BACKGROUND:The standard definition of Achilles tendon xanthoma in familial hypercholesterolemia (FH) remains unclear. OBJECTIVE:To examine the optimal cut-off points and diagnostic accuracy of Achilles tendon thickness measured by radiographs among Thai subjects with FH. METHODS:Achilles tendon thickness in the anteroposterior dimension was determined using plain radiographs of lateral ankles in 80 subjects with genetically confirmed FH, 57 non-FH subjects with elevated low-density lipoprotein-cholesterol (LDL-C) ≥130 mg/dL, and 54 control subjects (LDL-C <130 mg/dL). The optimal cut-off values, sensitivity, specificity, and diagnostic accuracy for FH diagnosis were examined. The diagnostic performance of Achilles tendon measurements obtained from radiographs, skinfold calipers, and ultrasound was compared in a subset of 16 subjects from each group. RESULTS:The Achilles tendon was significantly thicker in the FH group compared with the non-FH and the control groups (median values [IQR] were 11.5 [8.0-14.5] mm vs 5.9 [5.4-6.5] mm and 6.4 [5.5-7.5] mm, respectively, P < 0.001). The optimal cut-off values determined by receiver operating characteristic analysis were 7.95 mm for men and 7.25 mm for women, with sensitivity, specificity, and accuracy of 92%, 85%, and 88% for men, and 91%, 88%, and 89% for women, respectively. In the subgroup of subjects, tendon thickness measured by radiographs or ultrasound demonstrated higher sensitivity, specificity, and accuracy than tendon width measured by ultrasound or calipers. CONCLUSION:The Achilles tendon thickness values of 7.95 mm in men and 7.25 mm in women could be useful for identifying tendon xanthomas for the diagnosis of FH in the Thai population.

Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, has been implicated in atherosclerosis and adverse cardiovascular outcomes, but prospective data on lower extremity arterial disease (LEAD) in Asian populations remain limited. We conducted a single-center prospective cohort study of 155 Thai patients (mean age 63.5 ± 8.8 years; 64.5% male) with angiographically confirmed coronary artery disease and without LEAD at baseline. Plasma TMAO levels were measured by nuclear magnetic resonance spectroscopy and categorized into quartiles. Incident LEAD was assessed after 3 years, and all-cause mortality after 5 years. Multivariable logistic regression was used to evaluate incident LEAD, whereas Cox proportional hazards models were used to assess mortality. Higher TMAO quartiles were associated with progressively greater odds of incident LEAD (P for trend < 0.001). Compared with the lowest quartile, participants in the third and fourth quartiles had adjusted odds ratios of 5.30 (95% CI 1.32–20.48; P = 0.018) and 14.0 (95% CI 3.38–57.64; P < 0.001), respectively. The median follow-up duration, estimated using the reverse Kaplan–Meier method, was 59.1 months (interquartile range 58.3–60.3 months). Higher TMAO levels were also associated with increased 5-year all-cause mortality. In fully adjusted Cox models, the highest TMAO quartile was independently associated with mortality (hazard ratio 4.17, 95% CI 1.11–15.76; P = 0.035), and Kaplan–Meier analysis demonstrated progressively lower survival across increasing quartiles (log-rank P = 0.005). These findings support elevated plasma TMAO as an independent predictor of incident LEAD and long-term mortality in an Asian population. Trial Registration: This was an observational, non-interventional cohort study. The study was registered in the Thai Clinical Trials Registry to enhance transparency of reporting. Thai Clinical Trials Registry (TCTR20250613001).

Background Anemia is a prevalent comorbidity in acute heart failure (AHF) patients and is linked to poorer clinical outcomes. Despite its significance, data on the impact of anemia in AHF patients in Asians remains scarce, especially its impact across different levels of severity in patients presenting to the emergency department (ED) remains underexplored. Objectives This study aimed to evaluate the prevalence and severity of anemia and its association with clinical outcomes in adult patients with AHF. Methods A retrospective analysis was conducted on 890 adult AHF patients extracted from 100,420 ED visits at Srinagarind Hospital between October 2021 and March 2023. Anemia was classified into three categories: mild (hemoglobin 11.0 g/dl to normal), moderate (hemoglobin 8.0–10.9 g/dl), and severe (hemoglobin < 8.0 g/dl). Patient characteristics, laboratory markers, and outcomes were compared among groups. Data were presented as n (%), and median (Q1, Q3). Statistical analyses included Pearson’s Chi-squared test, Fisher’s exact test, and Kruskal-Wallis rank sum test. Results Of the 890 patients, 71% were anemic, with 25% having mild, 51% moderate, and 24% severe anemia. Anemic patients, particularly those with moderate and severe anemia, were older (median age 74 and 71.5 years vs. 64 years for non-anemic, p-value < 0.001) and had higher rates of comorbidities, including chronic kidney disease and diabetes. Severe anemia was associated with worse kidney function (median eGFR 28.9 vs. 62.9 mL/min/1.73m² for non-anemic, p-value < 0.001) and higher initial cardiac troponin T levels (85.8 vs. 39.1 ng/dL, p-value < 0.001). Hospital admission rates increased with anemia severity, with 85% of severely anemic patients being admitted compared to 72% of non-anemic patients (p-value = 0.043). In-hospital mortality was highest in the severe anemia group (8.6%), though this was not statistically significant (p-value = 0.238). Conclusion Anemia is common in patients with AHF, with many exhibiting moderate or severe levels of anemia. Greater severity of anemia correlates with older age, more comorbidities, and higher hospital admission rates, along with a trend toward higher mortality. Clinical trial number: not applicable.

Anemia is a common comorbidity among patients with acute heart failure (AHF) and is associated with worse clinical outcomes. However, there is limited data on the effects of anemia in AHF patients in Asian populations. Moreover, the impact of anemia at varying severity levels in patients presenting to the emergency department (ED) is still not well understood. This study aimed to evaluate the prevalence and severity of anemia, together with its association with clinical outcomes in adult patients with AHF. A retrospective analysis was conducted on 890 adult AHF patients extracted from 100,420 ED visits at Srinagarind Hospital between October 2021 and March 2023. Anemia was classified into three categories: mild (hemoglobin 11.0 g/dl to normal), moderate (hemoglobin 8.0–10.9 g/dl), and severe (hemoglobin < 8.0 g/dl). Patient characteristics, laboratory markers, and outcomes were compared among groups. Of the 890 patients, 71

Heart failure (HF) is one of the leading causes of hospitalization worldwide. In Thailand, data on HF burden remains limited. This study aimed to describe comprehensive evidence detailing the HF prevalence, hospital admission rates, in-hospital mortality, and overall mortality rates at the hospital level. All eligible adult patients’ medical records from 2018 and 2019 were analyzed retrospectively at five hospitals in different regions. The patients were diagnosed with HF, as indicated by the International Classification of Diseases (ICD)-10 code I50. Descriptive statistics were used to examine the hospital burden as well as patients’ clinical and outcome data. A total of 7384 patients with HF were identified from five tertiary hospitals. Around half of the patients were male. The mean age was 67 years, and the main health insurance scheme was the Universal Coverage Scheme. The prevalence of HF was 0.1

The gut microbiota metabolite trimethylamine-N-oxide (TMAO)-derived from dietary phosphatidylcholine-is mechanistically linked to cardiovascular disease (CVD) and increased cardiovascular risk. This study examined the relationship between fasting plasma TMAO levels and 5-year all-cause mortality in a cohort of patients at high risk of cardiovascular events (CORE-Thailand Registry). Of the 134 patients, 123 (92%) had established cardiovascular disease, and 11 (8%) had multiple risk factors. Fasting plasma TMAO levels were measured using nuclear magnetic resonance spectroscopy. Within this prospective cohort study, the median TMAO was 3.81 mu M [interquartile range (IQR) 2.89-5.50 mu M], with a mean age of 65 +/- 11 years; 61% were men, and 39.6% had type II diabetes. Among 134 patients, 65 (49%) were identified as the high-TMAO group (>= 3.8 mu M), and 69 (51%) were identified as the low-TMAO group (< 3.8 mu M). After a median follow-up of 58.8 months, the high-TMAO group was associated with a 2.88-fold increased mortality risk. Following adjustment for traditional risk factors, high-sensitivity cardiac troponin-T, estimated glomerular filtration rate, angiotensin-converting enzyme (ACEI), or angiotensin-receptor blocker (ARB) use, the high-TMAO group remained predictive of 5-year all-cause mortality risk (the high-TMAO vs. the low-TMAO group, adjusted hazard ratio 2.73, 95% CI 1.13-6.54; P = 0.025). Among Thai patients at high risk of cardiovascular events, increased plasma TMAO levels portended greater long-term mortality risk.

Abstract Background Heart failure (HF) presents a significant global public health challenge due to its high morbidity and mortality rates. Understanding the mortality patterns and underlying causes among HF patients is paramount for guiding effective interventions. The Thai Heart Failure Registry (THFR) offers comprehensive data on HF patients in Thailand, filling critical gaps in our understanding of HF mortality and providing valuable insights to inform both clinical practice and policy decisions. Purpose This registry aims to investigate the causes of death among heart failure patients in Thailand. Methods The follow-up cohort registry spanned from 2021 to 2023 and included 2,879 heart failure patients (68.1% male; mean age 59 years; mean ejection fraction 32%, with the majority classified as NYHA Class I-II, 90%). We utilized electronic health records (EHR) to identify causes of death, both cardiovascular (CV) and non-cardiovascular (non-CV), during this period. Results Overall, 301 deaths occurred (10.5%) (incidence rate 6.8 per 100 person-years); 149 were cardiovascular deaths (5.2%, 3.4 per 100 person-years), primarily attributed to heart failure (69, 46.3% of CV deaths), sudden cardiac death (48, 32.2% of CV deaths), acute myocardial infarction (10, 6.7%), stroke (6, 4%), and intracerebral hemorrhage (4, 2.7%). Non-CV deaths accounted for 116 out of the 301 overall deaths (4%, 2.6 per 100 person-years), predominantly due to infection or sepsis (38, 32.8% of non-CV deaths), renal causes (12, 10%), respiratory causes (9, 7.7%), trauma (7, 6%), malignancy (7, 6%), and other non-CV causes (31, 26.7%). The cause of death was undetermined in 36 patients (1.3%). Subgroup analysis revealed discrepancies in the leading causes of death between HFrEF and HFmrEF/HFpEF patients. For HFrEF patients, cardiovascular deaths predominated (125, 5.4% of overall patients), with heart failure (64, 51.2%), sudden cardiac death (38, 30.4%), and acute myocardial infarction (9, 7.2%) as primary contributors. In contrast, HFmrEF/HFpEF patients were more likely to die from non-CV causes, with sepsis or infection accounting for the majority (8, 32% of non-CV deaths). Risk factor analysis identified ischemic etiology, atrial fibrillation, peripheral edema, hyponatremia, hypokalemia, elevated blood urea nitrogen (BUN), and a history of loop diuretic administration as significant contributors to mortality risk among all HF patients (Adjusted HR, 95% CI, 1.34 (1.06-1.69), 1.57 (1.24-2.00), 2.11 (1.57-2.85), 1.83 (1.39-2.39), 1.44 (1.06-1.95), 1.56 (1.23-1.98), 1.61 (1.21-2.14), respectively). Conclusion The THFR reveals a 10% mortality rate among Thai HF patients, with cardiovascular deaths prevalent in HFrEF patients, and non-cardiovascular deaths more frequent in those with HFmrEF/HFpEF. Identified risk factors like ischemic etiology and electrolyte imbalances provide insights for interventions to reduce mortality risk in HF patients.Risk Factor Analysis in All-cause deathSurvival and Causes of Death in THFR

BACKGROUND:This research analyzed the demographics, management, and outcomes of patients with heart failure (HF) in Thailand. METHODS:The Thai Heart Failure Registry prospectively enrolled patients diagnosed with HF from 36 hospitals in Thailand. Follow-up data were recorded at 6, 12, 18, and 24 months. This study primarily focused on two outcomes: mortality and HF-related hospitalizations. RESULTS:The study included 2639 patients aged at least 18. Their mean age was 59.2 ± 14.5 years, and most were male (68.4%). Patients were classified as having HF with reduced ejection fraction (HFrEF, 80.7%), HF with preserved ejection fraction (HFpEF, 9.0%), or HF with mildly reduced ejection fraction (HFmrEF, 10.3%). Guideline-directed medical therapy utilization varied. Beta-blockers had the highest usage (93.2%), followed by mineralocorticoid receptor antagonists (65.7%), angiotensin-converting enzyme inhibitors (39.3%), angiotensin receptor blockers (28.2%), angiotensin receptor-neprilysin inhibitors (16.1%), and sodium-glucose cotransporter-2 inhibitors (8.0%). The study monitored a composite of mortality and HF incidents, revealing incidence rates of 11.74, 12.50, and 8.93 per 100 person-years for the overall, HFrEF, and HFmrEF/HFpEF populations, respectively. CONCLUSIONS:Despite high guideline-directed medical therapy adherence, the Thai Heart Failure Registry data revealed high mortality and recurrent HF rates. These findings underscore limitations in current HF treatment efficacy. The results indicate the need for further investigation and improvements of HF management to enhance patient outcomes.

IntroductionOff-label underdosed direct oral anticoagulants (DOACs) are commonly utilised in Asian patients with atrial fibrillation (AF) since they are prone to bleeding with OACs. However, the efficacy and safety of off-label underdosing DOACs are controversial. This study aimed to compare the effectiveness and safety of off-label underdosed DOACs in Asian patients with AF. MethodsPubMed, Embase, Cochrane library, and ClinicalTrials.gov were searched from 2010 to July 5, 2024, for randomised controlled trials or observational studies that compared off-label DOACs and on-label/warfarin in Asian patients with AF. The primary outcomes included ischaemic stroke or systemic embolism (ISSE) and major bleeding (MB), while secondary outcomes included all-cause death, gastrointestinal bleeding (GIB), intracranial haemorrhage (ICH), and myocardial infarction (MI). Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. ResultsTwenty observational studies were included. Seventeen studies compared off-label underdosed DOACs versus on-label DOACs, whereas five studies compared off-label underdosed DOACs versus warfarin. Off-label underdosed DOACs were associated with higher risk of ISSE (pooled HR [pHR] = 1.17; 95% CI: 1.00-1.38, p = 0.048) and ICH (pHR = 1.27; 95% CI: 1.06-1.52, p = 0.010) versus on-label. Subgroup analysis demonstrated increased ISSE risk with off-label underdosed rivaroxaban compared to on-label (pHR = 1.49; 95% CI: 1.07-2.08). Compared to warfarin, off-label underdosed DOACs were associated with decreased risk of MB (pHR = 0.46; 95% CI: 0.32-0.65, p < 0.001), GIB (pHR = 0.52; 95% CI: 0.29-0.93, p = 0.028), ICH (pHR = 0.60; 95% CI: 0.42-0.86, p = 0.005), and all-cause death (pHR = 0.70; 95% CI: 0.56-0.87, p = 0.001), while illustrating similar ISSE risk. ConclusionsOff-label underdosed DOACs, particularly rivaroxaban, was associated with increased ISSE risk but did not decrease bleeding compared to on-label. Adherence to appropriate DOAC doses should be emphasised to achieve the best clinical outcomes for Asian patients with AF.

There are limited data on the burden of newly diagnosed patients with heart failure (HF) in Thailand. Thus, this study aimed to fully understand the hospitalization, rehospitalization, mortality rates, demographics and characteristics, and quality of care in these patients. A retrospective review of all eligible adult patients' medical records from 2018 and 2019 was conducted at five hospitals. The patients were newly diagnosed with HF, as indicated by the International Classification of Diseases (ICD)-10 code “I50.” Descriptive statistics was used to investigate patients' hospital burden and clinical outcome data. There were 1134 patients newly diagnosed with HF, classified as HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction (HFmrEF) (44.0, 40.0, and 16.0

Aims: Familial hypercholesterolemia (FH) is currently underdiagnosed and undertreated. The establishment of a FH registry could facilitate a deeper understanding of this disease. We described the clinical characteristics of subjects with FH from the Thai FH Registry, compared our data with the regional and global data, and identified gaps in the care of these subjects.Methods: A multicenter, nationwide prospective FH registry was established in Thailand. Our data were compared with those of the European Atherosclerosis Society-FH Studies Collaboration. Multiple logistic regression analyses were performed for variables associated with lipid-lowering medication (LLM) use and the attainment of low-density lipoprotein-cholesterol (LDL-C) goal.Results: The study includes 472 subjects with FH (mean age at FH diagnosis: 46 +/- 12 years, 61.4% women). A history of premature coronary artery disease was found in 12%. The percentage of LLM use in subjects with a Dutch Lipid Clinic Network score of >= 6 (probable or definite FH) in our registry (64%) was slightly lower than the regional data but higher than the global data. Among those who received statins, 25.2% and 6.4% achieved LDL-C levels of <100 mg/dL and <70 mg/dL, respectively. Women with FH were less likely to achieve LDL-C <70 mg/dL (adjusted odds ratio: 0.22, 95% confidence interval: 0.06-0.71, p=0.012).Conclusions: FH in Thailand was diagnosed late, and treatment was inadequate for the majority of subjects. Women with FH were less likely to achieve LDL-C goals. Our insights could potentially help raise awareness and narrow the gap in patient care.

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Novartis (Thailand) Limited Background/Introduction Heart failure (HF) is a major health problem due to its significant prevalence, disease burden and cost, mainly driven by high rates of hospitalization and mortality. Although numerous studies have demonstrated HF burden in western countries, data on current burden of HF in Thailand are limited. Purpose To describe characteristics and burden of HF, in terms of HF subgroups, hospital visits/hospitalization from HF and mortality, in participating hospitals in Thailand in 2019. Methods We retrospectively reviewed hospital profiles and medical records of HF adult patients at the five study sites which located in different regions across Thailand. All patients were diagnosed (newly and existing) with HF during 2018-2019, as identified by the International Classification of Diseases (ICD)-10 coding "I50". The interim data cutoff was scheduled when 4,000 patients were included. Hospital burden and the patients’ clinical and outcome data were collected and analyzed with descriptive statistics. Results From 4,000 patients, a total of 2,826 patients had follow-up visits in 2019 and then included in this analysis. Most of them were female (51.8%) and the overall patients’ mean (SD) age was 67.6 (15.0). Among 1,668 patients with available baseline left ventricular ejection fraction (LVEF), HF with preserved EF (HFpEF) was the most common subgroup (47.3%), followed by HF with reduced EF (HFrEF (39.0%) and HF with mid-range EF (HFmrEF) (13.7%). Of the total hospital visits from HF, 11.5% (95% CI 10.8-12.3) were from unscheduled visits to emergency or outpatient departments. HFpEF accounted for the highest number of hospital visits for HF, both scheduled and unplanned visits (46.4%, 48.9%), followed by HFrEF (39.0%, 41.5%) and HFmrEF (14.6, 9.6%), respectively. Among these 2,826 HF patients, the numbers of hospitalizations and rehospitalization from HF were 2,553 and 447. The total rate of HF rehospitalization was highest at 30 days (39.1%, 95% CI 34.6-43.7), followed by at 180 days (26.8%, 95% CI 22.7, 30.9), and 60 days (23.5%, 95% CI 19.6-27.4), respectively. The rates of all-cause and CV deaths within identified HF patients were 8.6% (95% CI 7.6-9.7) and 7.2% (95% CI 6.3-8.2). HFrEF accounted for the highest proportions of both (re) hospitalization and deaths (all-cause and CV) while HFpEF had the highest number of total beds. Conclusion Among the studied patients, HFpEF was the most common form of HF and HF was associated with a substantial healthcare burden in Thailand. The hospitalization rates from HF were especially high during the first 30 days after discharge, with a number of visits being unplanned or emergency visits leading to high hospital resource utilization.

Background:This study aimed to assess the prescribing patterns of evidence-based pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) in Thailand. Methods:A retrospective cohort study of patients with HFrEF was conducted. Treatment with a β-blocker and renin-angiotensin system inhibitors (RASIs) with or without mineralocorticoid receptor antagonists (MRAs) at discharge was regarded as guideline-directed medical therapy (GDMT). All others were considered non-GDMT. The primary endpoint was the composite of all-cause mortality or heart failure (HF) rehospitalization. Inverse-probability-treatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects. Results:In total, 653 patients with HFrEF (mean age 64.1 ± 14.3 years; 55.9% male) were included. GDMT with β-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%. During a median of 1-year follow-up, 167 patients (27.5%) had a composite event, 81 patients (13.3%) had all-cause mortality, and 109 patients (18.0%) had HF rehospitalization. Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint (adjusted hazard ratio [HR] 0.63; 95% CI 0.44-0.89; p = 0.009) compared with patients who did not receive GDMT. The use of GDMT was also associated with a significantly lower risk of all-cause mortality (adjusted HR 0.59; 95% CI 0.36-0.98; p = 0.045) and HF rehospitalization (adjusted HR 0.65; 95% CI 0.43-0.96; p = 0.031). Conclusions:For HFrEF treatment, GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization. Nevertheless, prescribing GDMT remains underused, and it could be encouraged to improve HF outcomes in real-world settings.

Background: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. Methods: This was a retrospective cohort study. Patients aged ≥18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. Results: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10–6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27–10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01–1.06), male sex (OR = 2.15; 95% CI 1.09– 4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20–8.10) were associated with significant coronary stenosis. Conclusion: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.

We previously demonstrated that monosodium glutamate (MSG) consumption increases trimethylamine (TMA) level in the renal tissue as well as dimethylamine and methylamine levels in urine of rats, suggesting the effects of MSG on humans. To better define the findings, we investigated whether MSG consumption alters serum trimethylamine N-oxide (TMAO) level, and as a consequence, induces kidney injury in the rat model. Adult male Wistar rats (n = 40) were randomized to be fed with a standard diet (control group) or a standard diet with 0.5, 1.5 or 3.0 g% MSG corresponding to 7, 21, or 42 g/day in 60 kg man, respectively in drinking water (MSG-treated groups), or a standard diet with 3.0 g% MSG in drinking water which was withdrawn after 4 weeks (MSG-withdrawal group). Blood and urine samples were collected to analyze the TMAO levels using 1H NMR and markers of kidney injury. Fecal samples were also collected for gut microbiota analysis. We found serum TMAO levels increased and urinary TMAO excretion decreased during MSG consumption, in parallel with the increase of the neutrophil gelatinase-associated lipocalin (NGAL) excretion which subsided with the withdrawal of MSG. The fecal 16 S rRNA analysis during MSG consumption showed gut microbiota changes with a consistent suppression of Akkermansia muciniphila, a mucin producing bacteria, but not of TMA-producing bacteria. In conclusions, our findings suggested that prolonged high dose MSG consumption may cause TMAO accumulation in the blood via reduction of renal excretion associated with acute kidney injury. The mechanisms by which MSG reduced TMAO excretion require further investigation.

Objectives:Obstructive sleep apnea (OSA) is a common cause of atrial fibrillation (AF). The prevalence rate of OSA in AF is highest at 80%. There is limited data if who will develop AF in OSA patients. This study aimed to evaluate the prevalence of AF in patients with OSA and find clinical factors predictive of AF in patients with OSA. Material and Methods:This was a cross-sectional study. We enrolled consecutive patients diagnosed with obstructive sleep apnea diagnosed by polysomnography. The primary outcome was persistent AF identified by electrocardiogram. Prevalence and predictors of AF in patients with OSA were analyzed. Results:During the study period, there were 199 patients with OSA enrolled in the study. Of those, 31 patients (15.57%) had AF. There were five factors in the final model predictive for AF in OSA patients. Among those factors, three factors were independently associated with AF in OSA including age, tiredness, and glomerular filtration rate. The latter two factors were protective factors, while age was a predictor for AF with an adjusted odds ratio (95% confidence interval) of 1.052 (1.004, 1.103). Conclusion:The prevalence of AF in patients with OSA was 15.57%. Elderly patients with renal deterioration are at risk of AF but AF risk was decreasing in patients with tiredness.

Background: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. Methods: This was a retrospective cohort study. Patients aged >= 18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. Results: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27-10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01-1.06), male sex (OR = 2.15; 95% CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20-8.10) were associated with significant coronary stenosis. Conclusion: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.

Purpose To assess the efficacy and safety of low-dose prasugrel compared to clopidogrel based on the occurrence of major adverse cardiac events (MACEs) and major bleeding in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Methods The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were systematically searched up to May 2020 to identify relevant randomized controlled trials (RCTs) and observational studies. A meta-analysis was conducted using a random effects model to estimate relative risks (RRs) with 95% confidence intervals (CIs). The primary efficacy and safety endpoints were MACE and major bleeding, respectively. Results Three RCTs (n = 2884) and five observational studies (n = 30,117) were included. A meta-analysis of RCTs revealed no significant differences in terms of MACE (RR 0.92, 95% CI 0.74 to 1.16) or major bleeding (RR 0.97, 95% CI 0.57 to 1.65) between low-dose prasugrel and clopidogrel. A meta-analysis of observational studies revealed no significant difference in terms of MACE (RR 1.13, 95% CI 0.82 to 1.55) between the two groups, but low-dose prasugrel was associated with a significantly increased risk of major bleeding (RR 1.33, 95% CI 1.02 to 1.72). Conclusions We found that low-dose prasugrel was not associated with changes in MACE or major bleeding compared with clopidogrel in RCTs. However, analysis of data from observational studies revealed that low-dose prasugrel was associated with an increased risk of major bleeding compared with clopidogrel.

Introduction: Obstructive sleep apnea (OSA) is a common factor associated with hypertensive crises. There is limited evidence of prevalence and risk factors of OSA in hypertensive emergency. Methods: This study recruited adult patients who diagnosed as hypertensive emergency and tested for OSA. The study period was between July 2019 and January 2020. The patients were categorized as OSA and non-OSA groups by the evidence from polysomnography. Prevalence and risk factors for OSA were executed. Results: During the study, there were 52 eligible patients. Of those, 30 patients (57.69%) were diagnosed with OSA. The stepwise logistic regression analysis for predicting OSA had two remaining factors: body mass index and diastolic blood pressure. Only body mass index was independently associated with OSA with an adjusted odds ratio of 1.166 (95% confidence interval of 1.033, 1.316). The body mass index of 25.02 kg/m(2) gave sensitivity and specificity of 80.00% and 59.09%, respectively. The area under the receiver operating characteristic curve was 70.98%. Conclusion: OSA had high incidence rate in patients with hypertensive emergency. High body mass index was a predictor for OSA associated with hypertensive emergency.

Seventy-three year-old male with history of diabetes, hypertension, and chronic kidney disease stage 3 presented with epigastric pain and hyponatremia. ECG showed new ST segment elevation at precordial leads consistent with Cove-type Brugada ECG pattern. Cardiac catheterization revealed non-significant coronary artery stenosis. He experienced pre-syncope and palpitations a year prior to admission with family history sudden cardiac death. Brugada syndrome was diagnosed. Cove-type Brugada ECG pattern and palpitations resolved with corrected sodium to 135.