Browsing by Author "Kaolawanich, Yodying"

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    Electrocardiographic predictors of cardiovascular events in patients at high cardiovascular risk: a multicenter study.
    (Journal of geriatric cardiology : JGC, 2019-08) Krittayaphong, Rungroj; Muenkaew, Muenpetch; Chiewvit, Polakit; Ratanasit, Nithima; Kaolawanich, Yodying; Phrommintikul, Arintaya; CORE Investigators
    Background:There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. Methods:Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. Results:A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS) (21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD) (7.3%), left ventricular hypertrophy (LVH) (12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. Conclusions:A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.
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    Electrocardiographic predictors of myocardial fibrosis and apical hypertrophic cardiomyopathy.
    (Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 2019-03) Tangwiwat, Chayapat; Kaolawanich, Yodying; Krittayaphong, Rungroj
    BACKGROUND:Electrocardiography (ECG) may be an efficacious diagnostic and prognostic tool in hypertrophic cardiomyopathy (HCM). This study aimed to investigate association between deep T-wave inversion (TWI) and apical HCM, and between fragmented QRS (fQRS) complex and myocardial fibrosis in patients with HCM. METHODS:Patients with documented HCM by cardiac magnetic resonance imaging (CMR) during 2005-2015 were studied. The 12-lead ECG and CMR were performed on the same day. All patients underwent CMR for the assessment of cardiac structure, function, and late gadolinium enhancement (LGE). LGE was used to detect myocardial fibrosis. RESULTS:One hundred forty-four HCM (mean age 66 ± 15.8 years, 60.4% male) were included. Twenty-nine (20.14%) subjects had deep TWI, and apical HCM was found in 76 (52.78%). Deep TWI was associated with apical HCM with the Odds ratio (95%CI) of 5.82 (2.07, 16.04) and p < 0.001 in univariate analysis model. The association was still significant in multivariate analysis with adjusted Odds ratio (95%CI) of 9.86 (3.17, 30.66), p < 0.001. Forty-seven (32.64%) subjects had fQRS complex, and myocardial fibrosis was detected in 101 (70.14%). fQRS complex was found to be associated with myocardial fibrosis in univariate analysis with the Odds ratio (95%CI) = 2.75 (1.16, 6.54), p = 0.019. However, the association cannot be demonstrated in the multivariate analysis. CONCLUSION:Deep TWI is independently associated with apical HCM, but the relationship between fQRS complex and myocardial fibrosis did not survive multivariate analysis.
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    Incremental prognostic value of aortic stiffness in addition to myocardial ischemia by cardiac magnetic resonance imaging.
    (BMC cardiovascular disorders, 2020-06-11) Kaolawanich, Yodying; Boonyasirinant, Thananya
    BACKGROUND:Aortic stiffness is an independent predictor of cardiovascular (CV) events and mortality. However, no data exists for the prognosis of combined aortic stiffness and myocardial ischemia. Using cardiac magnetic resonance (CMR) imaging, we assessed the association of aortic stiffness by pulse wave velocity (PWV), myocardial ischemia, and CV events in patients with known or suspected coronary artery disease (CAD). METHODS:Velocity-encoded CMR was performed in 520 patients who had undergone adenosine stress CMR. The PWV was determined between the mid-ascending and mid-descending thoracic aorta. Patients were divided into 4 groups by PWV (higher or lower PWV) and myocardial ischemia (positive or negative ischemia). Combined CV events including mortality, acute coronary syndrome, heart failure, coronary revascularization, and stroke were analyzed among the 4 groups. RESULTS:The median follow-up period was 46.5 months, and the median PWV was 10.54 m/sec. Myocardial ischemia was positive in 199 patients (38.3%). The group with a higher PWV and positive ischemia had the most CV events (hazard ratio 8.94, p <  0.001). The group with a higher PWV and negative ischemia also was significantly associated with CV events (HR 2.19, p = 0.02). Groups with a lower PWV-positive ischemia and a higher PWV-negative ischemia showed no difference in terms of CV events (HR 0.60, p = 0.08). Patients with myocardial ischemia who had higher PWV demonstrated significantly higher event rates than those who had lower PWV (HR 2.41, p <  0.001). Multivariate analysis demonstrated that myocardial ischemia and PWV were independent predictors for combined CV events (HR 2.71, p <  0.001 and HR 2.42, p <  0.001, respectively). CONCLUSIONS:Stress perfusion CMR provided prognostic utility in patients with known or suspected CAD. Adding aortic stiffness to stress perfusion CMR could improve risk assessment and prediction for future CV events.
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    Prevalence of left ventricular diastolic dysfunction by cardiac magnetic resonance imaging in thalassemia major patients with normal left ventricular systolic function.
    (BMC cardiovascular disorders, 2019-11-06) Chinprateep, Benjaporn; Ratanasit, Nithima; Kaolawanich, Yodying; Karaketklang, Khemajira; Saiviroonporn, Pairash; Viprakasit, Vip; Krittayaphong, Rungroj
    BACKGROUND:The leading cause of mortality of thalassemia major patients is iron overload cardiomyopathy. Early diagnosis with searching for left ventricular diastolic dysfunction before the systolic dysfunction ensued might yield better prognosis. This study aimed to define the prevalence of the left ventricular diastolic dysfunction (LVDD) in thalassemia major patients with normal left ventricular systolic function and the associated factors. METHODS:Adult thalassemia major patients with normal left ventricular systolic function who were referred for cardiac T2* at Siriraj Hospital - Thailand's largest national tertiary referral center - during the October 2014 to January 2017 study period. Left ventricular diastolic function was defined by mitral valve filling parameters and left atrial volume index using CMR. Patients with moderate to severe valvular heart disease, pericardial disease, or incomplete data were excluded. Baseline characteristics, comorbid diseases, current medication, and laboratory results were recorded and analyzed. RESULTS:One hundred and sixteen patients were included, with a mean age of 27.5 ± 13.5 years, 57.8% were female, and 87.9% were transfusion dependent. Proportions of homozygous beta-thalassemia and beta-thalassemia hemoglobin E were 12.1 and 87.9%, respectively. The baseline hematocrit was 26.3 ± 3.3%. The prevalence of LVDD was 20.7% (95% CI: 13.7-29.2%). Cardiac T2* was abnormal in 7.8% (95% CI: 3.6-14.2%). Multivariate analysis revealed age, body surface area, homozygous beta-thalassemia, splenectomy, heart rate, and diastolic blood pressure to be significantly associated with LVDD. CONCLUSIONS:LVDD already exists from the early stages of the disease before the abnormal heart T2 * is detected. Homozygous beta-thalassemia and splenectomy were strong predictors of LVDD. These data may increase awareness of the disease, especially in the high risk groups.
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    Usefulness of apical area index to predict left ventricular thrombus in patients with systolic dysfunction: a novel index from cardiac magnetic resonance.
    (BMC cardiovascular disorders, 2019-01-11) Kaolawanich, Yodying; Boonyasirinant, Thananya
    BACKGROUND:LV systolic dysfunction presents an elevated risk of thromboembolism. Previous studies demonstrated low left ventricular ejection fraction (LVEF), ischemic cardiomyopathy and increased myocardial scarring as independent risk factors for LV thrombus formation. Structural changes that alter the size and shape of LV apex may have a significant role in predicting LV thrombus, but there is no definite evidence exists in this entity. METHODS:A case-control cardiac magnetic resonance (CMR) study of 150 patients with LV systolic dysfunction (LVEF < 40%; 30 patients with LV thrombus and 120 patients without thrombus) was performed. Factors associated with thrombus including sphericity index and 'new' apical area index (ratio of apical area to entire LV area from a cine four-chamber view) were evaluated. RESULTS:Average age was 63.48 ± 12.82 years and mean LVEF was 29.22 ± 8.53%. Patients with LV thrombus had significantly higher apical area index than those without thrombus (46.5 ± 3.27 vs. 42.71 ± 3.02, p <  0.001) while sphericity index in both groups was not different (1.63 ± 0.27 vs. 1.67 ± 0.19, p = 0.57). Univariate analysis revealed that male gender, prior myocardial infarction, presence of apical aneurysm, ischemic-typed scar, apical scar and apical area index were associated with thrombus. Further, multivariate analysis showed only apical area index and apical scar as independent predictors for thrombus formation. CONCLUSION:Apical area index from CMR is a new index to predict LV thrombus in patients with LV systolic dysfunction and may have a future role in early anticoagulant therapy.