Browsing by Author "Han, Xinqiang"

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    Five-Year Outcomes and Cardiac Remodeling Following Left Atrial Appendage Occlusion
    (Dovepress, 2021-04-19) Liu, Baoxin; Luo, Jiachen; Gong, Mengmeng; Li, Zhiqiang; Shi, Beibei; Zhang, Xingxu; Han, Xinqiang; Wei, Yidong; Medicine, School of Medicine
    Purpose: LAAO has been an alternative therapy to oral anticoagulants (OACs) for stroke prophylaxis in patients with nonvalvular atrial fibrillation (NVAF) with elevated CHA2DS2-Vasc score, but the long-term outcomes of LAAO and its impacts on cardiac electrical and mechanical remodeling remain to be learned. We aimed to describe the impact of left atrial appendage occlusion (LAAO) on atrial remodeling and cardiovascular outcomes within 5-year follow-up. Patients and methods: A total of 107 patients with nonvalvular atrial fibrillation (NVAF) undergoing LAAO in the Shanghai Tenth People's Hospital between January 2014 and July 2017 were included. All participants were followed for ECG, transthoracic echocardiography (TTE), and clinical outcomes (including cardiovascular death, heart failure, ischemic stroke/systemic embolism, and pericardial effusion) at 6 and 12 months, and thereafter every 12 months after LAAO discharge until 5 years. Results: After LAAO, the left atrial diameter significantly increased at 6 months (48.6 ± 6.7 vs 46.5 ± 7.0 mm); heart rate decreased immediately after the procedure (78.5 ± 14.7 vs 85.3 ± 21.7 bpm) when compared with the pre-procedure level. The QTc interval prolongated to the highest value of 460.7 ± 46.8 ms at 6 months (pre-procedure level of 433.7±49.0 ms). All these changes return to the pre-procedure level within the follow-up. For clinical outcomes, 51 patients suffered the composite of cardiovascular death (n=4, 3.7%), heart failure (n=25, 23.4%), ischemic stroke/systemic embolism (n=22, 20.6%), and pericardial effusion (n=26, 26.2%). Conclusion: LAAO did not change ECG or TTE characteristics and nonprocedure-related pericardial effusion is common during long-term follow-up. Further studies are warranted to investigate the optimal time frame of anticoagulation in patients undergoing LAAO.
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    Percutaneous Left Atrial Appendage Occlusion Therapy: Evolution and Growing Evidence
    (IMR Press, 2023-07-19) Han, Xinqiang; Benditt, David G.; Medicine, School of Medicine
    Atrial fibrillation (AF) is the most common cardiac arrhythmia and if untreated, significantly increases both the risk of intracardiac thrombus formation and ischemic stroke. In patients with nonvalvular AF (NVAF), the left atrial appendage (LAA) has been estimated to be the source of thrombus development in 91% to 99% of cases. Consequently, oral anticoagulation (OAC) to provide stroke prevention has become the standard of care for most AF patients; however, OACs are associated with a risk of bleeding and their efficacy depends on optimal patient compliance. In terms of alternative approaches to preventing embolic events, surgical LAA excision was attempted as early as in the late 1940s in patients with valvular AF; LAA excision remains a recommendation in surgical guidelines for NVAF patients who need open-heart coronary bypass or valvular replacement/repair surgeries. However, due to its invasive nature surgical LAA intervention has limited clinical application in present cardiology practice. Percutaneous LAA occlusion (LAAO) is increasingly being performed as an alternative to OAC for stroke prevention; this is particularly the case in patients at increased bleeding risk. Substantial progress has been made in percutaneous LAAO therapy since its inception some twenty years ago. Herein we systematically review both the critical literature that led to the development of LAAO, and the increasing clinical evidence supporting the application of this treatment strategy in NVAF. To this end we focus on recently published critical evaluations of United States Food and Drug Administration (US FDA) and Conformité Européenne (Commercial Sale of Licensed Product in the EU) (CE-Mark) approved LAAO devices, summarize the current status of LAAO therapy, and discuss the future perspectives regarding the knowledge and technology gaps in this area by recognizing the potential contributions of many ongoing but likely transformative clinical trials.
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    Precision cardio-oncology: understanding the cardiotoxicity of cancer therapy
    (Nature Research, 2017-09-12) Han, Xinqiang; Zhou, Yun; Liu, Wendi; Medicine, School of Medicine
    Current oncologic treatments have brought a strong reduction in mortality in cancer patients. However, the cancer therapy-related cardiovascular complications, in particular chemo-therapy and radiation therapy-induced cardiotoxicities are a major cause of morbidity and mortality in people living with or surviving cancer. The simple fact is that all antineoplastic agents and radiation therapy target tumor cells but also result in collateral damage to other tissues including the cardiovascular system. The commonly used anthracycline chemotherapy agents can induce cardiomyopathy and congestive heart failure. Targeted therapies with human epidermal growth factor antibodies, tyrosine kinase inhibitors or vascular endothelial growth factor antibodies, and the antimetabolites also have shown to induce cardiomyopathy and myocardial ischemia. Cardiac arrhythmias and hypertension have been well described with the use of tyrosine kinase inhibitors and antimicrotubule agents. Pericarditis can happen with the use of cyclophosphamide or cytarabine. Mediastinal radiation can cause constrictive pericarditis, myocardial fibrosis, valvular lesions, and coronary artery disease. Despite significant progresses in the understanding of the molecular and pathophysiologic mechanisms behind the cardiovascular toxicity of cancer therapy, there is still lack of evidence-based approach for the monitoring and management of patients. This review will focus mainly on the recent advances in the molecular mechanisms of cardiotoxicity related to common cancer therapies while introducing the concept of cardio-oncology service. Applying the general principles of multi-disciplinary approaches toward the diagnosis, prevention, monitoring, and treatment of cancer therapy-induced cardiomyopathy and heart failure will also be discussed.
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    Ventricular fibrillation in congenitally corrected transposition of great arteries treated with pacing: a case report
    (Oxford, 2019-12) Zhang, Lei; Liu, Hongyang; Wan, Qilin; Han, Xinqiang; Medicine, School of Medicine
    Background Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease which may present with sudden death from malignant arrhythmias including complete heart block and ventricular tachyarrhythmias as late complications. Only few cases about ventricular tachyarrhythmias, usually in those with markedly depressed systemic ventricular function, have been reported. Case summary A 26-year-old woman with a known history of CCTGA presented to the emergency department with palpitations and breathlessness for 3–4 weeks and worsening symptoms for 8 h. She had a history of ventricular septal defect repair 14 years ago. Her initial presentation electrocardiogram demonstrated high degree atrioventricular block with a ventricular rate of 44 b.p.m. She had two episodes of complete syncope during this hospitalization, both required external defibrillation due to documented bradycardia-dependent ventricular fibrillations. Her two-dimensional echocardiography study confirmed the diagnosis of CCTGA with preserved systolic ventricular function. She underwent urgent temporal pacing wire placement with a paced ventricular rate at 90 b.p.m. Having thoroughly reviewed the arrhythmia events and discussed with the patient about the option of defibrillator vs. pacemaker therapy a decision was made upon her request for dual-chamber pacemaker implantation. She was discharged home uneventfully 3 days after hospital presentation and has been physically active at 3-, 6-, and 9-month follow-ups. Discussion Our case illustrates the individualized clinical decision making in choosing device therapy for a rare congenital heart disease presented with malignant arrhythmia. Careful history taking, open communication, and closely planned long-term follow-up will be essential in caring for such patients.