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Nagata Y, Iwataki M, Nabeshima Y, Hei S, Onoue T, Hayashi A, Otani K, Tsuda Y, Araki M, Kim DH, Song JK, Hayashida A, Toki M, Yuasa T, Mizukami N, Nishimura Y, Levine RA, Otsuji Y. Potential mechanism of left ventricular spherical remodeling: association of mitral valve complex-myocardium longitudinal tissue remodeling mismatch. Am J Physiol Heart Circ Physiol 2020; 319:H694-H704. [PMID: 32795182 DOI: 10.1152/ajpheart.00279.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since mitral valve (MV) complex (MVC) longitudinally bridges left ventricular (LV) base end and its middle, insufficient MVC longitudinal tissue length (TL) elongation relative to whole LV myocardial longitudinal TL elongation could limit LV-base-longitudinal-TL elongation, leading to predominant LV-base-transverse-TL elongation, constituting LV spherical remodeling. In 30 patients with dilated cardiomyopathy (DCM), 30 with aortic regurgitation (AR), and 30 controls, LV sphericity, LV-apex- or base-transverse- and longitudinal-TL, MVC-longitudinal-TL, and whole-LV-longitudinal-TL were measured by three-dimensional (3D) echocardiography. Ratio of each measure versus mean normal value (i.e., LV-apex-transverse-TL ratio) was considered to express the directional and regional tissue elongation. [LV-base-longitudinal-TL ratio/global-LV-TL ratio] and [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] were obtained as the degree of LV-base-longitudinal-TL or MVC-longitudinal-TL elongation relative to the whole LV elongation. LV-apex-transverse-, LV-apex-longitudinal-, and LV-base-transverse-TL ratios were significantly increased (1.27 to 1.42, P < 0.01) in both DCM and AR, while the LV-base-longitudinal-TL ratio was not increased in DCM [1.04 ± 0.19, not significant (ns)] and only modestly increased in AR (1.12 ± 0.21, P < 0.01). Whole-LV-longitudinal-TL ratio was significantly increased in both DCM and AR (1.22 ± 0.18 and 1.20 ± 0.16, P < 0.01), while MVC-longitudinal-TL ratio was not or only modestly increased in both groups (1.07 ± 0.15, ns, and 1.12 ± 0.17, P = 0.02, respectively). Multivariable analysis revealed that LV sphericity was independently related to a reduced [LV-base-longitudinal-TL ratio/global-LV-TL ratio] (standard β = -0.42, P < 0.01), which was further related to a reduced [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] (standard β = 0.72, P < 0.01). These are consistent with the hypothesis that relatively less MVC-longitudinal-TL elongation in the process of primary LV myocardial tissue elongation may limit LV-base-longitudinal-TL elongation, contributing to LV spherical remodeling.NEW & NOTEWORTHY Left ventricular (LV) spherical remodeling is associated with poor prognosis and less-effective cardiac performance, which commonly develops in dilated cardiomyopathy. However, its mechanism remains unclear. We hypothesized and subsequently clarified that less mitral valve complex (MVC) tissue longitudinal elongation relative to whole LV myocardial tissue longitudinal elongation is related to disproportionately less LV base longitudinal versus transverse myocardial tissue elongation, constituting spherical remodeling. This study suggests modification of MVC tissue elongation could be potential therapeutic targets.
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Affiliation(s)
- Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.,Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mai Iwataki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Soshi Hei
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Takeshi Onoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Atsushi Hayashi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Kyoko Otani
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yuki Tsuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Masaru Araki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Dae-Hee Kim
- Department of Echocardiography, Asan Medical Center, Seoul, Korea
| | - Jae-Kwan Song
- Department of Echocardiography, Asan Medical Center, Seoul, Korea
| | - Akihiro Hayashida
- Department of Cardiology, the Sakakibara Heart Institution of Okayama, Okayama, Japan
| | - Misako Toki
- Department of Clinical Laboratory, the Sakakibara Heart Institution of Okayama, Okayama, Japan
| | - Toshinori Yuasa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medicine and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Naoko Mizukami
- Department of Clinical Laboratory, Graduate School of Medicine and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Uchiyama N, Yuasa T, Miyata M, Horizoe Y, Chaen H, Kubota K, Takasaki K, Mizukami N, Kisanuki A, Ohishi M. Correlation of Right Ventricular Wall Stress With Plasma B-Type Natriuretic Peptide Levels in Patients With Pulmonary Hypertension. Circ J 2019; 83:1278-1285. [DOI: 10.1253/circj.cj-18-1155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nami Uchiyama
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Toshinori Yuasa
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Yoshihisa Horizoe
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Hideto Chaen
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Kayoko Kubota
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Kunitsugu Takasaki
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
| | - Naoko Mizukami
- Department of Clinical Laboratory, Kagoshima University Medical and Dental Hospital
| | - Akira Kisanuki
- Department of Health Sciences, Kagoshima University Faculty of Medicine, Kagoshima University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medicine and Dental Sciences
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Horizoe Y, Takasaki K, Miyata M, Chaen H, Kubota K, Mizukami N, Yuasa T, Kisanuki A, Ohishi M. Analysis of Biphasic Right Ventricular Outflow Doppler Waveform in Patients with Pulmonary Hypertension. Int Heart J 2019; 60:108-114. [PMID: 30464137 DOI: 10.1536/ihj.18-149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary hypertension (PH) with pulmonary vascular disease (PVD) is a progressive and debilitating disease associated with increased pulmonary vascular resistance (PVR). Biphasic right ventricular outflow tract (RVOT) Doppler flow is frequently seen in severe PH patients with PVD. In association with hemodynamics, the precise analysis of biphasic RVOT Doppler flow (RVDF) has not been fully elucidated. Therefore, the purpose of the present study is to analyze the relation between the hemodynamics and indices of biphasic RVDF in PH patients with PVD.Seventy PH patients with biphasic RVDF were analyzed. All patients underwent transthoracic echocardiography and right heart catheterization. For the analysis of biphasic RVDF, the early waveform was determined as P1 while the late waveform was determined as P2. For each P1 and P2, the duration (D, seconds) and peak flow velocity (PFV, in m/second) were measured.P1D and P2PFV were significantly correlated with PVR (P1D: r = -0.542, P < 0.0001, P2PFV: r = -0.513, P < 0.0001). Therefore, we propose a novel RVDF formula for estimation of PVR, as follows. PVR = 26 - 77 × P1D - 14 × P2PFV. The PVR could be estimated by this proposed formula (r = 0.649, P < 0.0001), which is derived from one Doppler image only unlike previously used PVR prediction formula.P1D and P2PFV were associated with PVR. Moreover, this simple RVDF formula proposed herein can estimate PVR in PH patients with PVD.
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Affiliation(s)
- Yoshihisa Horizoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Kunitsugu Takasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Hideto Chaen
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Kayoko Kubota
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Naoko Mizukami
- Department of Clinical Laboratory, Kagoshima University Hospital
| | - Toshinori Yuasa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akira Kisanuki
- School of Health Sciences, Faculty of Medicine, Kagoshima University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
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Yuasa T, Takenaka T, Higuchi K, Uchiyama N, Horizoe Y, Cyaen H, Mizukami N, Takasaki K, Kisanuki A, Miyata M, Ohishi M. Fabry disease. J Echocardiogr 2017; 15:151-157. [PMID: 28674962 DOI: 10.1007/s12574-017-0340-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 05/13/2017] [Accepted: 06/09/2017] [Indexed: 02/02/2023]
Abstract
Fabry disease resulting from a deficiency of α-galactosidase A leads to the accumulation of globotriaosylceramide in various organs. Because the disease is an X-linked recessive disorder, males tend to develop more symptoms and more severe symptoms than females. There are also some variants of Fabry disease, and cardiac variant (cardiac Fabry disease) has the dysfunctions only in heart. Cardiac manifestations in Fabry disease are initially symmetrical and concentric left ventricular hypertrophy, and later progressive cardiac dysfunction with localized thinning of the basal posterior wall. In recent years, enzyme replacement therapy has been performed as a treatment for Fabry disease, and the initiation of this therapy is expected before the cardiac fibrosis develops. Therefore, early diagnosis of Fabry disease is essential, and echocardiography is an indispensable tool for clinical practice of this disease. Then, it is necessary to remember this disease as a differential diagnosis when encountering unexplained left ventricular hypertrophy.
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Affiliation(s)
- Toshinori Yuasa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan.
| | - Toshihiro Takenaka
- Department of Internal Medicine, Tarumizu Chuo Hospital, Tarumizu, Japan
| | - Koji Higuchi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Nami Uchiyama
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Yoshihisa Horizoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Hideto Cyaen
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Naoko Mizukami
- Clinical Laboratory, Kagosima University Hospital, Kagoshima, Japan
| | - Kunitsugu Takasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Akira Kisanuki
- Department of Health Science, Kagoshima University Faculty of Medicine, Kagoshima, Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
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Mizukami N. [Practical Use of Doppler Ultrasonography of the Cardiovascular System and Clinical Laboratory Tests for the Management of Pulmonary Embolism]. Rinsho Byori 2015; 63:957-963. [PMID: 26638433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Acute or chronic pulmonary embolism (PE) is a serious disease, and the risk of mortality is increased if untreated. In 90% of cases the embolus source is deep vein thrombosis (DVT) of the lower limbs or pelvic cavity. Therefore, it is necessary to recognize these as venous thromboembolism (VTE) which includes both DVT and PE. I suggest that Doppler ultrasonography of cardiovascular and clinical laboratory tests provide very valuable medical support for the management of VTE. Specifically, in the early diagnosis of VTE and the prevention of fatal PE, Doppler ultrasonography (cardiac and vascular) can provide very useful information. On the other hand, blood coagulation and thrombophilia tests are important to determine the risk of VTE and evaluate the effect of anticoagulant therapy on VTE. In this paper, I explain the main points of each examination of VTE by describing representative cases. I also show the results on investigating cases in our hospital involving diseases related to VTE and the onset site of DVT. In addition, I introduce how we convey the results of analysis to the clinical side.
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Yuasa T, Takasaki K, Mizukami N, Ueya N, Kubota K, Horizoe Y, Chaen H, Kuwahara E, Kisanuki A, Hamasaki S. Prosthetic tricuspid valve dysfunction assessed by three-dimensional transthoracic and transesophageal echocardiography. J Echocardiogr 2013; 11:97-9. [PMID: 27278613 DOI: 10.1007/s12574-013-0170-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/20/2013] [Accepted: 02/13/2013] [Indexed: 10/26/2022]
Abstract
A 39-year-old male who had undergone tricuspid valve replacement for severe tricuspid regurgitation was admitted with palpitation and general edema. Two-dimensional (2D) echocardiography showed tricuspid prosthetic valve dysfunction. Additional three-dimensional (3D) transthoracic and transesophageal echocardiography (TEE) could clearly demonstrate the disabilities of the mechanical tricuspid valve. Particularly, 3D TEE demonstrated a mass located on the right ventricular side of the tricuspid prosthesis, which may have caused the stuck disk. This observation was confirmed by intra-operative findings.
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Affiliation(s)
- Toshinori Yuasa
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan.
| | - Kunitsugu Takasaki
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Naoko Mizukami
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Nami Ueya
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Kayoko Kubota
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Yoshihisa Horizoe
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Hideto Chaen
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Eiji Kuwahara
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Akira Kisanuki
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Shuichi Hamasaki
- Department of Cardiology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Japan
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Ebihara A, Yamaoka A, Mizukami N, Sakoda A, Nitta JH, Imaichi R. A survey of the fern gametophyte flora of Japan: Frequent independent occurrences of noncordiform gametophytes. Am J Bot 2013; 100:735-43. [PMID: 23510760 DOI: 10.3732/ajb.1200555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PREMISE OF THE STUDY Ferns and lycophytes are the only extant land plants with two free-living generations (sporophytes and gametophytes); hence, a single species may have two different distributions. The distribution of the gametophytes of most fern species, which are much smaller in size than sporophytes, are almost unknown due to the difficulty of identifying gametophytes using morphological characters. METHODS Twelve quadrats (1 m(2) or 0.25 m(2)), each subdivided into a grid of 100 (10 × 10) or 25 (5 × 5) squares, were used to survey gametophytes in the Japanese Archipelago, where distribution data of sporophytes and "DNA barcodes" for identification of gametophytes have fully been established in previous studies. Collected gametophytes were identified using the plastid rbcL-a region. KEY RESULTS In total, gametophytes of 38 species in two broad morphological categories (28 cordiform and 10 noncordiform species) were identified among 407 collections. The cordiform gametophytes discovered are without exception accompanied by their conspecific sporophytes at the periphery of the quadrats. On the other hand, the sporophytic counterparts of the noncordiform gametophytes are often not found or are rare around the sites. CONCLUSIONS This study demonstrates with a regional flora that fern gametophytes do not always co-occur with sporophytes of the same species. In particular, noncordiform gametophytes tended to occur independently of conspecific sporophytes. This pattern may be due to the capability for indeterminate growth and vegetative reproduction by gemmae in noncordiform gametophytes.
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Affiliation(s)
- Atsushi Ebihara
- Deparment of Botany, National Museum of Nature and Science, 4-1-1 Amakubo, Tsukuba 305-0005, Japan.
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Takasaki K, Miyata M, Imamura M, Yuasa T, Kuwahara E, Kubota K, Kono M, Ueya N, Horizoe Y, Chaen H, Mizukami N, Kisanuki A, Hamasaki S, Tei C. Left ventricular dysfunction assessed by cardiac time interval analysis among different geometric patterns in untreated hypertension. Circ J 2012; 76:1409-14. [PMID: 22447013 DOI: 10.1253/circj.cj-11-1369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Left ventricular (LV) hypertrophy is a powerful independent predictor of morbidity and mortality in hypertensive patients. Abnormal LV geometric patterns are also associated with hypertensive complications, and concentric hypertrophy is associated with the highest mortality in hypertensive patients. However, the relationship between geometric patterns and cardiac dysfunction is not fully established. We hypothesized that the Tei index, which is a measure of global cardiac function, is a feasible parameter for estimating cardiac dysfunction among the different LV geometric patterns in hypertensive patients. METHODS AND RESULTS We enrolled 60 consecutive patients with untreated essential hypertension. Subjects were divided into 4 groups: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. We measured ejection fraction, mitral E/A ratio, Tei index, ejection time, and isovolumic contraction and relaxation times. There were significant correlations between LV mass index and systolic blood pressure (P<0.01), ejection fraction (P<0.05), mitral E/A ratio (P<0.05) and Tei index (P<0.0001). In multiple regression analysis, only the Tei index independently correlated with LV mass index (P<0.01). Concentric hypertrophy significantly increased the Tei index compared with the other 3 groups. CONCLUSIONS The Tei index provides a better marker for LV dysfunction by hypertensive hypertrophy than conventional parameters. LV function in concentric hypertrophy was most impaired among all the geometric patterns in untreated hypertensive patients.
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Affiliation(s)
- Kunitsugu Takasaki
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
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Mizukami N, Kisanuki A, Hamasaki S, Takasaki K, Yuasa T, Kuwahara E, Ueya N, Horizoe Y, Chaen H, Maruyama I, Imoto Y, Tei C. Different flow patterns between left and right internal thoracic artery grafts influence the evaluation of severe graft stenosis by transthoracic Doppler echocardiography. J Am Soc Echocardiogr 2011; 24:768-74. [PMID: 21555206 DOI: 10.1016/j.echo.2011.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An increase in the diastolic to systolic flow velocity ratio (D/S) in the proximal left internal thoracic artery (ITA) after coronary artery bypass grafting (CABG) enables noninvasive assessment of graft patency by transthoracic Doppler echocardiography (TTDE). The increase in the D/S can be less pronounced at a site distant from the anastomosis. We postulated that proximal ITA flow patterns differ between the left and right ITAs and that the increase in D/S is less pronounced in the right than in the left proximal ITA. METHODS Proximal ITA flow was examined by TTDE in 129 consecutive patients after CABG of the left (75) or right (69) ITA to the left coronary artery. The mean D/S of the ITAs was compared with coronary angiography. RESULTS The D/S was lower in the group with a patent right ITA than in the group with a patent left ITA (P < .05). The D/S of both the left and right ITAs negatively correlated with angiographic stenosis (r = 0.56 or 0.67, P < .001, respectively). The regression line was significantly shifted downward in the right ITA compared with the left ITA, according to analysis of covariance (P = .01). Graft stenosis was predicted by a D/S of <0.57 and <0.28 with an accuracy of 91% and 97% in the left and right ITAs, respectively. CONCLUSION The patency of both left and right ITA grafts to the left coronary artery can be assessed using TTDE, but different cutoff values of D/S are required to diagnose severe ITA stenosis.
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Affiliation(s)
- Naoko Mizukami
- Department of Cardiovascular, Respiratory, and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Japan.
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Nagamatsu H, Hiraki M, Mizukami N, Yoshida H, Iwamoto H, Sumie S, Torimura T, Sata M. Intra-arterial therapy with cisplatin suspension in lipiodol and 5-fluorouracil for hepatocellular carcinoma with portal vein tumour thrombosis. Aliment Pharmacol Ther 2010; 32:543-50. [PMID: 20500734 DOI: 10.1111/j.1365-2036.2010.04379.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Portal vein tumour thrombosis is a negative prognostic factor for hepatocellular carcinoma (HCC). AIM To assess the efficacy of cisplatin in lipiodol emulsion combined with 5-fluorouracil (5-FU) for patients with HCC and portal vein tumour thrombosis. METHODS The study subjects were 51 patients with the above-specified criteria who received injection of cisplatin suspension in lipiodol emulsion followed by intra-arterial infusion of 5-FU. The primary objective was to determine tumour response to the treatment, while the secondary objectives were safety and tolerability. Independent factors for survival were also assessed. RESULTS Ten patients had complete response and 34 patients had partial response (response rate, 86.3%). The median survival for all 51 patients was 33 months, while that for 10 complete response patients and 21 patients who showed disappearance of HCC following additional therapies was 39 months. The single factor that significantly influenced survival was therapeutic effect. Treatment was well tolerated and severe toxicity was infrequent, with only grade 3 toxicity (thrombocytopenia) in one patient. CONCLUSIONS The present study demonstrated the efficacy of hepatic arterial infusion chemotherapy using cisplatin-lipiodol emulsion and 5-FU without serious adverse effects in patients with unresectable HCC and portal vein tumour thrombosis.
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Yuasa T, Kouno M, Kisanuki A, Ueya N, Nakashiki K, Kuwahara E, Kubota K, Mizukami N, Takasaki K, Tei C. Assessment of Cardiac Function and Heart Failure by Cardiac Time Analysis (Tei Index). J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.07.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kono M, Kisanuki A, Takasaki K, Nakashiki K, Yuasa T, Kuwahara E, Mizukami N, Uemura T, Kubota K, Ueya N, Miyata M, Tei C. Left ventricular systolic function is abnormal in diastolic heart failure: Re-assessment of systolic function using cardiac time interval analysis. J Cardiol 2009; 53:437-46. [DOI: 10.1016/j.jjcc.2009.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
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Kim WS, Minagoe S, Mizukami N, Zhou X, Yoshinaga K, Takasaki K, Yuasa T, Kihara K, Hamasaki S, Otsuji Y, Kisanuki A, Tei C. No reflow-like pattern in intramyocardial coronary artery suggests myocardial ischemia in patients with hypertrophic cardiomyopathy. J Cardiol 2008; 52:7-16. [DOI: 10.1016/j.jjcc.2008.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 03/26/2008] [Accepted: 04/17/2008] [Indexed: 10/21/2022]
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Kajiya T, Anan R, Kameko M, Mizukami N, Minagoe S, Hamasaki S, Maruyama I, Sakata R, Tei C. Intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism in a patient with Behçet's disease: a case report and literature review. Heart Vessels 2007; 22:278-83. [PMID: 17653524 DOI: 10.1007/s00380-006-0973-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 12/22/2006] [Indexed: 11/28/2022]
Abstract
A 26-year-old woman with intermittent fever was admitted to our hospital, and gradually developed facial edema. Examinations including computed tomography, transesophageal echocardiography, digital subtraction angiography, and pulmonary perfusion scintigraphy revealed intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism. Clinical findings and laboratory data led us to make a diagnosis of Behçet's disease. Combination of intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism are rare complications in Behçet's disease. Behçet's disease should be considered in the differential diagnosis of intracardiac mass of the right heart, and early diagnosis and treatment are essential for the management of Behçet's disease especially with large-vessel manifestations. In addition to a case report, we review the literature and report the characteristics of intracardiac thrombus in Behçet's disease.
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Affiliation(s)
- Takashi Kajiya
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
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15
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Mizukami N, Minagoe S, Otsuji Y, Neishi Y, Akasaka T, Hamasaki S, Yuasa T, Miyata M, Maruyama S, Yoshida K, Sakata R, Tei C. Noninvasive quantitative evaluation of the patency of internal mammary artery grafts to the left anterior descending coronary artery by transthoracic Doppler echocardiography. J Cardiol 2006; 48:305-14. [PMID: 17243625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Evaluation of left anterior descending coronary artery (LAD) flow by transthoracic Doppler echocardiography (TTDE) may allow assessment of anastomosis of the internal mammary artery (IMA) grafted to the LAD. This study tested the feasibility of TTDE to evaluate anastomotic stenosis of the IMA grafted to the LAD. METHODS TTDE was performed in 66 patients (48 men and 18 women, mean age 67 +/- 10 years) with left or right IMA grafts to the LAD. The distal IMA flow at the anastomosis was visualized and the percentage stenosis was evaluated by the continuity equation using the anastomotic and pre-anastomotic flow velocity measured by TTDE as well as by angiography. If the anastomotic flow was not visualized by TTDE, the absence of augmented diastolic flow of the proximal IMA, by using the supraclavicular approach, with diastolic to systolic mean velocity ratio < 0.25 was considered as anastomotic occlusion. RESULTS Anastomotic flow was visualized and the percentage stenosis was obtained by the continuity equation in 50 patients. In 4 of the remaining 16 patients, the proximal IMA flow by TTDE showed the occlusion pattern. In these 54 (82%) patients, the percentage stenosis by TTDE showed a significant correlation with that by angiography (r2 = 0.86, p < 0.0001). In all the remaining 12 patients with the patent proximal IMA pattern but without visualized anastomotic flow, the patency was confirmed by angiography. CONCLUSIONS TTDE enables direct visualization and quantitative evaluation of the anastomotic patency in patients with IMA graft to the LAD.
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Affiliation(s)
- Naoko Mizukami
- Department of Clinical Laboratory, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, Kagoshima 890-8520.
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16
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Nakashiki K, Kisanuki A, Otsuji Y, Yoshifuku S, Yuasa T, Takasaki K, Kuwahara E, Yu B, Uemura T, Mizukami N, Hamasaki S, Minagoe S, Tei C. Usefulness of a novel ultrasound transducer for continuous monitoring treadmill exercise echocardiography to assess coronary artery disease. Circ J 2006; 70:1297-302. [PMID: 16998262 DOI: 10.1253/circj.70.1297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The feasibility of a novel ultrasound probe, which can be attached to the left ventricular (LV) apex chest wall and allows free rotation around its long axis direction for the continuous monitoring of LV wall motion, was tested. METHODS AND RESULTS There were 36 subjects who had coronary artery disease (CAD). By attaching a novel ultrasound probe to the chest wall, the LV apical views were recorded during treadmill exercise stress echocardiography (Echo). The continuous monitoring of LV wall motion was satisfactorily feasible in 30 of 36 patients. The visualization rate of the overall LV segments was higher at rest (90%) compared to that during peak exercise (77%). The segments were better visualized in apical portions (90-100%) than in mid (77-96%) or basal portions (68-87%). The sensitivity, specificity, and accuracy for detecting CAD were 61, 100 and 77%, respectively. The wall motion score index 3 and 6 min after exercise decreased significantly compared to those at peak exercise. The number of segments with dyssynergy was highest at the peak exercise. Ischemic ST-T depression on electrocardiography was observed only at peak stress periods. CONCLUSIONS Continuous monitoring treadmill exercise Echo using a novel ultrasound probe seems feasible for the non-invasive and physiological assessment of CAD.
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Affiliation(s)
- Kenichi Nakashiki
- Department of Cardiovascular Medicine, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University Hospital, Kagoshima University, Sakuragaoka, Kagoshima, Japan.
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17
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Kuwahara E, Otsuji Y, Iguro Y, Ueno T, Zhu F, Mizukami N, Kubota K, Nakashiki K, Yuasa T, Yu B, Uemura T, Takasaki K, Miyata M, Hamasaki S, Kisanuki A, Levine RA, Sakata R, Tei C. Mechanism of Recurrent/Persistent Ischemic/Functional Mitral Regurgitation in the Chronic Phase After Surgical Annuloplasty. Circulation 2006; 114:I529-34. [PMID: 16820632 DOI: 10.1161/circulationaha.105.000729] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Surgical annuloplasty can potentially hoist the posterior annulus anteriorly, exaggerate posterior leaflet (PML) tethering, and lead to recurrent ischemic/functional mitral regurgitation (MR). Characteristics of leaflet configurations in late postoperative MR were investigated.
Methods and Results—
In 30 patients with surgical annuloplasty for ischemic MR and 20 controls, the anterior leaflet (AML) and PML tethering angles relative to the line connecting annuli, posterior and apical displacement of the coaptation and the MR grade were measured by echocardiography before, early after, and late after surgery. Early after surgery, grade of MR and AML tethering generally decreased (
P
<0.01), whereas PML tethering significantly worsened (
P
<0.01). Nine of the 30 patients showed recurrent/persistent MR late after surgery. Compared with patients without late MR, those with the MR showed similar reduction in the annular area, significant re-increase in posterior displacement of the coaptation, and progressive worsening in PML tethering (
P
<0.05) late after surgery in comparison to the early phase. Both preoperative MR and late postoperative MR were significantly correlated with all tethering variables in univariate analysis. Although apical displacement of the coaptation was the primary determinant of preoperative MR (
r
2
=0.60,
P
<0.0001), increased PML tethering was the primary determinant of late MR (
r
2
=0.75,
P
<0.0001).
Conclusions—
Whereas both leaflets tethering is related to preoperative ischemic MR, both leaflets tethering but with predominant contribution from augmented and progressive PML tethering is related to recurrent/persistent ischemic/functional MR late after surgical annuloplasty.
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Affiliation(s)
- Eiji Kuwahara
- Department of Cardiovascular Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
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18
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Minagoe S, Mizukami N, Otsuji Y, Hamasaki S, Tei C. [Evaluation of coronary artery Doppler by transthoracic approach]. J Cardiol 2006; 47:323-6. [PMID: 16800376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Shinichi Minagoe
- Department of Cardiology, National Hospital Organization Kagoshima Medical Center, Shiroyama-cho 8-1, Kagoshima, Kagoshima 892-0853.
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19
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Nakashiki K, Otsuji Y, Uemura T, Yuasa T, Kuwahara E, Yu B, Kubota K, Mizukami N, Kisanuki A, Tei C. Influence of Mitral Inlet Geometry on the Flow Convergence Beyond the Anatomic Orifice in Patients with Mitral Stenosis. J Card Fail 2005. [DOI: 10.1016/j.cardfail.2005.08.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Ikeda O, Mizukami N, Murata Y, Arakawa A, Katabuchi H, Okamoto H, Yasunaga T, Tsunawaki A, Yamashita Y. Randomized Comparison of Intra-Arterial Chemotherapy Versus Intra-Arterial Chemotherapy and Gelfoam Embolization for Treatment of Advanced Cervical Carcinoma. Cardiovasc Intervent Radiol 2005; 28:736-43. [PMID: 16132387 DOI: 10.1007/s00270-004-4178-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We evaluated the effects of intra-arterial infusion therapy by comparing the results obtained with a combination of intra-arterial anticancer drugs with and without transcatheter arterial embolization (TAE) in patients with cervical cancer. METHODS Between April 1999 and March 2003, intra-arterial therapy was administered to 45 patients (mean age 49 years) with cervical cancer. Of these, 18 had stage IIb , 4 had stage IIIa, 19 had stage IIIb, and 4 had stage IVb cancer; the histopathologic types were squamous cell carcinoma (n = 35), adenocarcinoma (n = 8), and adenosquamous carcinoma (n = 2). A total of 45 patients gave their informed consent and were randomized on a continuous basis into one of three groups according to the therapeutic protocols: group A consisted of 15 patients who received cisplatin, group B consisted of 17 patients who received cisplatin, mitomycin, doxorubicin hydrochloride, and 5-fluorouracil, and group C consisted of 13 patients who received cisplatin and TAE. Each protocol was administered twice with a 3 week interval between treatments. The efficacy of treatment was evaluated on the basis of the tumor reduction ratio (%) using MR imaging and the side effects were analyzed. RESULTS In groups A, B, and C, the tumor reduction ratio was 54%, 84%, and 86%, respectively; it was significantly greater in groups B and C than in group A (p < 0.01). The difference between groups B and C was not statistically significant. Although all group C patients developed severe pain after TAE, the pain was controlled with analgesics. Thrombocytopenia occurred in 6 of 17 (35%) group B patients. CONCLUSION Group B and C patients had better tumor reduction than those in group A. Fewer hematologic complications occurred in group C patients compared with group B.
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MESH Headings
- Adult
- Aged
- Antibiotics, Antineoplastic/adverse effects
- Antibiotics, Antineoplastic/therapeutic use
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Carcinoma/diagnosis
- Carcinoma/drug therapy
- Carcinoma/therapy
- Cervix Uteri/pathology
- Cisplatin/adverse effects
- Cisplatin/therapeutic use
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Drug Therapy, Combination
- Embolization, Therapeutic/adverse effects
- Embolization, Therapeutic/methods
- Female
- Fluorouracil/adverse effects
- Fluorouracil/therapeutic use
- Gelatin Sponge, Absorbable/adverse effects
- Gelatin Sponge, Absorbable/therapeutic use
- Hemostatics/adverse effects
- Hemostatics/therapeutic use
- Humans
- Infusions, Intra-Arterial/methods
- Magnetic Resonance Imaging/methods
- Middle Aged
- Mitomycin/adverse effects
- Mitomycin/therapeutic use
- Treatment Outcome
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/drug therapy
- Uterine Cervical Neoplasms/therapy
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Affiliation(s)
- O Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1 Honjo, Kumamoto, 860-8505, Japan.
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21
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Uemura T, Otsuji Y, Nakashiki K, Yoshifuku S, Maki Y, Yu B, Mizukami N, Kuwahara E, Hamasaki S, Biro S, Kisanuki A, Minagoe S, Levine RA, Tei C. Papillary Muscle Dysfunction Attenuates Ischemic Mitral Regurgitation in Patients With Localized Basal Inferior Left Ventricular Remodeling. J Am Coll Cardiol 2005; 46:113-9. [PMID: 15992644 DOI: 10.1016/j.jacc.2005.03.049] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 02/03/2005] [Accepted: 03/15/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this research was to test whether papillary muscle (PM) dysfunction attenuates ischemic mitral regurgitation (MR) in patients with left ventricular (LV) remodeling of a similar location and extent. BACKGROUND Papillary muscle dysfunction could attenuate tethering and MR because of PM elongation. However, variability in the associated LV remodeling, which exaggerates tethering, can influence the relationship between PM dysfunction and MR. METHODS In 40 patients with a previous inferior myocardial infarction but without other lesions, the LV volume, sphericity, PM tethering distance, PM longitudinal systolic strain, and MR fraction were quantified by echocardiography. The patients were divided into two groups: group 1 with significant basal inferoposterior LV bulging but without advanced LV bulging involving other territories, therefore with a similar location and extent of LV remodeling, and group 2 without significant LV bulging. RESULTS The medial PM tethering distance was significantly correlated with the %MR fraction (r2 = 0.64, p < 0.01), and multiple regression analysis identified an increase in the tethering distance as the only independent determinant of the MR fraction in all subjects and also in group 1. The PM longitudinal systolic strain had no significant relationships with MR fraction in all subjects with variable degrees of LV remodeling, but it had a significant inverse correlation with the MR fraction (r2 = 0.33, p < 0.01) in group 1 with LV remodeling of a similar location and extent, indicating that PM dysfunction is associated with less MR. CONCLUSIONS Papillary muscle dysfunction, reducing its longitudinal contraction to induce leaflet tethering, attenuates ischemic MR in patients with basal inferior LV remodeling.
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Affiliation(s)
- Takeshi Uemura
- First Department of Internal Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
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22
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Nakashiki K, Kisanuki A, Otsuji Y, Yuge K, Yuasa T, Takasaki K, Uemura T, Yu B, Mizukami N, Hamasaki S, Minagoe S, Tei C. Application of a novel ultrasound transducer for continuous monitoring treadmill exercise stress echocardiography: Utility in the detection of coronary artery stenosis. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Minagoe S, Toyama Y, Niizoe K, Yamaguchi H, Toyoshima S, Umebayashi Y, Mizukami N, Ujino Y, Tei C. [Transthoracic Doppler echocardiographic detection of intramyocardial coronary artery flow in humans using high frequency transducer]. J Cardiol 1997; 30:149-55. [PMID: 9309512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The use of transthoracic color and pulsed Doppler echocardiography to detect intramyocardial coronary artery flow in humans was evaluated in 18 normal healthy subjects (mean age 54 years) and in 16 patients with hypertrophic cardiomyopathy (HCM; mean age 59 years) to measure the intramyocardial coronary artery flow velocity at the ventricular septum and the apex using a 10-5 or 7-4 MHz transducer. Linear inflow color Doppler signals which passed the interventricular septum were demonstrated in 15 of 18 normal subjects (83%) and 15 of 16 patients with HCM (94%). The phasic flow velocities measured by pulsed Doppler echocardiography consisted of two forward flow signals in mid-systole (S-wave) and holodiastole (D-wave), and were obtained in 11 of 18 in normal subjects (61%) and 14 of 16 patients with HCM (88%). The mean peak velocities of the S- and D-waves in patients with HCM (mean [+/-SD] 27 +/- 9 and 86 +/- 23 cm/sec, respectively) were significantly (p < 0.05) higher than those in normal subjects (18 +/- 4 and 54 +/- 11 cm/sec, respectively). At the apex, linear inflow color Doppler signals which passed the myocardium perpendicularly during the whole diastole were demonstrated in 14 of 18 normal subjects (78%) and all 16 patients with HCM (100%). The phasic flow velocities were measured by pulsed Doppler echocardiography in 10 of 18 normal subjects (56%) and 15 of 16 patients with HCM (94%). The mean peak velocities in patients with HCM (74 +/- 27 cm/sec) were significantly (p < 0.05) higher than those in normal subjects (33 +/- 13 cm/sec). Transthoracic color and pulsed Doppler echocardiography can detect intramyocardial coronary artery flow in humans at the interventricular septum and the apex noninvasively.
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Affiliation(s)
- S Minagoe
- Division of Cardiology, Nampuh Hospital, Kagoshima
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