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  • 1
    Language: English
    In: Annals of the Academy of Medicine, Singapore, September 2010, Vol.39(9), pp.667-3
    Keywords: Blood Pressure ; Hemodynamics ; Aorta -- Pathology ; Cardiovascular Diseases -- Pathology ; Coronary Vessels -- Pathology
    ISSN: 0304-4602
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 2
    In: Circulation, 2018, Vol.138(Suppl_1 Suppl 1), pp.A13320-A13320
    Description: Background: Severe functional tricuspid regurgitation (TR) is associated with poor outcomes. We sought to examine the predictors of early mortality and if severe TR with heart failure (HF) is a stage too late for intervention.Methods: Our study retrospectively identified 635 consecutive patients who had severe functional TR diagnosed on trans-thoracic echocardiography in an academic medical centre from 2000- 2016. We assessed their underlying comorbidities and analyzed their impact on survival.Results: Mean follow-up was 1084 days. There were 371 (58.4%) females, and the mean age at diagnosis was 68.6 years. The mean Body Mass Index, left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) were 23.8 kg/m, 48.6% and 53.8 mmHg, respectively. Pre-existing or incident atrial fibrillation (AF) and ischemic heart disease were 420 (66.1%) and 312 (49.1%) respectively. A total of 307 (48.4%) patients had HF prior and 123 (19.4%) had incident HF. The mechanisms for severe TR were left heart disease ± pulmonary hypertension (72 %), AF with annular modeling (20.4 %), and isolated right ventricular dilatation (7.6 %). There were 286 (45.0%) deaths during follow up, with 154 (24.3%) dying within a year. The median survival was about 690 days. Multivariate analysis revealed that age at diagnosis (HR 1.03, p: 0.001), prior HF admission (HR: 1.31, p: 0.048), PASP of more than 50 mmHg (HR: 1.48, p: 0.004) and LVEF less than 50% (HR: 1.35, p: 0.041) were significantly associated with time to death.Conclusion: In patients with severe functional TR, advanced age, prior HF admission, LVEF 〈50%, PASP 〉50 mm Hg are malignant features, representing an advanced stage of the disease and associated with early mortality. Ability to interpret effectiveness of trans-catheter therapies in this group of patients may be limited, which future clinical intervention trials should take into account.
    ISSN: 0009-7322
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  • 3
    In: Circulation, 2018, Vol.138(24), pp.2763-2773
    Description: BACKGROUND:: Heart failure with preserved ejection fraction (HFpEF), traditionally considered a disease of the elderly, may also affect younger patients. However, little is known about HFpEF in the young. METHODS:: We prospectively enrolled 1203 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions. We grouped HFpEF patients into very young (〈55 years of age; n=157), young (55–64 years of age; n=284), older (65–74 years of age; n=355), and elderly (≥75 years of age; n=407) and compared clinical and echocardiographic characteristics, quality of life, and outcomes across age groups and between very young individuals with HFpEF and age- and sex-matched control subjects without heart failure. RESULTS:: Thirty-seven percent of our HFpEF population was 〈65 years of age. Younger age was associated with male preponderance and a higher prevalence of obesity (body mass index ≥30 kg/m; 36% in very young HFpEF versus 16% in elderly) together with less renal impairment, atrial fibrillation, and hypertension (all P〈0.001). Left ventricular filling pressures and prevalence of left ventricular hypertrophy were similar in very young and elderly HFpEF. Quality of life was better and death and heart failure hospitalization at 1 year occurred less frequently (P〈0.001) in the very young (7%) compared with elderly (21%) HFpEF. Compared with control subjects, very young HFpEF had a 3-fold higher death rate and twice the prevalence of hypertrophy. CONCLUSIONS:: Young and very young patients with HFpEF display similar adverse cardiac remodeling compared with their older counterparts and very poor outcomes compared with control subjects without heart failure. Obesity may be a major driver of HFpEF in a high proportion of HFpEF in the young and very young.
    Keywords: Adults – Health Aspects ; Cardiac Output – Research ; Heart Failure – Research;
    ISSN: 0009-7322
    E-ISSN: 15244539
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  • 4
    Language: English
    In: Circulation, Nov 8, 2016, Vol.134(19)
    Keywords: Mitral Valve -- Research ; Echocardiography -- Usage ; Aortic Valve Stenosis -- Care And Treatment
    ISSN: 0009-7322
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  • 5
    Language: English
    In: American Heart Journal, September 2017, Vol.191, pp.75-81
    Description: Assessing health-related quality of life (HRQoL) in patients with heart failure (HF) is an important goal of clinical care and HF research. We sought to investigate ethnic differences in perceived HRQoL and its association with mortality among patients with HF and left ventricular ejection fraction ≤35%, controlling for demographic characteristics and HF severity. We compared 5697 chronic HF patients of Indian (26%), white (23%), Chinese (17%), Japanese/Koreans (12%), black (12%), and Malay (10%) ethnicities from the HF-ACTION and ASIAN-HF multinational studies using the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0-100; higher scores reflect better health status). KCCQ scores were lowest in Malay (58 ± 22) and Chinese (60 ± 23), intermediate in black (64 ± 21) and Indian (65 ± 23), and highest in white (67 ± 20) and Japanese or Korean patients (67 ± 22) after adjusting for age, sex, educational status, HF severity, and risk factors. Self-efficacy, which measures confidence in the ability to manage symptoms, was lower in all Asian ethnicities (especially Japanese/Koreans [60 ± 26], Malay [66 ± 23], and Chinese [64 ± 28]) compared to black (80 ± 21) and white (82 ± 19) patients, even after multivariable adjustment ( 〈 .001). In all ethnicities, KCCQ strongly predicted 1-year mortality (HR 0.45, 95% CI 0.30-0.67 for highest vs lowest quintile of KCCQ; for interaction by ethnicity .101). Overall, HRQoL is inversely and independently related to mortality in chronic HF but is not modified by ethnicity. Nevertheless, ethnic differences exist independent of HF severity and comorbidities. These data may have important implications for future global clinical HF trials that use patient-reported outcomes as endpoints.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 6
    Language: English
    In: Circulation, Nov 8, 2016, Vol.134(19)
    Keywords: Heart Failure -- Care And Treatment ; Women -- Health Aspects ; Cardiac Output -- Analysis ; Sex Differences (Biology) -- Analysis
    ISSN: 0009-7322
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  • 7
    Language: English
    In: Scientific reports, 04 August 2017, Vol.7(1), pp.7320
    Description: Endothelium-dependent flow-mediated dilation (ED-FMD), a biophysical marker of endothelial dysfunction, is apparently impaired in patients with systemic lupus erythematosus (SLE) but such observation is inconsistent. Here, we assessed and compared the brachial artery ED-FMD (baED-FMD) using ultrasonography between SLE patients without cardiovascular disease and healthy controls (HC) matched for age, gender and body mass index. We then performed a comprehensive meta-analysis of case-control studies which compared baED-FMD between SLE patients and HC by determining the effect size of baED-FMD as standardized mean difference (SMD). Factors associated with the effect size were explored by mixed-model meta-regression. Seventy one SLE patients and 71 HC were studied. SLE patients had lower baED-FMD than HC (3.72 ± 2.8% vs 4.63 ± 3.1%, p = 0.032). Meta-analysis of 25 case-control studies involving 1,313 SLE patients and 1,012 HC with the random effects model revealed lower baED-FMD in SLE patients compared to HC (SMD -1.077, p 〈 0.001). The presence of diabetes mellitus (p = 0.04747), higher diastolic blood pressure (p = 0.044), renal involvement (p = 0.027) and aspirin use (p = 0.001) were associated with more discrepant baED-FMD between both groups. In conclusion, SLE patients naïve of cardiovascular disease have impaired endothelial function. Diabetes mellitus, renal disease and diastolic hypertension are major contributors of endothelial dysfunction in SLE patients.
    Keywords: Article;
    E-ISSN: 2045-2322
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  • 8
    Language: English
    In: BMC nephrology, 23 November 2012, Vol.13, pp.156
    Description: Maintenance hemodialysis (HD) patients universally suffer from excess toxin load. Hemodiafiltration (HDF) has shown its potential in better removal of small as well as large sized toxins, but its efficacy is restricted by inter-compartmental clearance. Intra-dialytic exercise on the other hand is also found to be effective for removal of toxins; the augmented removal is apparently obtained by better perfusion of skeletal muscles and decreased inter-compartmental resistance. The aim of this trial is to compare the toxin removal outcome associated with intra-dialytic exercise in HD and with post-dilution HDF. The main hypothesis of this study is that intra-dialytic exercise enhances toxin removal by decreasing the inter-compartmental resistance, a major impediment for toxin removal. To compare the HDF and HD with exercise, the toxin rebound for urea, creatinine, phosphate, and β2-microglobulin will be calculated after 2 hours of dialysis. Spent dialysate will also be collected to calculate the removed toxin mass. To quantify the decrease in inter-compartmental resistance, the recently developed regional blood flow model will be employed. The study will be single center, randomized, self-control, open-label prospective clinical research where 15 study subjects will undergo three dialysis protocols (a) high flux HD, (b) post-dilution HDF, (c) high flux HD with exercise. Multiple blood samples during each study session will be collected to estimate the unknown model parameters. This will be the first study to investigate the exercise induced physiological change(s) responsible for enhanced toxin removal, and compare the toxin removal outcome both for small and middle sized toxins in HD with exercise and HDF. Successful completion of this clinical research will give important insights into exercise effect on factors responsible for enhanced toxin removal. The knowledge will give confidence for implementing, sustaining, and optimizing the exercise in routine dialysis care. We anticipate that toxin removal outcomes from intra-dialytic exercise session will be comparable to that obtained by standalone HDF. These results will encourage clinicians to combine HDF with intra-dialytic exercise for significantly enhanced toxin removal. ClinicalTrials.gov number, NCT01674153.
    Keywords: Exercise Therapy ; Hemodiafiltration -- Methods ; Kidney Failure, Chronic -- Diagnosis ; Toxins, Biological -- Blood ; Beta 2-Microglobulin -- Blood
    E-ISSN: 1471-2369
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  • 9
    Language: English
    In: Annals of the Academy of Medicine, Singapore, March 2011, Vol.40(3), pp.145-6
    Keywords: Hemodynamics ; Cardiac Catheterization -- Methods ; Echocardiography, Three-Dimensional -- Methods ; Heart Valve Prosthesis -- Adverse Effects ; Mitral Valve Insufficiency -- Therapy
    ISSN: 0304-4602
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 10
    Language: English
    In: BMC Nephrology, 01 November 2012, Vol.13(1), p.156
    Description: Abstract Background Maintenance hemodialysis (HD) patients universally suffer from excess toxin load. Hemodiafiltration (HDF) has shown its potential in better removal of small as well as large sized toxins, but its efficacy is restricted by inter-compartmental clearance. Intra-dialytic exercise on the other hand is also found to be effective for removal of toxins; the augmented removal is apparently obtained by better perfusion of skeletal muscles and decreased inter-compartmental resistance. The aim of this trial is to compare the toxin removal outcome associated with intra-dialytic exercise in HD and with post-dilution HDF. Methods/design The main hypothesis of this study is that intra-dialytic exercise enhances toxin removal by decreasing the inter-compartmental resistance, a major impediment for toxin removal. To compare the HDF and HD with exercise, the toxin rebound for urea, creatinine, phosphate, and β2-microglobulin will be calculated after 2 hours of dialysis. Spent dialysate will also be collected to calculate the removed toxin mass. To quantify the decrease in inter-compartmental resistance, the recently developed regional blood flow model will be employed. The study will be single center, randomized, self-control, open-label prospective clinical research where 15 study subjects will undergo three dialysis protocols (a) high flux HD, (b) post-dilution HDF, (c) high flux HD with exercise. Multiple blood samples during each study session will be collected to estimate the unknown model parameters. Discussion This will be the first study to investigate the exercise induced physiological change(s) responsible for enhanced toxin removal, and compare the toxin removal outcome both for small and middle sized toxins in HD with exercise and HDF. Successful completion of this clinical research will give important insights into exercise effect on factors responsible for enhanced toxin removal. The knowledge will give confidence for implementing, sustaining, and optimizing the exercise in routine dialysis care. We anticipate that toxin removal outcomes from intra-dialytic exercise session will be comparable to that obtained by standalone HDF. These results will encourage clinicians to combine HDF with intra-dialytic exercise for significantly enhanced toxin removal. Trial registration ClinicalTrials.gov number, NCT01674153
    Keywords: Hemodialysis ; Hemodiafiltration ; Intra-Dialytic Exercise ; Toxin Removal ; Inter-Compartmental Resistance ; Cardiac Output ; Regional Blood Flow Model ; Spent Dialysate ; Blood Temperature ; Medicine
    ISSN: 1471-2369
    E-ISSN: 1471-2369
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