Sudden occlusion of the coronary artery results in ischemia, myocardial cell death and myocardial infarction(MI). The most common cause is atherosclerotic plaque rupture. MI can be complicated by arrhythmia such as ventricular tachycardia, heart block, heart failure, ventricular wall rupture and death.

Introduction: End stage renal disease (ESRD) patients have a much higher rate of cardiac disease and cardiac mortality as compared with the general population. Revascularisation such as coronary artery bypass grafting (CABG) may also carry a higher rate of complications and morbidity. We compared our ESRD patients who underwent CABG with the general population and ESRD population. Methods: This is an observational study of ESRD patients who underwent CABG in our centre from 2003-2009 with case-control matching comparison with non-ESRD patients for ICU and hospital stay; and ESRD patients without CABG for survival. Patients with concomitant valvular operation were excluded. The primary outcomes were peri-operative complications and survival. Results: Eleven patients with mean age of 57.5±8.5 were included. All except 1 were diabetics. One patient had excessive haemorrhage requiring immediate re-thoracotomy, and t hi s was complicate d with thro mbosed AVF. Four patients e x perienced intr adialytic hyp otension postoperatively but all resolved within 1 week. Both ESRD and non-ESRD patients had equal number of ICU stay (3.1 versus 3.2 days, p=0.906) and hospital stay (7.6 versus 6.9 days, p=0.538). With average of 3.3 years follow-up (range from 1 to 7 years), 4 deaths were observed but only one from cardiac cause. Both ESRD cohorts with or without CABG have compatible left ventricular mass: 295 ± 86 vs 343 ± 113 g (p=0.226) and left ventricular mass: 174 ± 54 vs 206 ± 63 g/m2( p=0.157). The ou tco me of CAB G ESRD patien ts was comparable to matched ESRD patients without CABG with 90.9 % versus 91.9% 1 year survival, 95.5% versus 77.7% 2 year survival, 71.4% versus 70.3% 3 year and 40.0% versus 40.3% at 5 year survival (p=0.627, 0.386, 0.659 and 0.683 respectively). Conclusion: CABG in ESRD patients carries an acceptable perioperative complication rate. They have acceptable ICU and hospitalization duration in comparison to non-ESRD patients.Their long term survival was at least as good as matched ESRD patients without CABG.

Background and objectives The recent joint ACCF/AHA clinical competence statement on cardiac imaging with multi-detector computed tomography recommended a minimum of 6 months training and 300 contrast examinations, of which the candidate must be directly involved in at least 100 studies. Whether this is adequate to become proficient in interpretation of coronary computed tomogsignificant coronary stenosis in a center with 1 year's experience using a 64-row scanner. Methods A total of 778 patients underwent contrast-enhanced CTA between January and December 2005. Out of these patients, 301 patients also underwent contrast-enhanced conventional coronary angiography (CCA). These patients were divided into 4 groups according to the time the examination was underwent. Group Q1: first quarter of the year (n=20), Group Q2: second quarter (n=128), Group Q3: third quarter (n=134), and Group Results The sensitivity, specificity, positive, and negative predictive values were Q1 - 64%, 89%, 49% and 94%, respectively; Q2 -79%, 96%, 74% and 97%, respectively; Q3 - 78%, 96%, 74%, 97%, respectively, and Q4 - 100% for all. Conclusions In a center with formal training and high caseload, our accuracy in CTA analysis reached a plateau after 6 months experience. Test-bolus protocols produce better image quality and can improve accuracy. New centers embarking on CTA will need to overcome an initial 6-month learning curve depending upon the caseload during which time they should consider correlation with CCA.

Background Elderly patients generally have higher occurrence of coronary calcification, increased heart rate and difficulty with prolonged breath-holding. The aim of our study was to investigate the feasibility and accuracy of using 64-row multi-detector computed tomography (MDCT) in the assessment of coronary artery stenoses in elderly patients. Methods One hundred and fifty two patients with suspected or known coronary artery disease were divided into 4 groups according to their age (Group A: 40-49 years,n=34; Group B: 50-59 years, n=57; Group C: 60-69 years, n=48; Group D: 70 years and above; n=13). Coronary CT angiography (CTA) using a 64-row MDCT was performed and the findings were compared with that of conventional coronary angiography (CCA).Using axial images, multi-planar reconstructions (MPR) and maximum intensity projections (MIP), coronary segments of lumen diameter = 1.5mm were analyzed for the presence of significant stenosis (= 50% ). Results Percentages of poor image quality from coronary CTA preventing reliable correlations with CCA were 21%, 14%, 19% and 62% in Groups A to D respectively. Patients in Group D had significantly higher calcium scores compared with the other groups (P＜0.001). In patients where CTA images were of acceptable quality, percentages of accurate correlations with CCA were 89.8%, 93.4%, 86.6% and 78.0% for Groups A to D respectively.There were no significant difference in serum creatinine, heart rate and contrast volume between the 4 groups. Conclusions The 64-row MDCT coronary angiography was less accurate and feasible for patients aged 70 years or above due to heavy coronary calcification and inability to perform a satisfactory breath-hold. However, a high diagnostic accuracy with the MDCT is possible in patients aged less than 70 years.

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson method.Results The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

Background and Objectives: Heart failure (HF) poses substantial economic burden, primarily driven by high hospitalization and mortality rates. This study aimed to understand the economic burden of HF in 4 Asian countries under varying healthcare systems. Methods: This was a non-interventional, retrospective study conducted in South Korea, Taiwan, Thailand and Malaysia through medical chart review. Eligible patients included those who had either ≥1 hospitalization or ≥2 outpatient visits from January 1st to December 31st, 2014, and at least one year of follow-up. Resource use and direct healthcare costs (adjusted to 2015 USD) of HF were assessed. HF costs for subgroups stratified by age and sex were assessed. Results: A total of 568 patients were recruited from South Korea (n=200), Taiwan (n=200), Thailand (n=100) and Malaysia (n=68). The proportion of patients hospitalized ranged from 20.0% to 93.5% (South Korea 20.0%, Thailand 49.0%, Malaysia 70.6%, and Taiwan 93.5%).The overall annual HF cost per patient was $2,357, $4,513, $3,513 and $1,443 in South Korea, Taiwan, Thailand, and Malaysia, respectively; hospitalized HF care costs were $10,714, $4,790, $7,181 and $1,776, respectively. The length of stay was more than 12.2 days except in Malaysia. No specific trend was observed in subgroup analysis. Conclusions In Asia, HF poses significant economic burden and hospitalization has emerged as the major cost driver among healthcare costs. A streamlined treatment strategy reducing hospitalization rate can minimize the economic burden.

Background and Objectives: Heart failure (HF) poses substantial economic burden, primarily driven by high hospitalization and mortality rates. This study aimed to understand the economic burden of HF in 4 Asian countries under varying healthcare systems. Methods: This was a non-interventional, retrospective study conducted in South Korea, Taiwan, Thailand and Malaysia through medical chart review. Eligible patients included those who had either ≥1 hospitalization or ≥2 outpatient visits from January 1st to December 31st, 2014, and at least one year of follow-up. Resource use and direct healthcare costs (adjusted to 2015 USD) of HF were assessed. HF costs for subgroups stratified by age and sex were assessed. Results: A total of 568 patients were recruited from South Korea (n=200), Taiwan (n=200), Thailand (n=100) and Malaysia (n=68). The proportion of patients hospitalized ranged from 20.0% to 93.5% (South Korea 20.0%, Thailand 49.0%, Malaysia 70.6%, and Taiwan 93.5%).The overall annual HF cost per patient was $2,357, $4,513, $3,513 and $1,443 in South Korea, Taiwan, Thailand, and Malaysia, respectively; hospitalized HF care costs were $10,714, $4,790, $7,181 and $1,776, respectively. The length of stay was more than 12.2 days except in Malaysia. No specific trend was observed in subgroup analysis. Conclusions In Asia, HF poses significant economic burden and hospitalization has emerged as the major cost driver among healthcare costs. A streamlined treatment strategy reducing hospitalization rate can minimize the economic burden.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is primarily a familial disease with autosomal dominant inheritance. Incomplete penetrance and variable expression are common, resulting in broad disease spectrum. Three patterns of phenotypic expression have been described: (1) “classic” subtype, with predominant right ventricle involvement, (2) “left dominant” subtype, with early and dominant left ventricle involvement, and (3) “biventricular” subtype, with both ventricles equally affected. Genotypephenotype associations have been described, but there are other genetic and non-genetic factors that can affect disease expression. We describe two different phenotypic expressions of ARVC in a family.