Mackay Medical College and Mackay Medicine Nursing and Management College

Taipei, Taiwan

Mackay Medical College and Mackay Medicine Nursing and Management College

Taipei, Taiwan
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Yun C.-H.,Mackay Medical College and Mackay Medicine Nursing and Management College | Yun C.-H.,Mackay Memorial Hospital | Sun J.-Y.,National Yang Ming University | Templin B.,CardioKinetix | And 11 more authors.
Journal of Cardiac Failure | Year: 2017

Background Percutaneous ventricular restoration therapy with the use of a left ventricle (LV)–partitioning Parachute device has emerged as a clinical treatment option for LV apical aneurysm after extensive anterior myocardial infarction (AMI). We assessed changes of diastolic mechanics and functional improvements following LV Parachute device implantation by means of cardiac computerized tomography (CCT). Methods and Results CCT data were obtained from 28 patients before and after LV Parachute device implantation. Diastolic functional indices were determined by means of quantitative CCT assessment: 1) transmitral velocities in early (E) and late (A) diastole and ratio (E/A); 2) early diastolic mitral septal tissue velocity (Ea) and E/Ea; and 3) vortex formation time (VFT). Functional improvements were assessed with the use of New York Heart Association (NYHA) functional classification. Among the study patients, there were no significant differences in all transmitral velocities and E/A, though there was significantly increased Ea, reduced E/Ea, and greater VFT 6 months after LV Parachute device implantation. Finally, the improvement of diastolic functional indices after Parachute treatment correlated with observed clinical functional alterations (Δ E/Ea and Δ NYHA functional class:, r = 0.563; P = .002; Δ VFT and Δ NYHA functional class: r = −0.507; P = .006). Conclusions LV Parachute device implantation therapy in heart failure caused by AMI and LV apical aneurysm formation showed improvements in several diastolic functional mechanics according to CCT-based measures. © 2017 Elsevier Inc.

Lo C.,Mackay Memorial Hospital | Lo C.,Mackay Medical College and Mackay Medicine Nursing and Management College | Lai Y.,Mackay Memorial Hospital | Lai Y.,Mackay Medical College and Mackay Medicine Nursing and Management College | And 11 more authors.
Clinical and Experimental Hypertension | Year: 2017

Background: The associations among chronic health conditions, ventricular geometric alterations or cardiac contractile mechanics in different phenotypes heart failure (HF) remain largely unexplored. Methods: We studied 438 consecutive hospitalized patients (mean age: 64.9 ± 16.6 years, 52.5% female) with or without clinical evidence of HF. We examined the associations among clinical co-morbidities, LV geometries and systolic mechanics in terms of global myocardial strains. Results: Increasing clinical co-morbidities was associated with greater LV mass, worse longitudinal deformations and higher proportion of admission with HF diagnosis, which was more pronounced in HFpEF (from 6.4% to 40.7%, X2 < 0.001). The independent association between co-morbidity burden and longitudinal functional decay remained unchanged after adjusting for age and sex for all admissions and in HFpEF (Coef: 0.82 & 0.71, SE: 0.13 & 0.21, both p≤0.001). By using co-morbidity scores, the area under receiver operating characteristic curves (AUROC) in identifying HFpEF was 0.71 (95% CI: 0.65 to 0.77), 0.64 (95% CI: 0.58 to 0.71) for HFrEF and 0.72 for both (95% CI: 0.67 to 0.77). Co-morbidity burden superimposed on LV mass index and LV filling pressure (E/E’) further expanded the AUROC significantly in diagnosing both types HF (c-statistics from 0.73 to 0.81, p for ΔAUROC: 0.0012). Conclusion: Chronic health conditions in the admission population were associated with unfavorable cardiac remodeling, impair cardiac contractile mechanics and further added significantly incremental value in HF diagnosis. Our data suggested the potentiality for better cardiac function by controlling baseline co-morbidities in hospitalized HF patients, especially HFpEF. Abbreviations: CAD: coronary artery disease; CKD: chronic kidney disease; DT: deceleration time; eGFR: Estimated glomerular filtration rate; HF: heart failure; IVRT: iso-volumic relaxation time; LV: left ventricular; LVEF: left ventricular ejection fraction; RWT: relative wall thickness; TDI: Tissue Doppler imaging © 2017 Taylor & Francis

Yun C.-H.,National Yang Ming University | Yun C.-H.,Mackay Memorial Hospital | Longenecker C.T.,Case Western Reserve University | Chang H.-R.,National Taiwan University | And 19 more authors.
Data in Brief | Year: 2015

In this data, we present the details of the cross-sectional study from Mackay Memorial Hospital, Taipei, Taiwan that examined the relationship between three-dimensional (3D) peri-aortic root fat (PARF) volumes, cardiometabolic risk profiles, carotid artery morphology and remodeling. Our sample is composed of a total 1492 adults who underwent an annual cardiovascular risk survey in Taiwan.PARF was measured using images of gated non-contrast cardiac computed tomography (CT) and a dedicated workstation (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). The stratified analyses were performed in order to assess the association between carotid morphology, remodeling and PARF by tertile. For further analyses and discussion, please see "The Association among Peri-Aortic Root Adipose Tissue, Metabolic derangements and Burden of Atherosclerosis in Asymptomatic Population" by Yun et al. (2015) [1]. © 2015 The Authors.

Yang F.-S.,Mackay Memorial Hospital | Yun C.-H.,Mackay Memorial Hospital | Yun C.-H.,National Yang Ming University | Wu T.-H.,National Yang Ming University | And 21 more authors.
BMC Cardiovascular Disorders | Year: 2013

Background: Central obesity in relation to insulin resistance is strongly linked to the development of type 2 diabetes. However, data regarding the association between pericardial and peri-aortic adiposity, a potential estimate of visceral adipose tissue burden, and pre-diabetes status remains unclear. The aim of this study was to examine whether the degree of pericardial and thoracic peri-aortic adipose tissue, when quantified by multi-detector computed tomography (MDCT), differs significantly in a normal, pre-diabetic, and overtly diabetic population. Methods: We studied 562 consecutive subjects including 357 healthy, 155 pre-diabetic, and 50 diabetic patients selected from participants who underwent annual health surveys in Taiwan. Pre-diabetes status was defined by impaired fasting glucose or impaired glucose intolerance according to American Diabetes Association guidelines. Pericardial (PCF) and thoracic peri-aortic (TAT) adipose tissue burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). Body fat composition, serum high-sensitivity C-reactive protein (hs-CRP) level and insulin resistance (HOMA-IR) were also assessed. Results: Patients with diabetes and pre-diabetes had greater volume of PCF (89 ± 24.6, 85.3 ± 28.7 & 67.6 ± 26.7 ml, p < 0.001) as well as larger TAT (9.6 ± 3.1 ml vs 8.8 ± 4.2 & 6.6 ± 3.5 ml, respectively, p < 0.001) when compared to the normal group, although there were no significant differences in adiposity between the diabetic and pre-diabetic groups. For those without established diabetes in our study, increasing TAT burden, but not PCF, appear to correlate with insulin resistance (HOMA-IR) and hs-CRP in the multivariable models.Conclusions: Pre-diabetic and diabetic subjects, compared to normoglycemia, were associated with significantly higher pericardial and peri-aortic adipose tissue burden. In addition, visceral fat accumulation adjacent to the thoracic aorta seemed to exert a significant impact on insulin resistance and systemic inflammation. © 2013 Yang et al.; licensee BioMed Central Ltd.

Chao T.-F.,Taipei Veterans General Hospital | Chao T.-F.,National Yang Ming University | Hung C.-L.,Mackay Memorial Hospital | Hung C.-L.,Mackay Medical College and Mackay Medicine Nursing and Management College | And 27 more authors.
PLoS ONE | Year: 2013

Objectives:Epicardial fat was closely related to atrial fibrillation (AF). Transthoracic echocardiography (TTE) has been proposed to be a convenient imaging tool in assessing epicardial adipose tissue (EAT). The goal of the present study was to investigate whether the EAT thickness measured on TTE was a useful parameter in predicting procedural outcomes of AF ablations.Methods and Results:A total of 227 paroxysmal AF (PAF) and 56 non-paroxysmal AF (non-PAF) patients receiving catheter ablations from 2008-2010 were enrolled. Echocardiography-derived regional EAT thickness from parasternal long-axis view was quantified for each patient. Free of recurrence was defined as the absence of atrial arrhythmias without using antiarrhythmic agents after ablations. The mean EAT thickness of the study population was 6.1 ± 0.8 mm. Non-PAF patients had a thicker EAT than that of PAF patients (7.0 ± 0.7 mm versus 5.9 ± 0.7 mm, p value <0.001). During the follow-up of 16 ± 9 months, there were 95 patients (33.6%) suffering from recurrences of atrial arrhythmias. Non-PAF, chads2 score, left atrial diameter and EAT thickness were independent predictors of recurrence after catheter ablations. At a cutoff value of 6 mm for PAF and 6.9 mm for non-PAF, the measurement of EAT thickness could help us to identify patients at risk of recurrences.Conclusions:EAT thickness may serve as a useful parameter in predicting recurrences after AF ablations. Compared to other imaging modalities, TTE can be an alternative choice with less cost and time in assessing the effects of EAT on ablation outcomes. © 2013 Chao et al.

Hung C.-L.,Mackay Memorial Hospital | Hung C.-L.,Mackay Medical College and Mackay Medicine Nursing and Management College | Chao T.-F.,Taipei Veterans General Hospital | Chao T.-F.,National Yang Ming University | And 21 more authors.
Canadian Journal of Cardiology | Year: 2013

Background: Metabolic syndrome (MS) is an important risk factor of atrial fibrillation. However, an understanding of the adverse effects of MS on left atrial (LA) functional assessment in terms of electromechanical interval, a convenient parameter that can reflect the process of LA remodelling, has been lacking. The goal of this study was to investigate the association between electromechanical interval and MS. Methods: In all, 337 patients (91 with MS) with mean age of 51.9 ± 9.0 years were enrolled. Metabolic syndrome was defined by National Cholesterol Education Program-Adult Treatment Panel III score. Insulin resistance was assessed by the homeostasis model assessment-insulin resistance method. The electromechanical interval, defined as the time from initiation of P wave deflection to peak of mitral inflow Doppler A wave (PA-PDI), was measured. Results: Patients with MS had significantly longer PA-PDI intervals compared with those of patients without MS (131.0 ± 12.4 milliseconds vs 123.2 ± 14.0 milliseconds, P < 0.001). Longer PA-PDI intervals were observed in subjects with higher metabolic scores (P<0.05). In patients with small LA size, PA-PDI intervals, but not LA dimensions, were significantly different between groups with and without MS (P < 0.05). Additionally, PA-PDI interval was positively correlated with insulin resistance (r= 0.267, P < 0.001). Conclusions: PA-PDI intervals were longer in patients with MS compared with those of patients without MS and tracked with insulin resistance. PA-PDI may be a useful clinical parameter to represent the degree of atrial remodelling in subjects with metabolic derangements. © 2013 Canadian Cardiovascular Society.

PubMed | Baptist Cardiac Vascular Institute, Mackay Memorial Hospital, Ohio University, National Yang Ming University and Mackay Medical College and Mackay Medicine Nursing and Management College
Type: Journal Article | Journal: Journal of cardiac failure | Year: 2016

Diastolic dysfunction (DD), a precursor to clinical heart failure (HF), has traditionally been evaluated by means of echocardiography. Data regarding morphologic descriptions of pulmonary vein (PV) orifices in transition from DD to HF have been lacking.We retrospectively studied 124 subjects with computerized tomography (CT)-derived PV parameters and echocardiography-derived diastolic indices. We categorized our subjects as 1) non-DD, 2) DD, or 3) heart failure with preserved ejection fraction (HFpEF) and observed a graded enlargement for 4 PV orifice areas across these groups. Positive linear relationship between the 4 PV orifice areas, echocardiography-derived mean pulmonary capillary wedge pressure (PCWP), and velocity of propagation (VP) were observed. Finally, maximum areas of left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV) significantly increased clinical diagnosis of HFpEF (likelihood-ratio (2): from 42.92 to 50.75 and 54.67 for LSPV and LIPV, respectively) when superimposed on left ventricular mass index, PCWP, and left atrial volume.PV size measurements with the use of CT are feasible and further aid in diseases discrimination between preclinical DD and those progressed into HF, even with preserved global pumping. Our data suggest that CT-based PV measures may help to identify subjects at risk for HF.

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