Singapore medical journal最新文献

Introduction: Patients with paradoxical low-flow (LF) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) appear distinct from normal-flow (NF) patients, showing worse prognosis, more concentric hypertrophy and smaller left ventricular (LV) cavities. The left ventricular remodelling index (LVRI) has been demonstrated to reliably discriminate between physiologically adapted athlete's heart and pathological LV remodelling.

Methods: We studied patients with index echocardiographic diagnosis of severe AS (aortic valve area <1 cm 2 ) with preserved LVEF (>50%). The LVRI was determined by the ratio of the LV mass to the end-diastolic volume, as previously reported, and was compared between patients with LF and NF AS. Patients were prospectively followed up for at least 3 years, and clinical outcomes were examined in association with LVRI.

Results: Of the 450 patients studied, 112 (24.9%) had LF AS. While there were no significant differences in baseline clinical profile between LF and NF patients, LVRI was significantly higher in the LF group. Patients with high LVRI (>1.56 g/mL) had increased all-cause mortality (log-rank 9.18, P = 0.002) and were more likely to be admitted for cardiac failure (log-rank 7.61, P = 0.006) or undergo aortic valve replacement (log-rank 18.4, P < 0.001). After adjusting for the effect of age, hypertension, aortic valve area and mean pressure gradient on multivariate Cox regression, high LVRI remained independently associated with poor clinical outcomes (hazard ratio 1.64, 95% confidence interval 1.19-2.25, P = 0.002).

Conclusion: Pathological LV remodelling (increased LVRI) was more common in patients with LF AS, and increased LVRI independently predicts worse clinical outcomes.

Abstract: Twelve-lead electrocardiography (ECG) remains the gold standard for the diagnosis of cardiac arrhythmias. It provides a snapshot of the cardiac electrical activity while the leads are attached to the patient. As medical training is required to use the ECG machine, its use remains restricted to the clinic and hospital settings. These aspects limit the usefulness of 12-lead ECG in the diagnosis of cardiac arrhythmias, especially in individuals with short-lasting and infrequent paroxysmal symptoms. The introduction of ECG recording features in wearable and handheld smart devices has changed the paradigm of cardiac arrhythmia diagnosis, empowering patients to record their ECG as and when symptoms occur. This review describes contemporary ambulatory heart rhythm monitors commonly available in Singapore and their expanding role in the diagnosis of cardiac rhythm abnormalities.

Introduction: In-hospital cardiac arrest (IHCA) is a significant healthcare burden with a paucity of data in Singapore. Various factors, including time of cardiac arrest, affect survival from acute resuscitation.

Methods: This was a retrospective cohort study that evaluated the characteristics of patients who sustained an IHCA, including the Cardiac Arrest Survival Post Resuscitation In-hospital (CASPRI) scores, and the impact of arrest time in 220 consecutive cardiac arrests occurring in a tertiary hospital. The primary outcome was rate of return of spontaneous circulation (ROSC) post-IHCA, and the secondary outcome was 90-day survival.

Results: The ROSC rate among patients with IHCA out of and during office hours was 69.5% and 75.4%, respectively (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.39-1.42). There were no statistically significant differences between the CASPRI scores of both groups. After adjusted analysis, the OR of ROSC post-IHCA out of office hours as compared to that during office hours was 0.78 (95% CI 0.39-1.53). The 90-day survival rate of patients who had an IHCA out of and during office hours was 25.7% and 34.6%, respectively (OR 0.65, 95% CI 0.32-1.34). The adjusted OR of 90-day survival was 0.66 (0.28-1.59).

Conclusion: The results of this observational study did not show an association between the timing of cardiac arrest and the rate of ROSC or 90-day survival.

Abstract: Cardiac pacing has been an established therapy for bradyarrhythmia due to sinus or atrioventricular nodal disease since the 1950s. However, contemporary studies have shown that conventional right ventricular pacing (RVP) causes electromechanical dyssynchrony, which can lead to atrial fibrillation, heart failure and even death. Recently, the push for a more physiological cardiac pacing has seen a revival in the utilisation and development of conduction system pacing (CSP). There has been a shift towards adopting His bundle pacing (HBP) or left bundle branch area pacing (LBBaP) in bradycardia patients worldwide and in Singapore. This review serves to outline the electrophysiological concepts behind CSP and illustrate the different paced electrocardiogram characteristics of HBP, LBBaP and RVP to aid understanding of this revolutionary pacing approach among medical practitioners in Singapore.

Introduction: Upper extremity (UE) impairment is common after stroke. In a cohort of stroke survivors, we sought to evaluate UE impairment before and after rehabilitation, correlate UE impairment with performance of UE-dependent activities of daily living (ADL) and establish the clinical factors associated with UE impairment.

Methods: This is a retrospective review of the data of stroke survivors admitted to a rehabilitation centre in Singapore over a 1-year period. Outcome measures included Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Functional Independence Measure-ADL (FIM-ADL). Based on the FMA-UE score, upper limb function was classified into 'no to poor', 'limited', 'notable' or 'full' arm-hand capacity.

Results: A total of 259 stroke survivors with a mean age of 62.9 ± 12.3 years were studied. Significant improvements were noted in FMA-UE and FIM-ADL scores after rehabilitation (P < 0.01). Of the 135 (52.1%) stroke survivors with no to poor arm-hand capacity, only 32 (23.7%) had good UE outcome, defined as improvement to notable or full arm-hand capacity. Of the stroke survivors with limited arm-hand capacity, 72.2% achieved good UE outcome. Better cognition, less severe stroke and better truncal balance were associated with higher admission FMA-UE scores.

Conclusion: Significant improvements in UE impairment and related UE-dependent ADL were noted after inpatient rehabilitation. The findings of this study can serve as a guide in educating stroke survivors and caregivers on expected UE outcomes and caregiving needs upon discharge from rehabilitation.