BACKGROUND Many conditions may affect left ventricular(LV)phenotypes which have been classified according to LV mass and geometry.There is limited data on the prognostic value of LV phenotypes classified by cardiac ma...BACKGROUND Many conditions may affect left ventricular(LV)phenotypes which have been classified according to LV mass and geometry.There is limited data on the prognostic value of LV phenotypes classified by cardiac magnetic resonance(CMR).This study aimed to determine the prognostic value of LV phenotypes in elderly and non-elderly patients with known or suspected coronary artery disease.METHODS This is a retrospective cohort study among patients who underwent stress or viability CMR.LV phenotypes were classified according to the LV mass index,the LV end-diastolic volume index and the LV mass/volume ratio,into normal,concentric remodeling,concentric hypertrophy,and eccentric hypertrophy.The primary outcome was a composite of death or heart failure.RESULTS A total of 3289 patients was studied.The average age was 68.0±12.7 years,52.2%of patients were women.Elderly were defined as age≥65 years accounting for 63.9%of the cohort.LV phenotypes were normal,concentric remodeling,concentric hypertrophy,and eccentric hypertrophy at 74.5%,5.8%,9.2%,and 10.5%,respectively.The median duration of follow-up was 41.4 months.The composite outcome of death or heart failure occurred in 7.3%of patients.The prognostic impact of LV phenotypes was more pronounced in the elderly,with eccentric hypertrophy showing the worst prognosis,followed by concentric hypertrophy and concentric remodeling with the adjusted hazard ratio(95%CI)of 2.37(1.72–3.25),1.53(1.12–2.08),and 1.14(0.76–1.71),respectively,compared to normal phenotype.Patients with eccentric hypertrophy also demonstrated abnormal global longitudinal LV strain,left atrial strain,and extracellular volume fraction.CONCLUSIONS LV phenotypes by CMR independently predict adverse clinical outcomes in elderly patients with known or suspected coronary artery disease.In non-elderly patients,the prognostic value of LV phenotypes was less evident.Assessment of LV phenotypes may be useful for risk stratification.展开更多
Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary di...Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.展开更多
Background Asian population are at increased risk of bleeding during the warfarin treatment,so the recommended optimal international normalized ratio(INR)level may be lower in Asians than in Westerners.The aim of this...Background Asian population are at increased risk of bleeding during the warfarin treatment,so the recommended optimal international normalized ratio(INR)level may be lower in Asians than in Westerners.The aim of this prospective multicenter study was to determine the optimal INR level in Thai patients with non-valvular atrial fibrillation(NVAF).Methods Patients with NVAF who were on warfarin for stroke prevention were recruited from 27 hospitals in the nationwide COOL-AF registry in Thailand.We collected demographic data,medical history,risk factors for stroke and bleeding,concomitant disease,electrocardiogram and laboratory data including INR and antithrombotic medications.Outcome measurements included ischemic stroke/transient ischemic attack(TIA)and major bleeding.Optimal INR level was assessed by the calculation of incidence density for six INR ranges(<1.5,1.5–1.99,2–2.49,2.5–2.99,3–3.49,and≥3.5).Results A total of 2,232 patients were included.The mean age of patients was 68.5±10.6 years.The mean follow-up duration was 25.7±10.6 months.There were 63 ischemic stroke/TIA and 112 major bleeding events.The lowest prevalence of ischemic stroke/TIA and major bleeding events occurred within the INR range of 2.0–2.99 for patients<70 years and 1.5–2.99 for patients≥70 years.Conclusions The INR range associated with the lowest risk of ischemic stroke/TIA and bleeding in the Thai population was 2.0–2.99 for patients<70 years and 1.5–2.99 for patients≥70 years.The rates of major bleeding and ischemic stroke/TIA were both higher than the rates reported in Western population.展开更多
Objective To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation(NVAF). Methods We c...Objective To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation(NVAF). Methods We conducted a multicenter registry of patients with NVAF during 2014 to 2017 in Thailand. The following data were collected: demographic data, type of NVAF, medical illness, components of CHA2DS2-VASc and HAS-BLED scores, history of bleeding and severity, investigations, and antithrombotic medications. Clinical outcomes were death, bleeding, and ischemic stroke/transient ischemic attack(TIA). Results There were a total of 3218 patients. The average age was 67.3 ± 11.3 years, and 58.3% were men. Sixty-nine patients(2.14%) had a history of major bleeding. Antithrombotic use was, as follows: 2126 patients(75.3%) received oral anticoagulant(OAC) alone, 555(17.2%) received antiplatelet alone, 298(9.3%) received both, and 239(7.4%) received neither. During follow-up, 9.9% had major adverse outcomes, including death(5.9%), ischemic stroke/TIA(2.5%), and major bleeding(4.0%). There were no significant differences in the types of antithrombotic medications between patients with and without history of major bleeding. Multivariate analysis revealed old age, low body mass index, hypertension, diabetes, heart failure, and history of major bleeding to be independently associated with major adverse outcome. Adverse events significantly increased in patients with OAC plus antiplatelet. Conclusions History of major bleeding was identified as a factor that significantly affects clinical outcome. Inappropriate use of OAC plus antiplatelet should be avoided. Special caution should be made in this high-risk patients.展开更多
BACKGROUND Clinical outcomes of patients with non-valvular atrial fibrillation(AF)in Asian populations may be different from non-Asians.In this study,we aimed to determine the incidence of ischemic stroke/systemic emb...BACKGROUND Clinical outcomes of patients with non-valvular atrial fibrillation(AF)in Asian populations may be different from non-Asians.In this study,we aimed to determine the incidence of ischemic stroke/systemic embolism(SSE),major bleeding,and death,and the predictors for clinical outcomes in a contemporary Asian cohort of newly diagnosed AF patients.METHODS This is a prospective multicenter nationwide registry of patients with AF from 27 hospitals in Thailand.Baseline data and follow-up data were collected every 6 months until 3 years.Data collections included demographic,medical history,laboratory,and medication details.Clinical outcomes were SSE,major bleeding,and all-cause mortality.Incidence rates for each clinical outcome were calculated and presented as rate per 100 person-years.Univariate and multivariate analysis was performed to determine the independent predictors for clinical outcomes.RESULTS There was a total of 3405 patients:mean age was 67.8±11.3 years,1981(58.2%)were male.During 30.8±9.7 months follow-up,there was a total of 132 SSE(3.9%),191 major bleeding(5.6%),and 357 all-cause deaths(10.5%).The incidence rates of SSE,major bleeding,and death were 1.56(1.30-1.84),2.26(1.96-2.61),and 4.17(3.33-4.25),per 100 person-years respectively.Independent predictors for clinical outcomes were age,type of AF,and the presence of comorbid conditions.CONCLUSION The incidence rate of SSE,major bleeding,and death remains high reflecting the unmet needs in AF management。展开更多
文摘BACKGROUND Many conditions may affect left ventricular(LV)phenotypes which have been classified according to LV mass and geometry.There is limited data on the prognostic value of LV phenotypes classified by cardiac magnetic resonance(CMR).This study aimed to determine the prognostic value of LV phenotypes in elderly and non-elderly patients with known or suspected coronary artery disease.METHODS This is a retrospective cohort study among patients who underwent stress or viability CMR.LV phenotypes were classified according to the LV mass index,the LV end-diastolic volume index and the LV mass/volume ratio,into normal,concentric remodeling,concentric hypertrophy,and eccentric hypertrophy.The primary outcome was a composite of death or heart failure.RESULTS A total of 3289 patients was studied.The average age was 68.0±12.7 years,52.2%of patients were women.Elderly were defined as age≥65 years accounting for 63.9%of the cohort.LV phenotypes were normal,concentric remodeling,concentric hypertrophy,and eccentric hypertrophy at 74.5%,5.8%,9.2%,and 10.5%,respectively.The median duration of follow-up was 41.4 months.The composite outcome of death or heart failure occurred in 7.3%of patients.The prognostic impact of LV phenotypes was more pronounced in the elderly,with eccentric hypertrophy showing the worst prognosis,followed by concentric hypertrophy and concentric remodeling with the adjusted hazard ratio(95%CI)of 2.37(1.72–3.25),1.53(1.12–2.08),and 1.14(0.76–1.71),respectively,compared to normal phenotype.Patients with eccentric hypertrophy also demonstrated abnormal global longitudinal LV strain,left atrial strain,and extracellular volume fraction.CONCLUSIONS LV phenotypes by CMR independently predict adverse clinical outcomes in elderly patients with known or suspected coronary artery disease.In non-elderly patients,the prognostic value of LV phenotypes was less evident.Assessment of LV phenotypes may be useful for risk stratification.
文摘Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.
基金the Health System Research Institute(59-053)the Heart Association of Thailand under the Royal Patronage of H.M.the King.All authors had no conflicts of interest to disclose.The authors gratefully acknowledge Pontawee Kaewcomdee and Olaree Chaiphet for data management,and all investigators and nurse coordinators of the COOL-AF registry.
文摘Background Asian population are at increased risk of bleeding during the warfarin treatment,so the recommended optimal international normalized ratio(INR)level may be lower in Asians than in Westerners.The aim of this prospective multicenter study was to determine the optimal INR level in Thai patients with non-valvular atrial fibrillation(NVAF).Methods Patients with NVAF who were on warfarin for stroke prevention were recruited from 27 hospitals in the nationwide COOL-AF registry in Thailand.We collected demographic data,medical history,risk factors for stroke and bleeding,concomitant disease,electrocardiogram and laboratory data including INR and antithrombotic medications.Outcome measurements included ischemic stroke/transient ischemic attack(TIA)and major bleeding.Optimal INR level was assessed by the calculation of incidence density for six INR ranges(<1.5,1.5–1.99,2–2.49,2.5–2.99,3–3.49,and≥3.5).Results A total of 2,232 patients were included.The mean age of patients was 68.5±10.6 years.The mean follow-up duration was 25.7±10.6 months.There were 63 ischemic stroke/TIA and 112 major bleeding events.The lowest prevalence of ischemic stroke/TIA and major bleeding events occurred within the INR range of 2.0–2.99 for patients<70 years and 1.5–2.99 for patients≥70 years.Conclusions The INR range associated with the lowest risk of ischemic stroke/TIA and bleeding in the Thai population was 2.0–2.99 for patients<70 years and 1.5–2.99 for patients≥70 years.The rates of major bleeding and ischemic stroke/TIA were both higher than the rates reported in Western population.
基金supported by the Health System Research Institute(59-053)the Heart Association of Thailand under the Royal Patronage of H.M.the Kingthe Berlin Pharmaceutical Co.Ltd。
文摘Objective To compare clinical outcomes between patients with and without history of major bleeding according to types of antithrombotic medications in patients with non-valvular atrial fibrillation(NVAF). Methods We conducted a multicenter registry of patients with NVAF during 2014 to 2017 in Thailand. The following data were collected: demographic data, type of NVAF, medical illness, components of CHA2DS2-VASc and HAS-BLED scores, history of bleeding and severity, investigations, and antithrombotic medications. Clinical outcomes were death, bleeding, and ischemic stroke/transient ischemic attack(TIA). Results There were a total of 3218 patients. The average age was 67.3 ± 11.3 years, and 58.3% were men. Sixty-nine patients(2.14%) had a history of major bleeding. Antithrombotic use was, as follows: 2126 patients(75.3%) received oral anticoagulant(OAC) alone, 555(17.2%) received antiplatelet alone, 298(9.3%) received both, and 239(7.4%) received neither. During follow-up, 9.9% had major adverse outcomes, including death(5.9%), ischemic stroke/TIA(2.5%), and major bleeding(4.0%). There were no significant differences in the types of antithrombotic medications between patients with and without history of major bleeding. Multivariate analysis revealed old age, low body mass index, hypertension, diabetes, heart failure, and history of major bleeding to be independently associated with major adverse outcome. Adverse events significantly increased in patients with OAC plus antiplatelet. Conclusions History of major bleeding was identified as a factor that significantly affects clinical outcome. Inappropriate use of OAC plus antiplatelet should be avoided. Special caution should be made in this high-risk patients.
基金funded by a grant from the Health System Research Institute(Grant number 59-053)the Heart Association of Thailand under the Royal Patronage of H.M.the King.
文摘BACKGROUND Clinical outcomes of patients with non-valvular atrial fibrillation(AF)in Asian populations may be different from non-Asians.In this study,we aimed to determine the incidence of ischemic stroke/systemic embolism(SSE),major bleeding,and death,and the predictors for clinical outcomes in a contemporary Asian cohort of newly diagnosed AF patients.METHODS This is a prospective multicenter nationwide registry of patients with AF from 27 hospitals in Thailand.Baseline data and follow-up data were collected every 6 months until 3 years.Data collections included demographic,medical history,laboratory,and medication details.Clinical outcomes were SSE,major bleeding,and all-cause mortality.Incidence rates for each clinical outcome were calculated and presented as rate per 100 person-years.Univariate and multivariate analysis was performed to determine the independent predictors for clinical outcomes.RESULTS There was a total of 3405 patients:mean age was 67.8±11.3 years,1981(58.2%)were male.During 30.8±9.7 months follow-up,there was a total of 132 SSE(3.9%),191 major bleeding(5.6%),and 357 all-cause deaths(10.5%).The incidence rates of SSE,major bleeding,and death were 1.56(1.30-1.84),2.26(1.96-2.61),and 4.17(3.33-4.25),per 100 person-years respectively.Independent predictors for clinical outcomes were age,type of AF,and the presence of comorbid conditions.CONCLUSION The incidence rate of SSE,major bleeding,and death remains high reflecting the unmet needs in AF management。
