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160. Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y 12 Receptor Antagonist Effects in Patients With Acute Coronary Syndromes: Insights From the PLATO Trial

Author

Franchi, Francesco, James, Stefan, Ghukasyan, Tatevik, Budaj, Andrzej J., Cornel, Jan H., Katus, Hugo A., Keltai, Matyas, Kontny, Frederic, Lewis, Basil S., Storey, Robert F., Himmelmann, Anders, Wallentin, Lars, Angiolillo, Dominick J., Parkhomenko, Alexander Nikolaevich, Oto, Ali, Skene, Allan, Budaj, Andrzej, Freij, Anneli, Santoso, Anwar, Armando, A, Meier, Bernhard, Yu, Cheuk Man, Cannon, Christopher P., Zambahari, Dato Seri Robaayah, Wu, Delon Wu, Ardissino, Diego, Raev, Dimitar, Kremastinos, Dimitrios, Weaver, Douglas, Paolasso, Ernesto, Giannitsis, Evangelos, Verheugt, Freek, Maurer, Gerald, Katus, Hugo, Emanuelsson, Hakan, Horrow, Jay, Bassand, Jean-Pierre, Spinar, Jindrich, Morais, Joao, Lopez Sendon, Jose, Nicolau, Jose, Seung, Ki-Bae, Teik, Lim Soo, Heras, Magda, Claeys, Marc J., Sabatine, Marc, Vintila, Marius, Ruda, Mikhail, Thorsen, Mona, Kleiman, Neil, Babilonia, Noe, Commerford, Patrick, Gurbel, Paul, Aylward, Phil, Steg, Philippe Gabriel, Theroux, Pierre, Sritara, Piyamitr, Pais, Prem, Becker, Richard, Lassila, Riitta, Harrington, Robert A., Gao, Runlin, Husted, Steen, Duris, Tibor, Chapichadze, Zaza, HUS Comprehensive Cancer Center, University Management, Department of Oncology, and PLATO Investigators

Subjects
Male, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Comorbidity, 030204 cardiovascular system & hematology, urologic and male genital diseases, FUNCTION PROFILES, RESPONSIVENESS, Electrocardiography, 0302 clinical medicine, Risk Factors, Coronary Heart Disease, ARTERY-DISEASE, Medicine, Cardiac and Cardiovascular Systems, 030212 general & internal medicine, Myocardial infarction, Stroke, Original Research, Kardiologi, Absolute risk reduction, Diabetes, Type 2, DUAL ANTIPLATELET THERAPY, Middle Aged, Prognosis, Clopidogrel, female genital diseases and pregnancy complications, 3. Good health, Survival Rate, diabetes mellitus, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, Platelets, RENAL-FUNCTION, medicine.medical_specialty, Acute coronary syndrome, ANTITHROMBOTIC THERAPY, INHIBITION, acute coronary syndrome, ticagrelor, 03 medical and health sciences, Internal medicine, Diabetes mellitus, Humans, Renal Insufficiency, Chronic, Aged, Retrospective Studies, Pharmacology, clopidogrel, Dose-Response Relationship, Drug, business.industry, Thrombosis, medicine.disease, United States, REACTIVITY, 3121 General medicine, internal medicine and other clinical medicine, Purinergic P2Y Receptor Antagonists, Human medicine, business, Acute Coronary Syndromes, Platelet Aggregation Inhibitors, chronic kidney disease, Follow-Up Studies, Kidney disease
Abstract

Background There are limited data on how the combination of diabetes mellitus ( DM ) and chronic kidney disease ( CKD ) affects cardiovascular outcomes as well as response to different P2Y 12 receptor antagonists, which represented the aim of the present investigation. Methods and Results In this post hoc analysis of the PLATO (Platelet Inhibition and Patient Outcomes) trial, which randomized acute coronary syndrome patients to ticagrelor versus clopidogrel, patients (n=15 108) with available DM and CKD status were classified into 4 groups: DM +/ CKD + (n=1058), DM +/ CKD − (n=2748), DM −/ CKD + (n=2160), and DM −/ CKD − (n=9142). The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke at 12 months. The primary safety end point was PLATO major bleeding. DM +/ CKD + patients had a higher incidence of the primary end point compared with DM −/ CKD − patients (23.3% versus 7.1%; adjusted hazard ratio 2.22; 95% CI 1.88–2.63; P DM +/ CKD − and DM −/ CKD + had an intermediate risk profile. The same trend was shown for the individual components of the primary end point and for major bleeding. Compared with clopidogrel, ticagrelor reduced the incidence of the primary end point consistently across subgroups ( P ‐interaction=0.264), but with an increased absolute risk reduction in DM +/ CKD +. The effects on major bleeding were also consistent across subgroups ( P ‐interaction=0.288). Conclusions In acute coronary syndrome patients, a gradient of risk was observed according to the presence or absence of DM and CKD , with patients having both risk factors at the highest risk. Although the ischemic benefit of ticagrelor over clopidogrel was consistent in all subgroups, the absolute risk reduction was greatest in patients with both DM and CKD . Clinical Trial Registration URL : http://www.clinicatrials.gov . Unique identifier: NCT 00391872.

Published
2019

176. Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y12 Receptor Antagonist Effects in Patients With Acute Coronary Syndromes : Insights From the PLATO Trial

Author

Franchi, Francesco, James, Stefan, Ghukasyan, Tatevik, Budaj, Andrzej J., Cornel, Jan H., Katus, Hugo A., Keltai, Matyas, Kontny, Frederic, Lewis, Basil S., Storey, Robert F., Himmelmann, Anders, Wallentin, Lars, Angiolillo, Dominick J., Parkhomenko, Alexander Nikolaevich, Oto, Ali, Skene, Allan, Budaj, Andrzej, Freij, Anneli, Santoso, Anwar, Armando, A, Meier, Bernhard, Yu, Cheuk Man, Cannon, Christopher P., Zambahari, Dato Seri Robaayah, Wu, Delon Wu, Ardissino, Diego, Raev, Dimitar, Kremastinos, Dimitrios, Weaver, Douglas, Paolasso, Ernesto, Giannitsis, Evangelos, Verheugt, Freek, Maurer, Gerald, Katus, Hugo, Emanuelsson, Hakan, Horrow, Jay, Bassand, Jean-Pierre, Spinar, Jindrich, Morais, Joao, Lopez Sendon, Jose, Nicolau, Jose, Seung, Ki-Bae, Teik, Lim Soo, Heras, Magda, Claeys, Marc J., Sabatine, Marc, Vintila, Marius, Ruda, Mikhail, Thorsen, Mona, Kleiman, Neil, Babilonia, Noe, Commerford, Patrick, Gurbel, Paul, Aylward, Phil, Steg, Philippe Gabriel, Theroux, Pierre, Sritara, Piyamitr, Pais, Prem, Becker, Richard, Lassila, Riitta, Harrington, Robert A., Gao, Runlin, Husted, Steen, Duris, Tibor, Chapichadze, Zaza, Franchi, Francesco, James, Stefan, Ghukasyan, Tatevik, Budaj, Andrzej J., Cornel, Jan H., Katus, Hugo A., Keltai, Matyas, Kontny, Frederic, Lewis, Basil S., Storey, Robert F., Himmelmann, Anders, Wallentin, Lars, Angiolillo, Dominick J., Parkhomenko, Alexander Nikolaevich, Oto, Ali, Skene, Allan, Budaj, Andrzej, Freij, Anneli, Santoso, Anwar, Armando, A, Meier, Bernhard, Yu, Cheuk Man, Cannon, Christopher P., Zambahari, Dato Seri Robaayah, Wu, Delon Wu, Ardissino, Diego, Raev, Dimitar, Kremastinos, Dimitrios, Weaver, Douglas, Paolasso, Ernesto, Giannitsis, Evangelos, Verheugt, Freek, Maurer, Gerald, Katus, Hugo, Emanuelsson, Hakan, Horrow, Jay, Bassand, Jean-Pierre, Spinar, Jindrich, Morais, Joao, Lopez Sendon, Jose, Nicolau, Jose, Seung, Ki-Bae, Teik, Lim Soo, Heras, Magda, Claeys, Marc J., Sabatine, Marc, Vintila, Marius, Ruda, Mikhail, Thorsen, Mona, Kleiman, Neil, Babilonia, Noe, Commerford, Patrick, Gurbel, Paul, Aylward, Phil, Steg, Philippe Gabriel, Theroux, Pierre, Sritara, Piyamitr, Pais, Prem, Becker, Richard, Lassila, Riitta, Harrington, Robert A., Gao, Runlin, Husted, Steen, Duris, Tibor, and Chapichadze, Zaza

Abstract

Background-There are limited data on how the combination of diabetes mellitus (DM) and chronic kidney disease (CKD) affects cardiovascular outcomes as well as response to different P2Y(12) receptor antagonists, which represented the aim of the present investigation. Methods and Results-In this post hoc analysis of the PLATO (Platelet Inhibition and Patient Outcomes) trial, which randomized acute coronary syndrome patients to ticagrelor versus clopidogrel, patients (n=15 108) with available DM and CKD status were classified into 4 groups: DM+/CKD+ (n=1058), DM+/CKD- (n=2748), DM-/CKD+ (n=2160), and DM-/CKD- (n=9142). The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke at 12 months. The primary safety end point was PLATO major bleeding. DM+/CKD+ patients had a higher incidence of the primary end point compared with DM-/CKD- patients (23.3% versus 7.1%; adjusted hazard ratio 2.22; 95% CI 1.88-2.63; P<0.001). Patients with DM+/CKD- and DM-/CKD+ had an intermediate risk profile. The same trend was shown for the individual components of the primary end point and for major bleeding. Compared with clopidogrel, ticagrelor reduced the incidence of the primary end point consistently across subgroups (P-interaction=0.264), but with an increased absolute risk reduction in DM+/CKD+. The effects on major bleeding were also consistent across subgroups (P-interaction=0.288). Conclusions-In acute coronary syndrome patients, a gradient of risk was observed according to the presence or absence of DM and CKD, with patients having both risk factors at the highest risk. Although the ischemic benefit of ticagrelor over clopidogrel was consistent in all subgroups, the absolute risk reduction was greatest in patients with both DM and CKD.

Published
2019
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180. A prospective cohort study of the long-term effects of CPAP on carotid artery intima-media thickness in Obstructive sleep apnea syndrome

Author

Hui David S, Shang Qing, Ko Fanny W, Ng Susanna S, Szeto Cheuk-Chun, Ngai Jenny, Tung Alvin H, To Kin-Wang, Chan Tat-On, and Yu Cheuk-Man

Subjects
Diseases of the respiratory system, RC705-779
Abstract

Abstract Objective To examine the long-term effect of CPAP on carotid artery intima-media thickness (IMT) in patients with Obstructive sleep apnea syndrome(OSAS). Methods A prospective observational study over 12 months at a teaching hospital on 50 patients newly diagnosed with OSAS who received CPAP or conservative treatment (CT). Carotid IMT was assessed with B-mode Doppler ultrasound from both carotid arteries using images of the far wall of the distal 10 mm of the common carotid arteries at baseline, 6 months and 12 months. Measurements and results [mean (SE)] Altogether 28 and 22 patients received CPAP and CT respectively without significant differences in age 48.8(1.8) vs 50.5(2.0)yrs, BMI 28.2(0.7) vs 28.0(1.2)kg/m2, ESS 13.1(0.7) vs 12.7(0.6), AHI 38(3) vs 39(3)/hr, arousal index 29(2) vs 29(2)/hr, minimum SaO2 75(2) vs 77(2)% and existing co-morbidities. CPAP usage was 4.6(0.3) and 4.7(0.4)hrs/night over 6 months and 1 year respectively. Carotid artery IMT at baseline, 6 months, and 12 months were 758(30), 721(20), and 705(20)micron for the CPAP group versus 760(30), 770(30), and 778(30)micron respectively for the CT group, p = 0.002. Among those free of cardiovascular disease(n = 24), the carotid artery IMT at baseline, 6 months and 12 months were 722(40), 691(40), and 659(30)micron for the CPAP group (n = 12) with usage 4.5(0.7) and 4.7(0.7) hrs/night over 6 months and 12 months whereas the IMT data for the CT group(n = 12) were 660(20), 685(10), and 690(20)micron respectively, p = 0.006. Conclusions Reduction of carotid artery IMT occurred mostly in the first 6 months and was sustained at 12 months in patients with reasonable CPAP compliance.

Published
2012
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181. Changes of echocardiographic parameters in primary mitral regurgitation and determinants of symptom: an assessment from the Asian Valve Registry data

Author

Amano, Masashi, primary, Izumi, Chisato, additional, Kim, Yong-Jin, additional, Park, Sung-Ji, additional, Park, Seung Woo, additional, Tanaka, Hidekazu, additional, Hozumi, Takeshi, additional, Ling, Lieng His, additional, Yu, Cheuk-Man, additional, Fukuda, Shota, additional, Otsuji, Yutaka, additional, Song, Jae-Kwan, additional, and Sohn, Dae-Won, additional

Published
2019
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182. Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction

Author

Saha, Samir Kanti, Luo, Xia-Xia, Gopal, Aasha S., Govind, Satish C., Fang, Fang, Liu, Ming, Zhang, Qing, Ma, Chunyan, Dong, Ming, Kiotsekoglou, Anatoli, Yu, Cheuk-Man, Saha, Samir Kanti, Luo, Xia-Xia, Gopal, Aasha S., Govind, Satish C., Fang, Fang, Liu, Ming, Zhang, Qing, Ma, Chunyan, Dong, Ming, Kiotsekoglou, Anatoli, and Yu, Cheuk-Man

Abstract

Aims: Deformation imaging, particularly of left‐sided heart, is fast becoming an essential tool in clinical cardiology. However, data are scant regarding the value of biventricular and bi‐atrial deformation in association with comorbidities in heart failure with reduced left ventricular ejection fraction (HFREF). Methods and Results: Forty‐nine subjects (72 ± 13 years; 28 male) with HFREF and 14 age‐matched controls underwent deformation imaging including LV global longitudinal strain (LVGLS%), right ventricular strain (RVS%), and left atrial reservoir strain (LARS%). Standard echo parameters included LVEF%, E/E′ ratio, and pulmonary artery systolic pressure (PASP). Mean ± SD of LVEF, LVGLS%, and RVS% were 31% ± 8%, 7% ± 3%, and 17% ± 7%, respectively, and were significantly lower compared with controls (all P < .0001). Over a follow‐up period of 4.2 years, 24% of patients died and 48% had a composite outcome of death and heart failure hospitalization. In the logistic regression model, taking the composite of death and heart failure hospitalization as a dichotomous variable, RVS%, E/E′ ratio, and PASP were the only significant univariate predictors of adverse outcome (R2 = .68, all P < .05). In the multivariate model, however, only PASP predicted adverse outcome. PASP also had the largest AUC (0.8) in the ROC analysis. A creatinine level of >88 μmol/L (SCREAT) and a cutoff value of LA reservoir strain (LARS %) at <16.7% provided the best sensitivity (86%) and specificity (40%) with an odds ratio of 3.8. In the Kaplan–Meier survival estimate, LARS%‐SCREAT predicted all‐cause mortality and HF hospitalization. Conclusion: Multichamber deformation imaging along with renal function and PASP could best predict adverse outcome in HFREF.

Published
2018
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183. Quality of life in patients with coronary heart disease-I: Assessment tools

Author

Yu Cheuk-Man and Thompson David R

Subjects
Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Abstract Health-related quality of life (HRQL) assessment is an important measure of the impact of the disease, effect of treatment and other variables affecting people's lives. The review focused on the assessment of HRQL in patient with coronary heart disease (CHD) by appropriate tools. Although no consensus exists about the precise definition of HRQL, a plethora of instruments have been developed to assess it. Two broad types – generic and disease-specific – have been developed but there is some debate about their relative merits. There is a wide selection of instruments available but choice should be based on a careful consideration of an instrument's psychometric properties, the breadth and depth with which it addresses relevant health domains and the specific clinical or research purpose for which it is intended.

Published
2003
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187. Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction

Author

Saha, Samir K., primary, Luo, Xia-Xia, additional, Gopal, Aasha S., additional, Govind, Satish C., additional, Fang, Fang, additional, Liu, Ming, additional, Zhang, Qing, additional, Ma, Chunyan, additional, Dong, Ming, additional, Kiotsekoglou, Anatoli, additional, and Yu, Cheuk-Man, additional

Published
2018
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188. Comparison between characteristics of severe and very severe aortic stenosis

Author

Tanaka, Hidekazu, primary, Kim, Yong-Jin, additional, Park, Seung-Ji, additional, Park, Seung Woo, additional, Hozumi, Takeshi, additional, Izumi, Chisato, additional, Ling, Lieng His, additional, Yu, Cheuk-Man, additional, Fukuda, Shota, additional, Otsuji, Yutaka, additional, Song, Jae-Kwan, additional, and Sohn, Dae-Won, additional

Published
2018
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192. Cellular and molecular mechanisms of endothelial ischemia/reperfusion injury: perspectives and implications for postischemic myocardial protection

Author

Yang, Qin, He, Guo-Wei, Underwood, Malcolm John, and Yu, Cheuk-Man

Subjects
Review Article
Abstract

Ischemia/reperfusion (I/R) injury is a major cause of myocardial damage. Despite continuous efforts, minimizing I/R injury still represents a great challenge in standard medical treatments of ischemic heart disease, i.e., thrombolytic therapy, primary percutaneous coronary intervention, and coronary arterial bypass grafting. Development of effective interventions and strategies to prevent or reduce myocardial I/R injury is therefore of great clinical significance. Endothelial dysfunction plays a significant role in myocardial I/R injury, which renders endothelial cells an attractive target for postischemic myocardial protection. The rapidly evolving knowledge of the mechanisms of endothelial I/R injury helps broaden perspective for future development of novel strategies targeting endothelium for alleviating myocardial I/R damage. This review provides a comprehensive summary of the cellular and molecular mechanisms of endothelial I/R injury. Current perspectives and future directions for developing endothelium targeting therapeutics for postischemic myocardial protection are further discussed.

Published
2016

200. Cases in Cardiac Resynchronization Therapy

Author

Yu, Cheuk-Man, Hayes, David L., Auricchio, Angelo, Yu, Cheuk-Man, Hayes, David L., and Auricchio, Angelo

Subjects
Heart failure--Treatment, Cardiac pacing
Abstract

Cases in Cardiac Resynchronization Therapy, a brand-new medical reference book for cardiologists, electrophysiologists, surgeons, and primary care doctors, offers an informative and structured view of the newest approaches, treatments and follow-up care methods for heart failure patients treated with Cardiac Resynchronization Therapy. Complete with practical examples from top leaders in the field, this resource is designed to equip you with the cohesive, expert knowledge you need to make the best use of today's available technologies and research. Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.Better manage the challenging clinical scenarios you may encounter with case studies that include a brief introduction, clinical decision-making techniques, evidence-based rationales, and selected references for further study.Remain up-to-date in this rapidly evolving field with clinical recommendations, updates on the latest technological advances, troubleshooting techniques, and recent key clinical trials.Access practical examples regarding the process for selecting and implanting devices, as well as follow-up care for heart-failure patients being treated with CRT.Stay abreast of today's novel wireless technologies, information on robotic-assisted implantations, and current methodologies on VV optimization.

Published
2014

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