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Yeo K.K.,National Heart Center Singapore
Proceedings of Singapore Healthcare | Year: 2015

The MitraClip is the first-in-class percutaneous therapy for mitral regurgitation. It is delivered from the femoral vein and can be used for degenerative or functional mitral regurgitation. In Singapore, the device was first approved for use in 2011. This review describes the device and discusses the data supporting its use and the regional experience to date. The MitraClip, given the early experience, should only be used after consideration by Heart Teams and only in appropriately selected patients.


Liew R.,National Heart Center Singapore | Liew R.,National University of Singapore
Heart | Year: 2010

Many patients who survive an acute myocardial infarction (AMI) remain at risk of sudden cardiac death despite optimal medical treatment. AMI survivors are currently risk assessed and selected for implantable cardioverter defibrillator (ICD) insertion mainly on the basis of their left ventricular ejection fraction. Several other cardiovascular tests are available that can detect the myocardial substrate abnormalities and help refine risk. These investigations include ECG-based tests (signal averaged ECG and T-wave alternans), Holter-based recordings (heart rate variability and heart rate turbulence) and imaging techniques (cardiac magnetic resonance). Recent evidence also points towards a potential role for other indices on the 12-lead ECG and genetic profiling in risk prediction. This study reviews the current evidence for the use of these tests in AMI survivors and addresses their pros and cons in guiding the selection of ICD recipients.


Tan A.K.,National Heart Center Singapore
Asian cardiovascular & thoracic annals | Year: 2013

We describe a case of bronchial artery aneurysm presenting as a solitary lung mass (4 × 5 cm) in a 53-year-old man with symptoms of cough for 3 months. The aneurysm was only detected at surgery, and resected by performing a middle lobectomy.


Haude M.,Lukaskrankenhaus GmbH | Ince H.,Vivantes Klinikum im Friedrichshain and Am Urban | Abizaid A.,Dante Pazzanese Institute of Cardiology | Toelg R.,Herzzentrum Segeberger Kliniken GmbH | And 11 more authors.
The Lancet | Year: 2016

Background Absorbable scaffolds were designed to overcome the limitations of conventional, non-absorbable metal-based drug-eluting stents. So far, only polymeric absorbable scaffolds are commercially available. We aimed to assess the safety and performance of a novel second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) in patients with de-novo coronary artery lesions. Methods We did this prospective, multicentre, non-randomised, first-in-man trial at 13 percutaneous coronary intervention centres in Belgium, Brazil, Denmark, Germany, Singapore, Spain, Switzerland, and the Netherlands. Eligible patients had stable or unstable angina or documented silent ischaemia, and a maximum of two de-novo lesions with a reference vessel diameter between 2·2 mm and 3·7 mm. Clinical follow-up was scheduled at months 1, 6, 12, 24, and 36. Patients were scheduled for angiographic follow-up at 6 months, and a subgroup of patients was scheduled for intravascular ultrasound, optical coherence tomography, and vasomotion assessment. All patients were recommended to take dual antiplatelet treatment for at least 6 months. The primary endpoint was in-segment late lumen loss at 6 months. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01960504. Findings Between Oct 8, 2013, and May 22, 2015, we enrolled 123 patients with 123 coronary target lesions. At 6 months, mean in-segment late lumen loss was 0·27 mm (SD 0·37), and angiographically discernable vasomotion was documented in 20 (80%) of 25 patients. Intravascular ultrasound assessments showed a preservation of the scaffold area (mean 6·24 mm2 [SD 1·15] post-procedure vs 6·21 mm2 [1·22] at 6 months) with a low mean neointimal area (0·08 mm2 [0·09]), and optical coherence tomography did not detect any intraluminal mass. Target lesion failure occurred in four (3%) patients: one (<1%) patient died from cardiac death, one (<1%) patient had periprocedural myocardial infarction, and two (2%) patients needed clinically driven target lesion revascularisation. No definite or probable scaffold thrombosis was observed. Interpretation Our findings show that implantation of the DREAMS 2G device in de-novo coronary lesions is feasible, with favourable safety and performance outcomes at 6 months. This novel absorbable metal scaffold could be an alternative to absorbable polymeric scaffolds for treatment of obstructive coronary disease. Funding Biotronik AG. © 2016 Elsevier Ltd.


Kelly J.P.,Duke University | Mentz R.J.,Duke University | Mebazaa A.,University Paris Diderot | Voors A.A.,University of Groningen | And 7 more authors.
Journal of the American College of Cardiology | Year: 2015

Abstract Recent clinical trials in patients with heart failure with preserved ejection fraction (HFpEF) have provided important insights into participant selection strategies. Historically, HFpEF trials have included patients with relatively preserved left ventricular ejection fraction ranging from 40% to 55% and a clinical history of heart failure. Contemporary HFpEF trials have also incorporated inclusion criteria such as hospitalization for HFpEF, altered functional capacity, cardiac structural and functional abnormalities, and abnormalities in neurohormonal status (e.g., elevated natriuretic peptide levels). Careful analyses of the effect of these patient selection criteria on outcomes in prior trials provide valuable lessons for future trial design. We review recent and ongoing HFpEF clinical trials from a patient selection perspective and appraise trial patient selection methodologies in relation to outcomes. This review reflects discussions between clinicians, scientists, trialists, regulators, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum in Paris, France, on December 6, 2013. © 2015 By The American College of Cardiology Foundation.

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