Background: Pulmonary arterial hypertension (PAH) is a progressive disease with variable etiologies and poor prognosis. Long-term outcome data across etiologies remain limited. Methods: We retrospectively studied 70 patients with PAH confirmed by right heart catheterization at Kaohsiung class (FC), 6-minute walk distance, hemodynamics, comorbidities, and treatment regimens were collected. Survival was analyzed using the Kaplan-Meier method. Results: The mean age of the patients was 55 years, and 59% were female. Connective tissue disease (CTD) was the leading etiology (35.7%), followed by idiopathic PAH (24.3%) and congenital heart disease (21.4%). The overall survival rates were 80.9%, 76.6%, and 73.4% at 1, 3, and 5 years, respectively. WHO FC IV at diagnosis was significantly associated with worse survival (p < 0.05). Although patients with CTD-PAH had a numerically lower survival rate compared to other etiologies, the difference did not reach statistical significance. Chronic kidney disease (CKD) and coronary artery disease (CAD) were associated with increased mortality. Combination therapy was associated with numerically higher survival (91.8%, 87.0% and 80.8% at 1, 3 and 5 years, respectively) compared to monotherapy or no therapy, although without statistical significance. Baseline risk stratification using the COMPERA 2.0 four-strata model was significantly associated with survival (p < 0.05). Conclusions: CTD etiology, advanced FC, and comorbid CKD or CAD were associated with a poor prognosis in our cohort of patients with PAH. Combination therapy may improve long-term outcomes.
Background: Hereditary transthyretin amyloid cardiomyopathy (hATTR-CM) is a progressive disease. Emerging evidence supports bone scintigraphy as a noninvasive tool for monitoring treatment response. We aimed to evaluate the long-term impact of eplontersen therapy on technetium-99m pyrophosphate (99mTc-PYP) single-photon emission computed tomography/computed tomography (SPECT/CT) uptake in patients with hATTR-CM. Methods: We retrospectively analyzed data from a prospective cohort enrolled in the NEURO-TTRansform trial, including hATTR-CM patients treated with eplontersen. Patients who underwent baseline and at least two posttreatment 99mTc-PYP SPECT/CT imaging were included. Changes in biomarkers, echocardiographic and 99mTc-PYP SPECT/CT parameters were assessed. Results: Five patients met the inclusion criteria. The mean follow-up durations were 22.4 months (first follow-up) and 37.5 months (second follow-up). A significant reduction in the volumetric heart-to-lung ratio was observed from baseline to first follow-up (3.75 +/- 0.53 to 2.94 +/- 0.38, p = 0.010) and to second follow-up (3.75 +/- 0.53 to 2.86 +/- 0.39, p = 0.009). A further reduction between the first and second follow-up was also noted (2.94 +/- 0.38 to 2.86 +/- 0.39, p = 0.025). Conclusions: Serial 99mTc-PYP SPECT/CT imaging demonstrated a significant reduction in myocardial tracer uptake over a mean follow-up of 37.5 months in patients with hATTR-CM undergoing eplontersen therapy.
Background: Excess sodium intake is a major modifiable risk factor for hypertension and other non-communicable diseases, including stroke, ischemic heart disease, and chronic kidney disease. Globally, average sodium intake remains more than twice the World Health Organization (WHO) recommended limit of 2 g/day, and Taiwan similarly faces a substantial sodium burden, with mean intake exceeding 3 g/day and a persistent policy implementation gap. Given the salt sensitivity of East Asian populations, these excess levels translate into disproportionately higher cardiovascular (CV) and broader health risks. Objective: This consensus provides an evidence-based and culturally tailored roadmap to reduce sodium intake and increase potassium consumption in Taiwan, with the goal of achieving the WHO target of a 30% relative sodium reduction by 2030 and improving national CV health. Methods: The consensus was developed through a comprehensive review of epidemiological studies, randomized trials, meta-analyses, and global burden models on sodium, potassium, and health outcomes. National intake patterns were assessed using Nutrition and Health Survey in Taiwan data from 2017-2020, while disease burden and cost estimates were informed by the Global Burden of Disease 2019 framework and local health statistics. An interdisciplinary expert panel adapted international evidence to the dietary context in Taiwan through iterative deliberation. The Evidence: Robust evidence demonstrates a dose-dependent relationship between sodium intake, blood pressure, and CV risk, with each additional gram of sodium increasing CV disease risk by approximately 6%. Meta-analyses indicate that reducing sodium by 1 g/day lowers systolic blood pressure by about 3 mmHg in hypertensive individuals, and randomized trials such as the Salt Substitute and Stroke Study show that potassium-enriched salt can reduce stroke and major CV events. In Taiwan, sodium is derived mainly from salt, sauces, and processed foods, underscoring the need for both household-and industry-level interventions. Scope of the Recommendation: The consensus recommends limiting sodium intake to < 2.3 g/day for adults and < 1.5 g/day for salt-sensitive or hypertensive individuals, while promoting potassium intake > 3.5 g/day from fruits, vegetables, legumes, or potassium-enriched salts (with caution in those at risk of hyperkalemia). Key policy actions include mandatory front-of-pack sodium labeling, food reformulation, institutional procurement standards, and sustained public education, supported by multi-sectoral collaboration across government, academia, industry, and civil society.
Background: Intravascular lithotripsy (IVL) is a new endovascular therapy (EVT) for severe femoropopliteal artery calcification. Data from Taiwan are limited. Methods: Between March 2024 and March 2025, IVL-assisted EVT was performed in six patients (seven limbs, thirteen lesions) with significant femoropopliteal calcification. This study assessed device feasibility, procedural success, vessel patency, clinically driven target-lesion revascularization (CD-TLR), and quality-of-life scores at 12 months using imaging and the EQ-5D-5L. Results: The average age of the patients was 76 years and they had multiple comorbidities; the baseline anklebrachial index was 0.61. Most lesions were de novo (77%, mean length 48.5 mm). IVL balloons were deployed at all targets, delivering 153 pulses per lesion. All lesions then underwent specialty balloon treatment, and 77% subsequently received drug-coated balloon angioplasty. EVT reduced stenosis from 81% to 16% and increased lumen area from 2.97 mm2 to 26.6 mm2. No major complications or bailout stenting occurred. At 12 months, three lesions lost primary patency; one required CD-TLR, and that patient died four months later from intracranial hemorrhage. Quality-oflife scores improved from 0.505 to 0.814. Conclusions: Early experience with the combined use of IVL, specialty balloons, and drug-coated balloon therapy was encouraging, and this approach may be a promising adjunctive strategy for treating heavily calcified femoropopliteal lesions.
Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are widely used to prevent stroke in patients with atrial fibrillation (AF). Diabetes mellitus (DM) increases the risk of stroke in these patients, necessitating the careful selection of anticoagulant therapy. This study compared the effectiveness and safety of different NOACs in patients with both DM and AF. Methods: This retrospective cohort study included patients with DM and AF treated with NOACs (apixaban, dabigatran, edoxaban, or rivaroxaban) between December 2012 and June 2022 at a tertiary hospital in Taiwan. The primary outcomes were major adverse cardiovascular events (MACEs), all-cause mortality, and major bleeding. Multivariable Cox proportional hazards models were used to assess the risks associated with each NOAC. Results: After propensity score matching, 700 patients were included in the final analysis. The mean age was 72.71 +/- 10.08 years, and the mean CHA2DS2-VASc score was 4.96 +/- 1.76. No significant differences were observed among the four NOACs in the risks of acute myocardial infarction, ischemic stroke, or cardiovascular death. Similarly, the risks of intracranial hemorrhage and gastrointestinal bleeding were comparable across groups. However, dabigatran was associated with a significantly lower risk of MACEs (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.190.93; p = 0.032) and all-cause mortality (HR, 0.39; 95% CI, 0.15-0.99; p = 0.047) compared with apixaban. Conclusions: In this single-center study, the risk of major bleeding was similar across the four NOACs. In addition, dabigatran was associated with lower risks of MACEs and all-cause mortality compared with apixaban.
