Meng-Cheng Chiang

The prognostic value of circulating soluble cell adhesion molecules in patients with chronic congestive heart failure

Circulating soluble (s) cell adhesion molecules (CAMs) are elevated in patients with congestive heart failure (CHF) and may play an important role in the pathogenesis of CHF by mediating the cell–cell interactions of the immune response. However, clinical data about the prognostic value of sCAMs are sparse. The purpose of this study is to determine whether various sCAMs can provide prognostic information in patients with CHF.

The utilization of twelve-lead electrocardiography for predicting sudden cardiac death after heart transplantation

BACKGROUND Sudden cardiac death (SCD) occurs commonly after heart transplantation (HTX). The utilization of surface electrocardiography (ECG) to assess post-HTX SCD has not been investigated thoroughly. This study aimed to investigate the specific changes in surface ECG in HTX patients with SCD. METHODS A total of 227 HTX patients (age 48 ± 14 y/o, mean donor age 34 ± 14 y/o, 173 males) were followed up regularly at the outpatient clinic. Twelve-lead ECGs were recorded during 1-2 monthly visits. Serial ECG parameters and relevant clinical data were collected and analyzed. RESULTS During the follow-up period of 96 ± 51 months, SCD occurred in 28 (12.3%) patients. The baseline ECG parameters were comparable between patients with and without SCD. Important ECG trends of rising rest heart rates and prolongation of corrected QT (QTc) and JT (JTc) intervals were observed prior to development of SCD. After adjustment for other clinical variables, the independent predictors for SCD were older donor age (p = 0.014, OR 1.05, 95% CI 1.01-1.09), faster heart rate (p = 0.006, OR 1.06, 95% CI 1.02-1.1) and longer JTc interval (p = 0.015, OR 1.03, 95% CI 1.01-1.06). SCD occurred in 71.4% patients presenting with all three risk predictors. CONCLUSIONS Besides older donor age, important ECG signs, including prolongation of the JTc interval and increased heart rate during post HTX follow up, could predict SCD.

Development of an Echocardiographic Method for Choosing the Best Fitting Single‐Pass VDD Lead

YIN, W.‐H., et al.: Development of an Echocardiographic Method for Choosing the Best Fitting Single‐Pass VDD Lead. To achieve stable single‐lead VDD pacing, a selection of the electrode with the optimal distance between the lead tip and the floating atrial dipole (AV distance [AVD]) is important. The authors hypothesized that the size of the right heart chambers may affect atrial sensing, and that measurement of their internal dimension at end‐diastole (RHIDd) in the apical four chamber view by transthoracic echocardiography may aid in choosing the proper AVD. Twenty‐six consecutive cases that had undergone VDD pacer implantation using the conventional chest X ray were examined retrospectively by the echocardiographic method. The chest x‐ray method properly selected a lead with optimal atrial sensing, defined as minimum P wave amplitude ≥ 1.0 mV, for only 20 (77%) of 26 patients. By comparing these results with their respective RHIDd, a cut‐off point of 13 cm was obtained that indicated a criterion for choosing the proper AVD. The indication was that if the RHIDd was ≥ 13 cm, a lead with an AVD of 15.5/16 cm should have been used; if the RHIDd was < 13 cm, a lead with an AVD of 13/13.5 cm should have been chosen. Using the echocardiographic method, all six patients who had suboptimal atrial sensing could be identified and classified as having missized (four undersized; two oversized) permanent leads. In conclusion, the described method provides a promising preoperative assessment of the best fitting electrode length in single lead VDD pacing. A prospective study is ongoing to verify its applicability.

Circulating Soluble Tumor Necrosis Factor-α and Cell Adhesion Molecules in Patients with Acute Cardiogenic Pulmonary Edema

Background: Circulating soluble tumor necrosis factor-alpha (TNF-α) and cell adhesion molecules (CAMs) are elevated in patients with heart failure. Whether this elevation plays a role in heart failure or is merely a marker of inflammatory response remains to be determined. We hypothesized that TNF-α activated the vascular endothelium, resulting in endothelial dysfunction and permeability changes that may play a role in the development of acute cardiogenic pulmonary edema. Materials and Methods: We measured plasma levels of TNF-α and three CAMs [vascular cell adhesion molecule-1, (VCAM-1) intercellular adhesion molecule-1, (ICAM-1) and P-selectin] in 35 patients (mean age, 64±14 years) with acute myocardial infarction. Patients who had acute pulmonary edema (APE) were placed in the APE group, and those with no pulmonary edema were placed in the non-APE group. Univariate and multivariate comparisons of the clinical and hemodynamic characteristics and levels of TNF-α and CAMs between these two groups were performed. Results: The left ventricular ejection fraction was significantly lower (p=0.00l), the left ventricular end-diastolic pressure was significantly higher (p=0.005), and the levels of the TNF-ct and VCAM-1 were also significantly higher (p＜0.0001 and p=0.003, respectively) in the APE group than in the non-APE group. After adjustment for possible adverse baseline variables, circulating levels of TNF-α and VCAM-1 remain significant predictors of the development of APE [hazard ratio (HR) 32.7, p=0.015 and HR 27.6, p=0.048, respectively]. Conclusions: These findings indicated that inflammation and immune activation were associated with the development of acute cardiogenic pulmonary edema.

Statin Therapy is Associated with Improved Clinical Outcomes in Patients Undergoing Emergency Percutaneous Coronary Intervention

Purpose: Previous studies have suggested that the use of statins after percutaneous coronary intervention (PCI) is associated with better clinical outcomes. However, lipid-lowering treatment with statins is a neglected therapeutic approach in patients undergoing PCI in Taiwan. This study investigated the current status of statin use and the effect of statin treatment on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing emergency PCI. Methods: Two hundred and forty patients (aged 61±13 years, M/F=192/48) with AMI were enrolled. All of them underwent emergency coronary angiography and PCI. Patients were classified into 2 groups, those who were receiving continuous statin therapy (n=149, 62%) and those who were not (n=91, 38%). Cox proportional hazards model was performed to determine if continuous statin therapy was independently associated with a reduction in the risk of adverse clinical outcomes. Results: Our data demonstrated that continuous statin therapy was independently associated with a significant reduction (~35%) in the risk of adverse events (55% versus 36%; P=0.019). The adjusted odds ratio for the development of adverse events in patients receiving continuous statin therapy compared with patients who were not was 0.60 (95% CI, 0.41 to 0.90, P=0.012). Conclusion: Continuous statin therapy may reduce the risk of adverse clinical outcomes after PCI for AMI patients. However, the low use of statins (62%) in the study patients indicates that there is substantial room for improvement in implementation of statin therapy in AMI patients undergoing PCI.

Brachial Artery Distensibility as a Cardiovascular Risk Marker in Asymptomatic Individuals

Previous studies have shown that brachial arterial distensibility (BD) is a measure of arterial stiffness and may be used in risk assessment for cardiovascular disease (CVD). The aim of this study was to explore the predictive value of BD for CVD risk levels and to seek cardiovascular risk factors influencing BD. In this study, BD data were obtained using the DynaPulse 2000A instrument (Pulse Metric, Inc, USA) in 300 asymptomatic, apparently healthy subjects (M/F=152/148; aged 52±13 years) who were admitted for routine physical check-up. Family history, serum lipids and lipoproteins, glucose levels and mercury sphygmomanometer blood pressure measurements were obtained. The risk for CVD in each individual was assessed using the Framingham Risk Score system. Significant correlations were found between unadjusted BD and age, measures of blood pressure, height, body mass index, total cholesterol levels, LDL-cholesterol levels, and glucose levels. Multivariate regression analyses showed that age, systolic and diastolic blood pressures and glucose levels independently predicted changes in BD. There was a significantly negative correlation between BD and the Framingham risk scores (r=-0.45, P＜0.0001). Subjects with a 10-year risk for a future coronary heart disease events of ＜10% had significantly higher BD than those whose risk for coronary heart disease was 10% (6.12±1.25%/mmHg vs. 4.94±1.2%/mmHg, P=0.0001). These findings indicate that non-invasive measures of BD are effective in assessing CVD risk.