Kuang-Te Wang

Late Development of Renal Arteriovenous Fistula Following Gunshot Trauma A Case Report

A 43-year-old man presenting with symptoms of congestive heart failure, cardiomegaly, and impaired left ventricular (LV) function was diagnosed as having a huge left renal arteriovenous (AV) fistula. The AV fistula might be attributed to a gunshot wound suffered during his military service twenty years ago. Percutaneous transcatheter arterial embolization utilizing multiple spring coils in conjunction with cyanoacrylic glue success fully occluded the fistula, with subsequent improvement of LV function and reduction of LV size on his serial echocardiographic follow-up.

Concise Review of Optical Coherence Tomography in Clinical Practice

Optical coherence tomography (OCT) is a novel image modality with higher resolution in the catheterization laboratory. It can differentiate tissue characteristics and provide detailed information, including dissection, tissue prolapse, thrombi, and stent apposition. In this study, we comprehensively reviewed the current pros and cons of OCT clinical applications and presented our clinical experiences associated with the advantages and limitations of this new imaging modality.

Comparison of Clinical Characteristics of Acute Myocardial Infarction in Aborigines and Nonaborigines in Taitung Area of Taiwan

This study aims to examine the correlation between acute myocardial infarction and various risk factors in eastern Taiwan as well as compare the manifestations of this serious disorder in nonaborigine and aborigine populations in the region. We collected 440 consecutive patients (308 nonaborigines and 132 aborigines) who were diagnosed with acute myocardial infarction (AMI) at the Mackay Memorial Hospital, Taitung Branch, between the years 1994 and 2001. Analysis showed that AMI was more prevalent in nonaborigines than in aborigines (0.021 ∓0.009% vs 0.011 ∓0.009%, p=0.02). In term of gender, as a whole or within each ethnic group, AMI was more predominant in men than in women (as a whole, 70%; nonaborigines, 73%; aborigines, 63%; nonaborigines vs aborigines p=0.03), and nonaborigines had more male patients. Regarding in-hospital mortality, the distribution of age (aborigine 68.2 ∓13.1 vs nonaborigine 73.5 ∓10.4, p=0.02) and percentage of smokers (aborigine 15% vs nonaborigine 32%, p=0.05) were different between the ethnic groups. Significant risk factors as a whole included the age, total cholesterol, uric acid, and the Killip Class of AMI. Multiple regression analysis showed that diabetes, age ≥70 years, uric acid ≥9.0 mg/dL, and Killip class 3 or 4 had relative risk of 1.81, 2.08, 2.89, and 1.63, respectively. However, mortality rate was not affected by ethnicity.

The association among age, early mitral leaflet closure, cardiac structure, diastolic indices and NT-proBNP in an asymptomatic Taiwanese population

Background Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The association among aging, mitral leaflet closure (EF slope), cardiac structures, and diastolic indices in an asymptomatic Taiwanese population is largely unknown. Methods We studied 8103 asymptomatic participants (49.5 ± 11.6 years, 38.2% women) from a health evaluation cohort (2004–2012) in a tertiary center in Taiwan. Echo-derived LV structure/function, and M-mode based EF slope (mm/s) and serum NT-proBNP level were obtained. The association between EF slope and the other clinical or echo-based parameters was investigated. Results Average values for EF slope among various age groups in the Taiwanese population were determined for both genders. Advanced age was associated with reductions in EF slope (adjusted estimate: − 0.35/per decade). Reduced EF slope was associated with older age, higher blood pressure and greater body mass index in multivariate models (all p < 0.05). Reduced EF slope was correlated with greater cardiac concentricity, abnormal E′ and E/E′ (AUROC: 0.74 and 0.77, respectively, both p < 0.05) and elevated NT-proBNP (Coef: 5.98 pg/mL, per − 10 mm/s EF slope, 95% CI: 7.82 to 4.17, p < 0.001). EF-slope also clearly discriminated individuals with abnormal estimated LV filling (E/E′ categorized by < 8, ≥ 8 & < 15, ≥ 15, ANOVA p < 0.001). Conclusions EF-slope reduction in the asymptomatic Taiwanese population was correlated with age, several unfavorable LV remodeling, and impaired diastolic function parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor E′ and elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups.

Gender-differences in the associations between circulating creatine kinase, blood pressure, body mass and non-alcoholic fatty liver disease in asymptomatic asians

Background Creatine kinase (CK) is a pivotal regulatory enzyme in energy metabolism linked to both blood pressure and cardio-metabolic components. However, data is lacking in a large population of asymptomatic Asians. Methods and results Cardio-metabolic assessment including anthropometric measures and non-alcoholic fatty liver disease (NAFLD) were evaluated by abdominal echo in 4,562 consecutive subjects who underwent an annual health survey. Serum CK levels were related to blood pressure components [systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP)], anthropometric measures, and excessive adiposity in liver as indicated by NAFLD. Circulating CK levels ranged from 4 to 1842 IU/L (mean [SE]: 108.7 [1.1] IU/L) in the study population which consisted of 2522 males (mean age: 48.7 ± 11.2) and 2040 females (mean age: 49.4±11.5). In general, male subjects presented with higher circulating CK levels than females (mean ± SE: 127.3 ± 1.5 vs. 85.5 ± 1.3 IU/L, respectively, p < .001). Gender-differences in circulating CK levels were also observed with increasing age, which showed a more pronounced positive relationship with age in female subjects (gender interaction: p < .05). Furthermore, an elevated circulating CK level was independently associated with higher blood pressure, waist circumference and fat mass (FM), greater body mass index (BMI), increased lower estimated glomerular filtration rate (eGFR) and presence of NAFLD in multivariate analysis (all p < .05), with CK elevation more pronounced with greater BMI and FM in males compared with females (sex interaction: p < .05). Conclusion In a large asymptomatic Asian population, circulating CK levels were increased with more advanced age, higher blood pressure, and greater body mass with gender differences. Our findings may be useful in interpreting elevated CK from subjects free of ongoing myocardial damage.

Percutaneous Coronary Intervention for Left Main Coronary Artery Disease- A Single Hospital Experience without On-Site Cardiac Surgery

BACKGROUND To investigate the safety and outcome of percutaneous coronary intervention for left main coronary artery disease in hospital without on-site cardiac surgery. METHODS Between January 2007 and December 2010, all patients diagnosed with left main coronary artery disease and refused coronary artery bypass graft surgery in our hospital or a tertiary center, were enrolled. Data including clinical course, angiographic characteristics, and 1- and 3-years outcomes were recorded and analyzed. RESULTS Seventy patients (mean age 73.4 ± 10.2 years, 47 male, 23 females) were treated with a mean SYNTAX score of 34.8 ± 12.6 and EuroSCORE of 6.7 ± 3.3. Thirty-two (45.7%) patients had stable angina, 35 (50.0%) had unstable angina/non ST-elevation myocardial infarction, and 3 (4.3%) had ST-elevation Myocardial infarction. Forty-three (61.4%) patients received a single-stent, 26 (37.1%) received two-stents, and 1 (1.4%) received balloon angioplasty. No procedure-related mortalities were noted and no emergency coronary artery bypass graft surgery was required. In the 3-year follow-up period, 2 (2.9%) patients had non-fetal myocardial infarction, 11 (15.7%) had left main target lesion revascularization. The major adverse cardiac and cerebrovascular events rates were 24.3% at 1 year and 37.1% at 3-years. The all-cause mortality rate was 41.4% (29 patients), including 18 (25.7%) cases of septic shock, 7 (10.0%) of sudden cardiac death, 2 (2.8%) of hypovolemic shock due to upper gastrointestinal bleeding, 1 (1.4%) of terminal stage malignancy, and 1 (1.4%) of suffocation at 3 years. CONCLUSIONS Percutaneous coronary intervention for patients with left main coronary artery disease was found to be a safe and effective strategy in our hospital without on-site cardiac surgery. KEY WORDS Incomplete revascularization; Left main coronary artery (LM); No cardiac surgery; Percutaneous coronary intervention (PCI).

Intracoronary Stenting for Acute Myocardial Infarction Caused by Myocardial Bridging: A Case Report

Myocardial bridging is a benign condition with a favorable long-term outcome. However, some serious complications can be caused by myocardial bridges, such as myocardial infarction, sudden death, or serious arrhythmia, but such reports are rare. We report on a 61-year-old woman who experienced sudden onset of retrosternal chest tightness with radiation to the back lasting over 60 minutes and who came to our hosp ital for help. She had difficulty breathing and chest tightness, and an interoapical infarction on the EKG and elevated cardiac enzymes were found. Cardiac catheterization was performed and revealed myocardial bridging in the left anterior descending coronary artery, resulting in an estimated dynamic stenosis of 90% during systole and complete recovery during diastole. We successfully deployed an intracoronary stent to treat this patient, and she was asymptomatic without complications after 6 months of follow-up. We review the literature and discuss the clinical practice and methods in treating myocardial bridging. We feel we must remind physicians that even benign disease may need invasive intervention when serious complications occur. Intracoronary stenting causes little suffering, has few complications, and is an easy procedure as a first choice before an operation.