An upstream metabolic perturbation comprising medium- and long-chain dicarboxyl and hydroxyl acylcarnitines, likely reflecting changes in cellular fatty acid oxidation, was associated with arterial stiffness among aged adults. This advances mechanistic understanding of arterial stiffness among aged adults before clinical disease.

The assessment of atrioventricular junction (AVJ) deformation plays an important role in evaluating left ventricular systolic and diastolic function in clinical practice. This study aims to demonstrate the effectiveness and consistency of cardiovascular magnetic resonance (CMR) for quantitative assessment of AVJ velocity compared with tissue Doppler echocardiography (TDE). A group of 145 human subjects comprising 21 healthy volunteers, 8 patients with heart failure, 17 patients with hypertrophic cardiomyopathy, 52 patients with myocardial infarction, and 47 patients with repaired Tetralogy of Fallot were prospectively enrolled and underwent TDE and CMR scan. Six AVJ points were tracked with three CMR views. The peak systolic velocity (Sm1), diastolic velocity during early diastolic filling (Em), and late diastolic velocity during atrial contraction (Am) were extracted and analyzed. All CMR-derived septal and lateral AVJ velocities correlated well with TDE measurements (Sm1: r = 0.736; Em: r = 0.835; Am: r = 0.701; Em/Am: r = 0.691; all p < 0.001) and demonstrated excellent reproducibility [intrastudy: r = 0.921-0.991, intraclass correlation coefficient (ICC): 0.918-0.991; interstudy: r = 0.900-0.970, ICC: 0.887-0.957; all p < 0.001]. The evaluation of three-dimensional AVJ motion incorporating measurements from all views better differentiated normal and diseased states [area under the curve (AUC) = 0.918] and provided further insights into mechanical dyssynchrony diagnosis in HF patients (AUC = 0.987). These findings suggest that the CMR-based method is feasible, accurate, and consistent in quantifying the AVJ deformation, and subsequently in diagnosing systolic and diastolic cardiac dysfunction.

BackgroundSuPAR is a biomarker that reflects the level of immune activation. As inflammation plays an important role in the ageing process of the cardiovascular system, we hypothesized that suPAR might be a useful predictive biomarker of the ageing heart.MethodsWe performed conventional and tissue Doppler echocardiography and measured plasma suPAR levels.ResultsWe studied community adults (n=120, 37.5% female) (mean age: 70.3±9.3 years) without known cardiovascular disease (CVD). Participants with impaired myocardial relaxation were older (84% vs 59% were aged ≥71 years, p=0.002), with more diabetes mellitus (27% vs 11%, p=0.034). SuPAR levels were higher among participants with impaired myocardial relaxation (3.9 ng/ml vs 3.0 ng/ml, p=0.015). At the univariate level, older age (OR 3.6; 95%CI 1.6, 8.5; p=0.003), diabetes mellitus (OR 3.04; 95%CI 1.1, 8.8; p=0.04), systolic blood pressure (OR 1.03; 95%CI 1.001, 1.1; p=0.041) and suPAR levels ≥3.00ng/ml (OR 3.4; 95%CI 1.16, 7.4; p=0.002) were associated with impaired myocardial relaxation. In multivariable regression analysis, only older age (OR 2.8; 95%CI 1.1, 6.7; p=0.026) and suPAR (OR 2.7; 95%CI 1.2, 6.1; p=0.018) remained independently associated with impaired myocardial relaxation. Receiver operating characteristics (ROC) curve analysis revealed an area under the curve (AUC) value of 0.63 (95% CI 0.54, 0.71) for model that included age alone. Addition of suPAR significantly increased AUC value to 0.70 (95%CI 0.60, 0.79), which was significantly larger than the model with age alone (p=0.016).ConclusionWe demonstrate additional ability of suPAR, over age, to predict impaired myocardial relaxation.Trial registrationClinicalTrials.gov Identifier: NCT02791139 (Registered May 31, 2016).

BackgroundOur institution has initiated inpatient advance care planning (ACP) programme for heart failure patients in 2013. Enrollment rate has been low.AimExpansion of ACP programme to arrhythmia and myocardial infarction (MI) patients besides heart failure (HF) with support from nurse navigators to increase enrollment.MethodsPatients hospitalised for MI were approached by ACP trained nurse navigators from 1st October 2014 to 30th November 2014, while patients with arrhythmia were approached by ACP coordinators from 1st July 2014 to 30 November 2014. Heart failure patients were approached by ACP coordinators from 1st June 2013 to 30th November 2014.Results112 (5.8%) patients were enrolled from a total screening of 1943 patients. The mean age of patients was 63.9 years and majority was male (73.2%). Ethnic distribution: Chinese 83%, Malay 8%, Indians 7%. 7 out of 61 MI patients were enrolled by the nurse navigators. 8 out of 273 arrhythmia patients and 97 out of 1609 HF patients were enrolled by ACP coordinators. Enrollment rates for MI 11.5%, arrhythmia 2.9%, HF 6.0%.DiscussionThere is a significant increase in enrollment rate of ACP programme after the engagement of nurse navigators’ support. During the patient’s hospital stay, rapport and trust have built up among the patient, caregiver and nurse navigator. This resulted in patient being more open and able to accept ACP when approached by nurse navigator.ConclusionHealthcare providers who have built up a rapport with patients play an important role in advocating ACP programme.

BackgroundNHCS Heart Failure team and Medical Social Workers (MSWs) spearheaded ACP in August 2012. The Programme now incorporates sub-clinical teams, with support from 2 Clinical Coordinators, covering: Education, Research, and Clinical.AimThe team aims to increase awareness of ACP amongst Healthcare Workers (HCWs) in a South-East Asian (SEA) acute hospital, and to facilitate the understanding amongst MSWs of the impact of ACP on patients. ACP programme strives to ensure that patients of different disease stages and cardiac sub-specialities can benefit.MethodsThe ACP programme involves educational lectures delivered by MSWs for HCWs, pre/post-test surveys with patients and collaboration with DUKE-National University of Singapore and Singapore General Hospital MSWs. NHCS specialist physicians are involved in the formulation of workflows and protocols.ResultsThe educational lectures enjoyed good participation (162 registered/enrolled nurses and physicians). 20 HCWs trained in facilitating the delivery of ACP. Collaboration with the aforementioned institutions produced a manuscript, a research paper and two ongoing studies. Subspecialty-specific workflows were developed after consultation with NHCS cardiologists, targeting wide range of cardiac patients.DiscussionPatients and HCWs often find it difficult to discuss the crucial issue of ACP in view of Asian sensitivities. A holistic approach towards ACP in terms of educational lectures, training, and formulation of workflows greatly assisted NHCS in establishing a platform for future studies, research and improvement to the provision of care to our patients.ConclusionOngoing education and advocacy of ACP to patients and healthcare stakeholders is necessary in increasing the recognition of ACP as part of standard patient care.