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Zhao, Ying
Publications (10 of 12) Show all publications
Nicoll, R., Wiklund, U., Zhao, Y., Diederichsen, A., Mickley, H., Ovrehus, K., . . . Henein, M. (2016). Gender and age effects on risk factor-based prediction of coronary artery calcium in symptomatic patients: a Euro-CCAD study. Atherosclerosis, 252, 32-39
Open this publication in new window or tab >>Gender and age effects on risk factor-based prediction of coronary artery calcium in symptomatic patients: a Euro-CCAD study
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2016 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 252, p. 32-39Article in journal (Refereed) Published
Abstract [en]

Background and aims: The influence of gender and age on risk factor prediction of coronary artery calcification (CAC) presence in symptomatic patients is unclear.

Methods: From the European Calcific Coronary Artery Disease (EURO-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and USA. All had risk factor assessment and CT scanning for CAC scoring.

 Results: The prevalence of CAC among females was lower than among males in all age groups. Using multivariate logistic regression, age, dyslipidaemia, hypertension, diabetes and smoking were independently predictive of CAC presence in both genders. In addition to a progressive increase in CAC with age, the most important predictors of CAC presence were dyslipidaemia and diabetes (β = 0.64 and 0.63 respectively) in males and diabetes (β = 1.08) followed by smoking (β = 0.68) in females; these same risk factors were also important in predicting increasing CAC scores. There was no difference in the predictive ability of diabetes, hypertension and dyslipidaemia in either gender for CAC presence in patients aged <50 and 50-70 years. However, in patients aged >70, only dyslipidaemia predicted CAC presence in males and only smoking and diabetes were predictive in females. 

 

Conclusion:  In symptomatic patients, there are significant differences in the ability of conventional risk factors to predict CAC presence between genders and between patients aged <70 and ≥70, indicating the important role of age in predicting CAC presence.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Coronary calcification, age, gender, risk factors
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-124925 (URN)10.1016/j.atherosclerosis.2016.07.906 (DOI)000389480300006 ()27494449 (PubMedID)
Available from: 2016-08-30 Created: 2016-08-30 Last updated: 2018-06-07Bibliographically approved
Zhao, Y., Nicoll, R., He, Y. H. & Henein, M. Y. (2016). The effect of statins on valve function and calcification in aortic stenosis: A meta-analysis. Atherosclerosis, 246, 318-324
Open this publication in new window or tab >>The effect of statins on valve function and calcification in aortic stenosis: A meta-analysis
2016 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 246, p. 318-324Article in journal (Refereed) Published
Abstract [en]

Background: Aortic calcification has been shown to share the same risk factors as atherosclerosis which suggested a potential benefit from statins therapy. In view of the existing conflicting results, we aimed to provide objective evidence on the effect of statins in aortic stenosis (AS).

Methods and results: A meta-analysis of eligible studies that used statins in AS was performed. Fourteen studies were identified, 5 randomized controlled trials (RCTs) and 9 observational studies. In the 14 studies as a whole, no significant differences were found in all cause mortality (OR = 0.98, p = 0.91), cardiovascular mortality (OR = 0.80, P = 0.23) or the need for valve replacement (OR = 0.93, p = 0.45) between the statins and the control groups. LDL-cholesterol dropped in the statins groups in both <24 months and ≥24 months follow-up (p < 0.001 for both) but not in controls (p = 0.35 and p = 0.33, respectively). In the <24 months statins group, the annual increase in peak aortic velocity and peak gradient was less (p < 0.0001 and p = 0.004, respectively), but the mean gradient, valve area and calcification score were not different from controls. In the ≥24 months statins group, none of the above parameters was different from controls.

Conclusions: Despite the consistent beneficial effect of statins on LDL-cholesterol levels, the available evidence showed no effect on aortic valve structure, function or calcification and no benefit for clinical outcomes.

Keywords
Aortic valve stenosis, Meta-analysis, Statins
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-118384 (URN)10.1016/j.atherosclerosis.2016.01.023 (DOI)000370538200044 ()26828749 (PubMedID)
Available from: 2016-04-22 Created: 2016-03-18 Last updated: 2018-06-07Bibliographically approved
Zhao, Y., Nicoll, R., He, Y. H. & Henein, M. Y. (2016). The effect of statins therapy in aortic stenosis: Meta-analysis comparison data of RCTs and observationals.. Data in brief, 7, 357-361
Open this publication in new window or tab >>The effect of statins therapy in aortic stenosis: Meta-analysis comparison data of RCTs and observationals.
2016 (English)In: Data in brief, ISSN 2352-3409, Vol. 7, p. 357-361Article in journal (Refereed) Published
Abstract [en]

Aortic stenosis has been shown to share the same risk factors as atherosclerosis which suggested a potential benefit from statins therapy. Fourteen studies which provided the effect of statins treatment on aortic stenosis (AS) were meta-analyzed, including 5 randomized controlled trials (RCTs) and 9 observational studies. In the RCTs, statins did not have any influence on peak aortic valve velocity, peak valve gradient, mean valve gradient, aortic valve area and aortic calcification compared to controls. In the observational studies, the peak valve velocity, peak gradient and aortic valve area showed less progression in the statins group compared to controls. This article describes data related article title "The effect of statins on valve function and calcification in aortic stenosis: a meta-analysis" (Zhao et al., 2016) [1].

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-126956 (URN)10.1016/j.dib.2016.02.045 (DOI)26977437 (PubMedID)2-s2.0-84959303146 (Scopus ID)
Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2018-06-09Bibliographically approved
Zhao, Y., Lindqvist, P., Holmgren, A. & Henein, M. Y. (2013). Accentuated left ventricular lateral wall function compensates for septal dyssynchrony after valve replacement for aortic stenosis. International Journal of Cardiology, 164(3), 339-344
Open this publication in new window or tab >>Accentuated left ventricular lateral wall function compensates for septal dyssynchrony after valve replacement for aortic stenosis
2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 164, no 3, p. 339-344Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The interventricular septal motion becomes reversed after aortic valve replacement (AVR) for aortic stenosis (AS) despite maintained stroke volume (SV). We hypothesis that left ventricular (LV) lateral wall compensates for such disturbances, in order to secure normal SV. METHODS: We studied 29 severe AS patients (age 63±11years, 18 males) with normal ejection fraction (EF) before, 6months and 12months after AVR and compared them with 29 age- and gender-matched controls, using speckle tracking echocardiography. RESULTS: In patients, the LVEF and SV remained unchanged throughout. Before AVR, the septal radial motion, septal and lateral strain were reduced (p<0.001). Peak septal and lateral displacements, times from QRS to peak displacement were all not different from controls. Six months after AVR, septal radial motion reversed (p<0.001), lateral strain increased (p<0.05), peak septal displacement reduced (p<0.01) while lateral displacement increased (p<0.05). Time to peak septal displacement delayed (p<0.01) in contrast to lateral displacement which became early (p<0.05), resulting in a significant septal-lateral time delay (p<0.01). The accentuation of LV lateral wall correlated with septal displacement time delay (r=0.60, p<0.001) and septal-lateral time delay (r=0.64, p<0.001). SV correlated with lateral displacement (r=0.39, p<0.05). The systolic strain was correlated with opposite wall displacement (p<0.05 for both). There was no correlation between these measurements before and 12month after AVR. CONCLUSIONS: Accentuated lateral wall displacement compensates for septal dyssynchrony in order to maintain normal LVEF and SV. The continuing recovery of these disturbances 12months after complete mass regression suggests an ongoing reverse remodeling.

Keywords
aortic valve replacement, displacement, dyssynchrony, remodeling
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-45862 (URN)10.1016/j.ijcard.2011.07.031 (DOI)000316599700022 ()21807426 (PubMedID)
Note

Included in thesis in manuscript form.

Available from: 2011-08-19 Created: 2011-08-19 Last updated: 2018-06-08Bibliographically approved
Bengrid, T., Nicoll, R., Zhao, Y., Schmermund, A. & Henein, M. Y. (2013). Coronary calcium score is superior to exercise tolerance testing in predicting significant coronary artery stenosis [Letter to the editor]. International Journal of Cardiology, 168(2), 1697-1699
Open this publication in new window or tab >>Coronary calcium score is superior to exercise tolerance testing in predicting significant coronary artery stenosis
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2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 2, p. 1697-1699Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Coronary calcium score, Exercise stress testing, Angina
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-79946 (URN)10.1016/j.ijcard.2013.03.071 (DOI)000325412800245 ()23597571 (PubMedID)
Available from: 2013-09-04 Created: 2013-09-04 Last updated: 2018-06-08Bibliographically approved
Zhao, Y., Owen, A. & Henein, M. (2013). Early valve replacement for aortic stenosis irrespective of symptoms results in better clinical survival: a meta-analysis of the current evidence. International Journal of Cardiology, 168(4), 3560-3563
Open this publication in new window or tab >>Early valve replacement for aortic stenosis irrespective of symptoms results in better clinical survival: a meta-analysis of the current evidence
2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 4, p. 3560-3563Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Patients with severe, but asymptomatic aortic stenosis (AS) present a difficult clinical challenge. The conventional strategy is 'wait for symptoms' approach. However, some observational studies have suggested early aortic valve replacement (AVR) results in better outcome compared to late surgery. There are no randomised controlled trials comparing clinical outcome of early and late AVR. This meta-analysis is to examine the effect of the two approaches on clinical outcome in such patients. METHODS: We searched the PubMed for published studies on asymptomatic AS and treatment. Four observational studies (N=976 patients) were suitable for inclusion in the analysis. RESULTS: All four studies provided sufficient details. Using the subgroup of asymptomatic patients who underwent early surgery together or separately from the subgroup who had surgery after developing symptoms resulted in ORs of 0.17 and 0.16 respectively (p<0.00001) in favour of early AVR compared with conservational or late surgery. CONCLUSION: Meta-analysis of the available observational studies has demonstrated highly significant clinical outcome in favour of early AVR compared with late surgery, suggesting that early surgical approach offers substantial survival benefit for severe asymptomatic AS patients.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Aortic stenosis, Asymptomatic, Valve replacement
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-79935 (URN)10.1016/j.ijcard.2013.05.089 (DOI)000326219600069 ()23768864 (PubMedID)
Available from: 2013-09-04 Created: 2013-09-04 Last updated: 2018-06-08Bibliographically approved
Zhao, Y., Henein, M. Y., Mörner, S., Gustavsson, S., Holmgren, A. & Lindqvist, P. (2012). Residual compromised myocardial contractile reserve after valve replacement for aortic stenosis. European Heart Journal Cardiovascular Imaging, 13(4), 353-360
Open this publication in new window or tab >>Residual compromised myocardial contractile reserve after valve replacement for aortic stenosis
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2012 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 13, no 4, p. 353-360Article in journal (Refereed) Published
Abstract [en]

Objective: Despite recovery of left ventricular (LV) function and morphology after aortic valve replacement (AVR) for aortic stenosis (AS), its relationship with exercise capacity remains unknown. Twenty-one AVR patients (age 61 +/- 12 years, 14 male) with normal ejection fraction (EF, 64 +/- 7%) and 21 age- and sex-matched controls (57 +/- 9 years, 10 male, EF 68 +/- 8%) were studied.Methods and results: All subjects performed semi-supine bicycle exercise and speckle tracking echocardiography (STE) study. Peak oxygen consumption (pVO(2)) was collected during semi-supine bicycle exercise. Systolic (GLSRs) and early diastolic (GLSRe) longitudinal strain rate using STE and Doppler echocardiographic parameters were measured at rest, submaximal, peak exercise, and 4 min after exercise. The two groups had comparable resting echocardiographic measurements. At peak exercise, pVO(2) was lower in patients than controls (18.5 +/- 4.5 vs. 22.1 +/- 4.3 L/min/kg, P < 0.05). GLSRs (0.98 +/- 0.28 vs. 1.55 +/- 0.30 1/s, P < 0.001), septal Sm (7.9 +/- 1.4 vs. 11.1 +/- 2.3 cm/s, P < 0.001) and their changes between rest and peak exercise (Delta GLSRs: 0.16 +/- 0.33 vs. 0.68 +/- 0.27 1/s, P < 0.001; Delta Sm 2.29 +/- 2.23 vs. 4.63 +/- 2.29 cm/s, P < 0.01) were significantly lower in patients than controls. There was no correlation between pVO(2) and any echocardiographic measurements in controls. In patients, pVO(2) correlated with peak exercise GLSRs (r = 0.60, P = 0.0007), septal Sm (r = 0.65, P = 0.002), and Em (r = 0.57, P = 0.009). In a multivariate model, peak exercise GLSRs (beta = 7.18, P = 0.03) was the only independent predictor of pVO(2) in the patients group.Conclusion: Exercise capacity is subnormal after AVR for AS, irrespective of normal LVEF suggesting residual compromised myocardial functional reserve.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2012
Keywords
Exercise echocardiography, Aortic valve replacement, Strain rate, Reserve
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-47565 (URN)10.1093/ejechocard/jer246 (DOI)000303227200013 ()
Available from: 2011-09-23 Created: 2011-09-23 Last updated: 2018-06-08Bibliographically approved
Lindqvist, P., Zhao, Y., Bajraktari, G., Holmgren, A. & Henein, M. Y. (2011). Aortic valve replacement normalizes left ventricular twist function. Interactive Cardiovascular and Thoracic Surgery, 12(5), 701-706
Open this publication in new window or tab >>Aortic valve replacement normalizes left ventricular twist function
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2011 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 12, no 5, p. 701-706Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to assess the effect of aortic valve replacement (AVR) on left ventricular (LV) twist function. We studied 28 severe aortic stenosis (AS) patients with normal LV ejection fraction (EF) before and six months after AVR. LV long axis function was assessed using M-mode and tissue Doppler and twist function using speckle tracking echocardiography. The data were compared with 28 age and sex-matched normal controls. In patients, LVEF remained unchanged after AVR. LV long axis function was reduced before surgery but normalized after AVR. LV twist was increased before (19.7 ± 5.7° vs. 12.9 ± 3.2°, P<0.001) and normalized after AVR (14.4 ± 5.2 °, P < 0.001). In normals, LV twist correlated with LV fractional shortening (r = 0.81, P<0.001) but not with EF. This relationship was reversed in patients before ( r= 0.52, P < 0.01) and after AVR (r = 0.34, P = ns). In patients with severe AS and normal EF, LV twist is exaggerated suggesting potential compensation for the reduced long axis function. These disturbances normalize within six months of AVR but lose their relationship with basal LV function.

Keywords
Aortic stenosis; Aortic valve replacement; Left ventricular function; Twist
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-45905 (URN)10.1510/icvts.2010.262303 (DOI)21303867 (PubMedID)
Available from: 2011-08-19 Created: 2011-08-19 Last updated: 2018-06-08Bibliographically approved
Okamoto, S., Zhao, Y., Lindqvist, P., Backman, C., Ericzon, B.-G., Wijayatunga, P., . . . Suhr, O. B. (2011). Development of cardiomyopathy after liver transplantation in Swedish hereditary transthyretin amyloidosis (ATTR) patients. Amyloid: Journal of Protein Folding Disorders, 18(4), 200-205
Open this publication in new window or tab >>Development of cardiomyopathy after liver transplantation in Swedish hereditary transthyretin amyloidosis (ATTR) patients
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2011 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 18, no 4, p. 200-205Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies of liver transplanted (LTx) familial amyloidotic polyneuropathy (FAP) patients have shown a progression of cardiomyopathy in some patients after LTx, but knowledge of the underlying factors remains limited.

Methods: Seventy-five patients, who had undergone LTx from 1996 to 2008, were included. They had all been examined by echocardiography 1-16 months before LTx. Fifty-four had been re-examined 7-34 months, and forty-two 36-137 months after LTx.

Results: A significant increase in interventricular septum (IVS) thickness occurred after LTx (p < 0.01), particularly in males (p = 0.002) and late onset patients (p = 0.003). The development of post-LTx cardiomyopathy was related to patient's age at onset of the disease, male gender and pre-LTx IVS thickness. On multivariate regression analysis, however, age at onset was the only significant predictor for the development of cardiomyopathy (odds ratio = 1.14, 95% confident interval 1.01-1.30, p = 0.04).

Conclusion: An increase of IVS thickness can be observed in FAP patients after LTx. Age at onset of the disease is the main predictor for increased IVS thickness and for the development of cardiomyopathy after liver transplantation.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2011
Keywords
Amyloidosis-hereditary-neuropathic, cardiomyopathy-hypertrophic, senescence, transplantation-liver, transthyretin
National Category
Biochemistry and Molecular Biology
Identifiers
urn:nbn:se:umu:diva-50513 (URN)10.3109/13506129.2011.615872 (DOI)000296985200005 ()
Available from: 2011-12-14 Created: 2011-12-13 Last updated: 2018-06-08Bibliographically approved
Zhao, Y. (2011). Effect of valve replacement for aortic stenosis on ventricular function. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Effect of valve replacement for aortic stenosis on ventricular function
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

BackgroundAortic stenosis (AS) is the commonest valve disease in the West. Aortic valve replacement (AVR) remains the only available management for AS and results in improved symptoms and recovery of ventricular functions. In addition, it is well known that AVR results in disruption of LV function mainly in the form of reversal of septal motion as well as depression of right ventricular (RV) systolic function. The aim of this thesis was to study, in detail, the early and mid-term response of ventricular function to AVR procedures (surgical and TAVI) as well as post operative patients’ exercise capacity.

MethodsWe studied LV and RV function by Doppler echocardiography and speckle tracking echocardiography (STE) in the following 4 groups; (1) 30 severe AS patients (age 62±11 years, 19 male) with normal LV ejection fraction (EF) who underwent AVR, (2) 20 severe AS patients (age 79±6 years, 14 male) who underwent TAVI, (3) 30 healthy controls (age 63±11 years, 16 male), (4) 21 healthy controls (age 57±9 years, 14 male) who underwent exercise echocardiography.

Results: After one week of TAVI, the septal radial motion and RV tricuspid annulus peak systolic excursion (TAPSE) were not different from before, while surgical AVR had significantly reversed septal radial motion and TAPSE dropped by 70% compared to before. The extent of the reversed septal motion correlated with that of TAPSE (r=0.78, p<0.001) in the patients as a whole after AVR and TAVI (Study I). Compared with controls, the LV twist function was increased in AS patients before and normalized after 6 months of surgical AVR. In controls, the LV twist correlated with LV fractional shortening (r=0.81, p<0.001), a relationship which became weak in patients before (r=0.52, p<0.01) and after AVR (r=0.34, p=ns) (Study II). After 6 months of surgical AVR, the reversed septal radial motion was still significantly lower than before. The septal peak displacement also decreased and its time became prolonged. In contrast, the LV lateral wall peak displacement increased and the time to peak displacement was early. The accentuated lateral wall peak displacement correlated with the septal peak displacement time delay (r=0.60, p<0.001) and septal-lateral time delay (r=0.64, p<0.001) (Study III). In 21 surgical AVR patients who performed exercise echocardiography, the LV function was normal at rest but different from controls with exercise. At peak exercise, oxygen consumption (pVO2) was lower in patients than controls. Although patients could achieve cardiac output (CO) and heart rate (HR) similar to controls at peak exercise, the LV systolic and early diastolic myocardial velocities and strain rate as well as their delta changes were significantly lower than controls. pVO2 correlated with peak exercise LV myocardial function in the patients group only, and the systolic global longitudinal strain rate (GLSRs) at peak exercise was the only independent predictor of pVO2 in multivariate regression analysis (p=0.03) (Study IV).

Conclusion: Surgical AVR is an effective treatment for AS patients, but results in reversed septal radial motion and reduced TAPSE. The newly developed TAVI procedure maintains RV function which results in preservation of septal radial motion. In AS, the LV twist function is exaggerated, normalizes after AVR but loses its relationship with basal LV function. While the reversed septal motion results in decreased and delayed septal longitudinal displacement which is compensated for by the accentuated lateral wall displacement and the time early. These patients remain suffering from limited exercise capacity years after AVR.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. p. 68
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1442
Keywords
Aortic stenosis, aortic valve replacement, echocardiography, speckle tracking, exercise echocardiography, ventricular function, septal radial motion, twist, displacement, strain, strain rate
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-46809 (URN)978-91-7459-274-0 (ISBN)
Public defence
2011-10-14, sal 916, våning 9, UnodB9, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2011-09-23 Created: 2011-09-15 Last updated: 2018-06-08Bibliographically approved

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