• 期刊

The 2017 Focused Update of the Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS) for the Management of Hypertension

Hypertension (HT) is the most important risk factor for cardiovascular diseases. Over the past 25 years, the number of individuals with hypertension and the estimated associated deaths has increased substantially. There have been great debates in the past few years on the blood pressure (BP) targets. The 2013 European Society of Hypertension and European Society of Cardiology HT guidelines suggested a unified systolic BP target of 140 mmHg for both high-risk and low-risk patients. The 2014 Joint National Committee report further raised the systolic BP targets to 150 mmHg for those aged ≧60 years, including patients with stroke or coronary heart disease, and raised the systolic BP target to 140 mmHg for diabetes. Instead, the 2015 Hypertension Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society suggested more aggressive BP targets of ＜ 130/80 mmHg for patients with diabetes, coronary heart disease, chronic kidney disease with proteinuria, and atrial fibrillation patients on antithrombotic therapy. Based on the main findings from the Systolic Blood Pressure Intervention Trial (SPRINT) and several recent meta-analyses, the HT committee members of the Taiwan Society of Cardiology and the Taiwan Hypertension Society convened and finalized the revised BP targets for management of HT. We suggested a new systolic BP target to ＜ 120 mmHg for patients with coronary heart disease, chronic kidney disease with an eGFR of 20-60 ml/min/1.73 m^2, and elderly patients aged ≧ 75 years, using unattended automated office BP measurement. When traditional office BP measurement is applied,we suggested BP target of ＜ 140/90 mmHg for elderly patients with an age ≧ 75 years. Other BP targets with traditional office BP measurement remain unchanged. With these more aggressive BP targets, it is foreseeable that the cardiovascular events will decrease substantially in Taiwan.

• 期刊

Mini-Review of the Chin-Shan Community Cardiovascular Cohort Study in Population Health Research in Taiwan

Preventing and controlling non-communicable diseases (NCDs) is a growing global public health concern, and evidence-based data from population-based health studies are needed in order to develop appropriate public health policies for controlling NCDs. The Chin-Shan Community Cardiovascular Cohort (CCCC) study is a prospective cohort consisting of participants from one community in China in 1990-1991, and has provided substantial evidence-based data on domestic and global health issues in preventive cardiology fields. The present study is a mini-review of the CCCC study. In this review, we have described the historical background of the cardiovascular disease burden and related risk factors, especially lifestyle factors, subclinical disease markers, biomarkers and prediction models, and related international collaborative projects. In addition, this mini-review study provides a measure of insight into future plans for 21st century epidemiological research in cardiovascular diseases, suggesting possible areas of focus for future research.

• 期刊

Clinical Characteristics of Patients Less than Forty Years Old with Coronary Artery Disease in Taiwan: A Cross-Sectional Study

Background: Coronary artery disease (CAD) rarely occurs in young adults. Our objective was to investigate the baseline characteristics and outcomes of young patients with CAD. Methods: We retrospectively enrolled patients aged ＜ 40 years of age who underwent coronary angiography in a tertiary hospital in Taiwan between 2002 and 2015. The baseline characteristics and in-hospital outcomes of patients with acute coronary syndrome (ACS) and occlusive CAD (stenotic lesions ＞ 50%) were compared with those of patients without ACS and non-occlusive CAD, respectively. Results: We enrolled 245 young patients including 131 (53.5%) with ACS and 178 with occlusive CAD. The median age of the patients was 36.08 years and the mean follow-up period was 4.84 years. Of all study subjects, 220 (89.8%) were men and 140 (57.1%) were current smokers; there was an overall in-hospital mortality rate of 3.3%. Furthermore, age, body mass index, smoking, total leukocyte count, neutrophil-to-lymphocyte ratio, total cholesterol, and low-density lipoprotein were higher in patients with ACS and significant CAD than in those without ACS and nonstenotic CAD. Interestingly, triglyceride (TG) levels and the TG to high-density lipoprotein ratio were significantly higher in patients with ACS and occlusive CAD than in those without ACS and non-occlusive CAD. Logistic regression analysis revealed that smoking is an independent predictor of ACS and occlusive CAD. Conclusions: Our findings suggest that classical risk factors, obesity, and inflammation remain potent contributors to occlusive CAD and ACS in young adults in Taiwan. Efforts to prevent or minimize these risk factors, such as smoking cessation and aggressive lipid control, are necessary in young adults.

• 期刊

Aortic Arch Calcification Associated with Cardiovascular Events and Death among Patients with Acute Coronary Syndrome

Background: To date, it remains unsettled whether aortic arch calcification (AAC) has prognostic value in patients with acute coronary syndrome. Methods: From January 1 to December 31, 2013, a total of 225 patients with acute coronary syndrome (mean age 72 ± 26 years, 75% male) were enrolled in this study. Patients admitted to the coronary care unit of a tertiary referral medical center under the preliminary diagnosis of acute coronary syndrome were retrospectively investigated. The primary endpoint was composite of long-term major adverse cardiovascular events. The secondary endpoints were 30-day and long-term all-cause mortality. Results: Of the 225 patients enrolled in this study, 143 had detectable AAC. Those who had AAC were older, with higher Killip classification and thrombolysis in myocardial infarction (TIMI) score with a lower probability of single vessel disease. Acute coronary syndrome patients with AAC had significantly higher 30-day mortality (17.3% vs. 7.1%, log-rank p = 0.02). During a mean follow-up period of 165 ± 140 days (maximum 492 days), the calcification group had significantly increased cardiovascular deaths (27.6% vs. 11.2%, log-rank p = 0.002), all-cause mortality (28.3% vs. 11.2%, log-rank p = 0.001) and composite endpoint of major adverse cardiovascular events (39.4% vs. 24.6%, log-rank p = 0.01). After adjusting for age, gender, diabetes mellitus and hypertension, AAC was an independent risk factor for primary and secondary endpoints among patients with acute coronary syndrome. Conclusions: AAC provided valuable prognostic information on clinical outcomes in patients with acute coronary syndrome. However, different treatment strategies would be warranted for optimal risk reduction in such a population.

• 期刊

Everolimus-Eluting Bioresorbable Vascular Scaffold in Real World Practice -A Single Center Experience

Background: Drug-eluting stents are widely used in coronary artery intervention. However, vessel caging and very late thrombotic events are of persistent and substantial concern. Bioresorbable vascular scaffolds (BVS) were developed to deliver vascular reparative therapy, by eliminating permanent mechanical restraint. However, data regarding its clinical performance is lacking. Methods: After the BVS implantation procedure received national approval in May 2014, patients receiving BVS implantation until November 2014 in National Taiwan University Hospital (NTUH) were enrolled. Clinical variables, angiographic data, procedural details, and follow-up information were collected and compared with those receiving BVS at NTUH as part of the global ABSORB EXTEND trial. Results: A total of 35 patients (38 target vessels) with 48 BVS implanted after approval were enrolled, as the “real-world practice” group. Data of the 34 patients (34 target vessels) with 37 BVS implanted in the ABSORB EXTEND trial were also obtained. Differences in lesion complexity (0% type B2/C lesion in ABSORB EXTEND, versus 23.7% in real-world, p = 0.007) and lesion length (20.9 ± 6.1 mm in ABSORB EXTEND, versus 29.5 ± 15.9 mm in real-world, p = 0.008) were noted. The ischemia-driven target vessel revascularization after an average of 732 days follow-up was 11.8% in the ABSORB EXTEND trial. However, there was no ischemia-driven target lesion revascularization (TLR), no scaffold thrombosis, no myocardial infarction (MI), and no patients passed during the follow-up period. In real-world patients, there is 5.3% of MI, 2.6% ischemia-driven TLR, and 2.6% of non-fatal probable scaffold thrombosis. Conclusions: The use of BVS in real-world practice is feasible, with clinical outcomes comparable to those in the ABSORB EXTEND trial.

• 期刊

Local Intracoronary Infusion of Glycoprotein IIb/IIIa Inhibitors via a Perfusion Catheter versus Intracoronary Guiding Catheter Injection during Primary Percutaneous Coronary Intervention: A Pilot Observational Study

Background: Glycoprotein IIb IIIa inhibitors improved short- and long-term outcome when added to primary percutaneous coronary intervention (PPCI) in patients with ST-segment-elevation myocardial infarction (STEMI). We hypothesized that intracoronary eptifibatide infusion via a perfusion catheter improves angiographic and clinical outcome of patients with STEMI undergoing PPCI, versus conventional intracoronary bolus injection. Methods: Prospectively, we enrolled 80 patientswith acute STEMI and thrombolysis inmyocardial infarction (TIMI) thrombus grade ≧2. Patients were assigned to receive eptifibatide (180 μg) either via a dedicated coronary perfusion catheter (ClearWay^™) during PPCI (group I), or guiding catheter (group II). Assessment of TIMI thrombus grade, TIMI flow grade, and TIMI myocardial perfusion (TMP) grade was performed both at baseline and postprocedurally. The primary ‘angiographic’ endpoint was final TMP grade 0/1. The primary ‘clinical’ endpoint was a composite of cardiac death, non-fatal re-infarction, target vessel revascularization, and recurrent ischemia at 30-day follow-up. Results: Mean age was 52.3 ± 8.9 years (17.5% females). Clearance of visible thrombus (TIMI thrombus grade 0) at final angiogram was more frequent in group I. Additionally, both final TIMI flow grade 3 and final TMP grade 3 occurred more frequently in group I. The primary angiographic endpoint was more frequent in group II versus group I (17.5% versus 0%, respectively, p = 0.001). The primary clinical endpoint was more frequent in group II (20% versus 0%, respectively, p = 0.003). Conclusions: In patients with STEMI, intracoronary eptifibatide infusion via a perfusion catheter during PPCI improved immediate angiographic outcome, and reduced clinical events at 30-day follow-up, versus bolus injection via the guiding catheter.

• 期刊

Epicardial Adipose Tissue Thickness and Carotid Intima-Media Thickness in Hemodialysis Patients

Background: It is well-known that cardiovascular risk and all-cause mortality is increased in hemodialysis patients. Epicardial fat thickness (EFT), which reflects visceral adiposity, has been suggested as a new cardiometabolic risk factor. The purpose of this study was to investigate EFT in hemodialysis patients. Methods: A total of 144 consecutive patients (60 hemodialysis patients and 84 controls) were enrolled into the study, and patients with diabetes mellitus and cardiovascular diseases (CVD)were excluded. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Results: The groups were similar in terms of sex distribution, age, blood pressure, heart rate and frequencies of CAD risk factors including smoking status, family history of CAD and hypertension. There were no significant differences between the hemodialysis patients and controls in 2D echocardiographic parameters, including ejection fraction and biochemical parameters except low-density lipoprotein, high-density lipoprotein and creactive protein. Despite having lower body mass index, EFT levels were significantly higher in hemodialysis patients compared to the controls (8.0±2.2 mm vs. 5.8±1.9 mm; p ＜ 0.01). In multivariate linear regression analysis we determined that hemodialysis patient status was found to be an independent predictor for both EFT (β = 0. 700, p = 0.014) and carotid intima-media thickness (CIMT, β = 0. 614, p = 0.047). Conclusions: Hemodialysis patients are independently associated with high EFT and CIMT.

• 期刊

Platelet Endothelial Cell Adhesion Molecule-1 Gene Polymorphisms are Associated with Coronary Artery Lesions in the Chronic Stage of Kawasaki Disease

Background: Kawasaki disease is the most common cause of pediatric acquired heart disease. The role of platelet endothelial cell adhesion molecule-1 in the inflammatory process has been documented. To date, no report has investigated the relationship between coronary artery lesions of Kawasaki disease and platelet endothelial cell adhesion molecule-1 polymorphisms. Methods: A total of 114 Kawasaki disease children with coronary artery lesions and 185 Kawasaki disease children without coronary artery lesions were recruited in this study. The TaqMan assay was conducted to identify the genotype in this case-control study. Results: In three single nucleotide polymorphisms (Leu125Val, Ser563Asn, and Arg670Gly) of platelet endothelial cell adhesion molecule-1, we found that the Leu-Ser-Arg haplotype was associated with a significantly increased risk for coronary artery lesions in the chronic stage (odds ratio 3.05, 95% confidence interval 1.06-8.80, p = 0.039), but not for coronary artery lesions in the acute stage. Analysis based on the diplotypes of platelet endothelial cell adhesion molecule-1 also showed that Kawasaki disease with one or two alleles of Leu-Ser-Arg had a significantly increased risk of chronic coronary artery lesions (odds ratio 3.38, 95% confidence interval 1.11-10.28, p = 0.032) and had increased platelet counts after Kawasaki diseasewas diagnosed, as compared to those with other diplotypes. Conclusions: The haplotype of platelet endothelial cell adhesion molecule-1 Leu-Ser-Arg might be associated with the increased platelet counts and the following risk of chronic coronary artery lesions in a dominant manner in Kawasaki disease.

• 期刊

Shen-Yuan-Dan Capsule Inhibiting Inflammatory Reaction by Regulating Insulin Receptor Substrate 1/PI3K/Akt/NF-kB Signaling Pathway in Apoliprotein E Knockout Mice Fed with a High-Fat Diet

Background: Shen-Yuan-Dan Capsule (SYDC), a traditional Chinese medicine, is proposed to have the capacity to prevent angina pectoris. However, the effects and the related mechanisms of SYDC on atherosclerosis (AS) are still unknown. This study was designed to investigate the effects of SYDC on AS and inflammatory reaction in the apoliprotein E-knockout (ApoE^(-/-)) mice fed with a high-fat diet. Methods: Thirty eight-week-old male ApoE^(-/-) mice were randomly divided into three groups (n = 10) 6 weeks after being fed with a high-fat diet: the control group, the lipitor group, and the SYDC group. The hearts were collected for hematoxylin and eosin (HE) or Van Gieson (VG) staining, and the aortas were collected for quantitative reverse transcription polymerase chain reaction (RT-PCR) and western-blotting. Results: The data showed that the levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), atherosclerotic indexes (AI) and the corrected areas of atherosclerotic plaque of the mice on SYDC group were significantly decreased compared with those of the mice in the control group (p ＜ 0.01, p ＜ 0.05). SYDC can significantly increase collagen proportion in plaques as compared to the untreated mice (p ＜ 0.01). In addition, the messenger ribonucleic acid (mRNA) expressions of insulin receptor substrate 1 (IRS-1), PI3K, Akt, NF-kB and tumor necrosis factor-α (TNF-α) in the mice fed with a high-fat diet were significantly reduced by SYDC (p ＜ 0.05, p ＜ 0.01). Conclusions: SYDC can exert an anti-atherosclerotic effect on ApoE^(-/-) mice fed with a high-fat diet. The action mechanism of SYDC was attributed to its ability to inhibit inflammatory reaction by regulating IRS-1/PI3K/Akt/ NF-kB signaling pathway.

• 期刊

Mean Platelet Volume as a Predictor of Heart Failure-Related Hospitalizations in Stable Heart Failure Outpatients with Sinus Rhythm

Background: In this study, we investigated the relationship between the mean platelet volume (MPV) with mortality and heart failure (HF)-related hospitalization in stable chronic HF outpatients with reduced ejection fraction (HFrEF) and with sinus rhythm (SR). Methods: This retrospective cohort study included 197 consecutive stable chronic HFrEF outpatients with SR, who were admitted to our cardiology outpatient clinics for examination between January 2014 and January 2015. According to the receiver-operating characteristic curve analysis, the optimal cut-off value of MPV to predict HF-related hospitalization was ＞ 9.1 fL. Patients were classified into two categories according to threshold MPV levels, as group I with MPV≦9.1 fL and group II with MPV ＞ 9.1 fL. Results: The mean age of patients was 65 ± 13 years. The mean follow-up duration was 10 ± 3 months, and 44 patients (22%) succumbed to cardiovascular (CV) death. The rate of CV mortality was similar between the two groups (21% vs. 24%, p = 0.649). However, the rate of patients who experienced HF-related hospitalization was lower in group I compared with group II (41% vs. 87%, p ＜ 0.001, respectively). Univariate analysis demonstrated associations of many clinical factors in addition to increased MPV ＞ 9.1 fL with HF-related hospitalization; however, In the multivariate Cox proportional-hazards model, only increased MPV ＞ 9.1 fL (HR: 2.895, 95% CI: 1.774-4.724, p ＜ 0.001), systolic pulmonary artery pressure level (HR: 1.018, 95% CI: 1.001-1.036, p = 0.048) and pre-admission beta blocker use (HR: 0.517, 95% CI: 0.305-0.877, p = 0.014) remained associated with a risk of HF-related hospitalization. Conclusions: The mean platelet volume might be a useful parameter for risk stratification with regard to HF-related hospitalization in HFrEF outpatients with SR.