Publications by authors named "Kui Toh Gerard Leong"
Background: Natriuretic peptide (NP) elevations are prognostic in heart failure (HF), but relative atrial NP deficiency in acute HF has been suggested.
Objectives: The authors compared plasma concentrations and relative strength of associations of A- and B-type NPs with cardiac structure/function and clinical outcomes in HF.
Methods: Midregional pro-atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured in patients with compensated HF in a prospective, multicenter study.
Aims: To define plasma concentrations, determinants, and optimal prognostic cut-offs of soluble suppression of tumorigenesis-2 (sST2), high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in women and men with chronic heart failure (HF).
Methods And Results: Individual data of patients from the Biomarkers In Heart Failure Outpatient Study (BIOS) Consortium with sST2, hs-cTnT, and NT-proBNP measured were analysed. The primary endpoint was a composite of 1 year cardiovascular death and HF hospitalization.
Aims: Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). We assessed the influence of COPD on circulating levels and prognostic value of three HF biomarkers: N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and soluble suppression of tumorigenesis-2 (sST2).
Methods: Individual data from patients with chronic HF, known COPD status, NT-proBNP and hs-TnT values (n = 8088) were analysed.
Aims: The importance of iron deficiency (ID) in heart failure with preserved ejection fraction (HFpEF) is unknown. In HF with reduced ejection fraction (HFrEF), ID is reported as an independent predictor of mortality in HF although not all published studies agree. Different definitions of ID have been assessed, and the natural history of untreated ID not established, which may explain the conflicting results.
View Article and Find Full Text PDFObjective: ECG markers of heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We hypothesised that the Cornell product (CP) is a risk marker of HFpEF and has prognostic utility in HFpEF.
Methods: CP =[(amplitude of R wave in aVL+depth of S wave in V3)×QRS] was measured on baseline 12-lead ECG in a prospective Asian population-based study of 606 healthy controls (aged 55±10 years, 45% men), 221 hypertensive controls (62±9 years, 58% men) and 242 HFpEF (68±12 years, 49% men); all with EF ≥50% and followed for 2 years for all-cause mortality and HF hospitalisations.
Objective: Ethnic differences in the prevalence of atrial fibrillation (AF) in heart failure (HF) remain unclear. We compared the prevalence and clinical correlates of AF among different ethnicities in an Asian-Pacific population with HF.
Methods: Patients with validated HF were prospectively studied across Singapore and New Zealand (NZ).
Aims: Whether prevalence and mortality of patients with heart failure with preserved or mid-range (40-49%) ejection fraction (HFpEF and HFmREF) are similar to those of heart failure with reduced ejection fraction (HFrEF), as reported in some epidemiologic studies, remains highly controversial. We determined and compared characteristics and outcomes for patients with HFpEF, HFmREF, and HFrEF in a prospective, international, multi-ethnic population.
Methods And Results: Prospective multi-centre longitudinal study in New Zealand (NZ) and Singapore.
Background: Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care.
Aims: To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective.
Background: Right ventricular (RV) dysfunction is recognized as a major prognostic factor in left-sided heart failure (HF). However, the relative contribution of RV dysfunction in HF with preserved (HFpEF) vs. reduced ejection fraction (HFrEF) is unclear.
View Article and Find Full Text PDFHeart failure with preserved ejection fraction (HFpEF) has a high clinical burden and constitutes approximately 20% to 30% of patients with heart failure in Asia. Impaired global longitudinal strain (GLS), defined as an absolute value of <15.8%, has been shown to be a predictor of heart failure hospitalization, cardiovascular death, and aborted cardiac arrest in HFpEF.
View Article and Find Full Text PDFArticle Synopsis
- - The study identifies limited but effective 30-day heart failure (HF) readmission risk scores using common clinical data from a specific HF patient population, analyzing 1,475 admissions between 2010 and 2012.
- - Seven key factors were found to predict 30-day HF readmissions, including previous admissions, length of hospital stay, serum creatinine, and certain medication use at discharge.
- - The developed risk scoring tool demonstrated solid accuracy, with a sensitivity of 78.3% and a negative predictive value of 96%, making it a valuable tool for predicting readmissions in a diverse urban heart failure cohort.
Article Synopsis
- A study was conducted to compare the characteristics and outcomes of heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) among a Southeast Asian population, focusing on 1,978 patients from a hospital in Singapore.
- Approximately 29% of patients had HFpEF, who were generally older, more likely to be women, and had a higher prevalence of hypertension, yet both groups had similar 30-day outcomes and 1-year mortality rates (17% for HFrEF and 15% for HFpEF).
- Atrial fibrillation was found to significantly predict death or hospitalization in patients with HFpEF but not in those with HFrEF, indicating that while profiles
Aims: Current heart failure (HF) guidelines highlight the importance of iron deficiency (ID) in HF. Whether HF itself or age-related comorbidities contribute to ID is uncertain, and previous data were limited to Western populations. We aimed to study the prevalence, clinical correlates, functional significance and prognosis of ID in HF patients, compared with community-based controls in a multi-ethnic Southeast Asian population.
View Article and Find Full Text PDFRenal sympathetic denervation for the treatment of refractory hypertension.
Annu Rev Med
September 2014
Resistant hypertension poses significant health concerns. There are strong demands for new and safe therapies to control resistant hypertension while addressing its common causes, specifically poor compliance to lifelong polypharmacy, lifestyle modifications, and physician inertia. The sympathetic nervous system plays a significant pathophysiological role in hypertension.
View Article and Find Full Text PDFResistant hypertension poses significant health concerns. There are strong demands for new safe therapeutics to control resistant hypertension, while addressing its common causes, specifically poor compliance to lifelong polypharmacy, lifestyle modification and physician inertia. The sympathetic nervous system plays a significant pathophysiological role in hypertension.
View Article and Find Full Text PDFObjectives: To identify acute heart failure (HF) precipitants in patients with a history of chronic HF, and to analyse any relationship with early outcomes.
Background: There are limited studies on acute HF precipitants and the relationship with outcomes, and determining this will help to identify the avoidable precipitants and may lead to better outcomes.
Methods: Patients with a history of HF and admission to the authors' hospital in 2008, with a discharge primary diagnosis of HF, were enrolled.