Keiko Amano

Self-reported rate of eating correlates with body mass index in 18-y-old Japanese women.

OBJECTIVE: To examine associations between rate of eating and macronutrient and dietary fiber intake, and body mass index (BMI).DESIGN: Cross-sectional study.SUBJECTS: A total of 1695 18-y-old female Japanese dietetic students.MEASUREMENTS: Macronutrient intake (protein, carbohydrate, and fat) and dietary fiber intake were assessed over a 1-month period with a validated, self-administered, diet history questionnaire. Body height and weight and rate of eating (according to five categories) were self-reported.RESULTS: Among the nutrients examined, only dietary fiber intake weakly, but significantly, and negatively correlated with BMI in a multiple regression analysis. The rate of eating showed a significant and positive correlation with BMI. The mean BMI was higher by 2.2, 1.5, 1.0, and 0.5 kg/m2 in the ‘very fast’, ‘relatively fast’, ‘medium’, and ‘relatively slow’ groups, respectively, compared with the ‘very slow’ rate of eating group. This correlation remained evident after adjustment for nutrient intake.CONCLUSIONS: Rate of eating showed a significant and positive correlation with BMI, whereas only dietary fiber intake showed a weak correlation with BMI.

New subtype of apical hypertrophic cardiomyopathy identified with nuclear magnetic resonance imaging as an underlying cause of markedly inverted T waves

OBJECTIVES The aim of this study was to elucidate the clinical importance of a new subtype of apical hypertrophic cardiomyopathy that could not be diagnosed with the classical diagnostic criteria. BACKGROUND Apical hypertrophic cardiomyopathy is recognized by a characteristic spade-shaped intraventricular cavity on the end-diastolic left ventriculogram in the right anterior oblique projection, often associated with giant negative T waves [negativity > or = 1.0 mV (10 mm)]. As an underlying cause of giant negative T waves, an additional new subtype of apical hypertrophic cardiomyopathy has been identified. METHODS In 40 patients with inverted T waves (negativity > or = 0.5 mV), including 26 patients with giant negative T waves, nuclear magnetic resonance (NMR) long-axis images corresponding to the left ventriculogram in the right anterior oblique projection and short-axis images at various levels, including the apical level, were obtained to define the site of hypertrophied myocardium. RESULTS Long-axis images indicated a spadelike configuration in 17 patients, whereas this diagnostic configuration was not present in the other 23 patients. Nine of these 23 patients had significantly hypertrophied myocardium at the basal level. In the 14 remaining patients, short-axis images indicated no hypertrophy at the basal level and proved that the area of hypertrophied myocardium was confined to a narrow region of the septum or the anterior or lateral wall at the apical level (nonspade apical hypertrophic cardiomyopathy). The hypertrophied myocardium of the nonspade type was so narrowly confined that the mass did not form a spadelike configuration or could not be detected on the long-axis image. CONCLUSIONS Nonspade apical hypertrophic cardiomyopathy was newly identified on NMR short-axis images, and this could be an additional, important underlying cause of moderately to severely inverted T waves.

Left ventricular filling determined by Doppler echocardiography in diabetes mellitus

Abstract Diabetes mellitus is associated with a high mortality from cardiac disease attributed to coronary artery atherosclerosis or systemic hypertension. Increasing evidence indicates that cardiac dysfunction occurs even in diabetics with normal coronary arteries. 1–3 In 1972, Rubier et al 1 reported 4 adult-onset diabetic patients who had cardiomegaly and congestive heart failure in the absence of major coronary artery disease or hypertension. Hamby et al 2 observed a high incidence of diabetes mellitus in their series of patients with idiopathic cardiomyopathy. Furthermore, several investigators have shown that abnormalities of left ventricular (LV) diastolic function are common even in diabetics without clinical manifestations of congestive heart failure. 3–6 Whether these abnormalities result from a microangiopathic process in the heart or from metabolic abnormalities inherent to diabetes mellitus is still unclear. 7 Measurement of transmitral flow velocity by Doppler echocardiography has recently been shown to be useful in identifying abnormal LV diastolic filling properties in a variety of disease states. 8–11 This study evaluates the diastolic LV filling characteristics in patients with adult-onset diabetes mellitus using pulsed Doppler echocardiography.

Follow-Up in mitral valve prolapse by phonocardiography, M-mode and two-dimensional echocardiography and Doppler echocardiography

To assess the serial phonocardiographic and echocardiographic change in patients with mitral valve prolapse (MVP), phonocardiograms and echocardiograms were reviewed retrospectively in 116 patients (48 men and 68 women, mean age 27 years) who had been determined to have MVP and were reexamined 4.3 years (range 1 to 14) later by phonocardiography and echocardiography between 1971 and 1988. Follow-up phonocardiograms showed periods when 5 of 18 patients with silent MVP developed mid- or late systolic clicks. Of 57 patients with mid- or late systolic clicks, 15 had silent MVP, 6 developed a late systolic murmur with or without systolic clicks and 1 developed a pansystolic murmur. Two of 9 patients with an isolated late systolic murmur developed a pansystolic murmur. M-mode echocardiograms showed that left atrial and left ventricular dimensions at end-diastole and end-systole increased in patients with systolic murmur (33 +/- 10 vs 35 +/- 11, 46 +/- 6 vs 50 +/- 7 and 29 +/- 4 vs 31 +/- 5 mm, respectively, all p less than 0.001) and no statistically significant changes in any of these dimensions were found in patients without a systolic murmur. The degree of MVP evaluated by the anteroposterior mitral leaflet angle on the 2-dimensional echocardiogram was more severe in patients with a systolic murmur than in patients without systolic murmur (157 +/- 12 vs 131 +/- 16 degrees, p less than 0.001). The degree of prolapse did not change during the follow-up periods. The number of patients with mitral regurgitation detected by pulsed Doppler echocardiography increased from 21 of 72 (29%) to 31 of 72 (43%).(ABSTRACT TRUNCATED AT 250 WORDS)

Noninvasive study of the presystolic component of the first heart sound in mitral stenosis.

Echophonocardiography and pulsed Doppler echocardiography were performed in 30 patients with mitral stenosis (19 with atrial fibrillation and 11 with sinus rhythm) to investigate the genesis of the presystolic component or small apical vibrations preceding the first heart sound in mitral stenosis. In 27 patients, mitral valve closure preceded or coincided with tricuspid valve closure regardless of the preceding RR interval. Of three patients whose tricuspid valve closed prematurely, two had a prolonged PR interval. The soft apical vibrations, which were recorded during the final rapid closing motion of the mitral valve echogram (B-C slope), began with the upstroke of the apexcardiogram. During this event the pulsed Doppler echocardiogram revealed a deceleration in the velocity of mitral inflow. In two exceptional patients with a prolonged PR interval, this apical sound was separated from a presystolic rumble that occurred during an accelerated phase of mitral inflow or at the A wave of mitral valve echograms. In conclusion, the tricuspid valve is not a factor contributing to the genesis of the small apical vibrations preceding the first heart sound in mitral stenosis. These vibrations are caused by acceleration of left ventricular contraction and deceleration of mitral inflow in the presence of a stenotic valve.

Echophonocardiographic study of the initial low frequency component of the first heart sound.

To investigate the genesis of the initial low frequency component of the first heart sound that precedes the high frequency vibrations associated with closure of the atrioventricular valves, echophonocardiograms of 36 persons were recorded. These included 10 normal subjects and 26 patients with various types of heart disease including mitral valve replacement. Electrocardiograms demonstrated normal sinus rhythm in 23 subjects, atrial fibrillation in 9, complete atrioventricular block in 2 and atrial flutter in 2. In the phonocardiogram, the low frequency component of the first heart sound followed the onset of the QRS complex and preceded the first high frequency component of this sound. The low frequency component occurred simultaneously with the beginning of the final fast closing movement of the mitral valve on the echocardiogram and was found both in normal rhythm and in arrhythmias. However, in arrhythmias its intensity varied on a beat to beat basis, being loudest after a short RR interval or when atrial systole occurred very close to the expected time of ventricular systole. In patients in whom apexcardiograms were recorded, the low frequency component was coincident with or very close to the onset of ventricular systole. It is concluded that the low frequency component of the first heart sound represents vibrations caused by contraction of the left ventricle and deceleration of antegrade blood flow across the mitral valve. Neither atrial contraction nor mitral valve tension is necessary for the production of this soft initial component.

Aortic Valve Motion in Mitral Valve Prolapse Syndrome

Since the echocardiographic study of Shah and Gramiak in mitral valve prolapse (MVP) syndrome, there have been many reports concerning MV echo patterns of this syndrome. However, aortic valve (AV) echogram has not been described in detail. The purpose of the present study is to investigate AV motion of MVP syndrome.

Abnormal Motion of Interventricular Septum and Posterior Wall of Left Ventricle in Experimental “Wolff-Parkinson-White Syndrome” : Echocardiographic and Electrophysiologic Study

With the advent of echocardiography, the examination of motion of interventricular septum(IVS) and left ventricular posterior wall (LVPW) has become very important in the diagnosis of cardiac abnormalities. Some clinical reports on Wolff-Parkinson-White(WPW) syndrome, which is one of the conditions known to affect the motion of IVS and LVPW, demonstrate that, in Type A, LVPW shows early onset and peak formation of the anterior motion and that, in Type B, IVS shows early systolic posterior protrusion and subsequent paradoxical anterior motion, which are quite similar to those observed in left bundle branch block. Although some believe that unopposed systolic contraction of either right(RV) or left ventricle(LV) and/or reversed activation of IVS from right to left resulted in these abnormal motion, the exact mechanism still remain uncertain.

Echocardiogram in Pulsus Paradoxus: Respiration Dependent Cyclic Changes in Mitral and Aortic Valve Motion

The mechanism of production of pulsus paradoxus was echocardiographically studied in a 74-year-old male with subacute effusive-constrictive pericarditis which developed to constrictive pericarditis under the observation. Echocardiography disclosed the following phenomena during inspiration: 1) mitral valve did not open until the atrial systole, probably because of the lack of antegrade mitral flow during rapid filling phase (the E wave was not observed), 2) concomitantly, aortic valve opening decreased markedly in its grade, and 3) left ventricular ejection time (LVET) decreased and pre-ejection period (PEP) increased, resulting in a higher PEP/LVET ratio (up to 1.32). The opposite was true during expiration (PEP/LVET ratio was 0.40). This is probably the first case, in which the mechanism of pulsus paradoxus was investigated by aortic and mitral valve echograms.

Correlative Study of Pulmonary Valve Echogram and Indirect Pulmonary Artery Pulse

Recently, echocardiographic assessment of right ventricular (RV) performance by measurement of systolic time intervals (RSTIs) has been possible because of increased detectability of the sufficient pulmonary valve echo. In the previous study, we recorded indirect pulmonary artery pulse (PA pulse) tracing in patients with various conditions and preliminarily reported the method to measure RSTIs. Since these 2 techniques are the noninvasive method available at the present time for the assessment of RV performance, the purpose of this study is to obtain simultaneously these 2 records to evaluate the validity of each of them.