Mobile phone-assisted lifestyle modifications for the prevention of coronary heart diseaserandomi... more Mobile phone-assisted lifestyle modifications for the prevention of coronary heart diseaserandomized controlled single blinded clinical trial: protocol and descriptive analysis ABSTRACT:
Journal of nuclear medicine technology, Jan 15, 2015
Cardiac stress testing, gated cardiac imaging and monitoring critical patients expose the nuclear... more Cardiac stress testing, gated cardiac imaging and monitoring critical patients expose the nuclear medicine technologist to the electrocardiogram (ECG). Basic ECG interpretation skills are essential for the nuclear medicine technologist to enhance patient care and to recognise key arrhythmias. This article provides an insight into the anatomy of an ECG trace, basic ECG interpretation and a case example typical in the nuclear medicine environment.
We are currently in the midst of an epidemic of metabolic disorders, which may, in part, be expla... more We are currently in the midst of an epidemic of metabolic disorders, which may, in part, be explained by excess fructose intake. This theory is supported by epidemiological observations as well as experimental studies in animals and humans. Rising consumption of fructose has been matched with growing rates of hypertension, leading to concern from public health experts. At this stage, the mechanisms underlying fructose-induced hypertension have not been fully characterized and the bulk of our knowledge is derived from animal models. Animal studies have shown that high-fructose diets up-regulate sodium and chloride transporters, resulting in a state of salt overload that increases blood pressure. Excess fructose has also been found to activate vasoconstrictors, inactivate vasodilators, and over-stimulate the sympathetic nervous system. Further work is required to determine the relevance of these findings to humans and to establish the level at which dietary fructose increases the risk of developing hypertension
Background: Complementary and alternative medicine (CAM) may offer benefits as well as risks to p... more Background: Complementary and alternative medicine (CAM) may offer benefits as well as risks to people with cardiovascular disease. Understanding the prevalence and the nature of CAM use will encourage beneficial CAM therapies, prevent potential herb-drug interactions and foster communication between patients and physicians. Methods: A systematic search of eight bibliographic databases was conducted for studies that investigated CAM use in patients with cardiovascular diseases. Two independent reviewers selected relevant abstracts and evaluated the quality of included studies.
The Journal of Alternative and Complementary Medicine, 2009
A novel antithrombotic agent, lumbrokinase, was evaluated in this pilot study for its efficacy in... more A novel antithrombotic agent, lumbrokinase, was evaluated in this pilot study for its efficacy in the treatment of symptomatic stable angina. This was a single-armed cohort study. The study was conducted at the National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia. The study comprised 10 patients who had coronary artery disease and stable angina and who consented to the trial. Patients were treated with oral lumbrokinase for 30 consecutive days in addition to their standard medical therapy. Stress technetium-99m sestamibi myocardial perfusion imaging (MPI) was performed before and at the conclusion of the active treatment period. The degree and extent of inducible ischemia observed on the myocardial perfusion images were evaluated using the previously validated semiquantitative indices (Summed Stress Score and Summed Difference Score). Following active treatment, the mean Summed Stress Score and Summed Difference Score deceased by 39% and 37%, respectively. The anginal symptom was ameliorated in 6 of 10 patients. No adverse reaction including major or minor bleeding was observed. This paper represents the first description of the use of oral lumbrokinase in the treatment of chronic coronary artery disease with objective assessment using MPI. Oral lumbrokinase improves regional myocardial perfusion in patients with stable angina.
Journal of applied physiology (Bethesda, Md. : 1985), Jan 28, 2016
Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave ref... more Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences impact on the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects (mean age 78±10 (SD), 9 female) with in situ cardiac pacemakers were paced at 60, 70, 80, 90 and 100 bpm under atrial, atrioventricular or ventricular pacing. At each paced heart rate, brachial cuff-based pulse wave analysis was used to determine central haemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have signific...
The ability of cardiac rehabilitation to reduce mortality in those with cardiovascular disease is... more The ability of cardiac rehabilitation to reduce mortality in those with cardiovascular disease is well established. Despite its widespread use in the clinical setting, the Borg Rating of Perceived Exertion (RPE) scale is yet to be validated for its ability to lead to improvements in functional capacity. Methodology: Fifteen participants were assessed prior to and following completion of a cardiac rehabilitation program. Exercise was prescribed according to the Borg RPE scale. Pre and post Six-Minute Walk Test (6MWT) scores were obtained to determine the impact of the cardiac rehabilitation program. Results: Fifteen cardiac rehabilitation participants completed all requirements of the study after an initial enrolment of 22 patients. Wilcoxon signed-ranks test showed statistically significant improvements in 6MWT scores following participation in the cardiac rehabilitation program (p=.033) from a median value of 412 metres to 475 metres. Conclusion: In this pilot study, cardiac rehabilitation programs based on the Borg RPE scale may improvefunctional capacity measured by 6MWT during a 6-week period.
Journal of the American College of Cardiology, 1988
Twenty-one patients were studied who underwent thallium-201 stress-redistribution single photon e... more Twenty-one patients were studied who underwent thallium-201 stress-redistribution single photon emission computed tomography (SPEeT) both before and after coronary artery bypass grafting (n = 15) or transluminal coronary angioplasty (n = 6). All patients underwent thallium imaging 15 min, 4 h and late (18 to 72 h) after stress as part of the preintervention thallium-201 scintigram. In a total of 201 tomographic myocardial segments with definite post-stress thallium-201 perfusion defects in which the relevant coronary arteries were subsequently successfully reperfused, the 4 h redistribution images did not predict the postintervention scintigraphic improvement: 67 (85 % ) of the 79 4 h reversible as well as 88 (72 % ) of the 122 4 h nonreversible segments improved (p = NS). The 18 to 72 h late redistribution images effectively subcategorized the 4 h nonreversible segments with respect to postinter-
Carotid-femoral pulse wave velocity (cfPWV) quantifies large artery stiffness, it is used in hemo... more Carotid-femoral pulse wave velocity (cfPWV) quantifies large artery stiffness, it is used in hemodynamic research and is considered a useful cardiovascular clinical marker. cfPWV is blood pressure (BP) dependent. Intrinsic heart rate (HR) dependency of cfPWV is unknown because increasing HR is commonly accompanied by increasing BP. This study aims to quantify cfPWV dependency on acute, sympathovagal-independent changes in HR, independent of BP. Individuals (n=52, age 40-93 years, 11 female) with in situ cardiac pacemakers or cardioverter defibrillators were paced at 60, 70, 80, 90, and 100 bpm. BP and cfPWV were measured at each HR. Both cfPWV (mean [95% CI], 0.31 [0.26-0.37] m/s per 10 bpm; P<0.001) and central aortic diastolic pressure (3.78 [3.40-4.17] mm Hg/10 bpm; P<0.001) increased with HR. The HR effect on cfPWV was isolated by correcting the BP effects by 3 different methods: (1) statistically, by a linear mixed model; (2) mathematically, using an exponential relations...
We thank Dr Tabibian 1 for the comments and interest in our recent article on red blood cell scin... more We thank Dr Tabibian 1 for the comments and interest in our recent article on red blood cell scintigraphy in gastrointestinal hemorrhage. 2 Although our intention was not to provide some definitive measure of sensitivity or specificity but rather to provide a very broad ...
from gated SPECT images (54). Recently, our laboratory developed and validated an automatic and a... more from gated SPECT images (54). Recently, our laboratory developed and validated an automatic and accurate method to measure left ventricular ejection fraction (LVEF) from @Tc sestamibi gated SPECT images (7). We also successfully applied the same method to low-count images resulting from a standard @Tc-sestaimbi injection and a fast (6.7-mm) gated SPECT acquisition protocol (8), with the ultimate goal of measuring true stress myocardial function using pharmacologic stress and a very short gated-acquisition sequence (9). The current study investigates whether myocardial function assess ment is applicable to another class of relatively low-count images, those produced by gated 201Tl perfusion SPECT acqui sition (10,11).
dataset while an upper and lower reconstruction limit is chosen. The reasons for limiting the num... more dataset while an upper and lower reconstruction limit is chosen. The reasons for limiting the number of recon structed images are twofold. First, doing so reduces the amount of data processed and the digital storage space required. Secondly, discarding part of the projection image volume permits elimination of abdominal structures, such
Mobile phone-assisted lifestyle modifications for the prevention of coronary heart diseaserandomi... more Mobile phone-assisted lifestyle modifications for the prevention of coronary heart diseaserandomized controlled single blinded clinical trial: protocol and descriptive analysis ABSTRACT:
Journal of nuclear medicine technology, Jan 15, 2015
Cardiac stress testing, gated cardiac imaging and monitoring critical patients expose the nuclear... more Cardiac stress testing, gated cardiac imaging and monitoring critical patients expose the nuclear medicine technologist to the electrocardiogram (ECG). Basic ECG interpretation skills are essential for the nuclear medicine technologist to enhance patient care and to recognise key arrhythmias. This article provides an insight into the anatomy of an ECG trace, basic ECG interpretation and a case example typical in the nuclear medicine environment.
We are currently in the midst of an epidemic of metabolic disorders, which may, in part, be expla... more We are currently in the midst of an epidemic of metabolic disorders, which may, in part, be explained by excess fructose intake. This theory is supported by epidemiological observations as well as experimental studies in animals and humans. Rising consumption of fructose has been matched with growing rates of hypertension, leading to concern from public health experts. At this stage, the mechanisms underlying fructose-induced hypertension have not been fully characterized and the bulk of our knowledge is derived from animal models. Animal studies have shown that high-fructose diets up-regulate sodium and chloride transporters, resulting in a state of salt overload that increases blood pressure. Excess fructose has also been found to activate vasoconstrictors, inactivate vasodilators, and over-stimulate the sympathetic nervous system. Further work is required to determine the relevance of these findings to humans and to establish the level at which dietary fructose increases the risk of developing hypertension
Background: Complementary and alternative medicine (CAM) may offer benefits as well as risks to p... more Background: Complementary and alternative medicine (CAM) may offer benefits as well as risks to people with cardiovascular disease. Understanding the prevalence and the nature of CAM use will encourage beneficial CAM therapies, prevent potential herb-drug interactions and foster communication between patients and physicians. Methods: A systematic search of eight bibliographic databases was conducted for studies that investigated CAM use in patients with cardiovascular diseases. Two independent reviewers selected relevant abstracts and evaluated the quality of included studies.
The Journal of Alternative and Complementary Medicine, 2009
A novel antithrombotic agent, lumbrokinase, was evaluated in this pilot study for its efficacy in... more A novel antithrombotic agent, lumbrokinase, was evaluated in this pilot study for its efficacy in the treatment of symptomatic stable angina. This was a single-armed cohort study. The study was conducted at the National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia. The study comprised 10 patients who had coronary artery disease and stable angina and who consented to the trial. Patients were treated with oral lumbrokinase for 30 consecutive days in addition to their standard medical therapy. Stress technetium-99m sestamibi myocardial perfusion imaging (MPI) was performed before and at the conclusion of the active treatment period. The degree and extent of inducible ischemia observed on the myocardial perfusion images were evaluated using the previously validated semiquantitative indices (Summed Stress Score and Summed Difference Score). Following active treatment, the mean Summed Stress Score and Summed Difference Score deceased by 39% and 37%, respectively. The anginal symptom was ameliorated in 6 of 10 patients. No adverse reaction including major or minor bleeding was observed. This paper represents the first description of the use of oral lumbrokinase in the treatment of chronic coronary artery disease with objective assessment using MPI. Oral lumbrokinase improves regional myocardial perfusion in patients with stable angina.
Journal of applied physiology (Bethesda, Md. : 1985), Jan 28, 2016
Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave ref... more Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences impact on the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects (mean age 78±10 (SD), 9 female) with in situ cardiac pacemakers were paced at 60, 70, 80, 90 and 100 bpm under atrial, atrioventricular or ventricular pacing. At each paced heart rate, brachial cuff-based pulse wave analysis was used to determine central haemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have signific...
The ability of cardiac rehabilitation to reduce mortality in those with cardiovascular disease is... more The ability of cardiac rehabilitation to reduce mortality in those with cardiovascular disease is well established. Despite its widespread use in the clinical setting, the Borg Rating of Perceived Exertion (RPE) scale is yet to be validated for its ability to lead to improvements in functional capacity. Methodology: Fifteen participants were assessed prior to and following completion of a cardiac rehabilitation program. Exercise was prescribed according to the Borg RPE scale. Pre and post Six-Minute Walk Test (6MWT) scores were obtained to determine the impact of the cardiac rehabilitation program. Results: Fifteen cardiac rehabilitation participants completed all requirements of the study after an initial enrolment of 22 patients. Wilcoxon signed-ranks test showed statistically significant improvements in 6MWT scores following participation in the cardiac rehabilitation program (p=.033) from a median value of 412 metres to 475 metres. Conclusion: In this pilot study, cardiac rehabilitation programs based on the Borg RPE scale may improvefunctional capacity measured by 6MWT during a 6-week period.
Journal of the American College of Cardiology, 1988
Twenty-one patients were studied who underwent thallium-201 stress-redistribution single photon e... more Twenty-one patients were studied who underwent thallium-201 stress-redistribution single photon emission computed tomography (SPEeT) both before and after coronary artery bypass grafting (n = 15) or transluminal coronary angioplasty (n = 6). All patients underwent thallium imaging 15 min, 4 h and late (18 to 72 h) after stress as part of the preintervention thallium-201 scintigram. In a total of 201 tomographic myocardial segments with definite post-stress thallium-201 perfusion defects in which the relevant coronary arteries were subsequently successfully reperfused, the 4 h redistribution images did not predict the postintervention scintigraphic improvement: 67 (85 % ) of the 79 4 h reversible as well as 88 (72 % ) of the 122 4 h nonreversible segments improved (p = NS). The 18 to 72 h late redistribution images effectively subcategorized the 4 h nonreversible segments with respect to postinter-
Carotid-femoral pulse wave velocity (cfPWV) quantifies large artery stiffness, it is used in hemo... more Carotid-femoral pulse wave velocity (cfPWV) quantifies large artery stiffness, it is used in hemodynamic research and is considered a useful cardiovascular clinical marker. cfPWV is blood pressure (BP) dependent. Intrinsic heart rate (HR) dependency of cfPWV is unknown because increasing HR is commonly accompanied by increasing BP. This study aims to quantify cfPWV dependency on acute, sympathovagal-independent changes in HR, independent of BP. Individuals (n=52, age 40-93 years, 11 female) with in situ cardiac pacemakers or cardioverter defibrillators were paced at 60, 70, 80, 90, and 100 bpm. BP and cfPWV were measured at each HR. Both cfPWV (mean [95% CI], 0.31 [0.26-0.37] m/s per 10 bpm; P<0.001) and central aortic diastolic pressure (3.78 [3.40-4.17] mm Hg/10 bpm; P<0.001) increased with HR. The HR effect on cfPWV was isolated by correcting the BP effects by 3 different methods: (1) statistically, by a linear mixed model; (2) mathematically, using an exponential relations...
We thank Dr Tabibian 1 for the comments and interest in our recent article on red blood cell scin... more We thank Dr Tabibian 1 for the comments and interest in our recent article on red blood cell scintigraphy in gastrointestinal hemorrhage. 2 Although our intention was not to provide some definitive measure of sensitivity or specificity but rather to provide a very broad ...
from gated SPECT images (54). Recently, our laboratory developed and validated an automatic and a... more from gated SPECT images (54). Recently, our laboratory developed and validated an automatic and accurate method to measure left ventricular ejection fraction (LVEF) from @Tc sestamibi gated SPECT images (7). We also successfully applied the same method to low-count images resulting from a standard @Tc-sestaimbi injection and a fast (6.7-mm) gated SPECT acquisition protocol (8), with the ultimate goal of measuring true stress myocardial function using pharmacologic stress and a very short gated-acquisition sequence (9). The current study investigates whether myocardial function assess ment is applicable to another class of relatively low-count images, those produced by gated 201Tl perfusion SPECT acqui sition (10,11).
dataset while an upper and lower reconstruction limit is chosen. The reasons for limiting the num... more dataset while an upper and lower reconstruction limit is chosen. The reasons for limiting the number of recon structed images are twofold. First, doing so reduces the amount of data processed and the digital storage space required. Secondly, discarding part of the projection image volume permits elimination of abdominal structures, such
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