Mayumi Shigeru

Differences in Hemodynamic Parameters and Exercise Capacity Between Patients With Pulmonary Arterial Hypertension and Chronic Heart Failure

INTRODUCTION: Although pulmonary arterial hypertension (PAH) and chronic heart failure (CHF) lead to exercise limitation, their pathophysiology is different. Our objective was to evaluate, using right heart catheterization and cardiopulmonary exercise testing, the difference in hemodynamic parameters and exercise capacity between PAH and CHF, which have the same subjective symptoms. METHODS: We studied 20 PAH (mean pulmonary artery pressure: 36 ± 10 mmHg, all . 25 mmHg) and 20 CHF (ejection fraction: 35 ± 10%, all < 40%) patients who underwent both cardiopulmonary exercise testing and right heart catheterization. All patients were in New York Heart Association functional class II or III. RESULTS: Peak oxygen uptake (VO2) was lower for PAH patients than for CHF patients (11.7 ± 3.2 mL·kg21·min21 vs 14.5 ± 4.6 mL·kg21·min21, P = .03), while the slope of ventilation to carbon dioxide production ratio (VE/VCO2) was higher for PAH patients than for CHF patients (41.0 ± 12.7 vs 28.0 ± 9.0, P = .001), despite the similarity in their New York Heart Association functional class. Peak VO2 and VE/VCO2 correlated with cardiac index for both groups. An important finding was that peak VO2 correlated with pulmonary vascular resistance for PAH patients (r = 20.46, P = .04) but not for CHF patients (r = 0.33, P = .15). Furthermore, peak VO2 correlated with pulmonary capillary wedge pressure for CHF patients (r = 20.47, P = .03) but not for PAH patients (r = 0.17, P = .47), while the VE/VCO2 slope correlated with pulmonary capillary wedge pressure (r = 0.67, P = .002) but not with pulmonary vascular resistance (r = 0.12, P = .63) for CHF patients. CONCLUSION: Peak VO2 and VE/VCO2 slope were worse for PAH patients than for CHF patients despite the similar subjective symptoms. This difference might be explained by an altered hemodynamic status.

Optimal angulations for obtaining an en face view of each coronary aortic sinus and the interventricular septum: Correlative anatomy around the left ventricular outflow tract

An optimal image intensifier angulation used for obtaining an en face view of a target structure is important in electrophysiologic procedures performed around each coronary aortic sinus (CAS). However, few studies have revealed the fluoroscopic anatomy of the target area. This study investigated the optimal angulation for each CAS and the interventricular septum (IVS). The study included 102 consecutive patients who underwent computed tomography coronary angiography. The optimal angle for each CAS was determined by rotating the volume‐rendered image around the vertical axis. The angle formed between the anteroposterior axis and IVS was measured using the horizontal section. The frontal direction was defined as zero, positive, or negative if the en face view of the target CAS was obtained in the frontal view, left anterior oblique (LAO) direction, or right anterior oblique (RAO) direction, respectively. The optimal angles for the left, right, and non‐CASs were 120.3 ± 10.5°, 4.8 ± 16.3°, and −110.0 ± 13.8°, respectively. The IVS angle was 42.6 ± 8.5°. Accordingly, the optimal image intensifier angulations for the left, right, and non‐CASs and the IVS were estimated to be RAO 60°, LAO 5°, LAO 70°, and RAO 50°, respectively. The IVS angle was the most common independent predictor of the optimal angle for each CAS. Differences in the optimal angulations for each CAS and the IVS are demonstrated. The biplane angulation needs to be tailored according to the individual patients and target structures for electrophysiologic procedures. Clin. Anat. 28:494–505, 2015.

Association between the rotation and three-dimensional tortuosity of the proximal ascending aorta

Age‐related morphological changes of the aorta, including dilatation and elongation, have been reported. However, rotation has not been fully investigated. We focused on the rotation of the ascending aorta and investigated its relationship with tortuosity. One hundred and two consecutive patients who underwent computed tomography coronary angiography were studied. The angle at which the en face view of the volume‐rendered image of the right coronary aortic sinus (RCS) was obtained without foreshortening was defined as the rotation index. It was defined as zero if the RCS was squarely visible in the frontal view, positive if it rotated clockwise toward the left anterior oblique (LAO) direction, and negative if it rotated counter‐clockwise toward the right anterior oblique (RAO) direction. The tortuosity was evaluated by measuring the biplane tilt angles formed between the ascending aorta and the horizontal line. The mean rotation index, posterior tilt angle viewed from the RAO direction (αRAO), and anterior tilt angle viewed from the LAO direction (αLAO) were 4.8 ± 16.3, 60.7 ± 7.0°, and 63.6 ± 9.0°, respectively. Although no correlation was observed between the rotation index and the αLAO (β = −0.0761, P = 0.1651), there was a significant negative correlation between the rotation index and αRAO (β = −0.1810, P < 0.0001). In multivariate regression analysis, the rotation index was an independent predictor of the αRAO (β = −0.1274, P = 0.0008). Clockwise rotation of the proximal ascending aorta exacerbates the tortuosity by tilting the aorta toward the posterior direction. Clin. Anat. 27:1200–1211, 2014.

A Comparison of Quantitative T2 Mapping on Cardiovascular Magnetic Resonance Imaging with Metaiodobenzylguanidine Scintigraphy and Left Ventricular Functional Recovery in Dilated Cardiomyopathy: A Retrospective Pilot Study

OBJECTIVE Metaiodobenzylguanidine (MIBG) scintigraphy is used to assess heart failure (HF) severity and to predict cardiac functional recovery. Cardiovascular magnetic resonance (CMR) imaging has recently been used to diagnosis HF. We evaluated CMR T2 mapping and MIBG scintigraphy in dilated cardiomyopathy (DCM) patients. METHODS Consecutively, 22 DCM patients [aged 56.8 ± 13.4 years; 6 women and 16 men; left ventricular ejection fraction (LVEF), 31.9 ± 10.7%] who underwent T2 mapping and MIBG scintigraphy were retrospectively evaluated. Echocardiography results were recorded at baseline and the 6-month follow-up. Patients with an increased LVEF ≥15% between the 2 measures were considered to be responders. We measured each patients T2 values and MIBG indices [the heart-to-mediastinum ratio (H/M) in the early phase, H/M in the delayed phase, and the washout rate (WOR)] at baseline. We compared these values between the 12 responders and 10 non-responders. RESULTS The mean T2 value for all patients was 64.5 ± 6.6 ms. The mean values of early H/M, delayed H/M, and WOR were 2.06 ± 0.25, 1.94 ± 0.35, and 43.5 ± 11.8%, respectively. The T2 values were found to correlate with MIBG indices (p<0.05 for all) and were lower in the responders than non-responders (61.4 vs. 68.1 ms, p=0.013). MIBG indices were not significantly different. CONCLUSION Our study shows that the T2 values correlated with the MIBG indices and were increased in non-responders. T2 mapping may be useful in assessing the cardiac function and functional recovery in DCM patients.

Predicting the response to cardiac resynchronization therapy using 99mTc-tetrofosmin myocardial scintigraphy in patients with drug-refractory heart failure: additional value of the washout of 99mTc-tetrofosmin.

ObjectiveA lack of response to cardiac resynchronization therapy (CRT) has been reported in 20–40% of heart failure patients with left ventricular (LV) dyssynchrony who underwent treatment based on the established guidelines. The study aimed to investigate the relationship between 99mTc-tetrofosmin (99mTc-TF) myocardial scintigraphy and the response to CRT. Patients and methodsTwenty-one patients with drug-refractory heart failure who underwent CRT were evaluated. All patients underwent 99mTc-TF myocardial scintigraphy before and after CRT. Single-photon emission computed tomography images of 99mTc-TF were acquired at 30 min and 3 h after injection and were used to determine the total defect score (TDS) and washout score (WOS). The change in the LV volume and ejection fraction (&Dgr;LVEF) and relative reduction in left ventricular end-systolic volume (%&Dgr;LVESV) were calculated as an index of LV functional recovery after CRT. Response to CRT was considered to have occurred when &Dgr;LVEF was greater than 15% or when &Dgr;LVEF was greater than 5% and %&Dgr;LVESV was greater than 15%. ResultsSignificant differences were observed between the patients who responded to CRT (the responder group, 13 patients) and the nonresponder group (eight patients) for both early and delayed TDS and WOS (P<0.05). Moreover, there was a good correlation between early TDS before CRT and both &Dgr;LVEF and %&Dgr;LVESV (P<0.01) and an excellent correlation between WOS before CRT and both &Dgr;LVEF and %&Dgr;LVESV (P<0.01). ConclusionEvaluating the washout of 99mTc-TF in addition to myocardial perfusion before CRT using 99mTc-TF myocardial scintigraphy might be useful in drug-refractory heart failure patients.