Toshiya Kataoka

Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: Comparison with right heart catheterization and echocardiography

To compare the utility of phase contrast MR imaging (PC‐MRI) for assessment of pulmonary flow and pressure estimation with that of right heart catheterization and echocardiography (cardiac US) in patients with pulmonary arterial hypertension (PAH).

Preoperative systolic strain rate predicts postoperative left ventricular dysfunction in patients with chronic aortic regurgitation

Background—The best predictor for postoperative left ventricular (LV) systolic dysfunction in patients with chronic aortic regurgitation is still a matter of debate. The aim of this study was to assess the clinical significance of preoperative systolic radial strain rate (Ssr) derived from tissue Doppler echocardiography as a predictor of postoperative LV systolic dysfunction in patients with chronic aortic regurgitation. Methods and Results—In 52 patients (mean age, 58 years; 13 women) with isolated chronic aortic regurgitation, we performed standard and tissue Doppler echocardiography before and after operation, obtained echocardiographic parameters such as LV dimensions and LV ejection fraction, and measured Ssr in 4 walls of the LV. Linear regression analysis determined correlations between preoperative parameters and postoperative LV ejection fraction. Receiver-operating characteristic curve analysis assessed the optimal cutoff values of parameters that predicted postoperative LV systolic dysfunction (ejection fraction <50%). The operation caused significant decreases in LV dimensions and volumes and significant increases in Ssr (1.94±0.64 to 2.39±0.83 per second; P<0.001) and ejection fraction (53.0±8.7 to 59.0±8.8%; P<0.001). Multiple regression analysis demonstrated that averaged Ssr was the only independent predictor of postoperative LV systolic dysfunction among the covariates examined (P<0.001). Using receiver-operating characteristic curve analysis, averaged Ssr yielded the greatest area under the curve among preoperative parameters (0.80) and was indicated to be a good predictor of postoperative LV dysfunction, with 90.9% sensitivity and 73.2% specificity (cutoff value, 1.82 per second). Conclusions—Measurement of preoperative averaged Ssr is useful in predicting postoperative LV systolic dysfunction and optimizing surgical timing in patients with isolated chronic aortic regurgitation.

Dobutamine-induced improvement in inferior myocardial contractile function predicts reduction in functional mitral regurgitation: a study using tissue Doppler strain rate imaging.

Background—Left ventricular (LV) remodeling can increase tethering force to mitral valve and functional mitral regurgitation (FMR). Because the relationship between FMR and regional myocardial function has not been quantitatively evaluated, we conducted a quantitative investigation of this association. Methods and Results—The effective regurgitant orifice (ERO) of FMR in 51 patients with depressed LV ejection fraction (32±9%) secondary to ischemic or nonischemic cardiomyopathy was compared with mitral deformation (valve and annulus), global LV remodeling (volume indices, function, and sphericity), and regional myocardial contractile function, as assessed by longitudinal peak systolic strain rate (Ssr) in LV anterior, anteroseptal, inferoseptal, inferior, inferolateral, and anterolateral segments at rest. Low-dose dobutamine (10 &mgr;g/kg per minute)-induced changes in ERO were compared with changes in the variables. Multivariable analysis identified the predictors of ERO at rest as mitral valvular tenting (&bgr;=0.062; P<0.001), Ssr in the inferior segment (inferior Ssr) (&bgr;=−0.178; P<0.001), and LV sphericity (&bgr;=0.414; P=0.001) and the predictors of valvular tenting at rest as inferior Ssr (&bgr;=−1.680; P<0.001), LV end-systolic volume index (&bgr;=0.022; P=0.001), and LV sphericity (&bgr;=3.886; P=0.012). Furthermore, dobutamine-induced reduction in ERO was predicted by reduction in valvular tenting (&bgr;=0.087; P<0.001) and increase in inferior Ssr (&bgr;=−0.082; P<0.001), and dobutamine-induced reduction in valvular tenting was predicted by increase in inferior Ssr (&bgr;=−0.860; P<0.001). Conclusions—Inferior regional myocardial dysfunction was quantitatively associated with mitral valvular tenting and FMR. Moreover, improvement with dobutamine of inferior myocardial contractile function attenuated valvular tenting and FMR. Inferior myocardial contractile function can affect the configuration of the mitral apparatus and predict FMR severity.

Impact of Preserved Myocardial Contractile Function in the Segments Attached to the Papillary Muscles on Reduction in Functional Mitral Regurgitation

Background: Effectiveness of functional mitral regurgitation (FMR) in heart failure patients is of growing importance for patient prognosis. The purpose of this study was to investigate whether regional myocardial contractile function as assessed by tissue Doppler strain rate imaging can predict reduction in FMR caused by dobutamine. Methods: Fifty‐one patients with depressed left ventricular (LV) ejection fraction (32 ± 9%) secondary to dilated cardiomyopathy and FMR underwent evaluation of effective regurgitant orifice (ERO) of FMR, mitral valve deformation, global LV remodeling, and regional myocardial contractile function assessed by longitudinal peak systolic strain rate (Ssr) in 6 mid‐LV segments from standard apical views. We also determined the average Ssr of segments attached to the papillary muscles, that is, the inferior, inferolateral, and anterolateral segments (PM segments Ssr). Low‐dose (10 μg/kg per minute) dobutamine‐induced reduction in ERO was compared with baseline variables. Results: Baseline valve tenting was associated with dobutamine‐induced reduction in ERO (r = −0.30, P < 0.05). Receiver operating characteristic curve analysis showed that baseline valve tenting, LV sphericity index, inferior Ssr, inferolateral Ssr, and PM segments Ssr were predictors of dobutamine‐induced ≥30% reduction in ERO. Importantly, only PM segments Ssr predicted dobutamine‐induced ≥20% reduction in valve tenting with area under the curve of 0.67 (P < 0.05). Conclusions: Preserved myocardial contractile function in the segments attached to the PMs was associated with dobutamine‐induced reduction in mitral valve tenting and FMR, suggesting that our findings are important for improvement in cardiac function and FMR with medical treatment.

Large response to cardiac resynchronization therapy in a patient with segmental paradoxical systolic expansion identified by strain imaging

An 84-year-old man with non-ischaemic cardiomyopathy underwent cardiac resynchronization therapy (CRT) based on the presence of drug-refractory heart failure, depressed left ventricular ejection fraction (25%), and wide QRS complex (160 ms). Longitudinal tissue velocity revealed no significant dyssynchrony (23 ms in Yu index and 35 ms in opposing wall delay). However, longitudinal tissue Doppler strain revealed unique appearances in apical four-chamber and long-axis views. The anterior and inferior septum at basal and mid-levels had reversed strain (becoming positive), indicating paradoxical systolic expansion. Ejection fraction dramatically improved from 26 to 50% the day following CRT, and this beneficial effect of CRT was sustained 12 months following CRT. The presence of the segmental reversed strain might have a potential to predict a large response to CRT in the assessment of longitudinal dyssynchrony.

Dobutamine-Induced Improvement in Inferior Myocardial Contractile Function Predicts Reduction in Functional Mitral Regurgitation

Background—Left ventricular (LV) remodeling can increase tethering force to mitral valve and functional mitral regurgitation (FMR). Because the relationship between FMR and regional myocardial function has not been quantitatively evaluated, we conducted a quantitative investigation of this association. Methods and Results—The effective regurgitant orifice (ERO) of FMR in 51 patients with depressed LV ejection fraction (32±9%) secondary to ischemic or nonischemic cardiomyopathy was compared with mitral deformation (valve and annulus), global LV remodeling (volume indices, function, and sphericity), and regional myocardial contractile function, as assessed by longitudinal peak systolic strain rate (Ssr) in LV anterior, anteroseptal, inferoseptal, inferior, inferolateral, and anterolateral segments at rest. Low-dose dobutamine (10 &mgr;g/kg per minute)-induced changes in ERO were compared with changes in the variables. Multivariable analysis identified the predictors of ERO at rest as mitral valvular tenting (&bgr;=0.062; P<0.001), Ssr in the inferior segment (inferior Ssr) (&bgr;=−0.178; P<0.001), and LV sphericity (&bgr;=0.414; P=0.001) and the predictors of valvular tenting at rest as inferior Ssr (&bgr;=−1.680; P<0.001), LV end-systolic volume index (&bgr;=0.022; P=0.001), and LV sphericity (&bgr;=3.886; P=0.012). Furthermore, dobutamine-induced reduction in ERO was predicted by reduction in valvular tenting (&bgr;=0.087; P<0.001) and increase in inferior Ssr (&bgr;=−0.082; P<0.001), and dobutamine-induced reduction in valvular tenting was predicted by increase in inferior Ssr (&bgr;=−0.860; P<0.001). Conclusions—Inferior regional myocardial dysfunction was quantitatively associated with mitral valvular tenting and FMR. Moreover, improvement with dobutamine of inferior myocardial contractile function attenuated valvular tenting and FMR. Inferior myocardial contractile function can affect the configuration of the mitral apparatus and predict FMR severity.

Dobutamine-Induced Improvement in Inferior Myocardial Contractile Function Predicts Reduction in Functional Mitral RegurgitationClinical Perspective: A Study Using Tissue Doppler Strain Rate Imaging

Background—Left ventricular (LV) remodeling can increase tethering force to mitral valve and functional mitral regurgitation (FMR). Because the relationship between FMR and regional myocardial function has not been quantitatively evaluated, we conducted a quantitative investigation of this association. Methods and Results—The effective regurgitant orifice (ERO) of FMR in 51 patients with depressed LV ejection fraction (32±9%) secondary to ischemic or nonischemic cardiomyopathy was compared with mitral deformation (valve and annulus), global LV remodeling (volume indices, function, and sphericity), and regional myocardial contractile function, as assessed by longitudinal peak systolic strain rate (Ssr) in LV anterior, anteroseptal, inferoseptal, inferior, inferolateral, and anterolateral segments at rest. Low-dose dobutamine (10 &mgr;g/kg per minute)-induced changes in ERO were compared with changes in the variables. Multivariable analysis identified the predictors of ERO at rest as mitral valvular tenting (&bgr;=0.062; P<0.001), Ssr in the inferior segment (inferior Ssr) (&bgr;=−0.178; P<0.001), and LV sphericity (&bgr;=0.414; P=0.001) and the predictors of valvular tenting at rest as inferior Ssr (&bgr;=−1.680; P<0.001), LV end-systolic volume index (&bgr;=0.022; P=0.001), and LV sphericity (&bgr;=3.886; P=0.012). Furthermore, dobutamine-induced reduction in ERO was predicted by reduction in valvular tenting (&bgr;=0.087; P<0.001) and increase in inferior Ssr (&bgr;=−0.082; P<0.001), and dobutamine-induced reduction in valvular tenting was predicted by increase in inferior Ssr (&bgr;=−0.860; P<0.001). Conclusions—Inferior regional myocardial dysfunction was quantitatively associated with mitral valvular tenting and FMR. Moreover, improvement with dobutamine of inferior myocardial contractile function attenuated valvular tenting and FMR. Inferior myocardial contractile function can affect the configuration of the mitral apparatus and predict FMR severity.

Dobutamine-Induced Improvement in Inferior Myocardial Contractile Function Predicts Reduction in Functional Mitral RegurgitationClinical Perspective

Background—Left ventricular (LV) remodeling can increase tethering force to mitral valve and functional mitral regurgitation (FMR). Because the relationship between FMR and regional myocardial function has not been quantitatively evaluated, we conducted a quantitative investigation of this association. Methods and Results—The effective regurgitant orifice (ERO) of FMR in 51 patients with depressed LV ejection fraction (32±9%) secondary to ischemic or nonischemic cardiomyopathy was compared with mitral deformation (valve and annulus), global LV remodeling (volume indices, function, and sphericity), and regional myocardial contractile function, as assessed by longitudinal peak systolic strain rate (Ssr) in LV anterior, anteroseptal, inferoseptal, inferior, inferolateral, and anterolateral segments at rest. Low-dose dobutamine (10 &mgr;g/kg per minute)-induced changes in ERO were compared with changes in the variables. Multivariable analysis identified the predictors of ERO at rest as mitral valvular tenting (&bgr;=0.062; P<0.001), Ssr in the inferior segment (inferior Ssr) (&bgr;=−0.178; P<0.001), and LV sphericity (&bgr;=0.414; P=0.001) and the predictors of valvular tenting at rest as inferior Ssr (&bgr;=−1.680; P<0.001), LV end-systolic volume index (&bgr;=0.022; P=0.001), and LV sphericity (&bgr;=3.886; P=0.012). Furthermore, dobutamine-induced reduction in ERO was predicted by reduction in valvular tenting (&bgr;=0.087; P<0.001) and increase in inferior Ssr (&bgr;=−0.082; P<0.001), and dobutamine-induced reduction in valvular tenting was predicted by increase in inferior Ssr (&bgr;=−0.860; P<0.001). Conclusions—Inferior regional myocardial dysfunction was quantitatively associated with mitral valvular tenting and FMR. Moreover, improvement with dobutamine of inferior myocardial contractile function attenuated valvular tenting and FMR. Inferior myocardial contractile function can affect the configuration of the mitral apparatus and predict FMR severity.