Acta Cardiologica Sinica
中華民國心臟學會,正常發行
選擇卷期
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Background: Arrhythmias as important malfunctions of heart are known as abnormal rhythm of heart. Several causes can make arrhythmias and most of them are related to generation and/or conduction of action potential in heart. Action potential in myocytes results from the sequential opening and closing of ion channel proteins that span the plasma membrane of individual myocytes. Action potential's conduction through the heart is depended on electrical coupling between myocytes, which is mediated by gap junctions. Generation and conduction of action potentials are related to perfect action of ionic channels in heart. Objectives: This novel review comprehensively addressed the ionic mechanisms of the arrhythmogenic mutations in cardiac voltage-gated ionic channels including: CACNA1C, CACNA1D, KCNA5, KCND2, KCND3, KCNE1, KCNE2, KCNE5, KCNH2, KCNJ2, KCNJ5, KCNQ1, SCN4A, SCN5A, SCN1B, SCN2B, SCN3B and SCN4B. Methods: Current study, for the first time, review and discuses about relation between cardiac arrhythmias and whole of important voltage gated ionic channels from different families, altogether and at the same time. Results: This review clears that mutations in voltage-gated ionic channels play important roles in generation of severe cardiac arrhythmias, and among them it is looked that mutations in voltage-gated potassium channels are more important. Conclusions: Most of induced arrhythmias due to voltage-gated ionic channels mutations result in action potentials prolongation and long QT syndromes. Study on ionic channel regulators can be considered as a subject for future research.
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Background: Ischemia shown in non-invasive tests is considered to be a fundamental requirement for treating patients with stable coronary artery disease (CAD) with a percutaneous coronary intervention (PCI). In a nationwide cohort, we investigated the utilization of stress tests, including myocardial perfusion imaging (MPI), treadmill exercise test (TET) and stress echocardiography (SE) prior to elective PCI. Methods: This retrospective study used the Longitudinal Health Insurance Database 2000 (LHID2000) of the National Health Insurance program in Taiwan. The LHID2000 is comprised of one million randomly sampled beneficiaries. We enrolled patients receiving elective PCI for stable CAD from 2000 to 2013. Stress tests performed within 90 days prior to PCI and patient characteristics correlated with the utilization of stress tests were investigated. Results: During the investigation period, 3,163 patients received elective PCI for stable CAD and 1,847 (58.4%) patients had at least one stress test within 90 days prior to PCI. Among them, 1,461 (79.1%) had MPI, 1,228 had TET (66.4%) and only 1 had SE (0.05%). Age ＜ 80 years, regional hospital and hyperlipidemia were independently associated with an increased likelihood of receiving stress tests. On the other hand, Charlson-comorbidity index score ≥ 1, prior catheterization and heart failure were independently associated with a decreased likelihood of receiving stress tests. Conclusions: In the setting of stable CAD, almost 60% of our patients received stress tests within 90 days prior to elective PCI, and MPI was the most commonly used test.
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Background: We aimed to investigate whether non-alcoholic fatty pancreas disease (NAFPD) is associated with epicardial adipose tissue (EAT), which is a kind of ectopic fat accumulation, and aortic intima-media thickness (aIMT), which is associated with subclinical atherosclerosis. Methods: Fifty-four patients with NAFPD (22men; mean age: 52 ± 10 years) and 49 without NAFPD (16men; mean age: 49 ± 8 years) were included in this study. NAFPD and aIMT were evaluated using transabdominal ultrasonography (TUS). EAT was evaluated with transthoracic echocardiography. Results: EAT (6.09 ± 1.52 mm and 3.87 ± 1.31 mm, p ＜ 0.001) and aIMT [1.12 (0.60-1.90) mm vs. 0.93 (0.50-1.44) mm, p ＜ 0.001] were significantly higher in the NAFPD positive subjects, compared to the NAFPD negative subjects. Multivariate analysis showed that age (p = 0.016), body mass index (p = 0.004), and presence of NAFPD (p = 0.024) were associated with increased aIMT. In addition, multivariate analysis demonstrated that the presence of NAFPD (p ＜ 0.001) was associated with increased EAT. Conclusions: The presence of NAFPD on TUS is associated with increased aIMT and EAT. Our study results may suggest that NAFPD may reflect subclinical atherosclerosis and may be a simple warning sign for physicians.
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Background: Few studies have evaluated long-term vascular function after radial access catheterization. Furthermore, the impact of repeated catheterization remains unknown. We investigated flow-mediated dilatation (FMD) of the brachial artery after transradial catheterization. Methods: We prospectively enrolled 50 patients with suspected coronary artery disease referred for diagnostic coronary angiography. No ad-hoc percutaneous coronary interventions (PCI) had been performed at the time of the index procedure. In 30 patients (63.8%), PCI and/or repeated follow-up diagnostic catheterization were subsequently performed via the radial artery used at the index catheterization. FMD was successfully measured before catheterization, at 24 h after catheterization, and after long-term follow-up (mean, 32 months; range, 24-43) in 47 patients. FMD at follow-up was compared between patients receiving only one procedure and those receiving multiple procedures via the same arteries. Results: FMD was significantly decreased after catheterization and recovered well in long-term follow-up (3.7 ± 1.6%, 3.0 ± 1.7%, and 3.9 ± 1.6%). There was no significant difference in follow-up FMD between the patients undergoing single catheterization and those with multiple procedures (3.4 ± 1.3 vs. 4.3 ± 1.7, p = 0.06).When the patients were divided into two groups according to the median follow-up FMD value, no significant predictive factor was identified for worse FMD. Conclusions: After transradial catheterization, FMD of the brachial artery temporarily decreased but recovered in long-term follow-up. Recovery of FMD was not jeopardized by repeated catheterization, which suggests the potential of the brachial artery to recover endothelial function after repeated transradial procedures.
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Background: Cryoablation is an alternative treatment for atrioventricular nodal reentrant tachycardia (AVNRT) and right anteroseptal and midseptal accessory pathways (APs) with a low complication rate. A high recurrence rate is still a concern in pediatric patients. Methods: From February 2015 to March 2017, all consecutive patients who underwent cryoablation for supraventricular tachycardia were included in this study. The demographic and clinical data of the patients were reviewed. Results: Fifty-two patients (AVNRT 43, anteroseptal and midseptal AP 9) were enrolled, including 24 males and 28 females. The median age at the time of the procedure was 15.6 years. For patients with AVNRT, 34 (79.1%) had the typical form, 5 had the atypical form (11.6%), and another 4 had both forms. For AP, four patients had right midseptal and 5 had right anteroseptal APs. The median total procedure time was 114 min (range 69-331 min), and the median fluoroscopy time was 25.9 min (range 9.2-99.6 min). After a median 6 attempts of cryomapping and 3 of cryoablation, the arrhythmia substrate was successfully ablated in 51 of 52 patients (98.1%). Ten developed transient second degree atrioventricular (AV) block and one developed transient third degree AV block, but none had permanent AV block or other complications. After a mean follow-up of 1.95 ± 0.54 years (range 1.1-2.86 years), there were three cases of recurrence (5.9%). The mean number of cryoablations decreased from 6.6 ± 6.4 (early group) to 3.1 ± 2.6 (late group) (p = 0.01) after a 1-year learning period. Conclusions: Cryoablation for AVNRT and anteroseptal and midseptal APs in pediatric and adolescent patients is safe and effective.
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Background: Catheter-based renal denervation (RDN) has emerged as a promising treatment option for hypertension. However, randomized controlled trials (RCTs) have reported conflicting results on blood pressure (BP) reduction. Patient- and procedure-related confounders have been implied as the potential sources of inconsistent BP responses. We aimed to investigated whether unplanned and frequent medication changes in RDN studies affected the BP response to RDN by conducting sensitivity and subgroup analyses, according to antihypertensive medication change rates in a meta-analysis of RCTs. Methods: We searched the PUBMED, EMBASE, and COCHRANE databases up to May 2018. RCTs that studied the effects of RDN on hypertensive patients were included. A meta-analysis was carried out using RevMan 5.3. Results: A total of 12 studies were included, of which four fulfilled the inclusion criteria of ＜ 10% medication change rate in our review. Subgroup meta-analyses of the four RCTs with ＜ 10% medication change rates showed statistically significant reductions of 6.07 mmHg and 7.12 mmHg in 24-hour and office systolic BP, respectively. The 24-hour and office diastolic BP were also reduced (mean difference = -3.89 mmHg and -4.27 mmHg, respectively). These subgroup analyses had no heterogeneity (I^2 = 0%). In contrast, the pooled analysis of the 12 studies and the subgroup analysis of eight studies with ＞ 10% medication change rates both had a high level of heterogeneity and no significant BP reduction. Conclusions: The effectiveness of RDN was demonstrated across a broad range of antihypertensive medications used at baseline after removing the confounder of unplanned medication changes.
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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group IV pulmonary hypertension. This study aimed to report our institutional experience in managing CTEPH. Methods: We prospectively collected the data of 23 patients diagnosed with CTEPH between August 2001 and August 2017 in Linkou Chang Gung Memorial Hospital. Baseline characteristics including functional class (FC), 6-minute walk distance (6MWD), comorbidities, hematological and biochemical data, echocardiography, cardiac catheterization, and selective pulmonary angiography were recorded at diagnosis. All patients were referred to a cardiac surgeon for pulmonary endarterectomy (PEA) assessment. Results: The mean age at diagnosis was 48.4 ± 16.1 years. Nineteen patients (83%) underwent PEA with mean postoperative follow-up of 37.7 ± 42.8 months. The in-hospital mortality rate of PEA was 11%. The 1-, 2-, 3- and 5-year overall survival rates were 89%, 89%, 81%, and 50%, respectively. After 3 months of PEA, all patients had improvements in FC, 6MWD(from 326 ± 62 to 420 ± 63 m), B-type natriuretic peptide level (from 602 ± 599 to 268 ± 565 pg/mL), and systolic pulmonary artery pressure (from 79 ± 19 to 48 ± 19 mmHg). The patients with proximal disease (Jamieson type 1 or 2) had better survival than those with distal disease (Jamieson type 3 or 4), but there was no significant difference in mortality between FC III and IV. All of the four patients who did not undergo PEA survived for more than 3 years. Conclusions: Significant improvements in symptoms, functional capacity, and hemodynamics were achieved in the CTEPH patients after PEA. However, the overall survival was still unsatisfactory.
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Background: Proton pump inhibitors (PPIs) are frequently used to prevent or treat peptic ulcers. Recently, PPIs have been shown to increase the risk of myocardial infarction. The purpose of this study was to determine whether PPIs adversely affect ventricular remodeling in infarcted rats. Methods: Male Wistar rats were randomly assigned to receive either vehicle, omeprazole, omeprazole + vitamin C, omeprazole + olmesartan, or famotidine treatment for 4 weeks starting 24 hours after inducing myocardial infarction by ligating coronary arteries. Results: Compared with vehicle-treated infarcted rats, omeprazole-treated infarcted rats had significant changes with reduced myocardial vitamin C levels, increased oxidant production, and decreased dimethylarginine dimethylaminohydrolase 2 (DDAH2) activity, which in turn increased asymmetric dimethylarginine (ADMA) levels and impaired ventricular remodeling. With gastric protection similar to omeprazole, the H2 blocker famotidine had no effect on ventricular remodeling. In contrast to the in vivo results, the ex vivo study showed similar superoxide and DDAH2 protein levels between vehicle- and omeprazole-treated infarcted rats, suggesting involvement of gastric vitamin C uptake rather than myocardial vitamin C in mediating the impaired axis of vitamin C-superoxide- DDAH2 in the in vivo measurements. The administration of PPIs was associated with impaired DDAH2 expression and increased myocardial ADMA, which impaired ventricular remodeling after infarction. These effects were prevented by the coadministration of vitamin C or olmesartan. Conclusions: Our results indicate that the administration of PPIs was associated with impaired DDAH2 expression and increased myocardial ADMA by reducing gastric vitamin C uptake, which impaired ventricular remodeling after infarction.