35 results on '"Fung, Jeffrey W H"'
Search Results
2. Biventricular Pacing
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Yu, Cheuk-Man, Chan, Joseph Y.S., and Fung, Jeffrey W.-H.
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- 2010
3. Does atrial fibrillation preclude biventricular pacing?
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Fung, Jeffrey W H, Yip, Gabriel W K, and Yu, Cheuk-Man
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- 2008
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4. Preventing contrast nephropathy in catheter laboratory
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Fung, Jeffrey W H, Szeto, Check C, and Yu, Cheuk M
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- 2007
5. Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy
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Fung, Jeffrey W H, Chan, Joseph Y S, Yip, Gabriel W K, Chan, Hamish C K, Chan, Winnie W L, Zhang, Qing, and Yu, Cheuk-Man
- Published
- 2007
6. Severe Obstructive Sleep Apnea Is Associated With Left Ventricular Diastolic Dysfunction*
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Fung, Jeffrey W. H., Li, Thomas S. T., Choy, Dominic K. L., Yip, Gabriel W. K., Ko, Fanny W. S., Sanderson, John E., and Hui, David S. C.
- Published
- 2002
7. Combined pacing and percutaneous closing device therapy for dilated cardiomyopathy and patent ductus arteriosus
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FUNG, JEFFREY W H, LEUNG, M P, and CHAN, WILSON W M
- Published
- 2001
8. Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy
- Author
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Zhang, Qing, primary, Yip, Gabriel W.-K., additional, Chan, Yat-Sun, additional, Fung, Jeffrey W.-H., additional, Chan, Winnie, additional, Lam, Yat-Yin, additional, and Yu, Cheuk-Man, additional
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- 2009
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9. Improvement of left atrial function is associated with lower incidence of atrial fibrillation and mortality after cardiac resynchronization therapy.
- Author
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Fung JW, Yip GW, Zhang Q, Fang F, Chan JY, Li CM, Wu LW, Chan GC, Chan HC, Yu CM, Fung, Jeffrey W H, Yip, Gabriel W K, Zhang, Qing, Fang, Fang, Chan, Joseph Y S, Li, Chun Mei, Wu, Li Wen, Chan, Gary C P, Chan, Hamish C K, and Yu, Cheuk-Man
- Abstract
Background: Left atrial (LA) volume is a predictor of cardiovascular events in patients with heart failure. Improvement of LA function and reverse remodeling was observed after cardiac resynchronization therapy (CRT).Objective: The purpose of this study was to explore the clinical significance of improvement in LA function after CRT.Methods: Echocardiographic studies were performed before and 3 months after CRT in 97 patients (72 men and 25 women; age 63.8 +/- 13.3 years) with standard CRT indication but no history of atrial fibrillation (AF). LA active emptying fraction based on the change in volumes (LAV-EF) were calculated, and significant improvement in LA function (LA responder) was defined as a relative increase >/=50% from baseline LAV-EF. The primary end-points were newly developed AF detected by ECG or device and all-cause mortality.Results: After 1,200 +/- 705 days of follow-up, LA responders (n = 47 [48.5%]) had a significantly lower incidence of AF (12.8% vs 40%, P = .002) and mortality (17% vs 44%, P = .004) than did LA nonresponders. In Cox proportional hazard analysis, LA responders was the only independent predictor of lower risk of new-onset AF (hazard ratio 0.22, 95% confidence interval 0.08-0.61, P = .003), whereas both LA responders (hazard ratio 0.22, 95% confidence interval 0.09-0.53, P <.001) and left ventricular reverse remodeling (>10% reduction in left ventricular end-systolic volume at 3 months; hazard ratio 0.96, 95% confidence interval 0.93-0.99, P = .03) were independent predictors of lower risk of death after CRT.Conclusion: Improvement of LA function after CRT was associated with a lower incidence of AF and mortality in AF naïve patients with severe heart failure. [ABSTRACT FROM AUTHOR]- Published
- 2008
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10. Role of Beta-Blocker Therapy in Heart Failure and Atrial Fibrillation.
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Fung, Jeffrey W. H., Yu, Cheuk M., Kum, Leo C. C., Yip, Gabriel W.K., and Sanderson, John E.
- Abstract
Heart failure is a serious disorder associated with substantial morbidity and mortality. Approximately 15-30% patients with systolic heart failure are in atrial fibrillation and the proportion increases with severity of heart failure. Patients with heart failure and atrial fibrillation have worse outcome than those in sinus rhythm. Beta-blockers, together with angiotensin- converting enzymes inhibitors, are the standard therapy in patients with chronic heart failure. Retrospective studies have suggested that despite the improvement in left ventricular systolic function after treatment with beta-blockers, the exercise capacity and symptoms in those heart failure patients with atrial fibrillation was not improved as much as those in sinus rhythm. Moreover, the use of bisoprolol in the Cardiac Insufficiency Bisoprolol Study II, unlike those in sinus rhythm, failed to produce any survival benefit in patients with poor systolic function and atrial fibrillation. It seems that those patients with heart failure and atrial fibrillation may have different response to beta-blocker therapy. Prospective trials to clarify the impact of beta- blocker therapy and the optimal therapeutic strategy in this high-risk group of patients are warranted. [ABSTRACT FROM AUTHOR]
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- 2003
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11. Ablation of the Mahaim Pathway Guided by Noncontact Mapping.
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Fung, Jeffrey W. H., Chan, Hamish C. K., Chan, Winnie W. L., Sanderson, John E., and Rosenbaum, David S.
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CATHETER ablation ,HEART ventricles ,CARDIAC pacing ,CATHETERIZATION ,ELECTROSURGERY - Abstract
Discusses research being done on ablation of the Mahaim pathway guided by noncontact mapping. Reference to a study by John E. Sanderson et al published in the October 2002 issue of the "Journal of Cardiovase Electrophysiol"; Factors generally referred as Mahaim fibers; Result of ventricular pacing conducted on the patient.
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- 2002
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12. Biventricular Pacing.
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Cheuk-Man Yu, Chan, Joseph Y. S., and Fung, Jeffrey W. -H.
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LETTERS to the editor , *CARDIAC pacing , *BRADYCARDIA , *PATIENTS - Abstract
A response by Cheuk-Man Yu to a letter to the editor about his article on the use of biventricular pacing in patients with bradycardia in the November 26, 2009 issue is presented.
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- 2010
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13. Effect of beta blockade (carvedilol or metoprolol) on activation of the renin-angiotensin-aldosterone system and natriuretic peptides in chronic heart failure.
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Fung JWH, Yu CM, Yip G, Chan S, Yandle TG, Richards AM, Nicholls MG, Sanderson JE, Fung, Jeffrey W H, Yu, Cheuk M, Yip, Gabriel, Chan, Skiva, Yandle, Timothy G, Richards, A Mark, Nicholls, M Gary, and Sanderson, John E
- Abstract
Beta blockers are known to suppress renin release in hypertension and in patients taking angiotensin-converting enzyme (ACE) inhibitors. This study sought to explore the effect of additional beta blockade on neurohumoral modulation in patients with severe heart failure (HF) who received ACE inhibitors. Forty-nine patients with chronic HF who received ACE inhibitors were given metoprolol 50 mg or carvedilol 25 mg twice daily after a 4-week dose titration period in addition to standard therapy in a prospective trial. Samples of plasma renin activity (PRA), aldosterone, aminoterminal B-type natriuretic peptide (N-BNP), and atrial natriuretic peptide (ANP) were taken at baseline and at 4, 12, and 52 weeks after starting therapy. Treatment with either beta blocker significantly lowered PRA at 4 weeks compared with baseline (-2.0 +/- 0.6 nmol/L/hour, p = 0.006), but at 12 weeks, PRA had reduced to -1.1 +/- 0.6 nmol/L/hour (p = 0.08), but at 52 weeks, it was not significantly different from baseline (+1.05 +/- 0.6 nmol/L/hour, p = 0.13). Aldosterone levels did not change significantly from baseline at 4 or 12 weeks, although there was a nonsignificant trend for lower levels at 52 weeks (baseline 232 +/- 154 pmol/L, 52 weeks 192 +/- 100 pmol/L, p = 0.09). There was significant reduction in N-BNP and ANP together with an improvement in symptom and left ventricular systolic function at 1-year follow-up. These results indicate that the suppressive effect of beta blockers on PRA in patients with HF taking ACE inhibitors is temporary, and that there is no significant effect on serum aldosterone levels. [ABSTRACT FROM AUTHOR]
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- 2003
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14. Real-World Assessment of Acute Left Ventricular Lead Implant Success and Complication Rates: Results from the Attain Success Clinical Trial.
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Hummel JD, Coppess MA, Osborn JS, Yee R, Fung JW, Augostini R, Li S, Hine D, and Singh JP
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- Aged, Female, Follow-Up Studies, Heart Ventricles, Humans, Male, Postoperative Complications, Prospective Studies, Treatment Outcome, Cardiac Resynchronization Therapy, Prostheses and Implants
- Abstract
Background: Left ventricular lead (LVL) implant success rates have historically ranged between 70.5% and 95.5%. To date, there are few large studies that evaluate LVL implant success utilizing a single family of delivery catheters and leads. The Attain Success study was a prospective nonrandomized multicenter global study with the main objectives of assessing single-system LVL implant success and complication rates., Methods: Patients undergoing cardiac resynchronization therapy implantation were eligible for enrollment. There was no prespecified level of experience for investigator participation. LVL implant success and complication rates were assessed though 3 months of follow-up., Results: A total of 2,014 patients (69.1 ± 12.0 years, 71% male and 38% atrial fibrillation) were enrolled from 114 centers with a follow-up of 3.5 ± 2.1 months. Coronary sinus cannulation success rate was 96.4% with Attain Family delivery catheters. Implant success rate for Attain Family leads using Attain Family catheters was 94.0%; overall LVL implant success rate was 97.1%. Median procedure time was 4 minutes for cannulation and 9 minutes for LVL placement. Median fluoroscopy time was 17 minutes and median contrast used was 25 cc. There were 55 catheter or LVL-related complications in 53 subjects; the majority were LVL dislodgements (34, 1.7%) and extracardiac stimulation (11, 0.5%). The Kaplan-Meier estimate of the 3-month complication probability was 2.6%., Conclusion: This study represents the largest prospective evaluation of LVL implantation to date, revealing a high LVL implant success rate and low complication rate using a single family of leads and delivery catheters., (© 2016 Wiley Periodicals, Inc.)
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- 2016
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15. Regression of non-compaction in left ventricular non-compaction cardiomyopathy by cardiac contractility modulation.
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Wong PH and Fung JW
- Subjects
- Heart Failure etiology, Humans, Male, Middle Aged, Cardiac Pacing, Artificial, Heart Failure therapy, Isolated Noncompaction of the Ventricular Myocardium complications, Pacemaker, Artificial
- Published
- 2012
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16. Deleterious effect of right ventricular apical pacing on left ventricular diastolic function and the impact of pre-existing diastolic disease.
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Fang F, Zhang Q, Chan JY, Xie JM, Fung JW, Yip GW, Lam YY, Chan A, and Yu CM
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- Aged, Blood Flow Velocity physiology, Cardiac Volume physiology, Diastole, Female, Humans, Male, Middle Aged, Sick Sinus Syndrome physiopathology, Stroke Volume physiology, Systole, Ventricular Dysfunction, Left physiopathology, Cardiac Pacing, Artificial adverse effects, Sick Sinus Syndrome therapy, Ventricular Dysfunction, Left etiology
- Abstract
Aims: Right ventricular apex (RVA) pacing may have deleterious effects on left ventricular (LV) systolic function, but its impact on LV diastolic function has not been explored., Methods and Results: Ninety-seven patients with sinus node dysfunction and ejection fraction (EF) ≥ 50% with permanent RVA pacing were randomly programmed to V-sense and V-pace modes and examined by echocardiography. Tissue Doppler imaging was employed to assess myocardial systolic velocity (S') and early diastolic velocity (E') at the mitral annulus. Systolic dyssynchrony was assessed using 12 LV segmental model (Ts-SD). Switching from V-sense to V-pace resulted in the worsening of both diastolic and systolic functions as shown by the decreased EF, reduced mean E' and S' velocities, as well as increase in LV volume and Ts-SD (all P< 0.001). Reduction of mean E' and S' of ≥ 1 cm/s occurred in 35 (36%) and 45 (46%) patients, respectively. In pre-defined subgroup analysis, only patients with pre-existing LV diastolic dysfunction had a significant reduction of mean E' and S' (both P< 0.001) even after age adjustment. Multivariate logistic regression analysis showed that independent factors for the reduction of mean E' ≥ 1 cm/s or mean S' ≥ 1 cm/s at V-pace were pre-existing LV diastolic dysfunction [odds ratio (OR): 4.735, P= 0.007 for E'; OR: 3.307, P= 0.022 for S'] and systolic dyssynchrony at V-pace (OR: 5.459, P= 0.007 for E'; OR: 2.725, P= 0.035 for S')., Conclusion: In patients with preserved EF, RVA pacing is associated with the deterioration of both LV diastolic and systolic functions, which is particularly obvious in those with pre-existing LV diastolic dysfunction and V-pace-induced systolic dyssynchrony.
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- 2011
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17. The 2010 update of the ESC guidelines for the management of atrial fibrillation. Beyond the rate or rhythm strategy debate.
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Fung JW and Yu CM
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- Atrial Fibrillation epidemiology, Humans, Practice Guidelines as Topic, Atrial Fibrillation physiopathology, Atrial Fibrillation therapy
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- 2010
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18. Role of device therapy in left ventricular noncompaction cardiomyopathy: is it different from other causes of heart failure?
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Fung JW
- Subjects
- Humans, Treatment Outcome, Cardiac Resynchronization Therapy, Cardiomyopathies therapy
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- 2010
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19. Should we switch to RVOT pacing for all now? Not yet.
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Fung JW and Yu CM
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- Aged, Female, Humans, Male, Ventricular Dysfunction, Left diagnosis, Cardiac Pacing, Artificial adverse effects, Heart Conduction System physiopathology, Heart Ventricles physiopathology, Ventricular Dysfunction, Left etiology, Ventricular Dysfunction, Left physiopathology
- Published
- 2010
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20. Reversible left ventricular dyssynchrony and heart failure induced by right ventricular pacing.
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Fung JW, Zhang Q, Yip GW, and Yu CM
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- Aged, Heart Failure diagnostic imaging, Heart Ventricles, Humans, Male, Ultrasonography, Ventricular Dysfunction, Left diagnostic imaging, Heart Failure etiology, Pacemaker, Artificial adverse effects, Ventricular Dysfunction, Left etiology
- Abstract
Right ventricular (RV) pacing related heart failure is reported in some patients after long term pacing. The exact mechanism is not yet clear but may be related to left ventricular (LV) dyssynchrony induced by RV apical pacing. We report one case with baseline normal LV ejection fraction but complicated by heart failure and ventricular tachycardia after 4 months of pacing for complete heart block together with illustration of LV dyssynchrony demonstrated by tissue Doppler imaging.
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- 2009
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21. Effect of left ventricular lead concordance to the delayed contraction segment on echocardiographic and clinical outcomes after cardiac resynchronization therapy.
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Fung JW, Lam YY, Zhang Q, Yip GW, Chan WW, Chan GC, Chan JY, and Yu CM
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- Female, Humans, Male, Middle Aged, Treatment Outcome, Ultrasonography, Electrodes, Implanted, Heart Failure diagnostic imaging, Heart Failure prevention & control, Pacemaker, Artificial, Prosthesis Implantation methods, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left prevention & control
- Abstract
Introduction: The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT., Methods and Results: Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging. Echocardiographic and clinical outcomes among 101 consecutive patients with or without concordant LV lead positions were compared. There was no significant difference in changes in LV volumes and clinical parameters between patients with concordant (n = 46) or nonconcordant (n = 55) LV lead positions at 3 and 6 months. In multivariate analysis, the baseline asynchrony index (beta= 1.092, 95% CI: 1.050-1.114; P < 0.001), but not LV lead concordance, was the only independent predictor of LV reverse remodeling. By Cox regression analysis, ischemic etiology, and LV reverse remodeling, but not LV lead concordance, were independent predictors of mortality (beta= 2.475, 95% CI: 1.183-5.178; P = 0.016, and beta= 0.272, 95% CI: 0.130-0.567; P < 0.001, respectively), cardiovascular hospitalization (beta= 1.551, 95% CI: 1.032-2.333; P = 0.035, and beta= 0.460, 95% CI: 0.298-0.708; P < 0.001, respectively), and heart failure hospitalization (beta= 0.486, 95% CI: 0.320-0.738; P = 0.001 for LV reverse remodeling)., Conclusion: LV lead concordance to the delayed contraction segment may not be a major determining factor for favorable echocardiographic and clinical outcomes after CRT.
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- 2009
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22. Multicenter clinical experience with an atrial lead designed to minimize far-field R-wave sensing.
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Fung JW, Sperzel J, Yu CM, Chan JY, Gelder RN, Yang MX, Rooke R, Boileau P, and Fröhlig G
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- Aged, Aged, 80 and over, Atrial Fibrillation physiopathology, Electrocardiography, Ambulatory, Equipment Design, Female, Foreign-Body Migration, Humans, Male, Middle Aged, Sensitivity and Specificity, Atrial Fibrillation therapy, Electrocardiography, Heart Atria physiopathology, Pacemaker, Artificial adverse effects
- Abstract
Aims: To evaluate a novel atrial lead designed to reduce far-field sensing., Methods and Results: Sixty-three patients with standard pacing indications were randomized to receive an OptiSense 1699T (St Jude Medical, USA) or conventional pacing lead in the right atrium. Post-implant follow-up was conducted for all patients at 90 days and for a subset at 360 days. Standard electrical parameters were measured. Thresholds of sensing were determined for far-field ventricular signals. The number of inappropriate mode switches was determined from the stored intracardiac electrogram (IEGM). At 90 days, an IEGM Holter recorded 24 h of IEGM. With atrial sensitivity programmed at 0.3 mV, no far-field sensing occurred in the OptiSense group, but it did occur in 20% and 30% of the control group at 90 and 360 days, respectively. Inappropriate mode switching was observed in 4% of the OptiSense group in contrast to 23% of the control group. The IEGM Holter found no far-field sensing in the OptiSense group, but did find 83 023 far-field events from 22% of control patients. The standard electrical parameters of the OptiSense leads were acceptable., Conclusion: The OptiSense lead reduced ventricular far-field sensing in the atrium while maintaining satisfactory pacing and sensing performance, resulting in less inappropriate mode switch.
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- 2009
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23. Left ventricular systolic dyssynchrony is a predictor of cardiac remodeling after myocardial infarction.
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Zhang Y, Yip GW, Chan AK, Wang M, Lam WW, Fung JW, Chan JY, Sanderson JE, and Yu CM
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- Aged, Cardiac Volume physiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Sensitivity and Specificity, Stroke Volume physiology, Ventricular Dysfunction, Left diagnostic imaging, Echocardiography, Doppler, Color, Image Enhancement, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Cine, Myocardial Contraction physiology, Myocardial Infarction physiopathology, Systole physiology, Ventricular Dysfunction, Left physiopathology, Ventricular Remodeling physiology
- Abstract
Objectives: We sought to determine whether early assessment of left ventricular (LV) dyssynchrony by tissue Doppler imaging may predict progressive ventricular enlargement and cardiac dysfunction after acute myocardial infarction (MI)., Methods: Forty-seven patients (mean age 59.9 +/- 11.6 years) with normal QRS duration underwent tissue Doppler imaging and contrast-enhanced cardiac magnetic resonance imaging (Ce-MRI) at days 2 to 6, 3 months, and at 1 year after the index MI. Systolic dyssynchrony index (Ts-SD) was calculated from 12 LV segments, and infarct size (IS) by Ce-MRI., Results: The remodeling group (n = 16) (defined as an increase in end-systolic volume > or =10% between 1 year and baseline) had greater initial IS (27.2 +/- 9.6 vs 13.7 +/- 4.1%, P < .001) and Ts-SD (50.9 +/- 12.8 vs 33.6 +/- 7.7 milliseconds, P < .001) than nonremodeling group (n = 31). At 1 year, the remodeling group had progressive increase in Ts-SD and decrease in LV ejection fraction (57.3 +/- 18.5 and 36.0 +/- 7.6%, respectively; both P < .05 vs baseline). Both Ts-SD (odds ratio 1.19 [1.07-1.32], P = .001) and IS (odds ratio 1.65 [1.19-2.29], P = .003) were shown to be independent predictors of progressive LV remodeling. A cutoff value of Ts-SD > or =45 milliseconds predicted LV remodeling at 1 year (sensitivity 90.5%, specificity 90.9%, Area-under-curve 0.907) (P = .0005)., Conclusions: Left ventricular systolic dyssynchrony is a newly identified predictor of chronic LV remodeling after acute MI, which is independent and incremental to conventional assessment and IS as measured by Ce-MRI.
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- 2008
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24. Prognostic value of renal function in patients with cardiac resynchronization therapy.
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Fung JW, Szeto CC, Chan JY, Zhang Q, Chan HC, Yip GW, and Yu CM
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- Aged, Defibrillators, Implantable, Female, Heart Failure therapy, Humans, Kidney Function Tests, Male, Middle Aged, Pacemaker, Artificial, Predictive Value of Tests, Renal Insufficiency complications, Retrospective Studies, Treatment Outcome, Cardiac Pacing, Artificial, Electric Countershock, Heart Failure complications, Heart Failure physiopathology, Renal Insufficiency physiopathology, Ventricular Remodeling physiology
- Abstract
Background: Renal insufficiency is prevalent in patients with heart failure and indicates poor prognosis. We examine (i) the relationship between left ventricular (LV) reverse remodeling (RR) and renal function and (ii) the prognostic value of renal function in patients receiving cardiac resynchronization therapy (CRT)., Methods: The relationship between LV-RR, defined as a 10% reduction in LV end-systolic volume, and renal function was examined in 85 consecutive patients receiving CRT. Echocardiographic assessment and renal function tests were performed before and 3 months after CRT. All-cause mortality and the composite of mortality or heart failure hospitalization between those with preserved or deteriorated renal function at 3 months were assessed by Kaplan Meier analysis., Results: There was a slight improvement in glomerular filtration rate (GFR) in those with LV-RR (n=44; 51.7+/-20.4 vs. 54.2+/-19.1 ml/min/1.73 m2; p=0.024) while a significant deterioration (n=41; 61.9+/-17 vs. 48.8+/-13.0 ml/min/1.73 m2; p<0.001) was observed in those without LV-RR. The change (Delta) in GFR was significantly correlated with DeltaLV end-systolic/diastolic volumes and DeltaLV ejection fraction. After follow up of 856.4+/-576.8 days, patients with preserved renal function had significant lower all-cause mortality (log rank chi2=4.82, p=0.029) and the composite endpoints (log rank chi2=5.04, p=0.025)., Conclusion: Preservation of renal function was observed in patients with systolic heart failure and renal insufficiency responding to CRT and provided prognostic information. A rapid decline in renal function after CRT was associated with worse clinical outcomes.
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- 2007
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25. Impact of atrial fibrillation in heart failure with normal ejection fraction: a clinical and echocardiographic study.
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Fung JW, Sanderson JE, Yip GW, Zhang Q, and Yu CM
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- Aged, Aged, 80 and over, Atrial Fibrillation physiopathology, Female, Heart Failure physiopathology, Hospitalization trends, Humans, Male, Middle Aged, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Echocardiography trends, Heart Failure complications, Heart Failure epidemiology, Stroke Volume physiology
- Abstract
Background: The clinical significance of atrial fibrillation (AF) in heart failure with normal ejection fraction (HFNEF) remains undetermined., Methods and Results: We compared the clinical and echocardiographic characteristics among 238 patients hospitalized for HF. Using the cutoff of left ventricular EF of 50%, there were 146 patients with HFNEF (AF = 42) and 92 with systolic HF (AF = 30). When compared among HFNEF, the New York Heart Association (NYHA) class (2.61 +/- 0.51 versus 2.21 +/- 0.46; P < .05), 6-minute walk distance (279.7 +/- 66.0 versus 338.0 +/- 86.1 m; P < .01), quality of life score (26.1 +/- 14.3 versus 19.5 +/- 10.3; P < .05), and previous HF hospitalization were significantly worse in the AF group. These variables were significantly better in HFNEF than systolic HF with sinus rhythm, but the differences were not detected among those with AF. Patients with HFNEF and AF were associated with more severe diastolic dysfunction when compared to sinus rhythm. With a median follow-up of 10.5 months, the proportion of HFNEF patients in AF with recurrent HF hospitalization or death was significantly higher than those in sinus rhythm (28.6% versus 10.6%; P < .01). Both AF and restrictive diastolic dysfunction were independent predictors of HF hospitalization or death in HFNEF., Conclusion: Patients with HFNEF and AF were associated with more severe diastolic dysfunction and worse clinical outcomes than those in sinus rhythm.
- Published
- 2007
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26. Suboptimal medical therapy in patients with systolic heart failure is associated with less improvement by cardiac resynchronization therapy.
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Fung JW, Chan JY, Kum LC, Chan HC, Yip GW, Zhang Q, and Yu CM
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- Aged, Combined Modality Therapy, Female, Heart Failure drug therapy, Humans, Male, Middle Aged, Retrospective Studies, Systole, Electric Countershock, Heart Failure therapy
- Abstract
Background: Proven medical therapy is under-prescribed in heart failure (HF) for various reasons. Cardiac resynchronization therapy (CRT) is of proven value in selected patients with HF; however, the degree of benefit in those without the optimal therapy is not clear., Methods: This is a retrospective study comparing the effect of CRT in 30 patients without optimal combination therapy (group 1; 10 (33%) without ACEi or equivalent and 25 (83%) without beta-blockers) to an age, sex, ejection fraction (EF) and New York Heart Association (NYHA) class matched control but with the combination (group 2; n=30) at baseline. All patients were in NYHA class III or IV with EF < or = 35% and QRS interval > or = 120 ms. Echocardiographic examination and N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels before and 3 months after CRT were compared between the two groups. The composite endpoints of HF hospitalization or death during follow-up were compared by Kaplan-Meier analysis., Results: There were significantly less improvement in EF (+4.0+/-2.5% vs +10.1+/-3.2%; p<0.05) and degree of reverse remodeling in group 1 after 3 months. Patients in group 1 had significantly higher level of NT pro-BNP levels at 3 months (2221+/-2001 pg/mL vs 1038+/-905 pg/mL; p<0.001) and higher rates of HF hospitalization or death (53.3% vs 23.3%; Log rank chi2 5.52; p=0.019)., Conclusion: Patients receiving CRT but without optimal medical therapy were associated with less echocardiographic and clinical improvement. Optimal medical therapy, if tolerated, before CRT is necessary.
- Published
- 2007
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27. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaging study.
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Wang T, Wang M, Fung JW, Yip GW, Zhang Y, Ho PP, Tse DM, Yu CM, and Sanderson JE
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- Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Heart Atria diagnostic imaging, Heart Atria physiopathology, Humans, Male, Middle Aged, Predictive Value of Tests, Remission Induction, Treatment Failure, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation therapy, Echocardiography, Doppler, Echocardiography, Transesophageal, Electric Countershock
- Abstract
Aims: The purpose of this study was to assess the feasibility of measuring left atrial dysfunction with tissue Doppler imaging derived strain rate and to explore its role in predicting the maintenance of sinus rhythm after cardioversion for atrial fibrillation., Methods and Results: Strain rate (SR) and tissue Doppler imaging (TDI) were performed with offline analysis of the basal left atrial wall (LA). SR detected a systolic (Ssr) and early diastolic (Esr) deformation induced by ventricular motion. LA dimensions and volume were measured. Left atrial appendage emptying (LAA_EV) and filling (LAA_FV) velocities were also obtained by transesophageal echocardiography. 27 healthy age-matched controls and 42 patients with AF before cardioversion were studied. Patients were grouped into (1): those who remained in sinus rhythm (group S, n=12) and (2) those who either failed cardioversion or reverted to AF within 4 weeks (group F, n=30). LA dimensions were significantly larger and atrial Esr was significantly lower in group F than group S (all p<0.01). LAA_EV and LAA_FV were not different between groups S and F. Multivariate regression analysis showed that a lower Esr and larger transverse LA diameter (LADtr) were independent predictors of failure of cardioversion (HR, 95% CI: 0.36, 0.14-0.88 and 2.85, 1.33-6.10, respectively). Esr combined with LADtr improved the sensitivity and specificity for predicting successful cardioversion., Conclusions: SR can be measured in the basal LA wall in atrial fibrillation and the magnitude of the early diastolic SR could predict the success of cardioversion and the likelihood of maintenance of sinus rhythm.
- Published
- 2007
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28. Effect of cardiac resynchronization therapy in patients with moderate left ventricular systolic dysfunction and wide QRS complex: a prospective study.
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Fung JW, Zhang Q, Yip GW, Chan JY, Chan HC, and Yu CM
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- Aged, Arrhythmias, Cardiac diagnosis, Female, Heart Failure diagnosis, Humans, Male, Prognosis, Treatment Outcome, Ventricular Dysfunction, Left diagnosis, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac prevention & control, Cardiac Pacing, Artificial methods, Heart Failure etiology, Heart Failure prevention & control, Ventricular Dysfunction, Left complications, Ventricular Dysfunction, Left therapy
- Abstract
Background: We sought to investigate the effect of cardiac resynchronization therapy (CRT) on disease progression in patients with moderate left ventricular (LV) systolic dysfunction., Methods and Results: This is a prospective study to explore the effect of CRT in 15 optimally treated patients (age: 66.1 +/- 12.8 years; male = 13) with New York Heart Association (NYHA) class III, LV ejection fraction >35% and <45% and QRS duration >120 msec. Echocardiographic examination and standard heart failure assessment was performed before and 3 months after CRT implantation. The magnitude of echocardiographic remodeling measurements was compared with 30 age, sex, NYHA class, and heart failure etiology matched patients with conventional CRT indication. There were significant reductions in LV end-systolic (86.2 +/- 24.1 to 69.7 +/- 22.2 mL, P < 0.01)/end-diastolic (135.5 +/- 36.8 to 120.5 +/- 34.6 mL, P < 0.01) volumes, improvement in LV ejection fraction (39.1 +/- 2.2 to 44.2 +/- 5.5%, P = 0.01), and NYHA class (3.0 +/- 0.0 to 2.07 +/- 0.46, P < 0.001). There was no difference in changes in LV volumes, ejection fraction, NYHA class, and exercise capacity before and after CRT between the study and conventional groups except for greater improvement in the quality of life score in the conventional group., Conclusion: In this prospective study, significant LV reverse remodeling by CRT in those with a wide QRS complex and moderate LV systolic dysfunction was observed. Further studies to explore the benefit of CRT in patients with less severe heart failure are recommended.
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- 2006
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29. Cardiac resynchronization therapy: Part 1--issues before device implantation.
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Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, Gorcsan J 3rd, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, and Yu CM
- Subjects
- Cardiac Output, Low diagnostic imaging, Cardiac Output, Low physiopathology, Cardiac Output, Low surgery, Cardiac Pacing, Artificial, Echocardiography, Humans, Pacemaker, Artificial, Patient Selection, Randomized Controlled Trials as Topic, Cardiac Output, Low therapy
- Abstract
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
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- 2005
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30. Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions.
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Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, Gorcsan J 3rd, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, and Yu CM
- Subjects
- Atrial Fibrillation complications, Atrial Fibrillation therapy, Atrioventricular Node, Cardiac Output, Low complications, Cardiac Output, Low diagnostic imaging, Cardiac Output, Low physiopathology, Echocardiography, Electric Countershock, Humans, Intraoperative Care, Intraoperative Complications, Postoperative Care, Treatment Outcome, Cardiac Output, Low therapy, Cardiac Pacing, Artificial, Pacemaker, Artificial
- Abstract
Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed.
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- 2005
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31. Strain rate imaging differentiates transmural from non-transmural myocardial infarction: a validation study using delayed-enhancement magnetic resonance imaging.
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Zhang Y, Chan AK, Yu CM, Yip GW, Fung JW, Lam WW, So NM, Wang M, Wu EB, Wong JT, and Sanderson JE
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- Acute Disease, Aged, Case-Control Studies, Contrast Media, Coronary Stenosis diagnosis, Echocardiography, Doppler, Female, Gadolinium DTPA, Hong Kong, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Time Factors, Magnetic Resonance Imaging, Cine methods, Myocardial Infarction diagnosis
- Abstract
Objectives: The aim of this study was to determine if strain rate imaging (SRI) correlates with the transmural extent of myocardial infarction (MI) measured by contrast-enhanced magnetic resonance imaging (Ce-MRI)., Background: Identification of the transmural extent of myocardial necrosis and degree of non-viability after acute MI is clinically important., Methods: Tissue Doppler echocardiography with SRI and Ce-MRI were performed in 47 consecutive patients with a first acute MI between days 2 and 6 and compared to 60 age-matched healthy volunteers. Peak myocardial velocities and peak myocardial deformation strain rates were measured. Location and size of the infarct zone was confirmed by Ce-MRI using the delayed enhancement technique with a 16-segment model., Results: Contrast-enhanced MRI identified transmural infarction in 21 patients, non-transmural infarction in 15 (mean transmurality of infarct 72.3 +/- 10.6%), and another 11 patients with subendocardial infarction (<50% transmural extent of the left ventricular wall). Peak systolic strain rate (SRs) of the transmural infarction segments was significantly lower compared to normal myocardium or with non-transmural infarction segments (both p < 0.0005). A cutoff value of SRs >-0.59 s(-1) detected a transmural infarction with high sensitivity (90.9%) and high specificity (96.4%), and -0.98 s(-1) >SRs >-1.26 s(-1) distinguished subendocardial infarction from normal myocardium with a sensitivity of 81.3% and a specificity of 83.3%., Conclusions: Peak myocardial deformation by SRI can differentiate transmural from non-transmural MI, and it allows noninvasive determination of transmurality of the scar after MI and thereby the extent of non-viable myocardium.
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- 2005
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32. Do metoprolol and carvedilol have equivalent effects on diurnal heart rate in patients with chronic heart failure?
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Sanderson JE, Leung LY, Chan SK, Yip GW, Fung JW, and Yu CM
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- Adrenergic beta-Antagonists administration & dosage, Carbazoles administration & dosage, Carvedilol, Electrocardiography, Ambulatory, Heart Failure mortality, Heart Failure physiopathology, Humans, Metoprolol administration & dosage, Propanolamines administration & dosage, Randomized Controlled Trials as Topic, Stroke Volume, Adrenergic beta-Antagonists pharmacology, Carbazoles pharmacology, Heart Failure drug therapy, Heart Rate drug effects, Metoprolol pharmacology, Propanolamines pharmacology
- Abstract
Background: Carvedilol exerted a greater reduction in mortality than metoprolol tartrate in the Carvedilol or Metoprolol European Trial (COMET). However, it is unclear if the degree and time course of beta1-blockade during a 24-h period was similar with each agent at the doses used. Therefore we analyzed 24-h ECG Holter recordings from a study which compared the long-term clinical efficacy of metoprolol tartrate to carvedilol in chronic heart failure patients using the same dosing regimen as in COMET., Methods and Results: Fifty-one patients with chronic heart failure with a mean LVEF 26+/-1.8% were randomized in a double-blind fashion to receive metoprolol tartrate 50 mg bid or carvedilol 25 mg bid. 24-h ECG monitoring (Holter) was performed at baseline, 12 weeks and 1 year. Adequate quality recordings for analysis were obtained from 43 subjects at baseline, 42 at 12 weeks and 29 subjects at 1 year. Both drugs produced a fall in average 24-h heart rate from baseline at 12 weeks and at 1 year: metoprolol 88+/-3 to 71+/-2 and 69+/-3 bpm; carvedilol 83+/-3 to 70+/-2 and 70+/-3 bpm respectively (all p<0.001). The pattern of suppression of heart rate during the 24-h period was similar for both drugs., Conclusion: Metoprolol tartrate 50 mg bid and carvedilol 25 mg bid had similar effects on 24-h heart rate. This result suggests that the degree of beta1-blockade produced by these two drugs in these doses is comparable and the superior survival effect of carvedilol compared to metoprolol seen in COMET is likely to be due to actions of carvedilol other than beta1-blockade.
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- 2005
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33. Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial.
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Fung JW, Szeto CC, Chan WW, Kum LC, Chan AK, Wong JT, Wu EB, Yip GW, Chan JY, Yu CM, Woo KS, and Sanderson JE
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- Aged, Cardiovascular Diseases complications, Comorbidity, Coronary Angiography, Creatinine blood, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Renal Insufficiency complications, Urea blood, Acetylcysteine therapeutic use, Acute Kidney Injury chemically induced, Acute Kidney Injury prevention & control, Contrast Media adverse effects
- Abstract
Background: The effect of N-acetylcysteine (NAC) to prevent contrast nephropathy (CN) in patients with moderate to severe renal insufficiency undergoing coronary angiography or interventions is not clear., Methods: This is a prospective, open-label, randomized, controlled trial. Ninety-one consecutive patients with a serum creatinine level of 1.69 to 4.52 mg/dL (149 to 400 micromol/L) undergoing coronary procedures were recruited and randomly assigned to administration of either oral NAC, 400 mg, thrice daily the day before and day of the contrast procedure (the NAC group) or no drug (the control group). Serum creatinine was measured before and 48 hours after contrast exposure. The primary end point of this study was the development of CN, defined as an increase in serum creatinine concentration of 0.5 mg/dL or greater (> or =44 micromol/L) or a reduction in estimated glomerular filtration rate (GFR) of 25% or greater of the baseline value 48 hours after the procedure., Results: There were no significant differences between the 2 groups (46 patients, NAC group; 45 patients, control group) in baseline characteristics or mean volume of contrast agent administered. Six patients (13.3%) in the control group and 8 patients (17.4%) in the NAC group developed CN (P = 0.8). Serum creatinine levels increased from 2.27 +/- 0.54 to 2.45 +/- 0.65 mg/dL (201 +/- 48 to 217 +/- 57 micromol/L; P = 0.003) in the NAC group and 2.37 +/- 0.61 to 2.40 +/- 0.70 mg/dL (210 +/- 54 to 212 +/- 62 micromol/L; P = 0.6) in the control group. The increase in serum creatinine levels between the 2 groups had no difference (P = 0.7). Estimated GFR decreased from 30.3 +/- 8.4 to 28.1 +/- 8.4 mL/min (P = 0.01) in the NAC group and 28.4 +/- 8.6 to 27.5 +/- 8.8 mL/min (P = 0.3) in the control group. The decline in estimated GFR between the 2 groups had no difference (P = 0.7)., Conclusion: In the current study, oral NAC had no effect on the prevention of CN in patents with moderate to severe renal insufficiency undergoing coronary angiography or interventions. However, the sample size of our present study is small. Our findings highlight the need for a large-scale, randomized, controlled trial to determine the exact beneficial effect of NAC.
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- 2004
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34. Ablation of nonsustained or hemodynamically unstable ventricular arrhythmia originating from the right ventricular outflow tract guided by noncontact mapping.
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Fung JW, Chan HC, Chan JY, Chan WW, Kum LC, and Sanderson JE
- Subjects
- Adult, Electrophysiologic Techniques, Cardiac, Female, Heart Ventricles anatomy & histology, Heart Ventricles physiopathology, Humans, Imaging, Three-Dimensional, Male, Middle Aged, Treatment Outcome, Body Surface Potential Mapping methods, Catheter Ablation methods, Tachycardia, Ventricular surgery
- Abstract
Conventional activation or pacemapping is effective in guiding ablation of ventricular tachyarrhythmia originating from right ventricular outflow tract (RVOT). However, in selected patients with hemodynamically unstable or nonsustained tachycardia, noncontact mapping may be an effective alternative method to guide ablation in RVOT. Five patients with symptomatic hypotension during ventricular tachycardia (VT) or nonsustained tachyarrhythmia originating from the RVOT had radiofrequency ablation guided by noncontact mapping. All patients had a history of syncope and the tachyarrhythmias were refractory to antiarrhythmic therapy. Four patients had spontaneous sustained VT of a cycle length from 250 to 300 ms and one had symptomatic ventricular ectopic beats. Two patients were diagnosed to have arrhythmogenic right ventricular cardiomyopathy (ARVC). Sustained VT with hypotension was induced in two patients and nonsustained VT in three patients. Isopotential color maps were used to locate the earliest activation site of the tachyarrhythmia in RVOT. Three patients had tachyarrhythmia exit sites at the septal region and two at lateral region of RVOT. Low voltage area and diastolic activity were detected in the two patients with ARVC. Radiofrequency ablation guided by noncontact mapping was performed during sinus rhythm in all patients. The number of ablation attempts ranged from 1 to 14. After follow-up for 12 +/- 5.8 months, there was no recurrence of tachyarrhythmia and syncope in all five patients. Noncontact mapping is a safe and effective alternative method to guide ablation of hemodynamically unstable or nonsustained ventricular arrhythmia originating from RVOT.
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- 2003
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35. Is beta-blockade useful in heart failure patients with atrial fibrillation? An analysis of data from two previously completed prospective trials.
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Fung JW, Chan SK, Yeung LY, and Sanderson JE
- Subjects
- Adrenergic beta-Antagonists adverse effects, Adult, Aged, Aged, 80 and over, Atrial Fibrillation physiopathology, Carbazoles adverse effects, Carvedilol, Chronic Disease, Comorbidity, Double-Blind Method, Female, Heart Failure physiopathology, Humans, Male, Metoprolol adverse effects, Middle Aged, Propanolamines adverse effects, Prospective Studies, Stroke Volume drug effects, Treatment Outcome, Ventricular Function, Left drug effects, Adrenergic beta-Antagonists therapeutic use, Atrial Fibrillation drug therapy, Carbazoles therapeutic use, Heart Failure drug therapy, Metoprolol therapeutic use, Propanolamines therapeutic use
- Abstract
Background: Beta-adrenergic blockade is of proven value in chronic heart failure. It is uncertain, however, if beta-blockade provides a similar degree of clinical benefit for heart failure patients with atrial fibrillation (AF) as those in sinus rhythm (SR)., Aims: To compare the effectiveness of beta blockade in patients with heart failure and AF., Methods: Patients with chronic heart failure were randomized to treatment (double blind) with metoprolol 50 mg twice daily or carvedilol 25 mg twice daily in addition to standard therapy. Response was assessed after 12 weeks by a quality of life questionnaire, New York Heart Association class, exercise capacity (6-min walk test), radionucleotide ventriculography for LVEF, 2-D echocardiography measurement of left ventricular (LV) dimensions and diastolic filling and 24-h electrocardiograph monitoring to assess heart rate changes., Results: Both beta-blockers produced significant improvements in LVEF in both the SR group: (+6+/-10% at 12-week, P<0.001) and the AF group: (+11+/-9% at 12-week, P<0.05). However, significant improvement in symptoms (P<0.001) and exercise capacity (P<0.001) were observed only in the SR group but not in the AF group despite a significant improvement in LVEF., Conclusion: Beta-blockers were effective in improving LV ejection fraction in chronic heart failure patients in either SR or AF but had less effect on symptoms and exercise capacity in those with AF.
- Published
- 2002
- Full Text
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