Tomoichiro Kubo

Tissue Doppler-derived index of left ventricular filling pressure, E/E′, predicts survival of patients with non-valvular atrial fibrillation

Objectives: To investigate whether the ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (E′) predict prognosis in patients with non-valvular atrial fibrillation. Methods: 230 patients with non-valvular atrial fibrillation were enrolled and studied. According to E/E′ value, patients were divided into groups with lower (group A with E/E′ ⩽ 15) and higher (group B with E/E′ > 15) E/E′. Results: During follow up (average 245 days), 21 (9.1%) deaths were documented. All cause death (15/90 (16.7%) v 6/140 (4.3%)), cardiac death (10 (11.1%) v 2 (1.4%)) and congestive heart failure (16 (17.8%) v 8 (5.7%)) were more common in group B than in group A (all p < 0.01). A Kaplan–Meier survival curve showed that the cumulative survival rate was significantly lower in group B than in group A (log rank p  =  0.0013). By multivariate logistic regression analysis, E/E′ (χ2  =  4.47, odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01 to 1.11, p  =  0.03) and age (χ2  =  6.45, OR 1.06, 95% CI 1.01 to 1.11, p  =  0.02) were independent predictors of mortality. Conclusion: The Doppler-derived index of left ventricular filling pressure, E/E′, is a powerful predictor of the clinical outcome of patients with non-valvular atrial fibrillation.

Age- and Gender-Specific Changes in the Left Ventricular Relaxation A Doppler Echocardiographic Study in Healthy Individuals

Background—Although left ventricular diastolic function has been shown to deteriorate with advancing age, its gender-specific change is unknown. The aim of this study was to investigate age- and gender-specific changes in tissue Doppler–derived left ventricular diastolic index, E′. Methods and Results—A total of 1333 healthy individual without known heart disease or hypertension (mean age, 55 years; range, 10 to 89) were enrolled and studied. Peak early mitral annular velocity (E′) and peak late mitral annular velocity (A′) were recorded and measured. As an index of the left ventricular relaxation, E′ was used. As an index of the left ventricular filling pressure, E/E′ was calculated. Although systolic indices poorly correlated with age, diastolic indices correlated well with age. Among those aged 30 to 39 and 40 to 49 years, E′ was significantly lower in males than in females. In subjects aged 50 to 59 and 60 to 69 years, E′ was similar in both genders. Among those aged 70 to 79 and 80 to 89 years, E′ was significantly lower in females than in males. Predictors of the lowest quartile of E′ among subjects aged >50 years were age (P<0.0001; &khgr;2=66.11; odds ratio, 1.08; 95% CI, 1.058 to 1.097) and female gender (P=0.002; &khgr;2=9.23; odds ratio, 1.68; 95% CI, 1.202 to 2.343). Conclusion—Age-related changes in diastolic indices were gender specific. In the elderly population, diastolic function deteriorated more significantly in the female gender than in the male gender. These results may explain the relatively higher incidence in elderly females among patients with diastolic heart failure and higher cardiovascular mortality in the female gender.Background— Although left ventricular diastolic function has been shown to deteriorate with advancing age, its gender-specific change is unknown. The aim of this study was to investigate age- and gender-specific changes in tissue Doppler–derived left ventricular diastolic index, E′. Methods and Results— A total of 1333 healthy individual without known heart disease or hypertension (mean age, 55 years; range, 10 to 89) were enrolled and studied. Peak early mitral annular velocity (E′) and peak late mitral annular velocity (A′) were recorded and measured. As an index of the left ventricular relaxation, E′ was used. As an index of the left ventricular filling pressure, E/E′ was calculated. Although systolic indices poorly correlated with age, diastolic indices correlated well with age. Among those aged 30 to 39 and 40 to 49 years, E′ was significantly lower in males than in females. In subjects aged 50 to 59 and 60 to 69 years, E′ was similar in both genders. Among those aged 70 to 79 and 80 to 89 years, E′ was significantly lower in females than in males. Predictors of the lowest quartile of E′ among subjects aged >50 years were age ( P <0.0001; χ2=66.11; odds ratio, 1.08; 95% CI, 1.058 to 1.097) and female gender ( P =0.002; χ2=9.23; odds ratio, 1.68; 95% CI, 1.202 to 2.343). Conclusion— Age-related changes in diastolic indices were gender specific. In the elderly population, diastolic function deteriorated more significantly in the female gender than in the male gender. These results may explain the relatively higher incidence in elderly females among patients with diastolic heart failure and higher cardiovascular mortality in the female gender. Received July 22, 2008; accepted October 30, 2008. # CLINICAL PERSPECTIVE {#article-title-2}

Impact of arterial remodelling and plaque rupture on target and non-target lesion revascularisation after stent implantation in patients with acute coronary syndrome: an intravascular ultrasound study

Objectives: To investigate the impact of arterial remodelling on long-term clinical outcome after stent implantation in patients with acute coronary syndrome (ACS). Methods: 134 patients with ACS were enrolled. External elastic membrane (EEM) cross-sectional area (CSA) and lumen CSA were measured. Plaque and media CSA was calculated as EEM minus lumen CSA. Final minimal stent area (MSA) was also measured after stenting. Positive remodelling (PR) was defined as the ratio of the EEM CSA at the target lesion to that at the proximal reference of >1.05, and intermediate or negative remodelling (IR/NR) was defined as that of ⩽1.05. Results: Although final MSA was similar, target lesion revascularisation (TLR) rates at 2 years were significantly higher in patients with PR (33.7%) than in those with IR/NR (13.7%; p = 0.01). In addition, non-TLR rates were also significantly higher in patients with PR (42.2%) than in those with IR/NR (23.5%; p = 0.03). Cardiac event-free survival (for events such as death, myocardial infarction, TLR and non-TLR) was significantly lower in patients with PR than in those with IR/NR (log rank, p = 0.001). By multivariate logistic regression analysis, PR (χ2 6.57, OR 2.70; 95% CI, 1.27 to 5.78; p = 0.01) and plaque rupture (χ2 4.17, OR 2.38; 95% CI, 1.04 to 5.45; p = 0.04) were independent predictors of cardiac events. Conclusion: In patients with ACS, PR and intravascular ultrasound findings that may correspond with plaque rupture predict cardiac events including both TLR and non-TLR at 2 years.

Comparison of Coronary Microcirculation in Female Nurses After Day-Time Versus Night-Time Shifts

Nightshift work, which is known to cause mental stress and disrupt normal biological diurnal rhythms, leads to endothelial dysfunction resulting in increased risk for cardiovascular disease. This study aimed to investigate the acute effect of night-shift work on coronary microcirculation through assessment of coronary flow reserve (CFR) by transthoracic Doppler echocardiography. This study consisted of 36 women nurses who underwent transthoracic Doppler echocardiographic examinations after working a nightshift and on a regular day without previous nightshift work. Flow velocity in the distal portion of the left anterior descending coronary artery was measured at baseline and during adenosine infusion. CFR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFR after night work was lower than that on a regular workday (3.8 ± 0.6 vs 4.1 ± 0.6, p <0.001). Degree of decreases in CFR after night work was correlated to Framingham risk score (r = 0.35, p = 0.036). In conclusion, this study demonstrated that coronary microcirculation was impaired after nightshift work in women nurses.

Identification of multiple plaque ruptures by optical coherence tomography in a patient with acute myocardial infarction: a three-vessel study

Optical coherence tomography (OCT) is a new imaging modality capable of obtaining cross-sectional images of coronary vessels with a high resolution of about 10 μm, which is about 10-fold greater than that of intravascular ultrasound. A 57-year-old man was admitted to our hospital with acute posterior myocardial infarction. An emergency coronary angiography demonstrated 99% …

Pocket-Sized Echo for Evaluation of Mitral and Tricuspid Regurgitation

Advances in electronic miniaturization and digital techniqueshave resulted in the advent of portable transthoracic echocar-diography (pTTE) imaging devices in the area of echocardiog-raphy. A pocket-sized pTTE imaging device that has colorDoppler imaging capability has been recently introduced intoclinical practice. This study aimed to examine the feasibilityand accuracy of the pocket-sized pTTE in the assessment ofthe severity of mitral regurgitation (MR) and tricuspid regur-gitation (TR).One hundred and eighty-six consecutive patients (ages 66 19 years; 107 male) underwent standard transthoracic echo-cardiography (sTTE) and pTTE. Initially, pTTE was per-formed by a well-trained sonographer for 121 patients. For thelater 65 patients, pTTE was examined by a less experiencedsonographer who had 6 months of experience in echocardiog-raphy, with the number of TTE examinations compatible withAmerican Society of Echocardiography training level 1 (1).These sonographers were blinded to sTTE results and allclinical information.This study was approved by the ethics committees of OsakaEkisaikai Hospital and Okayama University. Pocket-sized pTTEwas performed using the Vscan (GE Medical Systems, Milwau-kee,Wisconsin).Theapical4-chamberviewbythecolorDopplerimages was obtained with sTTE and pTTE, respectively. Theratio of regurgitant jet area to atrial area was then calculated forMR (%MR) and TR (%TR). The severity of regurgitation wasgraded as mild if it occupied 20%, moderate if between 20%and 34%, and severe if 34% in TTE examination.Linear regression analysis was used for the correlation ofvariables of interest. Differences were considered significant atp 0.05.DifferencesbetweensTTEandpTTEresultswerealsocompared with the mean value obtained by sTTE and pTTEusing the Bland-Altman method, with the limits of agreementdefined as 2 SD of the difference between the 2 methods.Echocardiographic measurements were completed for sTTEand pTTE in all patients (feasibility 100%). In the examinationby the well-trained sonographer, there were excellent correlationsin MR jet area, left atrial area, %MR, TR jet area, right atrialarea, and %TR between sTTE and pTTE (r 0.89 to 0.96, p 0.001). Also, there were small systematic differences with closelimits of agreement between sTTE and pTTE measurements,respectively: 20.2 cm

Incidence and Predictors of Plaque Rupture in the Peripheral Arteries

Background—Plaque rupture may be present in the peripheral arteries of the patients at high risk for cardiovascular events and is possibly associated with vascular vulnerability. Methods and Results—One hundred one iliofemoral arteries from 101 patients undergoing angioplasty were studied. Intravascular ultrasound imaging was performed before intervention. Plaque rupture was defined as presence of a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Incidence, numbers, and location of the plaque rupture were investigated. Plaque rupture was found in 42 of 101 arteries (42%). Patients with plaque rupture had significantly higher prevalence of acute coronary syndrome than did patients without plaque rupture (42% vs 16%, P=0.01). By multivariable logistic regression analysis, acute coronary syndrome (P=0.004) and male sex (P=0.01) were independent clinical correlates of plaque rupture. During follow-up (median, 14.7 months), the incidence of major adverse cardiac or cerebrovascular events (death, myocardial infarction, and ischemic stroke) was similar between the 2 groups. The incidence of major adverse cardiac or cerebrovascular events plus peripheral vascular events (unplanned vascular intervention and amputation) was significantly higher in patients with plaque rupture than in patients without plaque rupture (46% vs 21%, P=0.008). By multivariable Cox regression analysis, plaque rupture (hazard ratio=2.80, 95% CI: 1.23 to 6.37, P=0.01) and Fontaine stage IV (hazard ratio=3.50, 95% CI: 1.58 to 7.71, P=0.002) were independent predictors of major adverse cardiac or cerebrovascular events plus peripheral vascular events. Conclusions—Ruptured plaque of the iliofemoral arteries is a common finding. Patients with plaque rupture had a higher prevalence of history of acute coronary syndrome and lower major adverse cardiac or cerebrovascular events plus peripheral vascular event-free survival.

Very rapid effect of pitavastatin on microvascular function in comparison to rosuvastatin: reactive hyperemia peripheral arterial tonometric study

Background: It has been reported that pitavastatin improves endothelial function faster than other statins. Recently introduced reactive hyperemia peripheral arterial tonometry (RH-PAT) provides objective and quantitative assessment of peripheral microvascular function. Purpose: This study aimed to investigate whether peripheral microvascular function improved 2 hours after pitavastatin in subjects with coronary artery disease (CAD) using RH-PAT, and the results were compared with those of rosuvastatin. Methods: This study included 94 subjects with CAD, assigned to a group given 2 mg of pitavastatin (n = 36), a group given 2.5 mg of rosuvastatin (n = 38), and a control group (n = 20). RH-PAT examinations were performed before and 2 hours after statin administration. Results: The RH-PAT index increased 2 hours after pitavastatin administration from 1.82 ± 0.45 to 2.16 ± 0.62 (P = 0.02), whereas there were no differences in the RH-PAT index in the rosuvastatin group (1.79 ± 0.71 to 1.91 ± 0.53, P = 0.09) and the control group (1.68 ± 0.36 to 1.84 ± 0.58, P = 0.4). No significant changes were observed at 2 hours in serum cholesterol levels in each group. Conclusion: The present study demonstrated that peripheral microvascular function improved 2 hours after a single clinical dose of pitavastatin, but not after rosuvastatin.

Identification of multiple plaque ruptures by optical coherence tomography in a patient with acute myocardial infarction: a three-vessel study.

Optical coherence tomography (OCT) is a new imaging modality capable of obtaining cross-sectional images of coronary vessels with a high resolution of about 10 μm, which is about 10-fold greater than that of intravascular ultrasound. A 57-year-old man was admitted to our hospital with acute posterior myocardial infarction. An emergency coronary angiography demonstrated 99% stenosis (TIMI 2 flow) in segment …

TARGET LESION THIN-CAP FIBROATHEROMA DETECTED BY VIRTUAL HISTOLOGY INTRAVASCULAR ULTRASOUND AND LONG-TERM PROGNOSIS IN PATIENTS WITH ANGINA PECTORIS

Background: Radiofrequency signal derived tissue characterization of intravascular ultrasound (IVUS) has become clinically available. Several reports suggested that virtual histology (VH)-IVUS lesion assessments could predict distal microembolization and microvascular injury during percutaneous coronary intervention (PCI). The aim of this study was to investigate whether pre-PCI lesion assessment (presence or absence of thincap fibroatheroma, TCFA) by VH-IVUS predicts long-term clinical outcome in patients with angina pectoris.