Hui-Chun Huang

Exercise training improves cardiac function in infarcted rabbits: involvement of autophagic function and fatty acid utilization.

To explore whether exercise can improve cardiac function in a post‐myocardial infarction (MI) rabbit model and to determine contributing factors in the left ventricle (LV).

Assessment of the Clinical Outcomes and Cost-Effectiveness of the Management of Systolic Heart Failure in Chinese Patients Using a Home-Based Intervention

This study was designed to assess the clinical effect of a home-based telephone intervention in Chinese heart failure patients. A total of 550 Chinese heart failure patients were enrolled into either (i) a group that received the usual standard of care (UC group); or (ii) a group that received a home-based heart failure centre management programme using nursing specialist-led telephone consultations (HFC group). The impact of the home-based intervention on admission rate, admission length and medical costs over 6 months was measured. Although the mean left ventricular ejection fraction in HFC patients was 29.3% compared with 34.8% in UC patients, the home-based intervention resulted in a significantly lower all-cause admission rate per person (HFC 0.60 ± 0.77 times/person; UC 0.96 ± 0.85 times/person), a shorter all-cause hospital stay (reduced by 8 days per person) and lower total 6-month medical costs (reduced by US

Risk stratification by T-wave morphology for cardiovascular mortality in patients with systolic heart failure.

2682 per patient). These results suggest that the home-based intervention with nursing specialist-led telephone consultations may improve the clinical outcome and provide cost-savings for Chinese patients with heart failure.

Multi-scale symbolic entropy analysis provides prognostic prediction in patients receiving extracorporeal life support

AIMS The objective was to investigate the prognostic value of T-wave morphology in systolic heart failure patients. T-wave morphology descriptors on standard 12-lead electrocardiograms (ECG) have been shown to have prognostic importance concerning the arrhythmic susceptibility of patients with previous myocardial infarction. However, these descriptors have not been considered with regard to further risk stratification in patients with systolic heart failure. METHODS AND RESULTS Patients with systolic heart failure [defined by a left ventricular ejection fraction (LVEF) <50%] were enrolled. Standard digitized 12-lead ECGs were used for analysis of T-wave morphology descriptors [lead dispersion, T-wave morphology dispersion, percentage of the loop area, percentage of the outer area, and the total cosine between QRS and T-wave (TCRT)]. A total of 650 patients with a mean age of 63 +/- 14 years were enrolled and followed-up for 2.7 +/- 1.8 years. The mean LVEF was 36 +/- 9%. During this study, the total mortality rate was 32.7% and cardiovascular mortality rate was 22.3%. A stepwise backward Cox regression analysis showed that cardiovascular mortality was significantly associated with age (P < 0.001), diabetes mellitus (P = 0.022), haemoglobin (P = 0.001), LVEF (P = 0.001), and TCRT (P = 0.003). On the basis of a median TCRT of -0.473 as a cut-off point, a significant difference in cardiovascular mortality was observed from a Kaplan-Meier survival curve (P = 0.01). Total cosine between QRS and T-wave further stratified the risk of LVEF (P = 0.007), age (P = 0.001), haemoglobin (P < 0.001), and diabetes mellitus (P < 0.001) in cardiovascular mortality for these patients. CONCLUSION Total cosine between QRS and T-wave may provide further risk stratification for and therefore impact on the prognosis of patients with systolic heart failure.

The prevalence and association of patients with impaired left ventricular ejection fraction and complete left bundle-branch block in Taiwan

IntroductionExtracorporeal life support (ECLS) can temporarily support cardiopulmonary function, and is occasionally used in resuscitation. Multi-scale entropy (MSE) derived from heart rate variability (HRV) is a powerful tool in outcome prediction of patients with cardiovascular diseases. Multi-scale symbolic entropy analysis (MSsE), a new method derived from MSE, mitigates the effect of arrhythmia on analysis. The objective is to evaluate the prognostic value of MSsE in patients receiving ECLS. The primary outcome is death or urgent transplantation during the index admission.MethodsFifty-seven patients receiving ECLS less than 24 hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6–20, Area 6–40) associated with the multiscale correlation and complexity of heart beat fluctuation were calculated.ResultsPatients receiving ECLS had significantly lower value of slope 5, area 6 to 20, and area 6 to 40 than control subjects. During the follow-up period, 29 patients met primary outcome. Age, slope 5, Area 6 to 20, Area 6 to 40, acute physiology and chronic health evaluation II score, multiple organ dysfunction score (MODS), logistic organ dysfunction score (LODS), and myocardial infarction history were significantly associated with primary outcome. Slope 5 showed the greatest discriminatory power. In a net reclassification improvement model, slope 5 significantly improved the predictive power of LODS; Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in MODS. In an integrated discrimination improvement model, slope 5 added significantly to the prediction power of each clinical parameter. Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment.ConclusionsMSsE provides additional prognostic information in patients receiving ECLS.

Q-004 RELATIONSHIP BETWEEN ARTERIAL STIFFNESS AND MENOPAUSE IN MIDDLE- AGE SUBJECTS WITH AND WITHOUT METABOLIC SYNDROME

BACKGROUND/PURPOSE A deleterious effect of complete left bundle-branch block (cLBBB) on left ventricular (LV) function has been established. The underutilization of cardiac resynchronization therapy has been noted in Taiwan and the Asian-Pacific area, but the reasons remain unclear. This study aimed to evaluate the prevalence and association of cLBBB and impaired LV ejection fraction (LVEF) in patients at the National Taiwan University Hospital (NTUH). METHODS We enrolled 164,049 patients who underwent standard 12-lead electrocardiography (ECG) between January 2010 and December 2013 at NTUH. Echocardiographic examinations within one year of the index ECG were analyzed. Baseline clinical characteristics, electrocardiography and ECG parameters, in patients with cLBBB were compared among those with three different LVEFs (EF <35%, 35%≤ EF<50%, and EF ≥50%). Multivariable logistic regression analysis were conducted to identify independent predictors of impaired LVEF in patient with cLBBB. RESULTS The prevalence of cLBBB was 0.4% (648 patients), and it increased with age. The estimated prevalence of cLBBB and LVEF <35% was about 0.1%. The effects of age on the distributions of patients with cLBBB by three different EF statuses were significantly disparate. In patients with cLBBB aged >80 years, 64% had a normal EF. However, in those aged between 40 and 60 years, the risk of EF <35% was as high as 45%, and the risk of EF <50% was even higher at 60%. CONCLUSION Patients in Taiwan had a low prevalence of LVEF<35% and cLBBB. About three-fourth of patients with cLBBB did not experience HF events, and 56% of them had a normal LVEF. The development of an effective triage strategy for these patients is warranted.

Effect of anti-hypertensive drug dose frequency on the clinic-home blood pressure difference in patients with stage 1 treated hypertension

Background Metabolic syndrome increases the risk for incident cardiovascular disease (CVD) and all cause mortality. Arterial distensibility decreases with age and extent of arteriosclerosis. Increased arterial stiffness predicts the development of cardiovascular disease and mortality in the general population and in type 2 diabetes. Therefore, we explored the effect of menopause and metabolic syndrome factors on brachial artery distensibility (BrachD) in middle- age aubjects. Methods A cross-sectional study of menopause and BrachD was performed in our study. Data were collected on 732 middle-age healthy adults (61% male, 39% female, aged 30∼60 years) including BrachD measured by pulse waveform analysis (DynaPulse 200 M, Pulse Metric, Inc.) Metabolic syndrome factors were considered abnormal according to the 2001 National Cholesterol Education Program (Adult Treatment Panel [ATP] III) guidelines. Results BrachD was much significantly lower in middle-age females with and without metabolic syndromes. (P < 0.05) but not in middle-age males. An inverse linear relationship was noted between BrachD and number of metabolic syndrome risk factors clustering in an individual. (P < 0.05) and menopause. Conclusions In middle-age healthy subjectives, increasing numbers of adverse metabolic syndrome risk factors and the presence of menopause are associated with decreased brachial artery distensibility. Noninvasive brachial artery function measures are useful in measuring subclinical arteriosclerotic vascular changes in relative healthy subjects.

A double-blind comparison of the efficacy and tolerability of telmisartan 40-80 mg vs. losartan 50-100 mg in Taiwanese hypertensive patients.

Clinic blood pressure (CBP) is generally used for diagnosis and treatment monitoring in hypertension, but target organ damage correlates more closely with home blood pressure (HBP). Eliminating the clinic-home blood pressure difference (CHBPD) would make conventional CBP a more accurate alternative to HBP. This prospective, randomized, open trial compared the effect of a once-daily versus a twice-daily regimen of anti-hypertensive therapy on CHBPD. After a 2-week wash-out period, 85 confirmed stage 1 hypertensive patients were randomized to receive 2 mg tri-chlormethiazide daily in one (40 subjects) or two (45 subjects) daily doses for 3 weeks. CBP and HBP measurements were taken during the third week of treatment and the CHBPD calculated. After treatment, the systolic and diastolic CHBPD values were significantly greater in the once-daily regimen than in the twice-daily regimen. Conventional CBP should not be used as an alternative to HBP for evaluating prognosis and monitoring anti-hypertensive therapy when using a once-daily regimen.