Publications by authors named "Yi-An Ko"
Background: Black and Hispanic patients with heart failure (HF) have a higher risk of adverse clinical outcomes. Currently, it is unclear whether there are disparities in referral to outpatient HF management programs based on race and ethnicity.
Methods And Results: We used the American Heart Association GWTG-HF (Get With The Guidelines-Heart Failure) registry to examine 402 225 patients hospitalized for acute HF from January 1, 2010 to December 31, 2021.
Background: Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress-induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in patients with coronary artery disease, after adjusting for sociodemographic and clinical factors.
Methods And Results: Individuals with stable coronary artery disease from 2 prospective cohort studies were studied.
Background: Atrial fibrillation (AF) is associated with cognitive decline. Use of oral anticoagulant (OAC) medications offers a lower risk of dementia, but it is unclear whether differences exist between types of OAC agents.
Objective: This was a secondary analysis to explore whether the progression from normal cognition to mild cognitive impairment to dementia differs between adults with AF on warfarin versus non-vitamin K inhibitor medications (NOACs) using data extracted from the National Alzheimer's Coordinating Center clinical case series.
Accounting for inflammation is necessary to assess iron deficiency using ferritin. A limitation of existing inflammation-adjustment methods is reliance on cross-sectional data to evaluate method performance. The study objective was to evaluate three inflammation-adjustment methods using longitudinal data from two controlled trials where apparently healthy adults (n = 52) were exposed to norovirus.
View Article and Find Full Text PDFBackground: Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction can entail high out-of-pocket (OOP) costs, prompting concerns about financial toxicity and access. OOP costs are generally unavailable during encounters. This trial assessed the impact of providing patient-specific OOP costs to patients and clinicians.
View Article and Find Full Text PDFIGAMT: Privacy-Preserving Electronic Health Record Synthesization with Heterogeneity and Irregularity.
Proc AAAI Conf Artif Intell
March 2024
Utilizing electronic health records (EHR) for machine learning-driven clinical research has great potential to enhance outcome predictions and treatment personalization. Nonetheless, due to privacy and security concerns, the secondary use of EHR data is regulated, constraining researchers' access to EHR data. Generating synthetic EHR data with deep learning methods is a viable and promising approach to mitigate privacy concerns, offering not only a supplementary resource for downstream applications but also sidestepping the privacy risks associated with real patient data.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates how acute psychological stress impacts cardiovascular disease (CVD) mortality, focusing on autonomic dysfunction as indicated by electrocardiographic measures.
- In a cohort of 765 participants with stable CVD, researchers monitored heart rate variability (HRV) during stress tests and found a significant association between decreased HRV during stress and a higher risk of CVD death.
- The findings suggest that both stress-induced decreases in HRV and low resting HRV independently increase the risk of CVD mortality, highlighting the need for further research on managing autonomic dysfunction to improve health outcomes.
Posttraumatic Stress Disorder and the Risk of Heart Failure Hospitalizations Among Individuals With Coronary Artery Disease.
Circ Cardiovasc Qual Outcomes
December 2024
Article Synopsis
- PTSD is linked to a higher risk of heart failure hospitalizations in individuals with coronary artery disease, with those diagnosed having a 4.4 times greater risk of hospitalizations compared to those without PTSD.
- The study involved 736 participants, revealing that 9.4% had PTSD, and higher PTSD symptom scores correlated with increased heart failure events.
- While PTSD is strongly associated with heart failure, it does not appear to influence rates of cardiovascular death or nonfatal heart attacks unrelated to heart failure hospitalizations.
Background: Depression is associated with major adverse cardiovascular events (MACE). Whether longitudinal changes in depression affect MACE in patients with coronary heart disease (CHD) remains unknown.
Objectives: The authors evaluated the hypothesis that increasing or persistent depression predicts MACE in patients with CHD.
Article Synopsis
- - The study focused on how obesity and depressive symptoms are linked to chest pain (CP) in patients with nonobstructive coronary artery disease, revealing that 71.5% of participants experienced CP, with a particularly higher prevalence in those with obesity (77.6% vs. 67%).
- - Out of 814 patients, obesity was found to significantly increase CP occurrence, especially in men, who showed more frequent and prevalent CP compared to women with similar obesity levels.
- - The research concluded that both obesity and depressive symptoms are independently associated with CP, and the impact of obesity on CP in men was partially mediated by levels of depressive symptoms.
Article Synopsis
- Metabolic dysfunction-associated Fatty Liver Disease (MAFLD) has become a leading cardiometabolic condition, and the transcriptional co-regulator FOG2 plays a key role in regulating liver lipid metabolism.
- A specific genetic variant of FOG2 (rs28374544) found mainly in individuals of African descent is linked to liver damage and cirrhosis, and analysis both in vitro and genomically suggests it influences the mTORC1 pathway.
- The study indicates that FOG2 may promote MAFLD through mechanisms such as increased lipid production and accumulation, shedding light on its role in the disease's underlying molecular processes.
Background: Patients with myocardial ischemia without obstructive coronary artery disease often have coronary microvascular dysfunction (CMD) and associated increased risk of cardiovascular (CV) events and anginal hospitalizations. Epicardial adipose tissue (EAT) covers much of the myocardium and coronary arteries and when dysfunctional, secretes proinflammatory cytokines and is associated with CV events. While oxidative stress and systemic inflammation are associated with CMD, the relationship between EAT and CMD in women is not well known.
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- Vitamin D deficiency (VDD) is linked to higher cardiovascular mortality and adverse outcomes in patients with coronary heart disease (CHD), potentially due to inflammation and impaired cell function.
- In a study involving over 5,400 individuals, those with VDD showed significantly increased risk of cardiovascular issues, especially when combined with high levels of inflammation and low counts of circulating progenitor cells (CPCs).
- The findings suggest that targeted interventions might be needed for those with both VDD and other risk factors, but more research is required to determine if supplementation can help reduce risks in these groups.
Article Synopsis
- Obstructive sleep apnea (OSA) is prevalent among older adults, particularly those over 65, and its relationship with posttraumatic stress disorder (PTSD) requires further research for personalized treatment approaches.
- The study utilized a cross-sectional design involving male Vietnam War veteran twins to examine the link between PTSD symptoms and OSA, employing in-laboratory polysomnography for evaluation.
- Results indicated that a 15-point increase in PTSD symptom severity was correlated with a higher apnea-hypopnea index, suggesting that PTSD may significantly impact OSA severity.
Article Synopsis
- Mental stress-induced myocardial ischemia (MSIMI) is linked to poorer heart health outcomes in people with coronary artery disease, but how stress affects heart function is not fully understood.
- This study involved 735 patients and looked at their heart rate variability (HRV) during stress to see if low HRV indicates autonomic dysfunction associated with MSIMI.
- Results showed that patients with low HRV during stress had significantly higher odds of experiencing MSIMI, suggesting that stress-related autonomic dysfunction could contribute to heart issues in these patients.
Background: The management of revascularization of chronic total occlusions (CTOs) remains controversial. Whether specific patients gain survival benefit from CTO revascularization remains unknown.
Objectives: We investigated whether (i) patients with CTO have higher N terminal pro-brain natriuretic peptide (NT pro-BNP) levels than patients without CTO, (ii) in patients with CTO, NT pro-BNP levels predict adverse events, and (iii) those with elevated levels benefit from revascularization.
Purpose: Coronary artery plaque burden, low attenuation non-calcified plaque (LAP), and pericoronary adipose tissue (PCAT) on coronary CT angiography (CCTA), have been linked to future cardiac events. The purpose of this study was to evaluate intra- and inter reader reproducibility in the quantification of coronary plaque burden and its characteristics using an artificial intelligence-enhanced semi-automated software.
Materials And Methods: A total of 10 women and 6 men, aged 52 (IQR 49-58) underwent CCTA using a Siemens Somatom Force, Somatom Definition AS and Somatom Definition Flash scanners.
Background: The role of circulating progenitor cells (CPC) in collateral formation that occurs in the presence of chronic total occlusions (CTO) of a coronary artery is not well established. In stable patients with a CTO, we investigated whether CPC levels are associated with (a) collateral development and (b) ischemic burden, as measured by circulating high sensitivity troponin-I (hsTn-I) levels.
Methods: CPCs were enumerated by flow cytometry as CD45 blood mononuclear cells expressing CD34 and both CD34 and CD133 epitopes.
Background: Among patients with advanced heart failure (HF), treatment with a left ventricular assist device (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL and outcomes after LVAD implantation.
Methods: A retrospective cohort (n = 9832) of adults aged ≥ 19 years who received durable LVADs between 2008 and 2017 was identified by using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).
Article Synopsis
- This study investigates the link between heart rate variability (HRV) and deceleration capacity (DC) as indicators of autonomic function and their impact on mortality, specifically in a community sample of Vietnam Era twins.* -
- After following 501 twin participants for an average of 12 years, findings indicate that higher low-frequency HRV and DC are significantly associated with lower risks of all-cause death, with day-time measures showing stronger correlations.* -
- The results suggest that autonomic inflexibility, particularly due to vagal withdrawal, plays a key role in mortality risk, independent of genetic influences, emphasizing the importance of these metrics in health assessments.*
Article Synopsis
- Psychological distress is a notable risk factor for patients with coronary heart disease (CHD), but its impact on clinical outcomes is not fully understood.
- A study analyzed data from 891 stable CHD patients to assess the relationship between psychological distress, measured by various factors like anxiety and depression, and adverse health events over an average of 5.9 years.
- Results showed that higher levels of psychological distress were linked to a greater risk of cardiovascular issues, and incorporating this distress measure into traditional risk assessments helped improve predictive accuracy for adverse outcomes.
Plasma metabolomics profiling is an emerging methodology to identify metabolic pathways underlying cardiovascular health (CVH). The objective of this study was to define metabolomic profiles underlying CVH in a cohort of Black adults, a population that is understudied but suffers from disparate levels of CVD risk factors. The Morehouse-Emory Cardiovascular (MECA) Center for Health Equity study cohort consisted of 375 Black adults (age 53 ± 10, 39% male) without known CVD.
View Article and Find Full Text PDFAlthough a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated.
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