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BACKGROUND Patients with chronic kidney disease (CKD) often have poor vascular compliance and poor left ventricular diastolic dysfunction (LVDD). The pulse pressure index (PPI) defined as ((systolic blood pressure – diastolic blood pressure)/systolic blood pressure) reflects vascular compliance. Vascular compliance is reportedly associated with left ventricular diastolic function. This study of CKD patients investigated whether PPI correlates with the ratio of transmitral E wave velocity (E) to early diastole mitral annulus velocity (Ea) or with LVDD. METHODS This study enrolled 511 CKD patients who had been referred for echocardiographic examination. Blood pressure was automatically measured with an ABI-form device. The LVDD was defined as E-to-transmitral A wave velocity ratio of ≥0.9, Ea <8cm/s, or E/Ea ≥15. RESULTS Compared with those with E/Ea <15, patients with E/Ea ≥15 had significantly higher systolic blood pressure, pulse pressure, and PPI (all P < 0.001). Multivariable analysis showed that PPI was independently associated with E/Ea (unstandardized coefficient β = 1.348; P < 0.001) and with LVDD (odds ratio = 1.441 per 0.064 increase; P < 0.001). CONCLUSIONS This study showed that increased PPI significantly correlates with elevated E/Ea and LVDD in CKD patients. Because PPI can be rapidly acquired during blood pressure measurement, it may be helpful for identifying CKD patients with a high left ventricular filling pressure and LVDD. [ABSTRACT FROM PUBLISHER]

BACKGROUND An interankle systolic blood pressure (SBP) difference has been associated with overall and cardiovascular mortality. We investigated whether an association existed between this difference and ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and echocardiographic parameters. METHODS A total of 1,059 patients referred for echocardiographic examination were included in the study. The 4 limb blood pressures were measured simultaneously using an ABI-form device. RESULTS We performed multivariate forward analysis to determine the factors associated with an interankle SBP difference ≥ 15mm Hg. An ABI < 0.9 (P < 0.001), high baPWV (P < 0.001), and increased left ventricular mass index (LVMI; P = 0.004) were associated with an interankle SBP difference ≥ 15mm Hg. Also, the addition of an interankle SBP difference ≥ 15mm Hg to a model of clinical features could significantly improve the value in predicting ABI < 0.9 (P < 0.001) and increased LVMI (P = 0.036). CONCLUSIONS Our study demonstrated that ABI < 0.9, high baPWV, and increased LVMI were independently associated with an interankle SBP difference ≥ 15mm Hg. Also, an interankle SBP difference ≥ 15mm Hg could offer an extra benefit in identifying patients with ABI < 0.9 and increased LVMI beyond conventional clinical features. Hence, calculation of interankle SBP difference may provide additional information for identifying patients with peripheral vascular disease and increased LVMI. [ABSTRACT FROM AUTHOR]

Combined anterior and inferior ST elevation due to occlusion of wrapped left anterior descending artery (LAD) is well reported in the literature. However, there is rare literature mentioned about inferolateral ST elevation in this patient group. Herein, we report a case of acute proximal wrapped LAD occlusion with initial electrocardiographic sign of inferolateral ST elevation. The most likely mechanism of this electrocardiographic finding might be related to old anteroseptal myocardial infarction, combination with other coronary abnormality, such as chronic total occlusion of left circumflex artery that caused larger injury current in inferolateral than anteroseptal myocardium, and made anteroseptal leads reveal isoelectric pattern. Ann Noninvasive Electrocardiol 2010;15(1):90–93 [ABSTRACT FROM AUTHOR]

Abstract: Objective: In reperfusion strategy for ST-elevation myocardial infarction (STEMI), emergency surgical bypass grafting might be considered for patients with significant multivessel coronary diseases complicated by cardiogenic shock. The culprit lesions in STEMI can be predicted from electrocardiographic (ECG) findings. However, whether the complexity of coronary artery lesions in STEMI can be predicted from characteristic ECG findings remained unclear. Materials and Methods: The initial 12-lead ECG parameters in each lead recording from patients with STEMI receiving primary percutaneous coronary intervention within 12 hours were retrospectively analyzed. A sequential ECG algorithm was developed to predict the complexity of coronary artery lesions. Results: In patients with inferior wall STEMI, the presence of the following 2-step criteria indicated 3-vessel disease (3VD), with a sensitivity of 92.1% and a specificity of 81.8%: (1) ST depression or flat T wave in leads V5 or V6; and (2) ST elevation of more than 2 mm in at least 1 of II, III, aVF, or Q (loss of septal r) without ST elevation in aVR. In patients with anterior wall STEMI, the following criteria indicated 3VD: (1) ST elevation of more than 4 mm in at least 1 of the precordial leads and combined with QRS interval of more than 120 ms; then (2) a flat T wave over aVR, or aVL combined with flat T wave ST depression over lead I or Q wave over all leads II, III, and aVF. This algorithm detects patients with 3VD with a sensitivity of 76.5% and a specificity of 100%. However, when the whole algorithm is completed, the sensitivity can reach up to 88.4% and the specificity can still be 100%. Conclusion: By using this ECG algorithm, 3VD might be distinguished early from single-vessel disease in patients with STEMI for appropriate reperfusion strategy. [Copyright &y& Elsevier]

Abstract: To test the applicability of isovolumic relaxation flow propagation velocity (IRFPV) as an indicator of relaxation, 38 patients undergoing cardiac catheterization for chest pain were included. The time constant of isovolumic left ventricular (LV) pressure decline (tau) had a significant correlation with the LV end-diastolic pressure, the peak negative dp/dt, the LV end-diastolic dimension, the fractional shortening, the late diastolic transmitral flow velocity, the early and late diastolic mitral annular velocities, the rapid filling flow propagation velocity, and the natural logarithms of heart rate, ejection fraction, LV end-systolic dimension and IRFPV (r = −0.773, p < 0.001). IRFPV was selected as the major independent determinant of tau, explaining 46% of its variance. In prediction of tau ≥42 ms, the sensitivity and specificity were 100% and 83% for IRFPV ≤104 cm/s, 77% and 67% for the rapid filling flow propagation velocity ≤50 cm/s, and 58% and 67% for the early diastolic mitral annular velocity ≤8 cm/s, respectively. In conclusion, our data suggest that IRFPV could be a better marker of LV relaxation than other parameters, as the rapid filling flow propagation velocity or the early diastolic mitral annular velocity. (E-mail: wcvoon@giga.net.tw) [Copyright &y& Elsevier]

OBJECTIVES: To test the association between fasting glucose level and left ventricular mass (LVM) and left ventricular hypertrophy (LVH) in people aged 60 and older. DESIGN: Population-based prospective study with 4-year follow-up. SETTING: Department of Internal Medicine and Family Medicine, Kaohsiung Medical University (KMU), Chung-Ho Memorial Hospital, and Graduate Institute of Medicine and Public Health, KMU. PARTICIPANTS: Of 1,500 people screened, 105 without symptoms or signs of diabetes mellitus, hypertension, or cardiovascular disease were recruited from senior activity centers in Kaohsiung city. MEASUREMENTS: All received two-dimensional echocardiography and fasting glucose examination at baseline and at 2- and 4-year follow-up. LVH was defined as a LVM index (LVMI) greater than 122.4 g/m2 or 51 g/m2.7. RESULTS: Age ranged from 60 to 81 (mean 71.7±3.9). Baseline glucose ranged from 83 to 118 mg/dL (mean 99.7±7.9 mg/dL). LVMI was significantly higher at the 4-year follow-up (97.5±24.9 vs 104.5±27.5 g/m2 and 44.2±12.1 vs 47.2±13.4 g/m2.7, both P<.01), as was the occurrence of LVH (16% vs 32% and 25% vs 39%, both P<.01). Baseline glucose correlates with 4-year change in LVMI (both P<.02). In the fourth year, baseline glucose was a significant predictor of LVMI (both P<.01) and LVH ( P=.03 in g/m2 definition) using logistic regression analysis. CONCLUSION: Because fasting glucose is an independent predictor for greater LVM and for development of LVH, it should be considered in assessment of cardiac disease and LVM in healthy older people without diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to correlate Tei index obtained from tissue Doppler echocardiography (TDE-Tei index) defined as the ratio of the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) over the ejection time (ET) with invasive measurements of left ventricular (LV) performance. Methods: Thirty-four patients who underwent an echocardiographic examination and cardiac catheterization were studied. Invasive measurements of peak +dp/dt, peak −dp/dt, and isovolumic relaxation constant of the left ventricle (tau) were obtained from a micromanometer-tipped catheter. Results: After a multivariate analysis, TDE-Tei index had a negative correlation with ejection fraction (EF) (β=−0.384, P = 0.046) and positive correlation with tau (β= 0.397, P = 0.040). ET had a negative correlation with heart rate (β=−0.446, P = 0.005) and positive correlation with EF (β= 0.379, P = 0.015). ICT + IRT had a positive correlation with tau (β= 0.512, P = 0.002). ICT/ET had a negative correlation with EF (β=−0.657, P < 0.001) and positive correlation with peak early transmitral filling wave velocity (β= 0.385, P = 0.001). IRT/ET had a positive correlation with tau (β= 0.402, P = 0.018). Conclusions: TDE-Tei index exerts a correlation both with accepted indices of LV systolic and diastolic function acquired by cardiac catheterization. Hence, TDE-Tei index is a simple and feasible indicator in assessing overall LV function. [ABSTRACT FROM AUTHOR]

Background: The TEa-E, which is defined as the time interval between the peak of the R-wave and the onset of early diastolic mitral annular waveform (TEa) minus the time interval between the peak of the R-wave and the onset of early diastolic mitral inflow waveform (TE), is recently proposed as a useful index of left ventricular (LV) relaxation. The aim of this study is to determine whether the TEa-E is preload-independent. Methods: Twenty hemodialysis (HD) patients (9 men; age 64 ± 9 years) underwent echocardiography 1 hour before and 1 hour after HD was studied. Results: After HD, the body weight (P < 0.001), early transmitral filling wave peak velocity (E) (P < 0.001), the ratio of E to late transmitral filling wave peak velocity (P = 0.011), the early diastolic mitral anuular velocity (Ea) (P = 0.002), E/Ea (P = 0.026), and TEa-E (P < 0.001) decreased significantly, and the TEa (P = 0.047) and TE (P = 0.005) increased significantly. In addition, TEa-E had a significant negative correlation with Ea either before (r =–0.457, P = 0.043) or after HD (r =–0.637, P = 0.003). Conclusions: TEa-E, as well as Ea, was a preload-dependent relaxation index. The preload dependence of this newer Doppler parameter limited its utility in evaluating LV diastolic function in HD patients. [ABSTRACT FROM AUTHOR]

Background: Mitral regurgitation from chordae tendinae rupture (CTR) may cause severe clinical symptoms and is a progressive disease that eventually results in the need for mitral valve surgery. Early recognition of CTR and identification of risk factors are important because early intervention increases the chances of survival. Hypertension may increase mitral valve complex mechanical strain and cause the chordae tendinae to rupture. Method: Using a cross-sectional study of medical files in one medical center in Taiwan, we enrolled 98 patients with mitral CTR and classified them into two groups, comprising 68 subjects (69%) without obvious predisposing factors (primary group) and 30 subjects (31%) with known predisposing causes (secondary group). Result: Of the subjects, 63 (64%) were men with a mean age of 57.5 ± 1.5 years. The posterior mitral leaflet was most commonly involved (64%). The known predisposing factors in secondary group include mitral valve prolapse, infective endocarditis, and rheumatic heart disease. The patients who had primary CTR were older (59.9 ± 1.6 v 52.1 ± 3.1 years, P = .029), had a higher prevalence of hypertension (56% v 30%, P = .018) and complained more often of dyspnea (82% v 53%, P = .003) than the patients in the secondary group. Using binary logistic regression analyses, the variation in primary group was found to be independently explained by age (P = .039, odds ratio = 1.039, 95% confidence interval = 1.002 to 1.077) and hypertension (P = .048, odds ratio = 2.717, 95% confidence interval = 1.008 to 7.326). Conclusion: We conclude that hypertension was an independent predictor for primary CTR in this study. [Copyright &y& Elsevier]

To evaluate if pericardium is a suitable calibration reference in the integrated backscatter (IBS) analysis, the grossly normal pericardial specimens from 23 patients without a history of pericarditis were mounted on a steel platform and immersed in a 0.9% saline bath. The 2-D IBS images acquired at the uniform time gain compensation settings of 50 and 70 dB were analyzed. For the pericardial IBS, the limits of agreement for intraobserver and interobserver measurements were -1.2 to 1.4 dB and -1.6 to 2.2 dB, respectively. However, the calibrated IBS intensity of the pericardium presented a rather wide range of variation and was -13 ± 5 (-5 to -29) and -10 ± 4 (-4 to -22) dB at the overall gain settings of 50 and 70 dB, respectively. Conclusively, pericardium may not be an ideal IBS calibration reference in a population study of cardiac tissue characterization. (E-mail: ) [Copyright &y& Elsevier]

Background: The actual relationship between the interval change of myocardial thallium 201 (Tl-201) radioactivity in the infarct area and the pattern of Q-wave regression is still unknown. This study was conducted to evaluate their relationship after acute myocardial infarction (AMI).Methods and Results: A total of 30 patients who had a first Q-wave AMI (11 without Q-wave regression and 19 with Q-wave regression) were retrospectively included. Two sets of 12-lead surface electrocardiograms and Tl-201 myocardial perfusion images were obtained 0 to 2 months and 14 to 84 months after the AMI event, respectively. The acute/subacute redistribution Tl-201 radioactivity was similar between the patients with and those without Q-wave regression. However, the patients with Q-wave regression had higher chronic redistribution Tl-201 radioactivity than those without Q-wave regression. Moreover, the patients with Q-wave regression presented a higher gradient in the redistribution Tl-201 radioactivity between the chronic and acute/subacute images than those without Q-wave regression.Conclusions: This study supports the role of functional recovery of stunning and/or hibernating myocardium in the disappearance of Q waves after AMI. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a public health issue and is associated with high morbidity and mortality. How to identify the high-risk CKD patients is very important to improve the long-term outcome. CHADS2 and CHA2DS2-VASc scores are clinically useful scores to evaluate the risk of stroke in patients with atrial fibrillation. However, there was no literature discussing about the usefulness of CHADS2 and CHA2DS2-VASc scores for cardiovascular (CV) and all-cause mortality prediction in CKD patients. This longitudinal study enrolled 437 patients with CKD. CHADS2 and CHA2DS2-VASc scores were calculated for each patient. CV and all-cause mortality data were collected for long-term outcome prediction. The median follow-up to mortality was 91 (25th–75th percentile: 59–101) months. There were 66 CV mortality and 165 all-cause mortality. In addition to age and heart rate, CHADS2 and CHA2DS2-VASc scores (both P value < 0.001) were significant predictors of CV and all-cause mortality in the multivariate analysis. Besides, in direct comparison of multivariate model, basic model + CHA2DS2-VASc score had a better additive predictive value for all-cause mortality than basic model + CHADS2 score (P = 0.031). In conclusion, our study showed both of CHADS2 and CHA2DS2-VASc scores were significant predictors for long-term CV and all-cause mortality in CKD patients and CHA2DS2-VASc score had a better predictive value than CHADS2 score for all-cause mortality in direct comparison of multivariate model. Therefore, using CHADS2 and CHA2DS2-VASc scores to screen CKD patients may be helpful in identifying the high-risk group with increased mortality. [ABSTRACT FROM AUTHOR]

Upstroke time (UT), measured from the foot-to-peak peripheral pulse wave, is a merged parameter used to assess arterial stiffness and target vascular injuries. In this study, we aimed to investigate UT for the prediction of cardiovascular and all-cause mortality in patients with chronic kidney disease (CKD). This longitudinal study enrolled 472 patients with CKD. Blood pressure, brachial pulse wave velocity (baPWV), and UT were automatically measured by a Colin VP-1000 instrument. During a median follow-up of 91 months, 73 cardiovascular and 183 all-cause mortality instances were recorded. Multivariable Cox analyses indicated that UT was significantly associated with cardiovascular mortality (hazard ratio (HR) = 1.010, p = 0.007) and all-cause mortality (HR = 1.009, p < 0.001). The addition of UT into the clinical models including traditional risk factors and baPWV further increased the value in predicting cardiovascular and all-cause mortality (both p < 0.001). In the Kaplan–Meier analyses, UT ≥ 180 ms could predict cardiovascular and all-cause mortality (both log-rank p < 0.001). Our study found that UT was a useful parameter in predicting cardiovascular and all-cause mortality in CKD patients. Additional consideration of the UT might provide an extra benefit in predicting cardiovascular and all-cause mortality beyond the traditional risk factors and baPWV. [ABSTRACT FROM AUTHOR]

The ratio of transmitral E-wave velocity (E) to a left ventricular diastolic parameter is reported to be well correlated with left ventricular filling pressure and is useful in the prediction of mortality. Left atrial (LA) strain has been demonstrated to be associated with left ventricular diastolic function. The aim of the study is to examine the ability of E/LA strain in predicting total and cardiovascular mortality in hemodialysis (HD) patients. In 197 routine HD patients, global LA strain during the reservoir phase was estimated by taking the average of longitudinal strain data obtained from the apical four-chamber and two chamber views by two-dimensional speckle tracking echocardiography. Twenty-nine total mortality and 14 cardiovascular mortality were documented during the 2.7 ± 0.6-year follow-up. After adjusting age, comorbidities, albumin, E/early diastolic mitral annular velocity (Ea), and LA strain, increased E/LA strain (hazard ratio (HR) = 1.191, 95% confidence interval (CI) = 1.072−1.324, p = 0.001) was still associated with increased total mortality. After adjusting age, comorbidities, albumin, E/Ea, left ventricular ejection fraction, and LA strain, increased E/LA strain (HR = 1.195, 95% CI = 1.041−1.372, p = 0.011) was still associated with increased cardiovascular mortality. In conclusion, E/LA strain is a useful parameter in the prediction of total and cardiovascular mortality in HD patients. Hence, E/LA strain deserves to be calculated in HD patients for better survival prediction. [ABSTRACT FROM AUTHOR]

Background: Left ventricular ejection fraction (LVEF) is a good indicator of cardiac function, and brachial-ankle pulse wave velocity (baPWV) is a good indicator of vascular function. Both of them can predict cardiovascular (CV) outcomes. Objectives: There is scarce literature discussing the impact of simultaneous consideration of cardiac and vascular function on overall and CV mortality. Methods: We included 958 patients and classified them into four groups. Groups 1 to 4 were patients with LVEF ≥ 50% and baPWV below the median, LVEF < 50% but baPWV below the median, LVEF ≥ 50% but baPWV above the median, and LVEF < 50% and baPWV above the median, respectively. Results: The median follow-up to mortality was 93 (25th–75th percentile: 69–101) months. There were 91 cases of CV mortality and 238 cases of all-cause mortality. After multivariable analysis, age, gender, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of all-cause mortality (P ≤ 0.038) and age, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of CV mortality (P ≤ 0.008). Conclusions: Patients with higher LVEF and lower baPWV had a similar overall and CV mortality as patients with higher LVEF and baPWV. Patients with lower LVEF and higher baPWV had the highest overall and CV mortality among the four study groups. In addition, patients with lower LVEF alone had a higher CV mortality than the patients with higher baPWV alone. Therefore, simultaneous consideration of cardiac and vascular function may be useful in predicting overall and CV mortality. [ABSTRACT FROM AUTHOR]

There were conflict data between alpha-adducin Gly460Trp genetic variant and changes of renal function. We conducted a prospective study to investigate the influence of alph-adducin Gly460Trp polymorphism on the quantitative changes of renal function. Of 1500 people screened, 112 non-diabetic normotensive elderly Chinese were recruited and received biochemistry examination at the baseline, at the second and fourth year follow-up. Serum creatinine and calculated renal parameter, using Modification of Diet in Renal Disease (MDRD) Study, were used to evaluate renal function and their progression. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. Age was 71.9 ± 3.7 years (range 60–81). Serum creatinine and MDRD glomerular filtration rate (GFR) were significantly worsened at the 2 and 4-year follow-up (all P < 0.001). The magnitude of 4-year decline of MDRD GFR was significantly higher in subjects carrying the a-adducin Gly460Trp G-allele than TT genotype (P = 0.045). The multivariate analyses showed that a-adducin Gly460Trp (P = 0.034), baseline MDRD GFR (P < 0.001), diastolic blood pressure (P = 0.021) and body weight (P = 0.022) could independently predict 4-year change of MDRD GFR. This longitudinal study showed that the aging process was associated with decline of renal function in the healthy elderly. The alpha-adducin Gly460Trp gene polymorphism might modulate these changes in the Chinese. This provides further knowledge essential in the assessment of renal disease and determination of renal function in the older subjects. [Copyright &y& Elsevier]

Abstract: The aim of this study is to evaluate whether isovolumic relaxation flow propagation velocity (IRFPV), a newly proposed relaxation parameter, is independent of load alterations. Thirty-nine uremic patients (21 men; age 62 ± 10 y) who underwent echocardiography 1 h before and 1 h after hemodialysis (HD) were included. After HD, body weight, systolic blood pressure, early transmitral filling wave velocity (E), early diastolic mitral annular velocity (Ea) and early diastolic inflow propagation velocity (EPV) decreased significantly (p ≤ 0.007), while IRFPV kept constant (p = 0.550). A subgroup analysis showed that in patients with body weight reduction <2.5 kg, E (p = 0.005) decreased significantly, but Ea (p = 0.078), EPV (p = 0.155) and IRFPV (p = 0.324) did not change after HD. In patients with body weight reduction ≥2.5 kg, E (p < 0.001), Ea (p = 0.001) and EPV (p = 0.001) decreased significantly but IRFPV (p = 0.715) was still constant after HD. In conclusion, IRFPV may be a load-independent parameter in assessing left ventricular diastolic function. However, Ea and EPV are load-independent only at minor load alterations. In evaluating left ventricular diastolic function in HD patients whose loading conditions frequently vary with time, IRFPV seems to be more adequate than Ea and EPV. (E-mail: wcvoon@giga.net.tw) [Copyright &y& Elsevier]

Diastolic mitral annular motion may terminate earlier in patients with higher left ventricular end-diastolic pressure (LVEDP). It was therefore hypothesized that the time interval measured from the end of the diastolic mitral annular velocity pattern to the onset of QRS (the AQ interval) would be a useful parameter in predicting LVEDP. The aim of this study was to evaluate the relation between the AQ interval and LVEDP. Forty-six patients with suspected coronary artery disease who underwent Doppler echocardiographic studies and cardiac catheterization were included. LVEDP was determined using a micromanometer-tipped catheter. On univariate analysis, the AQ interval had positive correlations with the PR interval (r = 0.405, p = 0.005), transmitral E-wave velocity (r = 0.502, p <0.001), isovolumic contraction time (r = 0.635, p <0.001), and LVEDP (r = 0.514, p <0.001) and a negative correlation with E-wave deceleration time (r = −0.430, p = 0.003). After stepwise multiple linear regression analysis, the PR interval, transmitral E-wave velocity, and LVEDP were the independent predictors of the AQ interval (β = 0.234, p = 0.033; β = 0.331, p = 0.004; and β = 0.350, p = 0.003, respectively). In conclusion, the AQ interval is a novel, simple, and easily obtained index in the prediction of LVEDP. [Copyright &y& Elsevier]

Pulse wave velocity (PWV) was a good marker of arterial stiffness and could predict cardiovascular (CV) outcomes. Recently, estimated PWV (ePWV) calculated by equations using age and mean blood pressure was reported to be an independent predictor of major CV events. However, there was no study comparing ePWV with brachial‐ankle PWV (baPWV) for CV and overall mortality prediction. We included 881 patients arranged for echocardiographic examination. BaPWV and blood pressures were measured by ankle‐brachial index‐form device. The median follow‐up period to mortality was 94 months. Mortality events were documented during the follow‐up period, including CV mortality (n = 66) and overall mortality (n = 184). Both of ePWV and baPWV were associated with increased CV and overall mortality after the multivariable analysis. ePWV had better predictive value than Framingham risk score (FRS) for CV and overall mortality prediction, but baPWV did not. In direct comparison of multivariable analysis using FRS as basic model, ePWV had a superior additive predictive value for CV mortality than baPWV (p =.030), but similar predictive valve for overall mortality as baPWV (p =.540). In conclusion, both ePWV and baPWV were independent predictors for long‐term CV and overall mortality in univariable and multivariable analysis. Besides, ePWV had a better additive predictive value for CV mortality than baPWV and similar predictive value for overall mortality as baPWV. Therefore, ePWV obtained without equipment deserved to be calculated for overall mortality prediction and better CV survival prediction. [ABSTRACT FROM AUTHOR]

A low ankle-brachial index (ABI) calculated using systolic blood pressure (SBP) (ABIsbp) is associated with poor cardiovascular outcome in patients with acute myocardial infarction (AMI). ABI is always calculated using SBP clinically. However, there was no study investigating ABI calculated using mean artery pressure (MAP)(ABImap) and diastolic blood pressure (DBP)(ABIdbp) for mortality prediction in AMI patients. Therefore, our study was aimed to investigate the issue. 199 AMI patients were enrolled. Different ABIs were measured by an ABI-form device. The median follow-up to mortality was 64 months. There were 40 cardiovascular and 137 all-cause mortality. The best cutoff values of ABImbp and ABIdbp for mortality prediction were 0.91 and 0.78, respectively. After multivariate analysis, only ABIdbp and ABIdbp < 0.78 could predict cardiovascular mortality (P ≤ .047). However, all of six ABI parameters, including ABIsbp, ABImap, ABIdbp, ABIsbp < 0.90, ABImap < 0.91, and ABIdbp < 0.78, could predict all-cause mortality (P ≤ .048). In a direct comparison of six ABI models for prediction of all-cause mortality, basic model + ABIdbp <0.78 had the highest predictive value (P ≤ .025). In conclusion, only ABIdbp and ABIdbp < 0.78 could predict cardiovascular and all-cause mortality after multivariate analysis in our study. Furthermore, when adding into a basic model, ABIdbp < 0.78 had the highest additively predictive value for all-cause mortality in the six ABI parameters. Hence, calculation of ABI using DBP except SBP might provide an extra benefit in prediction of cardiovascular and all-cause mortality in AMI patients. [ABSTRACT FROM AUTHOR]

Low ankle-brachial index (ABI) calculated using systolic blood pressure (SBP) is associated with poor prognosis. However, there is no study assessing ABI calculated using mean artery pressure (MAP) and diastolic blood pressure (DBP) in predicting mortality. Two cohort populations were enrolled. The first population comprised 379 patients (106 patients with angiography-proved peripheral artery disease (PAD) and 273 relative normal patients) to evaluate the best cutoff values of ABImbp and ABIdbp for prediction of PAD. The second population included 941 patients undergoing echocardiographic examinations to assess the ability of different ABIs in predicting mortality. ABIs were measured using an ABI-form device. The best cutoff values of ABImbp and ABIdbp for prediction of PAD were 0.92 and 0.88. In our second population, median follow-up to mortality was 93 months. There were 87 cardiovascular and 228 overall deaths. Multivariable analysis showed ABIsbp, ABImap, ABIdbp, ABIsbp <0.9, and ABImap <0.92 could predict overall and cardiovascular mortality (all p < 0.001). ABIdbp <0.88 could only predict CV mortality (p = 0.033). In a direct comparison of 6 multivariable models, the basic model consisting of significant variables in the univariable analysis plus ABImap <0.92 had the highest predictive value for overall and cardiovascular mortality (all p < 0.001). In a direct comparison of 6 multivariable models, the basic model + ABImap < 0.92 was the best model in predicting overall and cardiovascular mortality. Hence, calculation of ABI using MAP except SBP might provide extra benefit in survival prediction. Image 1 • Usefulness of ABI using mean arterial pressure (MAP) and diastolic blood pressure (DBP) to predict mortality is unknown. • We found the best cutoff values of ABImap and ABIdbp for prediction of peripheral artery disease were 0.92 and 0.88l. • Basic model + ABImap < 0.92 had the highest predictive value for overall and CV mortality than other models. • Calculation of ABImap except ABIsbp might provide an extra benefit in survival prediction. [ABSTRACT FROM AUTHOR]

In non-haemodialysis (HD) patients, increased epicardial adipose tissue (EAT) thickness was significantly associated with adverse cardiovascular (CV) events. This study was designed to investigate whether EAT thickness was a useful parameter in the prediction of adverse CV events in HD patients. In addition, we also evaluated the major correlates of EAT thickness in these patients. In 189 routine HD patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV death, non-fatal stroke, non-fatal myocardial infarction, peripheral artery disease, and hospitalization for heart failure. The follow-up period for CV events was 2.5 ± 0.7 years. Thirty-one CV events were documented. The multivariable analysis demonstrated that older age, smoking status, the presence of diabetes mellitus and coronary artery disease, and low albumin levels were independently correlated with adverse CV events. However, increased EAT thickness was not associated with adverse CV events (P = 0.631). Additionally, older age, female sex, low haemoglobin, and low early diastolic mitral annular velocity were correlated with high EAT thickness in the univariable analysis. In the multivariable analysis, older age and female sex were still correlated with high EAT thickness. In conclusion, high EAT thickness was associated with older age and female sex in the multivariable analysis in our HD patients. However, EAT thickness was not helpful in predicting adverse CV events in such patients. Further large-scale studies are necessary to verify this finding. [ABSTRACT FROM AUTHOR]

No randomized controlled trials evaluating metformin therapy efficacy in patients with type 2 diabetes mellitus (DM) and acute coronary syndrome (ACS) have been reported. We aimed to examine the mortality benefit of metformin therapy in patients with type 2 DM and ACS, compared with non-metformin anti-diabetes agents users. Data were extracted from the prospective nationwide ACS-DM Taiwan Society of Cardiology registry. Propensity score (PS) matching on baseline characteristics and treatment measures was performed for metformin versus non-metformin users. The Cox proportional hazards model was used to compare mortality outcomes among the PS-matched cohort as the primary analysis. The Cox proportional hazards models adjusting for all pre-determined covariates and quintiles of the PS among the overall population were performed as the secondary analyses. Of 1157 patients with type 2 DM and ACS receiving anti-diabetes agents, 78 patients (6.7%) died over the 2-year follow-up period. After PS matching, 318 metformin users were matched with 318 non-metformin users. Metformin users had a lower all-cause mortality rate (adjusted hazard ratio [aHR] 0.50, 95% confidence interval [CI] 0.26–0.95) in the primary analysis. The survival benefit of metformin therapy was consistent in the secondary analyses (aHR 0.30, 95% CI 0.17–0.54 while adjusting for all pre-determined covariates, and aHR 0.34, 95% CI 0.19–0.59 while adjusting for quintiles of the PS). Among patients with type 2 DM and ACS, metformin was associated with lower all-cause mortality. However, a detrimental effect of any of the comparators could not be excluded. • Metformin was associated with lower mortality in T2DM with ACS, in modern PCI era. • Similar benefit was found in patients with CKD, LV dysfunction and contrast exposure. • Similar benefit was found in patients with old age and advanced DM severity. [ABSTRACT FROM AUTHOR]

Background: Secondary prevention therapy for patients with coronary artery disease using an antiplatelet agent, β-blocker, renin-angiotensin system blocker (RASB), or statin plays an important role in the reduction of coronary events after coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI). We analyzed the status and effects of secondary prevention after coronary revascularization in Taiwan. Methods: This national population-based cohort study was conducted by analyzing the Longitudinal Health Insurance Database 2000 from the National Health Insurance Research Database of Taiwan. Patients who underwent CABG or PCI from 2004 to 2009 were included in the analysis. The baseline characteristics of the patients and ACC/AHA class I medication use at 12 months were analyzed. The primary endpoints were a composite of major adverse cardiac and cerebrovascular events. Results: A total of 5544 patients comprising 895 CABG and 4649 PCI patients were evaluated. CABG patients had more comorbidities and a higher rate of major adverse event during the follow-up period. However, use of antiplatelet agents and RASB at 12 months was significantly lower in CABG patients than in PCI patients (44.2% vs. 50.9% and 38.6% vs. 48.9%, both p < 0.01). Age, diabetes, and chronic kidney disease were independent risk factors while statin use was a protective factor for the primary endpoints in both PCI and CABG groups. Conclusion: There is still much room to improve class I medication use in secondary prevention for patients after revascularization in Taiwan. Statin could be an effective treatment to improve the outcomes. [ABSTRACT FROM AUTHOR]

Background: Several randomized control trials have established that drugs can decrease the heart failure (HF) rehospitalization in patients with HF. However, limited studies have investigated the duration of medicine use to decrease the rehospitalization period in the real world. Hence, this study aims to investigate whether the evidence-based medicine decreases the HF rehospitalization in different treatment intervals in the clinical practice. Method: We examined patients admitted with acute HF from the National Health Insurance Research Database in Taiwan. In addition, the major adverse cardiovascular events (MACE) were the composite endpoints of the in-hospital mortality and rehospitalization after 1 year. Furthermore, we analyzed the medicine use to decrease 14 days and 1, 6, and 12 months' HF rehospitalization. Results: Overall, we examined 11,012 patients. The use of the renin–angiotensin system (RAS) blockers [hazard ratio (HR), 0.58; P < 0.01], β-blocker (HR, 0.67; P < 0.01), spironolactone (HR, 0.63; P < 0.01), and digitalis (HR, 0.67; P < 0.01) associated with the lower in-hospital mortality rate. The Cox regression analysis revealed that RAS blocker (HR, 0.86; P < 0.01) and β-blocker (HR, 0.71; P < 0.01) were independent predictors for MACE. Although RAS blockers declined rehospitalization to 6 months, β-blocker decreased the rehospitalization rate after 1 month use and the benefit persisted till 12 months. Furthermore, digitalis only lowered rehospitalization to 14 days. Conclusion: This study suggests that the use of evidence-based medicine is associated with lower MACE for patients with HF, and these drugs could play vital roles in different periods to decrease the rehospitalization in the clinical setting. [ABSTRACT FROM AUTHOR]

Objective Previous studies demonstrated CHADS 2 score and impaired renal function were both associated with ankle–brachial index (ABI) < 0.9 in patients without atrial fibrillation (AF). Hence, we hypothesized the R 2 CHADS 2 score had a significant correlation with ABI < 0.9 and the aim of this study was to validate this association in non-AF patients. Methods A total of 1482 patients without AF were included. ABI was measured using an ABI-form device. Peripheral arterial occlusive disease (PAOD) was defined as ABI < 0.9 in either leg. Results Of the 1482 subjects, the prevalence of ABI < 0.9 was 5.6%. Multivariate analysis showed that increased age (odds ratio [OR], 1.049; P < 0.001), decreased estimated glomerular filtration rate (OR, 0.978; P = 0.006), and increased R 2 CHADS 2 score (OR, 1.738; P < 0.001) were associated with ABI < 0.9. In addition, in patients with CHADS 2 score ≧ 2, the presence of chronic kidney disease (CKD) was significantly associated with ABI < 0.9 ( P ≦ 0.006), but in patients with CHADS2 score < 2, there was no such association ( P = 0.357). Conclusions Our study demonstrated R 2 CHADS 2 score was positively correlated with ABI < 0.9. In addition, the presence of CKD was a risk factor of ABI < 0.9 in patients with CHADS 2 score ≧ 2. Hence, increased R 2 CHADS 2 score in non-AF patients and the presence of CKD in non-AF patients with CHADS 2 score ≧ 2 were useful parameters in identifying the high risk group of PAOD. [ABSTRACT FROM AUTHOR]

Abstract: Background: Clopidogrel, cilostazol, and aspirin were compared in terms of efficacy and safety for primary prevention of stroke in peripheral artery disease (PAD) patients. Methods: This retrospective cohort study analyzed data contained in the Taiwan National Health Insurance Bureau database for patients treated for PAD but not for stroke during 2002–2008. Patients were stratified according to treatment with aspirin, clopidogrel, cilostazol, or combined therapy. The primary efficacy and safety endpoints were stroke and hemorrhage. Results: Of the 931 patients enrolled in this study, 479 had received aspirin, 39 had received clopidogrel, 294 had received cilostazol alone, and 33 had received a cilostazol-based combined therapy. Compared to patients treated with aspirin, the patients treated with cilostazol had significantly lower all-stroke risk not only in the overall group (HR=0.66, 95% CI=0.48-0.90, p=0.0086), but also in the subgroup of patients with diabetes (HR=0.64, 95% CI=0.42-0.98, p=0.0394) and in the subgroup of patients with high cardiovascular risk (HR=0.66, 95% CI=0.46-0.95, p=0.0254). Additionally, compared to patients treated with aspirin, those treated with cilostazol did not have significantly more hemorrhagic events in the overall group, in the diabetes subgroup, or in the high cardiovascular risk subgroup. Clopidogrel, cilostazol-based combined therapy and aspirin did not significantly differ in terms of efficacy and hemorrhagic events. Conclusion: Although this database study indicated that cilostazol therapy is an effective alternative treatment for primary prevention of stroke in PAD, further confirmation is needed in large, prospective, and randomized trials. [Copyright &y& Elsevier]