There has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study ...(TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p < 0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia-Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.
Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies T2DM, and increases the risk of AF. However, the dose-relationship between body ...mass index (BMI) and AF risk has seldom been studied in patients with diabetes.
This cohort study utilized a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, 64,339 adult patients with T2DM were enrolled for analysis. BMI was measured and categorized as underweight (BMI < 18.5), normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), obesity class 1 (27 ≤ BMI < 30), obesity class 2 (30 ≤ BMI < 35), or obesity class 3 (BMI ≥ 35). Multivariate Cox regression and spline regression models were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM.
The incidence of AF was 1.97 per 1000 person-years (median follow-up, 70.7 months). In multivariate Cox regression, using normal BMI as the reference group, underweight (HR 1.52, 95% CI 1.25-1.87, p < 0.001) was associated with a significantly higher risk of AF, while overweight was associated with significantly reduced risk of AF (HR 0.82, 95% CI 0.73-0.89, p < 0.001). Kaplan-Meier analysis showed AF risk was highest in the underweight group, followed by obesity class 3, while the overweight group had the lowest incidence of AF (log-rank test, p < 0.001). The cubic restrictive spline model revealed a "J-shaped" or "L-shaped" relationship between BMI and AF risk.
Underweight status confers the highest AF risk in Asian patients with T2DM.
Cardiovascular magnetic resonance (CMR)-derived extracellular volume (ECV) requires a hematocrit (Hct) to correct contrast volume distributions in blood. However, the timely assessment of Hct can be ...challenging and has limited the routine clinical application of ECV. The goal of the present study was to evaluate whether ECV measurements lead to significant error if a venous Hct was unavailable on the day of CMR.
109 patients with CMR T1 mapping and two venous Hcts (Hct
: a Hct from the day of CMR, and Hct
: a Hct from a different day) were retrospectively identified. A synthetic Hct (Hct
) derived from native blood T1 was also assessed. The study used two different ECV methods, (1) a conventional method in which ECV was estimated from native and postcontrast T1 maps using a region-based method, and (2) an inline method in which ECV was directly measured from inline ECV mapping. ECVs measured with Hct
, Hct
, and Hct
were compared for each method, and the reference ECV (ECV
) was defined using the Hct
. The error between synthetic (ECV
) and ECV
was analyzed for the two ECV methods.
ECV measured using Hct
and Hct
were significantly correlated with ECV
for each method. No significant differences were observed between ECV
and ECV measured with Hct
(ECV
; 28.4 ± 6.6% vs. 28.3 ± 6.1%, p = 0.789) and between ECV
and ECV calculated with Hct
(ECV
; 28.4 ± 6.6% vs. 28.2 ± 6.2%, p = 0.45) using the conventional method. Similarly, ECV
was not significantly different from ECV
(28.5 ± 6.7% vs. 28.5 ± 6.2, p = 0.801) and ECV
(28.5 ± 6.7% vs. 28.4 ± 6.0, p = 0.974) using inline method. ECV
values revealed relatively large discrepancies in patients with lower Hcts compared with those with higher Hcts.
Venous Hcts measured on a different day from that of the CMR examination can still be used to measure ECV. ECV
can provide an alternative method to quantify ECV without needing a blood sample, but significant ECV errors occur in patients with severe anemia.
Background: Radiation exposure during fluoroscopic procedures increases the risk of cancer for both patients and operators. Objectives: The aim of this study was to investigate the safety and ...efficacy of adopting a three-dimensional electroanatomical mapping (3D EAM) system during ablation for paroxysmal supraventricular tachycardia (PSVT), without the assistance of intracardiac echocardiography (ICE), for both right- and left-chamber cardiac procedures. Methods:We retrospectively enrolled all patients with PSVT from September 2018 to December 2020. The patients were grouped according to the use of the 3D EAMsystem(3D-guided group, n = 102 vs. conventional group, n = 226). Results: The acute success rates were high in both groups (100% vs. 99.1%). The fluoroscopy time was significantly lower in the 3D-guided group than in the conventional group (2.4 4.4 vs. 19.0 10.8min); the procedure timewas significantly increased in the 3D-guided group (104.5 29.9 vs. 94.0 31.9 min), and this was associated with t
Even though the increasing clinical recognition of primary aldosteronism (PA) as a public health issue, its heightened risk profiles and the availability of targeted surgical/medical treatment being ...more understood, consensus in its diagnosis and management based on medical evidence, while recognizing the constraints of our real-world clinical practice in Taiwan, has not been reached.
The Taiwan Society of Aldosteronism (TSA) Task Force acknowledges the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics into the management of PA.
When there is suspicion of PA, a plasma aldosterone to renin ratio (ARR) should be obtained initially. Patients with abnormal ARR will undergo confirmatory laboratory and image tests. Subtype classification with adrenal venous sampling (AVS) or NP-59 nuclear imaging, if AVS not available, to lateralize PA is recommended when patients are considered for adrenalectomy. The strengths and weaknesses of the currently available identification methods are discussed, focusing especially on result interpretation.
With this consensus we hope to raise more awareness of PA among medical professionals and hypertensive patients in Taiwan, and to facilitate reconciliation of better detection, identification and treatment of patients with PA.
Extracorporeal membrane oxygenation (ECMO) is an effective support method for acute fulminant myocarditis (AFM) with cardiogenic shock. However, deciding whether to bridge to a left ventricular ...assist device (LVAD) or to maintain ECMO support until heart recovery is still controversial.
This was a retrospective observational study from a single center. Eighty-eight adults with AFM and ECMO support between 2006 and 2018 were included. The primary endpoint was heart recovery without heart transplantation or long-term LVAD support.
The heart recovery group contained 43 patients, of whom 41 were discharged after being weaned off ECMO and the other two after LVAD. Five patients with heart transplants and one with long-term LVAD support were discharged, accounting for an overall survival of 55.7%. Multivariate logistic regression revealed that peak CK-MB level, severe intraventricular conduction disturbance (asystole) and malignant arrhythmia (VT or VF) were prognostic factors for nonrecovery (P = .027 and 0.017, respectively), while early intravenous immunoglobulin (IVIG) use before ECMO was highly likely to have a protective effect with a trend toward statistical significance (P = .079). A risk score was developed: 4 points for VT/VF/asystole, 1 point for every 100 μg/L increase in the peak CK-MB level, up to a maximum of 5 points, and −3 points for early IVIG use. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.818.
High CK-MB levels and VT/VF/asystole in patients with AFM are associated with poor heart recovery. Early IVIG use shows a potentially protective effect.
•ECMO treatment for acute fulminant myocarditis (AFM) can achieve acceptable hospital outcomes in adult patients.•Whether to bridge to LVAD or to maintain ECMO support until heart recovery is still controversial in AMF with ECMO support.•High CK-MB levels and severe malignant arrhythmia (VT/VF/asystole) are associated with poor heart recovery.
Heart rhythm complexity (HRC), a subtype of heart rate variability (HRV), is an important tool to investigate cardiovascular disease. In this study, we aimed to analyze serial changes in HRV and HRC ...metrics in patients with inferior ST-elevation myocardial infarction (STEMI) within 1 year postinfarct and explore the association between HRC and postinfarct left ventricular (LV) systolic impairment. We prospectively enrolled 33 inferior STEMI patients and 74 control subjects and analyzed traditional linear HRV and HRC metrics in both groups, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE). We also analyzed follow-up postinfarct echocardiography for 1 year. The STEMI group had significantly lower standard deviation of RR interval (SDNN), and DFAα2 within 7 days postinfarct (acute stage) comparing to control subjects. LF power was consistently higher in STEMI group during follow up. The MSE scale 5 was higher at acute stage comparing to control subjects and had a trend of decrease during 1-year postinfarct. The MSE area under scale 1-5 showed persistently lower than control subjects and progressively decreased during 1-year postinfarct. To predict long-term postinfarct LV systolic impairment, the slope between MSE scale 1 to 5 (slope 1-5) had the best predictive value. MSE slope 1-5 also increased the predictive ability of the linear HRV metrics in both the net reclassification index and integrated discrimination index models. In conclusion, HRC and LV contractility decreased 1 year postinfarct in inferior STEMI patients, and MSE slope 1-5 was a good predictor of postinfarct LV systolic impairment.
Aims
A dramatic increase in pulmonary capillary wedge pressure (PCWP) during exercise is observed in patients with heart failure with preserved ejection fraction (HFpEF). This study was designed to ...determine whether iloprost inhalation could improve exercise haemodynamics and cardiac reserve in patients with HFpEF.
Methods
Thirty‐four HFpEF patients were enrolled in this double‐blind, randomized, placebo‐controlled, parallel‐group trial. Patients received both cardiac catheterization and underwent expired gas analysis at rest, during exercise, and before and 10 minutes after treatment with either inhaled iloprost or placebo. The primary endpoint was decrease in exercise PCWP.
Results
At baseline, enrolled patients showed an increase in PCWP during exercise (from 16 range, 14–23 mmHg to 27 21–36 mmHg; P < .0001). After iloprost inhalation, exercise PCWP was significantly reduced compared to placebo (adjusted mean: 20 16–29 mmHg vs 23 17–32 mmHg; P = .002). There was no difference for cardiac output reserve with exercise in the 2 groups (0.2 −1.3–1.2 L/min vs –0.7 −1.9–0.1 L/min; P = .099). Iloprost improved the pulmonary artery pressure flow relationships in HFpEF with exercise compared to placebo.
Conclusion
Iloprost inhalation improved haemodynamic deficits during exercise in patients with HFpEF. Prospective trials testing long‐term iloprost therapy in this population are warranted.
The association between indoor air pollution and heart rate variability (HRV) has been well-documented. Little is known about effects of household activities on indoor air quality and HRV alteration. ...To investigate changes in HRV associated with changes in personal exposure to household particulate matter (PM) and household activities.
We performed 24-h continuous monitoring of electrocardiography and measured household PM exposure among 50 housewives. The outcome variables were log10-transformed standard deviation of normal-to-normal (NN) intervals (SDNN) and the square root of the mean of the sum of the squares of differences between adjacent NN intervals (r-MSSD). Household PM was measured as the mass concentration of PM with an aerodynamic diameter <2.5 µm (PM2.5). We used mixed-effects models to examine the association between household PM2.5 exposure and log10-transformed HRV indices.
After controlling for potential confounders, an interquartile range change in household PM2.5 with 1- to 4-h mean was associated with 1.25-4.31% decreases in SDNN and 0.12-3.71% decreases in r-MSSD. Stir-frying, cleaning with detergent and burning incense may increase household PM2.5 concentrations and modify the effects of household PM2.5 on HRV indices among housewives.
Indoor PM2.5 exposures were associated with decreased SDNN and r-MSSD among housewives, especially during stir-frying, cleaning with detergent and burning incense.
BackgroundHeart rate recovery (HRR) and N terminal-pro B type natriuretic peptide (NT-proBNP) are markers for survival and cardiac function; however, Little is known about their association. MethodWe ...examined 2540 healthy subjects aged 12-49 years with data from National Health and Nutrition Examination Survey(NHANES) 1999-2002. HRR parameters 1-3 min after exercise were calculated from exercise test results. Baseline characteristics, anthropometric and NT-proBNP, and other risk covariates were obtained. ResultThe results showed that NT-proBNP was positively correlated with HRR2(correlation coefficient (cc) = 0.042 0.029-0.054, P < 0.001) and HRR3(cc = 0.046 0.029-0.064, P = 0.001); with further adjustment, the associations remained significant between NT-proBNP and HRR2(cc = 0.030 0.010-0.049, P = 0.004)/HRR3(cc = 0.0290.004-0.054, P = 0.025). Our study also found significant correlations between NT-pro BNP and SBP(cc = -0.026 -0.046∼-0.005, P = 0.017), DBP(cc = -0.037 -0.062∼-0.012, P = 0.005), and total cholesterol(cc = -0.065 -0.12∼-0.018, P = 0.009). ConclusionsOur results suggest that BNP might reduce heart rate after exercise by inhibiting the sympathetic nervous system (SNS), reducing HRR2 and HRR3, as these phases involve the reduction of heart rate through cardiac sympathetic withdrawal. Moreover, the interaction of BNP on the SNS might be related to the effect of BNP on cardiovascular risks.
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