T. Ohta, S. Nakatani, S. Izumi, S. Nagata, S. Beppu, K. Miyatake
Serial changes in the diastolic filling of both ventricles were studied using Doppler echocardiography in 19 patients with congestive heart failure from the acute to the convalescent stage. During the acute stage, left ventricular early filling velocity (E) was high (88 +/- 17 cm/s) and atrial filling velocity (A) was low (44 +/- 23 cm/s), whereas the right ventricular E was depressed (17 +/- 8 cm/s) and A was enhanced (40 +/- 9 cm/s). As the condition improved, left ventricular E decreased (43 +/- 11 cm/s, p < 0.01) and A increased (59 +/- 24 cm/s, p < 0.01) along with a decrease in the left ventricular and atrial dimensions. In contrast to the changes in left ventricular filling, right ventricular E increased (31 +/- 10 cm/s, p < 0.01) and A decreased (32 +/- 5 cm/s, p < 0.05). There are opposite directional changes in left and right ventricular filling with clinical improvement from the acute to the convalescent stage of congestive heart failure, which suggest that the changes are related to improvement of the hemodynamic conditions of both ventricles. The changes in the right ventricular filling pattern was likely to be related to changes in right ventricular afterload, ventricular interaction and external constraint rather than a change in right ventricular filling pressure.
本文应用多普勒超声心动图对19例充血性心力衰竭患者从急性期到恢复期双心室舒张充盈的变化进行了研究。急性期左室早期充盈速度(E)高(88 +/- 17 cm/s)，心房充盈速度(A)低(44 +/- 23 cm/s)，而右室E降低(17 +/- 8 cm/s)， A增强(40 +/- 9 cm/s)。随着病情的改善，左室E降低(43 +/- 11 cm/s, p < 0.01)， A升高(59 +/- 24 cm/s, p < 0.01)，左室和心房尺寸减小。与左心室充盈变化相比，右心室E升高(31 +/- 10 cm/s, p < 0.01)， A降低(32 +/- 5 cm/s, p < 0.05)。从充血性心力衰竭急性期到恢复期，随着临床改善，左右心室充盈呈现相反方向的变化，提示这种变化与两心室血流动力学状况的改善有关。右心室充盈模式的改变可能与右心室后负荷、心室相互作用和外约束的改变有关，而与右心室充盈压力的改变无关。
{"title":"Serial assessment of left and right ventricular filling in patients with congestive heart failure.","authors":"T. Ohta, S. Nakatani, S. Izumi, S. Nagata, S. Beppu, K. Miyatake","doi":"10.1253/JCJ.65.803","DOIUrl":"https://doi.org/10.1253/JCJ.65.803","url":null,"abstract":"Serial changes in the diastolic filling of both ventricles were studied using Doppler echocardiography in 19 patients with congestive heart failure from the acute to the convalescent stage. During the acute stage, left ventricular early filling velocity (E) was high (88 +/- 17 cm/s) and atrial filling velocity (A) was low (44 +/- 23 cm/s), whereas the right ventricular E was depressed (17 +/- 8 cm/s) and A was enhanced (40 +/- 9 cm/s). As the condition improved, left ventricular E decreased (43 +/- 11 cm/s, p < 0.01) and A increased (59 +/- 24 cm/s, p < 0.01) along with a decrease in the left ventricular and atrial dimensions. In contrast to the changes in left ventricular filling, right ventricular E increased (31 +/- 10 cm/s, p < 0.01) and A decreased (32 +/- 5 cm/s, p < 0.05). There are opposite directional changes in left and right ventricular filling with clinical improvement from the acute to the convalescent stage of congestive heart failure, which suggest that the changes are related to improvement of the hemodynamic conditions of both ventricles. The changes in the right ventricular filling pattern was likely to be related to changes in right ventricular afterload, ventricular interaction and external constraint rather than a change in right ventricular filling pressure.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"49 1","pages":"803-7"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90036431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Kawamoto, T. Imamura, K. Kawabata, H. Date, T. Ishikawa, M. Maeno, T. Nagoshi, Y. Fujiura, A. Matsuyama, T. Matsuo, Y. Koiwaya, T. Eto
A 39-year-old woman had exercise-induced ST segment depression associated with chest pain. Cardiac evaluation revealed moderate aortic stenosis (AS), related to the bicuspid valves, with an aortic mean pressure gradient of 22 mmHg, a calculated aortic valve area of 1.3 cm2 and normal left ventricular (LV) peak systolic and end-diastolic pressures, but no LV hypertrophy, resulting in normal LV wall stress. Although the coronary arteries were angiographically normal, rapid atrial pacing and an intracoronary papaverine injection revealed a significantly decreased coronary flow reserve (CFR), which may have played an important role in the pathogenesis of angina pectoris in this patient. Though the CFR is usually decreased in patients with AS, as well as in microvascular angina, in this particular case, it appeared to have decreased as a consequence of microvascular dysfunction rather than of AS-related mechanisms.
{"title":"Microvascular angina in a patient with aortic stenosis.","authors":"R. Kawamoto, T. Imamura, K. Kawabata, H. Date, T. Ishikawa, M. Maeno, T. Nagoshi, Y. Fujiura, A. Matsuyama, T. Matsuo, Y. Koiwaya, T. Eto","doi":"10.1253/JCJ.65.839","DOIUrl":"https://doi.org/10.1253/JCJ.65.839","url":null,"abstract":"A 39-year-old woman had exercise-induced ST segment depression associated with chest pain. Cardiac evaluation revealed moderate aortic stenosis (AS), related to the bicuspid valves, with an aortic mean pressure gradient of 22 mmHg, a calculated aortic valve area of 1.3 cm2 and normal left ventricular (LV) peak systolic and end-diastolic pressures, but no LV hypertrophy, resulting in normal LV wall stress. Although the coronary arteries were angiographically normal, rapid atrial pacing and an intracoronary papaverine injection revealed a significantly decreased coronary flow reserve (CFR), which may have played an important role in the pathogenesis of angina pectoris in this patient. Though the CFR is usually decreased in patients with AS, as well as in microvascular angina, in this particular case, it appeared to have decreased as a consequence of microvascular dysfunction rather than of AS-related mechanisms.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"42 1","pages":"839-41"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89069684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Akira Ito, K. Egashira, T. Narishige, Kouhei Muramatsu, Akira Takeshita
Endothelium-dependent/nitric oxide (NO)-mediated vasodilation is impaired in hypertensive individuals. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, is synthesized by many types of cells including vascular endothelial cells. The serum level of ADMA is elevated in patients with essential hypertension, but the mechanism for this increase is unknown. Therefore, the present study examined whether the renin-angiotensin system (RAS) is involved. Patients with essential hypertension [systolic blood pressure (BP) > 160 mmHg and/or diastolic BP > 95 mmHg] were randomized to an angiotensin-converting enzyme (ACE) inhibitor treatment group (perindopril, 4mg/day for 4 weeks, n = 7), an angiotensin II type 1 (AT1) receptor antagonist treatment group (losartan, 50 mg/day for 4 weeks, n = 7) or a beta-blocker treatment group (bisoprolol, 5 mg/day for 4 weeks, n = 7). Before and after the treatment, BP, serum concentration of ADMA and plasma concentration of von Willebrand factor (vWF, a biological marker of endothelial injury) were measured. Perindopril, losartan and bisoprolol decreased BP to a similar extent, and either perindopril or losartan, but not bisoprolol, significantly decreased serum ADMA and plasma vWF. These findings suggest that the RAS may contribute to the mechanism of increased serum ADMA as well as to the endothelial injury observed in hypertensive patients. The vasculoprotective actions of ACE inhibitors or AT1 receptor antagonists may be explained at least in part by amelioration of the endothelial injury through a decrease in the serum ADMA concentration.
{"title":"Renin-angiotensin system is involved in the mechanism of increased serum asymmetric dimethylarginine in essential hypertension.","authors":"Akira Ito, K. Egashira, T. Narishige, Kouhei Muramatsu, Akira Takeshita","doi":"10.1253/JCJ.65.775","DOIUrl":"https://doi.org/10.1253/JCJ.65.775","url":null,"abstract":"Endothelium-dependent/nitric oxide (NO)-mediated vasodilation is impaired in hypertensive individuals. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, is synthesized by many types of cells including vascular endothelial cells. The serum level of ADMA is elevated in patients with essential hypertension, but the mechanism for this increase is unknown. Therefore, the present study examined whether the renin-angiotensin system (RAS) is involved. Patients with essential hypertension [systolic blood pressure (BP) > 160 mmHg and/or diastolic BP > 95 mmHg] were randomized to an angiotensin-converting enzyme (ACE) inhibitor treatment group (perindopril, 4mg/day for 4 weeks, n = 7), an angiotensin II type 1 (AT1) receptor antagonist treatment group (losartan, 50 mg/day for 4 weeks, n = 7) or a beta-blocker treatment group (bisoprolol, 5 mg/day for 4 weeks, n = 7). Before and after the treatment, BP, serum concentration of ADMA and plasma concentration of von Willebrand factor (vWF, a biological marker of endothelial injury) were measured. Perindopril, losartan and bisoprolol decreased BP to a similar extent, and either perindopril or losartan, but not bisoprolol, significantly decreased serum ADMA and plasma vWF. These findings suggest that the RAS may contribute to the mechanism of increased serum ADMA as well as to the endothelial injury observed in hypertensive patients. The vasculoprotective actions of ACE inhibitors or AT1 receptor antagonists may be explained at least in part by amelioration of the endothelial injury through a decrease in the serum ADMA concentration.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"2012 1","pages":"775-8"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87858404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Tada, K. Egashira, M. Yamamoto, M. Usui, Y. Arai, Y. Katsuda, H. Shimokawa, A. Takeshita
The role of endothelium-derived nitric oxide (NO) in the metabolic control of coronary blood flow (CBF) in heart failure (HF) is poorly understood, so the present study investigated the effects of inhibitors of NO synthesis on the response of CBF to changes in myocardial oxygen consumption (MVO2) in dogs with HF produced by rapid ventricular pacing and in control dogs. The CBF, MVO2, and other hemodynamic parameters were measured in anesthetized animals. Before infusion of Nomega-nitro-L-arginine methyl ester (L-NAME), the increases in CBF and MVO2 during pacing tachycardia were not significantly different between the control and HF dogs. Intracoronary infusion of L-NAME did not alter the responses of CBF or MVO2 to pacing tachycardia in the control dogs, but in the HF dogs, it reduced the CBF response to pacing tachycardia without altering the tachycardia-induced changes in MVO2. Intracoronary infusion of L-arginine reversed the effect of L-NAME. These results suggest that in HF dogs NO contributes to the regulation of CBF in response to an increased metabolic demand.
内皮源性一氧化氮(NO)在心衰(HF)时冠状动脉血流量(CBF)代谢控制中的作用尚不清楚，因此本研究探讨了NO合成抑制剂对心衰(HF)犬和对照犬心肌耗氧量(MVO2)变化对CBF反应的影响。在麻醉动物中测量CBF、MVO2和其他血流动力学参数。在输注诺美加-硝基- l -精氨酸甲酯(L-NAME)前，起搏性心动过速期间CBF和MVO2的增加在对照组和HF犬之间无显著差异。冠状动脉内灌注L-NAME没有改变对照组犬CBF或MVO2对起搏性心动过速的反应，但在HF犬中，它降低了CBF对起搏性心动过速的反应，但没有改变心动过速引起的MVO2的变化。冠状动脉内灌注l -精氨酸逆转了L-NAME的作用。这些结果表明，在HF犬中，NO有助于调节CBF以应对代谢需求的增加。
{"title":"Role of nitric oxide in regulation of coronary blood flow in response to increased metabolic demand in dogs with pacing-induced heart failure.","authors":"H. Tada, K. Egashira, M. Yamamoto, M. Usui, Y. Arai, Y. Katsuda, H. Shimokawa, A. Takeshita","doi":"10.1253/JCJ.65.827","DOIUrl":"https://doi.org/10.1253/JCJ.65.827","url":null,"abstract":"The role of endothelium-derived nitric oxide (NO) in the metabolic control of coronary blood flow (CBF) in heart failure (HF) is poorly understood, so the present study investigated the effects of inhibitors of NO synthesis on the response of CBF to changes in myocardial oxygen consumption (MVO2) in dogs with HF produced by rapid ventricular pacing and in control dogs. The CBF, MVO2, and other hemodynamic parameters were measured in anesthetized animals. Before infusion of Nomega-nitro-L-arginine methyl ester (L-NAME), the increases in CBF and MVO2 during pacing tachycardia were not significantly different between the control and HF dogs. Intracoronary infusion of L-NAME did not alter the responses of CBF or MVO2 to pacing tachycardia in the control dogs, but in the HF dogs, it reduced the CBF response to pacing tachycardia without altering the tachycardia-induced changes in MVO2. Intracoronary infusion of L-arginine reversed the effect of L-NAME. These results suggest that in HF dogs NO contributes to the regulation of CBF in response to an increased metabolic demand.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"18 1","pages":"827-33"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79950166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Yamagishi, K. Akioka, N. Shirai, M. Yoshiyama, M. Teragaki, K. Takeuchi, J. Yoshikawa, H. Ochi
Many reports have demonstrated that smokers who have suffered an acute myocardial infarction (AMI) have a better prognosis than nonsmokers. The present study investigated the effects of current smoking on myocardial injury with resting 123I-15-iodophenyl 3-methyl pentadecanoic acid (BMIPP)/201Tl myocardial single photon emission computed tomography in 103 patients with conservatively treated AMI. The left ventricular myocardium was divided into 9 segments and BMIPP and 201Tl defects were scored using a 5-point grading system (0 = normal and 4 = no uptake). The sum of the defect scores was defined as the total defect score. There was no significant difference in either the baseline severity of the coronary artery disease or the total defect scores for BMIPP and 201Tl between the current smoker and nonsmoker groups. The difference between the total defect scores for BMIPP and 201Tl tended to be larger in the current smoker group than in the nonsmoker group (2.0 +/- 1.9 vs 1.3 +/- 1.6, p = 0.056). Forty-one (53%) of 77 patients in the current smoker group exhibited a BMIPP/201Tl mismatch, whereas only 8 (31%) of 26 patients in the nonsmoker group did (p = 0.047). In conclusion, current smokers had more likelihood of salvageable myocardium in areas at risk, as demonstrated by BMIPP/201Tl mismatch, in AMI than nonsmokers.
许多报告表明，吸烟者患急性心肌梗死(AMI)的预后比不吸烟者好。本研究采用静息123i -15-碘苯基3-甲基五酸(BMIPP)/201Tl心肌单光子发射计算机断层扫描对103例保守治疗的AMI患者观察吸烟对心肌损伤的影响。将左心室心肌分为9段，采用5分制对BMIPP和201Tl缺损进行评分(0 =正常，4 =未摄取)。缺陷分数的总和被定义为总缺陷分数。在当前吸烟者和非吸烟者之间，冠状动脉疾病的基线严重程度或BMIPP和201Tl的总缺陷评分均无显著差异。吸烟组BMIPP和201Tl总缺陷评分的差异大于不吸烟组(2.0 +/- 1.9 vs 1.3 +/- 1.6, p = 0.056)。当前吸烟者组77例患者中有41例(53%)表现出BMIPP/201Tl不匹配，而非吸烟者组26例患者中只有8例(31%)出现这种不匹配(p = 0.047)。总之，正如BMIPP/201Tl不匹配所证明的那样，在AMI中，当前吸烟者比非吸烟者更有可能在危险区域获得可修复的心肌。
{"title":"Effects of smoking on myocardial injury in patients with conservatively treated acute myocardial infarction: a study with resting 123I-15-iodophenyl 3-methyl pentadecanoic acid/201Tl myocardial single photon emission computed tomography.","authors":"H. Yamagishi, K. Akioka, N. Shirai, M. Yoshiyama, M. Teragaki, K. Takeuchi, J. Yoshikawa, H. Ochi","doi":"10.1253/jcj.65.769","DOIUrl":"https://doi.org/10.1253/jcj.65.769","url":null,"abstract":"Many reports have demonstrated that smokers who have suffered an acute myocardial infarction (AMI) have a better prognosis than nonsmokers. The present study investigated the effects of current smoking on myocardial injury with resting 123I-15-iodophenyl 3-methyl pentadecanoic acid (BMIPP)/201Tl myocardial single photon emission computed tomography in 103 patients with conservatively treated AMI. The left ventricular myocardium was divided into 9 segments and BMIPP and 201Tl defects were scored using a 5-point grading system (0 = normal and 4 = no uptake). The sum of the defect scores was defined as the total defect score. There was no significant difference in either the baseline severity of the coronary artery disease or the total defect scores for BMIPP and 201Tl between the current smoker and nonsmoker groups. The difference between the total defect scores for BMIPP and 201Tl tended to be larger in the current smoker group than in the nonsmoker group (2.0 +/- 1.9 vs 1.3 +/- 1.6, p = 0.056). Forty-one (53%) of 77 patients in the current smoker group exhibited a BMIPP/201Tl mismatch, whereas only 8 (31%) of 26 patients in the nonsmoker group did (p = 0.047). In conclusion, current smokers had more likelihood of salvageable myocardium in areas at risk, as demonstrated by BMIPP/201Tl mismatch, in AMI than nonsmokers.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"13 1","pages":"769-74"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88319581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hiroyuki Nakayama, T. Morozumi, S. Nanto, T. Shimonagata, T. Ohara, Yuzuru Takano, Jun-ichi Kotani, Tetsuya Watanabe, Masashi Fujita, Mayu Nishio, Hideo Kusuoka, Masatsugu Hori, Seiki Nagata
The left ventricle's morphological adaptation to high blood pressure is classified into 4 patterns based on mass and wall thickness. The geometric changes caused by maladaptation to pressure overload possibly relate to progression of contractile dysfunction with abnormal energy metabolism. The present study assessed whether the geometric adaptation of the left ventricle (LV) to high blood pressure relates to changes in myocardial energy metabolism, especially free fatty acid (FFA) utilization. Thirty-five patients with essential hypertension underwent echocardiography and dual isotopes myocardial scintigraphy using iodine-123 labeled 15-p-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP, an analogue of a FFA) and thallium-201 (Tl-201). Systolic (endocardial fractional shortening; %FS) and diastolic indices (the ratio of early to atrial filling waves; E/A) of LV function were also assessed. Quantitative myocardial BMIPP uptake was evaluated by the BMIPP/TI-201 myocardial uptake ratio (B/T). The subjects were divided into 4 groups based on LV mass and wall thickness: (1) concentric hypertrophy (CH), (2) eccentric hypertrophy (EH), (3) concentric remodeling (CR), and (4) normal geometry (N). The %FS was lower in the EH group than in the other groups. The mitral E/A ratio in the CH group was lowest. B/T was significantly decreased in the EH group compared with the N group (p < 0.05). B/T correlated with the mitral E/A ratio significantly (p < 0.05, r = 0.42), whereas there was no relationship between %FS and B/T. These results indicate that the geometric changes occurring in hypertensive hearts strongly correlate with alternations in cardiac function and with abnormal myocardial FFA metabolism, and that the latter is associated with diastolic abnormality, but not with systolic function.
{"title":"Abnormal myocardial free fatty acid utilization deteriorates with morphological changes in the hypertensive heart.","authors":"Hiroyuki Nakayama, T. Morozumi, S. Nanto, T. Shimonagata, T. Ohara, Yuzuru Takano, Jun-ichi Kotani, Tetsuya Watanabe, Masashi Fujita, Mayu Nishio, Hideo Kusuoka, Masatsugu Hori, Seiki Nagata","doi":"10.1253/JCJ.65.783","DOIUrl":"https://doi.org/10.1253/JCJ.65.783","url":null,"abstract":"The left ventricle's morphological adaptation to high blood pressure is classified into 4 patterns based on mass and wall thickness. The geometric changes caused by maladaptation to pressure overload possibly relate to progression of contractile dysfunction with abnormal energy metabolism. The present study assessed whether the geometric adaptation of the left ventricle (LV) to high blood pressure relates to changes in myocardial energy metabolism, especially free fatty acid (FFA) utilization. Thirty-five patients with essential hypertension underwent echocardiography and dual isotopes myocardial scintigraphy using iodine-123 labeled 15-p-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP, an analogue of a FFA) and thallium-201 (Tl-201). Systolic (endocardial fractional shortening; %FS) and diastolic indices (the ratio of early to atrial filling waves; E/A) of LV function were also assessed. Quantitative myocardial BMIPP uptake was evaluated by the BMIPP/TI-201 myocardial uptake ratio (B/T). The subjects were divided into 4 groups based on LV mass and wall thickness: (1) concentric hypertrophy (CH), (2) eccentric hypertrophy (EH), (3) concentric remodeling (CR), and (4) normal geometry (N). The %FS was lower in the EH group than in the other groups. The mitral E/A ratio in the CH group was lowest. B/T was significantly decreased in the EH group compared with the N group (p < 0.05). B/T correlated with the mitral E/A ratio significantly (p < 0.05, r = 0.42), whereas there was no relationship between %FS and B/T. These results indicate that the geometric changes occurring in hypertensive hearts strongly correlate with alternations in cardiac function and with abnormal myocardial FFA metabolism, and that the latter is associated with diastolic abnormality, but not with systolic function.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"162 1","pages":"783-7"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76985623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Igarashi, K. Kashimura, Y. Makiyama, T. Sato, K. Ojima, Y. Aizawa
The study tested the hypothesis that left atrial appendage (LAA) dysfunction in nonvalvular atrial fibrillation (NVAF) correlates with a prothrombotic state, and investigated whether the plasma natriuretic peptides are marker of LAA dysfunction in NVAF. Sixty-seven patients underwent transthoracic and transesophageal echocardiography. The left ventricular fractional shortening, left atrial diameter (LAD), LAA flow velocity and the grade of spontaneous echo contrast (SEC) were determined. The plasma concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), D-dimer, and thrombin-antithrombin III complex (TAT) were measured. The patients were divided into 2 groups according to LAA flow velocity: group I (LAA velocity <20 cm/s) and group II (LAA velocity > or = 20cm/s). The SEC score, D-dimer, TAT, BNP and LAD were significantly increased in group I. Based on simple linear regression analysis, SEC score (r=-0.638), LAD (r=-0.493), D-dimer (r = -0.485), BNP (r = -0.463), TAT (r = -0.455) and age (r = -0.314) were inversely correlated with LAA flow velocity. Multivariate analysis showed that SEC score (p = 0.0014) and plasma BNP level (p=0.0075) were independent negative predictors for LAA flow velocity. In conclusion, LAA dysfunction is associated with a prothrombotic state, and the plasma BNP concentration may serve as a determinant of LAA function in NVAF.
{"title":"Left atrial appendage dysfunction in chronic nonvalvular atrial fibrillation is significantly associated with an elevated level of brain natriuretic peptide and a prothrombotic state.","authors":"Y. Igarashi, K. Kashimura, Y. Makiyama, T. Sato, K. Ojima, Y. Aizawa","doi":"10.1253/JCJ.65.788","DOIUrl":"https://doi.org/10.1253/JCJ.65.788","url":null,"abstract":"The study tested the hypothesis that left atrial appendage (LAA) dysfunction in nonvalvular atrial fibrillation (NVAF) correlates with a prothrombotic state, and investigated whether the plasma natriuretic peptides are marker of LAA dysfunction in NVAF. Sixty-seven patients underwent transthoracic and transesophageal echocardiography. The left ventricular fractional shortening, left atrial diameter (LAD), LAA flow velocity and the grade of spontaneous echo contrast (SEC) were determined. The plasma concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), D-dimer, and thrombin-antithrombin III complex (TAT) were measured. The patients were divided into 2 groups according to LAA flow velocity: group I (LAA velocity <20 cm/s) and group II (LAA velocity > or = 20cm/s). The SEC score, D-dimer, TAT, BNP and LAD were significantly increased in group I. Based on simple linear regression analysis, SEC score (r=-0.638), LAD (r=-0.493), D-dimer (r = -0.485), BNP (r = -0.463), TAT (r = -0.455) and age (r = -0.314) were inversely correlated with LAA flow velocity. Multivariate analysis showed that SEC score (p = 0.0014) and plasma BNP level (p=0.0075) were independent negative predictors for LAA flow velocity. In conclusion, LAA dysfunction is associated with a prothrombotic state, and the plasma BNP concentration may serve as a determinant of LAA function in NVAF.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"28 1","pages":"788-92"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74102966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kajiyama, D. Saito, T. Murakami, T. Shiraki, T. Oka, M. Doi, T. Masaka, K. Tanemoto, T. Tsuji
The present study investigated the role of the dispersion of QT interval in percutaneous transluminal coronary angioplasty (PTCA)-induced ventricular tachyarrhythmias. Patients with effort angina without a previous myocardial infarction (n = 22), who had single-vessel disease of the anterior descending coronary artery (LAD), underwent PTCA if the coronary lesion was 75% or more stenosed in segment 6 or 7 of the LAD. The standard 12-lead ECG was continuously recorded during the procedure. Averaged QTc and QTac intervals, where QTac was the interval from the beginning of QRS complex to the nadir of T wave corrected by Bazett's formula, did not change significantly during PTCA. Of the 22 patients, 7 showed ventricular arrhythmias during PTCA. The maximum difference (deltaQTc) and the standard deviation (QTcSD) of the corrected QT interval in the standard 12-lead ECG increased significantly during PTCA in the 7 patients with ventricular arrhythmias, whereas they decrreased in the 15 patients without ventricular arrhythmias. deltaQTac and QTacSD were not affected by PTCA regardless of ventricular arrhythmias, which shows that the increases in the variation of the ventricular repolarization process play a role in PTCA-induced ventricular arrhythmias.
{"title":"Relation of QT-interval variability to ventricular arrhythmias during percutaneous transluminal coronary angioplasty.","authors":"A. Kajiyama, D. Saito, T. Murakami, T. Shiraki, T. Oka, M. Doi, T. Masaka, K. Tanemoto, T. Tsuji","doi":"10.1253/JCJ.65.779","DOIUrl":"https://doi.org/10.1253/JCJ.65.779","url":null,"abstract":"The present study investigated the role of the dispersion of QT interval in percutaneous transluminal coronary angioplasty (PTCA)-induced ventricular tachyarrhythmias. Patients with effort angina without a previous myocardial infarction (n = 22), who had single-vessel disease of the anterior descending coronary artery (LAD), underwent PTCA if the coronary lesion was 75% or more stenosed in segment 6 or 7 of the LAD. The standard 12-lead ECG was continuously recorded during the procedure. Averaged QTc and QTac intervals, where QTac was the interval from the beginning of QRS complex to the nadir of T wave corrected by Bazett's formula, did not change significantly during PTCA. Of the 22 patients, 7 showed ventricular arrhythmias during PTCA. The maximum difference (deltaQTc) and the standard deviation (QTcSD) of the corrected QT interval in the standard 12-lead ECG increased significantly during PTCA in the 7 patients with ventricular arrhythmias, whereas they decrreased in the 15 patients without ventricular arrhythmias. deltaQTac and QTacSD were not affected by PTCA regardless of ventricular arrhythmias, which shows that the increases in the variation of the ventricular repolarization process play a role in PTCA-induced ventricular arrhythmias.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"31 1","pages":"779-82"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87177388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Okayama, T. Sumimoto, N. Morioka, Kouzo Yamamoto, Hiroyuki Kawada
A 67-year-old woman with hypertrophic obstructive cardiomyopathy that was refractory to medical treatment underwent percutaneous transluminal septal myocardial ablation (PTSMA). The septal branch supplying the myocardium involved in the left ventricular outflow tract (LVOT) obstruction was identified by selective myocardial contrast echocardiography (MCE). MCE for the third and largest septal branch opacified the right side of the mid-septal myocardium and MCE for the second septal branch opacified the right side of the basal portion of the septal myocardium. Finally, contrast agent was injected into the first, small branch, which opacificied the myocardium protruding into the LVOT. Subsequently, septal myocardial ablation for this vessel with intracoronary alcohol was performed, followed by a reduction of the LVOT gradient and successful, dramatic improvement in the patient's clinical condition. Selective MCE was very useful to identify the appropriate septal branch for PTSMA and enabled maximal effect of this treatment with minimal myocardial damage.
{"title":"Usefulness of selective myocardial contrast echocardiography in percutaneous transluminal septal myocardial ablation: a case report.","authors":"H. Okayama, T. Sumimoto, N. Morioka, Kouzo Yamamoto, Hiroyuki Kawada","doi":"10.1253/JCJ.65.842","DOIUrl":"https://doi.org/10.1253/JCJ.65.842","url":null,"abstract":"A 67-year-old woman with hypertrophic obstructive cardiomyopathy that was refractory to medical treatment underwent percutaneous transluminal septal myocardial ablation (PTSMA). The septal branch supplying the myocardium involved in the left ventricular outflow tract (LVOT) obstruction was identified by selective myocardial contrast echocardiography (MCE). MCE for the third and largest septal branch opacified the right side of the mid-septal myocardium and MCE for the second septal branch opacified the right side of the basal portion of the septal myocardium. Finally, contrast agent was injected into the first, small branch, which opacificied the myocardium protruding into the LVOT. Subsequently, septal myocardial ablation for this vessel with intracoronary alcohol was performed, followed by a reduction of the LVOT gradient and successful, dramatic improvement in the patient's clinical condition. Selective MCE was very useful to identify the appropriate septal branch for PTSMA and enabled maximal effect of this treatment with minimal myocardial damage.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"17 1","pages":"842-4"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82532383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Fujii, S. Kibira, C. Izumi, T. Saito, A. Ryabikov, M. Miura
The proximal isovelocity surface area (PISA) method is one of the various methods used for quantitatively estimating mitral regurgitation. The PISA shape is hemielliptic rather than hemispheric on a slit-like orifice, and the hemielliptic method is more accurate than the hemispheric method for in vitro studies. Nevertheless, the hemispheric method is used clinically because of its simplicity, whereas the hemielliptic method is difficult to approach from 3 orthogonal directions. The present study tries to establish a modified hemielliptic method for use in clinical applications. A closed-circuit, constant flow system was designed to simulate PISA, and various types of slit-like orifices were selected. Three orthogonal PISA radii were measured and flow rates were calculated using the original hemielliptic formula from the 3 orthogonal radii. Flow rates were also calculated indirectly using a linear regression formula, and PISA radii from a bird's eye approach and lateral approaches (modified hemielliptic method) were compared. Flow rates that were determined using the original hemielliptic method correlated significantly with actual flow rates (r = 0.92, p < 0.0001; y = 1.1x - 13; SEE = 13.63 ml/s). Similarly, flow rates calculated using the modified hemielliptic method correlated significantly with actual flow rates (r = 0.90, p < 0.001; y = 0.94x - 0.78; SEE = 14.13 ml/s). The study's results imply that the modified hemielliptic method can be used to accurately quantify mitral regurgitation and could be applied for clinical examinations.
{"title":"Hemielliptic proximal isovelocity surface area method modified for clinical application: more accurate quantification of mitral regurgitation in Doppler echocardiography.","authors":"H. Fujii, S. Kibira, C. Izumi, T. Saito, A. Ryabikov, M. Miura","doi":"10.1253/JCJ.65.820","DOIUrl":"https://doi.org/10.1253/JCJ.65.820","url":null,"abstract":"The proximal isovelocity surface area (PISA) method is one of the various methods used for quantitatively estimating mitral regurgitation. The PISA shape is hemielliptic rather than hemispheric on a slit-like orifice, and the hemielliptic method is more accurate than the hemispheric method for in vitro studies. Nevertheless, the hemispheric method is used clinically because of its simplicity, whereas the hemielliptic method is difficult to approach from 3 orthogonal directions. The present study tries to establish a modified hemielliptic method for use in clinical applications. A closed-circuit, constant flow system was designed to simulate PISA, and various types of slit-like orifices were selected. Three orthogonal PISA radii were measured and flow rates were calculated using the original hemielliptic formula from the 3 orthogonal radii. Flow rates were also calculated indirectly using a linear regression formula, and PISA radii from a bird's eye approach and lateral approaches (modified hemielliptic method) were compared. Flow rates that were determined using the original hemielliptic method correlated significantly with actual flow rates (r = 0.92, p < 0.0001; y = 1.1x - 13; SEE = 13.63 ml/s). Similarly, flow rates calculated using the modified hemielliptic method correlated significantly with actual flow rates (r = 0.90, p < 0.001; y = 0.94x - 0.78; SEE = 14.13 ml/s). The study's results imply that the modified hemielliptic method can be used to accurately quantify mitral regurgitation and could be applied for clinical examinations.","PeriodicalId":14544,"journal":{"name":"Japanese circulation journal","volume":"203 1","pages":"820-6"},"PeriodicalIF":0.0,"publicationDate":"2001-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79694436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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