Elmer Llanes | University of the Philippines Manila (original) (raw)

Papers by Elmer Llanes

Research Square (Research Square), Jul 6, 2019

Background Various cardiovascular biomarkers are used to assess and compare the risk of cardiovas... more Background Various cardiovascular biomarkers are used to assess and compare the risk of cardiovascular diseases across populations. However, artefactual variations due to the use of different laboratories may make these comparisons invalid. This work describes the inter-laboratory variations in a multi-country cohort, LIFECARE, and the use of recalibration to a reference laboratory to minimise this variability. Methods LIFECARE is a cohort of 10,479 participants recruited from Indonesia, Malaysia, Philippines and Thailand between 2008 and 2011, with blood samples analysed at country-speci c laboratories(n=4). Thailand was the designated reference laboratory. The measurements from each laboratory were compared against the reference laboratory using a common set of samples analysed at all laboratories, using the MethComp package in R. Laboratory values for cohort participants were recalibrated using the equation generated by the package, if large, statistically signi cant differences were observed during the comparison. Results Glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride measurements were reported for all four countries. Cholesterol and HDL from all laboratories required recalibration while glucose did not. Recalibration altered the proportions of the population at risk substantially, with prevalence of high cholesterol changing from 56.3% to 75.0% in Malaysia, 52.1% to 37.5% in Indonesia and 31.3% to 22.7% in Philippines. Prevalence of low HDL was similarly altered. Conclusion There was signi cant variation in serum lipid levels measured by different laboratories, leading to variations in estimates of population at risk. Recalibration to a reference laboratory can overcome this variability and facilitate meaningful comparisons of laboratory data across countries.

European Heart Journal, 2020

Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular he... more Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who do not recover cardiac function, they will require advanced heart failure therapies. Bromocriptine, a dopamine agonist which inhibits prolactin release, has demonstrated improvement in left ventricular recovery and clinical outcome. We sought to determine the effect of adding Bromocriptine to standard heart failure therapy on the improvement and recovery of left ventricular function of these patients. Inclusion Criteria. Studies were included if they satisfied the following criteria:1) Randomized Controlled Trials; 2) Pregnant patients who fulfilled the criteria for diagnosis of peripartum cardiomyopathy and 3) Reported data on improvement in left ventricular ejection fraction and clinical outcomes. Methods. Using PUBMED, Clinical Key, Science Direct, Scopus, and Cochrane databases, a search for eligible studies was conducted from June to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of Bromocriptine on the improvement of left ventricular function and clinical outcomes among these patients. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results. We identified 2 randomized controlled trials of 58 pregnant patients diagnosed with peripartum cardiomyopathy, showing that among those who received Bromocriptine on top of standard heart failure therapy, there is a significant improvement in the left ventricular ejection fraction at 6 months [mean difference 15.14 (95% CI, 6.53 to 23.75) p <0.05] compared to standard heart failure therapy alone. It was also observed that those who received Bromocriptine had better clinical outcomes. Conclusion. The addition of Bromocriptine on top of standard heart failure therapy significantly improved the left ventricular ejection fraction of patients with peripartum cardiomyopathy at 6 months post-partum. This novel therapy may be considered to improve the management of these patients.

Lipids in Health and Disease, Apr 15, 2021

Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific ... more Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific region, with the prevalence of CVD risk factors such as plasma lipid disorders increasing in many Asian countries. As members of the Cardiovascular RISk Prevention (CRISP) in Asia network, the authors have focused on plasma lipid disorders in the six countries within which they have clinical experience: Indonesia, Malaysia, Philippines, Thailand, Vietnam, and Australia. Based on country-specific national surveys, the prevalence of abnormal levels of total cholesterol, low-and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), and triglycerides (TG) are reported. An important caveat is that countries have used different thresholds to define plasma lipid disorders, making direct comparisons difficult. The prevalence of abnormal lipid levels was as follows: high total cholesterol (30.2-47.7%, thresholds: 190-213 mg/dL); high LDL-C (33.2-47.5%; thresholds: 130-135 mg/dL); low/abnormal HDL-C (22.9-72.0%; thresholds: 39-50 mg/dL); and high/abnormal TG (13.9-38.7%; thresholds: 150-177 mg/dL). Similarities and differences between country-specific guidelines for the management of plasma lipid disorders are highlighted. Based on the authors' clinical experience, some of the possible reasons for suboptimal management of plasma lipid disorders in each country are described. Issues common to several countries include physician reluctance to prescribe high-dose and/or high-intensity statins and poor understanding of disease, treatments, and side effects among patients. Treatment costs and geographical constraints have also hampered disease management in Indonesia and the Philippines. Understanding the factors governing the prevalence of plasma lipid disorders helps enhance strategies to reduce the burden of CVD in the Asia-Pacific region.

European Heart Journal, Aug 1, 2018

Prediction of acute coronary syndromes prognosis 769 divided into two groups; survival (n=93) and... more Prediction of acute coronary syndromes prognosis 769 divided into two groups; survival (n=93) and non-survival (n=55). We assessed burden of ischemic myocardium using APPROACH, BARI, Jeopardy score (JS), Duke jeopardy score (DJS), Leaman score (LS), Genisini score (GS) and Syntax-I score (SS) before PCI. Results: Overall incidence of in-hospital mortality among patients with CS was 37.2% (55/148). TIMI postPCI and no-reflow during PCI were strongly associated with in-hospital-mortality. In the multi-variable analysis, the patients who were dead had higher score of SS ≥18.5 (HR, 2.7; 95% CI 1.2-5.9; p-value, 0.016) and higher rate of no-reflow (HR, 2.7; 95% CI, 1.1-6.8; p-value, 0.029) during PCI after adjustment with variables of angiography. In addition, following adjustment with clinical factors, SS ≥18.5 (HR, 2.7; 95% CI 1.2-5.9; p-value, 0.016) still remained an independent factor. Cox Regression Model for Syntax score Conclusions: Among angiographic parameters, SS can predict in-hospital mortality in the STEMI with CS. The SS may allow to aid rapid decision-making during PCI. P3682 The prognostic significance of early and late right precordial lead (V4R) ST-segment elevation in patients with acute anterior myocardial infarction

Cardiology research, 2019

Background: Pulmonary hypertension is a usual complication of long-standing mitral valve disease.... more Background: Pulmonary hypertension is a usual complication of long-standing mitral valve disease. Perioperative pulmonary hypertension is a risk factor for right ventricular failure and is an important cause of morbidity and mortality in patients with pulmonary hypertension undergoing mitral valve surgery. Phosphodiesterase-5 inhibitors particularly sildenafil citrate have proven clinical benefit for pulmonary arterial hypertension but have shown discordant results in group 2 pulmonary hypertension patients. We sought to determine the effect of pre-operative sildenafil on the intra-operative hemodynamic parameters of these patients. Methods: Studies were included if they satisfied the following criteria: 1) Randomized controlled trials; 2) Adult patients with pulmonary hypertension scheduled for elective mitral valve surgery; and 3) Reported data on changes in pre-, intra-, and post-operative hemodynamic parameters. Using PUBMED, Clinical Key, Science Direct, and Cochrane databases, a search for eligible studies was conducted from September 1 to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of pre-operative sildenafil on the improvement of intra-operative hemodynamic parameters such as systolic pulmonary artery pressure (sPAP), mean pulmonary arterial pressure, mean arterial pressure, pulmonary and systemic vascular resistances. We also investigated its effect on the post-operative mortality, length of cardiopulmonary bypass time, ventilation time, and inotrope support requirement. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results: We identified three studies involving 153 patients with pulmonary hypertension undergoing mitral valve surgery, showing that among those who received pre-operative sildenafil there is a significant decrease in intra-operative systolic pulmonary arterial pressure (mean difference-11.19 (95% confidence interval (CI),-20.23 to-2.15), P < 0.05) and post-operative sPAP (mean difference-13.67 (95% CI,-19.56 to-7.78), P < 0.05) without significantly affecting the mean arterial pressure (mean difference 1.94 (95% CI,-5.49 to 9.37), P < 0.05). The systemic and pulmonary vascular resistances were not affected as well. Conclusions: Administration of pre-operative sildenafil to patients with pulmonary hypertension undergoing mitral valve surgery decreases intra-operative and post-operative systolic pulmonary arterial pressure without significantly affecting other systemic hemodynamic parameters.

Preventive medicine reports, Jun 1, 2022

Dyslipidemia is a fundamental risk factor for cardiovascular diseases (CVDs) and can worsen the p... more Dyslipidemia is a fundamental risk factor for cardiovascular diseases (CVDs) and can worsen the prognosis, if unaddressed. Lipid guidelines are still evolving as dyslipidemia is affecting newer patient subsets. However, these guidelines are governed by regional demographics and ethnic data. Primary care practitioners (PCPs) are the first to offer treatment, and hence placed early in the healthcare continuum. PCPs shoulder a huge responsibility in early detection of dyslipidemia for primary prevention of future cardiovascular (CV) events. Therefore, as members of Cardiovascular RISk Prevention (CRISP) in Asia network, the authors intend to align and shape-up the daily clinical practice workflow for PCPs and have a goal-directed strategy for managing dyslipidemia. This paper reviews the major international lipid guidelines, namely the American and European guidelines, and the regional guidelines from Indonesia, Malaysia, Philippines, Thailand, and Vietnam to identify their commonalities and heterogeneities. The authors, with a mutual consensus, have put forth, best in-clinic practices for screening, risk assessment, diagnosis, treatment, and management of dyslipidemia, particularly to reduce the overall risk of CV events, especially in the Asian context. The authors feel that PCPs should be encouraged to work in congruence with patients to decide on best possible therapy, which would be a holistic approach, rather than pursuing a “one-size-fits-all” approach. Since dyslipidemia is a dynamic field, accumulation of high-quality evidence and cross-validation studies in the future are warranted to develop best in-clinic practices at a global level.

European Heart Journal

Funding Acknowledgements Type of funding sources: None. Background COVID-19 has been reported to ... more Funding Acknowledgements Type of funding sources: None. Background COVID-19 has been reported to cause cardiac injury. It can be detected by an electrocardiogram (ECG), which may show markers that may predict clinical outcome. Robust data on the ECG abnormalities among COVID-19 patients affected by the alpha, beta, and gamma variants have been reported, but there is paucity of data among patients affected by the delta and omicron variants. Purpose This study aims to describe the cardiovascular profile, ECG findings, and clinical course of adult patients with COVID-19, and to determine the association between certain ECG findings and clinical outcomes among these patients. Methods We evaluated 547 COVID-19 patients admitted from June 2021 to June 2022. Clinical profiles were extracted from electronic records. Admission ECGs were independently read and adjudicated by three cardiologists. Logistic regression analysis was done to determine the association between ECG abnormalities and a...

Asian Journal of Epidemiology, 2021

European Heart Journal, 2020

Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular he... more Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who do not recover cardiac function, they will require advanced heart failure therapies. Bromocriptine, a dopamine agonist which inhibits prolactin release, has demonstrated improvement in left ventricular recovery and clinical outcome. We sought to determine the effect of adding Bromocriptine to standard heart failure therapy on the improvement and recovery of left ventricular function of these patients. Inclusion Criteria. Studies were included if they satisfied the following criteria:1) Randomized Controlled Trials; 2) Pregnant patients who fulfilled the criteria for diagnosis of peripartum cardiomyopathy and 3) Reported data on improvement ...

Phillippine Journal of Internal Medicine, 2020

Hypertension and Cardiovascular Disease in Asia

The Philippine journal of science, Jun 22, 2021

Constituting one of the most commonly used antihypertensive drug families are the angiotensin rec... more Constituting one of the most commonly used antihypertensive drug families are the angiotensin receptor blockers (ARBs). The aim of this study was to identify the variants associated with response to ARBs that may potentially be used as markers for designing a tailor-fit treatment strategy for hypertension. An unmatched case-control study was done among adult hypertensive Filipino patients maintained on ARBs. Genotypic analysis of blood DNA was conducted. Logistic regression analyses were performed to determine association of clinical and genetic variables with ARB response. A total of 69 poor responders and 126 normal responders were included in the study. After performing univariate logistic regression, five single nucleotide polymorphisms showed association with poor response to ARBs. The genetic variant rs6596140 remained significant (dominant model; OR 2.36, p = 0.009) after adjusting for female sex and age. Variant rs6596140 was found to be associated with poor response to ARBs among Filipinos. Prior to clinical application, verification is recommended prior to clinical application. As the function of this variant is presently unknown, an investigation to elucidate its role in ARB response in hypertension is also recommended.

The Philippine journal of science, Aug 21, 2021

Genetics is an important component in the development of coronary artery disease (CAD); however, ... more Genetics is an important component in the development of coronary artery disease (CAD); however, studies on the Filipino population are lacking. This study aimed to determine the association of polymorphisms with the development of CAD among Filipinos. This is an ageand sex-matched case-control association study involving 122 adult Filipinos with CAD and 230 control participants without CAD. DNA from blood samples were genotyped for candidate single-nucleotide polymorphisms (SNPs) using Illumina GoldenGate Genotyping (GGGT) assay. Candidate variants and clinical data were correlated with the occurrence of CAD using chi-square and logistic regression analysis. Of the candidate variants analyzed, only rs17465637 in MIA3 (adjusted OR 2.38; p = 0.024) was found to have a nominal association with the development of CAD among Filipinos after adjusting for hypertension, type 2 diabetes mellitus (T2DM), and smoking status. This finding may potentially allow earlier identification of Filipino patients at risk for CAD. Validation of these findings in a larger cohort is recommended.

Acta Medica

Literature was reviewed semi-systematically with the purpose of generating Philippines-specific d... more Literature was reviewed semi-systematically with the purpose of generating Philippines-specific data for the patient journey stages for dyslipidemia and hypertension, namely, awareness, screening, diagnosis, treatment, adherence, and control. A structured search was conducted on EMBASE and MEDLINE databases for studies published in English in the last 10 years, whose full text was available. An unstructured search was conducted on Google, and websites of health ministries and international organizations, without any limits. The last search was run for dyslipidemia on 12.11.2019 and for hypertension on 28.07.2020. For dyslipidemia, six records out of 590 records were retrieved, and for hypertension, seven records and one unpublished conference presentation out of 160 records retrieved, were included in the final synthesis. The review estimated that in the Philippines, the prevalence of dyslipidemia was 38.8%, while 59.0% of patients were undergoing treatment, with 44.2% of patients a...

Medicine

Supplemental Digital Content is available in the text Abstract Genetic variation is known to affe... more Supplemental Digital Content is available in the text Abstract Genetic variation is known to affect response to calcium channel blockers (CCBs) among different populations. This study aimed to determine the genetic variations associated with poor response to this class of antihypertensive drugs among Filipinos. One hundred eighty one hypertensive participants on CCBs therapy were included in an unmatched case-control study. Genomic deoxyribonucleic acid were extracted and genotyped for selected genetic variants. Regression analysis was used to determine the association of genetic and clinical variables with poor response to medication. The variant rs1458038 near fibroblast growth factor 5 gene showed significant association with poor blood pressure-lowering response based on additive effect (CT genotype: adjusted OR 3.41, P = .001; TT genotype: adjusted OR 6.72, P < .001). These findings suggest that blood pressure response to calcium channels blockers among Filipinos with hypertension is associated with gene variant rs1458038 near fibroblast growth factor 5 gene. Further studies are recommended to validate such relationship of the variant to the CCB response.

Research Square (Research Square), Jul 6, 2019

Background Various cardiovascular biomarkers are used to assess and compare the risk of cardiovas... more Background Various cardiovascular biomarkers are used to assess and compare the risk of cardiovascular diseases across populations. However, artefactual variations due to the use of different laboratories may make these comparisons invalid. This work describes the inter-laboratory variations in a multi-country cohort, LIFECARE, and the use of recalibration to a reference laboratory to minimise this variability. Methods LIFECARE is a cohort of 10,479 participants recruited from Indonesia, Malaysia, Philippines and Thailand between 2008 and 2011, with blood samples analysed at country-speci c laboratories(n=4). Thailand was the designated reference laboratory. The measurements from each laboratory were compared against the reference laboratory using a common set of samples analysed at all laboratories, using the MethComp package in R. Laboratory values for cohort participants were recalibrated using the equation generated by the package, if large, statistically signi cant differences were observed during the comparison. Results Glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride measurements were reported for all four countries. Cholesterol and HDL from all laboratories required recalibration while glucose did not. Recalibration altered the proportions of the population at risk substantially, with prevalence of high cholesterol changing from 56.3% to 75.0% in Malaysia, 52.1% to 37.5% in Indonesia and 31.3% to 22.7% in Philippines. Prevalence of low HDL was similarly altered. Conclusion There was signi cant variation in serum lipid levels measured by different laboratories, leading to variations in estimates of population at risk. Recalibration to a reference laboratory can overcome this variability and facilitate meaningful comparisons of laboratory data across countries.

European Heart Journal, 2020

Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular he... more Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who do not recover cardiac function, they will require advanced heart failure therapies. Bromocriptine, a dopamine agonist which inhibits prolactin release, has demonstrated improvement in left ventricular recovery and clinical outcome. We sought to determine the effect of adding Bromocriptine to standard heart failure therapy on the improvement and recovery of left ventricular function of these patients. Inclusion Criteria. Studies were included if they satisfied the following criteria:1) Randomized Controlled Trials; 2) Pregnant patients who fulfilled the criteria for diagnosis of peripartum cardiomyopathy and 3) Reported data on improvement in left ventricular ejection fraction and clinical outcomes. Methods. Using PUBMED, Clinical Key, Science Direct, Scopus, and Cochrane databases, a search for eligible studies was conducted from June to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of Bromocriptine on the improvement of left ventricular function and clinical outcomes among these patients. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results. We identified 2 randomized controlled trials of 58 pregnant patients diagnosed with peripartum cardiomyopathy, showing that among those who received Bromocriptine on top of standard heart failure therapy, there is a significant improvement in the left ventricular ejection fraction at 6 months [mean difference 15.14 (95% CI, 6.53 to 23.75) p <0.05] compared to standard heart failure therapy alone. It was also observed that those who received Bromocriptine had better clinical outcomes. Conclusion. The addition of Bromocriptine on top of standard heart failure therapy significantly improved the left ventricular ejection fraction of patients with peripartum cardiomyopathy at 6 months post-partum. This novel therapy may be considered to improve the management of these patients.

Lipids in Health and Disease, Apr 15, 2021

Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific ... more Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific region, with the prevalence of CVD risk factors such as plasma lipid disorders increasing in many Asian countries. As members of the Cardiovascular RISk Prevention (CRISP) in Asia network, the authors have focused on plasma lipid disorders in the six countries within which they have clinical experience: Indonesia, Malaysia, Philippines, Thailand, Vietnam, and Australia. Based on country-specific national surveys, the prevalence of abnormal levels of total cholesterol, low-and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), and triglycerides (TG) are reported. An important caveat is that countries have used different thresholds to define plasma lipid disorders, making direct comparisons difficult. The prevalence of abnormal lipid levels was as follows: high total cholesterol (30.2-47.7%, thresholds: 190-213 mg/dL); high LDL-C (33.2-47.5%; thresholds: 130-135 mg/dL); low/abnormal HDL-C (22.9-72.0%; thresholds: 39-50 mg/dL); and high/abnormal TG (13.9-38.7%; thresholds: 150-177 mg/dL). Similarities and differences between country-specific guidelines for the management of plasma lipid disorders are highlighted. Based on the authors' clinical experience, some of the possible reasons for suboptimal management of plasma lipid disorders in each country are described. Issues common to several countries include physician reluctance to prescribe high-dose and/or high-intensity statins and poor understanding of disease, treatments, and side effects among patients. Treatment costs and geographical constraints have also hampered disease management in Indonesia and the Philippines. Understanding the factors governing the prevalence of plasma lipid disorders helps enhance strategies to reduce the burden of CVD in the Asia-Pacific region.

European Heart Journal, Aug 1, 2018

Prediction of acute coronary syndromes prognosis 769 divided into two groups; survival (n=93) and... more Prediction of acute coronary syndromes prognosis 769 divided into two groups; survival (n=93) and non-survival (n=55). We assessed burden of ischemic myocardium using APPROACH, BARI, Jeopardy score (JS), Duke jeopardy score (DJS), Leaman score (LS), Genisini score (GS) and Syntax-I score (SS) before PCI. Results: Overall incidence of in-hospital mortality among patients with CS was 37.2% (55/148). TIMI postPCI and no-reflow during PCI were strongly associated with in-hospital-mortality. In the multi-variable analysis, the patients who were dead had higher score of SS ≥18.5 (HR, 2.7; 95% CI 1.2-5.9; p-value, 0.016) and higher rate of no-reflow (HR, 2.7; 95% CI, 1.1-6.8; p-value, 0.029) during PCI after adjustment with variables of angiography. In addition, following adjustment with clinical factors, SS ≥18.5 (HR, 2.7; 95% CI 1.2-5.9; p-value, 0.016) still remained an independent factor. Cox Regression Model for Syntax score Conclusions: Among angiographic parameters, SS can predict in-hospital mortality in the STEMI with CS. The SS may allow to aid rapid decision-making during PCI. P3682 The prognostic significance of early and late right precordial lead (V4R) ST-segment elevation in patients with acute anterior myocardial infarction

Cardiology research, 2019

Background: Pulmonary hypertension is a usual complication of long-standing mitral valve disease.... more Background: Pulmonary hypertension is a usual complication of long-standing mitral valve disease. Perioperative pulmonary hypertension is a risk factor for right ventricular failure and is an important cause of morbidity and mortality in patients with pulmonary hypertension undergoing mitral valve surgery. Phosphodiesterase-5 inhibitors particularly sildenafil citrate have proven clinical benefit for pulmonary arterial hypertension but have shown discordant results in group 2 pulmonary hypertension patients. We sought to determine the effect of pre-operative sildenafil on the intra-operative hemodynamic parameters of these patients. Methods: Studies were included if they satisfied the following criteria: 1) Randomized controlled trials; 2) Adult patients with pulmonary hypertension scheduled for elective mitral valve surgery; and 3) Reported data on changes in pre-, intra-, and post-operative hemodynamic parameters. Using PUBMED, Clinical Key, Science Direct, and Cochrane databases, a search for eligible studies was conducted from September 1 to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of pre-operative sildenafil on the improvement of intra-operative hemodynamic parameters such as systolic pulmonary artery pressure (sPAP), mean pulmonary arterial pressure, mean arterial pressure, pulmonary and systemic vascular resistances. We also investigated its effect on the post-operative mortality, length of cardiopulmonary bypass time, ventilation time, and inotrope support requirement. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results: We identified three studies involving 153 patients with pulmonary hypertension undergoing mitral valve surgery, showing that among those who received pre-operative sildenafil there is a significant decrease in intra-operative systolic pulmonary arterial pressure (mean difference-11.19 (95% confidence interval (CI),-20.23 to-2.15), P < 0.05) and post-operative sPAP (mean difference-13.67 (95% CI,-19.56 to-7.78), P < 0.05) without significantly affecting the mean arterial pressure (mean difference 1.94 (95% CI,-5.49 to 9.37), P < 0.05). The systemic and pulmonary vascular resistances were not affected as well. Conclusions: Administration of pre-operative sildenafil to patients with pulmonary hypertension undergoing mitral valve surgery decreases intra-operative and post-operative systolic pulmonary arterial pressure without significantly affecting other systemic hemodynamic parameters.

Preventive medicine reports, Jun 1, 2022

Dyslipidemia is a fundamental risk factor for cardiovascular diseases (CVDs) and can worsen the p... more Dyslipidemia is a fundamental risk factor for cardiovascular diseases (CVDs) and can worsen the prognosis, if unaddressed. Lipid guidelines are still evolving as dyslipidemia is affecting newer patient subsets. However, these guidelines are governed by regional demographics and ethnic data. Primary care practitioners (PCPs) are the first to offer treatment, and hence placed early in the healthcare continuum. PCPs shoulder a huge responsibility in early detection of dyslipidemia for primary prevention of future cardiovascular (CV) events. Therefore, as members of Cardiovascular RISk Prevention (CRISP) in Asia network, the authors intend to align and shape-up the daily clinical practice workflow for PCPs and have a goal-directed strategy for managing dyslipidemia. This paper reviews the major international lipid guidelines, namely the American and European guidelines, and the regional guidelines from Indonesia, Malaysia, Philippines, Thailand, and Vietnam to identify their commonalities and heterogeneities. The authors, with a mutual consensus, have put forth, best in-clinic practices for screening, risk assessment, diagnosis, treatment, and management of dyslipidemia, particularly to reduce the overall risk of CV events, especially in the Asian context. The authors feel that PCPs should be encouraged to work in congruence with patients to decide on best possible therapy, which would be a holistic approach, rather than pursuing a “one-size-fits-all” approach. Since dyslipidemia is a dynamic field, accumulation of high-quality evidence and cross-validation studies in the future are warranted to develop best in-clinic practices at a global level.

European Heart Journal

Funding Acknowledgements Type of funding sources: None. Background COVID-19 has been reported to ... more Funding Acknowledgements Type of funding sources: None. Background COVID-19 has been reported to cause cardiac injury. It can be detected by an electrocardiogram (ECG), which may show markers that may predict clinical outcome. Robust data on the ECG abnormalities among COVID-19 patients affected by the alpha, beta, and gamma variants have been reported, but there is paucity of data among patients affected by the delta and omicron variants. Purpose This study aims to describe the cardiovascular profile, ECG findings, and clinical course of adult patients with COVID-19, and to determine the association between certain ECG findings and clinical outcomes among these patients. Methods We evaluated 547 COVID-19 patients admitted from June 2021 to June 2022. Clinical profiles were extracted from electronic records. Admission ECGs were independently read and adjudicated by three cardiologists. Logistic regression analysis was done to determine the association between ECG abnormalities and a...

Asian Journal of Epidemiology, 2021

European Heart Journal, 2020

Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular he... more Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who do not recover cardiac function, they will require advanced heart failure therapies. Bromocriptine, a dopamine agonist which inhibits prolactin release, has demonstrated improvement in left ventricular recovery and clinical outcome. We sought to determine the effect of adding Bromocriptine to standard heart failure therapy on the improvement and recovery of left ventricular function of these patients. Inclusion Criteria. Studies were included if they satisfied the following criteria:1) Randomized Controlled Trials; 2) Pregnant patients who fulfilled the criteria for diagnosis of peripartum cardiomyopathy and 3) Reported data on improvement ...

Phillippine Journal of Internal Medicine, 2020

Hypertension and Cardiovascular Disease in Asia

The Philippine journal of science, Jun 22, 2021

Constituting one of the most commonly used antihypertensive drug families are the angiotensin rec... more Constituting one of the most commonly used antihypertensive drug families are the angiotensin receptor blockers (ARBs). The aim of this study was to identify the variants associated with response to ARBs that may potentially be used as markers for designing a tailor-fit treatment strategy for hypertension. An unmatched case-control study was done among adult hypertensive Filipino patients maintained on ARBs. Genotypic analysis of blood DNA was conducted. Logistic regression analyses were performed to determine association of clinical and genetic variables with ARB response. A total of 69 poor responders and 126 normal responders were included in the study. After performing univariate logistic regression, five single nucleotide polymorphisms showed association with poor response to ARBs. The genetic variant rs6596140 remained significant (dominant model; OR 2.36, p = 0.009) after adjusting for female sex and age. Variant rs6596140 was found to be associated with poor response to ARBs among Filipinos. Prior to clinical application, verification is recommended prior to clinical application. As the function of this variant is presently unknown, an investigation to elucidate its role in ARB response in hypertension is also recommended.

The Philippine journal of science, Aug 21, 2021

Genetics is an important component in the development of coronary artery disease (CAD); however, ... more Genetics is an important component in the development of coronary artery disease (CAD); however, studies on the Filipino population are lacking. This study aimed to determine the association of polymorphisms with the development of CAD among Filipinos. This is an ageand sex-matched case-control association study involving 122 adult Filipinos with CAD and 230 control participants without CAD. DNA from blood samples were genotyped for candidate single-nucleotide polymorphisms (SNPs) using Illumina GoldenGate Genotyping (GGGT) assay. Candidate variants and clinical data were correlated with the occurrence of CAD using chi-square and logistic regression analysis. Of the candidate variants analyzed, only rs17465637 in MIA3 (adjusted OR 2.38; p = 0.024) was found to have a nominal association with the development of CAD among Filipinos after adjusting for hypertension, type 2 diabetes mellitus (T2DM), and smoking status. This finding may potentially allow earlier identification of Filipino patients at risk for CAD. Validation of these findings in a larger cohort is recommended.

Acta Medica

Literature was reviewed semi-systematically with the purpose of generating Philippines-specific d... more Literature was reviewed semi-systematically with the purpose of generating Philippines-specific data for the patient journey stages for dyslipidemia and hypertension, namely, awareness, screening, diagnosis, treatment, adherence, and control. A structured search was conducted on EMBASE and MEDLINE databases for studies published in English in the last 10 years, whose full text was available. An unstructured search was conducted on Google, and websites of health ministries and international organizations, without any limits. The last search was run for dyslipidemia on 12.11.2019 and for hypertension on 28.07.2020. For dyslipidemia, six records out of 590 records were retrieved, and for hypertension, seven records and one unpublished conference presentation out of 160 records retrieved, were included in the final synthesis. The review estimated that in the Philippines, the prevalence of dyslipidemia was 38.8%, while 59.0% of patients were undergoing treatment, with 44.2% of patients a...

Medicine

Supplemental Digital Content is available in the text Abstract Genetic variation is known to affe... more Supplemental Digital Content is available in the text Abstract Genetic variation is known to affect response to calcium channel blockers (CCBs) among different populations. This study aimed to determine the genetic variations associated with poor response to this class of antihypertensive drugs among Filipinos. One hundred eighty one hypertensive participants on CCBs therapy were included in an unmatched case-control study. Genomic deoxyribonucleic acid were extracted and genotyped for selected genetic variants. Regression analysis was used to determine the association of genetic and clinical variables with poor response to medication. The variant rs1458038 near fibroblast growth factor 5 gene showed significant association with poor blood pressure-lowering response based on additive effect (CT genotype: adjusted OR 3.41, P = .001; TT genotype: adjusted OR 6.72, P < .001). These findings suggest that blood pressure response to calcium channels blockers among Filipinos with hypertension is associated with gene variant rs1458038 near fibroblast growth factor 5 gene. Further studies are recommended to validate such relationship of the variant to the CCB response.