Kinuko Dote

Obesity as an independent risk for left ventricular diastolic dysfunction in 692 Japanese patients

SUMMARY BACKGROUND Both obesity and left ventricular (LV) diastolic dysfunction are associated with an increased risk of cardiovascular morbidity and mortality. There is a paucity of data as to whether obesity is independently associated with LV diastolic dysfunction. METHODS Adult patients with sinus rhythm referred for a transthoracic echocardiography between July, 2007, and December, 2007, were prospectively included. Exclusion criteria were patient who had a history of congenital or valvular heart disease, treatment with pacemaker implantation or implantable cardioverter defibrillator, myocardial infarction, or impaired LV systolic function. Diastolic function was classified by an algorithm incorporating data from mitral and pulmonary venous flow indices, and Doppler tissue imaging. Body mass index (BMI) was evaluated as a categorical variable (normal weight <25.0 kg/m(2); overweight 25.0 to <30.0 kg/m(2); and obese ≥30 kg/m(2)). Logistic models were used to assess the risk of abnormal LV diastolic function associated with BMI categories. RESULTS Of a total number of 692 patients who met all study criteria (mean 59 ± 15 year-old; 50% women, 48% hypertension, 16% diabetes, 26% overweight, 8% obese), 538 (78%) had abnormal LV diastolic function. In multivariate analyses adjusting for age, sex, and cardiovascular risk factors, obesity was independently associated with LV diastolic dysfunction (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.12-7.88; P = 0.03) compared to normal weight. LV mass did not weaken this association (OR: 2.88, 95% CI: 1.08-7.68; P = 0.04). Overweight was not independently associated with LV diastolic dysfunction. CONCLUSION Obesity was associated with LV diastolic dysfunction independent of cardiovascular risk factors and LV mass.

New index of regional arterial stiffness assessed by tissue Doppler imaging.

Background — Although brachial-ankle pulse wave velocity is a widely used index of arterial stiffness, there are several limitations of this method. The actual length of an artery used for measuring pulse wave velocity is estimated based on an anatomical correction value, and brachial-ankle pulse wave velocity is directly affected by systemic blood pressure or vascular occlusion. Thus, the aim of this study was to determine whether aortic wall strain rate as measured by tissue Doppler imaging is a more useful modality for evaluating regional arterial stiffness than brachial-ankle pulse wave velocity. Methods — Seventy-two patients (18 to 78 years) with normal cardiac function and without large vessel complications were enrolled in this study. Results — A significant positive correlation was found between brachial-ankle pulse wave velocity and age, and brachial-ankle pulse wave velocity increased with age (r = 0.64, P< 0.0001).A significant negative correlation was found between strain rate and age, and strain rate decreased with age (r = –0.44, P < 0.05). A significant correlation was also found between brachial-ankle pulse wave velocity and systolic blood pressure (r = 0.45, P < 0.02), but not between strain rate and systolic blood pressure. There was no significant difference in brachial-ankle pulse wave velocity between hyperlipidaemic and normolipidaemic subjects. However, strain rate was lower in hyperlipidaemic than in normolipidaemic subjects (P < 0.05). Conclusion — Strain rate on the ascending aortic wall is a novel and more accurate index of regional arterial stiffness than brachial-ankle pulse wave velocity.

Free-Floating Right Ventricular Thrombus as Assessed by Real-time 3-Dimensional Transesophageal Echocardiography

A 71-year-old woman being treated with predonine at a dose of 10 mg/d for rheumatoid arthritis had a short episode of syncope lasting a couple of minutes. Her physical examination on admission revealed clear consciousness, resting tachycardia of 96 beats per minute, blood pressure of 114/68 mm Hg, jugular venous distention, and edema of the dorsum of the right foot. Electrocardiography revealed sinus tachycardia and right axis deviation. Chest radiography showed no pulmonary congestion. Transthoracic echocardiography showed a moderately dilated right ventricle with impaired right ventricular systolic function containing a large freefloating echogenic mass. There was moderate tricuspid regurgitation with an estimated pulmonary artery pressure of 59/24 mm Hg. Subsequent investigation by real-time 3-dimensional transesophageal echocardiography revealed that the large floating right intraventricular mass was highly mobile (Figure 1A and Video 1) and attached to the chordal structures of the tricuspid valve, which was prolapsing through the pulmonary valve into the main pulmonary artery. The clinical suspicion of pulmonary thromboembolism was subsequently confirmed by lung perfusion scanning. Anticoagulation therapy with intravenous heparin was initiated, and urgent cardiac surgery was performed with complete removal of the thrombus (Figure 1B). Histopathologic examination of the removed material showed findings consistent with a thrombus. Long-term oral anticoagula-

Endocarditis and giant mitral valve aneurysms.

In a 65-year-old man with infective endocarditis, multiple mitral valve aneurysms were detected by echocardiography. Surgical treatment was successful. Aneurysms of the valve are a relatively rare complication of infective endocarditis. Prompt diagnosis and treatment can prevent complications such as embolisation and rupture of the aneurysms. For a patient with a history of unknown fever, this point should be kept in mind.