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Biomedical subjects

Z P Ding

Publications and source records attributed to Z P Ding.

At least 19 recordsLinked to original sources
PubMed2004

Ethnic variations in female vulnerability after an acute coronary event.

OBJECTIVE: To determine the ethnic variation of short and long term female vulnerability after an acute coronary event in a population of Chinese, Indians, and Malays. DESIGN: Population based registry. PATIENTS: Residents of Singapore between the ages of 20-64 years with coronary events. Case identification and classification procedures were modified from the MONICA (monitoring trends and determinants in cardiovascular disease) project. MAIN OUTCOME MEASURES: Adjusted 28 day case fatality and long term mortality. RESULTS: From 1991 to 1999, there were 16 320 acute coronary events, including 3497 women. Age adjusted 28 day case fatality was greater in women (51.5% v 38.6%, p < 0.001), with a larger sex difference evident among younger Malay patients. This inequality between the sexes was observed in both the pre-hospitalisation and post-admission periods. Among hospitalised patients, women were older, were less likely to have suffered from a previous Q wave or anterior wall myocardial infarction, and had lower peak creatine kinase concentrations. Case fatality was higher among women, with adjusted hazard ratios of 1.64 (95% confidence interval (CI) 1.43 to 1.88) and 1.50 (95% CI 1.37 to 1.64) for 28 day and mean four year follow up periods. There were significant interactions of sex and age with ethnic group (p = 0.017). The adjusted hazards for mortality among Chinese, Indian, and Malay women versus men were 1.30, 1.71, and 1.96, respectively. The excess mortality among women diminished with age. CONCLUSION: In this multiethnic population, both pre-hospitalisation and post-admission case fatality rates were substantially higher among women. The sex discrepancy in long term mortality was greatest among Malays and in the younger age groups.

Acute Disease↗
PubMed2002

Clinical outcomes of patients with diabetes mellitus and acute myocardial infarction treated with primary angioplasty or fibrinolysis.

OBJECTIVE: To compare the early and late outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) with fibrinolytic treatment among diabetic patients with acute myocardial infarction (AMI). DESIGN: Retrospective observational study with data obtained from prospective registries. SETTING: Tertiary cardiovascular institution with 24 hour acute interventional facilities. PATIENTS: 202 consecutive diabetic patients with AMI receiving reperfusion treatment within six hours of symptom onset. INTERVENTIONS: Fibrinolytic treatment was administered to 99 patients, and 103 patients underwent primary PTCA. Most patients undergoing PTCA received adjunctive stenting (94.2%) and glycoprotein IIb/IIIa inhibition (63.1%). MAIN OUTCOME MEASURES: Death, non-fatal reinfarction, and target vessel revascularisation at 30 days and one year were assessed. RESULTS: Baseline characteristics were similar in these two treatment groups except that the proportion of patients with Killip class III or IV was considerably higher in those treated with PTCA (15.5% v 6.1%, p = 0.03) and time to treatment was significantly longer (103.7 v 68.0 minutes, p < 0.001). Among those treated with PTCA, the rates for in-hospital recurrent ischaemia (5.8% v 17.2%, p = 0.011) and target vessel revascularisation at one year (19.4% v 36.4%, p = 0.007) were lower. Death or reinfarction at one year was also reduced among those treated with PTCA (17.5% v 31.3%, p = 0.02), with an adjusted relative risk of 0.29 (95% confidence interval 0.15 to 0.57) compared with fibrinolysis. CONCLUSION: Among diabetic patients with AMI, primary PTCA was associated with reduced early and late adverse events compared with fibrinolytic treatment.

Abciximab↗
PubMed2002

Coronary artery bypass grafts in situs inversus.

Coronary artery bypass grafting in dextrocardia is rare. A case is described for the first time where both arterial and venous conduits were used. The subtle changes required in the conduct of the operation are highlighted.

Aged↗
PubMed2002

Constrictive pericarditis--a rare but important cause of recurrent cardiac failure: a case report.

Constrictive pericarditis (CP) is an uncommon cardiac disease which is often difficult to diagnose because of its vague and myriad clinical presentations. We report a case of a middle-aged lady who had non-specific symptoms and signs for six years before she was eventually diagnosed to have idiopathic constrictive pericarditis. An awareness and understanding of this condition is important, as it is a progressive condition and the likelihood of cure depends very much on its early identification and treatment.

Adult↗
PubMed2002

An interesting case of left atrial myxoma.

Myxoma is the most common type of primary tumours of the heart in adults. Majority of these myxomas are found in the left atrium, followed by the right atrium and ventricles. We describe herein a patient who had a left atrial myxoma with interesting investigational results.

Aged↗
PubMed2001

Leopard syndrome.

The Leopard syndrome is a complex of multisystemic congenital abnormalities characterised by lentiginosis, electrocardiographic conduction abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth and deafness (sensorineural). Hypertrophic cardiomyopathy, though not included in the mnemonic, is often associated. Although the Leopard syndrome is rare, it is important to recognise it since it can be associated with serious cardiac disease. It is advisable to follow up patients with Leopard syndrome for new onset of cardiac abnormalities and to monitor the progression of existing cardiac disease. We present a case report and review of the literature of this syndrome.

Abnormalities, Multiple↗
PubMed2001

Isolated non-compaction of ventricular myocardium: a report of three cases.

INTRODUCTION: Isolated non-compaction of ventricular myocardium (INVM) is a rare disorder of myocardial morphogenesis in the absence of other cardiac anomalies. Both sporadic and sex-linked recessive forms have been described. It can be identified with two-dimensional echocardiography. CLINICAL PICTURE: We report a series of 3 cases of adult males with INVM in June 2000. Clinical manifestations were congestive cardiac failure with severely depressed left ventricle systolic function and stroke. One patient had biventricular INVM. CONCLUSION: Early diagnosis of INVM is important as it is associated with a high incidence of cardiac failure, ventricular arrhythmia and remobilisation. Anticoagulation and screening of first-degree relatives is advisable.

Adult↗
PubMed2001

A ten-year review of ruptured sinus of valsalva: clinico-pathological and echo-Doppler features.

Rupture of the sinus of valsalva (RSOV) is an uncommon condition with a variety of manifestations ranging from an asymptomatic murmur to cardiogenic shock. This retrospective 10-year review (1985-1995) of 18 patients from a single institution revealed that 6 (33%) were female and 12 (67%) were male with a mean age of 37.6 +/- 13.4 years and that 72% were Chinese by ethnic descent with the remaining 28% being Malay. Eight patients (44.4%) presented with an asymptomatic murmur, 4 (22.2%) with acute chest pain, 4 (22.2%) with mild heart failure, 2 (11.1%) with severe heart failure, and 2 (11.1%) with cardiogenic shock. Rupture of the right aneurysmal coronary cusp (RCC) made up 15 (83.3%) while those of the non-coronary cusp (NCC) made up the remaining. Most of the RCC ruptures were directed into the right ventricle and all of the NCC ruptures were into the right atrium. Ventricular septal defects (VSDs) were found in 9 (50%) of the patients, (although detected by echocardiography in only one third of those patients), aortic regurgitation in 6 (33.3%) and aortic valve vegetations in 2 (11.1%). Echocardiography was found to be accurate in diagnosing RSOVs with 100% diagnostic accuracy after 1990 with four misdiagnoses before 1990. Of these four patients, two were misdiagnosed as having VSDs, one as having a coronary arteriovenous fistula and one as having a patent ductus arteriosus. The anatomical structure of the "windsock" was seen in 64% of the patients who were correctly diagnosed. The pattern of colour flow and spectral Doppler was seen in all patients and helped to localise the site of rupture and the direction of flow. In summary, echocardiography is a simple and accurate way of diagnosing and defining RSOVs and is the imaging modality of choice.

Adult↗
PubMed2000

Mid-term clinical and angiographic follow-up outcome after placement of a new balloon expandable stent in native coronary arteries.

The widely disparate characteristics that exist among the different stent designs currently available for clinical use may impact on their acute and late angiographic and clinical results. The BeStent (Medtronic Instent, MN) is a relatively new stainless steel, laser-cut, serpentine stent design with only very limited data regarding its performance. In this report, we examined the results of 74 consecutive patients (54 men, 20 women; mean age, 58 years) treated with 76 BeStents in 75 native coronary arteries with a mean reference size of 2.8 mm. Successful stenting without 30-day major adverse cardiac complications was achieved in 97.3% of procedures, resulting in a significant improvement in diameter stenosis from 85% to 2% (P = 0.0001). Six-month angiographic restudy in 88% of patients revealed a per-lesion in-stent restenosis rate of 27%. At a mean follow-up period of 9.3 months, there were no deaths or myocardial infarctions. In summary, the present study demonstrates that the BeStent has an excellent performance profile, is associated with a low risk of stent thrombosis, and yields an acceptable restenosis rate despite the inclusion of a high proportion of patients with diabetes (41%) and small vessels (< 3.0 mm in diameter; 77%).

Aged↗
PubMed2000

Clinical and angiographic outcome after angiography-guided stent placement in small coronary vessels.

BACKGROUND: Although it is widely accepted that stenting confers favorable angiographic and clinical results in coronary arteries >/=3.0 mm in diameter, the outcome of stent placement in smaller vessels remains largely unclear. METHODS AND RESULTS: We sought to specifically determine the early and long-term clinical outcomes in a large series of 197 consecutive patients who underwent stent placement in 207 vessels <3.0 mm in diameter. Procedural success, accomplished in 97.3%, was accompanied by a significant reduction in lesion severity from 85% +/- 9% before to 3% +/- 7% diameter stenosis after the procedure (P =.0001) and a 0.5% incidence of subacute stent thrombosis. At 1 and 2 years of follow-up, survival rate without major target lesion-driven events was observed in 77.3% and 73.9% of patients, respectively. Repeat revascularization procedures accounted for most of these events; cardiac deaths (including those related to subacute stent thrombosis) and late (>30 days) myocardial infarctions were infrequent (2.4% and 1.0%, respectively). The 6-month angiographic binary instent restenosis rate was 30.1%. On multivariate analysis, diabetes mellitus (P =. 0275), small baseline reference vessel size (P =.0300), and stent size </=2.7 mm (P =.0111) were independently associated with an increased instent restenosis rate. CONCLUSIONS: Optimal angiography-guided coronary stenting of vessels <3.0 mm in diameter in association with the stringent use of a poststent combined aspirin-ticlopidine antiplatelet regimen confers a low risk of stent thrombosis, an acceptable incidence of angiographic instent restenosis, and a favorable long-term clinical outcome.

Aged↗
PubMed2000

Case report of Staphylococcus lugdunensis native valve endocarditis and review of the literature.

INTRODUCTION: Coagulase-negative staphylococci, commonly Staphylococcus epidermidis, cause 5% of native valve endocarditis. We describe a case due to Staphylococcus lugdunensis, a coagulase-negative staphylococcus identified in 1988, as a first report in Southeast Asia. It was previously misidentified as S. aureus because it is sometimes slide coagulase positive, but always tube coagulase negative, resulting in its delayed recognition as a pathogen. We also reviewed 36 other cases reported in the English literature from 1988 to 1999. CLINICAL PICTURE: Our patient was admitted 3 times over 4 months for unresolved weight loss and fever before the coagulase-negative staphylococcus bacteraemia was eventually considered significant. TREATMENT AND OUTCOME: He was treated with 4 weeks of high-dose intravenous penicillin and 2 weeks of gentamicin and did not require urgent valve replacement. CONCLUSION: A positive blood culture of coagulase-negative staphylococcus is not always a contaminant. S. lugdunensis can cause aggressive native valve endocarditis resulting in high mortality, especially without surgical intervention.

Adult↗
PubMed2000

Percutaneous interventional strategies in the treatment of chronic total coronary occlusions.

Chronic total coronary occlusions which make up 10% to 20% of all interventional procedures in high-volume centres remain a vexing problem for invasive cardiologists for 2 main reasons. First, they are only successfully recanalised in about 60% of attempts with most failures resulting from an inability to cross the lesions. Laser guidewire appears to be a promising innovation in overcoming this obstacle. Second, after initially successful recanalisation with conventional balloon angioplasty (PTCA), a high restenosis rate (range, 45% to 75%) is observed. Stent placement, by conferring maximal luminal expansion, appears to have resolved this problem to a large extent; both observational and randomised studies indicate that after stent placement, restenosis rate is at least halved that of PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1999

Angiographic restenosis rate in patients with chronic total occlusions and subtotal stenoses after initially successful intracoronary stent placement.

The 5-month angiographic in-stent restenosis rate did not differ between patients with chronic total occlusions (n = 43) and subtotal stenoses (n = 43) equally matched for diabetes status, exact stent design, final expanded stent diameter, stent length, and residual percent diameter stenosis after stent placement; it was 32.5% and 27.9% for those with chronic total occlusions and subtotal stenoses, respectively (p = 0.638). Furthermore, the stent occlusion rate (4.6% vs 6.9%, respectively) was low in both patient groups.

Angioplasty, Balloon, Coronary↗
PubMed1999

Immediate and mid-term results after MultiLink stent implantation in native coronary arteries.

Different stent designs have widely disparate characteristics that may exert a positive or negative impact on their early and mid-term outcomes. The MultiLink stent (Guidant/Advanced Cardiovascular Systems, Santa Clara, CA) is a new coronary stent with only very limited data. In this report, we examined the results of 50 consecutive patients treated with 57 premounted sheathless MultiLink stents in 53 native coronary arteries with reference diameter > or =2.7 mm. Successful stenting was achieved in 98% of patients, resulting in an improvement in diameter stenosis from 91%+/-11% to 1%+/-3% (P = 0.0001). At 1 month, there was no death, myocardial infarction, or stent thrombosis. Angiographic restudy at a mean of 5.0+/-1.8 months in 94% of patients revealed an in-stent restenosis rate of 20.7%. The restenosis rates for diabetic patients (vs. nondiabetic patients), type C lesions (vs. type A/B1 lesions), and the use of 35-mm-long stents (vs. 15-mm-long stents) were 45.4% (14.3%), 56% (< or =11%), and 80% (8.8%), respectively (P < 0.05). In conclusion, the present study demonstrates that the MultiLink stent has an excellent performance profile, is associated with a low risk of stent thrombosis in native coronary vessels, and yields a favorable restenosis rate, particularly after the use of short (15 mm) stents to treat simple lesions.

Aged↗
PubMed1999

Effects of pulmonary blood volume on vascular reactivity in the lung.

OBJECTIVE: Pulmonary flow resistance is mainly determined by vessel calibres, resulting from the interaction of volume-passive distension and active vasomotion. However, quantitative information on the interplay between these counteracting forces in the lung is lacking. Therefore, we aimed at quantifying (1) the effects of vasomotor tone on pulmonary blood volume (Qp) and (2) the influence of Qp on vascular reactivity. DESIGN: Experimental study in isolated zone III rabbit lungs perfused with autologous blood. SETTING: Research department of experimental anaesthesiology. INTERVENTIONS: Stepwise changes of pulmonary blood flow (Q = 0-200 ml.min-1) and Qp (10-30 ml) were applied independently of each other during normoxia (control), hypoxic vasoconstriction (3% O2) and vasodilation by papaverine (10(-4) M). MEASUREMENTS: The arteriovenous pressure gradient (delta P) was calculated as the difference between the pressures in the pulmonary artery and the left atrium. Qp was continuously measured as reciprocal volume changes in the blood reservoir. RESULTS: Vasomotor interventions did not alter Qp despite substantial changes in pulmonary artery pressure. Vasoconstriction and decreasing Qp shifted the pressure/flow curves to greater delta P, whereas vasodilation, as well as increasing Qp, had the opposite effect. Analysis of the pressure/flow relations by the equation delta P = K.Qm revealed that both parameters (K and m) were functions of Qp but only K was affected by vasoconstriction and vasodilation. K, an indicator of flow resistance, decreased hyperbolically to one-sixth and approached each other as Qp was tripled, whereas m increased only 1.5-fold (0.5-0.8). The factorial changes of K from constricted to dilated states varied from 2 to 2.9 and attained a maximum at Qp = 20 ml. CONCLUSIONS: Pulmonary blood volume, although not affected by vasomotor interventions, attenuates vascular reactivity in the lung.

Animals↗
PubMed1998

Early experience with the NIR intracoronary stent.

Immediate and midterm results of 61 NIR stent placement attempts in 55 native coronary vessels in 52 patients demonstrate a high clinical success rate of 98%, no early stent thrombosis, and a 5-month angiographic restenosis rate of 23%. The frequency of in-stent restenosis was significantly heightened in small vessel sizes and in diabetic patients.

Angioplasty, Balloon, Coronary↗
PubMed1998

Long-term (36-63 month) clinical and echocardiographic follow-up after Inoue balloon mitral commissurotomy.

Although Inoue balloon mitral commissurotomy (BMC) offers excellent short-term results, there remains a paucity of data on its long-term (> or =3 yr) outcome. We therefore analyzed the outcome of 68 consecutive patients who had regular long-term clinical and serial echocardiographic follow-up of > or =3 yr after successful BMC. The procedure provided significant improvements in transmitral valve gradient (13+/-6 mmHg before to 5+/-2 mmHg after BMC, P = 0.0001), left atrial pressure (21+/-6 mmHg before to 14+/-5 mmHg after BMC, P = 0.0001), and mitral valve area (0.8+/-0.2 cm2 before to 1.7+/-0.4 cm2 after BMC, P = 0.0001) without incurring > grade 2+ angiographic mitral regurgitation. At a mean follow-up of 44+/-9 mos (range, 36-63 mo), functional benefits were maintained in 91% of patients. Serial echocardiographic evaluations performed in 97% of patients revealed a restenosis rate of 15% (defined as a loss of >50% initial gain in valve area or a valve area of <1.5 cm2). No strokes or deaths were encountered. Of the 15 clinical, echocardiographic, and procedural variables analyzed in a multivariate model, only the presence of chronic atrial fibrillation was an independent correlate of restenosis (P < 0.05). It was clearly more common in patients with than those without restenosis (100% with vs. 57%, respectively, P = 0.009). In conclusion, our study shows that BMC confers maintained long-term functional benefits and a low anatomic restenosis rate 23 yr after BMC.

Adult↗