Susumu Nishio

Index-Beat Assessment of Left Ventricular Systolic and Diastolic Function during Atrial Fibrillation Using Myocardial Strain and Strain Rate

BACKGROUND Accurate assessment of left ventricular (LV) function in patients with atrial fibrillation (AF) remains difficult, mainly because of the beat-to-beat variability of many echocardiographic parameters. The aim of this study was to assess the hypothesis that LV function can be estimated from an index-beat echocardiographic assessment in patients with AF using myocardial strain and strain rate. METHODS A prospective study was conducted to assess 25 patients with AF (mean age, 66 ± 10 years). Peak systolic longitudinal strain (LS) and peak diastolic longitudinal strain rate (dSR) were measured using two different methods: (1) mean LS and dSR, the averages of instantaneous LS and dSR over 10 sec, and (2) index-beat LS and dSR, calculated when the ratio of the preceding (RR1) to the pre-preceding (RR2) interval was 1 (range, 0.96-1.04). These variables were compared with simultaneously measured LV pressure parameters using Millar catheters. RESULTS There was a positive linear relationship between mean LS and index-beat LS at RR1/RR2 = 1 (r = 0.94, P < .001) and a positive linear relationship between mean dSR and index-beat dSR (r = 0.69, P < .001). Index-beat LS was correlated with the maximal positive derivative of LV pressure (peak +dP/dt) (r = -0.73, P < .001). Index-beat dSR was correlated with the time constant of isovolumic LV pressure decay (τ) (r = -0.63, P < .001). To investigate the independent predictors of τ, a stepwise multilinear regression analysis showed that index-beat dSR was the best predictor of τ. CONCLUSIONS Index-beat parameters accurately reflect the mean values of parameters in patients with AF. These noninvasively obtained index-beat parameters are useful to assess surrogate LV function even in patients with AF.

Dehydroepiandrosterone sulfate is inversely associated with sex-dependent diverse carotid atherosclerosis regardless of endothelial function.

BACKGROUND Dehydroepiandrosterone sulfate (DHEAS) is thought to be associated with life expectancy and anti-aging. However, its biological significance in atherosclerosis remains controversial. Therefore, the aim of this study was to determine whether DHEAS is associated with development of carotid atherosclerosis in subjects with cardiovascular risk factors. SUBJECTS AND METHODS A total of 419 Japanese individuals (208 males and 211 females) were recruited from Tokushima University Hospital, Japan. In all subjects, maximum intima-media thickness (max-IMT) in all carotid arteries, and mean-IMT and mean blood flow volume (BFV) in the common carotid arteries (CCA) were measured by ultrasonography; endothelial function was assessed by flow-mediated vasodilation of the brachial artery (%FMD). Serum DHEAS and classical cardiovascular risk factors were also evaluated. Statistical significance was determined by multiple regression analysis to elucidate independent determinants of max-IMT, mean-IMT, mean CCA-BFV, and %FMD. RESULTS Serum DHEAS levels were higher in males than in females. Multiple regression analysis revealed that DHEAS was an independent negative factor for both max-IMT and mean-IMT in males but not in females. In contrast, DHEAS was the sole positive factor for mean CCA-BFV in females but not in males. In addition, there was no significant relationship between %FMD and DHEAS regardless of sex and other confounding factors. CONCLUSION Although DHEAS is not involved in endothelial function, DHEAS is inversely associated with sex-dependent diverse carotid atherosclerosis such as increased max-IMT and mean-IMT in males and decreased CCA-BFV in females.

Interval from the onset of transmitral flow to annular velocity is a marker of LV filling pressure.

Recently, the time interval between the onset of early diastolic transmitral flow velocity (E) and mitral annular velocity (e′) (TE-e′) was proposed as a new index representing left ventricular (LV) relaxation. A problem with the measurement of TE-e′ was that E and e′ could not be measured

Prevalence of Osteochondritis Dissecans of the Capitellum in Young Baseball Players Results Based on Ultrasonographic Findings

Background: Osteochondritis dissecans (OCD) of the capitellum is a well-recognized cause of elbow pain and disability in adolescent athletes. However, little is known about the prevalence of OCD in adolescent baseball players. Purpose: To determine the prevalence of OCD in baseball players aged 10 to 12 years based on ultrasonographic findings and to investigate the clinical characteristics of those with OCD lesions. Study Design: Descriptive epidemiology study. Methods: A total of 1040 players aged 10 to 12 years completed a questionnaire, ultrasound imaging, and radiographic examination to investigate OCD. Sonographic findings were classified into 5 grades (0, 1a, 1b, 2, and 3). Subjects with grade 1a, 1b, 2, or 3 were considered to have abnormal findings of the capitellum and were advised to undergo radiography. Radiographic and ultrasonographic findings were then compared. The prevalence of OCD was calculated, and differences by age and player position were determined. Results: Of the 1040 players, 33 (3.2%) had an abnormal finding on initial ultrasonography screening, and all 33 agreed to undergo radiography. Of them, 22 (66.7%) were found to have OCD of the capitellum on radiographs, giving an overall prevalence of 2.1%. Seven subjects (31.8%) had no history of elbow pain. Based on the radiographic classification, 20 subjects (90.9%) had stage I lesions. Analysis of OCD by age and player position revealed no significant differences. Conclusion: The prevalence of OCD of the capitellum was 2.1% in 1000 baseball players aged 10 to 12 years, with no differences in prevalence according to age or player position.

Optimal Analysis of Left Atrial Strain by Speckle Tracking Echocardiography: P‐wave versus R‐wave Trigger

Left atrial (LA) strain analysis using speckle tracking echocardiography is useful for assessing LA function. However, there is no established procedure for this method. Most investigators have determined the electrocardiographic R‐wave peak as the starting point for LA strain analysis. To test our hypothesis that P‐wave onset should be used as the starting point, we measured LA strain using 2 different starting points and compared the strain values with the corresponding LA volume indices obtained by three‐dimensional (3D) echocardiography.

Prognostic Implications of Non-Invasive Vascular Function Tests in High-Risk Atherosclerosis Patients

BACKGROUND The aim of this study was to assess the role of clinically available vascular function tests as predictors of cardiovascular events and decline in kidney function. METHODSANDRESULTS One hundred and fourteen patients who had at least 2 cardiovascular risk factors were recruited for vascular function assessment including ankle-brachial blood pressure index (ABI), brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI) and flow-mediated vasodilatation (%FMD). During a median period of 51 months, 35 patients reached the primary endpoint (29 cardiovascular events and 6 cardiac deaths), and 30 patients reached the secondary endpoint (decline in kidney function: defined as a 5% per year decline of estimated glomerular filtration rate). In sequential Cox models, a model on the basis of the Framingham risk score, hemoglobin, and high-sensitivity C-reactive protein (chi-squared, 16.6) was improved by the ABI (chi-squared: 21.5; P=0.047). The baPWV (hazard ratio: 1.42 per 1 SD increase; P=0.025) and the CAVI (hazard ratio: 1.52 per 1 SD increase; P=0.040) were associated with the secondary endpoint. The %FMD was only slightly associated with the primary and secondary endpoints. CONCLUSIONS Both ABI and baPWV are significantly associated with future cardiovascular events in high-risk patients with cardiovascular disease. The predictive capabilities of these parameters are greater than that of other parameters in this cohort.

Platypnea‐Orthodeoxia Syndrome Associated with Patent Foramen Ovale and Aortic Ectasia

A 59‐year‐old man was admitted for dyspnea on exertion and edema. The patient did not have any pulmonary diseases that could cause dyspnea. Transesophageal echocardiography on the tilting bed with contrast infusion revealed a right‐to‐left shunt through the patent foramen ovale. Therefore, he was diagosed as platypnea‐orthodeoxia syndrome due to the patent foramen ovale. Surgical closure was done and all of his symptoms had improved.

Serial imaging changes during treatment of Takayasu arteritis with pulmonary artery stenosis

Most cases of chronic stenosis or occlusive lesions of the pulmonary arteries are attributed to thromboembolism, and pulmonary arteritis is extremely rare as the primary cause of these entities. We report a case of pulmonary stenosis and occlusion caused by Takayasu arteritis. The patient was a 54-year-old woman who presented with dyspnea. Total occlusion of the left pulmonary artery and significant stenosis of the right pulmonary artery caused by Takayasu arteritis were confirmed by various imaging modalities including pulmonary angiography, 18fluorodeoxyglucose-positron emission tomography, magnetic resonance imaging and real-time three-dimensional transesophageal echocardiography. After 6 weeks of steroid therapy, follow-up imaging studies showed that the stenotic lesion had resolved.

Comparison of Tricuspid Annular Plane Systolic Excursion in Patients With Atrial Fibrillation Versus Sinus Rhythm.

Echocardiography now plays a central guiding role in the management of patients with atrial fibrillation (AF). However, the current guidelines mention little about the presence AF during the assessment of echocardiographic variables in the clinical setting. AF itself may impact on tricuspid annular plane systolic excursion (TAPSE) as a right ventricular systolic function compared with sinus rhythm (SR). The aim of this study was to compare and assess the echocardiographic parameters including TAPSE in patients with AF and SR. From January 1, 2013, to September 30, 2014, patients with AF without any cardiovascular disease were retrospectively evaluated using echocardiography. Age-, gender-, and left ventricular ejection fraction-matched patients with SR were selected from our database on the basis of a comprehensive history, physical examination, and echocardiographic findings. During the study period, we identified 239 patients with AF (74 ± 9 years; 65% men) and without any cardiac disease who underwent echocardiography. We also included 281 patients in the SR group (74 ± 8 years; 67% men). In all study subjects, TAPSE in AF was smaller than in SR regardless of age (17 ± 3 vs 20 ± 3 mm, p <0.001). In the stepwise multiple regression model, TAPSE was strongly associated with the presence of AF (standardized β = -0.362, p <0.001) and stroke volume index (standardized β = 0.173, p <0.001) after adjustment for age, gender, heart rate, left ventricular ejection fraction, and tricuspid regurgitant grade. In conclusions, patients with AF had lower TAPSE than those with SR regardless of age. When we assess TAPSE in the clinical setting, we must pay attention to the presence of AF.

Serial Imaging Changes During Treatment of Immunoglobulin G4–Related Disease With Multiple Pseudotumors

An 80-year-old man noticed a swollen eyelid on his left side and was admitted to our hospital. A chest x-ray showed eccentric cardiomegaly (Figure 1A), and transthoracic echocardiography revealed mild pericardial effusion and a large, low-echoic mass near the inferolateral left ventricular wall (Figure 1B). Other ultrasonic examinations showed thickened outer layers in the bilateral subclavian and iliac arteries (Figure 2B-1). A blood test indicated elevated levels of anti-immunoglobulin G (IgG; 4345 mg/dL), IgG4 (1210 mg/dL), C-reactive protein (7.08 mg/dL), and 60-minute erythrocyte sedimentation rate (100 mm/h). Figure 1. A , Chest x-ray showed eccentric cardiomegaly (arrow). B , Transthoracic echocardiography revealed mild pericardial effusion and a large, low-echoic mass near the inferolateral …