12 results on '"Gan, Gary C. H."'
Search Results
2. Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: Association With Exercise Capacity in Chronic Kidney Disease.
- Author
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Gan, Gary C. H., Bhat, Aditya, Chen, Henry H. L., Gu, Kennith H., Fernandez, Fernando, Kadappu, Krishna K., Byth, Karen, Eshoo, Suzanne, and Thomas, Liza
- Published
- 2021
- Full Text
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3. Left atrial function: evaluation by strain analysis
- Author
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Gan, Gary C. H., primary, Ferkh, Aaisha, additional, Boyd, Anita, additional, and Thomas, Liza, additional
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- 2018
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4. Myocardial Viability: From Proof of Concept to Clinical Practice
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Bhat, Aditya, Gan, Gary C. H., Tan, Timothy C., Hsu, Chijen, and Denniss, Alan Robert
- Subjects
Article Subject - Abstract
Ischaemic left ventricular (LV) dysfunction can arise from myocardial stunning, hibernation, or necrosis. Imaging modalities have become front-line methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal treatment pathways. Initial studies, although favorable, lacked sufficient power and sample size to provide conclusive outcomes of viability assessment. Recent trials, including the STICH and HEART studies, have failed to confer prognostic benefits of revascularisation therapy over standard medical management in ischaemic cardiomyopathy. In lieu of these recent findings, assessment of myocardial viability therefore should not be the sole factor for therapy choice. Optimization of medical therapy is paramount, and physicians should feel comfortable in deferring coronary revascularisation in patients with coronary artery disease with reduced LV systolic function. Newer trials are currently underway and will hopefully provide a more complete understanding of the pathos and management of ischaemic cardiomyopathy.
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- 2016
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5. An Update on Renal Artery Denervation and Its Clinical Impact on Hypertensive Disease
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Bhat, Aditya, Kuang, Ye Min, Gan, Gary C. H., Burgess, David, and Denniss, Alan Robert
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Article Subject - Abstract
Hypertension is a globally prevalent condition, with a heavy clinical and economic burden. It is the predominant risk factor for premature cardiovascular and cerebrovascular disease, and is associated with a variety of clinical disorders including stroke, congestive cardiac failure, ischaemic heart disease, chronic renal failure, and peripheral arterial disease. A significant subset of hypertensive patients have resistant hypertensive disease. In this group of patients, catheter-based renal artery denervation has emerged as a potential therapy, with favourable clinical efficacy and safety in early trials. Additional benefits of this therapy are also being identified and include effects on left ventricular remodeling, cardiac performance, and symptom status in congestive cardiac failure. Utility of renal denervation for the management of resistant hypertension, however, has become controversial since the release of the Symplicity HTN-3 trial, the first large-scale blinded randomised study investigating the efficacy and safety of renal artery denervation. The aim of this paper is to evaluate the history, utility, and clinical efficacy of renal artery denervation technology, including an in-depth appraisal of the current literature and principal trials.
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- 2015
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6. Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure.
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Kodsi M, Makarious D, Gan GCH, Choudhary P, and Thomas L
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- Humans, Heart, Treatment Outcome, Echocardiography methods, Heart Failure diagnostic imaging, Heart Failure drug therapy, Cardiac Resynchronization Therapy methods
- Abstract
Recently established heart failure therapies, including sodium glucose co-transporter 2 inhibitors, angiotensin-neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non-invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non-invasive end-points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non-invasive cardiac imaging techniques, in particular transthoracic echocardiography., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2023
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7. The impact of body mass index on cardiac structure and function in a cohort of obese patients without traditional cardiovascular risk factors.
- Author
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Chen HHL, Bhat A, Gan GCH, Khanna S, Ahlenstiel G, Negishi K, and Tan TC
- Abstract
Background: Obesity has been linked with alterations in hemodynamic, autonomic, and hormonal pathways in the body, leading to a spectrum of cardiovascular changes. We sought to evaluate the effects of obesity on structural and functional changes of the heart in the absence of cardiac disease and associated risk factors., Methods: We identified healthy outpatients without any cardiovascular disease or risk factors from our institution's echocardiography database (2017-2020). Patients were stratified by body mass index (BMI; normal: 18.5-25 kg/m
2 ; overweight: 25-30 kg/m2 ; class 1 obesity: 30-35 kg/m2 ; class 2 obesity: 35-40 kg/m2 ; class 3 obesity: >40 kg/m2 ). Traditional and advanced echocardiographic parameters of cardiac chamber size and function including left ventricular global longitudinal strain (LV-GLS), left atrial reservoir strain (LASr), and right ventricular free wall strain (RV-FWS) were examined. The optimal cut-off BMI for discriminating LV-GLS (>-17.5%), LASr (<23%), and RV-FWS (>-23%) impairment was calculated using ROC curves., Results: 307 patients were assessed (41.5 ± 13.3yrs; 36.5%male; LVEF 61.3 ± 4.8%). No significant differences in indexed chamber volumes or LVEF were appreciated across BMI groups (p > 0.05 for all). LV-GLS, LASr, and RV-FWS were all significant on one-way ANOVA for differences from the group mean (all p < 0.01). Jonckheere-Terpstra test confirmed a significant trend of lower absolute LV-GLS, LASr and RV-FWS values across the rising BMI groups. On ROC curve analysis, a BMI value of 29.9 kg/m2 , 35.1 kg/m2 , and 37.3 kg/m2 were associated with LASr (AUC: 0.75), RV-FWS (AUC: 0.72), and LV-GLS (AUC: 0.75) impairment respectively., Conclusion: Obesity is linked with subclinical reduction of cardiac function in otherwise healthy subjects without cardiovascular risk factors, with reduction of left atrial function occurring at lower BMI, followed by the right and left ventricular function., Competing Interests: None., (© 2023 Published by Elsevier B.V.)- Published
- 2023
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8. Embolic Stroke of Undetermined Source: Approaches in Risk Stratification for Cardioembolism.
- Author
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Bhat A, Mahajan V, Chen HHL, Gan GCH, Pontes-Neto OM, and Tan TC
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- Humans, Risk Factors, Embolic Stroke etiology, Heart Diseases complications
- Abstract
Ischemic stroke is a leading cause of morbidity and mortality worldwide. Embolic stroke of undetermined source has been recently proposed to categorize nonlacunar ischemic strokes without confirmed etiology after adequate investigation with a likely embolic stroke mechanism. A strategy of empirical anticoagulation for embolic stroke of undetermined source patients is attractive but may only be beneficial in a select subset of patients. Strategies which would help identify the subset of embolic stroke of undetermined source patients most likely to have cardioembolic origin of stroke, and hence benefit from anticoagulation, are needed. This article will review current evidence which may be useful in the development of a risk stratification approach based on arrhythmia monitoring, cardiac imaging, and clinical risk stratification. This approach may be beneficial in clinical practice in improving patient outcomes and reducing stroke recurrence in this population; however, further work is required with active trials underway.
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- 2021
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9. Integrated Care in Atrial Fibrillation: A Road Map to the Future.
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Bhat A, Khanna S, Chen HHL, Gupta A, Gan GCH, Denniss AR, MacIntyre CR, and Tan TC
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- Anticoagulants adverse effects, Hospitalization, Humans, Stroke, Telemedicine, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Delivery of Health Care, Integrated
- Abstract
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice with an epidemiological coupling appreciated with advancing age, cardiometabolic risk factors, and structural heart disease. This has resulted in a significant public health burden over the years, evident through increasing rates of hospitalization and AF-related clinical encounters. The resultant gap in health care outcomes is largely twinned with suboptimal rates of anticoagulation prescription and adherence, deficits in symptom identification and management, and insufficient comorbid cardiovascular risk factor investigation and modification. In view of these shortfalls in care, the establishment of integrated chronic care models serves as a road map to best clinical practice. The expansion of integrated chronic care programs, which include multidisciplinary team care, nurse-led AF clinics, and use of telemedicine, are expected to improve AF-related outcomes in the coming years. This review will delve into current gaps in AF care and the role of integrated chronic care models in bridging fragmentations in its management.
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- 2021
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10. Exercise E/e' Is a Determinant of Exercise Capacity and Adverse Cardiovascular Outcomes in Chronic Kidney Disease.
- Author
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Gan GCH, Kadappu KK, Bhat A, Fernandez F, Eshoo S, and Thomas L
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- Aged, Diastole, Echocardiography, Stress, Exercise Tolerance, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Ventricular Function, Left, Renal Insufficiency, Chronic, Ventricular Dysfunction, Left
- Abstract
Objectives: This study sought to assess the relationship between E/e' and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its prognostic role., Background: Patients with CKD have diastolic dysfunction, reduced physical fitness, and elevated risk of cardiovascular disease., Methods: Patients with stage 3 and 4 CKD without previous cardiac disease underwent resting and exercise stress echocardiograms with assessment of exercise E/e'. Patients were compared to age-, sex-, and risk factor-matched control individuals and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular event(s) (MACE). Exercise capacity was assessed as metabolic equivalents (METs), with reduced exercise capacity defined as METs of ≤7. Raised exercise E/e' was defined as >13., Results: A total of 156 patients with CKD (age 62.8 ± 10.6 years; male: 62%) were compared to 156 matched control individuals. Patients with CKD were more likely to be anemic (p < 0.01) and had increased left ventricular mass (p < 0.01), larger left atrial volumes (p < 0.01), and higher resting (p < 0.01) and exercise E/e' (p < 0.01). Patients with CKD achieved lower exercise METs (p < 0.01), and more patients with CKD had METs of ≤7 (p < 0.01). Receiver-operating characteristic curves showed exercise E/e' (area under the curve [AUC]: 0.89; 95% CI: 0.84 to 0.95; p < 0.01) as the strongest predictor of reduced exercise capacity in patients with CKD. Over a follow-up period of 41.4 months, a raised exercise E/e' of >13 was an independent predictor of cardiovascular death and MACE on unadjusted and adjusted hazard models., Conclusion: E/e' is a strong predictor of exercise capacity and METs achieved by patients with CKD. Exercise capacity was reduced in patients with CKD, presumably consequent to diastolic dysfunction. Elevated exercise E/e' in patients with CKD is an independent predictor of cardiovascular death and MACE., Competing Interests: Author Disclosures Dr. Kadappu is supported by an National Health and Medical Research Council Scholarship (GNT1018215). Dr. Gan is supported by a University of New South Wales University Postgraduate Award (UNSW3080080). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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11. Left Ventricular Sphericity Index is a reproducible bedside echocardiographic measure of geometric change between acute phase Takotsubo's syndrome and acute anterior myocardial infarction.
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Khanna S, Bhat A, Chen HH, Tan JWA, Gan GCH, and Tan TC
- Abstract
•TS and AMI are separate cardiac conditions with similar clinical presentations.•TS have a higher LVSI than AMI, indicating a more spherical left ventricle.•LVSI may be utilised acutely to assist differentiation of acute phase TS and AMI., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors. Published by Elsevier B.V.)
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- 2020
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12. Impairment of left atrial function and cryptogenic stroke: Potential insights in the pathophysiology of stroke in the young.
- Author
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Bhat A, Khanna S, Chen HH, Lee L, Gan GCH, Negishi K, MacIntyre CR, Nunes MCP, and Tan TC
- Abstract
Background: Stroke is one of the leading causes of morbidity and mortality with a significant percentage classified as cryptogenic. Left atrial (LA) remodelling, a substrate for atrial fibrillation (AF) and stroke development, may play a role in identification of the aetiology of cryptogenic stroke. We aimed to examine LA function to gain mechanistic insights into the pathophysiology of cryptogenic stroke in young patients otherwise at low risk for cardiovascular disease., Methods: Patients aged <60 years without traditional cardiovascular risk factors and who were diagnosed with ischaemic cryptogenic stroke or TIA were evaluated and compared to healthy controls and patients with paroxysmal AF with a CHA
2 DS2 -VA score of 0. Conventional and novel left ventricular (LV) and LA echocardiographic parameters between the three groups were assessed., Results: Each group consisted of thirty patients. There were no significant differences in LV parameters (LVEF, LV endoGLS) between groups. LA strain in stroke patients was significantly lower compared to the controls (median 33%; interquartile range (IQ) [32/39] vs 31 [27/34]; p = 0.008). LA strain was significantly lower in AF patients compared to stroke patients (median 21% [19/22] vs 31% [27/34]; p < 0.0001)., Conclusion: A stepwise reduction in measures of LA function was appreciated between controls, young stroke and paroxysmal AF groups. This may indicate dynamic LA remodelling occurring in the young stroke population and suggest a shared causal mechanism for stroke development in this group. LA strain may further refine the risk for cardioembolic stroke., (© 2019 The Authors.)- Published
- 2019
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