Browsing by Author "Chiang, Fu-Tien"

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Comparison of Home and Ambulatory Blood Pressure Measurements in Association With Preclinical Hypertensive Cardiovascular Damage
(2019-03-01)
Lin, Ting-Tse
;
Juang, Jimmy Jyh-Ming
;
Lee, Jen-Kuang
;
Tsai, Chia-Ti
;
Chen, Chen-Huan
Objective: To evaluate whether home or ambulatory blood pressure (BP) monitoring was associated with preclinical hypertensive cardiovascular target organ damage (TOD). Methods: We enrolled participants with prehypertension and stage 1 hypertension from 11 medical centers within the Taiwan hypertension-associated cardiac disease consortium. Recordings of clinical BP measurement, ambulatory BP monitoring for 24 hours, and home BP monitoring during morning and evening were made. The measured parameters of target organ damage included left ventricular mass index (LVMI), left atrial volume index (LAVI), and carotid-femoral pulse wave velocity (PWV). Results: Data were collected from 561 study participants (mean age, 65.0 +/- 10.8 years; men, 61.3%). Morning and evening home BP values were slightly higher than the daytime and nighttime ABP values (difference for systolic morning-daytime/evening-nighttime, 7.3 +/- 14.2/11.3 +/- 18.5 mm Hg, P <.001; for diastolic, 5.4 +/- 9.4/ 7.3 +/- 12.1, P <.001). Daytime ambulatory (r = 0.114), nighttime ambulatory (r = 0.130), morning home (r = 0.310), and evening home (r = 0.220) systolic BPs (SBPs) were all associated with LVMI (all P <.05). The correlation coefficient was significantly greater for the relationship between daytime home SBP and LVMI than for the relationship between ambulatory SBP and LVMI (P <.01). The goodness of fit of the association between SBP and LVMI improved by adding home daytime SBP to the other SBPs (P <.001). Similar findings were observed for LAVI, but not for PWV. Conclusion: These findings indicate that morning SBP assessed by home monitoring appears to be a better predictor than other BP measures to determine preclinical hypertensive cardiovascular damage in patients with early-stage hypertension.
Long-term Prognostic Value of Estimated Plasma Volume in Heart Failure with Preserved Ejection Fraction
(2019-10-07)
Huang, Chen-Yu
;
Lin, Ting-Tse
;
Wu, Yi-Fan
;
Chiang, Fu-Tien
;
Wu, Cho-Kai
Plasma volume, estimated by several indirect methods, has been viewed as a biological surrogate for intravascular fluid status. The clinical implication of estimated plasma volume status (ePVS) for long term outcomes in heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigate the prognostic value of ePVS calculated by Strauss formula and its association with cardiovascular events and mortality in a prospective HFpEF cohort. There were 449 individuals met the inclusion criteria of our cohort. Estimated plasma volume variation (Delta ePVS) and its instantaneous derivatives were calculated by the Strauss formula. Our study endpoints were events of heart failure hospitalization and mortality. Kaplan-Meier estimates and Cox regression analysis were applied to determine the power of Delta ePVS and baseline ePVS in predicting long term cardiovascular outcomes. Both baseline ePVS and Delta ePVS were independent predictors of heart failure hospitalization and mortality. Kaplan-Meier estimates of these outcomes stratified by optimal cut-off value showed that HFpEF individuals with higher baseline ePVS and Delta ePVS were associated with elevated risk of composite endpoint of heart failure hospitalization and mortality. This study demonstrated the prognostic value of a novel biological surrogate, instantaneous derivatives ePVS, in predicting long term cardiovascular outcomes in HFpEF population. Monitoring instantaneous plasma volume may assist in identifying patients at high risk for future cardiovascular events. Further prospective studies validating the role of ePVS in predicting long-term prognosis in patients with HFpEF are warranted.