Publications by authors named "Ewe S"
Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis (AS) and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exist a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomic variations, disparity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of AS in the Asia-Pacific region.
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- Transcatheter valve-in-valve (VIV) and valve-in-ring (VIR) therapies for failing mitral bioprosthetic valves are being researched to understand their effectiveness and safety over time.
- A meta-analysis reviewed 34 studies involving 7,047 patients to assess short and long-term outcomes, focusing on complications like mortality, stroke, and procedural success rates.
- Findings indicated high success rates of 94.8% for VIV and 80.5% for VIR, with varying short-term mortality and stroke risks across VIV, VIR, and traditional redo surgical mitral valve replacements (SMVR).
Article Synopsis
- Glycated haemoglobin (HbA1c), a key marker for diabetes, was investigated in older adults without cardiovascular disease to see its role in predicting myocardial ageing.
- A study with 247 participants showed significant correlations between HbA1c levels and various left atrial strain measures, indicating changes in heart function.
- The findings suggest that HbA1c could be a useful biomarker for assessing heart health risks related to ageing, regardless of whether an individual has diabetes.
Article Synopsis
- * Conducted on 122 patients with moderate to severe aortic stenosis, the research identified specific circulating proteins that correlate with higher risks of heart failure, severe symptoms, and mortality.
- * Key proteins linked to inflammation and immune responses were significantly associated with worse outcomes, particularly in patients showing reduced heart strain, suggesting new avenues for assessing patient risk beyond standard imaging methods.
Survival loss linked to guideline-based indications for degenerative mitral regurgitation surgery.
Eur Heart J Cardiovasc Imaging
November 2024
Article Synopsis
- The study evaluated the long-term survival outcomes of 2833 patients with severe degenerative mitral regurgitation (DMR) who underwent surgical correction, guided by various surgical indications.
- Results indicated that patients classified under Class-I triggers experienced significantly lower postoperative survival rates compared to those under Class-IIa triggers or no triggers, with a median follow-up of 8.5 years showing a stark difference in survival percentages.
- Overall, operating on patients with Class-I criteria resulted in a considerable loss of postoperative survival time, suggesting that immediate surgery based on these guidelines may not be the best approach for improving long-term outcomes in DMR patients.
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- The study addresses the rising need for echocardiograms (echo) in aging populations affected by heart failure (HF) while highlighting the shortage of trained sonographers and long waiting times.
- Researchers tested an AI-enhanced point-of-care echo conducted by novices after a short training period to see how accurately it could detect reduced left ventricular ejection fraction (LVEF) in patients suspected of having HF.
- The results showed that the AI novice method was quite effective, with a high accuracy and shorter testing time compared to standard echo, suggesting it could help improve HF diagnosis and expand access beyond specialized centers.
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- This updated meta-analysis examines the effectiveness and safety of the SENTINEL Cerebral Protection System during transcatheter aortic valve implantation (TAVI), revealing mixed results across various studies.
- The analysis included 15 studies with over 294,000 patients, finding significant reductions in mortality and strokes (both all and disabling) when using the SENTINEL device, especially in studies focusing on outcomes within 30 days.
- Despite positive findings, there was notable variability in outcome results, particularly for mortality and overall stroke rates among the studies, indicating a need for further research to clarify these differences.
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- The study investigates early diastolic dysfunction in older adults as a potential predictor of cardiovascular disease and death, finding that many individuals show signs of myocardial aging before clinical signs of heart issues.* -
- Among 956 participants, those with a peak early-to-late diastolic filling velocity (E/A) ratio of less than 0.8 had a significantly higher risk of non-fatal cardiovascular outcomes, with notable differences between sexes in outcomes and event rates.* -
- The findings suggest that impaired myocardial relaxation is common, particularly impacting women more severely than men, highlighting the importance of considering sex differences in aging-related cardiovascular health.*
Transcatheter structural heart intervention (TSHI) has gained popularity over the past decade as a means of cardiac intervention in patients with prohibitive surgical risks. Following the exponential rise in cases and devices developed over the period, there has been increased focus on developing the role of "structural imagers" amongst cardiologists. This review, as part of a growing initiative to develop the field of interventional echocardiography, aims to highlight the role of echocardiography in myriad TSHIs available within Asia.
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- A meta-analysis was conducted to compare clinical outcomes between left atrial appendage closure (LAAC) and direct oral anticoagulants (DOACs) in patients with atrial fibrillation, examining various cardiovascular events and mortality rates.
- The analysis included 7 studies with over 8,900 patients, showing that LAAC was linked to lower rates of major adverse cardiovascular events, all-cause mortality, and cardiovascular mortality compared to DOACs after an average follow-up of 22 months.
- However, there were no significant differences in ischemic stroke, systemic embolism, major bleeding, or hemorrhagic stroke rates between the two groups, suggesting that LAAC could be an effective alternative for stroke prevention in these patients
Article Synopsis
- * A study analyzed almost 25,000 patients who had multiple echocardiograms, revealing that the average expansion rate of the thoracic aorta is less than 2 mm per decade.
- * Younger males with larger aortas showed faster expansion rates, which could influence future management strategies for aortic health.
Background: Recent data showed poor long-term survival in patients with moderate AS. Although sex differences in left ventricular (LV) remodeling and outcome are well described in severe AS, it has not been evaluated in moderate AS.
Methods: In this retrospective, multicenter study, patients with a first diagnosis of moderate AS diagnosed between 2001 and 2019 were identified.
Article Synopsis
- The study examines outcomes of three aortic valve replacement (AVR) techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional (CAVR), focusing on all-cause mortality rates.
- A total of 27 studies with over 16,000 patients were analyzed, revealing that TAVI initially had lower mortality compared to CAVR, but this advantage diminished after 37.5 months.
- MIAVR demonstrated significantly lower mortality rates than both TAVI and CAVR, although TAVI showed consistent benefits specifically in patients undergoing transfemoral (TF) procedures; however, more research is needed for conclusive results.
Article Synopsis
- * It remains unclear whether these increased risks stem from patient comorbidities or the AS itself, and there's uncertainty about which patients require close monitoring or might benefit from earlier AVR.
- * The authors review existing literature on moderate AS, present a diagnostic algorithm for accurate identification, emphasize the heart's role beyond just the valve, and discuss how advanced imaging can enhance patient risk assessment and management strategies.
The impact of atrial fibrillation on prognosis in aortic stenosis.
Eur Heart J Qual Care Clin Outcomes
December 2023
Article Synopsis
- The study investigates the relationship between atrial fibrillation (AF) and aortic stenosis (AS), two common heart conditions that often occur together, focusing on their impact on patient mortality while considering left ventricular (LV) diastolic function.
- Out of 2849 patients with significant AS, 24.1% had a history of AF, and after a median follow-up of 60 months, the ten-year mortality rate was significantly higher in patients with AF (46.8%) compared to those with normal sinus rhythm (36.8%).
- Despite the initial findings linking AF to higher mortality, when adjusting for factors related to LV diastolic function, AF was not seen as
Article Synopsis
- The study investigates how aging affects cardiovascular health in men and women, focusing on differences in various biological markers called metabolites.* -
- It analyzed data from 567 adults in Singapore, revealing that women generally had better cardiovascular indicators, such as lower blood pressure and higher diastolic function scores than men.* -
- The findings suggest that specific metabolites are linked to cardiac function in women, indicating that understanding these relationships could help explain the impacts of aging on women's cardiovascular health.*
Prognostic Value of Left Atrial Strain in Aortic Stenosis: A Competing Risk Analysis.
J Am Soc Echocardiogr
January 2023
Article Synopsis
- * Using speckle-tracking echocardiography, researchers measured three types of LA strain and tracked patient outcomes over an average of 2.7 years, finding that lower strain values correlated with worse clinical results.
- * LA strain metrics (particularly LASr < 20%) demonstrated superior prognostic value compared to traditional echocardiographic variables and were strongly linked to adverse outcomes like heart failure hospitalizations and mortality.
Introduction: Data on patients with small aortic annuli (SAA) undergoing transcatheter aortic valve implantation (TAVI) are limited. We aim to describe the impact of aortic annular size, particularly SAA and TAVI valve type on valve haemodynamics, durability and clinical outcomes.
Method: All patients in National Heart Centre Singapore who underwent transfemoral TAVI for severe symptomatic native aortic stenosis from July 2012 to December 2019 were included.
The rate of aortic stenosis (AS) progression in patients with moderate AS is unclear. This study examined the risk factors of progression from moderate to severe AS and its impact on clinical outcomes. A total of 954 patients with moderate AS (valve area >1.
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- The study investigated the prevalence and prognostic implications of different flow-gradient patterns in patients with moderate aortic stenosis (AS), highlighting a gap in knowledge about their outcomes.
- Among 1,974 patients analyzed, 40% exhibited discordant grading, which correlated with significantly higher mortality rates compared to those with concordant moderate AS.
- Key findings indicated that both "paradoxical" and "classical" low-flow, low-gradient patterns were independently linked to increased all-cause mortality, emphasizing the importance of improved patient classification in moderate AS cases.
Objective: To investigate the prognostic impact of left ventricular (LV) diastolic dysfunction in patients with moderate aortic stenosis (AS) and preserved LV systolic function.
Methods: Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.
Article Synopsis
- The study aimed to find the significance of various biomarkers in predicting outcomes for patients with aortic stenosis (AS), particularly in terms of mortality and heart failure.
- Researchers measured biomarkers like NT-proBNP, hsTnT, and MR-proADM in 173 patients with moderate to severe AS over several years, analyzing their effectiveness in predicting primary and secondary health outcomes.
- Results indicated that MR-proADM had the strongest correlation with worse health outcomes, suggesting it could be the key biomarker for assessing risk in AS patients.
Article Synopsis
- The study investigates the prognostic significance of left ventricular global longitudinal strain (LV GLS) in patients with moderate aortic stenosis (AS), focusing on its relationship with all-cause mortality.
- It involved analyzing data from 760 patients over a median follow-up of 50 months, revealing that lower LV GLS was linked to higher mortality rates compared to those with better LV GLS values, regardless of ejection fraction.
- The findings suggest that LV GLS can identify higher-risk patients for adverse outcomes, even among those who are asymptomatic or have a preserved ejection fraction.
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- BMI is commonly used to assess obesity but doesn't effectively indicate cardiovascular risks, while waist circumference (WC) presents a better measure, especially in older adults.
- An observational study of 970 older adults revealed that more people were classified as obese using WC (35.7%) compared to BMI (12.8%), with a notable agreement in classifications.
- Higher WC was linked to worse heart function metrics, even among those with low BMI, suggesting that WC is a more reliable indicator of cardiovascular health in this population.