2010-- 心臟學會年會口頭報告題目： Levels of blood periostin, a novel extracellular protein to repair myocardial injury, decrease after acute myocardial infarction and are negati

vely associated with ventricular function at follow-up急性心肌梗塞後，病人血中 periostin 的濃度是否會上升 ?

作者：鄭淇文 王兆弘 程文俊Objective: Recent study showed that extracellular “periostin (PN)”, a novel target to repair injured myocardium, induced reentry of differentiated

mammalian cardiomyocytes into the cell cycle and help the repair and recovery of heart function after acute myocardial infarction (AMI). However, no data were available with respect to the PN in human after acute myocardial injury. This study sought to investigate whether PN levels increased after AMI but remain in normal range in patients with stable coronary artery disease (CAD).

Methods: This study recruited 108 patients, including 30 patients with AMI, 45 with CAD, and 33 normal controls (CON) documented by coronary angiograms. Serial blood levels of PN and N-termial-pro-brain natriuetic peptide (NT-pro-BNP) were measured after AMI, and also in CAD and CON groups. Follow-up cardiac echocardiography was performed 7 days and 3 months after AMI.

Results: The levels of blood PN in patients with AMI measured within 4 days after AMI were insignificantly lower than the levels in the CAD and the CON groups (179 ± 61 ng/ml, 232 ± 62 ng/ml, and 244 ± 67 ng/ml, respectively, p=NS). However, the PN concentrations significantly decreased 7 days after AMI (from 179 ± 61 ng/ml to 143 ± 57 ng/ml, p=0.003). NT-pro-BNP levels were similar among the CON, CAD and AMI groups (1.07 ± 28.9 ng/ml, 1.11 ± 4.2 ng/ml, 4.4 ± 23.4 ng/ml, respectively, p=NS). NT-pro-BNP levels were not decreased after AMI (p=0.074). The levels of PN were not significantly related to the NT-pro-BNP levels (r=0.029, p=0.78). With respect to cardiac function, the PN levels at baseline were not significantly correlated with the left ventricular ejection fraction (LVEF)(r=-0.27, p=0.19). Followed up at 3 months, the PN levels were significantly but negatively associated with the LVEF (r=-0.49, p=0.03).

Conclusions: AMI results in a decrease, rather than an increase, in the blood levels of PN. The levels of PN predict the left ventricular systolic function 3 months after AMI. To improve the outcome of patients after AMI, further study is needed to explore the kinetics of PN levels after myocardial injury.

題目： Suppressed Cerebral Hemodynamics by Ventilatory Abnormality Is Associated with Decreased Functional Capacity in Patients with Chronic Heart Failure

心臟衰竭復健目前趨勢與基隆長庚經驗 作者：傅鐵城 王鍾賢 許智欽 王兆弘 程文俊 Objective: Cerebral hemodynamics is an important factor in a central limitation to exercise performa

nce. Whether abnormal cerebral hemodynamic response to exercise contributes to the impairment of functional capacity in patients with chronic heart failure (CHF) remains unclear. This study compared cardiac, cerebral, and muscle hemodynamics during incremental exercise between the CHF patients with different functional capacities.

Methods: Twenty-four patients with CHF [NYHA functional class II (HF-II, n=12) and III (HF-III, n=12) patients] and 24 normal subjects [older (O-C, n=12) and young (Y-C, n=12) adults] performed a symptom-limited incremental exercise test using a bicycle ergometer. A recently developed noninvasive bio-reactance device was used to measure cardiac hemodynamics, and near-infrared spectroscopy was employed to assess perfusions in frontal cerebral lobe (QFC) and vastus lateralis muscle (QVL).

Results: The cardiac output (CO), QFC, and QVL during exercise were lower in the HF-III group than in the HF-II, O-C, and Y-C groups. As normalized the CO response to exercise, the levels of blood distribution to FC and VL (i.e., QFC/CO and QVL/CO) in the HF-III group significantly decreased during incremental exercise. These HF-III patients also had smaller “oxygen uptake efficiency slopes (OUES)” and greater VE-VO2 slopes compared to normal older/young adults. Moreover, the positive correlation between OUES and QFC/CO (r=0.789, P<0.0001) was stronger than that between OUES and QVL/CO (r=0.4201, P=0.0036), whereas only the QFC/CO was negatively correlated with the VE-VO2 slope (r=-0.808, P<0.0001).

Conclusion: Our results suggest that suppressed cerebral hemodynamics during exercise is associated with ventilatory abnormality, which subsequently decreases functional capacity in patients with CHF.

題目： A novel method of estimating optimal body fluid goals at different stages of heart failure 利用新的身體組成成分分析儀來評估心臟衰竭病人的最適當體重作者：郭李堂 劉敏慧 黃于晏 王兆弘 程文俊 Background: Current concepts in managing fluid status in patients with heart failure (HF) depend on i

ndividualized experience of physicians, vary widely, and often lead to over-dehydration. This study tested the hypothesis that a new commercialized and non-invasive body-fat analyzer exquisitely estimated the body fluid status and guide physicians to set up optimal body fluid goals for patients at different stages of HF.

Methods and results: A total of 159 patients were enrolled in this study and were divided into 6 groups: healthy control (CON), hypertension on diuretics (HTN), stable HF without diuretics (SHND), stable HF on diuretics (SHD), acute HF (AHF) and stabilized acute HF (SAHF). “Edema index” was higher in AHF and SAHF than CON, HTN, SHND and SHD (0.400±0.021 and 0.397±0.018 vs. 0.383±0.006, 0.385±0.007, 0.388±0.008, and 0.386±0.008, respectively, p<0.0001). A higher edema index was significantly related to a higher extracellular water (ECW) component (p<0.0001). In addition, the SAHF group, compared to the AHF, had more ECW only at right side extremities and lower extremities (p<0.05), and had higher serum albumin levels (3.7±0.6 vs. 3.4±0.5, p=0.04). The body fat percentage was also lower in AHF and SAHF than other groups (0.270±0.119, 0.276±0.102, vs. 0.311±0.058, 0.329±0.075, 0.297±0.075, and 0.299±0.061, respectively, p=0.028). After 4-month follow-up, the edema index and ECW percentage in AHF group became insignificantly different from SHD group. In multivariate analysis, the edema index in stage C HF was associated with age, brain natriuretic peptide (BNP) and serum albumin levels (RR=0.51, 0.38,-0.42, p=0.001, 0.009, 0.006, respectively). Also, along with the increase in stages from A to B, C, and D, the edema index (p<0.001), ECW (p=0.002) and BNP (p<0.001) increased, but serum albumin levels decreased (p<0.001). Based on these data, a novel formula was created to set up the goals of fluid status controlling at different stages of HF in a clinical setting.

Conclusions: The novel method of estimating fluid status is feasible to sensitively discriminate the optimal fluid status at different stages of HF. It is mandatory to test whether complying with these goals can early detect fluid overloading and avoid re-hospitalization in patients with HF.

題目： Plasma P-selectin, but not C-reactive protein, fibrinogen, or Troponin-I predicts long-term cardiac events in patients hospitalized with suspected coronary artery disease and preserved left ventricular function: a 10-year follow-up study

血漿 P-selectin, 而非 C 反應蛋白 , 纖維蛋白原 , 或心肌旋轉蛋白 I 對於預測左心功能良好但疑有冠狀動脈疾病之病患長期心血管疾病風險 : 十年追蹤研究報告作者：陳士仁 程文俊 王兆弘 郭李堂

Background ： A variety of biomarkers have been investigated on their values to predict cardiovascular outcomes, such as C-reactive protein (CRP), fibrinogen, troponin I (TnI), and p-selectin (p-sel). By a design of head-to-head comparison, this study sought to figure out the long-term prognostic values of these paraemeters in patients hospitalized with suspected coronary artery disease.

Methods ： A total of 123 patients hospitalized with suspected coronary artery disease were enrolled and followed up for averagely 10 years. P-selectin, CRP, TnI and fibrinogen levels were measured. During the follow-up period, cardiac events were recorded including cardiac death, non-fatal myocardial infarction, and acute coronary syndromes with hospitalization.

Results ： For all 123 patients, no parameter was able to significantly predict the occurrence of cardiac events. In subgroup analysis, a p-sel of 63.5ng/mL significantly predict the development of all composite cardiac events only in patients with a left ventricular ejection fraction >50% (n=47, p=0.04). However, the levels of CRP, TnI and fibrinogen did not have significant predictive values. Multivariate analysis also demonstrated the independent predictive value of p-sel on all cardiac events (Hazard ratio 5.82, p=0.02). All parameters, including p-sel, could not demonstrate prognostic values in patients with a left ventricular ejection fraction 50% (n=76, p=NS).

Conclusions ： In this 10 years long-term follow-up study, p-sel was demonstrated to have prognostic values in predicting the cardiac events in patients with preserved left ventricular systolic function.