Search

The energy consumption of air conditioning systems in large spaces is a concern due to inefficiencies caused by the high ceiling. This paper presents the Green aIr-distribution System (GIS) retrofitting technique as a solution to reduce energy consumption and optimize thermal comfort in a large Hong Kong sports center to achieve carbon neutrality. A comparison is made between the existing air distribution system with ceiling supply and return as baseline model and the GIS with occupied wall supply and ceiling return as retrofit models regarding ventilation performance, thermal comfort, and energy aspects. Computational fluid dynamics (CFD) is employed to analyze the average operative temperature, airspeed, and other thermal comfort parameters. The findings demonstrate that implementing the GIS in the large sports center allows for a 1.5 °C increase in the supply temperature without significantly compromising thermal comfort. The algorithm for developing GIS for the large space application is also discussed. Additionally, the GIS model exhibits notable improvements in ventilation factors, such as Local Mean Age (LMA), Local air change index (LACI), and Air Distribution Performance Index (ADPI), resulting in improved air quality and reduced energy use within the occupied space.

Introduction: Ticagrelor has demonstrated superiority to Clopidogrel in reducing major adverse cardiovascular events, but at the cost of higher bleeding risk. However, the benefits were not replicated in the Asian trials, which demonstrated excess bleeding risk. We aimed to study the effect of Ticagrelor dose reduction in Ticagrelor hyper-responders, in addition to explore the effect of genotypes on Ticagrelor PKPD. Methods: ST-elevation myocardial infarction patients who undergone percutaneous coronary intervention and tested to be Ticagrelor hyper-responders defined as platelet reactivity of MEA ), were recruited. Peak and trough concentration of Ticagrelor and its active metabolite AR-C124910XX, and platelet reactivity at the corresponding time points were measured when patients were on Ticagrelor 90 mg twice daily (BD) and again when reduced to Ticagrelor 45mg BD for at least 14 days. Platelet reactivity and plasma concentrations were measured using Multiplate ® Analyzer and liquid chromatography-mass spectrometry respectively. Results: Seventeen patients were recruited and 12 were reduced to Ticagrelor 45 mg BD. The mean age of the 12 patients was 55.92 (±9.41). Their average BMI was 25.33 (±4.24), there were 11 males, and comprised of 5 Chinese, 3 Malay, 3 Indian and 1 Eurasian. Plasma concentration (geometric mean) of parent Ticagrelor and its metabolite were 2-2.6 folds (p=0.002) higher at 90 mg compared to at 45 mg [C trough_Ticagrelor 267.22 ng/mL vs 131.83 ng/mL, C trough_metabolite 158.25 ng/mL vs 62.34 ng/mL, C peak_Ticagrelor 619.89 ng/mL vs 255.57 ng/mL and C peak_metabolite 236.21 ng/mL vs 91.64 ng/mL]. The mean MEA 45mg was 23U (±8) for trough 45mg . Even after dose reduction, all patients were still at “responder” MEA levels with responder MEA defined as MEA90mg and trough 90mg concentrations; p=0.037 and 0.025 respectively. Conclusions: Ticagrelor 45mg BD results in significantly lower serum levels but was still able to confer sufficient platelet inhibition. Larger studies should be conducted to correlate with clinical outcomes, and the impact of CYP3A5*3 on Ticagrelor response.

Introduction: Diabetes is associated with poorer outcomes and increased complication rates in STEMI patients undergoing percutaneous coronary intervention (PCI). Regional variations have been described but data are notably lacking in the Asia-Pacific region. Aims: We report the associations of diabetes with clinical characteristics and outcomes in STEMI patients undergoing PCI across the Asia-Pacific. Methods: The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration consists of data from the registries of contributing PCI centres across Australia, Hong Kong, Singapore, Malaysia, Indonesia and Vietnam. Clinical characteristics, lesion characteristics, and outcomes were provided for STEMI patients. Key outcomes included overall mortality at 30 days, and major adverse cardiovascular events (MACE; defined as peri-procedural myocardial infarctions, emergency CABG, stent thrombosis, target vessel revascularisation, cerebrovascular events, or death) at 30 days. Results: A total of 12,144 STEMI patients (mean(SD) age 59.3(12.3)) were included, of which 3912 (32.2%) had diabetes. Patients with diabetes were likely to be older, have a history of cardiovascular disease and previous acute coronary events (all p20mm (all p Conclusions: Diabetes portends poorer clinical outcomes in STEMI patients undergoing PCI in the Asia-Pacific. The development of effective preventative measures and interventional strategies targeted at this high-risk group is crucial.

Background The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration was established to better understand the characteristics of patients undergoing PCI and cardiac interventions across the Asia Pacific region, including STEMI. The aim of this study was to compare STEMI patient characteristics across Asia Pacific (AP) countries in order to understand regional differences. Methods Each site across Australia, Singapore, Malaysia, Vietnam and Hong Kong provided de-identified individual patient data. Comparison of characteristics by sites were performed using one-way ANOVA, Kruskal-Wallis or Chi-squared tests, using Stata 14.2. Results Of the 12,620 cases, there were more males (p Conclusions Patient characteristics varied significantly across AP countries. On-going analyses will focus on the impact of varying patient characteristics on clinical outcomes. Key messages As characteristics varied, prevention and procedural strategies need to be adapted carefully. Additional input from other AP countries will better inform these strategies.

Approximately one-half of the phenotypic susceptibility to atherosclerotic cardiovascular disease (ASCVD) has a genetic basis. Although individual allelic variants generally impart a small effect on risk for ASCVD, an emerging body of data has shown that the aggregation and weighting of many of these genetic variations into "scores" can further discriminate an individual's risk beyond traditional risk factors alone. Consistent with the theory of population genetics, such polygenic risk scores (PRS) appear to be ethnicity specific because their elements comprise single-nucleotide variants that are always ethnicity specific. The currently available PRS are derived predominantly from European ancestry and thus predictably perform less well among non-European participants, a fact that has implications for their use in the Asia-Pacific region. This paper describes the current state of knowledge of PRS, the available data that support their use in this region, and highlights the needs moving forward to safely and effectively implement them in clinical care in the Asia-Pacific region.

Background and Objectives: The aims of this study were (1) to examine the diagnostic accuracy of resting time-averaged distal coronary pressure (Pd) to mean aortic pressure (Pa) ratio to predict hyperemic fractional flow reserve (FFR) and (2) to identify a resting Pd/Pa value that can preclude the need for hyperemic FFR assessed with use of a monorail pressure catheter. Methods: A total of 191 stenoses were assessed. After exclusions, 157 FFR data sets from 103 patients were analyzed. Results: Resting Pd/Pa showed poor agreement with hyperemic FFR (r=0.619, P Conclusions: Resting Pd/Pa showed poor agreement with hyperemic FFR assessed with use of a monorail pressure microcatheter. However, resting Pd/Pa of 0.96 or greater had excellent sensitivity and negative predictive value to predict normal hyperemic FFR, and resting Pd/Pa of 0.82 or less had excellent specificity and positive predictive value to predict abnormal hyperemic FFR.

Background and Objective Ostial LM stenting potentially induces turbulence in the aortic wall near the LM ostium, which might be correlated with aorta dilation and dissection. We investigated through a computational fluid dynamic analysis (CFD), the presence and potential consequences of flow turbulences both in the ascending aorta and arch after a stenting left main (LM) mid shaft or distal disease. Methods The model of the ascending aorta and left coronary artery was reconstructed reviewing both angiographic and echocardiographic measurements of 80 consecutive patients (43 males, mean age 75.1 ± 6.2 years) with significant LM mid shaft or distal disease treated in our institution. For stent simulation, a third-generation everolimus-eluting stent was reconstructed. Two stenting procedures (lesion 1:1 or ostial coverage) were investigated. Results The net area averaged WSS of the model resulted higher when the stent covered the lesion 1:1 compared to the ostial coverage (3.68 vs. 2.06 Pa, P=0.01 and 3.97 vs. 1.98 Pa, P < 0.001, respectively). LM ostial coverage generates more turbulences in the LM itself, in the aortic wall at ostium level, and at the sino-tubular junction compared with the stenting of the lesion 1:1. Conversely, in the ascending aorta, the WSS appears lower when stenting the lesion 1:1. Conclusion Extending the stent coverage up to the ostium, when the ostial region is not diseased, might induce unfavorable alterations of flow; not only both at the level of the LM lesion and ostium sites, but also in the ascending aorta and aortic arch, potentially predisposing the aortic wall to long-term damage.

The analysis of ventilation strategies is fundamentally affected by regional climate conditions and local cost databases, in terms of energy consumption, CO2 emission and cost-effective analysis. A systematic approach is covered in this paper to estimate a local economic and environmental impact on a medium-sized space located in two regions during supply-and-installation and operation phases. Three ventilation strategies, including mixing ventilation (MV), displacement ventilation (DV) and stratum ventilation (SV) were applied to medium-sized air-conditioned space with this approach. The trend of the results for three ventilation systems in the life cycle assessment (LCA) and life cycle cost (LCC) analysis is SV &lt, DV &lt, MV. The result of CO2 emission and regional LCC shows that SV is the lowest one in both regional studies. In comparison with the Hong Kong Special Administrative Region (HKSAR) during 20 Service years, the case analysis demonstrates that the percentage differences in LCC analysis of MV, DV &amp, SV in Guangdong are less than 20.5%, 19.4% and 18.82% respectively. Their CO2 emission of MV, DV and SV in Guangdong are more than HKSAR in 10.69%, 11.22% and 12.05%, respectively. The present study could provide information about regional effects in the LCA and LCC analysis of three ventilation strategies emissions, and thereby help set up models for decision-making on high efficiency and cost-effective ventilation strategy plans.

Purpose To measure the baseline prevalence of cardiovascular disease (CVD), its modifiable and non-modifiable risk factors in breast cancer patients, and determine their association with adjuvant treatment decision-making. Method From 2016 to 2017, 2,127 women newly-diagnosed with breast cancer were prospectively recruited. Participants' cardiovascular biomarkers were measured prior to adjuvant treatment decision-making. Clinical data and medical histories were obtained from hospital records. Adjuvant treatment decisions were collated 6-8 months after recruitment. A priori risk of cardiotoxicity was predicted using the Cardiotoxicity Risk Score. Results Mean age was 54 years. Eighty-five patients had pre-existing cardiac diseases and 30 had prior stroke. Baseline prevalence of hypertension was 47.8%. Close to 20% had diabetes mellitus, or were obese. Dyslipidaemia was present in 65.3%. The proportion of women presenting with ≥2 modifiable CVD risk factors at initial cancer diagnosis was substantial, irrespective of age. Significant ethnic variations were observed. Multivariable analyses showed that pre-existing CVD was consistently associated with lower administration of adjuvant breast cancer therapies (odds ratio for chemotherapy: 0.32, 95% confidence interval: 0.17-0.58). However, presence of multiple risk factors of CVD did not appear to influence adjuvant treatment decision-making. In this study, 63.6% of patients were predicted to have high risks of developing cardiotoxicities attributed to a high baseline burden of CVD risk factors and anthracycline administration. Conclusion While recent guidelines recommend routine assessment of cardiovascular comorbidities in cancer patients prior to initiation of anticancer therapies, this study highlights the prevailing gap in knowledge on how such data may be used to optimise cancer treatment decision-making.

With the global spread of abdominal obesity, cardiovascular disease continues to spread to all countries of the world. Given the large population, the challenges presented by cardiometabolic risk in the Asia Pacific region are considerable. In addition to the clinical consequences of cardiovascular disease, in terms of its morbidity and mortality, the diversity of the Asia Pacific region brings heterogeneity in approaches to prevention, diagnosis and treatment of cardiometabolic risk. In this manuscript, we will review the current state of knowledge of cardiometabolic risk in Asia Pacific and highlight the needs moving forward to tackle this public health challenge.

Background: Heart failure (HF) is the most common long-term complication of acute myocardial infarction (MI). Understanding plasma proteins associated with post-MI HF and their gene expression may identify new candidates for biomarker and drug target discovery. Methods: We used aptamer-based affinity-capture plasma proteomics to measure 1305 plasma proteins at 1 month post-MI in a New Zealand cohort (CDCS [Coronary Disease Cohort Study]) including 181 patients post-MI who were subsequently hospitalized for HF in comparison with 250 patients post-MI who remained event free over a median follow-up of 4.9 years. We then correlated plasma proteins with left ventricular ejection fraction measured at 4 months post-MI and identified proteins potentially coregulated in post-MI HF using weighted gene co-expression network analysis. A Singapore cohort (IMMACULATE [Improving Outcomes in Myocardial Infarction through Reversal of Cardiac Remodelling]) of 223 patients post-MI, of which 33 patients were hospitalized for HF (median follow-up, 2.0 years), was used for further candidate enrichment of plasma proteins by using Fisher meta-analysis, resampling-based statistical testing, and machine learning. We then cross-referenced differentially expressed proteins with their differentially expressed genes from single-cell transcriptomes of nonmyocyte cardiac cells isolated from a murine MI model, and single-cell and single-nucleus transcriptomes of cardiac myocytes from murine HF models and human patients with HF. Results: In the CDCS cohort, 212 differentially expressed plasma proteins were significantly associated with subsequent HF events. Of these, 96 correlated with left ventricular ejection fraction measured at 4 months post-MI. Weighted gene co-expression network analysis prioritized 63 of the 212 proteins that demonstrated significantly higher correlations among patients who developed post-MI HF in comparison with event-free controls (data set 1). Cross-cohort meta-analysis of the IMMACULATE cohort identified 36 plasma proteins associated with post-MI HF (data set 2), whereas single-cell transcriptomes identified 15 gene-protein candidates (data set 3). The majority of prioritized proteins were of matricellular origin. The 6 most highly enriched proteins that were common to all 3 data sets included well-established biomarkers of post-MI HF: N-terminal B-type natriuretic peptide and troponin T, and newly emergent biomarkers, angiopoietin-2, thrombospondin-2, latent transforming growth factor-β binding protein-4, and follistatin-related protein-3, as well. Conclusions: Large-scale human plasma proteomics, cross-referenced to unbiased cardiac transcriptomics at single-cell resolution, prioritized protein candidates associated with post-MI HF for further mechanistic and clinical validation.

IntroductionEcarin clotting assay (ECA) and Russell Viper Venom Assay (RVV) are established to assess coagulation effects of Factor II inhibitor i.e. Dabigatran and Factor Xa inhibitors i.e. Rivaroxaban and Apixaban; respectively. These assays can be conducted on the ClotPro® , which is a point of care (POC) instrument that uses viscoelastometry principles to measure coagulation effects. ObjectiveTo determine the coagulation parameter values for ECA and RVV in Malaysian population and compare to the established preliminary reference ranges of ClotPro®. MethodologyWe recruited healthy volunteers (HV) with ECA and RVV assessment done on the ClotPro® at the Sarawak Heart Center (SHC) between August 2019 to June 2020. The parameters assessed were clotting time (CT) in seconds, clot formation time (CFT) in seconds and maximum clot firmness (MCF) in mm. The parameter values were compared to the preliminary reference ranges (PRR) established on the ClotPro® from 30 blood donors. ResultsA total of 63 HV were included in the study. Mean age was 25.37 ± 5.24 with a range of 20-46 years old. DiscussionThe ranges for both ECA and RVV coagulation parameters in our population were wider as compared to the preliminary established reference ranges reported by the manufacturer. The established reference ranges were obtained from Caucasians, which have different physical size, dietary habit, cultural and geographical influences that might affect responses in the coagulation system as compared to Asians. ConclusionAs the ECA and RVV coagulation parameter values for our population did not fall into the recommended reference ranges established for the ClotPro® , our study suggested to establish the reference ranges of these parameters specific for our population.

Background Various cardiovascular biomarkers are used to assess and compare the risk of cardiovascular diseases across populations. However, artefactual variations due to the use of different laboratories may make these comparisons invalid. This work describes the inter-laboratory variations in a multi-country cohort, LIFECARE, and the use of recalibration to a reference laboratory to minimise this variability. Methods LIFECARE is a cohort of 10,479 participants recruited from Indonesia, Malaysia, Philippines and Thailand between 2008 and 2011, with blood samples analysed at country-specific laboratories(n=4). Thailand was the designated reference laboratory. The measurements from each laboratory were compared against the reference laboratory using a common set of samples analysed at all laboratories, using the MethComp package in R. Laboratory values for cohort participants were recalibrated using the equation generated by the package, if large, statistically significant differences were observed during the comparison. Results Glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride measurements were reported for all four countries. Cholesterol and HDL from all laboratories required recalibration while glucose did not. Recalibration altered the proportions of the population at risk substantially, with prevalence of high cholesterol changing from 56.3% to 75.0% in Malaysia, 52.1% to 37.5% in Indonesia and 31.3% to 22.7% in Philippines. Prevalence of low HDL was similarly altered. Conclusion There was significant variation in serum lipid levels measured by different laboratories, leading to variations in estimates of population at risk. Recalibration to a reference laboratory can overcome this variability and facilitate meaningful comparisons of laboratory data across countries.

Background An impairment of the left atrial function similar to that usually observed in atrial fibrillation (AF) has been observed also in patients with patent foramen ovale (PFO) and permanent right-to-left shunting (RLS). Methods We reconstructed the geometrical model of right atrium (RA), PFO, left atrium (LA) and left atrial appendage (LAA) of 65 patients with mild (36 patients mean age 45.5±6.8 years, 24 females) or permanent (29 patients, mean age 45.1±5.3 years, 21 females) RLS using anatomical data obtained by transoesophageal echocardiography (TEE) and cardiac MRI, performed as a part of our institutional screening protocol for paradoxical embolism. Using computational fluid dynamic analysis (CFD) we assessed the vorticity magnitude in both the LA and LAA to analyse a possible rheological relationship between PFO and AF. Results The anatomical models, in terms of dimensions, were comparable among the patients with mild and permanent RLS. A higher vorticity magnitude was observed in the mild shunt both in the LA (101.12±21.3 vs 88.3±22.6, p=0.02) and LAA (62±14.4 vs 32.4±12.3, p

Studies on platelet reactivity (PR) testing commonly test PR only after percutaneous coronary intervention (PCI) has been performed. There are few data on pre- and post-PCI testing. Data on simultaneous testing of aspirin and adenosine diphosphate antagonist response are conflicting. We investigated the prognostic value of combined serial assessments of high on-aspirin PR (HASPR) and high on-adenosine diphosphate receptor antagonist PR (HADPR) in patients with acute coronary syndrome (ACS). HASPR and HADPR were assessed in 928 ACS patients before (initial test) and 24 hours after (final test) coronary angiography, with or without revascularization. Patients with HASPR on the initial test, compared with those without, had significantly higher intraprocedural thrombotic events (IPTE) (8.6 vs. 1.2%, p ≤ 0.001) and higher 30-day major adverse cardiovascular and cerebrovascular events (MACCE; 5.2 vs. 2.3%, p = 0.05), but not 12-month MACCE (13.0 vs. 15.1%, p = 0.50). Patients with initial HADPR, compared with those without, had significantly higher IPTE (4.4 vs. 0.9%, p = 0.004), but not 30-day (3.5 vs. 2.3%, p = 0.32) or 12-month MACCE (14.0 vs. 12.5%, p = 0.54). The c-statistic of the Global Registry of Acute Coronary Events (GRACE) score alone, GRACE score + ASPR test and GRACE score + ADPR test for discriminating 30-day MACCE was 0.649, 0.803 and 0.757, respectively. Final ADPR was associated with 30-day MACCE among patients with intermediate-to-high GRACE score (adjusted odds ratio [OR]: 4.50, 95% confidence interval [CI]: 1.14–17.66), but not low GRACE score (adjusted OR: 1.19, 95% CI: 0.13–10.79). In conclusion, both HASPR and HADPR predict ischaemic events in ACS. This predictive utility is time-dependent and risk-dependent.

Patient Initials or Identifier Number DJ ### Relevant Clinical History and Physical Exam Mr. DJ, 57-year-old, active smoker. No other medical illness. At 22:40, he presented to other hospital for chest pain for past 3 hours. At ED, BP 66/52, bibasal lungs crepitation, SPO2 92% on high flow

Introduction: Leucocyte telomere length (LTL) has been described as a marker of biological age, endothelial dysfunction and atherosclerosis. The association between LTL and clinical characteristics of Asian patients, and their outcomes following acute myocardial infarction (AMI) have been inconclusive. Objective: To investigate the relationship between LTL and developing AMI, the association of LTL with inpatient and 30-day mortality, and the comparison to LTL with established AMI risk scores in predicting these outcomes. Methodology: 100 patients aged 30-70 years admitted with an AMI to a tertiary referral center between May-Oct 2017 were enrolled; these were matched with 100 non-AMI ('healthy') controls for gender and age (+/- 1 year). Clinical data was obtained prospectively; inpatient and 30-day outcomes documented. LTL was reflected by a well described variable called a tis ratio (TSR). The TSR was measured at enrolment using a quantitative PCR-based methods (qPCR) and results blinded to the clinician.

In this meeting report, particularly addressing the topic of protection of the cardiovascular system from ischemia/reperfusion injury, highlights are presented that relate to conditioning strategies of the heart with respect to molecular mechanisms and outcome in patients’ cohorts, the influence of co-morbidities and medications, as well as the contribution of innate immune reactions in cardioprotection. Moreover, developmental or systems biology approaches bear great potential in systematically uncovering unexpected components involved in ischemia–reperfusion injury or heart regeneration. Based on the characterization of particular platelet integrins, mitochondrial redox-linked proteins, or lipid-diol compounds in cardiovascular diseases, their targeting by newly developed theranostics and technologies opens new avenues for diagnosis and therapy of myocardial infarction to improve the patients’ outcome. © 2016, The Author(s).

Patient initials or identifier number HCT ### Relevant clinical history and physical exam A 57-year-old man, known hypertension, and smoker. He presented with worsening angina for 1 month and was referred to us for a coronary angiogram. PE noted displaced apex beat with a systolic murmur.

Left ventricular hypertrophy (LVH) is common in elite athletes in response to physiologic stimuli from regular, high-intensity exercise. Severe LVH, such as seen in patients with pathological hypertrophic cardiomyopathy (pHCM), has been associated with sudden death. The utility of echocardiography

Background Acute Inferior ST Elevation Myocardial Infarction (Ac-Inf-STEMI) and associated posterior and right ventricular (RV) infarction has been extensively studied with electrophysiology and echocardiography. A recent CMR study showed that poor RV function was associated with poor long term survival post myocardial infarction. However, limited CMR data exists especially on short term clinical outcomes in Ac-Inf-STEMI.

Platelet reactivity (PR) testing has prognostic value in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). There are conflicting data on the optimal type and timing of PR testing. We investigated the prognostic value of high on-aspirin PR (ASPR) and

Hollingsworth, J. W., S. Maruoka, Z. Li, E. N. Potts, D. M. Brass, S. Garantziotis, A. Fong, W. M. Foster, and D. A. Schwartz. 2007. Ambient ozone primes pulmonary innate immunity in mice. J. Immunol. 179: [4367–4375][1]. Following an inquiry at Duke University, we were informed that FlexiVent