Acta Cardiologica Sinica
中華民國心臟學會,正常發行
選擇卷期
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Heart regeneration remains a critical question in current basic research and clinical practice. The adult mammalian heart exhibits a very limited regeneration capacity. In contrast, adult zebrafish and neonatal mice retain a remarkable ability of heart regeneration after damage. Understanding the mechanisms of heart regeneration would be very valuable to help design efficient treatment strategies against myocardial damage and heart failure. While inherent regeneration of the heart occurs after damage with varying efficiency among species, regeneration may also be induced exogenously. In this study, we briefly review the different approaches and current progress in improving heart regeneration.
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Background: To evaluate the neointimal conditions of everolimus-eluting stents (EESs) implanted in culprit lesions of patients with acute coronary syndrome (ACS) compared with stable angina pectoris (SAP) using optical coherence tomography (OCT). EESs are second-generation drug-eluting stents that have recently been shown to be useful in patients with ACS as well as in patients with SAP. However, few studies have analyzed the intra-stent conditions of EESs that can lead to favorable results in such ACS lesions. Methods: We evaluated 41 ACS patients with EES implantation (age, 66.7 ± 10.3 years) and 59 SAP patients enrolled as controls (age, 68.3 ± 10.7 years). OCT examinations were performed after 9 months of follow-up after stent implantation, and the condition of the neointimal coverage over every stent strut was assessed in 1-mm intervals. In addition, neointimal thickness (NIT) over each strut was measured and tissue characteristics were examined. Results: There was no significant difference in mean NIT between the ACS (90.8 ± 88.2 mm) and SAP (87.3 ± 74.2 mm, p = 0.11) group. The rate of uncovered struts was significantly lower in the ACS group (11.5%) than in the SAP group (12.5%, p = 0.03). Neointimal tissue characteristics were also similar between groups. Conclusions: Vascular responses after EES implantation differed significantly between ACS and SAP lesions using OCT. However, these differences were considered small in clinical terms. Our OCT data support the favorable results of patients with EES implantation at mid-term follow-up, even in those with ACS.
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Background: Endovascular stenting has surpassed bypass surgery to become the first-line treatment for superficial femoral artery (SFA) occlusive disease, and various types of stents including bare-metal stents (BMSs), covered stents, and drug-eluting stents (DESs), have been approved for treatment. This retrospective, single-institute study compared the short-term, real-world outcomes of BMSs and DESs for treating SFA occlusive disease. Methods: A retrospective chart review was used to enroll 94 patients who received a DES (n = 24) or BMS (n = 70) between 2009 and 2014. All patients had SFA occlusive disease with critical limb ischemia and an intermediate length of SFA occlusion [Trans-Atlantic Intersociety Consensus (TASC)-II B lesions] and were regularly followed for 2 years. All patient characteristics, procedural details, and outcomes were recorded. Result: The 1-year primary patency rates in the BMS and DES groups were 71.4% and 87.5% (p = 0.169), respectively, and the corresponding 2-year rates were 61.4% and 79.2% (p = 0.139). The target lesion revascularization rate was 38.6% versus 20.8% (p = 0.139), the in-stent restenosis rate was 22.9% versus 0% (p = 0.009), the major limb amputation rate was 4.3% versus 0% (p = 0.568), the peripheral arterial disease-related mortality rate was 8.6% versus 0% (p = 0.332), and the all-cause mortality rate was 11.4% versus 0% (p = 0.109), respectively. Conclusions: The 2-year results revealed higher safety, superior efficacy, and greater clinical benefits of DESs than BMSs for treating TASC-II B SFA occlusive disease. However, more cases and long-term follow-up are warranted.
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Background: The objective of this study was to investigate the prevalence of abdominal aortic aneurysm (AAA) in Turkish patients aged ≥ 65 years, and to demonstrate the applicability of echocardiography to AAA screening. Methods: Transthoracic echocardiography (TTE) was performed in all consecutive patients aged ≥ 65 years who were referred to cardiology clinics or were referred from other outpatient clinics. The abdominal aorta (AA) of each patient was scanned using the same probe, and the time spent was recorded. Demographic and clinic characteristics of the patients were recorded at the end of the echocardiography. Results: Among 1948 patients (mean age 70.9 ± 6 years; 49.8% male), the AA was visualized in 96.3%. AAA was identified in 3.7% (69/1878) of the patients, of whom AAA was previously known in 20.3% (n =14). The prevalence of unknown AAA was 2.93%. The average time needed to scan and measure the AA was 1 minute and 3 seconds (±23 seconds). Aortic root diameters were significantly higher in the patients with AAA than in those without AAA (34.7 ± 4.2 vs. 29.8 ± 4.7; P＜0.001). Age (per 1 year increase) [odds ratio (OR), 1.245; P＜ 0.001], male gender (OR, 5.382; P ＜ 0.001), smoking (OR, 2.118; P = 0.037), and aortic root diameter (per 1 mm increase) (OR, 1.299; P ＜ 0.001) were independent predictors of AAA. Conclusions: This study is important in that it showed a high prevalence of AAA in Turkish patients aged ≥ 65 years, and demonstrated that AAA can be visualized in the majority of patients in as little as 1 minute during TTE.
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Background: Remote cardiac rhythm monitoring and recording, using hand-carried electrocardiogram (ECG) device had been widely used in telemedicine. The feasibility and accuracy analysis on the data recorded by a new miniature ECG system-on-chip (SoC) system has not been explored before. Methods: This study evaluated the accuracy of the ECG recordings captured by CardioChip - a single-channeled, low-powered, miniature ECG SoC designed for mobile applications; comparing against Philips Pagewriter Trim III-a Food and Drug Administration certified, widely-used standard 12-lead ECG recording device, within Mackay Memorial Hospital in Taiwan. Results: Total of 111 participants, age ranging from 39 to 87years old [mean age: 61.2 ± 13.4, 57 male(51.3%) were enrolled. Two experienced cardiologists rated and scored the ECG morphology to be the same between the two devices, while CardioChip ECG was more sensitive to baseline noise. R-peak amplitudes measured both devices using single lead information (CardioChip ECG vs. Lead 1 in standard 12-lead ECG) showed statistical consistency. Offline analysis of signal correlation coefficients and coherence showed good correlation with both over 0.94 in average (0.94 ± 0.04 and 0.95 ± 0.04, respectively), high agreement between raters (94% agreement) for detecting abnormal cardiac rhythm with excellent R-peak amplitude (r = 0.98, p ＜ 0.001) and PR interval (r = 0.91, p ＜ 0.001) correlations, indicating excellent correlation between ECG recordings derived from two different modalities. Conclusions: The results suggested that CardioChip ECG is comparable to medical industry standard ECG. The future implementation of wearable ECG device embedded with miniature ECG system-on-chip (SoC) system is ready for clinical use, which will potentially enhance efficacy on identifying subjects with suspected cardiac arrhythmias.
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Background: Ventricular premature complexes (VPCs) with a burden higher than 10% to 20% of total daily heart beats can cause VPC-induced cardiomyopathy. The systolic blood pressure response (SBPR) is the difference between the SBP during maximal exercise and rest. A low SBPR was recently identified to be a marker of cardiomyopathy. The aim of this manuscript was to clarify the association between VPC burden and SBPR. Methods: From January to December 2015, all patients with a VPC burden larger than 240 beats/day on Holter recordings and treadmill exercise tests were enrolled. The patients with a heart rhythm other than sinus rhythm, coronary artery disease, and severe cardiomyopathy were excluded. The SBPR was measured during a treadmill test. The basic characteristics and echocardiographic findings were collected. Results: All patients were classified into three groups: Group 1; 240-1,000 VPCs/day (n = 78), Group 2; 1,000-10,000 VPCs/day (n = 54), and Group 3; ＞ 10,000 VPCs/day (n = 21). Group 1 had a higher SBPR than the other groups. Multivariate analysis revealed that only VPC burden was associated with SBPR. Receiver operating characteristic curve analysis showed that a VPC burden ＞ 1,055 beats/day predicted a SBPR＜40 mmHg. The results were consistent in all subgroups. There were no significant differences in echocardiographic findings among the groups. Conclusions: AVPC burden higher than 1,055 beats/day was associated with a reduced SBPR.
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Background: We aimed to evaluate the right ventricular (RV) systolic function in patients with ankylosing spondylitis (AS) compared to healthy subjects by using standard echocardiography and speckle-tracking echocardiography (STE) methods. Methods: This was a case-control study in which 64 patients (mean age, 55.7±9.2 years; male/female, 53/11), who had AS for at least five years (mean disease duration, 7.1 ±2.6 years) and 70 age-matched healthy subjects (mean age, 54.9 ± 8.5 years; male/female 55/15) were included. Clinical and laboratory signs of cardiac disease were recorded. The RV systolic function was assessed by standard echocardiography and two-dimensional STE method. Results: Case and control groups did not show significant difference in terms of clinical and laboratory signs of cardiac disease. RV function parameters in standard echocardiography were statistically similar between AS patients and control subjects. However, RV parameters in STE revealed significantly impaired RV function in AS patients compared to control group. RV-free wall longitudinal strain, RV-free wall longitudinal systolic strain rate, RV-free wall longitudinal early diastolic strain rate, RV-free wall longitudinal late diastolic strain rate were lower, and RV-early diastolic strain rate/RV-late diastolic strain rate ratio was higher for the patients in the AS group (p＜0.001 for all). Conclusions: AS is associated with impaired RV function as shown by STE even if there is no clinical or laboratory sign of cardiac abnormality. STE is more effective than standard echocardiography to detect RV function. Therefore we suggest regular evaluation of RV function in patients with AS.
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Background: We conducted a time-series analysis of daily ambient temperature and all-cause, cardiovascular, and respiratory disease mortality in Taiwan, which is generally neither extremely hot nor cold. Methods: Data on all-cause daily mortality rates (excluding accidents, suicide, and homicide), and mortality rates due to respiratory and cardiovascular diseases between 2008 and 2010 were obtained from the Taiwan Death Registry. The daily temperature for that period was averaged from 33 monitoring stations nationwide. A generalized least square model was constructed to assess the relationship between the time-series trends of temperature and mortality, and the cross-correlation function was used to determine the possible time lag for the effect of temperature on mortality. Results: As the average temperature increased, the daily all-cause (β =-0.006) and respiratory disease (β = 0.012) mortality rates decreased. On the other hand, an inverse relationship (β = -0.028) between average daily temperature and cardiovascular disease mortality was observed only for a temperature between 12.91 °C and 26.36 C. The time lag for all-cause and cardiovascular disease mortality was similar at 4-6 days, while the lag for respiratory disease was longer at 13-16 days. Conclusions: We found inverse associations between average temperature and all-cause and respiratory mortality. An inverse association between temperature and cardiovascular disease mortality was observed only from 12.91 °C to 26.36 °C.
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Background: Both miR-30a and miR-30e are significantly downregulated in cardiomyocytes (CMs) 2 days (d) post myocardial infarction (MI). This study aimed to identify their possible regulative network in CMs 2d post-MI. Methods: The dysregulated mRNAs in left ventricle tissues 2d post-MI in mice model were retrieved from one previous publication. The verified target genes of miR-30a/e and the predicted targets (upregulated 2d post-MI) were subjected to analysis of the involvement in biological processes according to their enrichment in gene ontology (GO) terms. Results: The known targets of miR-30a/e can regulate cellular responses to glucose starvation via targeting TP53, BECH1 and HSPAS, and also control cardiac epithelial to mesenchymal transition via targeting ETS-related gene (ERG), SNAI1 and NOTCH1. Bioinformatic prediction further showed that miR-30a might regulate some biological processes related to CM responses to Mi via some other potential targets, such as platelet aggregation (possibly via ITGB3 and STXBP1), regulation of intrinsic apoptotic signaling pathway in response to deoxyribonucleic acid damage (possibly via SNAI1) and positive regulation of tyrosine phosphorylation of Stat3 protein (possibly via LYN, SOCS3 and SLCF1). Conclusions: Considering the importance of these genes in cellular responses to MI, it is meaningful to further investigate the regulative effect of miR-30a/e on their expression, as well as their regulative network in CMs.