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10. 2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome

Author

Ueng, Kwo-Chang, Chiang, Chern-En, Chao, Ting-Hsing, Wu, Yen-Wen, Lee, Wen-Lieng, Li, Yi-Heng, Ting, Ke-Hsin, Su, Chun-Hung, Lin, Hung-Ju, Su, Ta-Chen, Liu, Tsun-Jui, Lin, Tsung-Hsien, Hsu, Po-Chao, Wang, Yu-Chen, Chen, Zhih-Cherng, Jen, Hsu-Lung, Lin, Po-Lin, Ko, Feng-You, Yen, Hsueh-Wei, Chen, Wen-Jone, and Hou, Charles Jia-Yin

Subjects
Guidelines
Abstract

Coronary artery disease (CAD) covers a wide spectrum from persons who are asymptomatic to those presenting with acute coronary syndromes (ACS) and sudden cardiac death. Coronary atherosclerotic disease is a chronic, progressive process that leads to atherosclerotic plaque development and progression within the epicardial coronary arteries. Being a dynamic process, CAD generally presents with a prolonged stable phase, which may then suddenly become unstable and lead to an acute coronary event. Thus, the concept of "stable CAD" may be misleading, as the risk for acute events continues to exist, despite the use of pharmacological therapies and revascularization. Many advances in coronary care have been made, and guidelines from other international societies have been updated. The 2023 guidelines of the Taiwan Society of Cardiology for CAD introduce a new concept that categorizes the disease entity according to its clinical presentation into acute or chronic coronary syndromes (ACS and CCS, respectively). Previously defined as stable CAD, CCS include a heterogeneous population with or without chest pain, with or without prior ACS, and with or without previous coronary revascularization procedures. As cardiologists, we now face the complexity of CAD, which involves not only the epicardial but also the microcirculatory domains of the coronary circulation and the myocardium. New findings about the development and progression of coronary atherosclerosis have changed the clinical landscape. After a nearly 50-year ischemia-centric paradigm of coronary stenosis, growing evidence indicates that coronary atherosclerosis and its features are both diagnostic and therapeutic targets beyond obstructive CAD. Taken together, these factors have shifted the clinicians’ focus from the functional evaluation of coronary ischemia to the anatomic burden of disease. Research over the past decades has strengthened the case for prevention and optimal medical therapy as central interventions in patients with CCS. Even though functional capacity has clear prognostic implications, it does not include the evaluation of non-obstructive lesions, plaque burden or additional risk-modifying factors beyond epicardial coronary stenosis-driven ischemia. The recommended first-line diagnostic tests for CCS now include coronary computed tomographic angiography, an increasingly used anatomic imaging modality capable of detecting not only obstructive but also non-obstructive coronary plaques that may be missed with stress testing. This non-invasive anatomical modality improves risk assessment and potentially allows for the appropriate allocation of preventive therapies. Initial invasive strategies cannot improve mortality or the risk of myocardial infarction. Emphasis should be placed on optimizing the control of risk factors through preventive measures, and invasive strategies should be reserved for highly selected patients with refractory symptoms, high ischemic burden, high-risk anatomies, and hemodynamically significant lesions. These guidelines provide current evidence-based diagnosis and treatment recommendations. However, the guidelines are not mandatory, and members of the Task Force fully realize that the treatment of CCS should be individualized to address each patient’s circumstances. Ultimately, the decision of healthcare professionals is most important in clinical practice.

Published
2023

11. Referral, Diagnosis, and Pharmacological Management of Peripheral Artery Disease: Perspectives from Taiwan

Author

Lee, Jen-Kuang, Hsieh, I-Chang, Su, Chun-Hung, Huang, Hsuan-Li, Lei, Meng-Huan, Chiu, Kuan-Ming, Huang, Chien-Lung, Chen, Chun-Chi, Hsu, Po-Chao, Hsu, Chung-Ho, Huang, Chun-Yao, Lee, Cheng-Han, Chang, Wei-Chun, Lee, Hsin-Fu, Liu, Ju-Chi, and Yeh, Hung-I

Subjects
Review Article
Abstract

Peripheral artery disease (PAD) imposes a heavy burden of major adverse cardiovascular events that are associated with considerable mortality and morbidity, and major adverse limb events (e.g., thrombectomy, revascularization, amputation) that can substantially impact patients’ daily functioning and quality of life. Global registry data have indicated that PAD is an underdiagnosed disease in Taiwan, and its associated risk factors remain inadequately controlled. This review discusses the burden of PAD in Taiwan, major guidelines on PAD management, and the latest clinical trial outcomes. Practical experience, opinions, and the latest trial data were integrated to derive a series of clinical algorithms – patient referral, PAD diagnosis, and the antithrombotic management of PAD. These algorithms can be adapted not only by physicians in Taiwan involved in the clinical management of patients with PAD but also by general practitioners in local clinics and regional hospital settings, with the ultimate aim of improving the totality of PAD patient care in Taiwan.

Published
2023

14. Impact of the Dual Antiplatelet Therapy Score on Clinical Outcomes in Acute Coronary Syndrome Patients Receiving P2Y12 Inhibitor Monotherapy

Author

Huang, Sheng-Wei, primary, Chen, Po-Wei, additional, Feng, Wen-Han, additional, Hsieh, I-Chang, additional, Ho, Ming-Yun, additional, Cheng, Chung-Wei, additional, Yeh, Hung-I, additional, Chen, Ching-Pei, additional, Huang, Wei-Chun, additional, Fang, Ching-Chang, additional, Lin, Hui-Wen, additional, Lin, Sheng-Hsiang, additional, Tsai, Chin-Feng, additional, Su, Chun-Hung, additional, and Li, Yi-Heng, additional

Published
2022
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19. Bisphenol A induced apoptosis via oxidative stress generation involved Nrf2/HO‐1 pathway and mitochondrial dependent pathways in human retinal pigment epithelium (ARPE‐19) cells

Author

Chiang, Yun‐Wei, primary, Su, Chun‐Hung, additional, Sun, Han‐Yin, additional, Chen, Shih‐Pin, additional, Chen, Chun‐Jung, additional, Chen, Wen‐Ying, additional, Chang, Chia‐Che, additional, Chen, Chuan‐Mu, additional, and Kuan, Yu‐Hsiang, additional

Published
2021
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24. Effect of aspirin treatment duration on clinical outcomes in acute coronary syndrome patients with early aspirin discontinuation and received P2Y12 inhibitor monotherapy

Author

Ho, Ming-Yun, primary, Chen, Po-Wei, additional, Feng, Wen-Han, additional, Su, Chun-Hung, additional, Huang, Sheng-Wei, additional, Cheng, Chung-Wei, additional, Yeh, Hung-I, additional, Chen, Ching-Pei, additional, Huang, Wei-Chun, additional, Fang, Ching-Chang, additional, Lin, Hui-Wen, additional, Lin, Sheng-Hsiang, additional, Hsieh, I-Chang, additional, and Li, Yi-Heng, additional

Published
2021
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25. CHA2DS2-VASc score as an independent outcome predictor in patients hospitalized with acute ischemic stroke.

Author

Su, Chun-Hung, Lo, Chien-Hsien, Chen, Hsin-Hung, Tsai, Chin-Feng, Yip, Hei-Tung, Hsu, Kai-Cheng, Hsu, Chung Y., and Kao, Chia-Hung

Subjects
*STROKE patients, *ATRIAL fibrillation, *DRUG-eluting stents, MORTALITY risk factors
Abstract

Purpose: Atrial fibrillation (AF) is a significant independent risk factor for 1-year mortality in patients with first acute ischemic stroke (AIS). The CHA2DS2-VASc score was initially developed to assess the risk of stroke in patients with AF. Recently, this scoring system has been demonstrated to have clinical value for predicting long-term clinical outcomes in AIS but the evidence is insufficient. This large-scale prospective cohort study investigated the independent predictive value of the score in such patients. Methods: We included patients with AIS from the Taiwan Stroke Registry (TSR) during 2006–2016 as the present study population. Patients were divided into those with high (≥2) and low (<2) CHA2DS2-VASc scores. We further analyzed and classified patients according to the presence of AF. The clinical endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 1 year after the index AIS. Results: A total of 62,227 patients with AIS were enrolled. The median age was 70.3 years, and 59% of the patients were women. After confounding factors were controlled, patients with high CHA2DS2-VASc scores had significantly higher incidence of 1-year MACCEs (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.52, 1.76), re-stroke (adjusted HR = 1.28; 95% CI = 1.16, 1.42), and all-cause mortality (adjusted HR = 2.03; 95% CI = 1.83, 2.24) than those with low CHA2DS2-VASc scores did. In the comparison between AF and non-AF groups, the AF group had increased MACCEs (adjusted HR = 1.74; 95% CI = 1.60, 1.89), myocardial infarction (adjusted HR = 4.86; 95% CI = 2.07, 11.4), re-stroke (adjusted HR = 1.47; 95% CI = 1.26, 1.71), and all-cause mortality (adjusted HR = 1.90; 95% CI = 1.72, 2.10). The Kaplan–Meier curve revealed that both CHA2DS2-VASc scores and AF were independent risk predictors for 1-year MACCEs and mortality. Conclusions: The CHA2DS2-VASc score and AF appeared to consistently predict 1-year MACCEs of AIS patients and provide more accurate risk stratification. Therefore, increased use of the CHA2DS2-VASc score may help improve the holistic clinical assessment of AIS patients with or without AF. [ABSTRACT FROM AUTHOR]

Published
2022
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29. Genotoxic effects of 1-nitropyrene in macrophages are mediated through a p53-dependent pathway involving cytochrome c release, caspase activation, and PARP-1 cleavage

Author

Wu, Sheng-Wen, primary, Su, Chun-Hung, additional, Ho, Yung-Chuan, additional, Huang-Liu, Rosa, additional, Tseng, Ching-Chi, additional, Chiang, Yun-Wei, additional, Yeh, Kun-Lin, additional, Lee, Shiuan-Shinn, additional, Chen, Wen-Ying, additional, Chen, Chun-Jung, additional, Li, Yi-Ching, additional, Lee, Chien-Ying, additional, and Kuan, Yu-Hsiang, additional

Published
2021
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36. Rutin‐protected BisGMA ‐induced cytotoxicity, genotoxicity, and apoptosis in macrophages through the reduction of the mitochondrial apoptotic pathway and induction of antioxidant enzymes

Author

Huang, Fu‐Mei, primary, Chang, Yu‐Chao, additional, Su, Chun‐Hung, additional, Wu, Sheng‐Wen, additional, Lee, Shiuan‐Shinn, additional, Lee, Min‐Wei, additional, Yeh, Kun‐Lin, additional, Chiang, Chen‐Yu, additional, Tu, Dom‐Gene, additional, Lu, Yin‐Che, additional, and Kuan, Yu‐Hsiang, additional

Published
2020
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39. P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Author

Chen, Po-Wei, primary, Feng, Wen-Han, additional, Ho, Ming-Yun, additional, Su, Chun-Hung, additional, Huang, Sheng-Wei, additional, Cheng, Chung-Wei, additional, Yeh, Hung-I, additional, Chen, Ching-Pei, additional, Huang, Wei-Chun, additional, Fang, Ching-Chang, additional, Lin, Hui-Wen, additional, Lin, Sheng-Hsiang, additional, Hsieh, I-Chang, additional, and Li, Yi-Heng, additional

Published
2020
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41. Bisphenol A induced apoptosis via oxidative stress generation involved Nrf2/HO‐1 pathway and mitochondrial dependent pathways in human retinal pigment epithelium (ARPE‐19) cells.

Author

Chiang, Yun‐Wei, Su, Chun‐Hung, Sun, Han‐Yin, Chen, Shih‐Pin, Chen, Chun‐Jung, Chen, Wen‐Ying, Chang, Chia‐Che, Chen, Chuan‐Mu, and Kuan, Yu‐Hsiang

Subjects
RHODOPSIN, OXIDATIVE stress, HEME oxygenase, BISPHENOL A, CELLULAR signal transduction, NUCLEAR factor E2 related factor, GERM cells
Abstract

Bisphenol A (BPA) is an estrogen‐like compound, and an environmental hormone, that is commonly used in daily life. Therefore, it may enter the human body through food or direct contact, causing BPA residues in blood and urine. Because most studies focused on the analysis of BPA in reproductive cells or tissues, regarding evidence the effect of BPA on human retinal pigment epithelium (ARPE‐19) cells unavailable. Accordingly, the present study explored the cytotoxicity of BPA on ARPE‐19 cells. After BPA treatment, the expression of Bcl‐XL an antiapoptotic protein, in the mitochondria decreased, and the expression of Bax, a proapoptotic protein increased. Then the mitochondrial membrane potential was affected. BPA changed in mitochondrial membrane potential led to the release of cytochrome C, which activated caspase‐9 to promote downstream caspase‐3 leading to cytotoxicity. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) and heme oxygenase 1 (HO‐1) pathway play a major role in age‐related macular degeneration. Our results showed that expression of HO‐1 and Nrf2 suppressed by BPA. Superoxide dismutase and catalase, which Nrf2 downstream antioxidants, were degraded by BPA. AMP‐activated kinase (AMPK), which can regulate the phosphorylation of Nrf2, and the phosphorylation of AMPK expression was reduced by BPA. Finally, BPA‐induced ROS generation and cytotoxicity were reduced by N‐acetyl‐l‐cysteine. Taken together, these results suggest that BPA induced ARPE‐19 cells via oxidative stress, which was associated with down regulated Nrf2/HO‐1 pathway, and the mitochondria dependent apoptotic signaling pathway. [ABSTRACT FROM AUTHOR]

Published
2022
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42. Photoinduced electron and energy transfer in molecular pentads

Author

Gust, Devens, Moore, Thomas A., Moore, Ana L., Macpherson, Alisdair N., Lopez, Arnaldo, DeGraziano, Janice M., Gouni, Isabelle, Bittersmann, Edith, Seely, Gilbert R., Gao, Feng, Nieman, Ronald A., Ma, Xiaochun C., Demanche, Lori J., Su-Chun Hung, Luttrull, David K., Seung-Joo Lee, and Kerrigan, Pamela K.

Subjects
Energy transfer -- Research, Electron transport -- Research, Emission spectroscopy -- Usage, Porphyrins -- Analysis, Chemistry
Abstract

Carotenoid-diporphyrin-diquinone pentads were prepared through electron-transfer reactions and characterized using steady state and transient emission and absorption spectroscopies. An analysis of the photoinduced electron transfer of a pentad reveals that nearly half of the excited singlet state energy is conserved by the artificial photosynthetic reaction unit as chemical potential.

Published
1993

45. Cadmium nitrate-induced neuronal apoptosis is protected by N-acetyl-l-cysteine via reducing reactive oxygen species generation and mitochondria dysfunction

Author

Lee, Chien-Ying, primary, Su, Chun-Hung, additional, Tsai, Ping-Kun, additional, Yang, Ming-Ling, additional, Ho, Yung-Chyuan, additional, Lee, Shiuan-Shinn, additional, Chen, Chia-Hui, additional, Chen, Wen-Ying, additional, Lin, Meng-Liang, additional, Chen, Chun-Jung, additional, Chian, Chen-Yu, additional, Huang-Liu, Rosa, additional, Chang, Ya-Lan, additional, and Kuan, Yu-Hsiang, additional

Published
2018
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46. Safrole induced cytotoxicity, DNA damage, and apoptosis in macrophages via reactive oxygen species generation and Akt phosphorylation

Author

Chien, Kuang-Jen, primary, Yang, Ming-Ling, additional, Tsai, Ping-Kun, additional, Su, Chun-Hung, additional, Chen, Chia-Hui, additional, Horng, Chi-Ting, additional, Yeh, Chung-Hsin, additional, Chen, Wen-Ying, additional, Lin, Meng-Liang, additional, Chen, Chun-Jung, additional, Chian, Chen-Yu, additional, and Kuan, Yu-Hsiang, additional

Published
2018
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47. Rutin‐protected BisGMA‐induced cytotoxicity, genotoxicity, and apoptosis in macrophages through the reduction of the mitochondrial apoptotic pathway and induction of antioxidant enzymes.

Author

Huang, Fu‐Mei, Chang, Yu‐Chao, Su, Chun‐Hung, Wu, Sheng‐Wen, Lee, Shiuan‐Shinn, Lee, Min‐Wei, Yeh, Kun‐Lin, Chiang, Chen‐Yu, Tu, Dom‐Gene, Lu, Yin‐Che, and Kuan, Yu‐Hsiang

Subjects
MITOCHONDRIA, REACTIVE oxygen species, APOPTOSIS, GENETIC toxicology, RUTIN, MACROPHAGES, CELL survival, ANTIBODY-dependent cell cytotoxicity
Abstract

Bisphenol‐A‐glycidyldimethacrylate (BisGMA) is a resin monomer frequently used in dentin restorative treatments. The leakage of BisGMA monomer from BisGMA‐based polymeric resins can lead to cytotoxicity in macrophages. Rutin has various beneficial bioeffects, including antioxidation and antiinflammation. In this study, we found that pretreatment of RAW264.7 macrophages with rutin‐inhibited cytotoxicity induced by BisGMA in a concentration‐dependent manner. BisGMA‐induced apoptosis, which was detected by levels of phosphatidylserine from the internal to the external membrane and formation of sub‐G1, and genotoxicity, which was detected by cytokinesis‐blocked micronucleus and single‐cell gel electrophoresis assays, were inhibited by rutin in a concentration‐dependent manner. Rutin suppressed the BisGMA‐induced activation of caspase‐3 and ‐9 rather than caspase‐8. Rutin inhibited the activation of the mitochondrial apoptotic pathway, including cytochrome C release and mitochondria disruption, after macrophages were treated with BisGMA. Finally, BisGMA‐induced reactive oxygen species (ROS) generation and antioxidant enzyme (AOE) deactivation could be reversed by rutin. Parallel trends were observed in the elevation of AOE activation and inhibition of ROS generation, caspase‐3 activity, mitochondrial apoptotic pathway activation, and genotoxicity. These results suggested that rutin suppressed BisGMA‐induced cytotoxicity through genotoxicity, the mitochondrial apoptotic pathway, and relatively upstream factors, including reduction of ROS generation and induction of AOE. [ABSTRACT FROM AUTHOR]

Published
2021
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48. A Comprehensive Review of US FDA-Approved Immune Checkpoint Inhibitors in Urothelial Carcinoma

Author

Hsu, Fu-Shun, Su, Chun-Hung, and Huang, Kou-How

Subjects
Article Subject
Abstract

Few effective treatment options are available for patients with advanced or metastatic urothelial carcinoma (UC) after unsuccessful first-line platinum-based chemotherapy. To date, immune checkpoint inhibitors are novel therapeutic agents for UC treatment. From May 2016 to May 2017, five anti-PD-1/PD-L1 monoclonal antibodies received accelerated or regular approval from the US Food and Drug Administration (FDA) for the treatment of patients with locally advanced or metastatic UC. The present comprehensive review presents the background information of these five US FDA-approved anticancer agents to provide a basic but concise understanding of these agents for advanced studies. We summarize their immune checkpoint mechanisms, clinical efficacy, recommended usage protocols, adverse events, and the limitations of the PD-L1 biomarker assays.

Published
2017
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