論文 - 楠瀬　賢也

退院前の推定左室充満圧および収縮期肺動脈圧は心不全患者の再入院と関連する

鳥居 裕太, 楠瀬 賢也, 山田 博胤, 瀬野 弘光, 西條 良仁, 西尾 進, 平田 有紀奈, 佐田 政隆

日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  82回   CP17 - 2   2018年03月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Age-related changes in morphology of left atrial appendage in patients with atrial fibrillation.

Hirata Y, Kusunose K, Yamada H, Shimizu R, Torii Y, Nishio S, Saijo Y, Takao S, Soeki T, Sata M

The international journal of cardiovascular imaging   34 ( 2 ) 321 - 328   2018年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

The purpose of this study was to evaluate the relationship between age and frequency of left atrial appendage (LAA) morphology in patients with atrial fibrillation (AF) compared with sinus rhythm (SR). We enrolled 145 AF patients, and 199 SR patients for the control group without any cardiovascular disease. LAA volume index (LAAVi) and morphology were assessed by electrocardiogram-gated computed tomography angiography. LAA morphology was classified into "chicken wing" or "non-chicken wing" according to the previously described classification. There was no significant trend in frequency of non-chicken wing morphology among ages in the SR group (p = 0.36 for trend), whereas the frequency was negatively related to age in the AF group (p = 0.002 for trend). In multivariable logistic regression, age > 65 (odds ratio [OR] 0.42, p = 0.002) and duration of AF (OR 0.53, p = 0.010) and LAAVi (OR 0.62, p = 0.017) were independent factors of non-chicken wing LAA morphology in the AF group. LAA morphology is affected by age, especially in patients with AF. When we utilize non-chicken wing LAA morphology as a stroke risk factor in patients with AF, we should pay attention to their age.

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Provocation of clinically significant left ventricular outflow tract obstruction by postural change in patients with sigmoid septum

Yukina Hirata, Hirotsugu Yamada, Kenya Kusunose, Susumu Nishio, Yuta Torii, Yuki Horike, Masataka Sata

Journal of Echocardiography ( Springer Tokyo )  Vol.- ( No.- ) 1 - 2   2018年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events

Akira Hirono, Kenya Kusunose, Norihito Kageyama, Masayuki Sumitomo, Masahiro Abe, Hiroyuki Fujinaga, Masataka Sata

Journal of Cardiology ( Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) )  71 ( 1 ) 24 - 30   2018年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Background An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. Methods From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. Results During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, p = 0.005). The receiver operating characteristic curve revealed that 5 mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p &lt 0.001). In the validation cohort, the presence of a large IAD (IAD ≥5 mmHg) was significantly associated with the primary endpoint (p = 0.021). Conclusions IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5 mmHg.

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Predictors for the Treatment Effect of Sodium Glucose Co-transporter 2 Inhibitors in Patients with Type 2 Diabetes Mellitus

Shusuke Yagi, Ken-ichi Aihara, Takeshi Kondo, Kiyoe Kurahashi, Sumiko Yoshida, Itsuro Endo, Daiju Fukuda, Yutaka Nakaya, Kin-ichiro Suwaki, Takashi Takeji, Toshihiro Wada, Hotimah Masdan Salim, Saori Hama, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Koji Yamaguchi, Takeshi Tobiume, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Munehide Matsuhisa, Michio Shimabukuro, Masashi Akaike, Masataka Sata

Advances in Therapy ( Springer Healthcare )  35 ( 1 ) 124 - 134   2018年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Introduction: Predictors for the effect of sodium glucose co-transporter 2 (SGLT2) inhibitors at lowering hemoglobin A1c (HbA1c) levels in type 2 diabetes mellitus patients remain unclear. We therefore aimed to elucidate these predictors in type 2 diabetes patients after 3 months of SGLT2 treatment. Methods: A total of 302 consecutive type 2 diabetes patients who had been treated with SGLT2 inhibitors as monotherapy or add-on therapy to existing antidiabetic treatments were enrolled retrospectively. After excluding 27 patients whose HbA1c levels could not be evaluated 3 months after treatment, the glucose-lowering effects of SGLT2 inhibitors were assessed in 275 patients by measuring HbA1c levels before and 3 months after treatment. The predictors for changes in HbA1c levels after 3 months of treatment were evaluated. Results: SGLT2 inhibitor treatment for 3 months decreased HbA1c levels from 7.8 ± 1.2% to 7.4 ± 1.0% (p &lt  0.0001). A multiple regression analysis showed that the independent determinants for SGLT2 inhibitor treatment effect included decreased HbA1c levels after 1 month of treatment, high baseline HbA1c levels, and a high estimated glomerular filtration rate (eGFR). Conclusion: We show that type 2 diabetes patients who received the greatest glucose-lowering effect with SGLT2 inhibitor treatment were those with preserved renal function (high baseline eGFR) and high baseline HbA1c levels. Moreover, SGLT2 inhibitor treatment efficacy could be predicted by the patients’ initial response to treatment.

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Effect of the epicardial adipose tissue volume on the prevalence of paroxysmal and persistent atrial fibrillation

Kageyuki Oba, Minetaka Maeda, Gulinu Maimaituxun, Satoshi Yamaguchi, Osamu Arasaki, Daiju Fukuda, Shusuke Yagi, Yukina Hirata, Susumu Nishio, Takashi Iwase, Shoichiro Takao, Kenya Kusunose, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masafumi Harada, Hiroaki Masuzaki, Masataka Sata, Michio Shimabukuro

Circulation Journal ( Japanese Circulation Society )  82 ( 7 ) 1778 - 1787   2018年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Background: Although increasing evidence suggests that epicardial adipose tissue volume (EATV) is associated with atrial fibrillation (AF), it is controversial whether there is a dose-response relationship of increasing EATV along the continuum of AF. We evaluated the effect of the EATV on the prevalence of paroxysmal AF (PAF) and persistent AF (PeAF) and the relationships with cardiac structure and functional remodeling. Methods and Results: Subjects who underwent multidetector computed tomography (MDCT) coronary angiography because of symptoms suggestive of coronary artery disease were divided into sinus rhythm (SR) (n=112), PAF (n=133), and PeAF (n=71) groups. The EATV index (EATV/body surface area, mL/m2) was strongly associated with the prevalence of PAF and PeAF on the model adjusted for known AF risk factors. The effect of the EATV index on the prevalence of PeAF, but not on that of PAF, was modified by the left atrial (LA) dimension, suggesting that extension of the LA dimension is related to EATV expansion in PeAF. The cutoff value of the EATV index for the prevalence was higher in PeAF than in PAF (64 vs. 55 mL/m2, P&lt 0.01). Conclusions: The EATV index is associated with the prevalence of PAF and PeAF, and its cutoff values are predictive for PAF and PeAF development independently of other AF risk factors.

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Local thickness of epicardial adipose tissue surrounding the left anterior descending artery is a simple predictor of coronary artery disease ― new prediction model in combination with framingham risk score ―

Gulinu Maimaituxun, Michio Shimabukuro, Daiju Fukuda, Shusuke Yagi, Yukina Hirata, Takashi Iwase, Shoichiro Takao, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Takeshi Tobiume, Koji Yamaguchi, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masafumi Harada, Masataka Sata

Circulation Journal ( Japanese Circulation Society )  82 ( 5 ) 1369 - 1378   2018年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Compared with global cardiac adiposity, the local accumulation of fat surrounding coronary arteries might have a more direct impact on coronary artery disease (CAD). Here, we compared the local epicardial adipose tissue (EAT) thickness and global cardiac adiposity volumes for predicting CAD. Methods and Results: A total of 197 consecutive subjects underwent 320-slice multi-detector computed tomography coronary angiography and were segregated into CAD (≥1 coronary artery branch stenosis ≥50%) and non-CAD groups. EAT thickness was measured at the right coronary artery (EATRCA), the left anterior descending artery (EATLAD), and the left circumflex artery (EATLCX). Although EATRCA and EATLCX were similar between the 2 groups, EATLAD was larger in the CAD group than in the non-CAD group (5.45±2.16 mm vs. 6.86±2.19 mm, P&lt 0.001). EATLAD, after correcting for confounding factors, was strongly associated with CAD (r=0.276, P&lt 0.001) and Gensini score (r=0.239, P&lt 0.001). On multiple regression analysis, Framingham risk score combined with EATLAD was a strong predictor of CAD (adjusted R2=0.121 P&lt 0.001). Conclusions: The local fat thickness surrounding the LAD is a simple and useful surrogate marker for estimating the presence, severity, and extent of CAD, independent of classical cardiovascular risk factors.

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Left ventricular mass influences relationship between filling pressure and early-diastolic ratio of inflow velocity to mitral annular velocity (E/e′)

Masahiro Nakabachi, Satoshi Yamada, Hiroyuki Iwano, Taichi Hayashi, Kazunori Okada, Kenya Kusunose, Kiyotaka Watanabe, Tomoko Ishizu, Kazuaki Wakami, Hirotsugu Yamada, Kaoru Dohi, Yoshihiro Seo, Nobuyuki Ohte, Chikara Shimizu, Taisei Mikami

Circulation Journal ( Japanese Circulation Society )  82 ( 3 ) 732 - 738   2018年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Early-diastolic mitral annular velocity (e′) and the ratio of early-diastolic left ventricular (LV) inflow velocity (E) to e′ (E/e′) have been widely used as indexes of LV relaxation and filling pressure, respectively. However, many recent studies have demonstrated that they are not reliable in various clinical settings. We thus investigated the factors influencing these echocardiographic parameters in a multicenter study. Methods and Results: The study group comprised 69 patients, referred for cardiac catheterization, and enrolled in 5 university hospitals. Time constant (τ) and LV mean diastolic pressure (LVMDP) were measured using a micromanometer-tipped catheter. Although e′ only weakly correlated with τ (r=−0.35, P&lt 0.01), E/e′ modestly correlated with LVMDP (r=0.48, P&lt 0.001). Multivariable analysis revealed that hypertension (β=−0.33, P&lt 0.01) and LV ejection fraction (LVEF) (β=0.44, P&lt 0.001) were the independent determinants of e′, and LV mass index (LVMI) (β=0.37, P&lt 0.001) and LVMDP (β=0.47, P&lt 0.001) were those of E/e′. Additionally, E/e′ significantly correlated with LVMDP in patients with normal LVMI (r=0.74, P&lt 0.001) but not in those with increased LVMI. Conclusions: The coincidence of hypertension and LVEF affected the relationship between LV relaxation and e′, whereas LVMI altered the relationship between LV filling pressure and E/e′. Thus, clinical conditions associated with an increase in LVMI, such as LV hypertrophy and LV dilatation, should be considered when estimating the filling pressure from E/e′.

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Activated Factor X Signaling Pathway via Protease-Activated Receptor-2 is a Novel Therapeutic Target to Prevent Atrial Fibrillation

Soeki Takeshi, Matsuura Tomomi, Fukuda Daiju, Uematsu Etsuko, Tobiume Takeshi, Hara Tomoya, Kusunose Kenya, Ise Takayuki, Yamaguchi Koji, Yagi Shusuke, Yamada Hirotsugu, Wakatsuki Tetsuzo, Sata Masataka

CIRCULATION   136   2017年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Preserved Endothelial Function and Suppressed Local Coagulative and Inflammatory Response After Biodegradable Polymer SES Implantation Compared to Durable Polymer SES

Yamaguchi Koji, Wakatsuki Tetsuzo, Kawabata Yutaka, Ito Hiroyuki, Matsuura Tomomi, Ise Takayuki, Kusunose Kenya, Tobiume Takeshi, Yagi Shusuke, Yamada Hirotsugu, Soeki Takeshi, Sata Masataka

CIRCULATION   136   2017年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Preload Stress Echocardiography Predicts Outcomes in Patients With Preserved Ejection Fraction and Low Gradient Aortic Stenosis

Kusunose Kenya, Yamada Hirotsugu, Nishio Susumu, Torii Yuta, Hirata Yukina, Seno Hiromitsu, Saijo Yoshihito, Ise Takayuki, Yamaguchi Koji, Yagi Shusuke, Soeki Takeshi, Wakatsuki Tetsuzo, Sata Masataka

CIRCULATION   136   2017年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Local Epicardial Adipose Tissue Thickness in Left Anterior Descending Artery Provides a New Prediction Model for Coronary Artery Disease

Maimaituxun Gulinu, Shimabukuro Michio, Hirata Yukina, Iwase Takashi, Takao Shoichiro, Matsuura Tomomi, Ise Takayuki, Kusunose Kenya, Tobiume Takeshi, Yamaguchi Koji, Yagi Shusuke, Fukuda Daiju, Yamada Hirotsugu, Soeki Takeshi, Wakatsuki Tetsuzo, Harada Masafumi, Sata Masataka

CIRCULATION   136   2017年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Epicardial Adipose Tissue Produces Proinflammatory Cytokines and Influences the Pathogenesis of Atrial Fibrillation

Soeki Takeshi, Matsuura Tomomi, Uematsu Etsuko, Tobiume Takeshi, Kusunose Kenya, Ise Takayuki, Yamaguchi Koji, Yagi Shusuke, Fukuda Daiju, Yamada Hirotsugu, Wakatsuki Tetsuzo, Sata Masataka

CIRCULATION   136   2017年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Direct Slow Pathway Capture: A New Electrophysiological Method of Catheter Ablation for Atrioventricular Nodal Reentrant Tachycardia

Matsuura Tomomi, Tobiume Takeshi, Takeshi Soeki, Kato Ritsushi, Hara Motoki, Ise Takayuki, Kusunose Kenya, Yamaguchi Koji, Yagi Shusuke, Yamada Hirotsugu, Wakatsuki Tetsuzo, Sata Masataka, Matsumoto Kazuo

CIRCULATION   136   2017年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Edoxaban improves acute venous thromboembolism while preserving protein C and protein S levels

山? 宙, 八木 秀介, Y Torii, R Amano, Y Oomichi, T Sangawa, 福田 大受, 門田 宗之, 伊勢 孝之, R Ueno, 原 知也, 楠瀬 賢也, 松浦 朋美, 飛梅 威, 山口 浩司, 山田 博胤, 添木 武, 若槻 哲三, 赤池 雅史, 佐田 政隆

Journal of Cardiology   Vol.71 ( No.3 ) 305 - 309   2017年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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It is well known that warfarin inhibits the synthesis of vitamin K-dependent anticoagulants, including thrombin, protein C and S, and factor Xa, leading, paradoxically, to an initial hypercoagulable state. Edoxaban, a direct inhibitor of activated factor X is widely used for the treatment of acute venous thromboembolism (VTE). However, the effect of edoxaban on circulating coagulation factors, in patients with acute VTE, remains unknown. We enrolled 57 patients with acute VTE with/without pulmonary embolism treated with edoxaban (n=37) or warfarin (n=20) in a clinical setting. Before treatment and 2 weeks after treatment, we evaluated thrombotic burden using ultrasound or computed tomography angiography. We also evaluated thrombin generation, represented by prothrombin fragment F1+2; thrombus degradation, represented by D-dimer; and levels of anticoagulants, including protein C, protein S, and antithrombin III. Both edoxaban and warfarin treatment improved thrombotic burden and decreased prothrombin fragment F1+2, and D-dimer. Edoxaban treatment preserved protein C and protein S levels. In contrast, warfarin decreased protein C and protein S levels. Neither treatment affected antithrombin III. Edoxaban improves VTE while preserving protein C and protein S levels, thereby indicating that edoxaban improves thrombotic burden while maintaining levels of anticoagulants.

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Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention

Kenya Kusunose, Nancy A. Obuchowski, Marc Gillinov, Zoran B. Popovic, Scott D. Flamm, Brian P. Griffin, Deborah H. Kwon

JOURNAL OF THE AMERICAN HEART ASSOCIATION ( WILEY )  6 ( 11 ) e007163 - e007163   2017年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background-Ischemic mitral regurgitation is associated with substantial risk of death. Although surgical mitral valve intervention (MVi) may improve symptoms, it has not been shown to improve survival. The aim of this study was to identify predictors of mortality in patients with ischemic mitral regurgitation and MVi. Methods and Results-We evaluated 117 consecutive patients (age, 65 +/- 10 years) with advanced ischemic cardiomyopathy who underwent cardiac magnetic resonance and subsequent MVi between January 1, 2002 and January 1, 2012. Cardiac magnetic resonance was used to assess left ventricular remodeling and myocardial scarring. The effective regurgitant orifice area was calculated from the proximal isovelocity surface area by echocardiography. There were 43 deaths (37%) during follow-up (median, 62 months). On multivariable analysis, age >= 70 years (P=0.013), diabetes mellitus (P=0.001), dyslipidemia (P=0.012), papillary muscle scar (P=0.010), incomplete revascularization (P=0.001), and total scar %xeffective regurgitant orifice area >= 0.20 cm(2) (P=0.005) were each independently associated with all-cause mortality. Although patients with effective regurgitant orifice area <0.2 cm(2) at baseline demonstrated an increased hazard ratio of 3.3 for every 10% increase in scar, the hazard ratio increased to 9 for every 10% increase in scar in those with baseline effective regurgitant orifice area >= 0.20 cm(2). Mortality also was significantly higher in patients with incomplete revascularization compared with those with vascularized viable myocardium (61% versus 28%; P<0.001). Conclusions-Increased total scar burden and the presence of incomplete revascularization are powerful predictors of mortality in patients with advanced ischemic cardiomyopathy undergoing MVi. Viability assessment with cardiac magnetic resonance imaging can identify which patients with ischemic mitral regurgitation are at highest risk for mortality after surgical MVi.

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症例検討:妊婦に発症した脳梗塞の1例

細川 忍, 戸根 沙織, 松井 尚子, 楠瀬 賢也, 賀川 久美子, 山上 圭, 廣島 裕也, 田村 洋人

日本内科学会雑誌   Vol.106 ( No.10 ) 2265 - 2272   2017年10月 [ 査読有り ]

掲載種別: 研究論文（大学，研究機関紀要）

Echocardiographic Epicardial Adipose Tissue Thickness Is Associated with Symptomatic Coronary Vasospasm during Provocative Testing

Susumu Nishio, Kenya Kusunose, Hirotsugu Yamada, Yukina Hirata, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Michio Shimabukuro, Masataka Sata

Journal of the American Society of Echocardiography ( Mosby Inc. )  30 ( 10 ) 1021 - 1027.e1   2017年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background Epicardial adipose tissue (EAT) is the ectopic visceral fat surrounding the heart, which plays an important role in atherosclerosis of the coronary arteries via endothelial damage. Several studies have also suggested that vasospasm with angina (VSA) causes endothelial dysfunction in the coronary arteries. The aim of this study was to evaluate the thickness of EAT in the anterior interventricular groove (EAT-AIG) using echocardiography in patients who had no obstructive coronary artery disease and were suspected of having VSA. Methods Sixty-five patients who underwent intracoronary acetylcholine provocation testing for clinical indications were prospectively enrolled. VSA was diagnosed by coronary artery stenosis increase of &gt 90% and the presentation of chest pain with ischemic changes on electrocardiography. Results Subjects were divided into two groups, with and without significant coronary spasm (VSA group, 30 patients non-VSA group, 35 patients), consistent with acetylcholine provocation testing. EAT-AIG thickness was significantly greater in the VSA group than in the non-VSA group (8.2 ± 2.7 vs 6.1 ± 2.5 mm, P =.002). By receiver operating characteristic analysis, EAT-AIG thickness had a high C statistic (area under the curve = 0.81, P &lt .001) after adjustment for conventional risk factors (smoking, diabetes mellitus, and dyslipidemia). EAT-AIG thickness had incremental diagnostic value over other conventional risk factors (area under the curve = 0.81 vs 0.64, P for comparison =.020). Conclusions EAT-AIG thickness, which is noninvasively and easily measured using transthoracic echocardiography, can be one of multiple clinical variables associated with VSA.

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RV Myocardial Strain During Pre-Load Augmentation Is Associated With Exercise Capacity in Patients With Chronic HF

Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Ayumi Ishii, Yukina Hirata, Hiromitsu Seno, Yoshihito Saijo, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

JACC: Cardiovascular Imaging ( Elsevier Inc. )  10 ( 10 ) 1240 - 1249   2017年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Objectives The aim of this study was to assess the relationship between right ventricular (RV) function during pre-load augmentation and exercise tolerance. Background Peak oxygen uptake (VO2) is a strong predictor of mortality in chronic heart failure. Cardiac function during pre-load augmentation is an important part of the phenomenon in the evaluation of exercise capacity. Methods We prospectively performed echocardiographic studies in 68 chronic heart failure patients with cardiopulmonary exercise testing (mean age 60 ± 12 years 69% male). After resting evaluations, echocardiographic parameters were repeated during leg positive pressure (LPP). Exercise capacity was assessed by peak VO2 in all patients (left ventricular ejection fraction: 43 ± 15%). Results Patients with severely reduced exercise capacity (peak VO2 &lt 14 ml/kg/min) had significantly lower stroke volume index, left ventricular global longitudinal strain and RV strain and higher filling pressure (E/e’ and pulmonary arterial systolic pressure) than the remainder. Stroke volume index (β = 0.49), global longitudinal strain (β = −0.61), E/e’ (β = −0.32), pulmonary arterial systolic pressure (β = −0.57), and RV strain (β = −0.66) during LPP were independently correlated to peak VO2 (all p &lt 0.01). RV strain during LPP was the most powerful predictor in identifying patients with severely reduced exercise capacity (cut off value: −17% sensitivity: 81% specificity: 88% areas under the curve: 0.88 p &lt 0.001) compared with other variables including resting parameters. Conclusions RV strain during pre-load augmentation correlated independently to peak VO2 and was a powerful predictor in identifying patients with severely reduced exercise capacity.

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Preload Stress Echocardiography Predicts Outcomes in Patients with Preserved Ejection Fraction and Low-Gradient Aortic Stenosis

Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Yuta Torii, Yukina Hirata, Hiromitsu Seno, Yoshihito Saijo, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

Circulation: Cardiovascular Imaging ( Lippincott Williams and Wilkins )  10 ( 10 )   2017年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background-The projected aortic valve area (AVAproj) at a normal transvalvular flow rate using dobutamine is helpful to determine the actual severity of aortic stenosis (AS) and to predict risk of adverse events in low-gradient AS cases with unclear surgical indication. Our study aimed to identify the independent and incremental value of preload stress echocardiography-derived AVAproj to predict outcomes in patients with preserved ejection fraction and low-gradient AS. Methods and Results-We prospectively performed echocardiographic studies in 79 patients with low-gradient AS (age, 77±7 years 30% men) with preload stress echocardiography using leg positive pressure. AVAproj was calculated using AVA and transvalvular flow rate at baseline and during leg positive pressure. The primary end point was the decision for aortic valve surgery or cardiac death. During a median period of 19 months, 23 patients had the decision for aortic valve surgery, and none died during follow-up. In a stepwise multivariable analysis, indexed AVAproj (AVAiproj hazard ratio, 2.00 per 0.1 cm2/m2 decrease 95% confidence interval, 1.36-2.96 P&lt 0.001) was associated with the primary end point. Using a receiver operating characteristic curve analysis, the best cutoff value of AVAiproj for predicting cardiac events was &lt 0.72 cm2/m2. By incorporating AVAiproj into AVAi at baseline, continuous net reclassification index for cardiac events was 0.48 (P=0.04). Conclusions-In patients with low-gradient AS, indexed AVAproj derived from preload stress echocardiography can be useful to predict risk of adverse events. The present article should be considered as a proof of concept study, and we think that larger multicenter studies are warranted.

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