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Background: Post-transcatheter aortic valve replacement (TAVR) thrombocytopenia has been reported to be a predictor of higher mortality and worse clinical outcomes in published studies mostly from Western countries; however, data from Asian countries are generally limited, while data from Thai population are lacking. Objective: To evaluate the incidence and outcomes of Thai patients who developed thrombocytopenia after TAVR. Materials and Methods: The present research was a retrospective observational study. The authors collected data from patients underwent TAVR at Siriraj Hospital between 2009 and 2019. The patients were stratified into four groups according to nadir platelet count, no thrombocytopenia with platelet of 150,000/uL or more, mild with platelet of 100,000 to 149,999/uL, moderate at 50,000 to 99,999/uL and severe at less than 50,000/uL. In addition, the patients with moderate to severe thrombocytopenia were stratified into two groups according to the percentage decline in platelet count (DPC) post procedure as DPC of less than 50% or DPC of 50% or more from the baseline platelet count. Results: Eighty-three patients were reviewed. One patient who died intraoperatively was excluded. Thrombocytopenia occurred in 62 patients (75.6%), in which 36.6% (n=30) of the cases were classed as moderate, and 8.5% (n=7) as severe thrombocytopenia. The platelet count returned to baseline before discharge or during the follow-up period in 83.8% (n=52) of patients. The incidence of in-hospital mortality was significantly higher in patients with severe thrombocytopenia than those with mild thrombocytopenia at 28.6% versus 4% (p=0.011). The duration of admission, length of stay in the CCU, incidence of life-threatening bleeding, clopidogrel discontinuation, platelet transfusion, rate of infection, shock, and acute kidney injury were also significantly higher in patients with moderate to severe thrombocytopenia. Conclusion: Acquired thrombocytopenia after TAVR is a common phenomenon in Thai patients (75%) but usually transient with a nadir platelet count greater than 50,000/uL. Most patients had spontaneous platelet recovery. The presence of severe thrombocytopenia with a nadir platelet count of less than 50,000 is a red flag sign for concomitant infection. The severity of thrombocytopenia is significantly associated with higher mortality and post-procedural adverse events. [ABSTRACT FROM AUTHOR]

Abstract Background The objective was to compare the value of late gadolinium enhancement (LGE) and end-diastolic wall thickness (EDWT) assessed by cardiovascular magnetic resonance (CMR) in predicting recovery of left ventricular function after coronary artery bypass surgery (CABG). Methods We enrolled patients with coronary artery disease and left ventricular ejection fraction < 45% who were scheduled for CABG. Regional contractility was assessed by cine CMR at baseline and 4 months after CABG. EDWT and LGE were assessed at baseline. Predictors for improvement of regional contractility were analyzed. Results We studied 46 men and 4 women with an average age of 61 years. Baseline left ventricular ejection fraction was 37 ± 13%. A total of 2,020 myocardial segments were analyzed. Abnormal wall motion and the LGE area were detected in 1,446 segments (71.6%) and 1,196 segments (59.2%) respectively. Wall motion improvement was demonstrated in 481 of 1,227 segments (39.2%) that initially had wall motion abnormalities at baseline. Logistic regression analysis showed that the LGE area, EDWT and resting wall motion grade predicted wall motion improvement. Comparison of Receiver-Operator-Characteristic (ROC) curves demonstrated that the LGE area was the most important predictor (p < 0.001). Adding information from LGE to the EDWT can decrease the number of false predictions by EDWT alone from 483 to 127 segments. Conclusion LGE and EDWT are independent predictors for functional recovery after revascularization. However, LGE appears to be a more important factor and independent of EDWT.

Objective: To compare 30 days mortality and clinical outcomes between transapical transcatheter aortic valve replacement (TA-TAVR) and transfemoral transcatheter aortic valve replacement (TF-TAVR) in Thai patients who underwent transcatheter aortic valve replacement (TAVR). Materials and Methods: The observational study included 83 consecutive patients that attended the authors' center for TAVR between January 2009 and December 2019. The patients' baseline demographic data and surgical risks were recorded. The clinical outcomes at 30 days and one year were prespecified targets. Results: Eighty-three patients underwent TAVR at the authors' center between 2009 and 2019, with 77% of them considered inoperable or at high surgical risk by the authors' heart team. Of the 83 patients, 40 had a porcelain aorta (48.2%). The median Society of Thoracic Surgeons (STS) score and logistic EuroSCORE were 5.7 (4.6, 8.3) and 21.7 (15.2, 31.2), respectively. Twenty-two patients had a transapical approach (26.5%). The cardiovascular (CV) mortality rate was 2.4% at 30 days. The all-cause mortality 30-day rate and 1-year rate were 3.6% and 12.0%, respectively. Comparing between TA-TAVR and TF-TAVR, TA-TAVR had a significantly lower incidence of new permanent pacemaker placement after TAVR (p=0.032), but a longer length of hospital stay (p=0.087). There was a trend for a higher incidence of new onset atrial fibrillation in TA-TAVR. The all-cause mortality 30-day rate and 1-year rate were similar between TA-TAVR and TF-TAVR. Conclusion: In Thai symptomatic severe aortic stenosis patients, of whom most patients were considered inoperable or at high surgical risk, both TA-TAVR and TF-TAVR showed acceptable short- and long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Many types of anomalous coronary artery have been reported. Some forms of the anomaly are potentially malignant and can lead to sudden death., Objective: To determine the prevalence and characters of anomalous coronary artery, including the associations of myocardial ischemia., Material and Method: This is a retrospective study. The authors enrolled patients who were referred for cardiac magnetic resonance (CMR) and had magnetic resonance coronary angiography (MRCA) images. Imaging of the coronary arteries was acquired. The presence and patterns of anomalous coronary artery and the presence of myocardial ischemia was recorded. Myocardial perfusion study was also performed in most patients using adenosine stress test., Results: Anomalous coronary artery was detected in 56 out of 3,703 patients (1.51%). There were 24 men (42.9%). Average age was 62.1 +/- 15.0 years. Most common type was right coronary artery (RCA) from left coronary cusp. Malignant form was demonstrated in 31 patients (55.4%) and myocardial ischemia was detected in 10 patients (23.3%)., Conclusion: Prevalence of anomalous coronary artery was 1.5%. Most common types were RCA from left coronary cusp (30%) and high take-off RCA (30%).

Objective: To compare inter-site observer variability of the Pixel- Wise (PW) method for cardiac T2* analysis in thalassemia patients using the mono-exponential with a constant fitting (offset) model and to compare the cross-model variability of the offset model to the mono-exponential (typical) model., Material and Method: Eighty-eight cardiac T2* measurements were performed on 72 Thalassemia major patients. Both bright- and black-blood techniques were acquired and analyzed at both the reference (REF) and local (LOC) sites using the PW method by defined region of interest on the whole (at the REF site) and partial (at the LOC site) septum. The offset model was analyzed at the reference site while both the offset and typical models were performed at the local site. The inter-site variability of the T2* values were analyzed by independent observers blinded to the results., Results: The T2* values from the REF-offset, LOC-offset and LOC-typical methods were statistically comparable on both scanning techniques. The inter-site variations of the offset model were about 5.2% and 4.4% on the bright- and black-blood techniques, respectively, which was about 1.7% higher than from the intra-site, but was still in a reasonable range compared to the conventional method of around 5.4%. The cross-model comparisons presented with 0.4 ms of bias and variation of about 6.9% and 4.7%, respectively, which is about 1.4% higher than from the intra-site., Conclusion: The observer variability on the PW method using the offset or typical model provided equivalent coefficient of variation on both scanning techniques, which was also comparable to the previous reports. The inter-site variability of the offset and cross models was also in a reasonable range, being less than 2% higher than the intra-site with bias of about 0.4 ms.

Background: Treatment of acute coronary syndrome requires a reliable measurement of quality for ensuring evidence-based care. Clinical registries have been used to support quality improvement activities in some countries, but there are few data concerning their implementation in developing countries. In 2008, a multidisciplinary Siriraj ST segment elevation myocardial infarction (STEMI) registry team was formed with the intention to improve the process of care. This report summarizes observational data collected within the first year to characterize the clinical profile, management and in-hospital outcomes of STEMI patients at the author's institute., Material and Method: The present study is a prospective, observational study. From June 2008 through June 2009, data from all consecutive patients presenting within 24 hours of STEMI at Siriraj Hospital were collected. The patient's data on demographics, procedures, medications and in-hospital outcomes were collected., Results: During the 1-year period, 112 patients with STEMI were enrolled. The mean age was 59.3 years old and 81.3% were males. There was a high prevalence of diabetes, hypertension, dyslipidemia and current smoking. Median time from symptom onset to presentation was 120 minutes. 98 patients (84.8% of the patients) received reperfusion therapy in the form of thrombolytic therapy (21.4%) or primary percutaneous coronary intervention (PCI, 63.40%). For thrombolytic therapy, the median door to needle time was 68 minutes. Rescue PCI was performed in 20.8% of the thrombolytic treated patients. For primary PCI, the median door to balloon time was 118 minutes. In-hospital coronary artery bypass graft surgery was performed in 6% of the patients. In-hospital mortality rate was 9.8%. Re-infarction and stroke were rare events., Conclusion: Despite a high utilization rate of reperfusion therapy the time to reperfusion therapy exceeds the length of time recommended by current guidelines. The authors' findings provide important data for future benchmarking and represent a significant opportunity for quality improvement in STEMI-related care and outcomes.

Objective: To assess the predictive value of in-training evaluation for determining future success in the internal medicine board certifying examination., Material and Method: Ninety-seven internal medicine residents from Faculty of Medicine Siriraj Hospital who undertake the Thai Board examination during the academic year 2006-2008 were enrolled. Correlation between the scores during internal medicine rotation and final scores in board examination were then examined., Results: Significant positive linear correlation was found between scores from both written and clinical parts of board certifying examination and scores from the first-year summative written and clinical examinations and also the second-year formative written examination (r = 0.43-0.68, p < 0.001). Monthly evaluation by attending staffs was less well correlated (r = 0.29-0.36) and the evaluation by nurses or medical students demonstrated inverse relationship (r = -0.2, p = 0.27 and r = -0.13, p = 0.48)., Conclusion: Some methods of in-training evaluation can predict successful outcome of board certifying examination. Multisource assessments cannot well extrapolate some aspects of professional competences and qualities.