ORCID Profile
0000-0002-4909-754X
Current Organisations
Tokushima University Hospital
,
University of the Ryukyus
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Publisher: Oxford University Press (OUP)
Date: 22-06-2012
DOI: 10.1093/EHJCI/JES078
Abstract: The diastolic stress test (DST) may facilitate the attribution of exertional dyspnoea to cardiac and non-cardiac diseases. However, there is currently no consensus as to the optimal marker of exertional diastolic dysfunction (DD)-the main alternatives being estimated left ventricular (LV) filling pressure (exercise E/e') and diastolic functional reserve (DFRI). We sought to compare the correlates of these parameters. DST was performed by adding the measurement of the transmitral (E) and annular (e') velocities to standard exercise echo in 559 consecutive patients without significant rest or exercise mitral regurgitation. Exertional DD was separately defined by post-stress E/e' >13 or DFRI <13.5. Logistic regression was used to identify the correlates of abnormal responses and linear regression was used to identify the contribution of both to exercise capacity. Abnormal exercise E/e' (n = 112, 20%) and DFRI (n = 317, 57%) were modestly associated (κ 0.35, P < 0.0001). In a linear regression, abnormal exercise E/e' (β = -0.19, P < 0.001) and DFRI (β = -0.15, P = 0.001) were associated with exercise capacity, independent of age, body mass index, wall thickness, haemodynamics or abnormal stress results. Logistic regression revealed abnormal exercise E/e' (R(2)= 0.34) to be independently associated with female gender (β = 0.26, 95% CI: 0.11-0.60, P = 0.002), age (β = 1.04, 95% CI: 1.01-1.07, P = 0.01), hypertension (β = 0.35, 95% CI: 0.15-0.80, P = 0.01) and wall thickness (β = 4.3, 95% CI: 1.3-14.1, P = 0.02). The closest association of abnormal DFRI was exercise capacity (β = 0.89, 95% CI: 0.79-1.02, P = 0.09) no other clinical or stress variable was independently associated. Exercise E/e' and DFRI are both associated with exercise capacity, but E/e' is more closely associated with the expected parameters of DD.
Publisher: Elsevier BV
Date: 11-2014
Publisher: AME Publishing Company
Date: 08-2018
Publisher: The Korean Society of Cardiology
Date: 2015
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.AMJCARD.2013.04.028
Abstract: The standard echocardiographic evaluation of left ventricular (LV) mass, particularly in ischemic cardiomyopathy (IC) is challenging because it is based on geometric assumptions. The aim of this study was to assess the accuracy of LV mass calculation using echocardiographic modalities compared with cardiac magnetic resonance (CMR) in IC and in nonischemic cardiomyopathy (non-IC). Echocardiography was performed in 104 patients (mean age 55 ± 15 years) referred for CMR: 63 with IC and 41 with non-IC. CMR, M-mode echocardiography, 2-dimensional echocardiography, and 3-dimensional echocardiography (3DE) were analyzed using standard commercial tools to obtain LV mass. LV mass on 3DE showed a higher correlation with CMR than 2-dimensional echocardiography (r = 0.87 vs r = 0.70, p <0.001). M-mode echocardiography overestimated LV mass (bias +30%) and 2-dimensional echocardiography underestimated LV mass (bias -11%), whereas measurements on 3DE showed only minimal bias (-2%). LV mass on 3DE in non-IC showed a significantly higher correlation with CMR than in IC (r = 0.92 vs r = 0.84, z = 2.3, p <0.05). In non-IC, the mean difference was -2 g (-1% of the mean), with 95% limits of agreement of ±33 g (±19% of the mean). In IC, the mean difference was -7 g (-4% of the mean), with limits of agreement of ±56 g (±31% of the mean). There was a correlation between the absolute LV mass differences (3DE derived and CMR derived) and scar percentage (infarcted mass/total LV mass) using delayed-hyperenhancement images (r = 0.40, p <0.05). The net reclassification index with 3DE was +16% for concentric LV hypertrophy. In conclusion, the most accurate and reliable echocardiographic measurement of LV mass is 3DE, but underestimation and variability remain challenges in IC.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.ECHO.2014.02.007
Abstract: Right ventricular (RV) global longitudinal strain (RV strain) is a sensitive measure of RV mechanics. Its relationship with standard clinical markers and long-term events in chronic systolic heart failure is not well established. The aim of this study was to examine the ability of RV strain to provide incremental prognostic value to left ventricular (LV) ejection fraction (LVEF) in patients with chronic systolic heart failure. In 171 patients with chronic systolic heart failure (LVEF ≤ 35%), a retrospective substudy of RV strain was performed using Velocity Vector Imaging to analyze previously recorded, comprehensive echocardiographic images. Death, cardiac transplantation, and heart failure hospitalization were tracked for 5 years. In this study cohort (mean age, 57 ± 14 years mean LVEF, 25 ± 6%), mean RV strain was -11.6 ± 5.4%. More impaired RV strain was associated with increasing New York Heart Association class (rank-sums P < .0001) and greater LV volume (LV end-systolic volume index: r = 0.35, P < .0001). Worse RV strain was associated with reduced LVEF (r = -0.45, P < .0001), worse LV diastolic dysfunction (E/e' septal: r = 0.19, P = .017 left atrial volume index: r = 0.18, P = .031), and standard indices of RV systolic and diastolic dysfunction (RV s': r = -0.43, P < .0001 RV e'/a': r = 0.16, P = .0040 right atrial volume index: r = 0.20, P = .015). RV strain predicted long-term adverse events (hazard ratio, 1.30 95% confidence interval, 1.02-1.70 P = .037). Furthermore, RV strain ≥ -14.8% predicted adverse events after adjustment for age, LVEF, RV s', E/e' septal, and right atrial volume index. In patients with chronic systolic heart failure, worse RV strain provides prognostic value incremental to LV function.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
DOI: 10.1161/CIRCIMAGING.112.000162
Abstract: The role of exercise-induced pulmonary hypertension in decision making regarding surgical timing for asymptomatic chronic mitral regurgitation is controversial. We reasoned that the exercise-induced pulmonary hypertension response could not be interpreted without knowledge of right ventricular (RV) function. The aim of this study was to assess the role of RV measures at rest and during exercise as predictors of prognosis in asymptomatic mitral regurgitation. Comprehensive resting and exercise echocardiography was performed in 196 consecutive patients (56±13 years 64% male) with isolated moderate to severe mitral regurgitation (effective regurgitant orifice area, 38±18 mm 2 ) and preserved left ventricular function in whom initial management was expectant. Left ventricular and RV longitudinal strain were analyzed at rest using velocity vector imaging. Tricuspid annular plane systolic excursion and systolic pulmonary arterial pressure were measured at rest and during exercise. Valve surgery was performed in 88 patients (45%) over 27±15 months. After adjustment for age and sex in a Cox proportional-hazards model, exercise tricuspid annular plane systolic excursion (hazard ratio, 0.26 P .001), was associated with valve surgery-free survival, independent of resting left ventricular strain (hazard ratio, 1.09 P =0.027), exercise systolic pulmonary arterial pressure (hazard ratio, 1.03 P .001), and resting RV strain (hazard ratio, 1.10 P =0.004). In sequential Cox models, a model based on clinical data and left ventricular strain (χ 2 , 15.9) was improved by RV strain and RV chamber size (χ 2 , 28.8 P =0.003) and exercise systolic pulmonary arterial pressure (χ 2 , 40.1 P =0.002) and further increased by exercise tricuspid annular plane systolic excursion (χ 2 , 52.2 P =0.002). Exercise-induced RV dysfunction provides important incremental prognostic value in the management of asymptomatic mitral regurgitation.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.AMJCARD.2014.03.022
Abstract: The ratio of early transmitral flow velocity (E) to mitral annular velocity (E') is considered a predictor of pulmonary capillary wedge pressure (PCWP). In a previous small study, the paradoxical relation between PCWP and E/E' ratio has been described in patients with constrictive pericarditis (CP). We sought to test this paradoxical relation in a larger cohort. We retrospectively identified 49 patients with surgically confirmed CP (40 men mean age 61 ± 10 years) who underwent right-sided cardiac catheterization with PCWP measurement, preceded by an echocardiographic study. Of these, 48 patients underwent either computed tomography or magnetic resonance imaging to measure pericardial thickness on the lateral side of the left ventricular wall. Mean interval time between echocardiogram and right-sided cardiac catheterization was 1.5 ± 3.8 days. There were no significant correlations between mean, medial, or lateral E/E' and PCWP (r = -0.17, 95% confidence interval [CI] -0.43 to -0.12 r = -0.17, 95% CI -0.43 to -0.12 and r = -0.12, 95% CI -0.39 to -0.17, respectively). Similarly, there was no correlation between mean E/E' and brain natriuretic peptide (Spearman r = -0.17, p = NS). Patients with increased pericardial thickness (defined as >4 mm) had both lower lateral peak systolic annular velocity (S') and lower lateral S' integral (7.8 ± 2.4 vs 9.6 ± 2.4, p = 0.02 and 13.2 ± 4.2 vs 15.9 ± 4.7, p = 0.04, respectively). In patients with CP, there were no correlations between septal, lateral, or mean E/E' and PCWP. In conclusion, E/E' is not predictive of filling pressures in patients with CP, and perhaps the "annulus paradoxus" phenomenon should be revisited. The relation between the mitral annular velocity and thickness of the parietal pericardium may affect this phenomenon.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
DOI: 10.1161/CIRCIMAGING.113.001177
Abstract: The decision-making role of exercise echocardiography in the surgical timing for aortic regurgitation remains a matter of debate because of limited data on its link with outcome. The aim of this study was to assess the role of echocardiographic measurements at rest and during exercise as predictors of valve surgery in asymptomatic aortic regurgitation. Comprehensive resting and exercise echocardiography was performed in 159 consecutive patients (50±15 years 80% male) with isolated moderately severe to severe aortic regurgitation and preserved left ventricular (LV) function (LV ejection fraction %, LV end-diastolic dimension ≤70 mm, LV end-systolic dimension ≤50 mm or ≤25 mm/m 2 ) in whom initial management was expectant. Echocardiographic measurements were performed at rest and during exercise. LV and right ventricular (RV) longitudinal strain was analyzed at rest using velocity vector imaging. Valve surgery was performed in 50 patients (31%) during 30±21 months. After adjustment for age and sex in a multivariable Cox proportional-hazards model, exercise tricuspid annular plane systolic excursion (TAPSE hazards ratio [HR], 0.48 P =0.001) was associated with valve surgery-free, independent of resting LV strain (HR, 1.63 P =0.005), exercise LV end-diastolic volume (HR, 1.38 P =0.048), and resting RV strain (HR, 1.69 P =0.002). In sequential Cox models, a model based on clinical data (χ 2 , 20.4) was improved by resting LV strain (χ 2 , 30.1 P =0.001), resting RV strain (χ 2 , 49.7 P .001), and further increased by exercise TAPSE (χ 2 , 64.4 P .001). In asymptomatic aortic regurgitation, resting LV strain, resting RV strain, and exercise TAPSE were independently associated with the need for earlier aortic surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
DOI: 10.1161/CIRCIMAGING.114.002077
Abstract: Infarct heterogeneity has been shown to be independently associated with adverse outcomes in previous smaller studies. However, it is unknown whether infarct characterization is an independent predictor of all-cause mortality in patients with advanced ischemic cardiomyopathy, after adjusting for clinical risk factors, severity of ischemic mitral regurgitation, incomplete revascularization, and device therapy. A total of 362 patients with ischemic cardiomyopathy (left ventricular dysfunction with % stenosis in ≥1 epicardial coronary artery) underwent delayed hyperenhancement-magnetic resonance imaging and coronary angiography between 2002 and 2006. Total myocardial scar and peri-infarct (PI) area were measured using various threshold techniques. Multivariate survival analysis (primary end point of all-cause mortality) was conducted. One hundred fifty-seven deaths occurred during a mean 5.4-year follow-up (mean left ventricular ejection fraction, 23±9% mean end-systolic volume index, 113±48 mL mean total myocardial scar %, 25.5±16.0% mean PI%, 5.7±2.9%). PI% (β=2.07 P .001) was an independent predictor of survival, independent of age, end-systolic volume, sex, mitral regurgitation, diabetes mellitus, dyslipidemia, coronary artery disease severity, implantable cardioverter defibrillator, and incomplete revascularization. PI% using 2 to 3 SD technique yielded the highest incremental prognostic power (χ 2 score 149). In advanced ischemic cardiomyopathy, PI% is a powerful independent and incremental predictor of all-cause mortality. Infarct heterogeneity offers substantial further risk stratification when compared with quantification of total myocardial scar % alone even after adjusting for clinical risk factors, end-systolic volume index, mitral regurgitation, incomplete revascularization, and implantable cardioverter defibrillator implantation.
Publisher: The Korean Society of Cardiology
Date: 2016
Publisher: Wiley
Date: 18-09-2014
DOI: 10.1111/ECHO.12740
Abstract: Longitudinal strain of right ventricle (RV) can be used to determine RV systolic function. This study compared RV longitudinal strain values of two different speckle tracking software technologies, velocity vector imaging (VVI) and two-dimensional speckle tracking echocardiography (2DSTE), and longitudinal strain by cardiac magnetic resonance (CMR). We studied 36 patients (28 men, 63 ± 11 years) with ischemic cardiomyopathy (ICM) who underwent echocardiography with GE machines and CMR. Longitudinal strain of RV analyzed with 2DSTE and VVI in same DICOM files. Longitudinal RV strain analyzed with 2DSTE and VVI in same raw data. These values were compared with RVEF and longitudinal strain by CMR. VVI strain showed significant correlations with RVEF by CMR (global RV: r = -0.56, P < 0.01, free wall: r = -0.52, P < 0.01, and septum: r = -0.49, P < 0.01). 2DSTE strain also revealed significant correlations (global RV: r = -0.40, P = 0.02, and septum: r = -0.35, P = 0.04). 2DSTE strain had significant bias with wide limits of agreement in global RV and septum compared with CMR strain. 2DSTE strain had significantly lower intra-observer variability than VVI (P = 0.03) or CMR strain (P = 0.04) in RV-free wall. RV longitudinal strains by VVI and 2SDTE demonstrated relatively good correlations with RVEF and longitudinal strain by CMR. However, when compared to CMR-derived strain, 2DSTE-derived strain underestimates longitudinal strain of RV septum and of global right ventricle. 2DSTE strain had significantly lower intra-observer variability compared with VVI or CMR strain analysis.
Publisher: BMJ
Date: 03-07-2012
DOI: 10.1136/HEARTJNL-2012-302007
Abstract: Left atrial (LA) function is an important contributor to cardiac function in a variety of disease states and especially with exercise. The purpose of this study was to assess the role of LA function in the left ventricular (LV) filling pressure (E/e') response to exercise and exercise tolerance in patients with preserved LV ejection fraction (LVEF). LA contractile function (LA strain peak negative), conduit function (LA strain peak positive), and reservoir function (LA strain total) were measured from speckle tracking in 486 patients with preserved LVEF and negative exercise echocardiography for ischaemia. Maximal exercise tolerance was expressed as the estimated metabolic equivalents (METs). Per cent predicted METs was calculated in accordance with described nomograms. Features associated with exercise capacity were sought in a multiple linear regression, and compared using standardised β. Patients with increased stress E/e' had significantly lower LA strain profiles and larger LA volume than the remainder. LA strain total was strongly associated with exercise capacity in multivariate analysis (ß=0.21, p<0.001). E/e' rest was also associated with exercise capacity (ß=-0.11, p=0.001). Other independent correlates of exercise capacity were age (ß=-0.36, p<0.001), male gender (ß=0.34, p<0.001) and body mass index (ß=-0.23, p<0.001). The best predictor of per cent predicted METs was total LA strain in multivariate analysis. The association of reduced LA function with impaired exercise capacity was similar to that of elevated LVE/e', emphasising the role of ventriculo-atrial coupling to cardiac dysfunction with preserved LVEF.
Publisher: Public Library of Science (PLoS)
Date: 29-06-2012
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