Objective: Creatine kinase-myocardial band (CK-MB) and troponin-I are the most specific and accurate indicators of myocardial infarction among different cardiac biomarkers. However, few studies have examined the correlation between temporal changes of these biomarkers and high risk echocardiographic and angiographic variables. The aim of our study was to assess the relationship between these variables. Methods: Our study was a prospective study of 113 patients with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) who were admitted within the first hours of the onset of chest pain. Troponin-I and CK-MB were measured serially at the time of hospital admission, at 6-9 hours and again at 12-24 hours. All patients underwent transthoracic echocardiography and coronary angiography and left ventricular ejection fraction (LVEF), mitral regurgitation and severity of coronary artery disease were determined. Results: Troponin-I level within 6-9 hours after admission was significantly associated with significant coronary artery disease among different variables (P-value=0.032, odds ratio=1.11, 95% confidence interval [1.01-1.22]). Also, patients younger than 65 years of age had higher levels of troponin-I within 6-9 and 12-24 risk THOMAS ANGER ET AL: Coronary Arcade Visualized in 256 Sliced Multi-Detector Cardiac Computed Tomography: A 52-year-old male patient presented to our Department of Internal Medicine with severe sustained chest pain for at least 18 hours, for ruling out acute myocardial infarction. We performed a cardiac 256 multi-sliced computed tomography to document a coronary arcade as the coronary abnormality. (J HK Coll Cardiol 2018;26: 90-93) A hallmark of atherosclerosis is progressive intimal thickening (or neointimal hyperplasia), which leads to occlusive vascular diseases such as coronary heart disease and stroke. Over-production of reactive oxygen species (ROS) and alteration of Ca2+ signaling are among the key factors contributing to neointimal growth in atherosclerosis. In the present study, we investigated the role of TRPM2, a ROS-sensitive Ca2+ entry channel, in neointimal hyperplasia. We first established a vascular injury-induced atherosclerosis model in mice. Immunostaining showed numerous TRPM2-positive smooth muscle cells in neointimal regions. ROS were over-produced and PCNA- positive proliferating cells were numerous in the neointimal regions. The neointimal hyperplasia was substantially reduced in TRPM2 knockout mice compared with wild-type mice. In addition, we generated a rabbit anti-TRPM2 antibody, named TM2E3, that can inhibit TRPM2 activity. TM2E3 can effectively inhibit the activity of TRPM2 channels in patch clamp recording. Importantly, TM2E3 treatment caused a marked reduction in neointimal hyperplasia in a human model of vascular wall hyperplasia. We also explored the mechanism of TRPM2 involvement in atherosclerostic development. The results demonstrated that TRPM2 participates in several key steps of atherosclerotic development; 1) it promotes the proliferation and migration of vascular smooth muscle cells; 2) it enhanced autophagic and apoptotic cell death of vascular cells. Taken together, our data suggest a critical functional role of TRPM2 in the progression of neointimal hyperplasia and atherosclerosis. The study also highlights the possibility of targeting TRPM2 as a potential therapeutic option for the treatment of atherosclerosis. Emerging evidences have suggested a link between osteoporosis and cardiovascular diseases (CVD), such relationship could be contributed by the shared pathophysiology and common risk factors. Calcium-parathyroid hormone-vitamin D axis plays an important role in bone and mineral metabolism, multiple studies have indicated their involvements in both diseases. In addition to this axis, vitamin K also plays a role in bone mineralization, and it is also a target of the anticoagulant warfarin. Our recent study showed that, compared with dabigatran, warfarin use is associated with increased risk of fracture in patients with nonvalvular atrial fibrillation. In terms of treatment of osteoporosis, nitrogen-containing bisphosphonates (N-BP) is usually regarded as the first line medication. Pharmacological study of N-BP showed that N-BP possesses the anti-inflammatory and immune-modulatory property, therefore N-BP is potentially beneficial for cardiovascular events. Using a large propensity score matched population, we recently showed that N-BP use in hip fracture patient was associated with reduced cardiovascular events, including 48% reduction in myocardial infarction. Notably, a recent unpublished randomized controlled trial in 3000 osteopenic postmenopausal women has also demonstrated a similar effect (42% reduction) of N-BP in myocardial infarction. Notably, N-BP reduces bone resorption by targeting the mevalonate pathway, which is the same molecular pathway that statin targets. We therefore evaluated the role of LDL-cholesterol in bone metabolism and found that it is inverse and causally associated with bone mineral density, whereas statin use is associated with better bone mass (submitted for publication). In conclusion, there is a substantial crosstalk between bone and cardiovascular systems, thus special attention is required in the treatment of bone and cardiovascular diseases, as the use of drug may affect both systems. Background: Intensive smoking cessation intervention in conjunction with a comprehensive preventive cardiology programme increases the rate of a successful quit attempt. However, the interaction of a multitude of other relevant factors surrounding care influences the attainment of abstinence at the end of treatment. Objective: To examine the factors associated with persistent smoking among smokers within the intervention arm of the EUROACTION plus varenicline (EA+) trial. Methods: A dataset consisted of 342 smokers (271 at high CVD risk and 71 with vascular disease) within the intervention arm of the EA+ trial was analysed using a post-hoc multivariate regression analyses. The primary outcome of the main trial was smoking abstinence as defined by a self-reported seven-day point prevalence abstinence (PPA), validated with a breath carbon monoxide (CO) measurement. Persistence of smoking as the outcome of the present study was compared with explanatory variables in a bivariate analysis using stepwise logistic regression to examine the association between them. Variables showing significant association in the analysis were subsequently included into the multivariate analysis. Results: The result of the multiple logistic regression revealed that anxiety is positively associated with an unsuccessful quit attempt at 16-week follow-up, with an odds ratio (OR) of 1.07 [95% confidence interval (CI) 1.01-1.13, p=0.01], following a nurse-led, comprehensive, multifactorial preventive cardiology programme with the focus on intensive smoking cessation. In non-quitters, every one-point increase in anxiety score was associated with an increase of 7% chance of continuing to smoke. Conclusion: The findings of this study highlighted the influence of psychosocial factors on smoking abstinence. Intensive smoking cessation emphasised within a preventive cardiology programme improved the likelihood of persistent smokers to stop smoking. Objective: To determine the impact of optimizing the primary percutaneous coronary intervention (pPCI) process and monitor the process by a mobile app for door-to-balloon time among ST-elevation myocardial infarction patients. Methods: A quasi-experimental before-and-after study. Consecutive ST- elevation myocardial infarction patients who visited the hospital emergency department between January 2016 and December 2016 were included. An intervention program was designed that incorporated an expert panel root cause analysis, a patient transfer protocol, a pPCI education scheme, standard preoperative preparation guidelines, and time monitoring via a mobile app. Results: Of the 180 patients examined, 22 were examined prior to the intervention; 55 immediately after the intervention, which was implemented to determine the short-term effect; and 103 at five months after the intervention was initiated. The D2B time was significantly shortened immediately after the intervention was implemented (108.26 [47.23] minutes) than before the intervention (162.56 [100.74] minutes) but was not as short as the D2B time at the end of the follow-up period (97.76 [44.02] minutes) (p<0.001). Achievement of D2B time within 90 min was 27.8% before intervention, 43.4% immediately after the intervention, and 48.5% during follow up (p=0.26). Before the intervention, two patients died before catheterization, while after the intervention, no patients died (p<0.05). A monthly time series analysis demonstrated a sustained improvement following the intervention. Conclusion: The process-optimizing intervention and monitoring by a mobile app significantly shortened the D2B time and reduced mortality. The rate of achieving a D2B time within 90 minutes has improved although not statistically significant. Background: The burden of congestive heart failure (CHF) in the modern society of Hong Kong is increasing annually. A local study in 1997 estimated the overall incidence rate per 1000 men and women was 5.7 and 4.8 respectively. Patients would benefit from a standardized guideline oriented inpatient hospital care. Clinical pathways for heart failure have been developed, but these models have not been evaluated in the local community setting. Here, we sought to assess the effectiveness of implementation of a clinical heart failure pathway by evaluating the use of heart failure medications, length of stay, rate of readmission in patients with congestive heart failure. Methods: Heart failure pathway was implemented in Pok Oi Hospital since December 2015. We retrospectively studied a total of 185 patients (mean age 66.5 ± 10.1) with diagnosis of co

The needs to counsel patients with chronic medical conditions to understand their risk of driving or their potential legal eligibility to drive has become more and more important because patients are deterring from retirement due to social reasons and older drivers with higher prevalence of chronic illness will continue to drive while more younger patients at their working age developed chronic illness. Nonetheless, counseling would not be effective without a good understanding of the current legal requirements on medical fitness to drive although it has remained unchanged for the past few decades. The law statement is simple yet it is too broad and not specific enough to be applied in medical setting. To enhance patients' understanding of their own risk of driving with respect to their medical condition and to provide instruction on what to do, a return-to-drive counseling service has been developed in Tuen Mun Hospital for the past few years. In this workshop, the current legal requirement in Hong Kong will be explored and the approach on this issue in our daily practice and common challenges will be discussed. number of arrhythmia such as atrial fibrillation are known to include anxiety as a symptomatic manifestation. There is difficulty in making this diagnosis and some aspects should be considered. This includes the presence of a clear temporal association between the cardiovascular disorder and the anxiety symptoms, the presence of symptoms that are atypical of a primary anxiety disorder and the presence of evidence in the literature that the cardiovascular disorder causes anxiety. The anxiety or panic attacks must not be better explained by a primary anxiety disorder. The assessment could be performed using Cardiac Anxiety Questionnaire which is an 18-item self-report inventory that measures anxiety related to cardiac symptoms. As cardiac anxiety causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and anxiety exerts negative acute and long-term effects on the outcome of cardiac rehabilitation, medical treatment of cardiac anxiety is indicated. This involves a combination of pharmacological and psychological treatment. Regarding the pharmacological treatment of cardiac anxiety, the main categories of medications used are antidepressants, beta-blockers and benzodiazepines. Antidepressants include selective serotonin reuptake inhibitors and newer atypical antidepressants. Although beta-blockers do not affect the emotional symptoms of anxiety, they can relieve the physical symptoms of anxiety such as increased heart rate and trembling voice. Benzodiazepines provide relief of acute anxiety. They have physiological effects such as immediate lowering of the catecholamine level and decreasing coronary vascular resistance. Apart from pharmacological treatment, psychological treatment is also useful for cardiac anxiety. Psychotherapy such as cognitive behavioural therapy is a form of intervention which has a positive effect on the quality of life of patients with cardiac anxiety. There was evidence that mindfulness-based stress reduction program was useful. There the flight, evaluating the effect made by the aviation factors in aggravating the symptoms of the disease, introducing the flight limitations for the cabin crew and sick travelers and evaluating the function of automatic external defibrillation are the subjects that will be analyzed in this article. The and frail and cardiac patients need to start at with 1 set of 10-15 reps as the adaptation is The patients are instructed to raise weights with slow, controlled movements to full extension, exhale during exertion phase of the lift, avoid straining and Valsalva maneuver, minimize rest periods to increase endurance, stop exercise upon alarming signs or symptoms and avoid tight gripping of the weight handles. In this workshop we show all kinds of these exercises in practical type for cardiac patients. As a result all kinds of physical activities are recommended for cardiac patients in scientific and correct manners. Acute coronary syndrome (ACS) is usually caused by atherosclerotic plaque rupture resulting in thrombosis of coronary artery and myocardial necrosis. Lipid management is pivotal in primary and secondary prevention of ACS and statins have been shown to improve clinical outcome. However, despite modern revascularization technology, potent antiplatelet agents, neurohormonal modulation and statins, long term major cardiovascular event rate is still high. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a chaperone to destroy low density lipoprotein (LDL) receptor. A loss-of-function mutation of PCSK9 increases LDL receptors and markedly lower circulating LDL level translating into very low incidence of atherosclerosis. Numerous research have been performed in PCSK9 inhibition and monoclonal antibody to PCSK9 emerges to be an effective mean to reduce LDL level. Two PCSK9 inhibitors Alirocumab and Evolocumab approved for treatment in ACS patients who additional LDL lowering to reduce future cardiovascular risks. In multiple studies, they reduced LDL by 50- 70% with or without background treatment of statins. They also decreased coronary plaque volume and were effective in patients with familial hypercholesterolemia and statin intolerance. In clinical outcome studies involved more than 40,000 high cardiovascular risk individuals (including ACS), both agents reduced long term cardiovascular events. Treatment related adverse events were minimal. In the journey of lipid lowering therapy research, numerous studies confirmed the 'lower is better' theory of relationship between LDL and cardiovascular events. PCSK9 inhibitors emerge to be strong weapons for ACS secondary prevention. Nevertheless, as treatment cost is relatively high and hence identifying patients potentially derive maximum benefit becomes essential. Clinical risk factors (e.g. TRS2P score), baseline LDL and pathogenic genetic mutations are important for consideration. Future research may identify other potential factors such as biomarkers, proteomics, genomics etc for of PCSK9 inhibitors if not all patients with artery talk will focus on: - The importance of physical activity and exercise - Overview of current technology (with emphasis on wearables) in exercise promotion - Review of evidence (reliability, validity, effectiveness) Background: Empowering patients with coronary heart disease (CHD) to perform adequate physical activity is a main goal of cardiac rehabilitation (CR) programme. Self-efficacy, one's belief in his or her ability to perform and succeed in a particular situation, could influence the self-reported physical activity level. This study aims to examine the association between the exercise self-efficacy, objectively assessed physical level and exercise capacity of CHD patients participating in a CR programme. Method: We recruited 110 Chinese adults (age: 63.7 ± 10.4 years old) with clinical diagnosis of CHD and participating in a CR programme. The self- efficacy for exercise of participants was measured by the Cardiac Exercise Self-efficacy Scale. The physical activity level and exercise capacity was measured by an activity tracker and 10-metre incremental shuttle walk test, respectively. Multiple regression models were used to adjust covariates of physical activity level and exercise capacity. Results: The CHD patients walked a mean 9893 ± 4476 steps per day, in which 60.3% of them walked ≥ 7500 steps/day. Higher exercise self-efficacy was significantly associated with higher odds of adequate walking activity (OR = 2.30, 95% CI: 1.05 - 5.02) after adjusting for age, sex and body mass index. The CHD patients also completed a mean 512.0 ± 175.3 meters in the incremental shuttle walk test. After adjusting for age, sex, physical activity level and body mass index, the exercise self-efficacy was significantly associated with the exercise capacity of CHD patients (beta = 0.24, p<0.05). Exercise capacity is limited in patients with heart failure (HF). Limited exercise capacity is associated with disease severity and symptom, which is the NYHA functional class itself. Furthermore, it is an independent predictor for the prognosis of patients with HF. That is, the lower the peak oxygen uptake, the poorer the prognosis has been shown. Several factors including cardiac function pulmonary function, central hemodynamics, pulmonary circulation, and peripheral skeletal muscle function are associated with oxygen uptake. On the other hand, given that the pathology of HF leads to systemic organ damage, it is clear that oxygen uptake is a very good indicator of the condition of HF. Especially, skeletal muscle abnormalities rather than other factors play an important role on the reduced oxygen uptake. Various skeletal muscle abnormalities including abnormal energy metabolism, transition of myofibers from type I to type II, mitochondrial dysfunction, reduction in muscular strength, and muscle atrophy have been reported in patients with HF. However, the mechanism by which these abnormalities are caused has not been clarified. In this session, I will outline the importance and mechanism of skeletal muscle abnormalities in HF. It is well known that exercise tolerance is a prognostic factor of patients with heart failure (HF), and skeletal muscle indices are associated with exercise tolerance besides cardiac and pulmonary functions. Chronic HF is often accompanied with substantial skeletal muscle weakness, caused by immune activation, neuro-hormonal factors, decreased anabolic hormone activities, low physical activity, malnutrition and sarcopenia. Nutrition status in acute heart failure patients is more easily aggravated, compared with that in chronic heart failure patients. Nutrition therapy combined with cardiac rehabilitation could be more effective than nutrition therapy alone, and it should be carried out by a multidiscip

Abstract should be after title page and numbered page 1. It should not exceed 250 words for major articles; case reports should have abstracts of no more than 100 words. At the end of the abstract, provide a maximum of 6 key words suitable for indexing. Abbreviations should be kept to a minimum and must be explained when they first appear; after first use, abbreviations alone may be used. Standard abbreviations should be used for all measurements (SI units). Text The text should follow the abstract and begin on a new page, as should References, Tables, and Legends. Abbreviations not defined in the abstract should be explained when they first appear in the text. References should be cited in numerical order, as should tables and figures. References Number in the order in which they appear in the text. Abbreviate titles of periodicals according to the style of the Index Medicus. Follow the format (arrangement, punctuation) shown below: Periodicals 1. Lewis T. Paroxysmal tachycardia. Heart 1909;1:43-72. (if more than three authors, please use "et al." after the third). Books (edited by other authors of article) 2. Furman S. Pacemaker follow-up. In Barold SS, (eds): Modern Cardiac Pacing. Mount Kisco, New York, Futura Publishing Company, 1985, pp. 889-958. Books (identical author and editor) 3. Chung EK. Principles of Cardiac Arrhythmias. Baltimore, MD, Williams & Wilkins, 1977, pp. 97-188. Abstracts 4. Same as periodicals and followed by "(abstract)". Tables Tables should supplement, but not duplicate, the text. Tables should be numbered consecutively in order of appearance in the text. Each table must be given an Arabic numeral and a title, placed at the top of the page. Abbreviations used in the table should be foot-noted and explained in the order in which they appear in the table, if they have not been previously used. Any material which is not self-explanatory should be foot-noted as well. Legends Be sure that legends and figures correspond. Identify all abbreviations used in a figure at the end of each legend, if the abbreviation has not been used in the text. Be sure abbreviations used for measurements are standard SI unit. Figures Submit either 3 black and white glossy prints or 2 prints and one photocopy, preferably of 13 cm x 18 cm (5" x 7") size. On the back of each figure, indicate number, senior author's surname, top of illustration; all of this should be written lightly with soft, black pencil. Submit written permission from publisher(s) for any figure which has been published previously. Do not use clips on illustrations; submit them in an envelope backed by cardboard. Any lettering or scale of measurement used in an illustration must be large enough to be legible in the event of half-size reduction. Do not send original art-work, X-rays, or ECGs. Photographs in which a patient or other person is identifiable must have written permission from that person. The consent must state specifically what the person is consenting to and what restrictions, if any, the person has placed upon the publication of the photo-graph. All restrictions must be strictly observed. Colour illustrations are costly and will be charged to the author. Authors should inquire about cost from the publisher before submitting a colour illustration. Ethics Published studies on human subjects should indicate the nature of consent and the approval of the institutional ethics committee if deemed appropriate. In case of animal experiments, ethical approval must be enclosed. The author is responsible for all material presented in a paper. The journal disclaims all responsibility for such material. No product or service advertised in this publication is guaranteed or warranted either by the Editors or publisher. Neither the Editors nor publisher guarantee any claims made by a manufacturer or an author in regard to a product or service. If a trademark item is named, the name(s) and address(es) of the manufacturer(s) or supplier(s), in addition to the generic name, should be foot-noted. Reprints are available. Ordering information can be obtained from the above address. Subscription Rates Local Subscription: HK$200/year (including postage) Overseas Subscription: US$120/year (including airmail postage)

Abstract should be after title page and numbered page 1. It should not exceed 250 words for major articles; case reports should have abstracts of no more than 100 words. At the end of the abstract, provide a maximum of 6 key words suitable for indexing. Abbreviations should be kept to a minimum and must be explained when they first appear; after first use, abbreviations alone may be used. Standard abbreviations should be used for all measurements (SI units). Text The text should follow the abstract and begin on a new page, as should References, Tables, and Legends. Abbreviations not defined in the abstract should be explained when they first appear in the text. References should be cited in numerical order, as should tables and figures. References Number in the order in which they appear in the text. Abbreviate titles of periodicals according to the style of the Index Medicus. Follow the format (arrangement, punctuation) shown below: Periodicals 1. Lewis T. Paroxysmal tachycardia. Heart 1909;1:43-72. (if more than three authors, please use "et al." after the third). Books (edited by other authors of article) 2. Furman S. Pacemaker follow-up. In Barold SS, (eds): Modern Cardiac Pacing. Mount Kisco, New York, Futura Publishing Company, 1985, pp. 889-958. Books (identical author and editor) 3. Chung EK. Principles of Cardiac Arrhythmias. Baltimore, MD, Williams & Wilkins, 1977, pp. 97-188. Abstracts 4. Same as periodicals and followed by "(abstract)". Tables Tables should supplement, but not duplicate, the text. Tables should be numbered consecutively in order of appearance in the text. Each table must be given an Arabic numeral and a title, placed at the top of the page. Abbreviations used in the table should be foot-noted and explained in the order in which they appear in the table, if they have not been previously used. Any material which is not self-explanatory should be foot-noted as well. Legends Be sure that legends and figures correspond. Identify all abbreviations used in a figure at the end of each legend, if the abbreviation has not been used in the text. Be sure abbreviations used for measurements are standard SI unit. Figures Submit either 3 black and white glossy prints or 2 prints and one photocopy, preferably of 13 cm x 18 cm (5" x 7") size. On the back of each figure, indicate number, senior author's surname, top of illustration; all of this should be written lightly with soft, black pencil. Submit written permission from publisher(s) for any figure which has been published previously. Do not use clips on illustrations; submit them in an envelope backed by cardboard. Any lettering or scale of measurement used in an illustration must be large enough to be legible in the event of half-size reduction. Do not send original art-work, X-rays, or ECGs. Photographs in which a patient or other person is identifiable must have written permission from that person. The consent must state specifically what the person is consenting to and what restrictions, if any, the person has placed upon the publication of the photograph. All restrictions must be strictly observed. Colour illustrations are costly and will be charged to the author. Authors should inquire about cost from the publisher before submitting a colour illustration. Ethics Published studies on human subjects should indicate the nature of consent and the approval of the institutional ethics committee if deemed appropriate. In case of animal experiments, ethical approval must be enclosed. The author is responsible for all material presented in a paper. The journal disclaims all responsibility for such material. No product or service advertised in this publication is guaranteed or warranted either by the Editors or publisher. Neither the Editors nor publisher guarantee any claims made by a manufacturer or an author in regard to a product or service. If a trademark item is named, the name(s) and address(es) of the manufacturer(s) or supplier(s), in addition to the generic name, should be foot-noted. Reprints are available. Ordering information can be obtained from the above address. Subscription Rates Local Subscription: HK$200/year (including postage) Overseas Subscription: US$120/year (including airmail postage)

Abstract should be after title page and numbered page 1. It should not exceed 250 words for major articles; case reports should have abstracts of no more than 100 words. At the end of the abstract, provide a maximum of 6 key words suitable for indexing. Abbreviations should be kept to a minimum and must be explained when they first appear; after first use, abbreviations alone may be used. Standard abbreviations should be used for all measurements (SI units). Text The text should follow the abstract and begin on a new page, as should References, Tables, and Legends. Abbreviations not defined in the abstract should be explained when they first appear in the text. References should be cited in numerical order, as should tables and figures. References Number in the order in which they appear in the text. Abbreviate titles of periodicals according to the style of the Index Medicus. Follow the format (arrangement, punctuation) shown below: Periodicals 1. Lewis T. Paroxysmal tachycardia. Heart 1909;1:43-72. (if more than three authors, please use "et al." after the third). Books (edited by other authors of article) 2. Furman S. Pacemaker follow-up. In Barold SS, (eds): Modern Cardiac Pacing. Mount Kisco, New York, Futura Publishing Company, 1985, pp. 889-958. Books (identical author and editor) 3. Chung EK. Principles of Cardiac Arrhythmias. Baltimore, MD, Williams & Wilkins, 1977, pp. 97-188. Abstracts 4. Same as periodicals and followed by "(abstract)". Tables Tables should supplement, but not duplicate, the text. Tables should be numbered consecutively in order of appearance in the text. Each table must be given an Arabic numeral and a title, placed at the top of the page. Abbreviations used in the table should be foot-noted and explained in the order in which they appear in the table, if they have not been previously used. Any material which is not self-explanatory should be foot-noted as well. Legends Be sure that legends and figures correspond. Identify all abbreviations used in a figure at the end of each legend, if the abbreviation has not been used in the text. Be sure abbreviations used for measurements are standard SI unit. Figures Submit either 3 black and white glossy prints or 2 prints and one photocopy, preferably of 13 cm x 18 cm (5" x 7") size. On the back of each figure, indicate number, senior author's surname, top of illustration; all of this should be written lightly with soft, black pencil. Submit written permission from publisher(s) for any figure which has been published previously. Do not use clips on illustrations; submit them in an envelope backed by cardboard. Any lettering or scale of measurement used in an illustration must be large enough to be legible in the event of half-size reduction. Do not send original art-work, X-rays, or ECGs. Photographs in which a patient or other person is identifiable must have written permission from that person. The consent must state specifically what the person is consenting to and what restrictions, if any, the person has placed upon the publication of the photograph. All restrictions must be strictly observed. Colour illustrations are costly and will be charged to the author. Authors should inquire about cost from the publisher before submitting a colour illustration. Ethics Published studies on human subjects should indicate the nature of consent and the approval of the institutional ethics committee if deemed appropriate. In case of animal experiments, ethical approval must be enclosed. The author is responsible for all material presented in a paper. The journal disclaims all responsibility for such material. No product or service advertised in this publication is guaranteed or warranted either by the Editors or publisher. Neither the Editors nor publisher guarantee any claims made by a manufacturer or an author in regard to a product or service. If a trademark item is named, the name(s) and address(es) of the manufacturer(s) or supplier(s), in addition to the generic name, should be foot-noted. Reprints are available. Ordering information can be obtained from the above address. Subscription Rates Local Subscription: HK$200/year (including postage) Overseas Subscription: US$120/year (including airmail postage)

A 32-year-old previously healthy female presented with a 2-day history of unstable angina. An electrocardiogram showed ST elevation in leads aVR and V1 with concomitant ST depression in leads I, aVL, V5, and V6. A troponin test was negative. Urgent coronary angiography revealed isolated left main ostial stenosis (Figure 1a) with no obstructive disease in the major coronary arteries. The left main stenosis persisted Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(5) 607–608 The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314523769 aan.sagepub.com

The role of the second-generation zotarolimus-eluting stent RESOLUTE in small-vessel coronary artery disease is unclear. The aim of this study was examine the angiographic results of RESOLUTE in de novo coronary lesions of ≥50 % diameter stenosis in target vessels ≤2.5 mm. From August 2008 to April 2010, 142 symptomatic patients with 159 lesions who fitted the inclusion criteria were treated with RESOLUTE. The mean age of patients was 66 ± 10 years, with male predominance (66 %). Diabetes mellitus was found in 62 (43.7 %) patients, whereas multivessel disease was observed in 105 (73.9 %). The mean stent size and length used were 2.33 ± 0.13 and 22 ± 8 mm, respectively. Follow-up angiography was performed on 143 (89.9 %) lesions in 127 (89.4 %) patients at a mean of 10.3 ± 3.6 months. Angiographic restenosis was found in 9 (6.3 %) lesions; the late loss was 0.26 ± 0.34 mm. At 1-year follow-up there were four cardiovascular deaths, two nonfatal myocardial infarctions, and six repeated revascularizations. The resultant major adverse cardiac event rate was 8.5 %. The use of RESOLUTE to treat small-vessel disease is associated with good clinical and angiographic outcomes at 1 year.

introduction: Biomarkers of subclinical systemic chronic inflammation are increasingly recognised as a key player in atherosclerosis. C-reactive protein, measured using high-sensitivity assay (hsCRP), is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). As obesity is associated with disregulated expression of various adipokines, either pro-inflammatory or anti-inflammatory, such adipokines may also serve as non-traditional biomarkers for the accelerated atherosclerosis associated with obesity. In this prospective cohort study, we examined the predictive value of a variety of non-traditional biomarkers for CVD among Hong Kong Chinese, and determined if they would enhance the predictive value in conjunction with the traditional markers. Methods: Subjects were recruited from the Hong Kong Cardiovascular Risk Factors Prevalence Study 2 (CRISPS 2) cohort. Those with known cardiovascular disease(s) were excluded. Baseline serum levels of hsCRP, IL-6, soluble tumour necrosis factor alpha receptor 2 (sTNF- α R2; a surrogate marker of TNF- α ), and adiponectin were determined. Subjects were followed prospectively for 6 years. Results: A total of 1776 subjects were included in the final analysis. The cumulative incidence of CVD was 85 (4.8%). At baseline, subjects with incident CVD had higher proportions of male gender and current/former smoker. They were older, and had higher body mass index (BMI), waist circumference (WC), blood pressure (BP), HOMA-IR, and fasting glucose levels (all P<0.001), compared to those who did not develop CVD (non- CVD). They also had higher LDL-cholesterol and triglycerides, and lower HDL-cholesterol levels. Among the non-traditional biomarkers, subjects with incident CVD had higher baseline levels of hsCRP (1.50 vs 0.69 mg/L), IL-6 (0.83 vs 0.56 pg/mL) and sTNFR2 (2276 vs 1879 ng/mL) [all P<0.001], but similar adiponectin levels, compared to non-CVD subjects. Cox proportional hazards regression showed that baseline hsCRP, IL-6, and sTNFR2 were independent predictors of incident CVD even after controlling for the established risk factors. Conclusion: In this 6-year prospective study, hsCRP, IL-6, and sTNFR2 were independent predictors of incident CVD in Hong Kong Chinese, in addition to the established CVD risk factors. Measurements of these non- traditional biomarkers may allow early CVD risk stratification among these low-risk, apparently healthy subjects. Background: Hepatocellular carcinoma (HCC) is a common malignancy especially in patients with chronic liver disease. It often presents late. Sorafenib is the only systemic treatment for advanced HCC proven to have survival benefit. Previous studies included predominantly patients with Child-Pugh A liver cirrhosis, and the use of sorafenib in patients with poor liver function is controversial. This study aimed to explore the efficacy and tolerability of using sorafenib in Child-Pugh B patients. Methods: Advanced HCC patients treated with sorafenib at Queen Mary Hospital, Hong Kong were analysed retrospectively. Treatment outcomes were analysed according to their respective Child-Pugh status. Results: The baseline demographic parameters were comparable between 108 Child-Pugh A and 64 Child-Pugh B patients. Both clinical benefit rate (21.3% vs 25.0%; P=0.58) and progression free survival (median, 3.2 vs 2.8 months; P=0.31) were similar between the two groups. The overall survival was significantly longer in Child-Pugh A patients (median, 6.1 vs 3.9 months; P=0.009). The most common grade 3/4 adverse events (AEs) were hand-foot-syndrome (13.5%), diarrhoea (9.9%), and rash (7.0%). Grade 3/4 leukopenia, thrombocytopenia, and anaemia occurred in 2.9%, 5.3%, and 8.8% of the patients, respectively. Child-Pugh A and B patients experienced similar incidence of most AEs. Nonetheless, Child-Pugh B patients experienced more anaemia (71.4% vs 50.5 %; P=0.01), gastrointestinal bleeding (15.6% vs 5.6%, P=0.05) and hepatic encephalopathy (10.9% vs 1.9%; P=0.01). Conclusions: Child-Pugh A and B patients tolerated sorafenib similarly and derived comparable clinical and progression-free survival benefit. Child-Pugh B patients were more susceptible to developing cirrhotic complications, thus vigilant surveillance is needed.

OBJECTIVES:The purpose of this study was to examine the angiographic and clinical results of stent full metal jacket in treating long lesions using everolimus-eluting stents (EES).BACKGROUND:Data are lacking regarding the use of EES for this lesion subgroup.METHODS:From 2007 to 2011, 77 symptomatic patients who had severe coronary stenoses necessitating implantation of stents with total length longer than 60 mm were treated with overlapping EES.RESULTS:The mean age of patient was 61 ± 11 years with male predominance (66%). Diabetes mellitus was seen in 35 (45.5%) patients. Majority of patients had class III angina with normal heart function. On average, 3.1 stents were implanted per lesion; the mean stent size and length were 2.70 ± 0.28 mm and 82 ± 16 mm. Restudy angiography was performed on 71 patients (72 lesions) at 8.9 ± 2.5 months. Angiographic restenosis was seen in 9 (12.5%) lesions; the lesion length and late loss were 67 ± 15 mm and 0.4 ± 0.6 mm, respectively. The use of intravascular ultrasound has been found to be a predictor of less restenosis (P = 0.02; HR: 0.02; CI: 0.01-0.59). The in-hospital and 1 year major adverse cardiac event rates were 7.8% and 13%. The annual cardiac death rates were 2.6%, 3.4%, and 5.3% in the first 3 years.CONCLUSIONS:The use of EES full metal jacket for long lesions is only associated with good short-term clinical and angiographic outcomes. Long-term follow-up has revealed a high cardiac death rate which may necessitate prolongation of dual antiplatelet therapy.

INTRODUCTION:A few electrocardiographic criteria have been described to identify the infarct-related artery in inferior myocardial infarction. The aim of this study was to devise an arithmetic score to further improve the diagnostic accuracy. MATERIALS AND METHODS:From 2004 to 2006, 78 patients who underwent primary angioplasty for inferior myocardial infarction within 6 hours from symptom onset were recruited for electrocardiographic and angiographic analysis. RESULTS:The mean age of patients was 65 ± 12 years with male predominance (74%). Less ST depression in lead I and aVL, and more prominent ST depression in lead V1-3 were observed in left circumflex artery (LCX) than right coronary artery (RCA) occlusions. In addition, more prominent ST depression in lead I and ST elevation in V1 were found in proximal RCA than distal RCA occlusions. Based on the findings, the Jeopardised Inferior Myocardium (JIM) score was constructed and defi ned as [II-V3/III+V1- I]. The sensitivity and specificity of JIM score ≤0.5 to predict proximal RCA occlusions; 0.5 1.5 to predict LCX occlusions were 58% and 85%, 69% and 68%, and 79% and 94%, respectively. The accuracy of prediction is slightly better than the 2 previously reported criteria. CONCLUSION:By taking into account more leads, the JIM score is capable of identifying the infarct-related artery with an improved diagnostic accuracy.

Background: No data has been published on the management of in-stent restenotic bifurcation lesions. The aim of this small case series was to examine the angiographic and long-term clinical outcomes of using sleeve technique to treat this lesion subset.Methods: Six consecutive and symptomatic patients with MEDINA classification 1,1,1 in-stent restenotic bifurcation lesion were treated with drug-eluting stents using sleeve technique. Dual antiplatelet therapy was prescribed for an average of 13.5 ± 2.3 months.Results: Most of the lesions (87%) were located at LAD/diagonal branch bifurcation. Kissing balloon inflation was performed successfully in all the patients. Follow-up angiography at nine months revealed a late loss of 0.35 ± 0.26 mm and 0.56 ± 0.56 mm in MV and SB, respectively. Angiographic restenosis was developed in 2 patients (33%), which were all located at the SB ostium. No in-hospital MACE was observed. One-year MACE was 17%, attributed by 1 patient with restenosis who needed revascularization. The mean follow up period was 50 ± 18 months, no stent thrombosis was detected.Conclusions: The use of sleeve technique to treat in-stent restenotic bifurcation lesions is associated with good acute procedural result, a fairly low one-year MACE and long-term clinical safety.

New lesion developed in an area which had received vascular brachytherapy poses a clinical dilemma. We report the successful use of endothelial progenitor cell capture stent implantation to treat this lesion sub-type, with no observed adverse event after withdrawal of clopidogrel.

Data of virtual histology (VH) acquired by intravascular ultrasound (IVUS) on saphenous vein graft (SVG) lesions is lacking. This study sought to report the VH IVUS findings in degenerative aortocoronary SVG lesions and correlate various types of plaque compositions (fibrous, fibro-fatty, dense calcium, and necrotic core) with different clinical and lesion characteristics. Virtual histology IVUS was performed on SVG in 38 symptomatic patients with a history of coronary artery bypass grafting, who underwent percutaneous coronary intervention on either native vessels or SVG. Measurements were made at the image slice with the smallest lumen. A total of 54 SVG lesions were analyzed; the mean graft age was 13.7 ± 4.0 years. The mean vessel size was 5.0 ± 1.0 mm; plaque area was 13.4 ± 7.3 mm2, and plaque burden was 63.0% ± 15.0%. Fibrous tissue represented the major plaque component (62.1% ± 17.1%). Lesions with a plaque burden of ≥70% were associated with positive remodeling, larger vessel size, higher percentage of fibro-fatty tissue, but lower percentage of dense calcium. Plaque burden was found to be positively correlated with remodeling index (r = 0.37, P = 0.01) and % fibro-fatty tissue (r = 0.49, P < 0.001) but negatively correlated with % dense calcium (r= −0.31, P = 0.03). The severity of SVG atherosclerosis paralleled with a proportional increase in fibro-fatty tissue. Unstable plaques in SVG were associated with positive remodeling, lipid-rich atheroma, and less calcium deposition, similar to the VH IVUS findings in native coronary arteries.

Background: We examined the long term clinical outcomes after administration of intravascular brachytherapy (IVBT) for instent restenosis (ISR) and de novo coronary artery lesions in percutaneous coronary intervention (PCI).Methods and Materials: From May 2000 to August 2004, 129 symptomatic patients with ISR and de novo coronary artery lesions were treated with intravascular beta radiation after successful PCI. The primary end-point was major adverse cardiac event (MACE), i.e., a composite of all-cause death, myocardial infarction and target lesion revascularization (TLR) within 5 years of follow-up.Results: The mean age of patients was 64+ 10 years with a male predominance (78%). The majority of patients had diffuse bare metal instent restenotic lesions and 19 patients (15%) had de novo coronary artery lesions. From hospital discharge to follow-up at 5 years (mean follow-up period 75.3+17.7 months), the annual consecutive MACE rates were 16.3%, 13.4%, 8%, 12.2% and 6.6% respectively and were mainly driven by the need for TLR. Left anterior descending artery (LAD) as target vessel of PCI was an independent predictor of long term MACE (OR: 3.5; 95% confidence interval: 1.2-10.6; P=.03). There were six cases of stent thrombosis (cumulative incidence of 4.7%) with case fatality rate of 33% (2/6).Conclusion: MACE rates remained high post IVBT at 5 years of follow-up and were mainly driven by the need for TLR. LAD as target vessel of PCI was an independent predictor of long term MACE. (C) 2011 Elsevier Inc. All rights reserved.

INTRODUCTIONThe objective of this case report was to illustrate the diagnostic and intervention approach of anomalous right coronary artery (RCA).CLINICAL PICTUREA 60-year-old man presented with acute inferior myocardial infarction. Cardiac catheterisation revealed an anomalous RCA arising from the posterior coronary sinus as the infarct-related artery.TREATMENTAd hoc percutaneous coronary intervention with stent implantation was performed using a few technical modifications.OUTCOMEGood angiographic result was achieved within 90 minutes, with 260 mL of contrast used.CONCLUSIONA high index of suspicion and logical diagnostic and intervention approach are required for the proper management of anomalous RCA.

A 56-year-old man with history of G6PD deficiency and aspirin-induced asthma presented with acute coronary syndrome. He complained of sudden onset of chest pain on the day of admission. Electrocardiography revealed dynamic ST changes in lead V1 and V2; troponon-I level was elevated at 7.05ng/mL (normal: <0.04ng/mL); creatinine phosphokinase level was normal. His clinical condition was stabilized with a course of subcutaneous injection of low-molecular-weight heparin (LMWH), clopidogrel, and statin.

We evaluated the clinical outcomes of prosthetic valve endocarditis in 2 major tertiary referral centers in Hong Kong. The study population comprised 80 consecutive Chinese patients who fulfilled the modified Duke criteria for prosthetic valve endocarditis from March 2000 to June 2007. The major clinical endpoints analyzed were hospital mortality, need for valve surgery, and relapse of prosthetic endocarditis. The mean age at presentation was 56 ± 13 years, with a slight male preponderance. There were 76 (95%) patients with involvement of a mechanical prosthesis; the majority (69%) had late prosthetic endocarditis. Major hospital complications occurred in 49 (61%) patients. The overall hospital mortality was 28% (22 patients). Thirty-four (42%) patients required valve surgery during index hospitalization, of whom 5 (15%) died due to uncontrolled sepsis. Factors associated with hospital mortality were older age at presentation, Staphylococcus aureus infection, embolic events, severe heart failure, valve surgery, and any major complication. On multivariate analysis, severe heart failure was the only independent predictor of hospital death. Among the 58 hospital survivors followed up for a mean of 48 ± 31 months, 6 (10%) developed late complications related to prosthetic valve endocarditis, with 5 documented cases of relapse.

BACKGROUND & OBJECTIVE:Little is known about the relative efficacies of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare-metal stents (BMS) in elderly patients. The objective of this study was to evaluate the clinical outcome for geriatric patients who received either DES or BMS.METHODS:From January 2002 to October 2005, 199 consecutive Chinese geriatric patients (≥ 75 years old) underwent PCI with coronary DES or BMS implantation at our institution. We analyzed the major clinical end points that included all-cause mortality, cardiovascular death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, and bleeding complications.RESULTS:The three-year cumulative rates of all-cause mortality, cardiovascular death, and myocardial infarction were significantly lower in the DES group (6.3%, 3.6%, 5.4%) compared with the BMS group (16.2%, 11.5%, 14.9%; P < 0.05). No significant differences were found in the three-year cumulative rate for target lesion revascularization (6.3% vs. 4.6%, P = 0.61) or stent thrombosis (3.6% vs. 2.3%, P = 0.70). Likewise, there were no statistically significant differences in the cumulative rate for intracranial hemorrhage, or major and minor hemorrhage at three years.CONCLUSIONS:DES-based PCI was associated with a significant reduction in the three-year cumulative rate of all-cause mortality, cardiovascular death, and myocardial infarction compared with BMS, without increased risk of TLR, stent thrombosis, or bleeding complications at three years in this group of Chinese geriatric patients.

BACKGROUND:The beneficial role of manual thrombus aspiration in thrombus-containing lesions has been proven in acute myocardial infarction but data is lacking in saphenous vein graft lesions.METHODS:From January 2004 to December 2008, 74 consecutive post-bypass patients underwent percutaneous coronary interventions to 76 saphenous vein graft lesions under the protection of FilterWire EX/EZ. Among them, the latest 25 consecutive patients with 25 lesions were treated with manual aspiration before stenting. The incidence of filter no reflow was compared between patients with and without manual aspiration pretreatment.RESULTS:No major difference in demography, clinical, lesion, and procedure characteristics, and in-hospital outcome has been observed between the two patient groups. Most importantly, the incidence of filter no reflow has not been reduced (32.0% versus 19.6%, P = 0.26) by manual aspiration, even among thrombus-containing lesions (63.2% versus 64.7%, P = 1.00). The absence of diabetes mellitus is found to be the independent predictor for the occurrence of filter no reflow.CONCLUSIONS:Adjunctive manual thrombus aspiration fails to reduce the filter no reflow, and probably has no additional benefit in saphenous vein graft lesions already protected by FilterWire EX/EZ.