Publications by authors named "Litan Yang"
Background: Clonal hematopoiesis of indeterminate potential (CHIP) has been linked to intensified systemic inflammation and represents a novel risk factor for atherosclerotic cardiovascular diseases, including aortic stenosis (AS).
Objectives: This study aimed to assess the clinical impact of CHIP in a cohort of severe AS patients undergoing transcatheter aortic valve implantation (TAVI).
Methods: We enrolled 110 severe AS patients in this retrospective study.
Background/purpose: The competency-based Internal Medicine Milestones (IMM) assesses physician training outcomes through six key competencies. This pilot study introduced IMM concepts through an echocardiography report interpretation course for postgraduate students (PGYs) and residents (Rs). We aimed to help young physicians understand and track competency development as they receive cardiovascular training, with a view to expanding IMM usage for all junior physicians.
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- - The study investigates how well deep-learning (DL) models can analyze electrocardiograms (ECGs) to predict changes in the left ventricle related to significant aortic regurgitation (AR), which has been challenging to identify in the past.
- - Researchers collected data from 573 patients and used a ResNet-based model to correlate ECG readings with various left ventricular parameters, achieving promising scores in distinguishing levels of left ventricular dysfunction.
- - The findings suggest that using DL models on ECGs could improve the detection of left ventricular issues and potentially reduce the need for additional echocardiography, especially in situations where access to such tests is limited.
Article Synopsis
- The study examines the reliability of the relative apical sparing (RAPS) pattern in diagnosing cardiac amyloidosis and its prognostic significance, highlighting concerns over its accuracy.
- A systematic review of 37 studies found that RAPS has a pooled sensitivity of 61% and specificity of 83%, but diagnostic accuracy varied significantly among different analytical software.
- While RAPS showed some association with outcomes in cardiac amyloidosis, its prognostic value diminished when further analyzed, suggesting it is not a strong predictor of patient outcomes.
Background: The occurrence of type A aortic dissection (TAAD) during transoesophageal echocardiography (TEE) has only been reported once. We present another case of pre-procedural type B AD with retrograde TAAD or TAAD during the TEE procedure.
Case Summary: An 81-year-old man with a pre-existing infrarenal abdominal aortic aneurysm and highly tortuous aorta was referred to our ward for acute decompensated heart failure (ADHF) with New York Heart Association functional class II.
Background: To examine whether left atrial (LA) strain was associated with adverse outcomes in asymptomatic chronic aortic regurgitation (AR).
Methods: Asymptomatic patients with ≥moderate-severe AR were retrospectively identified from 2008 through 2022 from a university hospital. Apical 4-chamber left ventricular longitudinal strain (A4C-LVLS), LA reservoir (LASr), conduit (LAScd), and contractile strain (LASct) were measured using fully-automated software.
Article Synopsis
- LV systolic strain is a potentially better indicator of heart function compared to LV ejection fraction (LVEF) in patients with mildly reduced ejection fraction heart failure (HFmrEF).
- A study involving 1,075 hospitalized HFmrEF patients demonstrated that LV strain is significantly associated with cardiac risk and clinical outcomes, outperforming LVEF in survival predictions.
- The research suggests that lower LV strain levels can more effectively indicate the benefits of angiotensin receptor-neprilysin inhibitor (ARNi) treatments compared to traditional LVEF, making it a valuable tool for risk assessment and therapy responsiveness in these patients.
Background: There are no sex-specific guidelines for chronic aortic regurgitation (AR). This retrospective study examined sex-specific differences and propose treatment criteria from an Asian AR cohort.
Methods and results: Consecutive 1,305 patients with moderate-severe AR or greater at 3 tertiary centers in Taiwan and Japan (2008-2022) were identified.
Article Synopsis
- The study assessed how left atrial (LA) strain, particularly LA reservoir strain (LASr), predicts outcomes in patients with moderate to severe aortic stenosis (AS), especially in an Asian population, where data was limited.
- Findings indicated that LASr was significantly linked to all-cause death and major cardiovascular events, suggesting it could be a crucial marker for patient prognosis, while left ventricular global longitudinal strain (LVGLS) was only predictive in severe AS.
- The researchers propose that incorporating LASr into the AS staging process could improve outcome predictions for patients undergoing evaluations for treatment.
Background: The prevalence of atrial fibrillation (AF) continues to increase in modern aging society. Patients with AF are at high risk for multiple adverse cardiovascular events, including heart failure, stroke, and mortality. Improved medical care is needed for patients with AF to enhance their quality of life and limit their medical resource utilization.
View Article and Find Full Text PDFBackground: Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with high mortality risks, which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, have been proven to improve the health management of chronic diseases, but the effects on MR and TR progression are unknown.
Objective: This study aimed to explore whether patients receiving telehealth services have less MR and TR progression compared with a control group.
Background And Aims: Bicuspid aortic valve (BAV) is the most common congenital heart anomaly. Lifetime morbidity and whether long-term survival varies according to BAV patient-sub-groups are unknown. This study aimed to assess lifetime morbidity and long-term survival in BAV patients in the community.
View Article and Find Full Text PDFImportance: Chronic hemodynamically significant aortic regurgitation (AR) is associated with excess risk of death, yet data for Asian patients are lacking, and whether Asian patients can abide by Western guidelines as to when aortic valve surgery should be performed is unknown.
Objective: To assess AR presentation and cutoffs of left ventricular ejection fraction (LVEF), LV end-systolic dimension index (LVESDi), and LV end-systolic volume index (LVESVi) that are associated with risk of death in Asian patients with AR.
Design, Setting, And Participants: This retrospective cohort study included consecutive patients with chronic, moderately severe to severe AR from 3 tertiary referral centers (2 in Japan and 1 in Taiwan) from June 11, 2008, through November 19, 2020, with follow-up through November 11, 2021.
Background: Although the Asian population is growing globally, data in Asian subjects regarding differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in aortic regurgitation (AR) remain unexplored.
Objectives: The aim of this study was to examine differences between Asian BAV-AR and TAV-AR in significant AR, including aorta complications.
Methods: The study included 711 consecutive patients with chronic moderate to severe and severe AR from 2008 to 2020.
Background: The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system.
Objective: To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center.
Background: Cardiac damage (CD) staging is associated with worse survival in aortic stenosis (AS). However, patients with bicuspid aortic valve (BAV) are less likely to develop CD than those with tricuspid aortic valve AS (TAV-AS). The aim of this study was to assess the prognostic value of multichamber strain (MCS) characterization, a sensitive measurement of subclinical CD, in patients with BAV- and TAV-AS.
View Article and Find Full Text PDFBackground Intracranial aneurysms are reported in 6%-10% of patients with bicuspid aortic valve (BAV), and routine intracranial aneurysm surveillance has been advocated by some. We assessed the prevalence and features of the most important patient-outcome: aneurysmal sub-arachnoid hemorrhage (aSAH), as compared with controls without aSAH, and tricuspid aortic valve (TAV) with aSAH. Methods and Results Adult patients with accurate diagnosis of aSAH and at least one echocardiogram between 2000 and 2019 were identified from a consecutive prospectively maintained registry of aSAH admissions.
View Article and Find Full Text PDFBackground: Whether automated left ventricular global longitudinal strain (LVGLS) is associated with outcomes in patients with asymptomatic aortic regurgitation (AR) is unknown. The aim of this study was to explore the impact of automated LVGLS on survival and compare it with conventional left ventricular (LV) parameters in patients with chronic asymptomatic AR.
Methods: LVGLS (presented as an absolute value) was measured using fully automated two-dimensional strain software in consecutive patients with isolated chronic moderate to severe or greater AR between 2004 and 2020; the incremental value of LVGLS was assessed.
Objective: To examine contemporary clinical differences between men and women with hemodynamically significant chronic aortic regurgitation (AR).
Patients And Methods: We retrospectively identified 1072 consecutive patients with moderate to severe or severe AR diagnosed between February 21, 2004, and April 29, 2019. Echocardiographic data, aortic valve surgical intervention (AVS), and all-cause death were analyzed.
Unicuspid aortic valve (UAV) presented as predominant severe aortic regurgitation (AR) is rare (<1%) in pure AR cohort. We present a case with UAV that took more than 1 decade to achieve accurate diagnosis. Multimodality imaging showcased precise anatomy of UAV and mechanisms of AR, resembling exactly the surgical findings.
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