Akira Yamashina

Diagnostic value of vasodilator-induced left ventricular dyssynchrony as assessed by phase analysis to detect multivessel coronary artery disease

Purpose: Phase analysis was recently developed to allow left ventricular(LV)mechanical dyssynchrony to be assessed by gated single-photon emission computed tomography(SPECT) . However, few studies have analyzed LV dyssynchrony during pharmacological stress and at rest by applying phase analysis to detect multivessel coronary artery disease(CAD)using the SyncTool TM . Methods: Adenosine triphosphate(ATP)loading electrocardiogram-gated 99m Tc-sestamibi SPECT was performed on 180 patients with suspected or known CAD. LV dyssynchrony was evaluated using the SyncTool TM ; the phase standard deviation(SD)and histogram bandwidth were derived. Results: The summed stress score(SSS) , summed difference score(SDS) , post-stress increase in phase SD, and histogram bandwidth were greater in 78 patients with multivessel CAD than in 102 patients with insignificant or single-vessel CAD. In the detection of multivessel CAD, SSS of >9 and SDS of >5 showed sensitivities of 74% and 74%,and specificities of 71% and 78% respectively, whereas an increase in phase SD>8.3°and in histogram bandwidth >16°after ATP loading had sensitivities of 62% and 74% and specificities of 77% and 68%, respectively. A multivariate logistic analysis revealed that the identification of multivessel CAD was superior with the combination of a post-ATP increase in phase SD, increase in histogram bandwidth, and SDS(sensitivity 82%, specificity 76%, chi-square=80.0)than with SDS alone (sensitivity 74%, specificity 78%, chi-square=58.9) . Conclusion: The addition of ATP-induced LV dyssynchrony parameters to conventional perfusion analysis enabled the superior identification of patients with multivessel CAD.

Clinical Considerations for the Association between Vascular Damage and Chronic Kidney Disease.

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Recently, noninvasive and simple morphological and functional methods have been introduced to assess atherosclerotic vascular damage. This review describes the association of CKD with vascular damage as assessed by these methods. Carotid intima-media thickness (IMT) and coronary artery calcium score (CACS) are morphological parameters of vascular damage, and an ankle-brachial index (ABI) <0.90 suggests the presence of peripheral arterial disease (i.e., it represents advanced atherosclerosis). Several prospective studies have demonstrated that CKD is a risk factor for an increased IMT, an increased CACS and a decreased ABI. While it has not been clarified whether measuring the IMT or CACS might be useful to predict the progression of renal function decline, a reduced ABI has been demonstrated as a predictor of accelerated renal function decline. On the other hand, pulse wave velocity (PWV) is a marker of arterial stiffness rather than atherosclerosis, reflecting functional abnormalities caused by vascular damage, and moderate-to-severe CKD may be a risk factor for the progression of arterial stiffness. The measurement of functional markers, especially of PWV or pulse pressure, has been demonstrated to be useful to predict the rate of progression of renal function decline. Thus, renal dysfunction and atherogenic states may be components of a vicious cycle, and vascular function abnormalities associated with atherosclerosis may accelerate this cycle. As the next step, we propose to examine whether improvement of vascular function abnormalities can interrupt this vicious cycle.

Increase in the Arterial Velocity Pulse Index of Patients with Peripheral Artery Disease

Background: Recently, a simple parameter calculated from the brachial pressure waveform recorded using an oscillometric device (arterial velocity pulse index [AVI]: ratio of the forward/reflected pressure wave amplitudes) has become available to assess the pathophysiological abnormalities associated with vascular damage. Peripheral artery disease (PAD) represents one of the disease entities associated with the advanced stages of atherosclerotic vascular damage. The present study was conducted to examine whether an increase in the AVI might be influenced by the presence of PAD. Methods and Results: The AVI was measured from oscillometric recordings of the brachial pressure waveform, and the ankle-brachial pressure index (ABPI) was determined by an oscillometric method. Study 1: In 341 consecutive patients admitted for the management of cardiovascular disease and/or cardiovascular risk factors, the ABPI and the AVI were measured simultaneously. An ABPI ≤0.90 was observed in 19 subjects, and logistic regression analysis revealed a significant association between AVI and ABPI ≤0.90 (odds ratio = 1.81; 95% confidence interval = 1.15–2.84; p = 0.01). Study 2: In another 19 patients with PAD, percutaneous transluminal angioplasty resulted in a decrease in the AVI from 31 ± 8 to 27 ± 8 (p < 0.01). Conclusion: Possible presence of PAD must be taken into account while applying the AVI for the assessment of vascular damage.

Front & Back Matter

of Review Articles: Should be divided into the following subsections: Background, Summary and Key Messages. The Background should provide a brief clinical context for the review and is followed by the Summary, which should include a concise description of the main topics covered in the text. The Key Messages encapsulate the main conclusions of the review. Submit the abstract on a separate page. The abstract should be less than 300 words. Abstracts of Original Papers: Each paper needs an abstract of up to 300 words. It should be structured as follows:s of Original Papers: Each paper needs an abstract of up to 300 words. It should be structured as follows: Background/Aims: What is the major problem that prompted the study? Methods: How was the study performed? Results: Most important findings? Conclusion: Implications, future directions

Contents Vol. 2, 2014

Walter Abhayaratna, Canberra, A.C.T. Fabio Angeli, Perugia Chen-Huan Chen, Taipei Julio Chirinos, Philadelphia, Pa. Olga Fedorova, Baltimore, Md. Jong-Won Ha, Seoul Berthold Hocher, Nuthetal Sae Young Jae, Seoul Xiongjing Jiang, Beijing Yuhei Kawano, Osaka Jae-Ryong Kim, Daegu Kee-Sik Kim, Daegu Kwang-il Kim, Seoul Carmen McEniery, Cambridge Abdul Rashid Rahman, Cyberjaya Ernst R. Rietzschel, Ghent Arno Schmidt-Trucksäss, Basel Jim Sharman, Hobart, Tas. Kohji Shirai, Sakura-shi Jun Tao, Guangzhou Hirofumi Tomiyama, Tokyo Raymond Townsend, Philadelphia, Pa. Hongyu Wang, Beijing Editor