East meets West: Bringing the ESH 2023 hypertension guidelines into Asia.

Hypertension remains a major problem worldwide, especially across the Asia-Pacific region, which reports high prevalence rates and slow improvements in treatment rate and blood pressure (BP) control rate. Asian patients with hypertension may also vary with regard to phenotype and the epidemiology of the complications of hypertension, especially when compared with Western patients. Given these differences, Western guidelines may not necessarily be applicable to countries in the Asia Pacific. This narrative review aims to provide a critical comparison between the recently published European Society of Hypertension (ESH) 2023 guidelines and existing local guidelines in select Asian countries, offer expert opinion on how to fill gaps in the ESH 2023 guidelines for hypertension in the Asian context, and examine the need for harmonisation of hypertension guidelines worldwide. This review focuses on the definition and diagnosis of hypertension, the treatment thresholds and targets, and recommendations on the use of pharmacotherapy.

A case of pulmonary tumoral thrombotic microangiopathy supported by VA-ECMO and a review of the literature.

We report a case of pulmonary tumoral thrombotic microangiopathy (PTTM) of pancreatobiliary origin who presented with fulminant right heart failure and was revived by extracorporeal membrane oxygenation-cardiopulmonary resuscitation (ECMO-CPR). Pathology of PTTM was illustrated. This case highlights the notorious difficulty of antemortem diagnosis of PTTM as well as the role of venoarterial-ECMO as a temporizing measure to diagnosis and treatment. .

A simplified reverse wire technique using an angulated supercross microcatheter.

Bifurcation lesion with an extreme angulated side branch remains a challenge in coronary intervention. Reverse wire technique was originally described by Dr. Kawasaki and nowadays this can be done by double-lumen catheter. We report a novel "simplified reverse wire technique with a specialized angle tip microcatheter," Supercross microcatheter™ (Teleflex). This can facilitate wiring of extreme angulated side branch by this simple and feasible method without using double lumen catheter.

Double trapper technique: A novel technique to facilitate retrograde wire externalization in aorto-ostial chronic total occlusion intervention without using snare.

Chronic total occlusion (CTO) remains a technical challenge for the interventional cardiologists. The application of the retrograde approach has dramatically improved success rates of CTO PCI. However, retrograde wire externalization could be very difficult especially when the antegrade guiding catheter cannot sit into the coronary ostium stably. We report a novel technique to facilitate retrograde wire externalization in aorto-ostial chronic total occlusion intervention without using snare.

A rare variant of transthyretin-related amyloidosis associated with exclusive cardiomyopathy in a Hong Kong Chinese patient.

Hereditary transthyretin-related amyloidosis (ATTR, MIM #105210), also previously known as familial amyloidotic polyneuropathy, is one of the most life-threatening types of amyloidosis. ATTR is inherited in autosomal dominant mode with variable penetrance. If untreated, it is a relentless and lethal disease. Patients typically present with polyneuropathy, carpal tunnel syndrome, autonomic insufficiency, cardiomyopathy, and gastrointestinal features, occasionally accompanied by vitreous opacities and renal insufficiency. Frequency of transthyretin (TTR)-related cardiac amyloidosis amongst Chinese populations is unknown. We report here a 63-year-old Chinese man suffering from TTR-related cardiac amyloidosis presented with exclusive cardiomyopathy. He had no other systemic involvement and no significant family history. Echocardiography revealed severe global myocardial impairment and left ventricular ejection fraction of 35%. Serum kappa-to-lambda ratio was normal. Genetic test detected a heterozygous TTR variant, NM_000371.3:c.425T > C p.(Val142Ala). To our knowledge, this is the first case of TTR-related cardiac amyloidosis caused by p.Val142Ala mutation reported in Asian patient. .

A "simplified" culotte technique using two dedicated bifurcation stents and additional angiographic stent enhancement to treat a complex bifurcation lesion in non-ST segment elevation myocardial infarction with poor left ventricular function.

We present a case of a bifurcation lesion treated with two dedicated sirolimus eluting bifurcation stents, BiOSS Lim in the setting of non-ST elevation myocardial infarction and poor left ventricular function. We demonstrate the feasibility of a new technique, a "simplified" culotte technique. The key differences of this new technique compared with conventional culotte are: better sizing of the stent due to the specific design of the stent with a larger proximal diameter and smaller distal diameter, direct stenting of the second stent without predilatation of the stent struts of the first deployed stent, and possibility to perform post-dilatation directly with properly sized balloons without additional predilatation.