Yoshinobu Suwa

Obesity as an independent risk for left ventricular diastolic dysfunction in 692 Japanese patients

SUMMARY BACKGROUND Both obesity and left ventricular (LV) diastolic dysfunction are associated with an increased risk of cardiovascular morbidity and mortality. There is a paucity of data as to whether obesity is independently associated with LV diastolic dysfunction. METHODS Adult patients with sinus rhythm referred for a transthoracic echocardiography between July, 2007, and December, 2007, were prospectively included. Exclusion criteria were patient who had a history of congenital or valvular heart disease, treatment with pacemaker implantation or implantable cardioverter defibrillator, myocardial infarction, or impaired LV systolic function. Diastolic function was classified by an algorithm incorporating data from mitral and pulmonary venous flow indices, and Doppler tissue imaging. Body mass index (BMI) was evaluated as a categorical variable (normal weight <25.0 kg/m(2); overweight 25.0 to <30.0 kg/m(2); and obese ≥30 kg/m(2)). Logistic models were used to assess the risk of abnormal LV diastolic function associated with BMI categories. RESULTS Of a total number of 692 patients who met all study criteria (mean 59 ± 15 year-old; 50% women, 48% hypertension, 16% diabetes, 26% overweight, 8% obese), 538 (78%) had abnormal LV diastolic function. In multivariate analyses adjusting for age, sex, and cardiovascular risk factors, obesity was independently associated with LV diastolic dysfunction (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.12-7.88; P = 0.03) compared to normal weight. LV mass did not weaken this association (OR: 2.88, 95% CI: 1.08-7.68; P = 0.04). Overweight was not independently associated with LV diastolic dysfunction. CONCLUSION Obesity was associated with LV diastolic dysfunction independent of cardiovascular risk factors and LV mass.

Real Time Three‐Dimensional Transesophageal Echocardiographic Images of Platypnea‐Orthodeoxia Due to Patent Foramen Ovale

A 74-year-old man with a patent foramen ovale was admitted with dyspnea and cyanosis that had become progressively worse along with dehydration. Transthoracic echocardiography (iE33, Philips Medical Systems, Andover, MA, USA) revealed a normal ventricular size and function and no evidence of intracardiac shunting by Doppler color interrogation. Neither chest x-ray nor chest computed tomography (Aquilion 64, Toshiba Medical Systems, Otawara, Japan) revealed any apparent pulmonary disease that could cause his dyspnea. A right and left heart catheterization demonstrated normal coronaries with a mean right atrial pressure of 3 mmHg and a normal mean pulmonary artery pressure of 13 mmHg. Careful history taking revealed that he developed dyspnea in a sitting position, whereas the symptoms were relieved in a supine position. The transesophageal echocardiographic images taken in the supine position showed the foramen ovale was closed (Fig. 1 right), and no apparent right-to-left shunt by Doppler color flow (Fig. 1 left). The images taken in the sitting position showed the foramen ovale was wide open (Fig. 2 right, Fig. 3), with a massive rightto-left shunt across the patent foramen ovale by Doppler color flow (Fig. 2 left), caused hypoxemia and dyspnea. The patient was given the diagnosis of platypnea-orthodeoxia syndrome. Platypnea-orthodeoxia, a syndrome character-

Effect of eicosapentaenoic acid on regional arterial stiffness: Assessment by tissue Doppler imaging

AIM To evaluate the effects of eicosapentaenoic acid (EPA) on regional arterial stiffness assessed by strain rate using tissue Doppler imaging. METHODS Nineteen eligible patients were prospectively studied (mean age 62 ± 8 years, 68% men). Subjects with large vessel complications and/or diabetes mellitus were excluded. The strain rate of the ascending aorta was measured by tissue Doppler imaging as an index of regional arterial stiffness, and brachial-ankle pulse wave velocity (baPWV) was measured as an index of degree of systemic arteriosclerosis. These indices were compared before and after administration of EPA at 1800 mg/d for one year. RESULTS The plasma concentration of EPA increased significantly after EPA administration (3.0% ± 1.1% to 8.5% ± 2.9%, P < 0.001). There were no significant changes in baPWV (1765 ± 335 cm/s to 1745 ± 374 cm/s), low-density lipoprotein cholesterol levels (114 ± 29 mg/dL to 108 ± 28 mg/dL), or systolic blood pressure (131 ± 16 mmHg to 130 ± 13 mmHg) before and after EPA administration. In contrast, the strain rate was significantly increased by administration of EPA (19.2 ± 5.6 s(-1), 23.0 ± 6.6 s(-1), P < 0.05). CONCLUSION One year of administration of EPA resulted in an improvement in regional arterial stiffness which was independent of blood pressure or serum cholesterol levels.

Atypical morphology and myocardial perfusion of mid-ventricular ballooning: A case report

Although some atypical types of transient left ventricular apical ballooning syndrome have been reported, only a few atypical types of transient mid-ventricular ballooning have been reported. A 70-year-old female underwent surgery for urothelial carcinoma. At day 5 after the surgery, she was admitted to our department without cardiac symptoms because of ST elevation in leads I, II, III, aVF and V1-V6 indicating acute coronary syndrome. She was diagnosed with stress induced cardiomyopathy based on an angiographically normal coronary artery, newly developed extensive wall motion abnormality (hyperbasal contraction and akinesis from the mid-left ventricle to the apex without hypercontraction of the small area adjacent to the apex) based on left ventriculography, and a small elevation of myocardial enzymes incongruous with the area of contraction abnormality. Myocardial scintigraphy with 99mTc-tetrofosmin showed a severely reduced myocardial perfusion in an extensive mid-ventricular area without a left ventricular base and top of apex, in accord with a wall motion abnormality different from typical apical ballooning or typical mid-ventricular ballooning previously diagnosed in our hospital. This is the first report presenting an atypical mid-ventricular ballooning based on the myocardial atypical perfusion findings.