Background To determine whether glucagon-like peptide 1 receptor agonists (GLP-1RAs) have cardiov... more Background To determine whether glucagon-like peptide 1 receptor agonists (GLP-1RAs) have cardiovascular and renal protective effects in patients with advanced diabetic kidney disease (DKD) with an estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73 m2. Methods In this cohort study, patients with type 2 diabetes mellitus and eGFR < 30 mL/min per 1.73 m2 with a first prescription for GLP-1RAs or dipeptidyl peptidase 4 inhibitors (DPP-4is) from 2012 to 2021 (n=125,392) were enrolled. A Cox proportional hazard model was used to access the cardiorenal protection between the GLP-1RA and DDP-4i groups. Results A total of 8,922 participants (mean [SD] age 68.4 [11.5] years; 4,516 [50.6%] males; GLP-1RAs, n=759; DPP-4is, n=8,163) were eligible for this study. During a mean follow-up of 2.1 years, 78 (13%) and 204 (13.8%) patients developed composite cardiovascular events in the GLP-1RA and DPP-4i groups, respectively (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0...
Aim: This case–control study aimed to investigate the interrelations of body measurements and sel... more Aim: This case–control study aimed to investigate the interrelations of body measurements and selected biomarkers in type 2 diabetes mellitus (T2DM).Methods: We recruited 98 patients with T2DM and 98 controls from 2016 to 2018 in Taiwan. Body measurements were obtained using a three-dimensional body surface scanning system. Four biomarkers related to insulin resistance, adipokines, and inflammation were assayed. A multiple logistic regression model was used to perform multivariable analyses.Results: Four body measurements, namely waist circumference (odds ratio, OR = 1.073; 95% confidence interval, CI = 1.017–1.133), forearm circumference (OR = 1.227; 95% CI = 1.002–1.501), thigh circumference (OR = 0.841; 95% CI = 0.73–0.969), and calf circumference (OR = 1.25; 95% CI = 1.076–1.451), were significantly associated with T2DM. Leptin (OR = 1.09; 95% CI = 1.036–1.146) and adiponectin (OR = 0.982; 95% CI = 0.967–0.997) were significantly associated with T2DM. Six body measurement combin...
Objectives: Mesenchymal stem cells (MSCs) from the bone marrow (BM) are pluripotent and have the ... more Objectives: Mesenchymal stem cells (MSCs) from the bone marrow (BM) are pluripotent and have the capacity to differentiate into cardiomyocytes, endothelial cells (ECs), and smooth muscle cells (SMCs). Currently, MSCs are one of a number of cell types undergoing extensive investigation for cardiac regeneration therapy. However, it has not yet been determined whether this cell therapy also substantially contributes to vascular remodeling of diseased vessels, such as in intimal hyperplasia. Methods and Results: Human MSCs and a variety of progenitor and vascular cells were used for in vitro and in vivo adhesion experiments. To test the contribution of MSCs to intimal hyperplasia, MSCs from eGFP mice were injected via the tail vein of wild-type littermates after femoral artery wire injury. A model of direct BM transplantation of eGFP MSCs into the tibias of irradiated wild-type littermates was also conducted. Wire-induced vascular injury mobilized MSCs into the circulation. Compared to ...
OBJECTIVE Obesity, high body mass index, and visceral fat accumulation are associated with renal ... more OBJECTIVE Obesity, high body mass index, and visceral fat accumulation are associated with renal diseases. However, the association between body measurements and chronic kidney disease (CKD) is still unclear. METHODS A cohort of 7,825 participants scheduled for follow-up of CKD was recruited from 2000 to 2008 in Taiwan. A questionnaire was developed to collect the basic demographics, lifestyle variables, personal disease history, and family disease history of the participants. A 3-dimensional body surface scanning system was used to take their body measurements. The participants underwent an average follow-up of 14.3 years for evaluation of the incidence of CKD. A multiple Cox regression model was built. RESULTS Three body measurements, namely chest width (hazard ratio [HR] 1.059, 95% confidence interval [CI] 1.011-1.110), waist circumference (HR 1.017, 95% CI 1.006-1.029), and thigh circumference (HR 0.941, 95% CI 0.922-0.961), were significantly associated with CKD. Two combinations of body measurements, namely the waist-to-thigh ratio and chest-to-thigh ratio, were derived to predict the occurrence of CKD. Participants with the highest quartile of waist-to-thigh ratio and chest-to-thigh ratio had a 2.175-fold and 2.182-fold risk of developing CKD, respectively. CONCLUSIONS This study suggests that along with central obesity, body limb measurements can be used as an indicator to predict the occurrence of CKD. The effects of limb measurements on CKD could help provide an innovative perspective regarding the intervention to be developed for the treatment of CKD and a preventive medicine for high-risk individuals. The association of thigh circumference with CKD warrants further investigation.
To determine clinical and laboratory characteristics and prognosis of consecutive Taiwanese patie... more To determine clinical and laboratory characteristics and prognosis of consecutive Taiwanese patients presenting with variant angina and normal or near-normal coronary arteries. A total of 1,329 consecutive patients with acute coronary syndrome who underwent coronary angiography at out hospital were retrospectively screened and reviewed. Over a 10-year period at our hospital, variant angina developed in 14 patients who had normal or near-normal coronary arteries. Of the 14 patients included in the study, mean age 52 years, 10 patients were men and 9 of the 10 men were cigarette smokers. All but one patient developed chest pain between midnight and morning. Twelve patients whose blood tests for high-sensitivity C-reactive protein on the second day after admission had a mean level of 5.5 mg/L. The electrocardiographic location of transient ST-segment elevation was in the anterior leads in 8 patients, inferior leads in 3 and both anterior and inferior leads in 3. Spasm of left anterior ...
BACKGROUND Heart failure (HF) is a global health problem. The Taiwan Society of Cardiology-Heart ... more BACKGROUND Heart failure (HF) is a global health problem. The Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry was a multicenter, observational survey of patients admitted with HFrEF in Taiwan. The aim of this study was to report the one-year outcome in this large-cohort of hospitalized patients presenting with acute decompensated HFrEF. METHODS Patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan. A total of 1509 patients were enrolled into the registry by the end of October 2014. Clinical status, readmission rates and dispensed medications were collected and analyzed 1 year after patient index hospitalization. RESULTS Our study indicated that re-hospitalization rates after HFrEF were 31.9% and 38.5% at 6 and 12 months after index hospitalization, respectively. Of these patients, 9.7% of them were readmitted more than once. At 6 and 12 months after hospital discharge, all-cause mortality rates were 9.5% and 15...
Few studies have demonstrated an association of sarcopenia-associated body measurements with chro... more Few studies have demonstrated an association of sarcopenia-associated body measurements with chronic diseases through a comprehensive methodology. This study aims to examine the relationship between sarcopenia-associated body measurements and chronic diseases. This is a cohort study. We recruited 316 community dwellers, including 76 patients with sarcopenia and 240 controls, and obtained their body measurements associated with sarcopenia. We collected three-dimensional anthropometric body-surface measurements from 11,158 participants during 2000–2008 and followed up this cohort for 15 years to examine the association of these measurements with the risk of chronic diseases such as hypertension, type 2 diabetes mellitus (T2DM), heart disease, and nephrotic syndrome. Univariate analysis, canonical correlation, and Cox regression analysis were performed to explore the associations. Decreased waist width, upper left arm circumference, and left thigh circumference were significantly assoc...
INTRODUCTION Heart failure (HF) is a medical condition with a rapidly increasing incidence both i... more INTRODUCTION Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. METHODS The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed. RESULTS A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean ...
Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approxima... more Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional regi...
This study investigated whether multidisciplinary disease management programs (MDPs) exert the sa... more This study investigated whether multidisciplinary disease management programs (MDPs) exert the same effects in heart failure (HF) patients across risk levels stratified by galectin-3 (Gal-3) level and what factors are associated with inadequate effectiveness of MDP. We used a longitudinal follow-up design based on a previous randomized trial. A total of 355 stabilized hospitalized HF patients were enrolled. The effects of MDP on death and HF-related rehospitalization were analyzed according to Gal-3 levels. During the 4-year follow-up, Gal-3 levels predicted mortality and composite events (p < .001). Multivariable analysis demonstrated the event-lowering effect of MDP (hazard ratio [HR] = 0.49, p = .001 for death and HR = 0.50, p < .001 for composite events). However, the effect of MDP was inadequate for those with high Gal-3 levels (≥17.9 ng/ml), whose 4-year composite event rate was 43% in the MDP arm. Further analysis showed that, in patients with Gal-3 ≥ 17.9 ng/ml, the in...
The role of direct renin inhibitors in myocardial ischemia-induced heart failure is controversial... more The role of direct renin inhibitors in myocardial ischemia-induced heart failure is controversial. We hypothesized that direct renin inhibitors play a positive role, affecting in vivo myocardial function as well as in vitro extracellular matrix change. Ten-week-old C57BL/6J male mice with 2-kidney 1-clip (2K1C) model were enrolled in this study. The mice were divided into 3 groups each with 18 mice; group 1 sham-operated, group 2 coronary artery ligation- induced heart failure, and group 3 coronary artery ligation-induced heart failure receiving aliskiren minipump infusion. These mice were assessed for systemic hemodynamics and left ventricular function by 2-dimensional echocardiography (iE33, Philips). Myocardial tissue was stained and crude protein was isolated from the non- ischemic viable left ventricle. Myocardial tissue contents of anti-angiotensin II type 1 (AT1) receptor, matrix metalloproteinase (MMP)-2 and MMP-9 were examined. There were 54 mice that received 2K1C and were...
The discovery of circulating endothelial progenitor cells (EPCs) opened up a new era of EPC-based... more The discovery of circulating endothelial progenitor cells (EPCs) opened up a new era of EPC-based therapies for cardiovascular diseases. While researchers are enthusiastic about applying EPCs to clinical therapy, progress has been substantially limited due to the lack of a thorough characterization and understanding of early and late outgrowth EPCs (also called endothelial colony-forming cell, ECFCs) biology. As a means of facilitating the understanding of how late EPCs can most effectively be applied to clinical therapeutics, this article reviews the recent progress covering 5 important issues: (1) The best passages of ex vivo-cultivated EPCs for cell therapy; (2) inflammatory activation of late EPCs: a real world consideration; (3) late EPC is not an endothelial cell: an issue of cell contamination; (4) ways to improve EPC function and differentiation; and (5) how to separate and delete smooth muscle progenitor cells (SPCs). Cardiovascular disease; Cell therapy; Endothelial progen...
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, Jan 5, 2015
This investigation explored how aerobic interval training influences central or peripheral hemody... more This investigation explored how aerobic interval training influences central or peripheral hemodynamic response(s) to exercise in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or those with HF with reduced ejection fraction (HFrEF). One hundred twenty HF patients were divided into four groups: HFpEF and HFrEF with aerobic interval training (3-min intervals at 40% and 80% VO2peak for 30 mins/day, 3 days/wk for 12 wks) and general health care groups. Exercise hemodynamics in the heart, frontal cerebral lobe, and vastus lateralis muscle, and oxygenation in the frontal cerebral lobe and vastus lateralis muscle were measured before and after the intervention. Aerobic interval training significantly (1) improved pumping function with enhanced peak cardiac power index in the HFrEF group and improved diastolic function with reduction of the E/E' ratio in the HFpEF group, (2) increased blood distribution to the frontal cerebral lobe/vastus lateralis muscle and...
Journal of cardiovascular medicine (Hagerstown, Md.), Jan 7, 2014
Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be ef... more Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be effective in Western countries. However, it is not known whether they improve outcomes in a high population density country with a national health insurance programme. In total, 349 patients hospitalized because of heart failure were randomized into control and MDP groups. All-cause death and re-hospitalization related to heart failure were analyzed. The median follow-up period was approximately 2 years. Mean patient age was 60 years; 31% were women; and 50% of patients had coronary artery disease. MDP was associated with fewer all-cause deaths [hazard ratio (HR) = 0.49, 95% confidence interval (CI) = 0.27-0.91, P = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25-0.77, P = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29-0.98, P = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26-0.8...
Thyroid dysfunction has an important role in renal insufficiency. The aim of the study was to cor... more Thyroid dysfunction has an important role in renal insufficiency. The aim of the study was to correlate the change of renal function with other clinical factors after thyroxine therapy in hypothyroid patients. A prospective study was designed and 30 hypothyroid patients were included. All study subjects received 0.15–0.2 mg/day thyroxine for 12 weeks. Diastolic blood pressure and serum levels of creatine phosphokinase (CPK) and myoglobulin decreased significantly after thyroxine therapy. Serum creatinine decreased (0.87 ± 0.22 vs. 0.70 ± 0.17 mg/dl, p < 0.001) and estimated glomerular filtration rate (eGFR) increased significantly (82.06 ± 31.08 vs. 100.31 ± 31.79 ml/min/1.73 m2; p < 0.001) after thyroxine replacement. Left ventricular ejection fraction (LVEF) was significantly increased after thyroxine replacement (64.47 ± 11.94 vs. 72.40 ± 13.89%, p = 0.026). No significant vascular functional changes of peripheral (pulse wave velocity) and renal interlobar arteries (pulsati...
Background To determine whether glucagon-like peptide 1 receptor agonists (GLP-1RAs) have cardiov... more Background To determine whether glucagon-like peptide 1 receptor agonists (GLP-1RAs) have cardiovascular and renal protective effects in patients with advanced diabetic kidney disease (DKD) with an estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73 m2. Methods In this cohort study, patients with type 2 diabetes mellitus and eGFR < 30 mL/min per 1.73 m2 with a first prescription for GLP-1RAs or dipeptidyl peptidase 4 inhibitors (DPP-4is) from 2012 to 2021 (n=125,392) were enrolled. A Cox proportional hazard model was used to access the cardiorenal protection between the GLP-1RA and DDP-4i groups. Results A total of 8,922 participants (mean [SD] age 68.4 [11.5] years; 4,516 [50.6%] males; GLP-1RAs, n=759; DPP-4is, n=8,163) were eligible for this study. During a mean follow-up of 2.1 years, 78 (13%) and 204 (13.8%) patients developed composite cardiovascular events in the GLP-1RA and DPP-4i groups, respectively (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0...
Aim: This case–control study aimed to investigate the interrelations of body measurements and sel... more Aim: This case–control study aimed to investigate the interrelations of body measurements and selected biomarkers in type 2 diabetes mellitus (T2DM).Methods: We recruited 98 patients with T2DM and 98 controls from 2016 to 2018 in Taiwan. Body measurements were obtained using a three-dimensional body surface scanning system. Four biomarkers related to insulin resistance, adipokines, and inflammation were assayed. A multiple logistic regression model was used to perform multivariable analyses.Results: Four body measurements, namely waist circumference (odds ratio, OR = 1.073; 95% confidence interval, CI = 1.017–1.133), forearm circumference (OR = 1.227; 95% CI = 1.002–1.501), thigh circumference (OR = 0.841; 95% CI = 0.73–0.969), and calf circumference (OR = 1.25; 95% CI = 1.076–1.451), were significantly associated with T2DM. Leptin (OR = 1.09; 95% CI = 1.036–1.146) and adiponectin (OR = 0.982; 95% CI = 0.967–0.997) were significantly associated with T2DM. Six body measurement combin...
Objectives: Mesenchymal stem cells (MSCs) from the bone marrow (BM) are pluripotent and have the ... more Objectives: Mesenchymal stem cells (MSCs) from the bone marrow (BM) are pluripotent and have the capacity to differentiate into cardiomyocytes, endothelial cells (ECs), and smooth muscle cells (SMCs). Currently, MSCs are one of a number of cell types undergoing extensive investigation for cardiac regeneration therapy. However, it has not yet been determined whether this cell therapy also substantially contributes to vascular remodeling of diseased vessels, such as in intimal hyperplasia. Methods and Results: Human MSCs and a variety of progenitor and vascular cells were used for in vitro and in vivo adhesion experiments. To test the contribution of MSCs to intimal hyperplasia, MSCs from eGFP mice were injected via the tail vein of wild-type littermates after femoral artery wire injury. A model of direct BM transplantation of eGFP MSCs into the tibias of irradiated wild-type littermates was also conducted. Wire-induced vascular injury mobilized MSCs into the circulation. Compared to ...
OBJECTIVE Obesity, high body mass index, and visceral fat accumulation are associated with renal ... more OBJECTIVE Obesity, high body mass index, and visceral fat accumulation are associated with renal diseases. However, the association between body measurements and chronic kidney disease (CKD) is still unclear. METHODS A cohort of 7,825 participants scheduled for follow-up of CKD was recruited from 2000 to 2008 in Taiwan. A questionnaire was developed to collect the basic demographics, lifestyle variables, personal disease history, and family disease history of the participants. A 3-dimensional body surface scanning system was used to take their body measurements. The participants underwent an average follow-up of 14.3 years for evaluation of the incidence of CKD. A multiple Cox regression model was built. RESULTS Three body measurements, namely chest width (hazard ratio [HR] 1.059, 95% confidence interval [CI] 1.011-1.110), waist circumference (HR 1.017, 95% CI 1.006-1.029), and thigh circumference (HR 0.941, 95% CI 0.922-0.961), were significantly associated with CKD. Two combinations of body measurements, namely the waist-to-thigh ratio and chest-to-thigh ratio, were derived to predict the occurrence of CKD. Participants with the highest quartile of waist-to-thigh ratio and chest-to-thigh ratio had a 2.175-fold and 2.182-fold risk of developing CKD, respectively. CONCLUSIONS This study suggests that along with central obesity, body limb measurements can be used as an indicator to predict the occurrence of CKD. The effects of limb measurements on CKD could help provide an innovative perspective regarding the intervention to be developed for the treatment of CKD and a preventive medicine for high-risk individuals. The association of thigh circumference with CKD warrants further investigation.
To determine clinical and laboratory characteristics and prognosis of consecutive Taiwanese patie... more To determine clinical and laboratory characteristics and prognosis of consecutive Taiwanese patients presenting with variant angina and normal or near-normal coronary arteries. A total of 1,329 consecutive patients with acute coronary syndrome who underwent coronary angiography at out hospital were retrospectively screened and reviewed. Over a 10-year period at our hospital, variant angina developed in 14 patients who had normal or near-normal coronary arteries. Of the 14 patients included in the study, mean age 52 years, 10 patients were men and 9 of the 10 men were cigarette smokers. All but one patient developed chest pain between midnight and morning. Twelve patients whose blood tests for high-sensitivity C-reactive protein on the second day after admission had a mean level of 5.5 mg/L. The electrocardiographic location of transient ST-segment elevation was in the anterior leads in 8 patients, inferior leads in 3 and both anterior and inferior leads in 3. Spasm of left anterior ...
BACKGROUND Heart failure (HF) is a global health problem. The Taiwan Society of Cardiology-Heart ... more BACKGROUND Heart failure (HF) is a global health problem. The Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry was a multicenter, observational survey of patients admitted with HFrEF in Taiwan. The aim of this study was to report the one-year outcome in this large-cohort of hospitalized patients presenting with acute decompensated HFrEF. METHODS Patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan. A total of 1509 patients were enrolled into the registry by the end of October 2014. Clinical status, readmission rates and dispensed medications were collected and analyzed 1 year after patient index hospitalization. RESULTS Our study indicated that re-hospitalization rates after HFrEF were 31.9% and 38.5% at 6 and 12 months after index hospitalization, respectively. Of these patients, 9.7% of them were readmitted more than once. At 6 and 12 months after hospital discharge, all-cause mortality rates were 9.5% and 15...
Few studies have demonstrated an association of sarcopenia-associated body measurements with chro... more Few studies have demonstrated an association of sarcopenia-associated body measurements with chronic diseases through a comprehensive methodology. This study aims to examine the relationship between sarcopenia-associated body measurements and chronic diseases. This is a cohort study. We recruited 316 community dwellers, including 76 patients with sarcopenia and 240 controls, and obtained their body measurements associated with sarcopenia. We collected three-dimensional anthropometric body-surface measurements from 11,158 participants during 2000–2008 and followed up this cohort for 15 years to examine the association of these measurements with the risk of chronic diseases such as hypertension, type 2 diabetes mellitus (T2DM), heart disease, and nephrotic syndrome. Univariate analysis, canonical correlation, and Cox regression analysis were performed to explore the associations. Decreased waist width, upper left arm circumference, and left thigh circumference were significantly assoc...
INTRODUCTION Heart failure (HF) is a medical condition with a rapidly increasing incidence both i... more INTRODUCTION Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. METHODS The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed. RESULTS A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean ...
Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approxima... more Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional regi...
This study investigated whether multidisciplinary disease management programs (MDPs) exert the sa... more This study investigated whether multidisciplinary disease management programs (MDPs) exert the same effects in heart failure (HF) patients across risk levels stratified by galectin-3 (Gal-3) level and what factors are associated with inadequate effectiveness of MDP. We used a longitudinal follow-up design based on a previous randomized trial. A total of 355 stabilized hospitalized HF patients were enrolled. The effects of MDP on death and HF-related rehospitalization were analyzed according to Gal-3 levels. During the 4-year follow-up, Gal-3 levels predicted mortality and composite events (p < .001). Multivariable analysis demonstrated the event-lowering effect of MDP (hazard ratio [HR] = 0.49, p = .001 for death and HR = 0.50, p < .001 for composite events). However, the effect of MDP was inadequate for those with high Gal-3 levels (≥17.9 ng/ml), whose 4-year composite event rate was 43% in the MDP arm. Further analysis showed that, in patients with Gal-3 ≥ 17.9 ng/ml, the in...
The role of direct renin inhibitors in myocardial ischemia-induced heart failure is controversial... more The role of direct renin inhibitors in myocardial ischemia-induced heart failure is controversial. We hypothesized that direct renin inhibitors play a positive role, affecting in vivo myocardial function as well as in vitro extracellular matrix change. Ten-week-old C57BL/6J male mice with 2-kidney 1-clip (2K1C) model were enrolled in this study. The mice were divided into 3 groups each with 18 mice; group 1 sham-operated, group 2 coronary artery ligation- induced heart failure, and group 3 coronary artery ligation-induced heart failure receiving aliskiren minipump infusion. These mice were assessed for systemic hemodynamics and left ventricular function by 2-dimensional echocardiography (iE33, Philips). Myocardial tissue was stained and crude protein was isolated from the non- ischemic viable left ventricle. Myocardial tissue contents of anti-angiotensin II type 1 (AT1) receptor, matrix metalloproteinase (MMP)-2 and MMP-9 were examined. There were 54 mice that received 2K1C and were...
The discovery of circulating endothelial progenitor cells (EPCs) opened up a new era of EPC-based... more The discovery of circulating endothelial progenitor cells (EPCs) opened up a new era of EPC-based therapies for cardiovascular diseases. While researchers are enthusiastic about applying EPCs to clinical therapy, progress has been substantially limited due to the lack of a thorough characterization and understanding of early and late outgrowth EPCs (also called endothelial colony-forming cell, ECFCs) biology. As a means of facilitating the understanding of how late EPCs can most effectively be applied to clinical therapeutics, this article reviews the recent progress covering 5 important issues: (1) The best passages of ex vivo-cultivated EPCs for cell therapy; (2) inflammatory activation of late EPCs: a real world consideration; (3) late EPC is not an endothelial cell: an issue of cell contamination; (4) ways to improve EPC function and differentiation; and (5) how to separate and delete smooth muscle progenitor cells (SPCs). Cardiovascular disease; Cell therapy; Endothelial progen...
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, Jan 5, 2015
This investigation explored how aerobic interval training influences central or peripheral hemody... more This investigation explored how aerobic interval training influences central or peripheral hemodynamic response(s) to exercise in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or those with HF with reduced ejection fraction (HFrEF). One hundred twenty HF patients were divided into four groups: HFpEF and HFrEF with aerobic interval training (3-min intervals at 40% and 80% VO2peak for 30 mins/day, 3 days/wk for 12 wks) and general health care groups. Exercise hemodynamics in the heart, frontal cerebral lobe, and vastus lateralis muscle, and oxygenation in the frontal cerebral lobe and vastus lateralis muscle were measured before and after the intervention. Aerobic interval training significantly (1) improved pumping function with enhanced peak cardiac power index in the HFrEF group and improved diastolic function with reduction of the E/E' ratio in the HFpEF group, (2) increased blood distribution to the frontal cerebral lobe/vastus lateralis muscle and...
Journal of cardiovascular medicine (Hagerstown, Md.), Jan 7, 2014
Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be ef... more Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be effective in Western countries. However, it is not known whether they improve outcomes in a high population density country with a national health insurance programme. In total, 349 patients hospitalized because of heart failure were randomized into control and MDP groups. All-cause death and re-hospitalization related to heart failure were analyzed. The median follow-up period was approximately 2 years. Mean patient age was 60 years; 31% were women; and 50% of patients had coronary artery disease. MDP was associated with fewer all-cause deaths [hazard ratio (HR) = 0.49, 95% confidence interval (CI) = 0.27-0.91, P = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25-0.77, P = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29-0.98, P = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26-0.8...
Thyroid dysfunction has an important role in renal insufficiency. The aim of the study was to cor... more Thyroid dysfunction has an important role in renal insufficiency. The aim of the study was to correlate the change of renal function with other clinical factors after thyroxine therapy in hypothyroid patients. A prospective study was designed and 30 hypothyroid patients were included. All study subjects received 0.15–0.2 mg/day thyroxine for 12 weeks. Diastolic blood pressure and serum levels of creatine phosphokinase (CPK) and myoglobulin decreased significantly after thyroxine therapy. Serum creatinine decreased (0.87 ± 0.22 vs. 0.70 ± 0.17 mg/dl, p < 0.001) and estimated glomerular filtration rate (eGFR) increased significantly (82.06 ± 31.08 vs. 100.31 ± 31.79 ml/min/1.73 m2; p < 0.001) after thyroxine replacement. Left ventricular ejection fraction (LVEF) was significantly increased after thyroxine replacement (64.47 ± 11.94 vs. 72.40 ± 13.89%, p = 0.026). No significant vascular functional changes of peripheral (pulse wave velocity) and renal interlobar arteries (pulsati...
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