Yoshifumi Oishi

The Functional Role of Longitudinal, Circumferential, and Radial Myocardial Deformation for Regulating the Early Impairment of Left Ventricular Contraction and Relaxation in Patients With Cardiovascular Risk Factors: A Study With Two-Dimensional Strain Imaging

BACKGROUND Two-dimensional strain imaging allows rapid and accurate analysis of regional left ventricular (LV) systolic and diastolic mechanics in the longitudinal, radial, and circumferential directions. The aim of this study was to assess precisely the differences in early impairment of LV myocardial contraction and relaxation among the 3 directions in 70 patients with cardiovascular risk factors and preserved LV pump function. METHODS The patients were classified into 2 groups according to the ratio of early diastolic to atrial systolic velocity (E/A) of transmitral flow: E/A > or = 1 (n = 35, 57 +/- 6.8 years) or E/A < 1 (n = 35, 60 +/- 4.9 years). The longitudinal strain and strain rate curves were determined in apical 2- and 4-chamber views, and radial and circumferential strain and strain rate curves and LV torsion curve were determined in the parasternal short-axis views. RESULTS The mean peak systolic longitudinal strain and strain rate were lower, whereas the mean peak systolic circumferential strain and strain rate were greater in the E/A < 1 group. There were no significant differences in the mean peak systolic radial strain and strain rate between the 2 groups. The mean peak early diastolic longitudinal strain rate was markedly lower in the E/A < 1 group. The mean peak LV strain rates during atrial systole in all 3 directions were greater in the E/A < 1 group. The mean peak LV systolic longitudinal strain and longitudinal strain rate during atrial systole were independent predictors related to E/A in all patients. There were no significant differences in torsion and torsional and untwisting rates between the 2 groups. CONCLUSION LV myocardial contraction and relaxation were first impaired in the longitudinal direction among the 3 directions in subclinical patients with cardiovascular risk factors. However, LV pump function and LV filling were compensated by circumferential shortening at ventricular systole and 3 directional lengthenings at atrial systole, respectively.

Circulating adhesion molecules and severity of coronary atherosclerosis.

BackgroundCirculating leukocytes are recruited at atherosclerotic sites through a family of adhesion molecules. Circulating forms of adhesion molecules in peripheral blood can be quantified now. ObjectiveTo evaluate the relationship between circulating adhesion molecules and severity of coronary atherosclerosis. MethodsSubjects included 81 patients undergoing diagnostic coronary angiography, 12 of whom had normal coronary arteries (control group). The remaining 69 patients with demonstrable coronary atherosclerosis were divided into two groups by use of Gensini scores, namely mild atherosclerosis (n=36, Gensini score 1–20) and severe atherosclerosis (n =33, Gensini score>20). Serum levels of circulating intercellular adhesion molecule‐1 (ICAM‐1), vascular cellular adhesion molecule‐1 (VCAM‐1), and E‐selectin of groups measured before angiography were compared. ResultsCirculating levels of ICAM‐1 in members of mild and severe atherosclerosis groups were significantly higher than those in members of the control group, whereas there was no significant difference among circulating levels of VCAM‐1 in members of the three groups. Circulating levels of E‐selectin in members of the mild atherosclerosis group were significantly higher than those in members of the severe atherosclerosis and control groups. ConclusionsThese findings suggest that E‐selectin is related to the early stage, and ICAM‐1 is related to the advanced stage, of coronary atherosclerosis. With progression of atherosclerosis, one‐step adhesion by ICAM‐1 could become more important than multistep adhesion involving E‐selectin, ICAM‐1, and VCAM‐1. These molecules may serve as markers for severity of coronary atherosclerosis.

A novel approach to assess aortic stiffness related to changes in aging using a two-dimensional strain imaging.

Background: Recently, it has been demonstrated that aortic stiffness is associated with cardiovascular morbidity and mortality. The objective of the present study was to accurately evaluate the aortic stiffness relative to the changes in aging using two‐dimensional (2D) strain imaging in 39 comparatively normal patients (15–85 years). Methods: We obtained short‐axis images of the abdominal aorta (Ao) and determined the peak circumferential strain (Ao‐S) and strain rate (Ao‐SR) and the time from Q‐wave of electrocardiogram to peak Ao‐S using the 2D strain imaging. The stiffness parameters β1 and β2 of the abdominal aorta were measured using M‐mode ultrasonography and 2D strain imaging, respectively. Results: The stiffness parameters β1 and β2 correlated significantly with age (r=0.51, P < 0.001 and r=0.69, P < 0.0001, respectively), particularly the latter parameter β2. The peak circumferential Ao‐S and Ao‐SR correlated strongly with age (r=−0.79, P < 0.0001 and r=−0.87, P < 0.0001, respectively). The stiffness parameter β1 was significantly greater in the old‐aged group (>60 years) than in the young‐aged group (<30 years). The peak circumferential Ao‐S and Ao‐SR were significantly lower in the middle‐aged (30–60 years) and old‐aged groups than in the young‐aged group. Conclusion: The aortic circumferential strain and strain rate measured by 2D strain imaging allow simple and accurate determination of the aortic stiffness.

Early detection of abnormal left atrial-left ventricular-arterial coupling in preclinical patients with cardiovascular risk factors: evaluation by two-dimensional speckle-tracking echocardiography

AIMS Data are lacking on the left atrial (LA)-left ventricular (LV)-arterial coupling for evaluating the functional abnormalities in the left heart disease, whereas LA-LV or LV-arterial coupling has been recognized. This study was designed to earlier detect the abnormal LA-LV-arterial coupling using two-dimensional speckle-tracking echocardiography (2DSTE) in patients with cardiovascular risk factors and no overt cardiovascular disease. METHODS AND RESULTS We studied 30 age-matched healthy individuals and 64 preclinical patients with cardiovascular risk factors, who measured carotid arterial intima-media thickness and stiffness β by M-mode ultrasonography, and strain and strain rate of the LA and LV walls by 2DSTE. The stiffness β and LA volume index (LAVI) were greater in the patient group than in the control group. However, the peak systolic LV longitudinal strain, peak systolic and early diastolic LV longitudinal strain rates, peak systolic and early diastolic LA strains and strain rates, and peak atrial systolic LA strain rate were lower in the patient group. There were correlations between the stiffness β and the age, pulse pressure, LAVI, peak early diastolic LV longitudinal strain rate, and all LA strains and strain rate variables. Multivariate regression analysis indicated that peak early diastolic LV longitudinal strain rate and peak LA strain rate during ventricular systole are defined as strong predictors related to stiffness β. CONCLUSION Impaired LA and LV relaxation in the longitudinal direction are early signs of abnormal LA-LV coupling related to arterial stiffness in preclinical patients with cardiovascular risk factors. 2DSTE enables the quantitative assessment of the LA and LV function, and can be considered a sensitive tool for detecting the abnormal LA-LV-arterial coupling.

Leukocyte counts and concentrations of soluble adhesion molecules as predictors of coronary atherosclerosis.

BackgroundAuthors of recent studies have reported that there is a relationship between level of adhesion molecules and atherosclerosis. In an animal study it was demonstrated that there is an interaction between adhesion molecules and leukocytes in atherosclerotic tissue. ObjectiveTo study the relationships between coronary‐artery atherosclerosis and both differential blood‐leukocyte count and concentrations of soluble adhesion molecules in patients with and without coronary artery disease (CAD). MethodsOur subjects were 168 patients who underwent diagnostic coronary angiography. Forty‐eight patients had normal coronary angiograms (control group), and 120 patients had significant coronary‐artery stenoses (diameter stenosis > 70%) in at least one major coronary‐artery branch (CAD group). Total and differential blood‐leukocyte counts, and concentrations of soluble intercellular adhesion molecule‐1 (sICAM‐1) and vascular cell adhesion molecule‐1 (sVCAM‐1) were assayed prior to angiography. ResultsMonocyte counts for patients in the CAD group were significantly greater than those for patients in the control group (366 ± 99 versus 258 ± 44/μl, P  < 0.0001), as were the sICAM‐1 concentrations (272 ± 52 versus 203 ± 24 ng/ml, P  < 0.0001). The mean concentrations of sVCAM‐1 in members of the two groups were the same (671 ± 138 versus 668 ± 97 ng/ml, P  = 0.4). There was a higher incidence of significant coronary‐artery stenosis among patients with both a high monocyte count and a high concentration of sICAM‐1 (≥ mean+SD) than there was among patients with a low monocyte count and a low concentration of sICAM‐1 (≥ mean−SD; 100 versus 25%, P  < 0.0001). ConclusionsHigher levels both of monocyte counts and of serum concentrations of ICAM‐1 may serve as markers for coronary atherosclerosis.

Beneficial effects of telmisartan on left ventricular structure and function in patients with hypertension determined by two-dimensional strain imaging.

Background Telmisartan is an angiotensin II receptor blocker with established beneficial effects on cardiac structure and function in animal models. Our aim was to clinically clarify the cardiprotective ability, beyond lowering blood pressure (BP), of telmisartan on left ventricular (LV) myocardial mechanics in patients with hypertension using a two-dimensional (2-D) strain imaging. Methods Telmisartan (20–40 mg daily) was administered to 35 previously untreated patients with hypertension. Conventional and 2-D strain echocardiography were performed after medication had been continued for 1–2 months with values of systolic BP less than 140 mmHg and diastolic BP less than 90 mmHg (phase I) and for 12 months (phase II) in all patients and 30 age-matched normal individuals. Results There were no differences in BP, LV ejection fraction, and ratio of peak early to late diastolic transmitral flow velocity (E/A) between phases I and II of hypertension group and normal group. In phase I, the mean peak systolic strains and strain rates in the longitudinal and circumferential directions, mean peak early diastolic strain rates in the longitudinal, circumferential, and radial directions, and mean peak atrial systolic strain rate in the longitudinal direction were lower than those in the normal group. In phase II, the LV mass index, relative LV wall thickness, isovolumic relaxation time, torsion and torsional rate were decreased, whereas the mean peak systolic strains and early diastolic strain rates in all the three directions, mean peak systolic strain rates in the longitudinal and circumferential directions, and mean peak atrial systolic strain rate in the longitudinal direction were increased compared with phase I. Conclusion The use of telmisartan in patients with hypertension improved not only LV geometric remodeling but also regional LV myocardial contraction and relaxation in the three directions, especially longitudinal and circumferential directions. Our results support beneficial effects on LV structure and function beyond BP reduction from continuous long-term telmisartan therapy.

Vascular aging of common carotid artery and abdominal aorta in clinically normal individuals and preclinical patients with cardiovascular risk factors: diagnostic value of two-dimensional speckle-tracking echocardiography

Increased arterial stiffness is becoming an increasing health care problem as the population ages. Our aim was to detect the vascular aging of common carotid artery (CCA) and abdominal aorta (AAO) more easily and earlier using two-dimensional speckle-tracking echocardiography, and to evaluate the regional differences in mechanical properties related to changes in aging between the two arteries in preclinical patients. Twenty-nine clinically normal individuals and 68 preclinical patients with cardiovascular risk factors were examined. The peak circumferential strains were measured from the short-axis views of the CCA and AAO, and each stiffness β was determined. The CCA and AAO diameters increased with advanced age, and the latter diameter was widely distributed in patients of 50 years or older. The mean strain and stiffness index of the AAO were greater and lower, respectively, than those of the CCA at all ages. The CCA and AAO strains decreased with age, expressing dramatic declines before the fifth decade of life. The CCA and AAO stiffness indices increased with age, expressing rapid ascents after the fifth decade of life, particularly in the AAO. The best markers of subclinical arterial aging were strain in younger persons and stiffness in older individuals. Two-dimensional speckle-tracking echocardiography is a new tool that can be used to directly and easily evaluate arterial function.

Aortic stiffness is strikingly increased with age ≥50 years in clinically normal individuals and preclinical patients with cardiovascular risk factors: Assessment by the new technique of 2D strain echocardiography

BACKGROUND Various measures of aortic stiffness have been proposed as cardiovascular risk markers, but interest has now shifted to more direct and easier evaluation of aortic function. The present study was conducted to determine the feasibility of measuring aortic stiffness (β) with two-dimensional (2D) strain echocardiography and the impact of age and gender on preclinical atherosclerosis. METHODS AND RESULTS The peak circumferential strain of the abdominal aorta was measured using 2D strain echocardiography, and β was determined in 54 clinically normal individuals and 104 patients with cardiovascular risk factors and no evidence of cardiovascular disease. The β correlated significantly with age in all 158 patients. However, the relationship was nonlinear, and β was markedly greater in patients ≥ 50 years. In 54 clinically normal individuals, the relationship was comparatively linear. The systolic blood pressure and pulse pressure were significantly greater in patients ≥ 50 years. There were no significant differences in β and blood pressure parameters between genders. CONCLUSIONS The β increased dramatically with advanced age (≥ 50 years), regardless of gender, in clinically healthy and community-based patients with cardiovascular risk factors. The aortic circumferential strain was measured with 2D strain echocardiography which is a new tool that can be used to directly and easily evaluate aortic stiffness.

Possible mechanisms of left ventricular torsion evaluated by cardioreparative effects of telmisartan in patients with hypertension.

AIMS Left ventricular (LV) torsion may be an important component of normal LV systolic function. However, its mechanics remain unresolved. Two-dimensional (2-D) strain imaging is increasingly used to quantify LV torsion in the clinical setting. Telmisartan has cardioreparative effects, including attenuation of subendocardial myocardial fibrosis and improvement of LV remodelling. To clarify the mechanisms of LV torsion, in the present study, we evaluated changes in LV longitudinal deformation and torsion after medication with telmisartan using 2-D strain imaging in patients with hypertension (HT). METHODS AND RESULTS Telmisartan (20-40 mg daily) was administered to 37 previously untreated patients with HT. Two-dimensional strain echocardiography was performed after medication had been continued for 1-2 months with normal values for blood pressure (BP) (phase I) and for 12 months (phase II). In the phase II, relative LV wall thickness, LV mass index, LV torsion, and torsional rate were reduced, whereas the mean peak systolic longitudinal strain and strain rate were increased, compared to the phase I. LV torsion correlated well with relative LV wall thickness, but not LV mass index. CONCLUSION Our results obtained from cardioreparative effects of telmisartan suggested that LV torsion is associated with systolic longitudinal deformation related to subendocardial myocardial fibrosis, and/or LV concentric hypertrophy-related difference in torques between the subendocardial and subepicardial sides.

Association of left atrial reservoir function with left atrial structural remodeling related to left ventricular dysfunction in asymptomatic patients with hypertension: evaluation by two-dimensional speckle-tracking echocardiography

Abstract Left atrial (LA) structural and functional abnormalities are vital steps on the pathway toward heart failure with preserved ejection fraction in asymptomatic patients. The purpose of this study was to assess the relationship of LA function, particularly reservoir function, with LA structural remodeling related to the left ventricular (LV) dysfunction in asymptomatic patients with hypertension (HT) using conventional, tissue Doppler, and 2-D speckle-tracking echocardiography. Fifty age-matched healthy individuals and 140 patients with HT, including 75 with LA volume index (LAVI) < 29 ml/m2 (normal LA group) and 65 with LAVI ≥ 29 ml/m2 (large LA group), were enrolled. We defined peak early diastolic transmitral flow velocity/peak early diastolic mitral annular motion velocity (E/e′)/peak systolic LA strain (S-LAs) as LA diastolic stiffness. The LV mass index, relative LV wall thickness, peak atrial systolic transmitral flow velocity, LA total, active, and passive emptying volume indexes, and E/e′/S-LAs were greatest, and S-LAs, peak early diastolic LA strain, peak systolic LV longitudinal strain and circumferential strain rate, and peak early diastolic LV radial strain rate were lower in the large LA group compared with control and/or normal LA group. Multivariate linear regression analysis revealed that aging, LA remodeling, and LV systolic and diastolic dysfunction are defined as strong predictors related to increased LA diastolic stiffness in the large LA group. HT alters LA dynamics significantly, with resultant increased LA volume and diastolic stiffness related to LV diastolic and systolic dysfunction, even in asymptomatic patients. Earlier treatment with reninangiotensin system inhibitors may improve abnormal LA-LV interaction in this patient population.