Yasuaki Wada

Urinary 8-hydroxy-2′-deoxyguanosine reflects symptomatic status and severity of systolic dysfunction in patients with chronic heart failure

Oxidative stress is known to play a crucial role in the pathogenesis of heart failure (HF). We investigated whether urinary 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), a product of oxidative DNA damage, is a clinically useful biomarker of the severity of chronic heart failure (CHF) and oxidative stress levels in failing hearts.

Impact of intraoperative transesophageal echocardiography in cardiac and thoracic aortic surgery: Experience in 1011 cases

BACKGROUND Although intraoperative transesophageal echocardiography (IOTEE) has been widely used in cardiovascular surgery, the exact incidence of abnormalities detected by IOTEE in each type of surgical procedure is still unclear. The aim of this study was to review our experiences of IOTEE, in patients who underwent different types of cardiovascular surgery and to evaluate the clinical usefulness of IOTEE. METHODS AND RESULTS Our database of 1011 consecutive patients, who underwent cardiovascular surgery and IOTEE monitoring was reviewed. The incidence of abnormal findings was 115 of 1011 patients (11.4%), and the highest incidence was the appearance of new wall motion abnormalities after cardiopulmonary bypass. These findings influenced surgical decision-making in 59 of the evaluated 1011 patients (5.8%). CONCLUSIONS IOTEE provides important intraoperative and postoperative information that may influence surgical decision-making in various cardiovascular surgeries.

Diastolic response during dobutamine stress echocardiography evaluated by a tissue velocity imaging technique is a sensitive indicator for diagnosing coronary artery disease

BACKGROUND Tissue velocity imaging (TVI) is a new method that measures regional myocardial velocities on the basis of color Doppler myocardial imaging principles. METHODS To diagnose coronary artery disease (CAD) objectively by evaluating left ventricular diastolic responses during dobutamine stress echocardiography (DSE) with TVI, we performed DSE in 22 healthy participants and 28 patients with angina pectoris without wall-motion abnormality at rest. Before and during DSE, we measured the differences of time intervals from the R wave on electrocardiogram to the peak of early diastolic myocardial velocity in the same cardiac cycle between basal segments and midsegments in the septal (dT-S) and inferior (dT-I) walls by TVI. RESULTS During DSE, dT-S in patients with left anterior descending CAD and dT-I in patients with right CAD were prolonged compared with that in healthy participants (both P <.01). The localization of the segments with a dT-S or dT-I during low-dose (10 microg/kg/min) dobutamine infusion of >32 milliseconds allowed the correct identification of the stenosed vessel in 87% of 23 patients for whom DSE was performed with the TVI technique before coronary angiography. CONCLUSIONS The analysis of regional left ventricular diastolic responses to dobutamine stress using TVI was useful for the objective diagnosis of CAD.

A Low-Dose β1-Blocker Effectively and Safely Slows the Heart Rate in Patients with Acute Decompensated Heart Failure and Rapid Atrial Fibrillation

Objective: Recently, we reported that low-dose landiolol (1.5 µg·kg-1·min-1), an ultra-short-acting β-blocker, safely decreased the heart rate (HR) in patients with acute decompensated heart failure (ADHF) and sinus tachycardia, thereby improving cardiac function. We investigated whether low-dose landiolol effectively decreased the HR in ADHF patients with rapid atrial fibrillation (AF). Methods: We enrolled 23 ADHF patients with rapid AF (HR ≥120 beats·min-1 and New York Heart Association class III-IV) and systolic heart failure (SHF: n = 12) or diastolic heart failure (DHF: n = 11) who received conventional therapy with diuretics, vasodilators, and/or low-dose inotropes. They were administered continuous intravenous infusion of low-dose landiolol (1.0-2.0 µg·kg-1·min-1), and their electrocardiograms and blood pressures were monitored for 24 h thereafter. Results: Two hours after starting landiolol, the HR was reduced significantly (22%), without a reduction in blood pressure, and remained constant thereafter. The HR reduction 2 h after landiolol administration was significantly greater in the DHF group than in the SHF group. No incidence of hypotension was recorded. Conclusions: Digitalis or amiodarone is currently recommended for HR control in ADHF patients with rapid AF. Our results showed that continuous infusion of low-dose landiolol may also be useful as first-line therapy in these patients.

The impact of intermittent pneumatic compression devices on deep venous flow velocity in patients with congestive heart failure

BACKGROUND Intermittent pneumatic compression (IPC) has been used to prevent deep venous thrombosis (DVT), but the effects of IPC on the hemodynamics of popliteal and soleal veins, especially in patients with congestive heart failure (CHF) have not been evaluated. The aim of this study was to evaluate the effects of IPC on the flow velocity of deep veins in the lower extremities and to compare the efficacy of two different types of IPC in deep venous flow enhancement in patients with CHF. METHODS Flow velocities of popliteal and soleal veins were recorded in 19 patients with CHF and in 19 control subjects using a high-resolution linear probe. Peak and mean flow velocities were measured (1) at rest, (2) with sequential foot and calf IPC (SFC-IPC) which consists of an electrically driven air compressor and four air chambers, and (3) with impulse foot IPC (IF-IPC) which consists of a pneumatic impulse generator operated at an applied pressure of 130 mmHg. RESULTS In the resting condition, popliteal venous flow velocity in the CHF group was attenuated (12.8+/-4.7 cm/s vs. 21.1+/-13.5 cm/s; p<0.05). Both SFC-IPC and IF-IPC increased venous velocity, but the increase with IF-IPC in CHF patients was lower than that in control subjects. In the soleal veins, after applying SFC-IPC, the peak and mean velocity in CHF increased to the same extent as in the control group. IF-IPC increased soleal venous velocity in control subjects, but there was no increase in CHF patients. CONCLUSION Two-dimensional Doppler scanning revealed a significant increase in the mean and peak velocities in the soleal and popliteal veins with SFC-IPC but not with IF-IPC in patients with CHF. These results indicate that SFC-IPC could have favorable effects in preventing DVT in patients with CHF.

Right ventricular dysfunction in patients with Brugada-like electrocardiography: a two dimensional strain imaging study

BackgroundSodium channel blockers augment ST-segment elevation in the right precordial leads in patients undergoing Brugada-type electrocardiography (ECG). However, their effect on echocardiographic features is not known. We address this by assessing global and regional ventricular function using conventional Doppler and two- dimensional (2D) speckle tracking techniques.MethodsThirty-one patients with Brugada-type ECG were studied. A pure sodium channel blocker, pilsicainide, was used to provoke an ECG response. The percentage longitudinal systolic myocardial strain at the base of both the right ventricular (RV) free wall and the interventricular septum wall was measured using 2D speckle tracking. Left ventricular (LV) and RV myocardial performance (TEI) indices were also measured.ResultsThe pilsicainide challenge provoked a positive ECG response in 13 patients (inducible group). In the inducible group, longitudinal strain was significantly reduced only at the RV (-27.3 ± 5.4% vs -22.1 ± 3.6%, P < 0.01), and both RV and LV TEI indices increased (RV: 0.19 ± 0.09 vs 0.27 ± 0.11, P < 0.05; LV: 0.30 ± 0.10 vs 0.45 ± 0.10, P < 0.01) after pilsicainide administration.ConclusionsTemporal and spatial analysis using the TEI index and 2D strain imaging revealed the deterioration of global ventricular function associated with conduction disturbance and RV regional function in patients with Brugada-type ECG and coved type ST elevation due to administration of a sodium channel blocker.

Is the ratio of transmitral peak E wave velocity to color flow propagation velocity useful for evaluating severity of heart failure in atrial fibrillation

BACKGROUND Although analysis of the transmitral inflow (TMF) pattern is widely used for evaluating left ventricular diastolic function and provides valuable information for the management of heart failure (HF) in sinus rhythm, its utility in patients with atrial fibrillation (AF) has not been established. The aim of this study was to investigate the relationship between the ratio of transmitral peak E-wave velocity to flow propagation velocity (E/Vp) obtained by a newly developed dual Doppler system and the plasma B-type natriuretic peptide (BNP) concentration or pulmonary capillary wedge pressure (PCWP) for evaluating the severity of heart failure with AF. METHODS AND RESULTS In 68 patients with AF, the E/Vp was compared with plasma BNP concentration and PCWP. A cutoff value of > or =1.7 for E/Vp predicted a plasma BNP concentrationl of > or =200 pg/ml, with 80% sensitivity and 84% specificity. Only E/Vp was found to be independently significant by stepwise multilinear regression analysis (r=0.40, p=0.01). PCWP values had good correlation with E/Vp (r=0.63, p<0.01) and were significantly higher in the group with E/Vp >/=1.7 (16+/-6 mmHg vs 11+/-4 mmHg, p<0.05). CONCLUSION The Doppler-derived index of E/Vp correlated well with the neurohormonal and hemodynamic parameters, and was useful for evaluating the severity of heart failure with AF.

1-Year Follow-Up of Contained Aortic Root Rupture After Transcatheter Aortic Valve Replacement

The authors performed a transfemoral aortic valve replacement (TF-TAVR) in an 89-year-old woman with severe aortic stenosis. The pre-operative transthoracic echocardiography (TTE) revealed severe aortic stenosis (aortic valve area 0.6 cm2) with huge calcifications at each leaflet. At multislice

Coronary obstruction occurring 72 h after transcatheter aortic valve replacement with a self-expandable valve

Article history: Received 6 July 2016 Accepted 5 August 2016 Available online 07 August 2016 tive valve close to the LCA ostium. After dilation using a 20-mmballoon, paravalvular leakage was reduced from moderate to mild without any significant findings of myocardial ischemia. Her hemodynamic status was stable and final aortography showed no coronary flow impairment (Fig. 1). Three days after TAVR, she complained of sudden strong dyspnea.

Bow hunter's syndrome

A 62-year-old man with non-obstructive hypertrophic cardiomyopathy developed rotatory vertigo and pre-syncope on turning his head to the left, since the past 2 months. He had received an implantable cardioverter defibrillator owing to a history of syncope caused by ventricular fibrillation. Ultrasonography of the carotid artery (UCA) showed a significant decrease in the …