-W.L.), and School of Medicine, National Defense Medical Center (W.H.H.S.), Taipei - all in Taiwan · Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA (X.G., J.I.R., Y.-D.I.C.) · the Division of Cardiology, Department of Medicine, Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC (W.E.K., S.H.S.) · the Department of Clinical Biochemistry, Rigshospitalet (A.B.W., B.G.N., A.T.-H.), the Copenhagen General Population Study (B.G.N., A.T.-H.) and Department of Clinical Biochemistry (B.G.N.), Herlev and Gentofte Hospital, and the Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, and Faculty of Health and Medical Sciences, University of Copenhagen (B.G.N., A.T.-H.) - all in Copenhagen · and TNO Metabolic Health Research, Gaubius Laboratory, Leiden, the Netherlands (A.M.H., H.M.G.P.). ·N Engl J Med · Pubmed #28538136.

ABSTRACT: BACKGROUND: Loss-of-function variants in the angiopoietin-like 3 gene (ANGPTL3) have been associated with decreased plasma levels of triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol. It is not known whether such variants or therapeutic antagonism of ANGPTL3 are associated with a reduced risk of atherosclerotic cardiovascular disease. METHODS: We sequenced the exons of ANGPTL3 in 58,335 participants in the DiscovEHR human genetics study. We performed tests of association for loss-of-function variants in ANGPTL3 with lipid levels and with coronary artery disease in 13,102 case patients and 40,430 controls from the DiscovEHR study, with follow-up studies involving 23,317 case patients and 107,166 controls from four population studies. We also tested the effects of a human monoclonal antibody, evinacumab, against Angptl3 in dyslipidemic mice and against ANGPTL3 in healthy human volunteers with elevated levels of triglycerides or LDL cholesterol. RESULTS: In the DiscovEHR study, participants with heterozygous loss-of-function variants in ANGPTL3 had significantly lower serum levels of triglycerides, HDL cholesterol, and LDL cholesterol than participants without these variants. Loss-of-function variants were found in 0.33% of case patients with coronary artery disease and in 0.45% of controls (adjusted odds ratio, 0.59; 95% confidence interval, 0.41 to 0.85; P=0.004). These results were confirmed in the follow-up studies. In dyslipidemic mice, inhibition of Angptl3 with evinacumab resulted in a greater decrease in atherosclerotic lesion area and necrotic content than a control antibody. In humans, evinacumab caused a dose-dependent placebo-adjusted reduction in fasting triglyceride levels of up to 76% and LDL cholesterol levels of up to 23%. CONCLUSIONS: Genetic and therapeutic antagonism of ANGPTL3 in humans and of Angptl3 in mice was associated with decreased levels of all three major lipid fractions and decreased odds of atherosclerotic cardiovascular disease. (Funded by Regeneron Pharmaceuticals and others; ClinicalTrials.gov number, NCT01749878 .).

23 Clinical Trial When Atrial Fibrillation Co-Exists with Coronary Artery Disease in Patients with Prior Coronary Intervention - Does Ablation Benefit? 2016

Chong, Eric / Chang, Hung-Yu / Chen, Yun-Yu / Poh, Kian-Keong / Chung, Fa-Bo / Chang, Shih-Lin / Lo, Li-Wei / Hu, Yu-Feng / Chao, Tze-Fan / Tuan, Ta-Chuan / Chen, Shih-Ann / Lin, Yenn-Jiang. ·Division of Cardiology, Jurong General Hospital, Singapore; Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: ericchong80@hotmail.com. · Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan. · Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan. · National University Heart Centre, National University Hospital, Singapore. · Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan. Electronic address: epsachen@ms41.hinet.net. ·Heart Lung Circ · Pubmed #26839165.

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.

24 Clinical Trial Additive Value of Heart Rate Variability in Predicting Obstructive Coronary Artery Disease Beyond Framingham Risk. 2016

Li, Hsin-Ru / Lu, Tse-Min / Cheng, Hao-Min / Lu, Dai-Yin / Chiou, Chuen-Wang / Chuang, Shao-Yuan / Yang, Albert C / Sung, Shih-Hsien / Yu, Wen-Chung / Chen, Chen-Huan. ·Department of Medicine, Shuang Ho Hospital, Taipei Medical University. ·Circ J · Pubmed #26701182.

ABSTRACT: BACKGROUND: Heart rate variability (HRV) is usually reduced in patients with CAD. We therefore investigated whether reduced HRV is predictive of angiographic CAD beyond Framingham risk in patients with stable angina. METHODS AND RESULTS: A total of 514 patients (age, 66.1 ± 14.3 years, 358 men) were enrolled. Holter ECG was performed before catheterization, and 24-h HRV was analyzed in both the frequency domain (VLF, LF, HF and total power) and the time domain (SDNN, SDANN, RMSSD and pNN20). Angiographic CAD was defined as ≥ 50% diameter reduction of 1 or more coronary arteries. On coronary angiography 203 patients (39.6%) had angiographic CAD. Patients with CAD had significantly higher Framingham risk and lower HRV according to both frequency and time domain parameters. After controlling for age, gender, heart rate, SBP, renal function, lipids and Framingham risk, reduced HRV indices remained predictors of CAD (OR, 95% CI for LF, HF, SDNN, RMSSD and pNN20: 0.81, 0.66-0.99; 0.77, 0.63-0.94; 0.75, 0.59-0.96; 0.72, 0.58-0.88; and 0.76, 0.62-0.94, respectively). On subgroup analysis, HRV parameters appeared to be predictive of CAD only in subjects with high Framingham risk or diabetes. CONCLUSIONS: Reduced HRV is predictive of CAD in patients with stable angina, independent of traditional risk factors and Framingham risk. The predictive value of HRV may be relevant only in subjects with high Framingham risk or diabetes.

25 Clinical Trial Intracoronary Transfusion of Circulation-Derived CD34+ Cells Improves Left Ventricular Function in Patients With End-Stage Diffuse Coronary Artery Disease Unsuitable for Coronary Intervention. 2015

Lee, Fan-Yen / Chen, Yung-Lung / Sung, Pei-Hsun / Ma, Ming-Chun / Pei, Sung-Nan / Wu, Chiung-Jen / Yang, Cheng-Hsu / Fu, Morgan / Ko, Sheung-Fat / Leu, Steve / Yip, Hon-Kan. ·1Division of thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 2Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 3Division of Hema-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 4Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 5Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 6Center of Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 7Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. ·Crit Care Med · Pubmed #26154930.

ABSTRACT: OBJECTIVE: This study tested the hypothesis that intra-coronary transfusion of circulation-derived autologous CD34+ cells can improve ischemia-related left ventricular dysfunction in patients with severe diffuse coronary artery disease refractory to medication and unsuitable for coronary intervention. DESIGN: A prospective, randomized, double-blinded phase I clinical trial. SETTING: Tertiary care center. PATIENTS: Thirty-eight patients with severe diffuse coronary artery disease were randomized into group 1 and group 2 receiving CD34+ cell infusion with dosages of 1.0 x 107 and 3.0 x 107 cells/vessel, respectively, after subcutaneous G-CSF injection (5 μg/kg twice a day for 4 d). INTERVENTIONS: Cardiac catheterization and intra-coronary administration of CD34+ cells. MEASUREMENTS AND MAIN RESULTS: This clinical trial was to test effectiveness and safety of these two different dosages of CD34+ cells in the setting of severe diffuse coronary artery disease. Blood samples were collected for endothelial progenitor cell culture before and after granulocyte colony-stimulating factor injection for matrigel-assay and comparison of levels of soluble angiogenesis factors (vascular endothelial growth factor, epithelial growth factor, hepatocyte growth factor, angiopoietin-1, and transforming growth factor-β). Procedural safety was 100% with all patients uneventfully discharged. The numbers of endothelial progenitor cells in blood samples from coronary sinus after transfusion were higher than those in circulation, and the circulatory level was higher after granulocyte colony-stimulating factor treatment (all p < 0.001). Cardiac MRI and three-dimensional echocardiography at 6 month and angiographic follow-up at 9 month showed improvement in left ventricular ejection fraction (p < 0.001) and consistent increase in neovascularization (p < 0.001), respectively, in both groups. Despite good correlation in angiogenesis between 9-month angiography and matrigel-assay (p < 0.001), no significant correlation was noted in of soluble angiogenesis factor levels. Angina and heart failure were improved in both groups at 12-month follow-up (all p < 0.001). The survival rate at 18.5-month follow-up was 94.7% (n = 36). CONCLUSIONS: CD34+ cell therapy was safe and efficacious in improving heart function for patients with severe diffuse coronary artery disease unsuitable for coronary intervention and with poor response to pharmacotherapy.

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