Pulmonary arterial hypertension in Thai patients with systemic sclerosis.

OBJECTIVE: Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with systemic sclerosis (SSc), and compare these features between those with limited (lc) SSc and diffuse (dc) SSc. MATERIAL AND METHOD: The medical records of SSc patients attending the Division of Rheumatology, Chiang Mai University were reviewed. PAH was defined by pulmonary arterial systolic pressure (PASP) > 35 mmHg, determined by Doppler echocardiography. RESULTS: Among 275 patients with SSc, 66 had Doppler echocardiography measurement. Thirty-nine patients (59.1%) had PAH. Among the PAH-SSc patients, 36 (92.3%) presented with dyspnea on exertion, and 37 (94.8%) were in a New York Heart Association functional class of II and III. Twenty-four of 39 patients (61.5%) had interstitial lung disease. Diffuse SSc patients had a significantly higher proportion of males, and shorter disease duration between SSc and PAH diagnosis than lcSSc patients. CONCLUSION: PAH was not uncommon in Thai patients with SSc. Interstitial lung disease might have been the cause associated with over half of these cases. Annual routine Doppler echocardiography screening for PAH in patients with SSc may detect preclinical PAH, and lead to early management and improved functional outcome.

In-hospital invasive strategy and outcomes in non-ST elevation acute coronary syndrome management from Thai Acute Coronary Syndrome Registry.

BACKGROUND: The management guideline of acute coronary syndrome has been changed in recent years, especially in the group of non-ST elevation acute coronary syndrome (NSTE-ACS). Presently, there is no existing guideline in Thailand. Additionally, several different management factors of health care from Western countries being used. OBJECTIVE: Evaluate the real management strategy, including the utilization of invasive management and pharmacotherapy of NSTE-ACS Thai patients in the absence of official clinical management guideline. MATERIAL AND METHOD: Thai Acute Coronary Syndrome (Thai ACS) Registry is a large, observational prospective, population-based registry designed to collect the data of "real-life" patient management. The full details of methods have been published in the present supplement. RESULTS: Five thousand five hundred and thirty-seven consecutive patients were registered between August 1, 2002 and July 31, 2005. Among these patients, 3,548 (64.1%) were diagnosed with non-ST elevation myocardial infarction (NSTEMI) and 1,989 (35.9%) with unstable angina. Coronary angiography was performed during hospitalization in 2,476 patients (44.7%). From 2,476 patients who underwent coronary angiogram, 405 (16.4%) had revascularization within 2 days and 1,019 (42.9%) after 2 days. Overall, in-hospital mortality was 9.5% and cardiac mortality was 6.3%. Patients with NSTEMI had more than 4 times the mortality of patients with unstable angina (13.1 vs. 3.0%, p < 0.001). Patients who received only medical treatment without coronary angiogram had the highest mortality rate. The in-hospital outcomes were not different between patients who received early or delayed revascularization. CONCLUSION: Mortality rate of NSTEACS in the authors' registry was very high. NSTEMI had the worse prognosis. Invasive strategy is associated with better in-hospital outcome but is underutilized.

A predictive model for distinguishing ischemic from non-ischemic cardiomyopathy.

OBJECTIVES: To develop a predictive model to distinguish ischemic from non-ischemic cardiomyopathy MATERIAL AND METHOD: The authors randomly assigned 137 patients with LV systolic dysfunction into two subsets--one to derive a predictive model and the other to validate it. Clinical, electrocardiographic and echocardiographic data were interpreted by blinded investigators to the subsequent coronary angiogram results. Ischemic cardiomyopathy was diagnosed by the presence of significant coronary artery disease from the coronary angiogram. The final model had been derived from the clinical data and was validated using the validating set. The receiver-operating characteristics (ROC) curves and the diagnostic performances of the model were estimated. RESULTS: The authors developed the following model: Predictive score = (3 x presence of diabetes mellitus) + number of ECG leads with abnormal Q waves--(5 x presence of echocardiographic characteristic of nonischemic cardiomyopathy). The model was well discriminated (area under ROC curve = 0.94). Performance in the validating sample was equally good (area under ROC curve = 0.89). When a cut-off point > or = 0 was used to predict the presence of significant coronary artery disease, the model had a sensitivity, specificity and positive and negative predictive values of 100%, 57%, 74% and 100%, respectively. CONCLUSION: With the high negative value of this model, it would be useful for use as a screening tool to exclude non-ischemic cardiomyopathy in heart failure patients and may avoid unnecessary coronary angiograms.