Wei Ting Chang

Changes in Right Ventricular Free Wall Strain in Patients with Coronary Artery Disease Involving the Right Coronary Artery

BACKGROUND Chronic ischemia related occult systolic dysfunction of the right ventricle is difficult to detect using traditional echocardiography. The aim of this study was to verify the diagnostic value of speckle-tracking echocardiography in proximal right coronary artery (pRCA) lesion-induced right ventricular (RV) occult dysfunction. METHODS One hundred forty-two patients undergoing elective coronary angiography for suspected coronary artery disease were divided into two groups according to involvement of the right coronary artery. In further analysis, significant stenosis before the acute marginal branch was defined as pRCA involvement and compared with a control group. Global longitudinal strain and RV free wall longitudinal train (RVLS-FW) were measured using speckle-tracking echocardiography. Other traditional parameters to evaluate RV function were also measured. RESULTS Eighty-seven patients in the right coronary artery group (61.2%) displayed significant decreases in the magnitudes of both global longitudinal strain (-13.65 ± 3.83% vs -15.69 ± 4.37%, P = .04) and RVLS-FW (-16.04 ± 5.4% vs -21.18 ± 4.6%, P = .04), independent of other parameters. Conversely, when focusing on pRCA involvement, only RVLS-FW showed significant attenuation in the group with pRCA involvement (-14.26 ± 4.32% vs -19.96 ± 4.8%, P = .001). On multivariate analysis, RVLS-FW was still independently lower in the group with pRCA involvement (odds ratio, 1.07; 95% confidence interval, 1.01-1.14; P = .02). CONCLUSIONS The results of this study show that RVLS-FW was independently impaired in patients with coronary artery disease with right coronary artery stenosis, especially with involvement of the acute marginal branches. RV strain can be used to detect occult RV dysfunction in patients with stable coronary artery disease.

Characterization of Aging-Associated Cardiac Diastolic Dysfunction

Aims Diastolic dysfunction is common in geriatric heart failure. A reliable parameter to predict myocardium stiffness and relaxation under similar end-diastolic pressure is being developed. We propose a material and mathematical model for calculating myocardium stiffness based on the concept of linear correlation between and wedge pressure. Methods and Results We enrolled 919 patients (male: ). Compared with the younger population of controls (mean age: years; ; male: ), the elderly (mean age: ; ; male: ) had a greater prevalence of hypertension, diabetes mellitus, and coronary artery disease (all ). We collected their M-mode and 2-D echocardiographic volumetric parameters, intraventricular filling pressure, and speckle tracking images to establish a mathematical model. The feasibility of this model was validated. The average early diastolic velocity of the mitral annulus assessed using tissue Doppler imaging was significantly attenuated in the elderly (: vs. ; ) and corresponded to the higher estimated wedge () pressure ( vs. ; ) in that cohort. E (Youngs modulus) was calculated to describe the tensile elasticity of the myocardium. With the same intraventricular filling pressure, E was significantly higher in the elderly, especially those with values . Compared with diastolic dysfunction parameters, E also presented sentinel characteristics more sensitive for detecting early myocardial relaxation impairment, which indicates stiffer myocardium in aging hearts. Conclusion Our material and geometric mathematical model successfully described the stiffer myocardium in aging hearts with higher intraventricular pressure. Additional studies that compare individual differences, especially in health status, are needed to validate its application for detecting diastolic heart failure.

Serum Vitamin D, intact parathyroid hormone, and Fetuin A concentrations were associated with geriatric sarcopenia and cardiac hypertrophy

With aging, intact parathyroid hormone (iPTH) increases. It plays a crucial role in left ventricular hypertrophy (LVH). Also, 25-hydroxy vitamin D (Vit-D) and iPTH have been observed to be determinants of muscle wasting known as sarcopenia. Fetuin A (FetA), a systemic calcification inhibitor, involves in the development of diastolic heart failure. Hence, we hypothesized that the interplay among FetA, Vit-D and iPTH may contribute to sarcopenic LVH among the elders. We analyzed a database from the Tianliao Old People study with 541 elders (≥65 years) in a Taiwan’s suburban community. After excluding patients with renal function impairment, 120/449 (26.7%) patients were diagnosed with sarcopenia. Sarcopenic patients had lower serum Vit-D levels but higher FetA as well as iPTH. Notably, sarcopenic patients with LVH had significantly lower FetA and higher iPTH levels. In multivariate logistic regression analysis, only the increase in iPTH was independently associated with sarcopenic LVH (Odds ratio: 1.05; confidence interval: 1.03–1.08, p = 0.005). Using iPTH >52.3 ng/l as a cutoff point, the sensitivity and specificity was 66% and 84%, respectively. In conclusion, FetA, Vit-D, and iPTH levels were all associated with sarcopenia in this geriatric population. Among them, iPTH specifically indicates patients with sarcopenic LVH.

Fetuin-A as a predicator of sarcopenic left ventricular dysfunction

Sarcopenia is an aging condition involving low muscle mass and function. Fetuin-A (FetA) appears to be a factor for body composition remodeling. We hypothesized that age increases FetA levels and deteriorates the myocardial function by affecting diastolic function, especially in people with sarcopenia. We enrolled 541 asymptomatic elderly (≥65 years) patients. Compared with non-sarcopenic population, FetA levels were significantly elevated in the ninety-two (17%) patients (79 ± 6 years; male: 34.7%) diagnosed with sarcopenia (621.1 ± 140.7 vs. 697.3 ± 179.6 μg/ml, < 0.001). Sarcopenic left ventricular dysfunction (S-LVD) was defined by the coexistence of sarcopenia and systolic impairment (LVEF < 50%) and 23 (4.3%) of them met the criteria. Patients with S-LVD showed relatively reduced systolic heart function, higher end-diastolic pressure and a higher FetA level (all p < 0.001) than did those with sarcopenia but without LV dysfunction (S-NLVD). Conversely, in the group without sarcopenia, FetA levels were similar regardless of systolic function. Multivariable logistic regression showed that older age, impaired diastolic function, and higher FetA levels were significantly associated with S-LVD. In conclusion, we found that FetA was significantly higher in elderly patients with sarcopenia, which was associated with impaired diastolic and systolic functions.

The pathogenesis of human cervical epithelium cells induced by interacting with Trichomonas vaginalis

Background Trichomonas vaginalis is a protozoan parasite that occurs in the urogenital-vaginal tract and is the primary causative agent of trichomoniasis, a common sexually transmitted disease in humans. The aggregation of this protozoan tends to destroy epithelial cells and induce pathogenesis. Principal Findings This study cultured T. vaginalis and human cervical epithelial cells (Z172) under the same conditions in the experiments. Following co-culturing for ten hours, the protozoans became attached to Z172, such that the cells presented a round shape and underwent shrinkage. Time-lapse recording and flow cytometry on interacted Z172 revealed that 70% had been disrupted, 18% presented a necrosis-like morphology and 8% showed signs of apoptosis. Gene expression profiling revealed in the seven inflammatory Z172 genes as well as in T. vaginalis genes that code for adhesion proteins 65 and 65-1. Significance These results suggest that cytopathogenic effects progress while Z172 is in contact with T. vaginalis, and the resulting morphological changes can be categorized as disruption.

A two-case series of entrapment of a ruptured balloon in the coronary artery: Avoidable complications and nonsurgical management

The entrapment of a ruptured catheter balloon during percutaneous coronary intervention (PCI) is rare, but it can lead to life-threatening complications, such as myocardial infarction (MI) and lethal arrhythmias. Ruptured balloon entrapment usually occurs in either tortuous, calcified, or angulated coronary lesions without adequate balloon deflation. The avoidance of drastic balloon pull-out and the use of appropriate catheter-based retrieval techniques could prevent surgical intervention. Herein, we describe two cases of ruptured coronary balloon entrapment during emergency or elective PCI. We successfully removed the ruptured and entrapped balloons through nonsurgical techniques. Coronary interventionists should be aware of the possibility of balloon entrapment during complex coronary interventions; they should also become familiar with nonsurgical catheter-based methods for the retrieval of ruptured and entrapped balloons.

The association between right ventricular free wall strain and exercise capacity for health check-up subjects

Background Right ventricular (RV) function has been found to be a major factor of exercise capacity in patients with heart failure. However, the role of RV function in exercise capacity in healthy subjects has not been well studied. This study aims to validate the role of RV strain derived from speckle tracking echocardiography for exercise capacity for health check-up subjects. Methods This study prospectively recruited subjects from a routine health examination. All of them were symptom free. RV function represented by RV strain was derived from speckle tracking echocardiography in addition to traditional echocardiography parameters. Functional capacity was determined by a symptom limited treadmill exercise test with the Bruce protocol. Results Among 164 recruited subjects (age 52.2 ±9.2 years, 66.4% male), 32 subjects represented impaired functional capacity (MET<8), which was significantly correlated with age, left ventricular mass index, left ventricular filling pressure (E/e’), global longitudinal strain of the left ventricle (LVGLS) (-16.0±2.5% vs. -18.9±3.8%, p < 0.001) and RV free wall strain (RVLS_FW) (-17.0±4.9% vs. -21.9±3.2%, p <0.001). After multivariate logistic regression, RVS_FW was an independent predictor for impaired functional capacity (OR 1.62, CI 1.32–1.98; p <0.001). Conclusions In conclusion, RV strain is independently associated with exercise capacity for health check-up subjects. RV function is an important factor for functional capacity.

Interplay of aging and hypertension in cardiac remodeling: A mathematical geometric model

Hypertensive disorder can cause cardiac deformities. Elastic characteristic parameters, like Young’s modulus of elasticity (E) derived from a traditional cylindrical model, increase significantly with aging. However, the geometric and component changes of aging hearts because of chronic hypertension remain unknown. To better describe the effects, we propose an elliptical elastic and mathematical model to evaluate myocardial stiffness. Ninety-six hypertensive patients (HTNPos) (men: 59.3%; age ≥ 65 years: 20.8%) were enrolled and compared with normotensive controls (HTNNeg) (n = 47, 48.9%). HTNPos patients had a thicker interventricular septum in diastole (IVSd) (HTNPos: 0.96 ± 0.21 cm vs. HTNNeg: 0.77 ± 0.15; p = 0.005) and higher intracardiac pressure (e/e′: 9.06 ± 4.85 cm vs. 7.76 ± 3.41; p = 0.01), especially the elderly (> 65 years) (IVSd: 1.03 ± 0.19 cm, e/e′: 11.39 ± 1.99; p = 0.006 and 0.01, respectively). Nevertheless, the internal dimension decreased more significantly in the HTNPos rather than in the HTNNeg elderly (5.23 ± 0.46 vs. 4.74 ± 0.69 cm; p = 0.02). We found different directions of cardiac remodeling with normotensive and hypertensive loads. Different from the longitudinal and circumferential strain, E and Poisson’s ratio (υ) are values that directly present the rigidity of myocardium. E was significantly higher in the elderly (8011.92 ± 2431.85 vs. 6052.43 ± 3121.50; p = 0.02), whereas υ was significantly higher in all HTNPos patients (0.73 ± 0.12 vs. 0.61 ± 0.07; p < 0.001). Because E and υ reflected the material changes of myocardium in the HTNPos elderly, the proposed elliptical mathematical heart model better describes the geometric deformity induced by aging and hypertension.

Left ventricular noncompaction cardiomyopathy: an under-recognized disease diagnosed by echocardiography and computed tomography.

Heart failure is a threatening burden in clinical practice, in elders, largely because of atheromatous coronary disease. Conversely, in the younger, congenital structure heart disease and cardiomyopathy, which have been ignored most of the time, take the leading places. Here, we present a unique case with heart failure and newly developed neurologic signs. A 38-year-old woman was diagnosed with idiopathic dilated cardiomyopathy 9 years previously and had been under irregular medical control since then. The family

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