Chih Chan Lin

Effects of oxidative stress on endothelial function after a high-fat meal

Postprandial lipaemia is known to cause endothelial dysfunction, but its underlying mechanism is still under debate. The present study was undertaken to investigate the effects of postprandial lipaemia on endothelial dysfunction and oxidative stress. We measured plasma glutathione peroxidase (GSH-Px), an antioxidant enzyme, and the urinary excretion of 8-epi-prostaglandin F2alpha (8-PGF2alpha), a free radical-catalysed product from the oxidative modification of arachidonic acid, in 16 healthy subjects (mean age, 30 +/- 5 years) without major coronary risk factors. Plasma high-sensitive C-reactive protein, soluble intercellular cell-adhesion molecule-1 and vascular cell-adhesion molecule-1 were also measured. High-resolution ultrasound was used to assess the flow-mediated vasodilatation (FMD) of the brachial artery. Blood and urine samples were collected before and 2, 4 and 6 h after a standard high-fat meal (3677 J, containing 50 g of fat). Serum triacylglycerol (triglyceride) increased and FMD decreased significantly after a high-fat meal. Plasma GSH-Px significantly decreased from 27.2 +/- 12.3 microg/ml to 25.7 +/- 11.8 microg/ml (P=0.022) 2 h after the meal, and urinary excretion of 8-PGF2alpha significantly increased from 1286 +/- 1401 pg/mg of creatinine to 2197 +/- 1343 pg/mg of creatinine (P=0.014) at 4 h after the meal. However, there were no significant changes in the levels of high-sensitive C-reactive protein and adhesion molecules after a high-fat meal. In conclusion, endothelial dysfunction was observed after consuming a high-fat meal and is associated with augmented oxidative stress manifested by the depletion of serum antioxidant enzymes and increased excretion of oxidative modification products.

Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation.

BACKGROUNDnThe objective of this study was to investigate myocardial deformation of the left atrium (LA) assessed by two-dimensional speckle tracking echocardiography in patients with permanent atrial fibrillation (AF) and its value for risk stratification for stroke.nnnMETHODSnWe recruited 66 consecutive patients with permanent AF who were referred to our echocardiography laboratory for evaluation. These patients were divided into two groups according to the presence of previous stroke or not.nnnRESULTSnPeak positive longitudinal strain (LASp) during atrial filling, peak strain rate in the reservoir phase of LA (LASRr), and peak strain rate in the conduit phase (LASRc) were identified from LA strain and strain rate curves. The ratio of peak early filling velocity (E) of mitral inflow to early diastolic annulus velocity (E) of the medial annulus (E/E) was calculated. LASp (10.44% ± 4.2% vs. 15.69% ± 5.1%, P < .001), LASRr (1.09 ± 0.27 1/s vs. 1.37 ± 0.32 1/s, Pxa0= .001), and LASRc (-1.28 ± 0.38 1/s vs. -1.62 ± 0.43 1/s, Pxa0=xa0.002) were significantly lower in patients with AF with stroke than those without stroke. By multivariate analysis controlling for age, LA volume index, and left ventricular ejection fraction, LASp (OR 0.787, 95% CI, 0.639-0.968, Pxa0= .023) and LASRr (OR 0.019, 95% CI, 0.001-0.585, Pxa0= .023) were independently associated with stroke but not LASRc, E, and E/E ratio.nnnCONCLUSIONnDecreased LASp and LASRr were independently associated with stroke in patients with permanent AF.

Diagnostic Value of Segmental Longitudinal Strain by Automated Function Imaging in Coronary Artery Disease without Left Ventricular Dysfunction

BACKGROUNDnThe aim of this study was to investigate the role of segmental longitudinal strain for the diagnosis of coronary artery disease (CAD) assessed by automated function imaging.nnnMETHODSnOne hundred fifty-two subjects (mean age, 63 ± 12 years; 77 men) referred for assessment of cardiac function under suspicion of CAD were recruited for this study. Patients with left ventricular dysfunction or with acute coronary syndromes were excluded.nnnRESULTSnPeak systolic global longitudinal strain (GLS) was significantly decreased in patients with CAD. Peak segmental longitudinal strain difference (LSD) and its ratio to peak systolic GLS were significant higher in patients with CAD. The areas under receiver operating characteristic curves for the diagnosis of CAD were 0.813 for peak systolic GLS, 0.851 for the number of abnormal segments, 0.805 for peak segmental LSD, and 0.862 for the ratio of peak segmental LSD to peak systolic GLS. Using 1.0 as a cutoff point for the ratio of peak segmental LSD to peak systolic GLS, sensitivity was 77.3% and specificity 79.2%.nnnCONCLUSIONSnThis study suggests that it may be possible to assess CAD with strain by automated function imaging, but further larger scale studies are needed to confirm this.

Trends in the Incidence and Management of Acute Myocardial Infarction From 1999 to 2008: Get With the Guidelines Performance Measures in Taiwan

Background The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results We used the Taiwan National Health Insurance Research Database (1999–2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age‐adjusted incidence of AMI (/100 000 person‐years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline‐based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β‐blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in‐hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, β‐blocker, and statin use during hospitalization were all associated with reduced in‐hospital mortality in our AMI patients. Conclusions AMI incidence was increasing, but the guideline‐based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

The effects of left ventricular hypertrophy on the respiratory changes in transmitral Doppler flow patterns of hypertension patients

Background:u2002 Left ventricular early diastolic fillings can be reduced by inspiration. However, the effects of left ventricular hypertrophy on such changes have not been studied before. This study was undertaken to investigate whether respiratory changes in transmitral Doppler flow were affected by left ventricular hypertrophy in hypertension patients.

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.

Efficacy of postoperative prophylactic antibiotics in reducing permanent pacemaker infections

Despite limited evidence, postoperative prophylactic antibiotics are often used in the setting of permanent pacemaker implantation or replacement. The aim of this study is to investigate the efficacy of postoperative antibiotics.

The efficacy and safety of using extension catheters in complex coronary interventions: A single center experience

BACKGROUNDnThe extension catheter was originally developed to facilitate stent delivery to challenging lesions. We evaluated the efficacy and safety of using an extension catheter in patients undergoing percutaneous coronary interventions (PCI).nnnMETHODSnTwo interventional cardiologists reviewed the records of all consecutive patients who, between November 2011 and October 2015, had undergone PCI with a GuideLiner or Heartrail ST-01 extension catheter. Clinical demographics, vessel characteristics, procedural details, and outcomes were recorded.nnnRESULTSnWe identified 136 (3.7%) eligible patients (male: 81.6%; mean age: 66.2 ± 11.2 years) in 3665 PCI procedures. Seventy-two (52.9%) cases required increased support to cross severely calcified lesions. The remainder were coronary tortuosity [47 (34.6%)], chronic total occlusions [35 (25.7%)], previously deployed proximal stents [16 (11.8%)], and anomalous origin of coronary artery [9 (6.6%)]. There were 43 type B and 91 type C lesions. The success rate was 86.8% (118) and the complication rate was 6.6% (7 coronary dissections, 1 thrombus formation, and 1 stent dislodgement). All complications were successfully managed using endovascular interventions. The failure rate significantly (25.5%) increased if more than 3 of 6 peri-procedural factors coexisted: 1) long lesions (> 30 mm), 2) tortuosity, 3) calcification, 4) chronic total occlusion, 5) previous intervention history, and 6) previously deployed proximal stents.nnnCONCLUSIONSnUsing an extension catheter for challenging complex PCIs is safe and highly successful if the practitioner has adequate experience manipulating extension catheters.

Interarterial course of coronary artery anomaly presenting as Brugada-like ECG and aborted cardiac death—Multidisciplinary images facilitate the diagnosis

A 33-year-old man suffered a sudden collapse while teaching in school, and a bystander administered cardiopulmonary cerebral resuscitation. The emergency medical technicians on arrival administered defibrillation for ventricular fibrillation. After resuscitation, his electrocardiogram (ECG) showed sinus rhythmwith transient cove-type STsegment elevation in leads V1 and V2, which is suggestive of a Brugada-like ECG (Fig. 1A). However, this characteristic disappeared on subsequent ECG recordings. Transthoracic echocardiography was also unremarkable. Neither a significant electrolyte imbalance nor an elevated cardiac marker was measured. He regained consciousness 2 days later. Owing to negative family or medical risks of coronary artery disease, he was further evaluated by multidetector computed tomography (MDCT), rather than by conventional angiography. The result surprisingly displayed an abnormal right coronary artery (RCA) originating from the left coronary cuspid. The RCA had an interarterial course (i.e., between the aorta and pulmonary artery), which probably led to ostium kinking and impingement (Fig. 1B and C). The findings of a thallium scan were negative, but whether there was hemodynamical compression of the RCA flow was undetermined. Therefore, he underwent