Browsing by Author "Lee, Jen-Kuang"

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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.
Myocardial adipose deposition and the development of heart failure with preserved ejection fraction
(1970-01-01)
Wu, Cho-Kai
;
Lee, Jen-Kuang
;
Hsu, Jung-Chi
;
Su, Mao-Yuan M.
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Wu, Yi-Fan
Aims It has been proposed that an increase of myocardial adiposity is related to left ventricular (LV) diastolic dysfunction. The specific roles of myocardial steatosis including epicardial fat and intramyocardial fat for diastolic function are unknown in those patients suffering heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF). This study aims to determine the complex relationship between myocardial adiposity in patients with HFrEF or HFpEF. Methods and results Using cardiac magnetic resonance imaging (CMRI), myocardial steatosis was measured in 305 subjects (34 patients with HFrEF, 163 with HFpEF, and 108 non-HF controls). We also evaluated cardiac structure and diastolic and systolic function by echocardiography and CMRI. Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non-HF controls [intramyocardial fat content (%), 1.56 (1.26, 1.89) vs. 0.75 (0.50, 0.87) and 1.0 (0.79, 1.15), P < 0.05]. Intramyocardial fat amount (%) was higher in HFpEF women than in men [1.91% (1.17%, 2.32%) vs. 1.22 (0.87%, 2.02%), P = 0.01]. When estimated by CMRI (left ventricular peak filling rate), echocardiographic E/e ' level, or left atrial volume index, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients, and this was independent of age, co-morbidities, body mass index, gender, and myocardial fibrosis (standardized coefficient: beta = -0.34, P = 0.03; beta = 0.29, P = 0.025; and beta = 0.25, P = 0.02, respectively). Conclusions Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non-HF controls. Independent of risk factors or gender, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients.
The differential method of phase space matrix for AF/VF discrimination application
(2010-06-01)
Liu, Chien-Sheng
;
Tseng, Wei-Kung
;
Lee, Jen-Kuang
;
Hsiao, Tze-Chien
;
Lin, Chii-Wann
The advances in electrocardiographic (ECG) technology have facilitated the development of numerous successful clinical applications and commercial monitoring products for diagnosing disease and monitoring health. All of these demand the development of smart algorithms and computational resources for the real-time, early indication of critical cardiac conditions. This study presents the development of a Complex Phase Space Difference (CPSD) algorithm with differential method to analyze spatial and temporal changes in reconstructed phase space matrix, and derives an index for real-time monitoring. We used total of 5306 data segments from MIT-BIH, CU, and SCDH databases and clinical trial data to determine the optimal working parameters and verified the classification capability by using a quantitative index of this algorithm. With threshold values set to 2.0 and 6.0, this method can successfully differentiate normal sinus rhythm (NSR) signals (1.48 +/- 0.21), low risk of atrial fibrillation (AF) signals (3.71 +/- 0.99) and high risk of ventricular fibrillation (VF) signals (9.38 +/- 2.22). It is the first real-time algorithm that reports the best performance to distinguish AF and VF with sensitivity of 97.9% and specificity of 98.4%. With self-normalization, the algorithm is not subjected to the inter-variability or sampling size effects. Its computational scheme only requires matrices addition and subtraction, and thus significantly reduces the complexity for real-time implementation. It will be able to adopt in different scenarios of tele-healthcare and implantable applications. (C) 2010 IPEM. Published by Elsevier Ltd. All rights reserved.