Biomedical subjects

Sheng-Hsiung Sheu

Publications and source records attributed to Sheng-Hsiung Sheu.

At least 19 recordsLinked to original sources

PubMed2007

Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus.

BACKGROUND: There is increasing evidence that leukocytes play a central role in obesity, glucose intolerance, type 2 diabetes mellitus (T2DM), and cardiovascular diseases, but the role of differential leukocytes in metabolic syndrome (MetS) and atherosclerosis is largely unknown. The aim of this study was to examine the relationship between the component features of MetS and peripheral leukocyte counts and to explore whether leukocyte counts are associated with clustering of MetS and macrovascular diseases in patients with T2DM. METHODS: 1872 subjects with T2DM who enrolled in a diabetes disease management program were studied. The definition of MetS was modified from that outlined by the criteria of NCEP-ATP III. Areas under the receiver-operating characteristic curve and odds ratios at various intervals of the WBC counts were computed. RESULTS: The peripheral total leukocyte, monocyte, and neutrophil cell counts are increased parallel to the clustering of components of MetS. When white cell counts were analyzed per quartile and as continuous variables after adjustment for age, sex, and other known risk factors with multiple regression analysis, peripheral total leukocyte, monocyte, neutrophils, and lymphocyte counts were independently and significantly associated with specific features of clustering of MetS and prevalence of ischemic cardiovascular diseases. Leukocyte counts, especially neutrophil/lymphocyte ratio, in addition with MetS is associated with the risk of ischemic cardiovascular diseases. CONCLUSION: Our results indicate that differential leukocyte counts are associated with MetS and that peripheral leukocytes may play a role in the pathogenesis of macrovascular complications in patients with T2DM.

Aged↗

PubMed2007

Effect of preload alterations by hemodialysis on the time interval between the onsets of early diastolic mitral inflow and annular waveforms.

BACKGROUND: The T(Ea-E), which is defined as the time interval between the peak of the R-wave and the onset of early diastolic mitral annular waveform (T(Ea)) minus the time interval between the peak of the R-wave and the onset of early diastolic mitral inflow waveform (T(E)), is recently proposed as a useful index of left ventricular (LV) relaxation. The aim of this study is to determine whether the T(Ea-E) is preload-independent. METHODS: Twenty hemodialysis (HD) patients (9 men; age 64 +/- 9 years) underwent echocardiography 1 hour before and 1 hour after HD was studied. RESULTS: After HD, the body weight (P < 0.001), early transmitral filling wave peak velocity (E) (P < 0.001), the ratio of E to late transmitral filling wave peak velocity (P = 0.011), the early diastolic mitral anuular velocity (Ea) (P = 0.002), E/Ea (P = 0.026), and T(Ea-E) (P < 0.001) decreased significantly, and the T(Ea) (P = 0.047) and T(E) (P = 0.005) increased significantly. In addition, T(Ea-E) had a significant negative correlation with Ea either before (r =-0.457, P = 0.043) or after HD (r =-0.637, P = 0.003). CONCLUSIONS: T(Ea-E), as well as Ea, was a preload-dependent relaxation index. The preload dependence of this newer Doppler parameter limited its utility in evaluating LV diastolic function in HD patients.

Aged↗

PubMed2007

D-allele of ACE polymorphism is associated with increased magnitude of QT dispersion prolongation in elderly Chinese: 4-year follow-up study.

BACKGROUND: There has not been a longitudinal investigation of the influence of angiotensin-converting enzyme (ACE) insertion/deletion and angiotensinogen (AGT) M235T gene polymorphisms on repolarization parameters, such as QT dispersion (QTd) and the peak and the end of the T-wave interval (Tpe). METHODS AND RESULTS: Electrocardiographys were recorded from 106 elderly Chinese at baseline, and 2nd and 4th year follow-up. The corrected QT (QTc), QTd, QTc dispersion (QTcd) and Tpe were manually calculated. Average age was 72.7+/-4.1 years (range 62-81). QTd, QTcd and Tpe were significantly prolonged (all p<0.001 at the 2nd and 4th year). At the 4th year the magnitude of the QTd prolongation, but not Tpe, was significantly higher in subjects carrying the ACE D allele than non-D-allele carriers (p=0.001), as was QTcd (p=0.002). This association was still significant in the multivariate analyses (p<0.001 and p=0.001 for QTc and QTcd, respectively). No significant correlation was found between repolarization parameters and AGT genotype. CONCLUSIONS: This longitudinal study shows that the ageing process is associated with prolongation of QTd, QTcd and Tpe after 4 years follow-up. The elderly Chinese subjects with the ACE D-allele had greater prolongation QTd and QTcd.

Aged↗

PubMed2006

Reactive hyperemic pre-ejection shear stress of brachial artery determines endothelial function in patients with untreated essential hypertension.

The aim of this study was to identify which phase of wall shear stress (SS) augmentation during reactive hyperemia (RH) is the crucial determinant of endothelial reactivity. Fifty-three patients with untreated essential hypertension were enrolled. A 7.5-MHz linear array transducer was used to record the 2D images and Doppler flow signals of brachial artery at baseline and during RH. Wall SS and flow-mediated vasodilation were calculated sequentially. The result of this study demonstrated that augmentation of wall SS at end-diastolic phase during peak RH is the main rheologic determinant of endothelial function in patients with untreated essential hypertension.

Adult↗

PubMed2006

Effects of verapamil on superior vena cava electrical remodeling induced by short-term pacing from right atrium and superior vena cava in human.

BACKGROUND: Although the superior vena cava (SVC) may be involved in the triggering or maintenance of atrial fibrillation (AF), the electrophysiological properties of SVC in human are ill-defined. METHODS: The baseline effective refractory periods (ERPs) of high right atrium (HRA), SVC and the conduction time (CT) between HRA and SVC were measured at pacing cycle lengths (PCL) of 600 and 400 ms respectively in 20 patients (12 females, age 46+/-13 years) with paroxysmal supraventricular tachycardia. Immediately after acute electrical remodeling (ER) induced by constant HRA or SVC pacing at PCL of 400 ms for 5 min, ERPs of HRA, SVC and the CT between HRA and SVC were determined. After verapamil was administered, the same protocols for determining ERPs of HRA, SVC and the CT between HRA and SVC were repeated. RESULTS: The baseline ERP of SVC was significantly longer than that of HRA. The CT from SVC to HRA was significantly longer than that from HRA to SVC. After acute ER, both the ERPs of HRA and SVC were significantly shortened. However, no significant changes of the CT between HRA and SVC could be demonstrated. After verapamil infusion, significant shortening of the ERP of HRA and SVC still occurred following acute ER and the ERP of SVC was still longer than that of HRA. CONCLUSIONS: In human, ER can occur both in HRA and SVC after a short and moderately rapid heart rate pacing either from HRA or SVC. Verapamil cannot prevent such ER from occurring.

Calcium Channel Blockers↗

PubMed2006

Successful catheter ablation of idiopathic left ventricular tachycardia during sinus rhythm.

Successful catheter ablation of idiopathic left ventricular tachycardia (ILVT) can be performed at the site of the earliest Purkinje potential or at the site with recording of diastolic and presystolic Purkinje potentials simultaneously during ventricular tachycardia (VT). However, these critical potentials might be difficult to be recorded and mapped in some patients during VT. It is rare to report the ablation of ILVT during sinus rhythm. We present a case with ILVT who received successful catheter ablation during sinus rhythm.

Catheter Ablation↗

PubMed2006

Usefulness of time interval between end of diastolic mitral annular velocity pattern and onset of QRS for predicting left ventricular end-diastolic pressure.

Diastolic mitral annular motion may terminate earlier in patients with higher left ventricular end-diastolic pressure (LVEDP). It was therefore hypothesized that the time interval measured from the end of the diastolic mitral annular velocity pattern to the onset of QRS (the AQ interval) would be a useful parameter in predicting LVEDP. The aim of this study was to evaluate the relation between the AQ interval and LVEDP. Forty-six patients with suspected coronary artery disease who underwent Doppler echocardiographic studies and cardiac catheterization were included. LVEDP was determined using a micromanometer-tipped catheter. On univariate analysis, the AQ interval had positive correlations with the PR interval (r = 0.405, p = 0.005), transmitral E-wave velocity (r = 0.502, p <0.001), isovolumic contraction time (r = 0.635, p <0.001), and LVEDP (r = 0.514, p <0.001) and a negative correlation with E-wave deceleration time (r = -0.430, p = 0.003). After stepwise multiple linear regression analysis, the PR interval, transmitral E-wave velocity, and LVEDP were the independent predictors of the AQ interval (beta = 0.234, p = 0.033; beta = 0.331, p = 0.004; and beta = 0.350, p = 0.003, respectively). In conclusion, the AQ interval is a novel, simple, and easily obtained index in the prediction of LVEDP.

Cardiac Catheterization↗

PubMed2006

Septum hematoma: a complication of retrograde wiring in chronic total occlusion.

In spite of the remarkable technological innovation and improved outcomes with percutaneous coronary intervention (PCI), chronically total occlusion in coronary arteries (CTO) remains a formidable challenge for coronary interventionalist. Recently Japanese interventionists have proposed a retrograde wiring technique which provides another way to resolve such difficulties. The retrograde wire in the distal CTO vessel can then be used as a clear landmark in the distal true lumen, facilitating antegrade wiring and possibly increasing the success rate of CTO-PCI. Reported here is a patient who experienced retrograde wire technique but suffered from a complication with septum hematoma and myocardial infarction. The patient had a complete recovery of chest symptoms and resolution of septum hematoma in 1 month. Retrograde wire manipulation should be used as a last resort and via a large collateral vessel in the treatment of CTO.

Angioplasty, Balloon, Coronary↗

PubMed2006

Effects of rosiglitazone alone and in combination with atorvastatin on nontraditional markers of cardiovascular disease in patients with type 2 diabetes mellitus.

Combination therapy of rosiglitazone and atorvastatin has been shown to have beneficial effects on glycemic control and lipid profiles in patients with type 2 diabetes mellitus. This study investigated the effects of the combination of rosiglitazone and atorvastatin on vascular inflammation by studying their effects on levels of biomarkers in patients with type 2 diabetes mellitus. Thirty patients with type 2 diabetes mellitus and hyperlipidemia were enrolled to receive rosiglitazone monotherapy at 4 mg/day for 3 months and then atorvastatin at 10 mg/day was added for 3 more months as combined therapy. Inflammatory biomarkers, including high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase-9 (MMP-9), soluble CD40 ligand (sCD40L), and adiponectin, and lipid profiles were measured at the time of initiation, after rosiglitazone monotherapy and after combination therapy with rosiglitazone and atorvastatin. With treatment of rosiglitazone at 4 mg/day monotherapy for 3 months, hs-CRP levels decreased significantly by 26% (p <0.05) and adiponectin levels increased significantly by 192% (p <0.05), but no significant changes in levels of MMP-9 and sCD40L were demonstrated. After combination therapy, hs-CRP levels further significantly decreased by another 23% (p <0.05) and adiponectin further increased by another 124%. In addition, serum levels of MMP-9, sCD40L, total cholesterol, and low-density lipoprotein cholesterol decreased significantly compared with baseline levels. In conclusion, combination therapy with rosiglitazone and atorvastatin not only significantly improved lipid profiles but also decreased levels of vascular biomarkers, such as hs-CRP, MMP-9, and sCD40L, and increased serum adiponectin levels in patients with type 2 diabetes mellitus.

Adiponectin↗

PubMed2006

Validation of a new index for estimating arterial stiffness: measurement of the QPV interval by Doppler ultrasound.

BACKGROUND: Pulse wave velocity (PWV), a relevant indicator of arterial stiffness, can be measured noninvasively with a variety of automatic devices, but most are complexly equipped. We developed a novel index for estimating arterial stiffness as "QPV interval," which was determined by means of surface electrocardiogram and Doppler ultrasound of the brachial artery simultaneously. HYPOTHESIS: This study aimed to validate the QPV interval as an exact and convenient index for estimation of arterial stiffness. METHODS: Forty-seven patients with untreated essential hypertension and 19 normotensive subjects were enrolled. Brachial-ankle PWV (baPWV) was measured using an automatic volume-plethysmographic apparatus, and Doppler ultrasound was implemented sequentially to measure the QPV interval in each subject. Clinical biochemistry and echocardiography were performed on the same day. RESULTS: Mean baPWV was significantly higher in hypertensive patients than in normotensive subjects (p = 0.002), whereas mean QPV interval was significantly shorter in hypertensive patients than in the normotensive group (p = 0.019). A simple regression analysis demonstrated an inverse correlation between the QPV interval and baPWV (r = -0.671, p < 0.001) in all enrolled subjects. In a stepwise regression model that adjusted for age, systolic blood pressure, and other determinants of baPWV, the negative association remained between the QPV interval and baPWV (p < 0.001). CONCLUSION: The QPV interval correlates inversely with baPWV, independent of age and other determinants of baPWV; hence, the QPV interval can serve as a simple and convenient index for assessing arterial stiffness in clinical practice.

Adult↗

PubMed2006

Association between hypertension and primary mitral chordae tendinae rupture.

BACKGROUND: Mitral regurgitation from chordae tendinae rupture (CTR) may cause severe clinical symptoms and is a progressive disease that eventually results in the need for mitral valve surgery. Early recognition of CTR and identification of risk factors are important because early intervention increases the chances of survival. Hypertension may increase mitral valve complex mechanical strain and cause the chordae tendinae to rupture. METHOD: Using a cross-sectional study of medical files in one medical center in Taiwan, we enrolled 98 patients with mitral CTR and classified them into two groups, comprising 68 subjects (69%) without obvious predisposing factors (primary group) and 30 subjects (31%) with known predisposing causes (secondary group). RESULT: Of the subjects, 63 (64%) were men with a mean age of 57.5 +/- 1.5 years. The posterior mitral leaflet was most commonly involved (64%). The known predisposing factors in secondary group include mitral valve prolapse, infective endocarditis, and rheumatic heart disease. The patients who had primary CTR were older (59.9 +/- 1.6 v 52.1 +/- 3.1 years, P = .029), had a higher prevalence of hypertension (56% v 30%, P = .018) and complained more often of dyspnea (82% v 53%, P = .003) than the patients in the secondary group. Using binary logistic regression analyses, the variation in primary group was found to be independently explained by age (P = .039, odds ratio = 1.039, 95% confidence interval = 1.002 to 1.077) and hypertension (P = .048, odds ratio = 2.717, 95% confidence interval = 1.008 to 7.326). CONCLUSION: We conclude that hypertension was an independent predictor for primary CTR in this study.

Age Factors↗

PubMed2006

Single-beat differentiation among left ventricular filling patterns by pulsed wave Doppler echocardiography.

We sought to evaluate whether the combination of phantom E wave peak velocity (Ep) to phantom A wave peak velocity (Ap) ratio at the apex (Ep/Ap) and pulsed wave Doppler left ventricular (LV) inflow propagation velocity (LVIPVpw) or the combination of Ep/Ap and Ep/LVIPVpw obtained from the same heartbeat can effectively differentiate LV filling patterns. The study population included 132 patients. They were classified into normal, abnormal relaxation, and pseudonormal/restrictive groups according to the ratio of early to late transmittal filling wave peak velocity (E/A), color M-mode Doppler LV inflow propagation velocity, and E/color M-mode Doppler LV inflow propagation velocity. Standard Doppler parameters of LV filling such as E, A, E/A, and E-wave deceleration time had a bimodal distribution, but LVIPVpw decreased and Ep/LVIPVpw increased progressively with worsening of LV diastolic function (both P < .001). The sensitivity and specificity of combination of Ep/Ap 1 or greater and LVIPVpw less than 77 cm/s or of Ep/Ap 1 or greater and Ep/LVIPVpw greater than 0.87 from the same heartbeat in identifying the pseudonormal/restrictive LV filling pattern were 81% and 95% or 81% and 93%, respectively. In conclusion, with application of range ambiguity phenomenon, it is simple and feasible to differentiate LV filling patterns on the same cardiac cycle by pulsed wave Doppler echocardiography.

Adult↗

PubMed2006

Effects of different contrast media on glutathione peroxidase and superoxide dismutase activities in the heart and kidneys of normal and streptozotocin-induced diabetic rats.

BACKGROUND/PURPOSE: Hemodynamic changes and contrast nephropathy are well known complications of contrast media injection. However, the mechanisms of toxicity leading to these complications remain unclear. We hypothesized that contrast media toxicity would manifest as a change in antioxidant enzyme activity, thus leading to tissue damage. METHODS: This study investigated the effects of injection of ionic high-osmolar diatrizoate, ionic low-osmolar ioxaglate, and nonionic low-osmolar iopromide on the activities of two antioxidant enzymes, glutathione peroxidase (GPX) and superoxide dismutase (SOD), in the heart and kidney tissue of normal male Wistar rats (n = 51) and streptozotocin (STZ)-induced diabetic rats (n = 54). Activities of GPX and SOD were assayed spectrophotometrically. RESULTS: Renal GPX activities were significantly decreased in both normal (458.3 +/- 64.6 to 385.5 +/- 63.4 mU/mg, p = 0.005) and diabetic rats (669.0 +/- 98.1 vs. 564.0 +/- 153.3 mU/mg, p = 0.035) at 1 hour after diatrizoate injection. Renal SOD activities were not affected after contrast injection. Ioxaglate and iopromide injection did not cause any change in renal antioxidant enzyme activity. In contrast to kidney tissue, there was no significant change in GPX and SOD activities in heart tissue at 1 hour after injection of different contrast media. CONCLUSION: Intravenous injection of ionic high-osmolar diatrizoate reduced renal GPX activity during the first hour in both normal and STZ-induced diabetic rats. Heart tissue was not prone to antioxidant enzyme activity changes after intravenous contrast media injection. GPX activity reduction can be an important mechanism of nephrotoxicity after contrast media injection.

Animals↗

PubMed2006

Positive interference from contrast media in cardiac troponin I immunoassays.

Cardiac troponin I (cTnI) has been found to be a sensitive and reliable marker of myocardial damage, and elevated levels of cTnI can indicate high risk for acute coronary syndrome. To determine how to intervene in possible cases of acute coronary syndrome, cTnI levels must be measured by immunoassay. However, cTnI immunoassay results are prone to interference from many substances such as heparin and common drugs. The contrast media used in the coronary angiography might also interfere with results. To explore this possibility, we performed two in vivo and two in vitro studies. In the first in vivo study, we evaluated the effects of contrast media on cTnI immunoassays by collecting blood samples from 45 patients undergoing coronary angiography before and after the procedure. We used the Opus Magnum immunoassay system to measure cTnI levels. In the second in vivo study, we collected 25 blood samples from another group of patients also undergoing angiography at various times before and after the procedure to determine cTnI values by both the Opus Magnum and ACCESS systems. In the first in vitro study, 12 different contrast media were treated as samples to disclose the potential interference of measurement in the two assay systems. In the second in vitro study, we made sequential dilutions of iopromide (Ultravist; Schering) with serum to explore their potential for interfering with the detection of cTnI by the Opus Magnum and ACCESS assays. In the first in vivo study using the Opus Magnum assay, cTnI concentrations in samples taken after angiography were significantly higher at 5 minutes than at 30 minutes, and, at 60 minutes, all cTnI concentrations had dropped below the cutoff point. In the second in vivo study, we found a substantial difference in detection of cTnI by the Opus Magnum and ACCESS assays. All cTnI concentrations checked by ACCESS assay were below the cutoff value. In our first in vitro study, the Opus Magnum assay gave false positive results for all 12 contrast media; the ACCESS assay gave a positive result for only one contrast medium, poppy-seed oil (Lipiodol; Guebert). In our second in vitro study, we found that, in the Opus Magnum assay, the more concentrated the contrast medium, the higher the cTnI value, but not in the ACCESS assay. We conclude that contrast media may cause false-positive results in cTnI assays and that, when contrast media are being used for angiography, cTnI results, especially those based on samples taken within the first hour of the procedure, should be interpreted carefully.

Adult↗

PubMed2006

Lercanidipine and losartan effects on blood pressure and fibrinolytic parameters.

Antihypertensive agents may modulate fibrinolysis in addition to reducing blood pressure. We conducted a randomized trial to assess the effects of lercanidipine and losartan on blood pressure (BP) lowering and three fibrinolytic parameters: plasminogen activator inhibitor-1 (PAI-1), D-dimer, and fibrinogen. All patients enrolled had essential hypertension and underwent a placebo run-in period of 2 weeks before randomization to either lercanidipine tablets 10-20 mg once daily or losartan tablets 50-100 mg once daily. Twenty-six patients completed this study. After 8 weeks of treatment, both groups of patients had significantly reduced systolic (SBP) and diastolic BP (DBP) (SBP, p = 0.034 and 0.050, respectively; DBP, p = 0.018 and 0.034 for lercanidipine and losartan, respectively). Both drugs were well tolerated. Only in the group treated with lercanidipine was PAI-1 concentration significantly reduced (57.1 +/- 4.7 to 43.1 +/- 4.8 ng/mL, p = 0.047). No difference was found with D-dimer and fibrinogen in either group. This study shows that both lercanidipine and losartan are effective antihypertensive drugs in patients with essential hypertension. Lercanidipine may provide additional benefit in fibrinolysis.

Antihypertensive Agents↗

PubMed2006

An avoidable complication of percutaneous coronary intervention-entrapment of stent and disconnected balloon catheter.

During percutaneous coronary intervention, entrapment of catheter materials is a rare but life-threatening complication that sometimes requires emergency surgical treatment. Coronary artery stents have been developed to prevent acute coronary closure and reduce restenosis after coronary angioplasty. The most frequently reported complications of coronary stents are related to stent thrombosis and anticoagulation problems. This case study describes a 60-year-old female who had stable angina pectoris and underwent stent insertion into the left circumflex artery. Unfortunately, the coronary stent with balloon catheter was entrapped while crossing the angulated segment between the left circumflex and left main coronary artery. The stent catheter was surgically removed, and the patient underwent coronary artery bypass grafting successfully. Physicians should keep in mind that extremely angulated segments may reduce the successful rate of coronary stenting and contribute to the stent entrapment complication.

Angioplasty, Balloon, Coronary↗

PubMed2006

Randomized comparative study of the effects of treatment with once-daily, niacin extended-release/lovastatin and with simvastatin on lipid profile and fibrinolytic parameters in Taiwan.

Hyperlipidemia can be effectively treated either with niacin or HMG-CoA reductase inhibitor (statin), or a combination of both. Few reports showed the effects of the combination regimen with niacin and statin on hemostatic functions. We conducted a single-center, double-blind, double-dummy, randomized, two-arm study to assess the effects of the niacin extended-release/lovastatin therapy in a fixed-dose formulation and of simvastatin on lipid lowering and two fibrinolytic parameters, fibrinogen and d-dimer. All patients were enrolled according to NCEP-ATP III guidelines and underwent a placebo run-in period of 4 weeks before being randomized to either niacin extended-release/lovastatin tablets (500/20 mg) once daily (n = 36) or simvastatin capsule (20 mg) once daily (n = 34). After 16 weeks of treatment, both groups of patients showed significantly reduced low-density lipoprotein cholesterol and total cholesterol (LDL-C, p < 0.001 and < 0.001, respectively, p = 0.159 between the groups; TC, p < 0.001 and < 0.001, respectively, p = 0.018 between the groups). Both drugs were well tolerated. Only in the group treated with niacin extended-release/lovastatin was fibrinogen concentration significantly reduced after treatment (2.48 +/- 0.65 to 1.99 +/- 0.62 g/L, p = 0.008). No difference was found with d-dimer in either group. This study shows that both niacin extended-release/lovastatin and simvastatin are effective and well-tolerated lipid-lowering drugs in Taiwanese patients with dyslipidemia. A combinational treatment with niacin extended-release/lovastatin may provide additional benefit in fibrinolysis.

Aged↗

PubMed2006

St-segment elevation acute myocardial infarction in a patient with acromegaly: a case report and literature review.

Acromegaly is a disorder caused by the excess production of pituitary growth hormone and is characterized by the enlargement of the hands, feet and head. Increased morbidity and mortality with acromegaly is associated with cardiovascular complications, hypertension, glucose intolerance, cardiomyopathy and coronary artery disease. We report a case of acromegaly, which presented with ST-segment elevation acute myocardial infarction. The patient received successful primary transluminal coronary angioplasty with stent implantation. Acromegaly was suspected from typical appearance, and confirmed with hormonal examination and imaging of the pituitary mass. We discuss this case in comparison with previous literature.

Acromegaly↗