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Purpose: The aim is to determine whether serial post-systolic shortening (PSS) using speckle tracking echocardiography (STE) could predict major adverse cardiovascular events (MACE), especially symptom-driven infarct-related artery (IRA) revascularization and improvement in segmental function in post-myocardial infarction patients., Methods/results: Ninety-four patients (average age 61.1 ± 12.5 y, 84 [84.9%] male) with new-onset acute myocardial infarction were enrolled. Serial echocardiography was performed during the initial presentation, and at 3, 6 and 12 months after admission. PSS, strain and systolic strain rate were calculated using STE. Improvement in segmental function was defined as a decrease of ≧1 grade in wall motion score. During the follow-up (29.4 ± 12.7months), 22 patients (23.4%) had MACE and 17 patients had symptom-driven IRA revascularization. In multivariate model, PSS at 3 months was independently predictive for symptom-driven IRA revascularization (Hazard ratio (HR) = 0.5, 95% CI = 0.26-0.97) and for MACE (HR = 0.4, 95% CI = 0.24-0.67) (p < 0.05). Segmental function improvements were found in 255 segments (66.1%) and ROC curve analyses showed that AUC (95% CI) of the initial PSS was 0.7(0.65-0.77) (cut-off values = -1.08, sensitivity = 58%, specificity = 73% specificity)., Conclusions: Post-systolic shortening at 3 months is an independent predictor for symptom-driven IRA revascularization and MACE. Regional wall motion recovery also could be predicted by initial PSS. Serial assessment of two-dimensional STE should be investigated in post-myocardial infarction patients in the future., Competing Interests: The authors have declared that no competing interests exist.

Background: Estimated glomerular filtration rate (eGFR) is used for diagnosis of chronic kidney disease (CKD). The eGFR models based on serum creatinine or cystatin C are used more in clinical practice. Albuminuria and neck circumference are associated with CKD and may have correlations with eGFR., Aim: We explored the correlations and modelling formulates among various indicators such as serum creatinine, cystatin C, albuminuria, and neck circumference for eGFR., Design: Cross-sectional study., Methods: We reviewed the records of patients with high cardiovascular risk from 2010 to 2011 in Taiwan. 24-hour urine creatinine clearance was used as the standard. We utilized a decision tree to select for variables and adopted a stepwise regression method to generate five models. Model 1 was based on only serum creatinine and was adjusted for age and gender. Model 2 added serum cystatin C, models 3 and 4 added albuminuria and neck circumference, respectively. Model 5 simultaneously added both albuminuria and neck circumference., Results: Total 177 patients were recruited in this study. In model 1, the bias was 2.01 and its precision was 14.04. In model 2, the bias was reduced to 1.86 with a precision of 13.48. The bias of model 3 was 1.49 with a precision of 12.89, and the bias for model 4 was 1.74 with a precision of 12.97. In model 5, the bias could be lower to 1.40 with a precision of 12.53., Conclusions: In this study, the predicting ability of eGFR was improved after the addition of serum cystatin C compared to serum creatinine alone. The bias was more significantly reduced by the calculation of albuminuria. Furthermore, the model generated by combined albuminuria and neck circumference could provide the best eGFR predictions among these five eGFR models. Neck circumference can be investigated potentially in the further studies.

Background: Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients., Methods: A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1-4 CKD. A linear regression was performed using the Enter method to present an unadjusted R(2), standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence., Results: Most anthropometric measurements from patients aged ≧ 65 were lower than those from patients aged < 65, except for women's waist circumference (WC) and waist hip ratio. Female NC obtained the highest R(2) values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine., Conclusions: NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future.

Background: The beneficial effects of statins in patients undergoing hemodialysis are controversial. Our study aimed to investigate the use of statins and the subsequent risk of cardiovascular morbidity and mortality in patients undergoing hemodialysis., Methods: We conducted a cohort study using data from the Taiwan National Health Insurance Research Database. Cox regressions were performed to determine the hazard ratio (HR) of cardiovascular morbidity and mortality in the HD patients taking statins (statin cohort) compared with a propensity-matched comparison cohort., Results: The statin cohort included a total of 4074 patients who received statin treatment while also undergoing hemodialysis (mean age 53.3 ± 13.5 years, male 34.9%). The comparison cohort included 8148 propensity-matched hemodialysis patients who were not using statins. During the three years of follow-up, the statin cohort had lower incidence of ischemic stroke (p < 0.001), hospitalizations due to unstable angina (p < 0.001), deep vein thrombosis (p < 0.001), cardiovascular mortality (p < 0.001), and all-cause mortality (p < 0.001). After Cox regression analysis, statin use was independently associated with lower risk of future ischemic stroke (HR, 0.49; 95% confidence interval [CI], 0.39-0.63), hospitalization for unstable angina (HR, 0.57; 95% CI, 0.47-0.70), deep vein thrombosis (HR, 0.11; 95% CI, 0.05-0.27), cardiovascular mortality (HR, 0.29; 95% CI, 0.18-0.46), and all-cause mortality (HR, 0.49; 95% CI, 0.41-0.58)., Conclusion: Statin use was associated with a lower incidence of cardiovascular morbidity and mortality in patients undergoing hemodialysis., (© 2013.)

Background: High-sensitivity C-reactive protein (hs-CRP) is a sensitive inflammatory marker suggested for cardiovascular risk stratification. This study aimed to assess the potential genetic determinants for serum hs-CRP levels in a cohort with well-controlled nondiabetic hypertension., Materials and Methods: Ethnic Chinese nondiabetic hypertensive patients were enrolled in Taiwan. They received comprehensive evaluation including history taking, physical check-up, blood pressure (BP) measurement, 24-h ambulatory BP monitoring and blood sampling. Serum hs-CRP levels were determined. CRP genotyping was performed in two stages. In the first stage, 4 single-nucleotide polymorphisms (SNPs) of CRP including rs1572970, rs2794520, rs3093077 and rs2808630 were investigated in the 400 participants. In the second stage, only SNPs significant in the first stage were selected for complete genotyping in the whole population., Results: Total 915 consecutive patients (40·9 ± 7·3 years, 68·3% male) completed the study. Two of the 4 SNPs including rs1572970 and rs3093077 were correlated to hs-CRP levels in the whole population. Stepwise multiple linear regression indicated that age (P = 0·001), body mass index (P < 0·001), waist-hip ratio (P = 0·032), smoking habits (P = 0·001), night-time systolic BP (P = 0·040), total cholesterol (P = 0·005) and CRP rs3093077 polymorphism (P < 0·001) were independently associated with serum hs-CRP levels. Overall, genetic correlates explained 2·4%, BMI explained 11·9% and all other clinical correlates explained 4·8% of interindividual variability in serum hs-CRP level., Conclusion: C-reactive protein genotype contributed limitedly to serum hs-CRP levels in subjects with well-controlled hypertension, suggesting the impacts of clinical rather than genetic determinants to serum hs-CRP levels for cardiovascular risk stratification in this intermediate-risk Taiwanese cohort., (© 2013 The Authors. European Journal of Clinical Investigation © 2013 Stichting European Society for Clinical Investigation Journal Foundation.)

Objective: Poor oral hygiene has been associated with an increased risk for cardiovascular disease. However, the association between preventive dentistry and cardiovascular risk reduction has remained undetermined. The aim of this study is to investigate the association between tooth scaling and the risk of cardiovascular events by using a nationwide, population-based study and a prospective cohort design., Methods: Our analyses were conducted using information from a random sample of 1 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed individuals consisted of all subjects who were aged ≥ 50 years and who received at least 1 tooth scaling in 2000. The comparison group of non-exposed persons consisted of persons who did not undergo tooth scaling and were matched to exposed individuals using propensity score matching by the time of enrollment, age, gender, history of coronary artery disease, diabetes, hypertension, and hyperlipidemia., Results: During an average follow-up period of 7 years, 10,887 subjects who had ever received tooth scaling (exposed group) and 10,989 age-, gender-, and comorbidity-matched subjects who had not received tooth scaling (non-exposed group) were enrolled. The exposed group had a lower incidence of acute myocardial infarction (1.6% vs 2.2%, P<.001), stroke (8.9% vs 10%, P=.03), and total cardiovascular events (10% vs 11.6%, P<.001) when compared with the non-exposed group. After multivariate analysis, tooth scaling was an independent factor associated with less risk of developing future myocardial infarction (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57-0.85), stroke (HR, 0.85; 95% CI, 0.78-0.93), and total cardiovascular events (HR, 0.84; 95% CI, 0.77-0.91). Furthermore, when compared with the non-exposed group, increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events (P for trend<.001)., Conclusion: Tooth scaling was associated with a decreased risk for future cardiovascular events., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: Erectile dysfunction (ED) is an early sign of vascular dysfunction. Studies have reported a correlation between arterial stiffness and cardiovascular events. The objective of this study was to evaluate the association among different criteria for assessing arterial stiffness and cardiovascular risk factors in ED patients., Methods: Assessment of pulse wave velocity (PWV), pulse pressure (PP), ratio of mitral inflow velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging (E/Et), and intima-medial thickness (IMT) were performed in 200 ED patients., Results: Linear statistical analysis of the coronary artery disease risk factors revealed that PWV, PP and E/Et were positively correlated with age, duration of diabetes mellitus (DM), and systolic and diastolic blood pressures. PWV and E/Et were positively correlated with waist circumference and number of metabolic syndrome (MS) components. For category-wise analysis, the PWV, PP and E/Et were higher in patients with DM, hypertension and MS. Multiple regression analysis showed that the independent determinants for PWV comprised age, DM, hypertension, and MS; for PP comprised age, hypertension, and MS; for E/Et comprised age and MS; and for IMT comprised only DM., Conclusions: Thus, PWV, PP and E/Et may be employed as markers to identify ED patients with potential cardiovascular risk factors, including MS and obesity.