DR. JAIME ALFONSO M. AHERRERA
University of the Philippines Manila
Sex: Male
Education:
University of the Philippines, Philippine General Hospital Fellowship Training in Interventional Cardiology, 2016-2018
University of the Philippines, Philippine General Hospital Fellowship Training in Adult Cardiology, 2013-2016
University of the Philippines, Philippine General Hospital Residency
Training in Internal Medicine, 2009-2012
Doctor of Medicine 2004-2008
De La Salle University, BS Human Biology, 2002-2004
Field of Specialization:
Internal Medicine (General Medicine)
Epidemiology
Cardiology
Researches:
Article title: BAG6 Variant rs805303 is Nominally Associated with ACEi-induced Cough Among Filipinos
Authors: Paul Ferdinand M. Reganit, Rody G. Sy, Jezreel L. Taquiso, Charlene F. Agustin, Richard Henry Perlas Tiongco II, Jaime Manalo Aherrera, Elmer Balasico Llanes Felix Eduardo Punzalan, Lauro Lim Abrahan IV
Publication title: Philippine Journal of Science 149 (1) 35-41, March 2020
Abstract:
Cough is a common side effect of angiotensin converting enzyme inhibitor (ACEi) therapy. The incidence of ACEi-induced cough has been shown to correlate with genetic variation among different populations. This study aimed to determine the association of candidate genetic polymorphisms with ACEi-induced cough among Filipinos. Two hundred twenty (220) participants on ACEi therapy pressure-lowering in an unmatched case-control study (82 cases with ACEi-induced cough and 138 controls). Genomic DNA samples were extracted and genotyped for selected genetic variants. The association of genetic variants and clinical factors with ACEi-induced cough was determined using regression analyses. Univariate logistic regression showed that the BAG6 variant rs805303 is nominally associated with ACEi-induced cough among Filipinos, at a per-comparison error rate (PCER) of 0.05 (OR 2.10, p = 0.016). The association of the variant with ACEi cough was statistically significant after multiple regression analysis (adjusted OR 2.09, p = 0.022) while adjusting for confounding clinical factors (sex, alcohol intake, and diastolic blood pressure). Further studies are needed to validate these findings.
Full text link: https://tinyurl.com/y7jrbuh9
Article title: The Klotho Variant rs36217263 Is Associated With Poor Response to Cardioselective Beta-Blocker Therapy Among Filipinos
Authors: Rody G. Sy, Jose B. Nevado, Elmer Balasico Llanes, Jose Donato A. Magno, Deborah Ignacia D. Ona, Felix Eduardo R. Punzalan, Paul Ferdinand M. Reganit, Lourdes Ella G. Santos, Richard Henry Perlas Tiongco II, Jaime Manalo Aherrera, Lauro L. Abrahan, Charlene F. Agustin, Aimee Yvonne Criselle Landicho Aman, Adrian John P. Bejarin, Eva Maria C. Cutiongco-de la Paz
Publication title: Clinical Pharmacology & Therapeutics 107(1), July 2019
Abstract:
A common drug used for hypertension among Filipinos are beta‐blockers. Variable responses to beta‐blockers are observed, and genetic predisposition is suggested. This study investigated the association of genetic variants with poor response to beta‐blockers among Filipinos. A total of 76 Filipino adult hypertensive participants on beta‐blockers were enrolled in an unmatched case‐control study. Genotyping was done using DNA from blood samples. Candidate variants were correlated with clinical data using chi‐square and logistic regression analysis. The deletion of at least one copy of allele A of rs36217263 near Klotho showed statistically significant association with poor response to beta‐blockers [dominant; odds ratio (OR)=3.89, p=0.017)], adjusted for diabetes and dyslipidemia. This association is observed among participants using cardioselective beta‐blockers (crude OR=5.60, p=0.008), but not carvedilol (crude OR=2.56, p=0.67). The genetic variant rs36217263 is associated with poor response to cardioselective beta‐blockers, which may become a potential marker to aid in the management of hypertension.
Article title: Disease characteristics of takayasu’s arteritis among filipino patients seen at rheumatology clinics
Authors: I.E.S. Afos, J.R.L. Hipe, C.M.G. Faustino, Jaime Manalo Aherrera, Lauro Lim Abrahan IV, B.H.M. Reyes
Abstract:
Introduction: Takayasu’s arteritis (TA), a large vessel vasculitis has various initial presenting manifestations; making it difficult to diagnose. Hence, the number of those with the disease in the population is underestimated. The study intends to update local data and to describe different presentations of the disease to enhance awareness for TA. Methods: This is a retrospective study done in a tertiary government hospital. Twenty-two out of twenty three charts of patients diagnosed with TA based on the 1990 ACR criteria were reviewed. Demographic profile, initial clinical manifestations, imaging, treatment and outcomes were collected. Descriptive statistics was applied. Institutional Review Board approval was obtained prior to study initiation. Results: Majority (90.1%) were female; mean age at onset of symptoms and at diagnosis were 30.4 (+12.3)years and 33.2 (+12.0)years respectively. The common reasons for consult were hypertension (26.3%), claudication (21.1%) and abdominal pain (11%). Laboratories showed elevated erythrocyte sedimentation rate (87.5%), leukocytosis (43.8%), anemia (31%) and thrombocytosis (4.5%). Common imaging findings were cardiomegaly (27.3%), aortic regurgitation (27.3%) and carotid stenosis (18.2%). CT angiogram in 90% of cases demonstrated arterial wall narrowing. Other findings were aneurysm (31.8%), contour irregularities (13.6%) and femoral artery occlusion (4.5%). Treatment for active disease were glucocorticoids alone (44%) and combined glucocorticoids and other immunosuppressants (56%). Of the 22 records reviewed, six patients (27%) had stroke. Four (18.2 %) had different surgical procedures; ray amputation of toe for digital ischemia, embolectomy for digital gangrene, balloon angioplasty of the renal artery and renal angioplasty for stenosis. Two (9.1%) who had pregnancies after TA diagnosis had premature deliveries without neonatal complications. No mortality was recorded over the mean follow-up of 49.33 patient-years. Conclusion: Clinicians should be aware of the different initial presenting signs and symptoms of TA since development of collateral circulation may mask other symptoms. Thus, thorough history and physical assessment are essential tools in the diagnosis of TA.
Full text link: https://tinyurl.com/ybfh5qfv
Article title: Clinical Profile and MACE in Patients who Underwent Revascularization for Left Main Coronary Artery and Left Main Equivalent Coronary Artery Disease in UP-PGH
Authors: Jezreel L. Taquiso, Jaime Manalo Aherrera, Richard Henry Perlas Tiongco II, Enqirue, Lii Chua
Publication title: Atherosclerosis Supplements 32: 71-72, June 2018
Abstract:
No available
Article title: Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort
Authors: Giselle G. Gervacio, Jaime Manalo Aherrera, Rody G. Sy, Lauro Lim Abrahan IV, Michael Joseph Agbayani, Feliz Eduardo Punzalan, Elmer Balasico Llanes, Paul Ferdinand M. Reganit, Olivia Sison, E-Shyong Tai, Felicidad V. Velandria, Allan Gumatay, Nina Castillo-Carandang
Publication title: Heart Asia 10(2) May 2018
Abstract:
Background Brugada syndrome is the mechanism for sudden unexplained death. The Brugada ECG pattern is found in 2% of Filipinos. There is a knowledge gap on the clinical outcome of these individuals. The clinical profile and 5-year cardiac event rate of individuals with the Brugada ECG pattern were determined in this cohort. Methods This is a sub-study of LIFECARE (Life Course Study in Cardiovascular Disease Epidemiology), a community based cohort enrolling healthy individuals 20 to 50 years old conducted in 2009–2010. ECGs of all enrollees were screened independently by three cardiologists. The prevalence of the coved Brugada ECG pattern was ascertained, and the 5-year cardiac event rate was determined among those individuals with this pattern. The participants were contacted to determine the occurrence of cardiac events, which included syncope, presyncope, seizures, cardiac arrest and unexplained vehicular accidents. Results A total of 3072 ECGs were reviewed, and 14 subjects (0.4%) with the coved Brugada ECG pattern were identified. Four had a cardiac event on follow-up at 5 years, but all remained alive. Most of these 14 coved Brugada individuals were healthy and asymptomatic at baseline. Conclusion Cardiac events occurred commonly among initially asymptomatic Filipinos with the coved Brugada ECG pattern. Such patients need to be followed up closely.
Article title: “The Sticky LAD”: Large Intracoronary Thrombus in an Aneurysmal Left Anterior Descending Artery Presenting as ST-Elevation Myocardial Infarction
Authors: Jaime Manalo Aherrera, Marc Denver Tiongson, Eric Oliver Dizon Sison
Publication title: Journal of medical cases 9(8) 243-245, January 2018
Abstract:
Management of acute coronary syndrome in coronary ectasia and large intracoronary thrombus has been culled from case reports. A 55-year old male sought consult for severe chest pain. On angiography there was note of large burden intracoronary thrombus. Various percutaneous coronary techniques were done. Angiographic success was not achieved, and then he was maintained on tirofiban. Repeat angiography after 2 weeks revealed dissolution of thrombus with optimal medical therapy. Management of atypical cases should be individualized.
Full text link: https://tinyurl.com/yded5ugt
Article title: “Too Young to Have a Broken Heart”: Spontaneous Coronary Artery Dissection Causing ST-Elevation Myocardial Infarction in a Young Adult: A Case Report
Authors: Marc Denver A. Tiongson, Eric Oliver Dizon Sison, Jaime Manalo Aherrera, Dioscoro DC Bayani, Joerelle Mojica, Nashiba Daud, John Daniel Ramos
Publication title: Journal of medical cases 9(6) 164-169, January 2018
Abstract:
ST-elevation myocardial infarction (STEMI) rarely occurs among patients 18 to 34 years old. Spontaneous coronary artery dissection (SCAD) is a rare cause of STEMI and is frequently described among patients in peripartum period. SCAD has a high mortality rate if not recognized and treated immediately. We present a case of SCAD presenting as STEMI in a 19-year-old nonpregnant patient. A 19-year-old female with chronic kidney disease, complained of sudden onset substernal chest pain. Physical examination showed a blood pressure of 140/90 mm Hg, HR of 112 bpm, with note of rales, pedal edema, and cold clammy extremities. Electrocardiogram showed ST-elevation in leads V3 to V6. Cardiac troponin was elevated andechocardiography revealed left ventricular segmental hypokinesia and depressed systolic function. Patient was diagnosed with acute anterolateral wall STEMI. Coronary angiogram revealed total occlusion of the mid-segment of the left anterior descending artery (LAD), while the rest of the coronary arteries were strikingly normal. After
initial balloon angioplasty and stenting of the mid LAD, coronary artery dissection was noted at the distal LAD. A stent was successfully deployed, achieving TIMI flow grade III with no residual stenosis. She remained stable and was discharged improved. STEMI rarely happens in the young adults. Moreover, literature highlights the rarity of STEMI caused by SCAD. SCAD usually occurs among young pregnant patients without risk factors for atherosclerosis. We highlighted the significance of suspecting SCAD among young patients who present with STEMI and prompt treatment with revascularization in clinical situations such as this case. SCAD remains to be a rare cause of STEMI. However, SCAD should be considered among
young individuals with STEMI. Treatment is primarily medical unless there is persistent chest pain and/or ischemic ECG changes, hemodynamic instability, or unstable arrhythmia, where revascularization is necessary.
Full text link: https://tinyurl.com/y9ddvlhg
Article title: Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
Authors: Jezreel Taquiso, Stephanie Martha O. Obillos, Joerelle V. Mojica, Lauro Lim Abrahan IV, Elleen C. Cunanan, Jaime Manalo Aherrera, Jose Donato A. Magno
Publication title: Cardiology Research 8(5) 258-264, October 2017
Abstract:
Systolic anterior motion (SAM) of the mitral valve or chordate is one characteristic seen in hypertrophic cardiomyopathy (HCM) either in obstructive or non-obstructive phenotypes. More often than not, the obstruction is caused by valvular rather than chordal SAM. We describe the role of echocardiography in identifying the actual anatomical location of the mitral valve apparatus involved in SAM and in assessing consequent left ventricular outflow tract (LVOT) obstruction in an otherwise asymptomatic patient. We report a case of a 29-year-old male admitted for an elective non-cardiac surgery, presenting with a cardiac murmur and left axis deviation with biventricular hypertrophy on electrocardiogram. On 2D transthoracic echocardiography (TTE), an asymmetrically hypertrophied left ventricle with systolic motion of anterior mitral valve was incidentally seen. Continuous wave Doppler assessment across the LVOT showed some gradient of obstruction (peak gradient: 9 mm Hg). Transesophageal echocardiography (TEE) demonstrated a redundant anterior mitral valve with the subchordal apparatus mainly causing SAM and confirmed the gradient obtained on TTE, with a mild degree, yet non-significant, degree of LVOT obstruction (mean gradient: 10 mm Hg) documented. Because of this finding, patient was cleared for surgery. Management was deemed conservative with emphasis on close surveillance for signs and symptoms attributable to development of significant LVOT obstruction in patients with HCM. To our knowledge, this is the first reported case in our country of an echocardiographic pattern of systolic anterior motion primarily of the subchordal mitral valve apparatus causing some, though non-significant, degree of LVOT obstruction in HCM. Echocardiographic features such as asymmetric left ventricular hypertrophy and presence of some LVOT obstruction caused primarily by subchordal apparatus could impact management in asymptomatic patients.
Full text link: https://tinyurl.com/y8aqakjr
Article title: A Rare Case of Pneumopericardium in the Setting of Tuberculous Constrictive Pericarditis
Authors: Lauro Lim Abrahan IV, Stephanie Martha O. Obillos, Jaime Manalo Aherrera, Jose Donato A. Magno, Celia Catherine C. Uy-Agbayani, Ulysses King G. Gopez, Jobelle Baldonado
Publication title: Case Reports in Cardiology (12) 1-6, May 2017
Abstract:
A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5–7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.
Full text link: https://tinyurl.com/ycd3oqzo
Article title: Pulmonary vein mass with extension to the left atrium diagnosed by echocardiography
Authors: Jezreel L. Taquiso, Jaime Manalo Aherrera, Jose Donato Magno, Eric Oliver Dizon Sison
Publication title: BMJ Case Reports, March 2017
Abstract:
We report a case of a man aged 65 years presenting with chronic cough, haemoptysis and intermittent atrial tachyarrhythmias on ECG. On 2D transthoracic echocardiography, an incidental left atrial mass was seen, initially thought to be a thrombus predisposed by intermittent atrial fibrillation. Transoesophageal echocardiography confirmed that this left atrial mass originated from a fixed, non-homogenous, right superior pulmonary vein mass with an extracardiac extension. Because of this finding, a thorough search for a primary focus lead to the discovery of a contiguous posterior mediastinal mass, which was a round cell neoplasm on histology. Management was deemed palliative. Although rare, left-sided cardiac masses should prompt the physician to search for a malignancy in the lung in high-risk patients, as haematogenous spread via the pulmonary vein is a potential mechanism for spread.
Full text link: https://tinyurl.com/y79y2v6x
Article title: PS 08-73 Strange Connections: Case series of Coronary Arterial-Venous Fistulas seen at the Philippine General Hospital
Authors: Christine Train, Jodette Joy Lavente, Elleen Cunanan, Michael Estur, John Daniel Ramos, Jorelle Mojica, Jaime Manalo Aherrera, Eric Oliver Dizon Sison, Jose Donato Magno, Wilfred Dee, John Anonuevo, Elmer Balasico Llanes
Publication title: Journal of Hypertension 34 (Supplement I) September 2016
Abstract: Not available.
Article title: PS 08-01 The Neutrophil-Lymphocyte Ratio (NLR) Predicts Severity of stable Coronary Artery Disease determined by the syntax score
Authors: Jaime Manalo Aherrera, Lowe Chiong, Christine Train, Paul Reganit, Felix Punzalan, John Anonuevo, Ramon Abarquez
Publication title: Journal of Hypertension 34 (Supplement i) September 2016
Abstract:
Objective: The neutrophil-lymphocyte ratio (NLR) is believed to be associated with the complexity of coronary artery disease (CAD). We aim to investigate the association between the NLR and severity of CAD using the SYNTAX scoring system among adult Filipinos. Design and Method: This is a cross-sectional study conducted at a tertiary hospital. The NLR of included patients, taken within 1 week prior to the angiogram, was computed (neutrophil divided by lymphocyte count). After coronary angiogram, the severity of CAD was determined independently, using the SYNTAX scoring system. The primary outcome was presence of severe CAD represented by a SYNTAX score of > 32. Results: A total of 211 patients with a mean age of 57 years were included. Diagnosis after coronary angiogram was 1-Vessel CAD in 64 (30%), 2-Vessel CAD in 34 (16%), and 3-Vessel CAD in 66 (31%). 46 patients (22%) were found to have severe CAD based on a SYNTAX score of > 32. The NLR, neutrophil, and lymphocyte count correlated with SYNTAX score using Pearson's correlation coefficient. The optimal cutoff value of NLR to predict high syntax score is 2.51. On multiple logistic regression, only the NLR (OR 6.98, p < 0.001) and smoking history (5.84, p 0.002) were associated with a SYNTAX score > 32. Conclusions: Among adult Filipinos with angina suspected of CAD, the NLR is a useful, inexpensive tool to predict severity of multi-vessel disease using the SYNTAX scoring system. A cut-off NLR of 2.51 may be used to stratify patients with a high NLR and predict the presence of severe CAD (SYNTAX > 32).
Article title: PS 02-23 Association of the Platelet–Lymphocyte Ratio (PLR) with outcomes in patients admitted for Acute Coronary Syndrome
Authors: Lauro Lim Abrahan IV, Jaime Manalo Aherrera, John Daniel Ramos, Paul Ferdinand Reganit, Felix Eduardo Punzalan
Publication title: Journal of Hypertension 34(3), September 2016,
Abstract:
Introduction: Patients with acute coronary syndrome (ACS) exhibit a wide spectrum of early risk of death (one to 10 percent). High platelet counts may indicate a propensity for platelet-rich thrombi. Lymphocyte counts drop during ACS due to stress-induced cortisol release. Combining these two markers, recent studies have found that the platelet-to-lymphocyte ratio (PLR) is associated with adverse cardiac events among patients with ACS, but local data is limited. The objective of this study is to determine if an elevated PLR taken on admission is associated with higher rates of adverse cardiac events. Methods: A retrospective cohort of adult patients with ACS admitted at the UP-Philippine General Hospital was analyzed. Leukocyte and platelet counts were measured by an automated hematology analyzer. The PLR values of these patients were computed, and they were stratified into two groups after determining the optimal cut-off from the receiver operating characteristic curve (ROC) curve. The primary outcome was in-hospital mortality. Secondary outcomes included development of heart failure, cardiogenic shock, reinfarction, and significant arrhythmias. Results: A total of 174 Filipinos with ACS were included. In-hospital mortality occurred in 30 patients (17%). These patients had a higher PLR compared to those who were discharged alive (p-value <0.0001). The optimal cutoff value of PLR to predict in-hospital mortality is 165, with a sensitivity of 77% and specificity of 70% (area under the ROC curve of 0.766). On multiple logistic regression analysis, a high PLR was an independent predictor of in-hospital mortality (RR 8.52; p 0.003) after controlling for the effect of other variables. The development of the predetermined secondary outcomes did not correlate with PLR on multivariate analysis. Conclusion: Among Filipino patients with ACS, an elevated PLR taken within 24 hours of admission is a useful marker to predict in-hospital mortality, thus providing vital information for risk stratification and more aggressive management strategies.
Article title: PS 14-78 Renal Artery Stenosis in Takayasuʼs Arteritis causing early-onset hypertension: a report of four cases at the UP-Philippine General Hospital
Authors: Lauro Lim Abrahan IV, Elleen Cunanan, Percy Jun Prieto, Jaime Manalo Aherrera, Antonio Faltado, Maria Teresa Bacnis Abola
Publication title: Journal of Hypertension 34(Supplement I), September 2016
Abstract: No abstract
Article title: PS 11-26 The “Weekend Effect” among patients presenting with Acute Coronary Syndrome in the Philippine General Hospital
Authors: John Daniel Ramos, Jaime Manalo Aherrera, Felix Eduardo Punzalan
Publication title: Journal of Hypertension 34(3), September 2016
Abstract:
Introduction: Studies have shown that weekend and holiday admissions for patients with acute coronary syndrome (ACS) are associated with higher incidence of in-hospital mortality and major adverse cardiovascular events (MACE). This has been referred to as the “weekend effect.” Objectives: We aim to determine whether adults with ACS admitted on weekends have an increased risk for adverse outcomes, primarily in-hospital mortality. Methodology: This is a retrospective cohort observational study. An ACS database of a prospectively collected cohort was reviewed. Participants in this database included patients with a diagnosis of ACS who satisfied pre-defined inclusion and exclusion criteria. Clinical characteristics and admission data (weekend/holiday versus regular day admission) of all patients were collected. Outcomes of interest were in-hospital mortality, severe heart failure, and re-infarction. Analysis: Descriptive analysis was done by obtaining the mean and standard deviation of quantitative variables. Proportions and frequencies were reported for qualitative variables. For quantitative variables, T-test of two independent samples was used to determine if there is a significant difference. For categorical variables, the Z-test was used. Multiple logistic regression was also done to explore the predictors of the weekend effect. Results: A total of 175 patients were included in this study, 59 were admitted on a weekend/holiday and 116 on a regular day. The duration of symptoms prior to admission were longer among those who were admitted during the weekend (40.86±54.11 hrs vs 11.83±8.40 hrs, p=<0.0001). A weekend hospital admission was found to be an independent predictor of in-hospital mortality. Conclusion: For patients with ACS, a weekend admission was associated with increased in-hospital mortality despite similar management approach in both groups. There is a need to further explore the factors that contribute to this “weekend effect” in our setting by a prospective trial.
Article title: PS 17-81 Prognostic Impact of Coronary Collaterals in Acute Coronary Syndrome (ACS): a meta-analysis (PICCACS STUDY)
Authors: John Daniel Ramos, Jaime Manalo Aherrera, Lowe Chiong, Mark Vicente, Felix Eduardo Punzalan
Publication title: Journal of Hypertension 34(supplement I), September 2016
Abstract: No abstract
Full text link: https://tinyurl.com/y8t5j94e
Article title: Prediction of Symptomatic Embolism in Filipinos With Infective Endocarditis Using the Embolic Risk French Calculator
Authors: Jaime Manalo Aherrera, Maria Teresa Bacnis Abola, Maria Margarita O. Balabagno, Lauro Lim Abrahan IV, Jose Donato A. Magno, Paul Ferdinand M. Reganit, Felix Eduardo R. Punzalan
Publication title: Cardiology Research 7(4), August 2016
Abstract:
Background Cardioembolic events are life-threatening complications of infective endocarditis (IE). The embolic risk French calculator estimates the embolic risk in IE computed on admission. Variables in this tool include age, diabetes, atrial fibrillation, prior embolism, vegetation length, and Staphylococcus aureus on culture. A computed risk of > 7% was considered high in the development of this tool. Knowledge of this risk applied in our local setting is important to guide clinicians in preventing such catastrophic complications. Among patients with IE, we aim to determine the efficacy of the embolic risk French calculator, using a computed score of > 7%, in predicting major embolic events. Methods All adults admitted from 2013 to 2016 with definite IE were included. The risk for embolic events was computed on admission. All were monitored for the duration of admission for the occurrence of the primary outcome (any major embolic event: arterial emboli, intracranial hemorrhage, pulmonary infarcts, or aneurysms). Secondary outcomes were: 1) composite of death and embolic events; and 2) death from any cause. Results Eighty-seven adults with definite IE were included. Majority had a valvular heart disease and preserved ejection fraction (EF). The mitral valve was most commonly involved. Embolic events occurred in 25 (29%). Multivariate analysis identified a high embolic score > 7% (relative risk (RR): 15.12, P < 0.001), vegetation area ≥ 18 mm² (RR: 6.39, P < 0.01), and a prior embolism (RR: 5.18, P = 0.018) to be independent predictors of embolic events. For the composite of embolic events and death, independent predictors include a high score of > 7% (RR: 13.56, P < 0.001) and a prior embolus (RR: 13.75, P = 0.002). Independent predictors of death were a high score > 7% (RR: 6.20, P = 0.003) and EF ≤ 45% (RR: 9.91, P = 0.004). Conclusion Cardioembolic events are more prevalent in our study compared to previous data. The embolic risk French calculator is a useful tool to estimate and predict risk for embolic events and in-hospital mortality. The risk of developing embolic events should be weighed against the risks of early preventive cardiac surgery, as to institute timely and appropriate management.
Full text link: https://tinyurl.com/yccjraeq
Article title: The Triply Twisted Heart: Cyanosis in an Adult With Situs Inversus, Levocardia, Double Outlet Right Ventricle, and Malposition of the Great Arteries
Authors: Jaime Manalo Aherrera, Jose Donato A. Magno, Celia Catherine C. Uy, Lauro Lim Abrahan IV, Helga F. Sta. Maria, Rodel R. Buitizon, Danny Marcelo Hara
Publication title: Cardiology Research 6(6), August 2015
Abstract:
We present a case of a 19-year-old female presenting with cyanosis since birth. The major anomaly demonstrated was a “triply twisted heart” with a balanced physiology, allowing her to survive into adulthood. Non-invasive imaging was done using 2D and real-time 3D (or 4D) echocardiography with multi-slice imaging from 4D volume datasets. Findings were confirmed using cardiac magnetic resonance imaging (MRI). A segmental approach revealed atrial and visceral situs inversus, levocardia, atrioventricular discordance, and ventriculoarterial discordance. Both the aorta and pulmonary artery were malposed and arise from the right ventricle (double outlet right ventricle or DORV). There was also a complete atrioventricular septal defect (CAVSD) associated with a functional single atrium and a functional univentricle (single ventricle). Other findings include a severe pulmonic stenosis (PS), preserved right and left ventricular systolic function, and a normal pulmonary arterial pressure. She also had a persistent left superior vena cava (SVC) that drains into the morphologic right atrium, while the right-sided SVC drains into the morphologic left atrium. A multidisciplinary team deemed that management be palliative. She is on regular follow-up at our clinics for non-invasive monitoring. To our knowledge, this is the first reported case in an adult with this combination of anomalies.
Full text link: https://tinyurl.com/yborj7ma
Article title: APSC2015-1204 The Platelet-To-Lymphocyte Ratio (PLR) Is a Predictor of In-Hospital Mortality in Filipinos With Acute Coronary Syndrome: A Prospective Cohort
Authors: Lauro Lim Abrahan IV, Jaime Manalo Aherrera, John Daniel Ramos, Paul Ferdinand Reganit, Felix Eduardo Punzalan, Ramon Abarquez Jr.
Publication title: Global Heart 10(2), June 2015
Abstract: No abstract
Article title: APSC2015-1177 The Neutrophil-Lymphocyte Ratio Predicts Severity of Coronary Artery Disease Using the Syntax Score
Authors: Jaime Manalo Aherrea, Lowe Chiong, Christine Train, Marcelyn Fusilero, Paul Ferdinand Reganit, Feliz Eduardo Punzalan, Wilfredo Dee, John Anonuevo, Ramon Abarquez
Publication title: Global Heart 10(2) supplement June 2015
Abstract: No abstract
Article title: APSC2015-1178 Depression and Anxiety in Adult Filipinos With Congenital Heart Disease Using the Validated Filipino Version of the Hospital Anxiety and Depression Score (HADS)
Authors: Jaime Manalo Aherrera, Lauro Lim Abrahan IV, Geraldine Racaza, Christine Train, Danny Marcelo Jara
Publication title: Global Heart 10(2) June 2015
Abstract: No abstract
Article title: APSC2015-1176 Risk of Death and Adverse Outcomes in Adult Filipinos Admitted for Infective Endocarditis: A Prospective Cohort
Authors: Jaime Manalo Aherrera, Lauro Lim Abrahan IV, Maria Margarita Balabagno, Antonio Faldato, Paul Ferdinand Reganit, Felix Eduardo Punzalan
Publication title: Global Heart June 10 (2), June 2015
Abstract: No abstract
Article title: Cardiac tamponade as a rare manifestation of systemic lupus erythematosus: A report on four cases in the philippine general hospital
Authors: Jaime Manalo Aherrera, B.H.D. Manapat-Reyes, F.L. Lantion-Ang, Alexander Manguba, Evelyn Salido, F.E. Punzalan, Allan Corpuz, J.R. Magallanes
Publication Title: European Journal of Heart Failure 53(2), April 2015
Abstract:
Synopsis: Cardiac tamponade among systemic lupus erythematosus (SLE) patients is an unusual event. The pericardial effusion may be a consequence of uremia, infections in the pericardium, or the lupus pericarditis itself. We present four atypical cases of cardiac tamponade from pericarditis of connective tissue disease (CTD), all of which were treated with drainage and immunosuppressants. Due to the rarity of this combination, management was a challenge. Clinical Presentation: Four females each sought consult for dyspnea associated with typical manifestations of connective tissue disease such as arthritis, characteristic rashes, serositis, typical laboratory features, and a positive ANA and/or anti-dsDNA. The first three cases fulfilled the criteria for SLE, while the fourth fulfilled the criteria for SLE-dermatomyositis overlap syndrome. Echocardiography was done due to suspicion of pericardial involvement and revealed massive pericardial effusion in tamponade physiology in all cases. Diagnosis: Cardiac tamponade from serositis due to connective tissue disease [SLE (case 1 to 3) or SLE-dermatomyositis overlap (case 4). Other common etiologies of tamponade such as bacterial, tuberculous, malignant, and uremic pericardial effusion were ruled out by clinical and laboratory tools, including Gram stain and culture, cytology, PCR, and biochemical testing. The pericardial fluid of the first case tested positive for lupus erythematosus (LE) cells, indicative of lupus serositis. Treatment and Outcome: All patients underwent pericardial drainage via tube pericardiostomy. They received high dose glucocorticoids after infectious etiologies for the pericardial effusion were ruled out. The fourth case with the overlap syndrome, however, required more immunosuppressants using azathioprine and methotrexate. Resolution of pericardial effusion was noted with this approach. Three of four were discharged improved, however, the third case suffered from worsening nephritis and pulmonary hemorrhage leading to her demise. Significance and Recommendations: Four cases of cardiac tamponade as a manifestation of connective tissue disease were presented. Literature underlines the rarity of this condition anytime during the course of SLE. Despite this, SLE should be considered as one of the differential diagnosis of cardiac tamponade, especially in patients who manifest with multi-systemic findings. Likewise, massive pericardial effusion should be considered in patients with a connective tissue disease presenting with subtle evidence of pericardial involvement. It requires timely identification and treatment with high dose steroids, after other causes such as infections have been excluded. Immediate drainage through pericardiocentesis or pericardiostomy in combination with immunosuppressants may be life-saving.
Full text link: https://tinyurl.com/yburbof5
Article title: Coarctation of the Aorta and a Parachute Mitral Valve in an Adult With Differential Cyanosis
Authors: Jaime Manalo Aherrera, Maria Teresa Bacnis Abola, Jose Donato A. Magno, Ma. Helga F. Sta. Maria, Lauro Lim Abrahan IV, Richard Henry Perlas Tiongco II, John C. Anonuevo
Publication title: Cardiology Research 6(1) February 2015
Abstract:
Differential cyanosis may occur in Eisenmenger physiology in the presence of a patent ductus arteriosus (PDA). We present a unique case of a 22-year-old male manifesting as cyanosis of the left upper extremity and both lower extremities, but with preservation of the right upper extremity. Work-up revealed multiple congenital defects, reminiscent of the Shone’s complex. Survival into adulthood is presumed to be due to a PDA, at the expense of a right-to-left shunt. This report highlights the interplay of multiple anomalies documented on echocardiography and MRI, wherein diagnosis was made non-invasively.
Full text link: https://tinyurl.com/yal67pvk
Article title: GW25-e0613 Clinical profile and predictors of outcomes of patients with mitral stenosis undergoing percutaneous transseptal mitral commissurotomy
Authors: Edgar Timbol, Jaime Manalo Aherrera, Gino Rei Quizon, Wilfredo Dee,
Publication title: Journal of the American College of Cardiology 64(16) October 2014
Abstract: No abstract
Full text link: https://tinyurl.com/y7lxdpnv
Article title: GW25-e0537 Association of the neutrophil–lymphocyte ratio (NLR) with outcomes in patients admitted for an acute coronary syndrome
Authors: Jaime Manalo Aherrera, Lowe Chiong, Paul Ferdinand Reganit, Felix Eduardo Punzalan
Publication title: Journal of the American College of Cardiology 64(16) October 2014
Abstract: No abstract
Article title: "The heart is blind" endogenous endophthalmitis secondary to endocarditis in a patient with systemic lupus erythematosus
Authors: Jaime Manalo Aherrera, J. E. Duya, A. Fausto, J.R. Magallanes
Publication title: European Journal of Heart Failure 16, April 2014
Abstract: No abstract
Article title: PW054 Acquired Arteriovenous Fistula of the Right Common Iliac Artery and Left Common Iliac Vein and Bilateral Lower Extremity Deep Venous Thrombosis in a Woman Presenting as High Output Failure
Authors: Jaime Manalo Aherrera, Edgar Wilson Timbol, Antonio Faltado, Agnes D. Mejia, Mark Vicente
Publication title: Global Heart 9(1) March 2014
Abstract: No abstract
Article title: A Comparison of 12 Lead Electrocardiogram and 2d-Echocardiography Derived Ejection Fraction among Patients with Depressed Ejection Fraction
Authors: Jaime Manalo Aherrera, Paul Ferdinand Reganit, Feliz Eduardo Punzalan, Danny Marcelo Jara, Ramon F. Abarquez
Publication title: Journal of Atherosclerosis and Thrombosis V.21 January 2014
Abstract: No abstract
Article title: "Double Trouble" Wolff Parkinson White Syndrome and Mitral Stenosis Presenting as a Stroke in the Young
Authors: Jaime Manalo Aherrera, Anastasio Manuel Degayo, Lauro Lim Abrahan IV, Michael Joseph Agbayani, Michael Joseph Reyes, Wilfredo Dee
Publication title: Journal of Atherosclerosis and Thrombosis V.21 January 2014
Abstract: No abstract
Article title: When Stemi Is Not Stemi HIV Myocarditis Mimicking St-Elevation Myocardial Infarction on Electrocardiogram: A Case Report
Authors: Jaime Manalo Aherrera, Deonne Thaddeus Vite Gauiran, Agnes D. Mejia
Publication title: Journal of Atherosclerosis and Thrombosis V.21 January 2014
Abstract: No abstract
Article title: Pulmonic Valve Endocarditis with an underlying ventricular septal defect: a report on three cases at the Philippine General Hospital
Authors: Jaime Manalo Aherrera, Michael Joseph T. Reyes, Geraldine O. Floro, Edgar Timbol, Jan Melvin Zapanta, Lauren R. Blanquisco, Kristine D. Tumabiene, Felix Eduardo Punzalan
Publication title: Annual International Conference on Cardiology and Cardiovascular Medicine Research, December 2013
Abstract: No abstract
Article title: An unparsimonious quandary: Mitral stenosis and ventricular septal defect complicating systemic lupus erythematosus and pregnancy
Authors: J.D.A. Magno, M. Barguero, P.I. Pagauitan-Alan, Jaime Manalo Aherrera, F. Eduardo Punzalan
Abstract:
Multiple cardiac defects can significantly affect the course of pregnancy, tilting the hemodynamic balance against the mother and complicating her overall clinical condition. A 29-year-old female presented with heart failure symptoms into her third trimester of pregnancy. After a thorough work up, she was diagnosed with ventricular septal defect (VSD) with eisenmengerization, mitral stenosis (MS), and systemic lupus erythematosus (SLE). After delivery, she developed cyanosis. Management was a challenge, but she was eventually sent home on a calcium blocker, a diuretic and a beta-blocker. The service recommended hemodynamic studies, discussion of management options, antiphospholipid antibody syndrome work-up and advised the patient regarding avoidance of dehydration, high-altitude travels, and avoidance of vasodilators.
Article title: Routine angioplasty after fibrinolytic therapy for ST-segment elevation myocardial infarction: An updated meta-analysis (RAFT-STEMI)
Author: J.D.A. Magno, J.D. Alcover, A.D.C Javier, Jaime Manalo Aherrera, F.E.R. Punzalan, W.G. Dee
Abstract:
Context: The usefulness of a routine invasive strategy has still not yet been fully established among patients with ST-segment elevation myocardial infarction (STEMI) initially treated with fibrinolytic therapy, despite results of previous meta-analyses. Methods: We included newer and larger randomized trials to determine whether routine percutaneous coronary intervention (PCI) after fibrinolysis in STEMI patients was more beneficial than ischemia-guided PCI management in reducing all-cause mortality and reinfarction rates while being safe in terms of occurrence of stroke and major in-hospital bleeding. Using the keywords angioplasty, stent, percutaneous coronary intervention, fibrinolysis, thrombolysis, and myocardial infarction, seven PCI trials were identified, enrolling 2,560 STEMI patients followed up from 30 days to 1 year. Results: A routine invasive strategy did not lead to any significant reduction in mortality (relative risk [RR] 0.79, 95% CI 0.56-1.11; P = 0.18) but showed a significant reduction in reinfarction rates (RR 0.55, 95% CI 0.40-0.77; P = 0.0004) compared with ischemia-guided management. Meanwhile, there were no significant differences in the risk of stroke (RR 0.96, 95% CI 0.40-2.30; P = 0.92) or major bleeding (RR 0.98, 95% CI 0.70-1.36; P = 0.89). Conclusion: Routine PCI after fibrinolytic therapy for STEMI patients is not associated with any significant reduction in mortality but may be considered for its benefit in reducing reinfarction rates, without increasing rates of stroke or major bleeding. These results suggest that an ischemia guided strategy is still relevant in the management of STEMI patients, especially in situations where catheterization technology is not readily accessible.
Article title: Clinical and Echocardiographic Profile and Outcomes of Peripartum Cardiomyopathy: The Philippine General Hospital Experience
Authors: Vim I. Samonte, Queenie G. Ngalob, Ghea Divina B. Mata, Jaime Manalo Aherrera, Eugenio P. Reyes, Felix Eduardo R. Punzalan
Publication title: Heart Asia 5(1) 245-249, January 2013
Abstract:
Background Peripartum cardiomyopathy (PPCM) is a rare disease entity of unknown aetiology. High rates of mortality or poor overall clinical outcome are reported in women with this condition. Certain characteristics are risk factors for this disease. In Asia, there are limited data, especially in the Southeast Asian region. In the Philippines, no data exist regarding the prevalence or risk factors. Objectives To determine the prevalence, profile and outcomes of PPCM in Philippine General Hospital and to describe their echocardiographic findings. Methods All patients diagnosed with PPCM in the period of 1 January 2009–31 December 2010 were seen and examined. Demographic data and echocardiogram of the patients were reviewed. Results 9 were diagnosed with PPCM during the study period. The prevalence is 1 in 1270 live births. Mean age was 29. 78% presented with moderate to severe heart failure symptoms in the prepartum period. Among purported risk factors for PPCM, obesity, multiparity and pre-eclampsia were seen in most. Conversely, only one patient admitted to having more than a single sexual partner. Only one patient had multifetal pregnancy. None were smokers. 44% underwent caesarean section for maternal indication. No mortality was seen. Fetal outcomes were good with all resulting in live births and most were appropriate for gestational age. Echocardiographic findings showed global wall motion abnormalities in the majority, mean ejection fraction of 34% and mean fractional shortening of 20%. Conclusions PPCM is rare in the Philippines. Compared with international data, our patients are younger with low percentages of promiscuity, multifetal pregnancy, smoking history and tocolytic use. Similar to previous studies, obesity, multiparity and pre-eclampsia were also present in our PPCM patients. Immediate maternal and fetal outcomes were generally good. Adherence to standard heart failure management is high.
Full text link: https://tinyurl.com/yd2jssjb
Article title: Febuxostat versus allopurinol for hyperuricemia and gout: a meta-analysis (Fame study)
Authors:T.E.N. Lo, Jaime Manalo Aherrera, A.Q. Taguba, Ester Gonzales Penserga
Publication title: Annals of the Rheumatic Diseases 70(3) January 2011
Abstract: No Abstract