Journal of Asian Pacific Society of Cardiology最新文献

{"title":"Validation of Hospital Frailty Risk Score in Heart Failure","authors":"Zhenwei Teo, Ying Zi Oh, Weiliang Huang, Sheldon Lee, Ting Yu Chang, Aileen Lim, Lydia Euphemia Sim, Wrenzie Del Valle Espelata, Simon Conroy, B. H. Rosario","doi":"10.15420/japsc.2023.38","DOIUrl":"https://doi.org/10.15420/japsc.2023.38","url":null,"abstract":"Background: Frailty is prevalent in older people and results from age-related decline in physiological function and reserve. The objective of this study was to validate the Hospital Frailty Risk Score (HFRS) in predicting outcomes and hospitalisation usage in older hospitalised heart failure (HF) patients. Methods: This study was a retrospective review of electronic medical records. Patients aged ≥65 years admitted with HF to a Singapore tertiary hospital between 1 January 2021 and 30 April 2021 were included. Patients were identified as HF patients in the value-driven care pathway and using ICD codes for HF. They were categorised into low risk (<5), intermediate risk (5–15) and high risk (>15) of frailty using the HFRS. Results: A total of 208 older patients with HF were included (mean age 79.4 years; 50.5% males). Using the HFRS, 35.1% were deemed at low risk, 46.2% at intermediate risk and 18.8% at high risk of frailty. Those at high risk of frailty were older than those at low risk (mean age 84.8 versus 76.5 years, respectively; p<0.001). Women had a higher risk of frailty than men. Univariate analyses showed longer length of stay (LOS) and higher 30-, 90- and 365-day mortality in those at high frailty risk. In multivariate analyses, HFRS was associated with long LOS, 90-day and 1-year mortality. Dementia, acute MI and renal disease were more common in high-risk patients. Comparing HFRS with the Charlson Comorbidity Index (CCI), HFRS was a better predictor of long LOS, mortality at 30, 90, 1 year and 30-day readmission than CCI. HFRS alone was a better predictor than combining the HFRS and CCI. Conclusion: Older patients with higher HFRS have increased healthcare utilisation, including longer LOS and higher mortality.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"82 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141121218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Tuberculous Constrictive Pericarditis Due to Disseminated Tuberculosis with Response to Anti-tuberculosis Chemotherapy and Steroids in a Developed City State","authors":"Luokai Wang, Jade Soh, Yun Yun Go, I. Balakrishnan, Srujana Ganti, Min-On Tan","doi":"10.15420/japsc.2023.52","DOIUrl":"https://doi.org/10.15420/japsc.2023.52","url":null,"abstract":"A 27-year-old man presented with a 1-week history of atypical chest pain and sinus tachycardia. His physical examination was unremarkable. His resting ECG showed sinus tachycardia with widespread T-wave inversion. His initial blood tests show mildly raised troponin T and inflammatory markers and marked raised D-dimer. A CT pulmonary angiogram was performed to exclude pulmonary embolism but incidentally revealed an anterior mediastinal mass. A transthoracic echocardiogram and cardiac MRI showed features of constrictive pericarditis. A video-assisted thoracoscopic surgical biopsy of the anterior mediastinal mass showed thymic tissue with necrotising granulomatous inflammation and an acid-fast bacilli culture was positive to tuberculosis infection. The patient was started on anti-tuberculosis chemotherapy and a 6-week tapering course of oral steroids. A repeat cardiac MRI performed after 6 weeks of treatment showed a significant response to treatment with resolution of constrictive physiology.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"383 2‐3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Quantitative Flow Ratio for Decisions and Outcomes in Percutaneous Coronary Intervention Study","authors":"S. Sukahri, A. Zuhdi, K. Chee, I. Abidin, Ramesh Singh Argan Singh, Alexander Loch, Nor Ashikin Md Sari, Nursyuhada Khairul Anuar, Kee Wei Lee, M. A. Aseri, Mohamad Rodi Isa, Waw Ahmad","doi":"10.15420/japsc.2023.72","DOIUrl":"https://doi.org/10.15420/japsc.2023.72","url":null,"abstract":"Background: This pilot study explores the impact of quantitative flow ratio (QFR) guidance on decision-making for angioplasty and post-intervention procedures in stable coronary artery disease. Aim: The primary aim was to evaluate the vessel-oriented composite endpoint (VOCE) at 6 months, encompassing cardiac death, vessel-related MI and ischaemia-driven target vessel revascularisation. Secondary objectives included assessing individual components of VOCE and the influence that the QFR had on decision-making before and after interventions. Methods: The pilot study was conducted from 1 January to 31 July 2023 and included all angiogram patients. Cardiologists used QFR readings for decision-making, with QFR >0.80 indicating non-significance and <0.80 denoting significant stenosis, prompting angioplasty. The lesions were re-evaluated post-angioplasty and QFR >0.90 indicated that no further intervention was necessary. Results: A total of 770 subjects were screened. Most of the patients in the post-percutaneous coronary intervention (PCI) without QFR group were Malaysian (36.1%), while there were more Chinese patients in the PCI with QFR group (49.2%). Hypertension was the primary risk factor for both groups (79.5% and 73%, respectively). Decision changes were more common in pre-intervention assessments (39%), with 34% of these opted not to proceed whereas 66% agreed to proceed. Post-PCI decision changes were less common (22%); 19% of these opted for further intervention and 81% accepted the angiographic results before the QFR reading. VOCE at 6-month follow-up showed one cardiac death in the PCI without QFR group and none in the PCI with QFR group (p=0.316). Conclusion: QFR readings demonstrated significant value in guiding pre-PCI decisions. This study underscores the potential for enhanced decision-making and improved patient outcomes by using QFR-guided interventions.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Polypill Approach in Heart Failure: A Survey Study","authors":"R. Shariff, Khairul Shafiq Ibrahim, S. Kasim","doi":"10.15420/japsc.2023.64","DOIUrl":"https://doi.org/10.15420/japsc.2023.64","url":null,"abstract":"This survey study aimed to assess readiness, amongst cardiologists and cardiology trainees, in using a polypill strategy in the management of heart failure. A national-level, 21-item survey study was conducted between 1 January 2023 and 30 June 2023. A total of 120 participants responded, with clinical practice differing greatly. Potential challenges in polypill prescription were mainly surrounding clinical safety and cost. Dosing strategies were also an important aspect, many believing that polypills should exist with various dosing combinations. In addition, evidence focused on safety and tolerability were felt important, pre-marketing. This survey demonstrates how implementation of a polypill strategy may remain challenging, especially in an Asia-Pacific community.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"18 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140726649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Amyloidosis: Everywhere, but Nowhere","authors":"Aqtab Mazhar Alias, R. Shariff, Norashikin Saidon, Muhammad Afif Munshi, U. Asmawi, Mohd Rahal Yusoff, S. Kasim","doi":"10.15420/japsc.2023.32","DOIUrl":"https://doi.org/10.15420/japsc.2023.32","url":null,"abstract":"Clinical pathways in the evaluation and management of cardiac amyloidosis (CA) are haphazard in Malaysia. Presented here are two cases that serve as examples of how diagnosis of CA can often be missed or delayed, leading to serious consequences. A complex interplay between various factors contributes to this, including lack of expertise and facilities to support early recognition and confirmation of CA affecting laboratory services, radiological services, and expertise in the disease. A lack of coordinated care involving various disciplines and subspecialties has been a barrier in establishing a national-level clinical pathway for CA. Additionally, there is poor awareness among clinicians surrounding CA, where limited experience in managing the disease is concentrated in major centres. Building an amyloidosis network may be the way forward, as the onus is on clinicians to improve the way they communicate with each other.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"104 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Percutaneous Pulmonary Valve Implantation: The Singapore Experience","authors":"F. Y. Lim, J. S. Foo, Jonathan Yap, Phong Teck Lee, S. Sundararaghavan, Ju Le Tan","doi":"10.15420/japsc.2023.79","DOIUrl":"https://doi.org/10.15420/japsc.2023.79","url":null,"abstract":"Background: Right ventricular outflow tract (RVOT) dysfunction in adult congenital heart disease patients frequently requires repeated interventions. Percutaneous pulmonary valve implantation (PPVI) is being used increasingly to treat pulmonary stenosis (PS) and regurgitation (PR), improving symptoms, right ventricular haemodynamics and function and, indirectly, left ventricular filling and function. This article explores the authors’ early local experience with PPVI. Methods: Between 2017 and 2022, PPVI was attempted in 10 patients at a single tertiary centre, including six with PS and four with PR. Patients underwent multimodality imaging and dental clearance. PPVI was then performed. Patients were continued on lifelong single antiplatelet therapy and dental hygiene was reinforced. Results: Overall, there was an 80% success rate of Melody PPVI in the 10 adult congenital heart disease (ACHD) patients (mean age 35.8 ± 13.7 years; 60% male), with significant improvements in RVOT pathology, right ventricle function and pulmonary pressures. Melody PPVI was cancelled in one patient due to risk of coronary compression, and an Edwards S3 PPVI was implanted in another patient instead due to a large RVOT size causing stent embolisation. Two patients experienced complications of bleeding and stent fracture, both of which were conservatively managed and had good long-term outcomes. Conclusion: The authors present their early local experience with PPVI in ACHD patients at a single tertiary centre. PPVI has proven to be safe and efficacious, improving PS and PR, right and left ventricle function and pulmonary pressures. Nonetheless, precautions must be taken to minimise complications such as coronary compression, access site bleeding, device embolisation and stent fracture.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"123 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140752681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Onset Severe Aortic Stenosis Presenting with Recurrent Ventricular and Supraventricular Arrhythmia and Postoperative Stroke in a 44-year-old Man with Uncontrolled Rheumatoid Arthritis","authors":"Arvinjay A Bautista, Danilo S Kuizon","doi":"10.15420/japsc.2023.27","DOIUrl":"https://doi.org/10.15420/japsc.2023.27","url":null,"abstract":"Calcific aortic stenosis is the most common aetiology of aortic stenosis and is mostly seen in older people. Systemic inflammatory diseases, such as rheumatoid arthritis (RA), are rarely associated with aortic stenosis in the literature. Uncontrolled systemic inflammation related to RA may lead to postoperative complications but this is not well documented. The patient in this case report was a 44-year-old man who had been diagnosed with RA that had been poorly controlled. He had a 7-month history of heart failure symptoms attributed to severe calcific aortic stenosis. He underwent surgical aortic valve replacement, but developed an acute cerebrovascular infarct 2 hours after surgery and recurrent unstable ventricular tachycardia on the first postoperative day warranting 15 synchronised cardioversions. RA is a rare antecedent cause of severe calcific aortic stenosis especially in younger people. Such a valvular complication associated with acute ischaemic stroke and ventricular arrhythmia warrants further study to provide optimal medical management, especially for patients with RA and early cardiovascular complications.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"56 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140080743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and Perception Surrounding Heart Failure Fellowship Training: A Survey Study","authors":"R. Shariff, Mohd Afiq Hannan Mohd Azri, Burhanuddin Moize, Aqtab Mazhar Alias, Mohd Rahal Yusoff, Khairul Shafiq Ibrahim, Azmee B. Mohd Ghazi, Sazzli Kasim","doi":"10.15420/japsc.2023.28","DOIUrl":"https://doi.org/10.15420/japsc.2023.28","url":null,"abstract":"Background: Despite the burgeoning burden of heart failure (HF) in South-east Asia, very few opportunities exist to be formally trained in HF within the region. The aim of this study was to assess the knowledge, attitudes and perception surrounding HF training and HF as a potential subspeciality. Methods: A national-level, 28-item online survey study was conducted between 20 October and 20 November 2022. The target group for the survey was cardiology fellows-in-training, cardiologist post-training (non-consultants) and consultant cardiologists. A total of 82 people were asked to complete the survey. The type of data collected included the following areas of interest: respondent demographics; knowledge and perception of current clinical practice locally; knowledge, attitudes and perceptions of training in HF, associated cardiology subspecialities and AHFT; and attitudes and perceptions towards a recommended HF curriculum designed by the authors. Results: Fifty-one responses were obtained (response rate 62.2%). The mean (± SD) age of respondents was 39.4 ± 6.5 years, most of whom were men (84.3%). Most respondents were cardiology fellows-in-training (58.8%) and consultant cardiologists (29.4%). Although most respondents (82.4%) felt that advanced HF and transplantation (AHFT) training should be made available, only 52.9% felt that training was feasible in Malaysia. Nevertheless, training without AHFT exposure may still be feasible, especially when incorporating other subspecialities. When introduced to our proposed HF curriculum, most respondents (82.4%) felt that it was feasible for implementation locally, although many (66.7%) felt that the lack of AHFT exposure would make it less attractive and that a rotation in an AHFT-capable centre would be essential (90.2%). When asked about other ‘adjunctive’ rotations, again most agreed that echocardiography, critical care cardiology and cardiac MRI training were potentially supplementary. Although exposure to clinical research and training was most welcome (78.4%), formal research through a Master’s or PhD degree was not essential. Conclusion: The survey highlights several important issues surrounding knowledge and perception of current cardiology training in South-east Asia. The information obtained will be useful in designing a HF curriculum that is ‘fit for purpose’ in Malaysia.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"33 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The State and Direction of Treatment of Heart Failure with Reduced Ejection Fraction in Papua New Guinea","authors":"Leslie Bahn Kawa","doi":"10.15420/japsc.2023.19","DOIUrl":"https://doi.org/10.15420/japsc.2023.19","url":null,"abstract":"The pharmacological treatment of heart failure has evolved over the last three decades since the demonstration of the effect of angiotensin-converting enzyme inhibitors on major cardiovascular events in patients with heart failure with reduced ejection fraction. Composite analysis of heart failure with reduced ejection fraction trials and the recent identification of newer drug treatments show early benefits on the major cardiovascular outcomes, ushering in a change of the treatment strategy; from a ‘sequential’ initiation of the treatments to a ‘simultaneous’ initiation to harness the early benefits. The adoption and implementation of these changes at the bedside have been dismal in many healthcare settings. Papua New Guinea, like many other lower-to-middle-income countries, is facing many barriers that impact on the care of heart failure patients. It needs to adopt and implement these changes to provide evidence-based treatment for its people with heart failure with reduced ejection fraction.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139220910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telomere and Telomerase Biology in Cardiovascular Disease: A State-of-the-art Review and Outlook","authors":"Xian Wen Tan, Alan Yean Yip Fong","doi":"10.15420/japsc.2023.26","DOIUrl":"https://doi.org/10.15420/japsc.2023.26","url":null,"abstract":"Telomeres are short repetitive hexanucleotides located at the ends of eukaryotic DNA sequences. They progressively shorten with each mitotic cycle, and telomerase counteracts the process by regulating and extending the telomeres. Ageing, oxidative stress and inflammation are predisposing factors that accelerate telomere shortening, and eventually drive cells to senescence. Recent findings have observed the associations of short telomere length with traditional cardiovascular risk factors leading to cardiovascular phenotype. However, such association remains hypothesised as a reserved causation, mainly confounded by unfathomable covariates and mixed research findings. Based on the recent literature, the present review aimed to provide a concise update and diverging view on telomere−telomerase biology in cardiovascular disease.","PeriodicalId":321604,"journal":{"name":"Journal of Asian Pacific Society of Cardiology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139217461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}