BackgroundThe clinical predictors and prognosis of heart failure (HF) by categories of left ventr... more BackgroundThe clinical predictors and prognosis of heart failure (HF) by categories of left ventricular ejection fraction (LVEF) have not been well studied in people with diabetes. In a retrospective cohort of Chinese with type 2 diabetes, we examined 1) clinical factors associated with incident decompensated HF, and 2) mortality post-HF, stratified by LVEF.MethodsWe conducted a retrospective analysis of the Hong Kong Diabetes Register comprising 23,348 people with type 2 diabetes without history of HF enrolled between 1993–2015, followed for incident decompensated HF until 2017. Heart failure subtypes were defined according to LVEF on echocardiography. Multivariate Cox proportional hazards models were used to identify clinical factors associated with incident HF versus no HF, stratified by HF subtypes. All-cause mortality rates were compared by HF subtypes.ResultsOver median follow-up of 7.1 years from enrolment, 1,195 (5.1%) people developed decompensated HF. Among 611 (51.1%) peo...
Mayo Clinic proceedings. Innovations, quality & outcomes, 2018
To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognos... more To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Comorbiditie...
Regulatory T cells (Tregs) have been shown to play a protective role in glomerulonephritis (GN) a... more Regulatory T cells (Tregs) have been shown to play a protective role in glomerulonephritis (GN) and Foxp3 is a master transcription factor in Treg development. In this study, we examined the functional role and mechanisms of Foxp3 in a mouse model of accelerated anti-glomerular basement membrane (anti-GBM) GN induced in antigen-primed Foxp3 transgenic (Tg) mice. Compared with littermate of wildtype (WT) mice in which induced severe crescentic GN developed with progressive renal dysfunction, Foxp3 Tg mice had reduced crescent formation, urinary protein excretion, plasma creatinine and decline in creatinine clearance. The protective role of Foxp3 in crescentic GN was associated with a markedly suppressed expression of proinflammatory interleukin-1 beta (IL-1β), tumour necrosis factor-alpha (TNF-α) and monocyte chemoattractant protein 1 (MCP-1), and diminished infiltration of the kidneys by CD3(+) T cells and F4/80(+) macrophages. Moreover, overexpression of Foxp3 resulted in a signifi...
Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. C... more Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable "on-body" ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and...
Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late... more Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years; 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years; all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G > A mutation. FD patients presented with heart failure (n = 5), heart block (n = 2), ventricular tachycardia (n = 1), chest pain (n = 3), and/or murmur (n = 1...
BackgroundThe clinical predictors and prognosis of heart failure (HF) by categories of left ventr... more BackgroundThe clinical predictors and prognosis of heart failure (HF) by categories of left ventricular ejection fraction (LVEF) have not been well studied in people with diabetes. In a retrospective cohort of Chinese with type 2 diabetes, we examined 1) clinical factors associated with incident decompensated HF, and 2) mortality post-HF, stratified by LVEF.MethodsWe conducted a retrospective analysis of the Hong Kong Diabetes Register comprising 23,348 people with type 2 diabetes without history of HF enrolled between 1993–2015, followed for incident decompensated HF until 2017. Heart failure subtypes were defined according to LVEF on echocardiography. Multivariate Cox proportional hazards models were used to identify clinical factors associated with incident HF versus no HF, stratified by HF subtypes. All-cause mortality rates were compared by HF subtypes.ResultsOver median follow-up of 7.1 years from enrolment, 1,195 (5.1%) people developed decompensated HF. Among 611 (51.1%) peo...
Mayo Clinic proceedings. Innovations, quality & outcomes, 2018
To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognos... more To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Comorbiditie...
Regulatory T cells (Tregs) have been shown to play a protective role in glomerulonephritis (GN) a... more Regulatory T cells (Tregs) have been shown to play a protective role in glomerulonephritis (GN) and Foxp3 is a master transcription factor in Treg development. In this study, we examined the functional role and mechanisms of Foxp3 in a mouse model of accelerated anti-glomerular basement membrane (anti-GBM) GN induced in antigen-primed Foxp3 transgenic (Tg) mice. Compared with littermate of wildtype (WT) mice in which induced severe crescentic GN developed with progressive renal dysfunction, Foxp3 Tg mice had reduced crescent formation, urinary protein excretion, plasma creatinine and decline in creatinine clearance. The protective role of Foxp3 in crescentic GN was associated with a markedly suppressed expression of proinflammatory interleukin-1 beta (IL-1β), tumour necrosis factor-alpha (TNF-α) and monocyte chemoattractant protein 1 (MCP-1), and diminished infiltration of the kidneys by CD3(+) T cells and F4/80(+) macrophages. Moreover, overexpression of Foxp3 resulted in a signifi...
Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. C... more Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable "on-body" ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and...
Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late... more Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years; 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years; all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G > A mutation. FD patients presented with heart failure (n = 5), heart block (n = 2), ventricular tachycardia (n = 1), chest pain (n = 3), and/or murmur (n = 1...
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Papers by Erik Fung