Publications by authors named "Charles Hou"

For the primary prevention of atherosclerotic cardiovascular disease (ASCVD), the recommended treatment target for each modifiable risk factor is as follows: reducing body weight by 5-10%; blood pressure < 130/80 mmHg (systolic pressure < 120 mmHg in high-risk individuals); low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL in high-risk individuals, LDL-C < 115 mg/dL in moderate-risk individuals, LDL-C < 130 mg/dL in low-risk individuals, and LDL-C < 160 mg/dL in those with a minimal; complete and persistent abstinence from cigarette smoking; hemoglobin A1C < 7.0%; fulfilling recommended amounts of the six food groups according to the Taiwan food guide; and moderate-intensity physical activity 150 min/wk or vigorous physical activity 75 min/wk. For the primary prevention of ASCVD by pharmacological treatment in individuals with modifiable risk factors/clinical conditions, statins are the first-line therapy for reducing LDL-C levels; some specific anti-diabetic drugs proven to be effective in randomized controlled trials for the primary prevention of ASCVD are recommended in patients with type 2 diabetes mellitus; pharmacological treatment is recommended to assist in weight management for obese patients with a body mass index ≥ 30 kg/m (or 27 kg/m who also have at least one ASCVD risk factor or obesity-related comorbidity); an angiotensin-converting enzyme inhibitor, a glucagon-like peptide-1 receptor agonist, a sodium-dependent glucose cotransporter-2 inhibitor, and finerenone can be used in diabetic patients with chronic kidney disease for the primary prevention of ASCVD.

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In the past, patients with pulmonary hypertension (PH) were advised to avoid exercise due to concerns that it might strain cardiac function and exacerbate symptoms. However, recent evidence indicates that structured exercise programs can enhance outcomes and improve health-related quality of life for these patients. Consequently, exercise rehabilitation is now recommended in international guidelines as a key component of PH management.

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Article Synopsis
  • * The guidelines address various aspects of ASCVD, including chronic coronary syndrome and cerebrovascular diseases, while promoting health education and the management of clinical risk factors like diet, exercise, and smoking.
  • * A catchy slogan and a memorable acronym were proposed to reinforce lifestyle changes related to modifiable risk factors, emphasizing the importance of healthy eating, physical activity, and overall well-being for ASCVD prevention.
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Background: Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, is an epochal oral antidiabetic drug that improves cardiorenal outcomes. However, the effect of early dapagliflozin intervention on left ventricular (LV) remodeling in patients with type 2 diabetes free from cardiovascular disease remains unclear.

Methods And Results: The ELUCIDATE trial was a prospective, open-label, randomized, active-controlled study that enrolled 76 patients with asymptomatic type 2 diabetes with LV ejection fraction ≥50%, randomized to the dapagliflozin 10 mg/day add-on or standard-of-care group.

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Peripheral artery disease (PAD) shares common clinical risk factors, for example, endothelial dysfunction, with preserved ejection fraction (LVEF) heart failure (HFpEF). Whether PAD is associated with preclinical systolic dysfunction and higher HF risk among individuals presenting preserved LVEF remains uncertain. We retrospectively included outpatients with at least one known or established cardiovascular (CV) risk factor with LVEF ≥ 50%.

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  • - Metabolic dysfunction-associated fatty liver disease (MAFLD) is a rising global health concern that is diagnosed through imaging, histology, or serum markers, alongside metabolic conditions like obesity and type 2 diabetes.
  • - MAFLD not only affects the liver but is also linked to cardiovascular diseases (CVD), which significantly increase the health risks and mortality for affected individuals.
  • - A recent position statement from Taiwan synthesizes research on MAFLD's prevalence, risk factors, and treatment options, emphasizing the need for collaboration between liver and heart specialists to better manage this interrelated health issue.
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  • Sleep disordered breathing (SDB) is common and has potential connections to cardiovascular diseases like atrial fibrillation, hypertension, and heart failure.
  • A task force from several Taiwanese medical societies reviewed evidence on assessing and managing SDB in these patients using the GRADE process.
  • They created 11 recommendations, weighing evidence quality and patient needs to help clinicians tailor care strategies for individuals with SDB and related heart conditions.
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  • The study evaluates LCZ696, an angiotensin receptor-neprilysin inhibitor, as a treatment for patients with reduced ejection fraction heart failure (HFrEF) and examines its benefits across different subgroups.
  • A pooled analysis of 2,206 patients identified three distinct phenogroups based on clinical characteristics, with varied outcomes: phenogroup 1 had the best clinical results, phenogroup 2 experienced the highest cardiovascular death rates, and phenogroup 3 faced the most all-cause deaths and hospitalizations for heart failure.
  • The findings suggest that understanding these phenogroups can improve prognosis and treatment strategies for HFrEF patients receiving sacubitril/valsartan therapy.
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  • A nationwide registry study is being conducted in Taiwan with 3,600 patients to better understand the treatment of acute coronary syndrome (ACS) by gathering data during and after hospitalization.
  • Data will be collected at three key time points: during hospitalization, 6 months, and 12 months post-discharge to assess the use of guideline-directed therapies and identify predictors of one-year health outcomes.
  • The study aims to improve ACS treatment by analyzing results over the next 20 years, enhancing knowledge about the adherence to medical guidelines and patient prognoses.
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  • Cardiac amyloidosis is a type of systemic amyloidosis where abnormal amyloid fibrils accumulate in heart tissue, leading to heart failure due to restrictive cardiomyopathy and conduction problems.
  • The condition is more common than previously thought, especially in certain populations, but is often diagnosed late, indicating a need for better awareness and collaboration among healthcare professionals.
  • The Taiwan Society of Cardiology has created an "Expert Consensus" to enhance the diagnosis and treatment of cardiac amyloidosis, introducing helpful tools and algorithms to aid in early detection and care for patients, including acronyms for diagnosing transthyretin amyloid cardiomyopathy.
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Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome with multiple underlying mechanisms and comorbidities that leads to a variety of clinical phenotypes. The identification and characterization of these phenotypes are essential for better understanding the precise pathophysiology of HFpEF, identifying appropriate treatment strategies, and improving patient outcomes. Despite accumulating data showing the potentiality of artificial intelligence (AI)-based phenotyping using clinical, biomarker, and imaging information from multiple dimensions in HFpEF management, contemporary guidelines and consensus do not incorporate these in daily practice.

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The prevalence of heart failure is increasing, causing a tremendous burden on health care systems around the world. Although mortality rate of heart failure has been significantly reduced by several effective agents in the past 3 decades, yet it remains high in observational studies. More recently, several new classes of drugs emerged with significant efficacy in reducing mortality and hospitalization in chronic heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

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Background: Pulmonary arterial hypertension (PAH), defined as the presence of a mean pulmonary artery pressure > 20 mmHg, pulmonary artery wedge pressure ≤ 15 mmHg, and pulmonary vascular resistance (PVR) > 2 Wood units based on expert consensus, is characterized by a progressive and sustained increase in PVR, which may lead to right heart failure and death. PAH is a well-known complication of connective tissue diseases (CTDs), such as systemic sclerosis, systemic lupus erythematosus, Sjogren's syndrome, and other autoimmune conditions. In the past few years, tremendous progress in the understanding of PAH pathogenesis has been made, with various novel diagnostic and screening methods for the early detection of PAH proposed worldwide.

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Background: We tested the hypothesis that non-invasive pulse wave analysis (PWA)-derived systemic circulation variables can predict invasive hemodynamics of pulmonary circulation and the indicator of right heart function, N-terminal pro-brain natriuretic peptide (NT-proBNP), in patients with precapillary pulmonary hypertension (PH).

Methods: This prospective study enrolled patients with group 1 and 4 PH who had complete PWA, NT-proBNP, and hemodynamics data. Risk assessment-based "hemodynamic score (HS)" and principal component analysis-based PWA variable grouping were determined/performed.

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  • Fragmented QRS (fQRS) may indicate myocardial scarring and is linked to worse outcomes in heart failure patients, especially those with preserved ejection fraction (HFpEF).
  • A study of 960 HFpEF patients identified different fQRS patterns and found that those with anterior/lateral fQRS had higher biomarkers indicating cardiac stress and more severe structural heart issues.
  • Over a follow-up period, patients with anterior/lateral fQRS faced a doubled risk of heart failure readmission and higher mortality rates, emphasizing the need for early detection and tailored treatment strategies.
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  • Coronary artery disease (CAD) ranges from asymptomatic individuals to those experiencing acute coronary syndromes and sudden cardiac death, highlighting its spectrum and serious nature.
  • Over time, CAD is marked by the development of atherosclerotic plaques in coronary arteries, with a tendency for sudden progression to critical events despite stable periods and treatments.
  • Recent changes in CAD guidelines now categorize the disease into acute and chronic coronary syndromes, recognizing its complexity and emphasizing a shift from merely addressing coronary ischemia to focusing on the broader aspects of atherosclerosis for better prevention and treatment.*
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  • Epicardial adipose tissue (EAT) and peri-aortic fat (PAF) are linked to metabolic disorders and unfavorable cardiovascular events, influencing heart rate recovery after exercise.
  • A study involving 156 participants assessed how regional visceral fat affects heart rate and blood pressure during exercise, utilizing advanced imaging techniques to quantify fat.
  • Results indicated that higher EAT and PAF levels correlate with reduced heart rate recovery post-exercise and altered blood pressure, suggesting that excess visceral fat could impact autonomic function and contribute to cardiovascular issues.
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Visceral adipose tissue (VAT) is associated with central obesity, insulin resistance and metabolic syndrome. However, the association of body-site specific adiposity and non-alcoholic fatty liver disease (NAFLD) has not been well characterized. We studies 704 consecutive subjects who underwent annual health survey in Taiwan.

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  • - Hypertension is a major risk factor for cardiovascular disease and overall mortality, yet the traditional blood pressure threshold for diagnosing hypertension has remained at 140/90 mmHg despite evidence suggesting lower thresholds may be more beneficial.
  • - Recent studies, like SPRINT and STEP, challenge this long-standing belief and highlight the benefits of home blood pressure monitoring (HBPM), which is found to be more reliable than office measurements for tracking true blood pressure levels and related health risks.
  • - The 2022 Taiwan Hypertension Guidelines redefine hypertension as blood pressure ≥ 130/80 mmHg and suggest a target of < 130/80 mmHg, advocating for HBPM using a specific protocol to improve hypertension management and enhance patient outcomes.
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Background: Despite known sex differences in cardiac structure and function, little is known about how menopause and estrogen associate with atrioventricular mechanics and outcomes.

Objective: To study how, sex differences, loss of estrogen in menopause and duration of menopause, relate to atrioventricular mechanics and outcomes.

Methods: Among 4051 asymptomatic adults (49.

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Advances in cancer management have significantly improved survival in patients with cancers. Cardiovascular complications of cancer treatment are becoming significant competing causes of death in these patients. Radiotherapy is an indispensable component of cancer treatment, and irradiation of the heart and vasculature during cancer radiotherapy is now recognized as a new risk factor for cardiovascular diseases.

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Background Visceral adipose tissue is assumed to be an important indicator for insulin resistance and diabetes beyond overweight/obesity. We hypothesized that region-specific visceral adipose tissue may regulate differential biological effects for new-onset diabetes regardless of overall obesity. Methods and Results We quantified various visceral adipose tissue measures, including epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue in 1039 consecutive asymptomatic participants who underwent multidetector computed tomography.

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Aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism is a common genetic variant in Asians that is responsible for defective toxic aldehyde and lipid peroxidation metabolism after alcohol consumption. The extent to which low alcohol consumption may cause atrial substrates to trigger atrial fibrillation (AF) development in users with ALDH2 variants remains to be determined. We prospectively enrolled 249 ethnic Asians, including 56 non-drinkers and 193 habitual drinkers (135 (70%) as ALDH2 wild-type: GG, rs671; 58 (30%) as ALDH2 variants: G/A or A/A, rs671).

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Background: This study aims to explore the clinical correlates of myocardial deformations using speckle-tracking algorithm and to determine the prognostic utility of such measures in asymptomatic ethnic Chinese population.

Methods: Global longitudinal (GLS), circumferential strain (GCS), and torsion were analyzed using featured tissue-tracking algorithm among 4049 symptom-free ethnic Chinese population. Hypertrophy (LVH) was classified into 4 tiers: indeterminate, dilated, thick and thick/dilated, by gender-stratified partition of end-diastolic volume index (EDVi) and LV mass/EDV0.

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Advances in cancer treatments have led to an increasing number of cancer survivors, but also high rates of short- and long-term cardiovascular (CV) toxicities. The number of new cancer drugs is constantly increasing, and the uncertain CV toxicities of these drugs make long-term care and monitoring difficult. Moreover, traditional type I and type II cardiotoxicities may not be applicable to all of these agents.

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