Anna Kin-Yin Chan

Microalbuminuria and other cardiovascular risk factors in nondiabetic subjects

The association between urinary albumin:creatinine ratio and other cardiovascular risk factors such as age, blood pressure, obesity, glycemic indices, insulin and lipid profile was examined in a population in a Chinese community consisting of 795 men (mean age 35.8 +/- 8.8 yr) and 538 women (mean age 37.9 +/- 8.9 yr) with a normal glucose tolerance defined by WHO criteria. Men with a urinary albumin:creatinine ratio above the 90th percentile had higher systolic and diastolic blood pressures, fasting plasma glucose, 2-h glucose after a 75 g oral glucose load, and fasting serum insulin. Women with high urinary albumin:creatinine values had higher systolic and diastolic blood pressures, body mass index, waist-hip ratio, fasting insulin and triglycerides. Multivariate analysis showed that only systolic blood pressure and fasting glucose in men, and diastolic blood pressure and fasting insulin in women, independently contributed to urinary albumin:creatinine. When the effect of blood pressure was eliminated by excluding subjects with systolic blood pressure > 140 and diastolic > 90 mm Hg, only fasting insulin was associated with urinary albumin:creatinine in women. No associations were found for men. We conclude that microalbuminuria may be a marker for cardiovascular disease only because of its association with blood pressure in men, while in women, there is an additional independent association with fasting serum insulin.

Serum lipid profile and its association with some cardiovascular risk factors in an urban chinese population

&NA; The lipid profile of a Chinese population, which has a lower prevalence of coronary heart disease compared with Caucasians, is studied to determine whether lipid‐modifying disease prevention programs are necessary. The study population consisted of 910 men (mean age 36.7 ± 9.2 yrs) and 603 women (mean age 38.6 ± 9.1 yrs), who were employees of a public utility company and non‐medical staff of a district hospital. Indices of obesity, fasting cholesterol (TC), and its various subfraction, triglycerides (TG), apolipoprotein A‐1 (Apo A‐1), and apolipoprotein B (Apo B) concentrations were measured. Glucose tolerance was also estimated by measuring fasting and 2 h glucose after a 75 g oral glucose load. The lipid profile was similar to that of the North American population, with an overall prevalence of low density lipoprotein cholesterol (LDL‐C) ≥ 4.1 mmol/L of 21% and 11% in men and women respectively. Similar variations with age, sex, smoking and glucose tolerance compared with Caucasian populations were observed. The high prevalence of subjects with “undesirable” lipid values in this Chinese population, which at present has a coronary artery disease prevalence of one‐eighth to one‐quarter compared with that in Caucasians, suggests that the incidence of the disease may well rise in the future to pose a similar problem to that in Caucasian populations. Cut off values of lipids conferring increased cardiovascular risks need to be determined in this population, so that public health strategies may be formulated.

Difference in prevalence and pattern of mechanical dyssynchrony in left bundle branch block occurring in right ventricular apical pacing versus systolic heart failure.

BACKGROUND This study compared the prevalence and pattern of mechanical dyssynchrony in patients with normal heart and right ventricular apical (RVA) pacing versus patients with systolic heart failure (SHF) and spontaneous left bundle branch block (LBBB). METHODS A total of 112 patients having LBBB pattern on surface electrocardiogram were included (57 with ejection fraction>50% received RVA pacing; 55 had SHF with ejection fraction<35%). Using tissue Doppler imaging, systolic and diastolic dyssynchrony was defined by the standard deviation of the time to peak systolic and peak early diastolic velocity, respectively. RESULTS Despite comparable QRS duration and LBBB pattern, the prevalence of electromechanical dyssynchrony was significantly lower in the patients with RVA pacing (systolic: 54% vs 73%, chi2=4.058, P=.044; diastolic: 32% vs 61%, chi2=9.738, P=.002). The presence of coexisting systolic and diastolic dyssynchrony, isolated systolic dyssynchrony, isolated diastolic dyssynchrony, and no dyssynchrony also showed a different distribution between the 2 groups (RVA pacing: 14%, 40%, 18%, and 28%; SHF: 51%, 22%, 11%, and 16%; chi2=17.498, P=.001). Furthermore, the SHF group had a higher prevalence of medial wall (ie, septal, anteroseptal, and inferior) delay (56% vs 30%), whereas RVA pacing resulted in more free wall (ie, lateral, posterior and anterior) delay (44% vs 70%) (chi2=8.050, P=.005). CONCLUSIONS The prevalence of mechanical dyssynchrony is lower in patients with normal ejection fraction and RVA pacing when compared with patients with SHF and spontaneous LBBB. The pattern of delay in contraction also appears to be different between the 2 groups.

Three-Dimensional Printing for Planning Occlusion Procedure for a Double-Lobed Left Atrial Appendage

A 78-year-old woman with atrial fibrillation and contraindication to oral anticoagulation because of high bleeding risk was referred for catheter-based left atrial appendage (LAA) occlusion. Preprocedural transesophageal echocardiography (TEE) using the biplane mode showed an LAA with double-lobed anatomy with a dominant posterior lobe (p) and an accessory anterior lobe (a; Figure [A]). It was thought that successful LAA occluder implantation may be made more challenging by this anatomy because it is necessary to occlude the ostia of both lobes with the device. For better planning, we decided to simulate the actual procedure using three-dimensional (3D) printing technology. A computer-based hollow cast of the LAA was created from the 3D TEE data set and then converted to a stereolithography file for 3D printing using dedicated software (Mimics, Materialize Software, Leuven, Belgium; …

Intramural Left Atrial Hematoma Complicating Catheter Ablation for Atrial Fibrillation

![Figure][1] [![Graphic][3] ][3] A 52-year-old woman became hypotensive during radiofrequency ablation for paroxysmal atrial fibrillation. She received heparin 5,000 IU after transseptal puncture, and continued as an infusion to maintain an activated clotting time of 270 s during the

Using Multimaterial 3-Dimensional Printing for Personalized Planning of Complex Structural Heart Disease Intervention

A 56-year-old woman presented with dyspnea 6 months after percutaneous closure of atrial septal defect with a Cocoon Septal Occluder. Transesophageal echocardiography revealed partial device prolapse and recurrent left-to-right interatrial shunt through a crescent-shaped, tunnel-like peridevice

Minimalistic Approach to Left Atrial Appendage Occlusion Using the LAmbre Device

Left atrial appendage occlusion (LAAO) is predominantly performed under general anesthesia, guided by transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE). The LAmbre (Lifetech Science, Shenzhen, China) is a novel LAAO device that allows: 1) a less selective transseptal