Asian Pacific Society Research Articles

Correction to APSR Annual Conference ‐ 28th Congress of the Asian Pacific Society of Respirology, 7–10 November 2024, Hong Kong. Respirology 29 (Suppl. 3)

Correction to <scp>APSR</scp> Annual Conference ‐ 28th Congress of the Asian Pacific Society of Respirology, 7–10 November 2024, Hong Kong. <i>Respirology</i> 29 (Suppl. 3)

Correction to 26th Congress of the Asian Pacific Society of Respirology Above and Beyond, 17–20 November 2022, Seoul. Respirology 28 (Suppl. 1)

Correction to 26th Congress of the Asian Pacific Society of Respirology Above and Beyond, 17–20 November 2022, Seoul. Respirology 28 (Suppl. 1)

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exists a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomical variations, disparity in healthcare resources and infrastructure and the lack of consensus on the optimal management of aortic stenosis in the Asia-Pacific region. Hence, an Asian Pacific Society of Cardiology (APSC) working group, including a multidisciplinary group of general and interventional cardiologists, cardiac surgeons and imaging specialists, developed a position statement on the recommendations for TAVI in the management of aortic stenosis. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral.’ The resulting 28 statements provide guidance for clinical practitioners in the region on the use of TAVI in the treatment of patients with aortic stenosis.

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

APSR Annual Conference - 28th Congress of the Asian Pacific Society of Respirology, 7-10 November 2024, Hong Kong.

APSR Annual Conference - 28th Congress of the Asian Pacific Society of Respirology, 7-10 November 2024, Hong Kong.

Asian Pacific Society of Cardiology Consensus Statements on the Use of Percutaneous Coronary Intervention on Stenosis of the Left Main Coronary Artery

Stenosis of the left main coronary artery (LM stenosis) is associated with significant mortality and morbidity due to the large area of affected myocardium. Evidence on the use of percutaneous coronary intervention (PCI) for the treatment of LM stenosis is growing. However, the role of Western guidelines on patients in the Asian-Pacific region is unclear due to anatomical variations, substantial heterogeneity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of LM stenosis in the Asia-Pacific region. Hence, an Asian Pacific Society of Cardiology (APSC) working group developed consensus recommendations on the use of PCI in the management of LM stenosis in the Asia-Pacific region. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral’. The resulting 12 statements provide guidance for clinical practitioners in the region on the use of PCI in the treatment of patients with LM stenosis.

Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension.

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.

Cardiovascular Care and Research in the Asia-Pacific Region during the COVID-19 Pandemic: Insights from Early and Mid-career Physicians

Background: The COVID-19 pandemic imposed a significant burden on healthcare systems in the Asia-Pacific region and has had a varying impact on physicians at different stages of their career. This study sought to evaluate the personal perspectives and the experiences of early and mid-career cardiologists and cardiothoracic surgeons with regard to the impact of the pandemic in the region. Methods: A cross-sectional web-based survey was conducted from June to July 2023 among members of the Asian Pacific Society of Cardiology (APSC) young community. The survey aimed to assess the impact of COVID-19 on cardiovascular clinical care and research activities that contained sections on demographic information, pandemic-related clinical and research experiences, personal stories, and interest in long-COVID research. Results: Overall, 60 physicians (44%) in the APSC young community responded to the survey. Cardiovascular disease patient numbers initially dropped in 2020 during the pandemic’s early stages but gradually increased in the following 3 years. Non-cardiovascular patient care workloads also rose during the first 2 years of the pandemic. Respondents observed notable changes in clinical care, research and personal life. Positive aspects included increased adaptability and telemedicine adoption, while challenges involved higher workloads and stress. More than 70% expressed interest in understanding the impact of long COVID, with Southeast Asian members showing the highest levels of interest. Conclusion: This survey conducted in the aftermath of the pandemic shed light on the challenges experienced by early to mid-career Asia-Pacific cardiovascular physicians. Physicians at this career stage encounter distinctive hurdles that require thoughtful consideration and effective solutions.

Enhanced diabetic retinopathy detection and classification using fundus images with ResNet50 and CLAHE-GAN

Diabetic retinopathy (DR), a progressive eye disorder, can lead to irreversible vision impairment ranging from no DR to severe DR, necessitating precise identification for early treatment. This study introduces an innovative deep learning (DL) approach, surpassing traditional methods in detecting DR stages. It evaluated two scenarios for training DL models on balanced datasets. The first employed image enhancement via contrast limited adaptive histogram equalization (CLAHE) and a generative adversarial network (GAN), while the second did not involve any image enhancement. Tested on the Asia pacific tele-ophthalmology society 2019 blindness detection (APTOS-2019 BD) dataset, the enhanced model (scenario 1) reached 98% accuracy and a 99% Cohen kappa score (CKS), with the non-enhanced model (scenario 2) achieving 95.4% accuracy and a 90.5% CKS. The combination of CLAHE and GAN, termed CLANG, significantly boosted the model's performance and generalizability. This advancement is pivotal for early DR detection and intervention, offering a new pathway to prevent irreversible vision loss in diabetic patients.

An obituary to Yukio Yoneda (1950-2023).

Yukio Yoneda died on 31 December 2023, at 73 years old after a long fight against cancer. He was an eminent neurochemist in academia and industry and also had leadership roles within the International Society for Neurochemistry (ISN) and the Asian Pacific Society for Neurochemistry (APSN) and Japanese Society for Neurochemistry (JSN). Photo credit: Yukio Yoneda provided the APSN with the photo during his service to APSN.

Asian Pacific Society of Cardiology Consensus Statements on the Diagnosis and Management of Acute MI-Cardiogenic Shock and Endorsed by the Asian Pacific Society of Interventional Cardiology

In the Asia-Pacific region, acute MI (AMI) is associated with a high rate of cardiogenic shock (CS), which increases the risk of mortality several-fold. The management of AMI-CS in the region is heterogeneous and lacks consensus. Hence, an Asian Pacific Society of Cardiology working group developed consensus recommendations on the management of AMI-CS in the Asia-Pacific region. The Asian Pacific Society of Cardiology expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were ‘agree’ or ‘neutral.’ The resulting statements, which have been endorsed by the Asian Pacific Society of Interventional Cardiology and affirmed by the Society for Cardiovascular Angiography and Interventions, provide guidance on the diagnosis, assessment and treatment of patients with AMI-CS among clinical practitioners in the region.

Retraction

Retraction: Rajagopalan P. , Ahmed K. (2022) Respirology, v21.S1: 132. https://doi.org/10.1111/resp.14226 Rajagopalan P. , Ahmed K. (2022) Respirology, v21.S1: 133. https://doi.org/10.1111/resp.14226. Rajagopalan P. , Ahmed K. (2022) Respirology, v21.S1: 219. https://doi.org/10.1111/resp.14226.The above abstracts from Respirology, TSANZSRS 2022 Supplement, published online on March 2022, in Wiley Online Library (http://onlinelibrary.wiley.com/), have been retracted by agreement between the authors, the journal Editors in Chief, Prof Philip Bardin and Prof Paul Reynolds, The Thoracic Society of Australia and New Zealand (TSANZ), The Asian Pacific Society of Respirology (APSR) and John Wiley &amp; Sons Ltd. The retraction has been agreed to following the acceptance of responsibility by the first author, P Rajagopalan, for unattributed overlap between these abstracts and the following abstracts published in Thorax, “P15 Lung cancer multidisciplinary meeting – does the presence of emphysema on ct imaging correlate with obstructive spirometry or transfer factor?” by C Rutherford, C Bradley, N Magee (doi: 10.1136/thorax‐2020‐BTSabstracts.160), “P32 Reduction in the rate of acute exacerbations of COPD and asthma during the COVID‐19 pandemic” by AJ Taylor, TR Simpson, T Joseph (doi:10.1136/thorax‐2020‐BTSabstracts.177), and “S99 The role of anticoagulation therapy in management of COVID‐19 patients” by S Shahid, A Elsharkawy, A Dethabnew, A Gani, M Elgizouli, R Islam, MA Zahid, O Taylor, S Gupta, M Kashem, O Newman, M Kashem, S Kuckreja S Naik, U Ekeowa, K Khan, MS Anwar (doi:10.1136/thorax‐2020‐BTSabstracts.104), Volume 76 Issue Supplement 1. The second author, K Ahmed, was not involved in any way.

Retraction: Role of mesenchymal stem cells versus angiotensin converting enzyme inhibitor in kidney repair.

The retraction has been agreed due to duplications within Figure 2 and the inclusion of figure elements in Figure 1 and 2 that were previously published [1-4]. Thus, the conclusions of this article are considered invalid. The authors have been informed of the decision to retract but did not agree with it.

Abstracts from 27th Asian Pacific Society of Cardiology Congress

Abstracts from 27th Asian Pacific Society of Cardiology Congress

Rationale and protocol paper for the Asia Pacific Network for inherited eye diseases

PurposeThere are major gaps in our knowledge of hereditary ocular conditions in the Asia-Pacific population, which comprises approximately 60% of the world's population. Therefore, a concerted regional effort is urgently needed to close this critical knowledge gap and apply precision medicine technology to improve the quality of lives of these patients in the Asia-Pacific region. DesignMulti-national, multi-center collaborative network. MethodsThe Research Standing Committee of the Asia-Pacific Academy of Ophthalmology and the Asia-Pacific Society of Eye Genetics fostered this research collaboration, which brings together renowned institutions and experts for inherited eye diseases in the Asia-Pacific region. The immediate priority of the network will be inherited retinal diseases (IRDs), where there is a lack of detailed characterization of these conditions and in the number of established registries. ResultsThe network comprises 55 members from 35 centers, spanning 12 countries and regions, including Australia, China, India, Indonesia, Japan, South Korea, Malaysia, Nepal, Philippines, Singapore, Taiwan, and Thailand. The steering committee comprises ophthalmologists with experience in consortia for eye diseases in the Asia-Pacific region, leading ophthalmologists and vision scientists in the field of IRDs internationally, and ophthalmic geneticists. ConclusionsThe Asia Pacific Inherited Eye Disease (APIED) network aims to (1) improve genotyping capabilities and expertise to increase early and accurate genetic diagnosis of IRDs, (2) harmonise deep phenotyping practices and utilization of ontological terms, and (3) establish high-quality, multi-user, federated disease registries that will facilitate patient care, genetic counseling, and research of IRDs regionally and internationally.

The 27th Congress of the Asian Pacific Society of Respirology, 16-19 November 2023, Singapore.

The 27th Congress of the Asian Pacific Society of Respirology, 16-19 November 2023, Singapore.

Unearthing Gaps in the Heart Failure Ecosystem: An Asian Pacific Society of Cardiology Online Survey

Background: Information about the availability and accessibility of diagnostics and treatments for heart failure (HF) is sparse. The aim of this study was to describe the gaps in the diagnosis and treatment of HF in member countries of the Asian Pacific Society of Cardiology using an online survey. Methods: A cross-sectional observational study was conducted among medical professionals practising in member countries of the Asian Pacific Society of Cardiology who provide care to patients with HF. The participants answered an English online self-administered questionnaire. Results: The study included 257 respondents from 26 countries or regions. The majority of respondents (58%) responded that 50% or fewer of their patients would have natriuretic peptide levels checked during the hospital stay. More than half of the respondents (52%) said that more than 50% of their patients had access to transthoracic echocardiography. For mineralocorticoid receptor antagonists, angiotensin receptor–neprolysin inhibitors and sodium–glucose cotransporter 2 inhibitors, the proportion with access was 86%, 84% and 81%, respectively. Conclusion: Healthcare professionals in the Asian Pacific Society of Cardiology member countries identified substantial gaps in the availability of diagnostic and therapeutic interventions for HF in their areas of practice. Natriuretic peptide testing was less available than transthoracic echocardiography, which is the primary diagnostic modality for HF in the region. At least 10% had no access to mineralocorticoid receptor antagonists, angiotensin receptor–neprolysin inhibitors or sodium–glucose cotransporter 2 inhibitors in their centres.

Asian Pacific Society of Cardiology Consensus Statement on Management of Coronary Artery Disease in Adults with Late Complications of Kawasaki Disease

Despite reductions in the mortality of Kawasaki disease with advances in its treatment, a proportion of patients still develop coronary artery dilatation that may persist even into adulthood. These lesions carry an increased risk of myocardial ischaemia and infarction. However, published clinical guidelines on the management and long-term follow up of patients with these late complications of Kawasaki disease are limited. The Asian Pacific Society of Cardiology convened an expert panel to review the available literature and develop consensus recommendations to guide clinicians in this area. The panel developed statements on the assessment and risk stratification of coronary artery disease, investigations for follow up, as well as considerations around treatment of stenotic lesions with medical therapy, percutaneous coronary intervention and coronary artery bypass grafting. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted ‘agree’ or ‘neutral’. This process resulted in the development of consensus recommendations to guide cardiologists and internists in the follow up and management of patients with coronary artery lesions as a late complication of Kawasaki disease.

Interpretation of Asian Pacific Society of Cardiology consensus recommendations on the use of MitraClip for mitral regurgitation

The Asian Pacific Society of Cardiology proposed an expert consensus on the treatment of mitral regurgitation (MR) using transcatheter edge-to-edge repair technique (the representative product: MitraClip) in 2021. The expert panel reviewed the latest literature to develop consensus recommendations on the use of MitraClip for treating MR. The current article combines the current situation of MR treatment in China and provides a comprehensive interpretation and reflection on the consensus in terms of the concept and classification of MR, and the use of MitraClip for the treatment of degenerative and functional MR, thereby providing valuable reference for the clinical practice of MR treatment in China.

A Survey of Drug-coated Balloon Usage Patterns in the Asia-Pacific Region

Background: Drug-coated balloon (DCB) therapy has been shown to be an effective alternative to drug-eluting stents as a revascularisation option, but usage of DCB varies widely between different countries. The aim of this study was to review the awareness of the DCB expert consensus paper and the prevalence of DCB usage among interventionists in the Asia-Pacific region. Methods: An online questionnaire was designed to explore the awareness of the DCB expert consensus paper and evaluate the prevalence of DCB usage. This was sent to interventional cardiologists in collaboration with the Asian Pacific Society of Cardiology. Results: The total number of respondents was 237. Slightly more than half were unaware of the DCB expert consensus paper, and the majority use fewer than 10 DCBs per month. Statistical analysis showed that awareness of the DCB expert consensus paper had a positive correlation with increased DCB usage when treating patients with high bleeding risk, bifurcation disease and small vessel disease, while increased frequency of DCB usage was positively correlated with the treatment of patients with high bleeding risk and small vessel disease. However, these two factors were not significantly associated with the increased use of DCB to treat in-stent restenosis. Conclusion: With emerging data expanding the indications for DCB and increasing operator experience, DCB usage is likely to become more commonplace during percutaneous coronary intervention.