Chi-Ming Chu

Independent Determinants of Coronary Artery Disease in Erectile Dysfunction Patients

INTRODUCTION There is growing evidence of a link between erectile dysfunction (ED) and coronary artery disease (CAD). AIMS The purpose of this study was to explore the independent determinants of CAD in ED outpatients. METHODS This study enrolled 243 patients, ranging in age from 21 to 81 years old, suffering from ED as diagnosed by the International Index of Erectile Function (IIEF) scores. All patients underwent exercise stress tests or thallium-201 single-photon emission computed tomography perfusion imagings. Based on examination results, patients were divided into study (22 patients with a positive finding) and control groups (221 patients with a negative finding). MAIN OUTCOME MEASURES The differences of demographic characteristics, biochemical profiles, pro-inflammatory and inflammatory markers, and echocardiographic characteristics between study and control group were compared. RESULTS The age, presence of DM and current smoking status were significant high in the study group. A significant lower high-density lipoprotein (HDL) cholesterol level, a higher percentage of HDL cholesterol level < 40 mg/dL, and a higher apo-lipoprotein B/A1, high sensitive C-reactive protein (hs-CRP) and homocysteine found in the study group. The Framingham cardiac risk scores, the ratio of mitral inflow velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging (E/Et), the ratio of E/Et > or = 15, the value of carotid intima-media thickness (IMT), and IMT > or = 1 mm were higher in study group than in the control group. In stepwise multiple logistic regression analysis, a high waist-to-hip ratio (WHR), high IMT, high E/Et, hs-CRP levels, LDL cholesterol > or = 130 mg/dL, smoking status, and the presence of DM and metabolic syndrome (MS) were independent determinants of CAD in ED patients. CONCLUSIONS This study first shows the independent determinants of CAD in ED outpatients. This novel finding may improve the screening of low-risk ED patients for CAD.

Arterial Stiffness Is the Independent Factor of Left Ventricular Hypertrophy Determined by Electrocardiogram

Introduction:Arterial stiffness may contribute to left ventricular hypertrophy (LVH). This study was conducted to evaluate the independent factor of LVH and the quantification of LVH by electrocardiogram (ECG) to predict the degree of aortic stiffness using brachial-ankle pulse wave velocity (baPWV) in subjects with hypertension. Materials and Methods:A total of 984 consecutive patients who were diagnosed as having essential hypertension were entered into the study. baPWV determination, ECG and blood sampling were performed after a 12-hour overnight fast. LVH was diagnosed using electrocardiography; Romhilt-Estes point score was subsequently calculated. Participants were separated into LVH and non-LVH groups. Additional factors associated with LVH were examined using multivariate analyses. Results:The non-LVH groups were younger (P = 0.001), had less men (P = 0.001), lower systolic and diastolic blood pressure and pulse pressure (P < 0.001 for each) and lower baPWV (P < 0.001). Stepwise multiple logistic regression analysis demonstrated that sex, age, systolic blood pressure and baPWV are independent factors. Using a baPWV value of 1825 cm/sec, the area under the receiver operating characteristic curve was 0.644 and the highest discriminating sensitivity and specificity were 60% and 65%, respectively. Conclusion:Aortic stiffness may be related to electrocardiographically determined LVH in patients with hypertension. Thus, stiffening of large arteries, together with increased systolic blood pressure, seems to significantly contribute to the pathogenesis of LVH. Quantification of LVH by ECG can also predict the degree of aortic stiffness.

Quantification of Aortic Stiffness to Predict the Degree of Left Ventricular Diastolic Function

Introduction:The association between the arterial stiffness and the severity of left ventricular (LV) diastolic function in hypertension has not been fully evaluated. This study was conducted to evaluate the relationship of aortic stiffness by brachial-ankle pulse wave velocity (baPWV) to parameters reflecting the atherosclerosis and the severity of LV diastolic function in patients with hypertension. Methods:LV ejection fraction, the ratio of peak velocity of early rapid filling and peak velocity of atrial filling (E/A ratio) and LV mass index were determined with echocardiography in 800 patients with hypertension. LV diastolic function was estimated by pulsed-tissue Doppler imaging (TDI) echocardiography, averaging diastolic mitral annular velocity measurements (Emav, Amav and Emav/Amav ratio) from 2 separate sites (basal septal and lateral). The baPWV was measured by the volume rendering method. Results:Stepwise multiple logistic regression analysis demonstrated that the independent factors of LV diastolic function were deceleration time, baPWV, age and Emav/Amav ratio. The receiver- operator characteristic curve demonstrated a baPWV of 1566 cm/sec was useful to discriminate mild LV diastolic dysfunction (sensitivity, 78%; specificity, 78%), and that a baPWV of 1730 cm/sec was useful to discriminate moderate LV diastolic dysfunction (sensitivity, 73%; specificity, 57%). Conclusions:Increased baPWV relates not only to the parameters reflecting atherosclerosis but also to those reflecting LV diastolic dysfunction. TDI-detected LV diastolic dysfunction is accompanied by increased aortic stiffness in essential hypertension. Therefore, quantification of aortic stiffness can predict the degree of LV diastolic function.

Differences in Prevalence and Severity of Coronary Artery Disease by Three Metabolic Syndrome Definitions

BACKGROUND People with metabolic syndrome (MS) are at increased risk for cardiovascular disease-associated morbidity and all-cause mortality. However, predicting the severity of coronary artery disease (CAD) according to different MS definitions is controversial. This study explores the prevalence and severity of CAD according to different MS definitions, focusing on their predictive value. METHODS We enrolled 690 Taiwanese adults with CAD in this study. Coronary artery lesions were classified by the modified American Heart Association-American College of Cardiology grading system. MS was diagnosed in 3 groups of randomly assigned subjects according to World Health Organization (WHO), International Diabetes Federation (IDF), and revised Adult Treatment Panel III (rATP III) criteria. RESULTS More MS components and more severe CAD were identified in the WHO group. Prevalence of MS in the WHO, IDF, and rATP III groups was 33.9%, 47.4%, and 52.8%, respectively (P < 0.001). Mean lesion and culprit vessel numbers were slightly higher in WHO-group patients. The WHO group had more complex stenoses with type C classification than did the IDF and rATP III groups (32.7%, 26.3%, and 28.1%; P = 0.041) and significantly more calcified stenoses (21.5%, 16.2%, and 16.4%; P = 0.027). In a comparison of CAD severity by complex morphology lesions, the area under the receiver operating characteristic curve was higher in the WHO group (0.552; 95% confidence interval, 0.509-0.595; P = 0.019). CONCLUSION Compared with IDF and rATP III definitions, the WHO definition of MS has superior predictive value of CAD severity in Taiwanese patients.

Scrutiny of cardiovascular risk factors by assessing arterial stiffness in erectile dysfunction patients

PurposeErectile dysfunction (ED) is an early sign of vascular dysfunction. Studies have reported a correlation between arterial stiffness and cardiovascular events. The objective of this study was to evaluate the association among different criteria for assessing arterial stiffness and cardiovascular risk factors in ED patients.MethodsAssessment of pulse wave velocity (PWV), pulse pressure (PP), ratio of mitral inflow velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging (E/Et), and intima-medial thickness (IMT) were performed in 200 ED patients.ResultsLinear statistical analysis of the coronary artery disease risk factors revealed that PWV, PP and E/Et were positively correlated with age, duration of diabetes mellitus (DM), and systolic and diastolic blood pressures. PWV and E/Et were positively correlated with waist circumference and number of metabolic syndrome (MS) components. For category-wise analysis, the PWV, PP and E/Et were higher in patients with DM, hypertension and MS. Multiple regression analysis showed that the independent determinants for PWV comprised age, DM, hypertension, and MS; for PP comprised age, hypertension, and MS; for E/Et comprised age and MS; and for IMT comprised only DM.ConclusionsThus, PWV, PP and E/Et may be employed as markers to identify ED patients with potential cardiovascular risk factors, including MS and obesity.

Coronary Phenotypes in Patients with Erectile Dysfunction and Silent Ischemic Heart Disease: A Pilot Study

INTRODUCTION Accumulated evidence shows that erectile dysfunction (ED) may be a precursor of coronary artery disease (CAD). AIMS The purpose of this study was to explore the differences in coronary phenotypes between patients with ED and patients with angina pectoris. METHODS The study enrolled 30 ED patients (study group) and 120 age-matched angina patients who had no ED (control group). All patients had angiographically documented CAD. MAIN OUTCOME MEASURES The differences in demographic characteristics, biochemical profiles and coronary characteristics between the study and control groups were compared. RESULTS Diabetes mellitus (DM) and obesity defined by body mass index were more common in the study group than in the control group. The mean number of lesions and mean number of vessels with evidence of CAD were significantly different between the study and control groups (2.3 ± 0.1 vs. 2.2 ± 0.1, P < 0.001; 2.0 ± 0.2 vs. 1.8 ± 0.1, P < 0.001). The distribution of vessel involvement was similar between the groups, except for more common involvement of the ramus in the study group. There were no differences in distribution of lesion sites between the two groups. The control group had a higher percentage of type A stenotic lesions than the study group (16.3% vs. 2.9%, P = 0.004). Significant differences were also observed in type C lesions (52.9% in study group vs. 38.0% in control group, P = 0.026). Fewer calcified, irregular, and bifurcated lesions were present in the study group compared to control. CONCLUSIONS This study documented coronary phenotypes in ED patients without symptomatic CAD. Although the artery size hypothesis and ED had well been thought to be a precursor of CAD, the severity of coronary lesions in these patients was not more benign than that observed in angina pectoris patients who have no ED.

Role of ankle-brachial pressure index as a predictor of coronary artery disease severity in patients with diabetes mellitus

BACKGROUND Previous studies have reported a close correlation between low ankle-brachial pressure index (ABPI) and various cardiovascular risk factors. However, despite the well-established potential hazards of consequent coronary artery disease (CAD), no data exist on the relationship between ABPI and the severity of CAD, particularly in patients with diabetes mellitus (DM). METHODS A total of 840 patients ranging from 35 to 87 years of age (mean [+/- SD] 63.9+/-10.2 years) with suspected CAD in a clinical practice were enrolled. All patients underwent ABPI measurements and coronary angiography. Patients were divided into four groups according to the results of ABPI measurements and the presence or absence of DM: group A had an ABPI value of at least 0.9 but no DM (A-/D-); group B had an ABPI value of at least 0.9 and DM (A-/D+); group C had an ABPI of less than 0.9 but no DM (A+/D-); and group D had an ABPI value of less than 0.9 and DM (A+/D+). RESULTS Age was significantly higher in the A+ (groups C and D) than the A- patients (groups A and B). Moreover, men predominated in all four groups. Comparisons of sex distribution among the four groups revealed that group D had the highest percentage of women, while group A had the lowest. Total cholesterol level did not differ among the four groups, although group D tended to have the highest result. Patients in group D had the highest percentages of hypertension, hypercholesterol, hypertriglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol among the four groups. Group D exhibited the highest triglyceride and uric acid levels, the lowest high-density lipoprotein cholesterol level, and the highest metabolic syndrome criteria number and percentage of metabolic syndrome. Furthermore, group D had the highest mean lesion numbers, mean numbers of target vessel involvement, stenoses with type C classification and complex morphology lesions (chronic total occlusion, diffuse or calcified lesions) among the four groups. There were still significant differences in lesion numbers (P<0.001) and numbers of target vessel involvement (P<0.001) for ABPI predicting CAD severity after controlling for the effects of DM and age. The sensitivity, specificity, positive predictive value and negative predictive value of using an ABPI of less than 0.9 to predict CAD differed significantly between patients with and without DM. CONCLUSIONS ABPI is a useful noninvasive tool for predicting CAD severity, even in patients with DM.

Neck Circumference as a Predictive Indicator of CKD for High Cardiovascular Risk Patients

Background. Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients. Methods. A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1–4 CKD. A linear regression was performed using the Enter method to present an unadjusted R 2, standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence. Results. Most anthropometric measurements from patients aged ≧65 were lower than those from patients aged <65, except for womens waist circumference (WC) and waist hip ratio. Female NC obtained the highest R 2 values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine. Conclusions. NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future.

Prognostic Significance of Thrombocytopenia in Acute Pulmonary Embolism

A reduced platelet count has been reported in acute pulmonary embolism. This study investigated the prognostic role of thrombocytopenia in acute pulmonary embolism (APE). This study retrospectively reviewed 225 consecutive APE patients. Diagnosis of APE was confirmed by either spiral computed tomography or high probability ventilation and perfusion lung scans. On the day of admission, all enrolled patients underwent initial blood tests, including platelet count. Patient exclusion criteria included intermediate- or low-probability lung scan, clinical suspicion of septic emboli, recurrent APE, chronic lung disease, hematological malignancy, liver cirrhosis, gastrointestinal bleeding or stroke within the preceding 6 months and recent surgery with bleeding risk. Assessment of the prognostic value of initial thrombocytopenia was based on either 30-day death or 30-day composite event (death, cardiopulmonary resuscitation, mechanical ventilation, thrombolytic treatment and vasopressor therapy). The 30-day mortality rate was 21.8%, and the 30-day composite event rate was 34.2% in this study. Incidence of thrombocytopenia significantly differed between the 30-day death group and the 30-day survival group (P＜0.001) and between the 30-day composite endpoint group and the 30-day composite event-free survival group (P＜0.001). Multivariate Cox regression analysis revealed the hazard ratio for thrombocytopenia was 1.63 (95% CI=0.92-2.90) for 30-day death and 1.76 (95% CI=1.07-2.89) for 30-day composite event. The study revealed thrombocytopenia is a predictor of short-term composite event. The simple blood examination is a rapid, noninvasive and effective test for short-term risk stratification of APE.

Different degrees of overweight: anthropometric indices in patients with coronary heart disease

Objectives — Obesity is a risk factor for all-cause mortality.The obesity incidence depends on different definitions. Among patients with high-risk coronary heart disease (HRCA), we have studied differences in obesity incidence, according to different anthropometric indices. Methods and results — Based on the definitions of the International Guidelines Committees for body mass index (BMI), waist circumference (WCF), and waist-hip ratio (WHR), we have classified 487 CAD patients into 3 groups: normal (group 1), overweight (group 2), and obese patients (group 3). Among men, obesity criteria BMI, WCF and WHR were positive in 17.5%, 14.2%, and 66.4% of the subjects. Among male subjects < 65 years, the incidence of HRCA (%), for the 3 groups (normal, overweight, obese) were for BMI (2.4, 21.5, 28.9, P = 0.005); WCF (17.9, 12.1, 37.9, P= 0.012); WHR (0, 15.4, 30.4, P= 0.024). In male subjects > 65 years, for the HRCA incidence (%), only WHR showed a significant difference between the 3 groups (0, 15.4, 30.4, P= 0.024). Among women, 30.6%, 63.6%, and 87.6% were obese by the BMI, WCF, and WHR criteria, respectively. We did not find any significant differences in the HRCA distribution between age groups and degrees of obesity. Conclusions — HRCA distribution varied among obese male patients. According to the different methods of measurement, obesity percentages varied from 4- to 5-fold among men and 3-fold among women. In our view, WHR measurement is the method of choice for the determination of obesity among patients with CAD.