Two-year outcome of ventricular assist device via a modified left atrium to aorta approach in cardiac amyloidosis.

Cardiac amyloidosis is a debilitating disease associated with poor long-term survival. Medical or palliative treatment is the usual course of therapy, but patients are often intolerant of conventional heart failure treatment. The current standard of care of sequential heart and bone marrow transplant is usually not feasible for ill or frail patients or in countries with limited organ donors or without transplant programmes.

Atrial Fibrillation and the Prognostic Performance of Biomarkers in Heart Failure.

Background: Consideration of circulating biomarkers for risk stratification in heart failure (HF) is recommended, but the influence of atrial fibrillation (AF) on prognostic performance of many markers is unclear. We investigated the influence of AF on the prognostic performance of circulating biomarkers in HF.

Methods: N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-regional-pro-atrial natriuretic peptide, C-type natriuretic peptide (CNP), NT-proCNP, high-sensitivity troponin-T, high-sensitivity troponin-I, mid-regional-propeptide adrenomedullin, co-peptin, growth differentiation factor-15, soluble Suppressor of Tumorigenicitiy (sST2), galectin-3, and procalcitonin plasma concentrations were measured in a prospective, multicenter study of adults with HF.

Building a Longitudinal National Integrated Cardiovascular Database - Lessons Learnt From SingCLOUD.

Real world data on clinical outcomes and quality of care for patients with coronary artery disease (CAD) are fragmented. We describe the rationale and design of the Singapore Cardiovascular Longitudinal Outcomes Database (SingCLOUD). We designed a health data grid to integrate clinical, administrative, laboratory, procedural, prescription and financial data from all public-funded hospitals and primary care clinics, which provide 80% of health care in Singapore.

Systematic assessment of procedural parameters, influence on downstream testing and 12-month outcomes of a CT-myocardial perfusion service.

Aims: This study describes the real-world referral pattern of patients to a CT myocardial perfusion service, the technical issues associated with providing the service, the results of the studies, and the subsequent downstream utilization of other investigations, and patient outcomes.

Methods And Results: 115 consecutive patients underwent CTA, dynamic rest and dipyridamole-stress perfusion scanning. There were 29 (25%) and 14 (12%) patients who had reversible defects and fixed defects respectively, indicating abnormal flow reserve and previous infarction respectively.

Thymosin Beta-4 Is Elevated in Women With Heart Failure With Preserved Ejection Fraction.

Background: Thymosin beta-4 (TB4) is an X-linked gene product with cardioprotective properties. Little is known about plasma concentration of TB4 in heart failure (HF), and its relationship with other cardiovascular biomarkers. We sought to evaluate circulating TB4 in HF patients with preserved (HFpEF) or reduced (HFrEF) ejection fraction compared to non-HF controls.

Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction.

Young patients with acute myocardial infarction (MI) have a more favorable prognosis than older patients with MI. However, there are limited data comparing the prognosis of young patients with MI with young population controls. Comparison with an age-matched background population could unmask residual mortality risk in young patients with MI that would otherwise not be apparent when merely comparing the mortality risk of young and older patients with MI.

Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction.

Aim: Growth differentiation factor 15 (GDF15) is a cytokine highly expressed in states of inflammatory stress. We aimed to study the clinical correlates and prognostic significance of plasma GDF15 in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction(HFrEF), compared with N-terminal pro-brain natriuretic peptide (NT-proBNP), an indicator of haemodynamic wall stress.

Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction.

Objectives: There are conflicting data on the relationship between the time of symptom onset during the 24-hour cycle (circadian dependence) and infarct size in ST-elevation myocardial infarction (STEMI). Moreover, the impact of this circadian pattern of infarct size on clinical outcomes is unknown. We sought to study the circadian dependence of infarct size and its impact on clinical outcomes in STEMI.

Intra-aortic balloon pump may grant no benefit to improve the mortality of patients with acute myocardial infarction in short and long term: an updated meta-analysis.

Intra-aortic balloon pump (IABP) has been extensively used in clinical practice as a circulatory-assist device. However, current literature demonstrated significantly varied indications for IABP application and prognosis.The objective of the study was to assess the potential benefits or risks of IABP treatment for acute myocardial infarction (AMI) complicated with or without cardiogenic shock.

Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients.

Nocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated.

Long-term prognosis and risk heterogeneity of heart failure complicating acute myocardial infarction.

The Killip classification of acute heart failure was developed decades ago to predict short-term mortality in patients with acute myocardial infarction (AMI). The aim of this study was to determine the long-term prognosis of acute heart failure graded according to the Killip classification in 15,235 unselected patients hospitalized for AMI from 2000 to 2005. Vital status for each patient was ascertained, through to March 1, 2012, from linkage with national death records.

Dynamic CT myocardial perfusion measurements of resting and hyperaemic blood flow in low-risk subjects with 128-slice dual-source CT.

Aims: The aim of the study was to measure rest and stress myocardial blood flow (MBF) values prospectively in a low-risk population with 128-slice dual-source computed tomography (CT) and to compare MBF/coronary flow reserve (CFR) values to that of a second population with a documented coronary artery disease (CAD).

Methods And Results: This study evaluates resting and hyperaemic MBF in 35 low-risk individuals identified by the modified Framingham Risk score and a calcium score of <100. The patients were scanned using 80 kV and quantitative blood flow values were generated using complete time-attenuation curves.

Differences in late cardiovascular mortality following acute myocardial infarction in three major Asian ethnic groups.

Aim: the purpose of this study was to investigate differences in long-term mortality following acute myocardial infarction (AMI) in patients from three major ethnicities of Asia.

Methods And Results: We studied 15,151 patients hospitalized for AMI with a median follow-up of 7.3 years (maximum 12 years) in six publicly-funded hospitals in Singapore from 2000-2005.

Optimizing the management of elderly colorectal surgery patients.

With the ever increasing number of geriatric surgical patients, there is a need to develop efficient processes that address all of the potential issues faced by patients during the perioperative period. This article explores the physiological changes in elderly surgical patients and the outcomes achieved after major abdominal surgery. Perioperative management strategies for elderly surgical patients in line with the practices of the Geriatric Surgical Team of Alexandra Health, Singapore, are also presented.

Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction.

Introduction: The Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a fi rst cardiac event. Because young patients presenting with a fi rst myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these patients.

Materials And Methods: We studied 1267 patients between January 2002 and November 2007 presenting with a fi rst MI.

Prognostic value of left atrial size in chronic kidney disease.

Aims: Patients with chronic kidney disease (CKD) have high cardiovascular risk. Although stress imaging provides accurate risk estimation in this population, it is unknown if combinatorial cardiac imaging adds incremental value.

Methods And Results: We performed transthoracic echocardiography and stress single photon emission computed tomography (SPECT) to assess their value in predicting late cardiovascular disease (CVD) mortality in 200 patients with creatinine clearance <60 mL/min without a history of coronary heart disease.

Gas exchange responses to constant work-rate exercise in patients with glycogenosis type V and VII.

During constant work-rate exercise above the lactic acidosis threshold, oxygen consumption fails to plateau by 3 minutes, but continues to rise slowly. This slow component correlates closely with the rise in lactate in normal subjects. We investigated if oxygen consumption during constant work-rate exercise could rise after 3 minutes in the absence of a rise in lactate.