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Ticagrelor provides faster and more consistent platelet inhibition than clopidogrel; however, its effect on myocardial injury during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. The aim of this pilot study was to assess the feasibility and preliminary effects of ticagrelor versus clopidogrel loading on myocardial injury in STEMI patients undergoing PCI, using cardiac magnetic resonance (CMR) imaging. Thirty STEMI patients were randomized to receive aspirin with either clopidogrel (300 mg) or ticagrelor (180 mg) before PCI, followed by standard maintenance therapy. Myocardial injury was evaluated 4-10 days post-PCI using CMR parameters (infarct size, myocardial salvage index [MSI], microvascular obstruction [MVO], and infarct transmurality). Enzymatic infarct size and 5-year clinical outcomes were also analyzed. No significant differences in infarct size, MSI, MVO, or other CMR parameters were detected between the two groups. Left ventricular volume and function were comparable, with no major adverse cardiovascular events, stent thrombosis, or major bleeding over the 5-year follow-up period. Ticagrelor and clopidogrel showed similar effects on CMR-based myocardial injury and long-term outcomes in STEMI patients undergoing PCI. These pilot findings are hypothesis-generating and support the feasibility and inform sample-size planning for future multicenter trials.
Thyroid storm represents a critical and potentially life-threatening complication of thyrotoxicosis. Despite modern critical care, it has a high mortality rate and often requires admission to the intensive care unit (ICU) and the application of extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the outcomes of thyroid storm patients requiring ECMO in a Taiwanese ICU setting. This retrospective study included patients admitted to the ICU at a medical center in Taiwan from 2018-2021 who were diagnosed with thyroid storm and required ECMO. The patients were categorized into survivor and non-survivor groups. The primary outcome evaluated was ICU mortality rate. Univariate logistic regression analysis was conducted to determine associations between study variables and ICU mortality. Fourteen patients received ECMO, with a median age of 39 years, and 57.1% were male. Key triggers included non-compliance with medications and amiodarone use. The median ECMO support duration and ICU stay were 93.5 hours and 10 days, respectively. Four patients (28.6%) died, of whom three died from unsuccessful ECMO removal. An elevated lactate level on the first day of admission was significantly associated with increased mortality risk (odds ratio = 1.64, 95% confidence interval: 1.02-2.63, p = 0.04). The survival rate of ICU patients with thyroid storm and treated with ECMO was approximately 70%, highlighting the effectiveness of ECMO and potential benefits in critical cases. Early lactate levels on admission day 1 may serve as a prognostic tool in this specific patient subgroup.
Myocardial infarction (MI) remains a leading cause of mortality and morbidity worldwide. Cardiac rehabilitation (CR) is an evidence-based intervention that improves cardiovascular outcomes; however, the optimal timing and contents of CR remain unclear. This study aimed to investigate the effects of an early-phase, exercise-based supervised comprehensive CR program on functional exercise capacity, grip strength, fatigue, sleep quality, and health-related quality of life (HRQOL) in patients with MI. A randomized controlled trial was conducted involving 32 medically stable MI patients allocated to either an intervention or control group. The intervention group received a two-phase supervised CR program initiated within the first week post-MI, including inpatient and outpatient aerobic, calisthenic, and strengthening exercises for eight weeks. The control group received usual care. Primary and secondary outcomes included the 6-minute walk distance (6MWD), 30-second sit-to-stand test (30-sec STS), grip strength, fatigue (functional assessment of chronic illness therapy [FACIT]-fatigue), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and HRQOL (12-Item Short-Form Questionnaire and MacNew Heart Disease Health-Related Quality of Life Questionnaire). Compared to the control group, the intervention group showed significant improvements in 6MWD (mean difference [MD] = 97.3 m, p < 0.001), 30-sec STS (MD = 3.1 repetitions, p = 0.001), grip strength (MD = 5.7 kg, p = 0.04), FACIT-Fatigue score (MD = 8.8 points, p < 0.001), PSQI score (MD = -2.7 points, p < 0.001), and HRQOL subdomains (p < 0.05). No adverse events were reported. Early-phase supervised CR significantly enhanced physical capacity, fatigue, sleep quality, and HRQOL in this cohort of MI patients. Early initiation of structured CR should be considered in clinical practice to promote faster recovery and improve long-term outcomes following MI.
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The prevalence of cardiovascular disease (CVD) is increasing globally. Hypertension and dyslipidemia are well-established risk factors, and their co-existence significantly increases the risk of CVD. Epidemiological studies consistently report a high prevalence of their co-existence, ranging from 15% to 31%. The combined impact of hypertension and dyslipidemia on the vascular endothelium is more detrimental than their individual effects, potentially accelerating atherosclerosis and increasing the overall risk of CVD. This review highlights the benefits of concurrently treating dyslipidemia and hypertension to prevent CVD, drawing insights from the Anglo-Scandinavian Cardiac Outcomes Trial study and recent clinical studies conducted in Asia. Notably, the single-pill combination of amlodipine and atorvastatin has been shown to enhance adherence while providing a synergistic effect in protecting the vascular endothelium and preventing CVD. By aggressively managing both conditions, healthcare providers can significantly reduce the risk of future cardiovascular events across diverse patient populations and ethnicities.
We aimed to investigate how microRNA-138-5p (miR-138-5p) promotes heart failure (HF) in rats by inhibiting enhancer of zeste homolog 2 (EZH2) and reducing histone methylation in the myeloid differentiation primary response gene 88 (MyD88) promoter region. An HF rat model and isoproterenol (ISO)-induced H9c2 cell injury model were established. Echocardiography was used to assess cardiac function in the rats, flow cytometry was used to detect cardiomyocyte apoptosis, and reverse transcription quantitative polymerase chain reaction or Western blotting was performed to detect the expressions of miR-138-5p, EZH2, and Myd88, as well as Bax, Bcl-2, and Caspase-3. The relationship between miR-138-5p and EZH2 was analyzed by luciferase reporter assay. The methylation level of histone H3 lysine 27 trimethylation (H3K27me3) at the Myd88 promoter region mediated by EZH2 was assessed by chromatin immunoprecipitation assay. The expression of miR-138-5p was increased in myocardial tissue in the HF rats and ISO-induced H9c2 cells. Inhibition of miR-138-5p enhanced cardiac function in the HF rats. Inhibiting miR-138-5p decreased cardiomyocyte apoptosis, downregulated the expressions of Bax and Caspase-3 genes, and upregulated the expression of Bcl-2. miR-138-5p targeted and bound to the 3'-untranslated region of EZH2 mRNA, and promoted cardiomyocyte apoptosis by inhibiting EZH2 expression. EZH2 increased the H3K27me3 methylation level in the Myd88 promoter region, leading to decreased Myd88 expression. Overexpression of Myd88 and high EZH2 expression promoted cardiomyocyte apoptosis. miR-138-5p targets and inhibits the expression of the EZH2 gene, reducing H3K27me3 methylation in the Myd88 promoter region, thereby enhancing Myd88 expression, promoting cardiomyocyte apoptosis, and exacerbating HF.
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The Taiwan Registry of Hypertrophic Cardiomyopathy (THIC) is a multicenter national registry containing the clinical and imaging data of patients with hypertrophic cardiomyopathy (HCM) in Taiwan. The aim of the registry is to systematically evaluate the clinical, genetic and biochemical features, possible natural course, and outcomes of HCM and relevant rare diseases that mimic HCM such as Fabry disease (FD) and transthyretin amyloid cardiomyopathy in Taiwan, and to identify their specific "red-flag" signs, which are especially valuable from the perspective of unique genetic mutations or clinical manifestations in Taiwanese patients. Herein, we present the design and initial baseline data from the registry. The THIC is an observational program that aims to collect prospective and/or retrospective data of patients with HCM in Taiwan. The registry plans to recruit 800 individuals with unexplained left ventricular hypertrophy, including 200 with FD, with a follow-up period of at least 12 months, and the project is expected to run for 5 years. Data on baseline characteristics, laboratory and imaging results, deaths, major adverse cardiovascular, cerebrovascular and renal events are collected. The THIC has been in the enrollment phase since December 2022, and has enrolled 534 patients (age 62.37 ± 13.41 years, male 65.6%) as of March 15, 2025 from 13 centers. At enrollment, 284 of these patients had HCM, 227 had FD, and 23 had ATTR-CM. Family history was found to be an important diagnostic clue; however, common echocardiographic and laboratory data including N-terminal pro-brain natriuretic peptide were not significantly different between the three groups. The THIC will contain comprehensive clinical and imaging data of patients with HCM, FD and ATTR-CM in Taiwan, and provide an opportunity to extend our knowledge on the clinical presentations and long-term consequences of these disease entities. It will aid in understanding patients with unexplained LVH in the context of the genetic background of Taiwanese patients, and in identifying predictors of LVH and important clinical events.
In advanced heart failure patients, limited exercise capacity often prevents significant increases in core temperature. Due to reduced muscle mass and minimal blood flow in inactive muscles, their limb temperatures tend to be lower. This study investigates whether core-hand temperature difference can serve as a distinguishing criterion between New York Heart Association (NYHA) Class III and IV heart failure. This study included 80 patients with NYHA Class IV (median age: 68 years) and 82 with NYHA Class III (median age: 65 years) heart failure with reduced ejection fraction. Core body temperature was measured using an infrared thermometer, while hand temperature was recorded with a forward looking infrared C5 thermal camera after a 15-minute acclimatization at room temperature. The core-mean hand temperature difference (Tc-Mht) was 8.7 °C ± 1.5 °C in the Class IV group and 7.1 °C ± 1.7 °C in the Class III group (p < 0.001). The difference in hand temperature (highest-lowest) was 3 °C (2-4 °C) in the Class IV group and 1 °C (0-2 °C) in the Class III group (p < 0.001). A Tc-Mht > 7.7 °C showed 76% sensitivity (95% confidence interval: 66-84%) for detecting NYHA Class IV in thermoneutral environments. Tc-Mht may serve as a prognostic marker in heart failure patients.
Transthyretin amyloidosis (ATTR) is a rare but progressive disease. Its heterogeneous clinical presentation often leads to a delayed diagnosis. This study aimed to review the clinical manifestations of ATTR at diagnosis across cardiology and neurology subspecialties and to identify common red-flag symptoms in real-world practice. We analyzed consecutive patients diagnosed with ATTR between March 2018 and December 2024. Variant ATTR (ATTR-v) was confirmed by genetic testing, while wild-type ATTR (ATTR-wt) was diagnosed based on the absence of monoclonal protein, a positive 99mtechnetium-pyrophosphate scan, and no transthyretin gene mutations. All patients underwent clinical assessments, electrocardiography (ECG), and comprehensive echocardiography at diagnosis. Among the 63 enrolled ATTR patients (median age 64 years, 66.7% men), 27% were diagnosed in cardiology clinics and 73% in neurology clinics. Six had ATTR-wt (all diagnosed by cardiologists), while 57 had ATTR-v (94.7% with the Ala97Ser mutation), predominantly diagnosed by neurologists. Some patients presenting to cardiology clinics had considerable neurological symptoms or a history of bilateral carpal tunnel syndrome in addition to prominent cardiac involvement. Conversely, patients presenting to neurology clinics had significant cardiac involvement comparable to those diagnosed in cardiology clinics. Peripheral neuropathy was the most prevalent red flag, followed by autonomic dysfunction, discordant QRS voltages on ECG, and a history of bilateral carpal tunnel syndrome. Notably, the absence of low-voltage QRS or the presence of left ventricular hypertrophy on ECG did not necessarily exclude ATTR. Recognizing red-flag symptoms remains the key to identifying ATTR. Early detection of ATTR requires clinical vigilance and multidisciplinary collaboration across subspecialties.
Transeptal puncture (TSP) is an important technique in catheter ablation and structural interventions. Several novel techniques and equipment have been developed, however they are limited by availability and cost. To evaluate the efficacy and safety of a modified TSP technique guided by a 0.014″ angioplasty wire and an electrified Brockenbrough (BRK) stylet. One hundred consecutive patients who received the modified TSP technique and another 100 undergoing conventional TSP for pulmonary vein isolation for non-valvular atrial fibrillation from January 2019 to January 2023 were retrospectively analyzed. A historical comparison with three associated studies was performed. Age, gender, left atrial diameter, left ventricular ejection fraction, acute complications, and BRK needle jump distances during TSP were analyzed. Both groups demonstrated comparable characteristics, including age (conventional TSP vs. modified TSP; 65.8 ± 9.6 vs. 63.63 ± 10.3 years; p = 0.077), sex (conventional TSP vs. modified TSP; males, 75% vs. 67%; p = 0.213), and left atrial diameter (conventional TSP vs. modified TSP; 40.55 ± 7.7 vs. 42.60 ± 8.2 mm; p = 0.069). All received continuous periprocedural nonvitamin K oral anticoagulants and underwent TSP with a BRK needle. There was no acute pericardial effusion or tamponade immediately after TSP or at the end of catheter ablation. Inadvertent jump of the BRK needle was significantly attenuated in the modified TSP group (conventional TSP vs. modified TSP; 0.766 ± 0.19 vs. 1.455 ± 0.48 cm; p < 0.001). No TSP-related complications were observed. The modified TSP technique using readily available equipment with an electrified stylet and a 0.014″ angioplasty wire is a simple, safe, and cost-effective alternative. This method reduces the built-up tension by mechanical force during tenting and minimizes the risk of inadvertent jumping.
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Effective lipid control is essential in the secondary prevention of cardiovascular disease to reduce recurrent events. However, the low-density lipoprotein cholesterol (LDL-C) goal attainment rates among high-risk patients in Taiwan remain unclear. This study aimed to evaluate LDL-C goal attainment and adherence to lipid-lowering therapy (LLT) in Taiwanese patients with atherosclerotic cardiovascular disease (ASCVD) using data from the Chang Gung Research Database. We conducted a retrospective observational study of 116,228 ASCVD patients treated between 2017 and 2021. LDL-C levels, LLT intensity, and goal attainment (< 70 mg/dL) were analyzed. Multivariate logistic regression was used to identify factors associated with LDL-C goal attainment. The mean age of the patients was 67.4 years, and 63.8% were male. Coronary artery disease (CAD) comprised 57.3% of the diagnoses. At baseline, 12.2% of the patients achieved LDL-C < 70 mg/dL, improving to 25.1% at 12 months. High-intensity LLT was associated with a significantly higher likelihood of goal attainment (relative risk 1.54, p < 0.001). Male sex, diabetes mellitus, and prior percutaneous coronary intervention were positively correlated with LDL-C goal attainment. Despite treatment, LDL-C control remained suboptimal, particularly in cerebrovascular disease and peripheral artery disease subgroups. Real-world LDL-C goal attainment among Taiwanese ASCVD patients is low, underscoring the need for intensified lipid management and improved adherence to guideline-based therapy. Tailored interventions are especially warranted for non-CAD ASCVD patients to reduce cardiovascular risk.
The aim of this study was to assess the prognostic significance of the longitudinal tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio as a surrogate marker of right ventricular (RV) to pulmonary arterial (PA) coupling in patients with pulmonary arterial hypertension (PAH). A retrospective cohort study was conducted on patients with PAH. The TAPSE/PASP ratio at baseline and at 3 to 6 months of follow-up was evaluated along with other echocardiographic and clinical parameters. The study included 68 patients with PAH, 75% of whom were female, with a mean age of 46 years and a mean follow-up duration of 64 months. At baseline, non-survivors had higher brain natriuretic peptide levels, shorter 6-minute walk distance (6MWD), and worse hemodynamic profiles compared with survivors. A TAPSE/PASP ratio > 0.22 mm/mmHg at baseline and > 0.23 mm/mmHg at 3 to 6 months of follow-up was associated with improved survival. Compared with baseline, survivors had lower pulmonary vascular resistance, lower PASP, and reduced left ventricular eccentricity indexat follow-up. In addition, better outcomes were observed in patients with World Health Organization functional class (WHO FC) I/II and 6MWD > 390 m compared with those in WHO FC III/IV and 6MWD ≤ 390 m. The TAPSE/PASP ratio is a noninvasive marker of RV-PA coupling that can provide dynamic prognostic insights in patients with PAH. It may assist in guiding treatment escalation and individualized therapy. Further studies are needed to verify its role and integration into comprehensive PAH risk assessment frameworks.
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This study aimed to compare access and target lesion patency rates between undersized and apposed/oversized lateral-edge covered stents in patients with hemodialysis access-related central venous occlusive disease (CVOD). A retrospective analysis of 76 hemodialysis patients undergoing endovascular treatment for CVOD was conducted. All of the patients received undersized covered stents at the medial edge. Based on lateral-edge sizing, the patients were divided into undersized (n = 14) and apposed/oversized (n = 62) groups. Patency outcomes were compared using the log-rank test, and multivariable analysis was used to identify risk factors associated with the primary outcome. The 12-month access primary patency rate was significantly higher in the undersized group than in the apposed/oversized group (76.4% vs. 25.9%, p = 0.047). The 12-month target lesion primary patency rate was also higher in the undersized group; however, the difference was not statistically significant (76.4% vs. 52.1%, p = 0.186). Factors associated with the primary outcome included older age (odds ratio [OR] = 1.03, p = 0.011), coronary artery disease (OR = 2.03, p = 0.041), stenting to central veins for access thrombosis (OR = 3.53, p = 0.001), more stents (OR = 3.11, p = 0.002), apposed/oversized lateral stent edge (OR = 2.73, p = 0.044), and higher stent-to-vessel ratio (OR = 1.19, p = 0.022). The 12-month primary patency rate was better in the undersized group than in the apposed/oversized group. Endovascular treatment with undersized covered stents may be a feasible approach for hemodialysis access-related CVOD. Larger randomized studies are required to confirm these findings.