論文 - 楠瀬　賢也

Assessment of Right Ventricular Longitudinal Strain in Patients with Ischemic Cardiomyopathy: Head-to-Head Comparison between Two-Dimensional Speckle-Based Strain and Velocity Vector Imaging Using Volumetric Assessment by Cardiac Magnetic Resonance as a "Gold Standard"

Jae-Hyeong Park, Kenya Kusunose, Hirohiko Motoki, Deborah H. Kwon, Richard A. Grimm, Brian P. Griffin, Thomas H. Marwick, Zoran B. Popovic

ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES ( WILEY )  32 ( 6 ) 956 - 965   2015年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BackgroundLongitudinal 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). MethodsWe studied 36 patients (28 men, 6311years) 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. ResultsVVI 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. ConclusionsRV 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.

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Serial Imaging Changes During Treatment of Immunoglobulin G4-Related Disease With Multiple Pseudotumors

Kenya Kusunose, Junko Hotchi, Yuriko Takagawa, Susumu Nishio, Takayuki Ise, Takeshi Tobiume, Koji Yamaguchi, Shusuke Yagi, Takashi Iwase, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

CIRCULATION ( LIPPINCOTT WILLIAMS & WILKINS )  131 ( 21 ) 1882 - 1883   2015年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction

Michael A. Bolen, Prabhakar Rajiah, Kenya Kusunose, Patrick Collier, Allan Klein, Zoran B. Popovic, Scott D. Flamm

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING ( SPRINGER )  31 ( 4 ) 859 - 866   2015年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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To assess the utility of cardiac magnetic resonance (MR) imaging in the diagnosis of constrictive pericarditis (CP). This study was approved by the institutional review board, with a waiver of informed consent. A total of 42 consecutive patients (mean age, 55 +/- A 16 years; 3 women, 39 men) with CP treated with pericardiectomy who had undergone cardiac MR before surgery were evaluated retrospectively. An additional 21 patients were evaluated as a control group; of these, 10 consecutive patients received cardiac MR for reasons other than suspected pericardial disease, and 11 consecutive patients had a history of pericarditis but no clinical suspicion of pericardial constriction. MR imaging parameters were analyzed independently and with a decision tree algorithm for usefulness in the prediction of CP. Catheterization data were also reviewed when available. A model combining pericardial thickness and relative interventricular septal (IVS) excursion provided the best overall performance in prediction of CP (C statistic, 0.98, 100 % sensitivity, 90 % specificity). Several individual parameters also showed strong predictive value in the assessment of constriction, including relative IVS excursion (sensitivity, 93 %; specificity, 95 %), pericardial thickness (sensitivity, 83 %; specificity, 100 %), qualitative assessment of pathologic coupling (sensitivity, 88 %; specificity, 100 %), diastolic IVS bounce (sensitivity, 90 %; specificity, 85 %), left ventricle area change (sensitivity, 86 %; specificity, 100 %), and eccentricity index (sensitivity, 86 %; specificity, 90 %; all P < 0.001). Strong agreement was observed between catheterization and surgical findings of constriction (97 %). Cardiac MR provides robust quantitative and qualitative analysis for the diagnosis of CP.

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Right Ventricular Echocardiographic Parameters Are Associated with Mortality after Acute Pulmonary Embolism

Danai Khemasuwan, Teerapat Yingchoncharoen, Pichapong Tunsupon, Kenya Kusunose, Ajit Moghekar, Allan Klein, Adriano R. Tonelli

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY ( MOSBY-ELSEVIER )  28 ( 3 ) 355 - 362   2015年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: There is limited information on the utility of certain echocardiographic measurements, such as right ventricular RV) strain analysis, in predicting mortality in patients with acute pulmonary embolism PE). Methods: A total of 211 patients with acute PE admitted to a medical intensive care unit (ICU) were retrospectively identified. Echocardiographic variables were prospectively measured in this cohort. The focus was on ICU, hospital, and long-term mortality. Results: The mean age was 61 6 15 years. Median Acute Physiology and Chronic Health Evaluation IV and simplified Pulmonary Embolism Severity Index scores were 60 (interquartile range, 40-71) and 2 interquartile range, 1-2), respectively. Thirty-eight patients (18%) died during the sentinel hospitalization (13% died in the ICU). A total of 61 patients (28.9%) died during a median follow-up period of 15 months interquartile range, 526 months). The echocardiographic variables associated with long-term mortality from PE diagnosis) were ratio of RV to left ventricular end-diastolic diameter hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2-4.8), tricuspid annular plane systolic excursion HR, 0.53; 95% CI, 0.31-0.92), and RV-right atrial gradient HR, 1.02; 95% CI, 1.01-1.4). ICU mortality was associated with ratio of RV to LV end-diastolic diameter HR, 4.4; 95% CI, 1.3-15), RV systolic pressure HR, 1.03; 95% CI, 1.01-1.05), tricuspid annular plane systolic excursion HR, 0.4; 95% CI, 0.18-0.9), and inferior vena cava collapsibility < 50% HR, 4.3; 95% CI, 1.7-11). These variables remain significantly associated with mortality after adjusting by Acute Physiology and Chronic Health Evaluation IV score, Pulmonary Embolism Severity Index score, or the use of thrombolytic agents. RV strain parameters were not correlated with hospital or long-term mortality. Conclusions: Four simple parameters that measure different aspects of the right ventricle ratio of RV to left ventricular end-diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion, and inferior vena cava collapsibility) were independently associated with mortality in patients presenting with acute PE who were admitted to the ICU.

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Plasma MicroRNA-100 Is Associated With Coronary Plaque Vulnerability

Takeshi Soeki, Koji Yamaguchi, Toshiyuki Niki, Etsuko Uematsu, Sachiko Bando, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Junko Hotchi, Takeshi Tobiume, Shusuke Yagi, Daiju Fukuda, Yoshio Taketani, Takashi Iwase, Hirotsugu Yamada, Tetsuzo Wakatsuki, Michio Shimabukuro, Masataka Sata

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  79 ( 2 ) 413 - 418   2015年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Although numerous studies have reported altered plasma levels of various microRNAs (miRNAs) in patients with cardiovascular disease, there are no data on the relationship between plasma miRNAs and vulnerable coronary plaque. In this study, we investigated whether plasma miRNAs might be a sensitive marker of coronary plaque vulnerability. Methods and Results: Integrated backscatter intravascular ultrasound (IB-IVUS) was performed in 32 consecutive patients with angina pectoris who underwent percutaneous coronary intervention. Three-dimensional analysis of IB-IVUS was performed to determine the percentage of lipid volume (%LV) and fibrous volume (%FV). Circulating miRNAs were measured in EDTA-plasma simultaneously obtained from the aorta and the coronary sinus (CS). Muscle-enriched (miR-133a, miR-208a, miR-499), vascular-enriched (miR-92a, miR-100, miR-126, miR-127, miR145), and myeloid cell-enriched miRNAs (miR-155, miR-223) were measured. Plasma miR-100 was higher in the CS than in the aorta, but there were no significant differences in the levels of other miRNAs between the aorta and CS. Plasma miR-100 in the aorta was positively correlated with %LV (r=0.48, P<0.01) and negatively correlated with % FV (r=-0.41, P<0.05). Importantly, transcoronary concentration gradient of circulating miR-100 was more strongly correlated with % LV (r=0.53, P<0.01) and % FV (r=-0.56, P<0.01). Conclusions: miR-100 might be released into the coronary circulation from vulnerable coronary plaques. This study provides insights into the role of miRNAs in coronary atherosclerotic disease.

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Regurgitant Volume Informs Rate of Progressive Cardiac Dysfunction in Asymptomatic Patients With Chronic Aortic or Mitral Regurgitation

Kenya Kusunose, Paul C. Cremer, Rayji S. Tsutsui, Richard A. Grimm, James D. Thomas, Brian P. Griffin, Zoran B. Popovic

JACC-CARDIOVASCULAR IMAGING ( ELSEVIER SCIENCE INC )  8 ( 1 ) 14 - 23   2015年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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OBJECTIVES This study hypothesized that regurgitation severity, as determined by using the regurgitant volume index, would better delineate differential cardiac dysfunction in asymptomatic patients with moderate to severe aortic regurgitation (AR) and mitral regurgitation (MR). BACKGROUND Frequent surveillance echocardiography is considered appropriate in asymptomatic patients with moderate to severe AR and MR. However, the evidence to support this practice and to define the appropriate frequency is Limited. METHODS This was an observational cohort study of consecutive patients with moderate to severe asymptomatic AR or MR who underwent exercise echocardiography. Our cohort included 130 patients with moderate to severe asymptomatic MR and 130 patients with moderate to severe asymptomatic AR who were matched according to age and regurgitant volume index. All patients underwent yearly echocardiographic follow-up studies. Regurgitation severity was determined according to regurgitant volume index, with a Level >= 30 ml/m(2) considered a marker of severe regurgitation. RESULTS During follow-up, regardless of etiology, patients with severe regurgitation demonstrated increasing left ventricular volume indexes (4.2 +/- 1.5 ml/m(2) per year; p = 0.01) and decreasing left ventricular ejection fractions (1.3 +/- 0.4% per year; p = 0.002). In patients with moderate regurgitation, left ventricular volumes and ejection fractions did not significantly change. In addition, patients with severe regurgitation experienced a similar drop in contractility (end-systolic pressure/end-systolic volume ratio and single-beat pre-Load recruitable stroke work) during follow-up independent of regurgitation etiology. Contractility parameters did not change in patients with moderate regurgitation. CONCLUSIONS These asymptomatic patients with moderate AR or MR had stable cardiac function during 3 years of follow-up; thus, frequent echocardiography without a change in clinical status may not be necessary. In the setting of severe regurgitation, further cardiac deterioration occurred at a similar rate and manner irrespective of whether the dysfunction was related to AR or MR. (C) 2015 by the American College of Cardiology Foundation.

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Effect of ghrelin on autonomic activity in healthy volunteers

Takeshi Soeki, Kunihiko Koshiba, Toshiyuki Niki, Kenya Kusunose, Koji Yamaguchi, Hirotsugu Yamada, Tetsuzo Wakatsuki, Michio Shimabukuro, Kazuo Minakuchi, Ichiro Kishimoto, Kenji Kangawa, Masataka Sata

PEPTIDES ( ELSEVIER SCIENCE INC )  62   1 - 5   2014年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Ghrelin is a novel growth hormone (GH)-releasing peptide originally isolated from the stomach. Recently, we have shown that ghrelin suppresses cardiac sympathetic activity and prevents early left ventricular remodeling in rats with myocardial infarction. In the present study, we evaluated the effect of ghrelin on autonomic nerve activity in healthy human subjects. An intravenous bolus of human synthetic ghrelin (10 mu g/kg) was administered to 10 healthy men (mean age, 33 years). Holter monitoring assessment was performed before and during 2 h after the ghrelin therapy. The standard deviation of normal RR intervals (SDNN), square root of the mean of the sum of the squares of differences between adjacent RR intervals (rMSSD), high-frequency power (HF), and low-frequency power (LF) were analyzed. Blood samples were also obtained before and after the therapy. A single administration of ghrelin decreased both heart rate and blood pressure. Interestingly, ghrelin significantly decreased the LF and LF/HF ratio of heart rate variability and increased the SDNN, rMSSD, and HF. Ghrelin also elicited a marked increase in circulating GH, but not insulin-like growth factor-1. These data suggest that ghrelin might suppress cardiac sympathetic nerve activity and stimulate cardiac parasympathetic nerve activity. (C) 2014 Elsevier Inc. All rights reserved.

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Global Left Atrial Strain in the Prediction of Sinus Rhythm Maintenance after Catheter Ablation for Atrial Fibrillation

Hirohiko Motoki, Kazuaki Negishi, Kenya Kusunose, Zoran B. Popovic, Mandeep Bhargava, Oussama M. Wazni, Walid I. Saliba, Mina K. Chung, Thomas H. Marwick, Allan L. Klein

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY ( MOSBY-ELSEVIER )  27 ( 11 ) 1184 - 1192   2014年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Left atrial (LA) strain is a sensitive measure of LA mechanics. However, its relationship with rhythm outcomes after catheter ablation in patients with atrial fibrillation (AF) is not well established. The aim of this study was to evaluate whether baseline LA global longitudinal strain (LA epsilon) predicts rhythm outcomes in patients who undergo catheter ablation for AF. Methods: In 256 patients with AF (paroxysmal, 204; persistent, 52), comprehensive echocardiography was performed with assessment of LA epsilon by using Velocity Vector Imaging to calculate average strain values from apical four- and two-chamber views before ablation (median, 41 days; interquartile range, 1-95 days). Results: After a median of 8.0 months (interquartile range, 4.0-23.3 months) of follow-up, 149 patients (58%) had maintained sinus rhythm and 107 patients (42%) had recurrence of AF. In our study cohort (mean age 59 +/- 11 years; mean left ventricular ejection fraction, 58 +/- 10%), impaired total LA epsilon (LA epsilon(total)) was associated with greater left ventricular mass index (r = -0.245, P < .001) and worsening left ventricular diastolic function (ratio of transmitral flow peak early diastolic velocity to peak early diastolic velocity of the mitral annulus: r = -0.357, P < .001; maximal LA volume index: r = -0.393, P < .001). Patients with LA epsilon(total) < 23.2% showed a higher incidence of AF recurrence compared with patients with LA epsilon(total) >= 23.2% (log-rank P < .001). In multivariate Cox proportional-hazards analysis, LA epsilon(total) was independently related to rhythm outcomes (hazard ratio, 0.944; 95% confidence interval, 0.915-0.975; P < .001) after AF ablation. Moreover, LA epsilon(total) provided incremental predictive value for rhythm outcomes over clinical features (increment in global chi(2) = 14.63, P < .001). Conclusions: In patients with AF, baseline LA epsilon(total) was associated with rhythm outcome after catheter ablation.

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Prognostic Value of RV Function Before and After Lung Transplantation

K. Kusunose, Michael A. Bolen

JACC-CARDIOVASCULAR IMAGING ( ELSEVIER SCIENCE INC )  7 ( 11 ) 1085 - 1094   2014年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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OBJECTIVES We investigated the effects of lung transplantation on right ventricular (RV) function as well as the prognostic value of pre-and post-transplantation RV function. BACKGROUND Although lung transplantation success has improved over recent decades, outcomes remain a challenge. Identifying predictors of mortality in lung transplant recipients may Lead to improved long-term outcomes after lung transplantation. METHODS Eighty-nine (age 60 +/- 6 years, 58 men) consecutive patients who underwent single or double lung transplantation and had pre-and post-transplantation echocardiograms between July 2001 and August 2012 were evaluated. Echocardiographic measurements were performed before and after lung transplantation. Left ventricular (LV) and RV longitudinal strains were analyzed using velocity vector imaging. Cox proportional prognostic hazard models predicting all-cause death were built. RESULTS There were 46 all-cause (52%) and 17 cardiac (19%) deaths during 43 +/- 33 months of follow-up. After lung transplantation, echocardiography showed improved systolic pulmonary artery pressure (SPAP) (50 +/- 19 mm Hg to 40 +/- 13 mm Ng) and RV strain (-17 5% to - 18 +/- 4%). No pre-transplantation RV parameter predicted all-cause mortality. After adjustment for age, sex, surgery type, and etiology of lung disease in a Cox proportional hazards model, both posttransplantation RV strain (hazard ratio: 1.13, 95% confidence interval: 1.04 to 1.23, p = 0.005), and post-transplantation SPAP (hazard ratio: 1.03,95% confidence interval: 1.01 to 1.05, p = 0.011) were independent predictors of all-cause mortality. When post-transplantation RV strain and post-transplantation SPAP were added the clinical predictive model based on age, sex, surgery type, and etiology, the C-statistic improves from 0.60 to 0.80 (p = 0.002). CONCLUSIONS Alterations of RV function and pulmonary artery pressure normalize, and post-transplantation RV function may provide prognostic data in patients after lung transplantation. Our study is based on a highly and retrospectively selected group. We believe that larger prospective studies are warranted to confirm this result. (C) 2014 by the American College of Cardiology Foundation.

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Prognostic Significance of Left Atrial Appendage "Sludge'' in Patients with Atrial Fibrillation: A New Transesophageal Echocardiographic Thromboembolic Risk Factor

Boris S. Lowe, Kenya Kusunose, Hirohiko Motoki, Brandon Varr, Kevin Shrestha, Christine Whitman, W. H. Wilson Tang, James D. Thomas, Allan L. Klein

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY ( MOSBY-ELSEVIER )  27 ( 11 ) 1176 - 1183   2014年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: When stratifying thromboembolic risk to patients with atrial fibrillation (AF), left atrial appendage (LAA) thrombus is currently the only echocardiographic index that absolutely contraindicates cardioversion. The aim of this study was to identify the predictors of LAA "sludge'' and its impact on subsequent thromboembolism and survival in patients with AF. Methods: A total of 340 patients (mean age, 66 +/- 12 years; 75% men) who underwent transesophageal echocardiography to exclude LAA thrombus before electrical cardioversion or radiofrequency pulmonary vein isolation) for AF were retrospectively studied. LAA sludge was defined as a dynamic, viscid, layered echodensity without a discrete mass, visualized throughout the cardiac cycle. Follow-up was obtained after a mean of 6.7 +/- 3.7 years, and patients were analyzed according to LAA thrombus (n = 62 [18%]), sludge (n = 47 [14%]), or spontaneous echocardiographic contrast (n = 84 [25%]). Patients without these transesophageal echocardiographic characteristics served as controls (n = 147 [43%]). Results: LAA sludge was independently predicted by enlarged left atrial area (odds ratio, 4.54; 95% confidence interval [CI], 2.38-8.67; P < .001), reduced LAA emptying velocity (odds ratio, 12.7; 95% CI, 6.11-26.44; P < .001), and reduced left ventricular ejection fraction (odds ratio, 2.11; 95% CI, 1.03-4.32; P < .001). Thromboembolic event and all-cause mortality rates in patients with sludge were 23% and 57%, respectively. Multiple logistic regression analyses identified the presence of LAA sludge to be independently associated with thromboembolic complications (adjusted hazard ratio, 3.43; 95% CI, 1.42-8.28; P = .006) and all-cause mortality (adjusted hazard ratio, 2.02; 95% CI, 1.22-3.36; P = .007). Conclusion: Sludge within the LAA is independently associated with subsequent thromboembolic events and all-cause mortality in patients with AF.

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Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Aortic Stenosis and Preserved Ejection Fraction

Kenya Kusunose, Andrew Goodman, Roosha Parikh, Tyler Barr, Shikhar Agarwal, Zoran B. Popovic, Richard A. Grimm, Brian P. Griffin, Milind Y. Desai

CIRCULATION-CARDIOVASCULAR IMAGING ( LIPPINCOTT WILLIAMS & WILKINS )  7 ( 6 ) 938 - +   2014年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background-We sought to assess the utility of left ventricular global longitudinal strain (LV-GLS) in predicting mortality in moderate to severe and paradoxical severe aortic stenosis (AS) patients with preserved ejection fraction. Methods and Results-We studied 395 AS patients (70 +/- 14 years, 57% men) with aortic valve area <1.3 cm(2) evaluated between January to June 2008 (excluding severe other valve disease and LV ejection fraction <50%). Clinical and echocardiographic data were recorded. LV-GLS was analyzed using Velocity Vector Imaging. AS patients were classified as (a) moderate-severe (n=93; aortic valve area, 1.1-1.3 cm(2)), (b) standard severe (n=161; aortic valve area, <= 1 cm2; mean gradient >= 40 mm Hg), and (c) paradoxical severe (n=141; aortic valve area, <= 1 cm2 and mean gradient <40 mm Hg). Additive Euroscore was 7 +/- 3. The association of LV-GLS with all-cause mortality was assessed after risk-adjustment using Cox proportional hazards models. Median LV-GLS was -14.8% (interquartile range, -17.2%, -12.1%). At 4.4 +/- 1.4 years, there were 92 (23%) deaths. On multivariable Cox analysis, additive Euroscore (hazard ratio, 1.19; 1.13-1.27; P<0.001), New York Heart Association class (hazard ratio, 1.44; 1.11-1.87; P<0.001), AV surgery with time-dependent covariate analysis (hazard ratio, 0.29; 0.19-0.45; P<0.001), and LV-GLS (hazard ratio, 1.05; 1.03-1.07; P<0.001) were independent predictors of mortality. LV-GLS <-12.1% (4th quartile) was associated with significantly reduced survival. Addition of LV-GLS to clinical parameters (additive Euroscore+New York Heart Association class) led to significant improvement in prediction of mortality (chi(2) increased from 48 to 58; P<0.01). Conclusions-LV-GLS independently predicts mortality in moderate-severe and severe AS patients with preserved LV ejection fraction, providing incremental prognostic utility, in addition to standard clinical and echocardiographic parameters.

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Targeting Sleep Disordered Breathing to Prevent Heart Failure: What is the Evidence?

Kusunose K, Mehra R

Current cardiovascular risk reports   8 ( 10 ) 403   2014年10月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

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Infarct Characterization and Quantification by Delayed Enhancement Cardiac Magnetic Resonance Imaging Is a Powerful Independent and Incremental Predictor of Mortality in Patients With Advanced Ischemic Cardiomyopathy

Deborah H. Kwon, Lisa Asamoto, Zoran B. Popovic, Kenya Kusunose, Monique Robinson, Milind Desai, Thomas H. Marwick, Scott D. Flamm

CIRCULATION-CARDIOVASCULAR IMAGING ( LIPPINCOTT WILLIAMS & WILKINS )  7 ( 5 ) 796 - U79   2014年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background-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. Methods and Results-A total of 362 patients with ischemic cardiomyopathy (left ventricular dysfunction with >70% 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% (beta=2.07; P<0.001) 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 (chi(2) score 149). Conclusions-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.

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Pentraxin 3 is a local inflammatory marker in atrial fibrillation

Takeshi Soeki, Sachiko Bando, Etsuko Uematsu, Tomomi Matsuura, Toshiyuki Niki, Takayuki Ise, Kenya Kusunose, Junko Hotchi, Yuka Ueda, Noriko Tomita, Koji Yamaguchi, Shusuke Yagi, Daiju Fukuda, Yoshio Taketani, Takashi Iwase, Hirotsugu Yamada, Tetsuzo Wakatsuki, Michio Shimabukuro, Masataka Sata

HEART AND VESSELS ( SPRINGER )  29 ( 5 ) 653 - 658   2014年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Increasing evidence indicates that inflammation contributes to the pathogenesis of atrial fibrillation (AF). Pentraxin 3 (PTX3) is produced abundantly in local inflammatory lesions while C-reactive protein (CRP) is produced mainly in the liver. In this study, we investigated whether a local level of PTX3 might be a sensitive marker for the local inflammation of AF. Blood from the periphery and left atrial appendage (LAA) was sampled from 23 patients with AF undergoing pulmonary vein isolation, and from 10 control subjects with Wolff-Parkinson-White syndrome. We measured peripheral and LAA plasma concentrations of CRP, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and PTX3. Plasma PTX3 concentrations in both locations were higher in patients with AF than in control subjects. PTX3 concentrations were significantly higher in the LAA than the periphery in patients with AF (3.7 +/- 1.4 vs 3.3 +/- 1.2 ng/ml, P < 0.01), but not in control subjects (2.4 +/- 0.5 vs 2.4 +/- 0.5 ng/ml, not significant). Patients and controls showed no significant differences in CRP, IL-6, or TNF-alpha concentrations between the periphery and LAA. Interestingly, there was a significant positive correlation between LAA plasma concentrations of PTX3 and left atrial volume (r = 0.55, P < 0.01). These data demonstrate that Local PTX3 production in the left atrium might reflect the local inflammation of AF.

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Pre-Load Stress Echocardiography for Predicting the Prognosis in Mild Heart Failure

Hirotsugu Yamada, Kenya Kusunose, Susumu Nishio, Mika Bando, Junko Hotchi, Shuji Hayashi, Takayuki Ise, Shusuke Yagi, Koji Yamaguchi, Takashi Iwase, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

JACC-CARDIOVASCULAR IMAGING ( ELSEVIER SCIENCE INC )  7 ( 7 ) 641 - 649   2014年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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OBJECTIVES This study sought to introduce and confirm the efficacy of pre-load stress echocardiography with Leg-positive pressure (LPP) for improving risk stratification of patients with mild stable heart failure. BACKGROUND Heart failure patients with mild symptoms and a poor prognosis should be identified and treated aggressively to improve clinical outcome. METHODS We performed transthoracic echocardiography with LPP in 202 patients with chronic cardiac disease. Twenty-two of these patients also underwent cardiac catheterization, and left ventricular pressure was measured during LPP along with simultaneous Doppler recordings. Patients were classified into 3 groups on the basis of their left ventricular (LV) diastolic dysfunction as assessed by transmitral flow velocity: restrictive or pseudonormal (PN) at rest, impaired relaxation (IR) at rest and during LPP (stable IR), and IR at rest and PN during LPP (unstable IR). Clinical outcome was compared among these groups. RESULTS The LPP increased LV end-diastolic pressure from 15.8 +/- 4.7 mm Hg to 20.5 +/- 5.0 mm Hg in the unstable IR group and from 10.5 +/- 2.6 mm Hg to 14.7 +/- 3.8 mm Hg in the stable IR group (both p < 0.001). During an average follow-up of 548 +/- 407 days, 5 patients had cardiac death, 37 had acute heart failure, 4 had an acute myocardial infarction, and 7 had a stroke. The all-cause cardiac event rate in unstable IR was higher than in stable IR (p < 0.001), and was similar in the PN group (p = 0.81). Event-free survival was significantly lower in unstable IR than in stable IR (p = 0.003). In a Cox proportional hazards model, unstable IR was an independent predictor of all-cause cardiac events (hazard ratio: 8.0; p < 0.001). CONCLUSIONS The left LV end-diastolic pressure-volume relationship can be estimated by changes in transmitral flow velocity during LPP. Thus, pre-load stress echocardiography using LPP provides additional prognostic information in mild heart failure beyond that provided by conventional Doppler echocardiography at rest. (C) 2014 by the American College of Cardiology Foundation.

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Right Ventricular Global Longitudinal Strain Provides Prognostic Value Incremental to Left Ventricular Ejection Fraction in Patients with Heart Failure

Hirohiko Motoki, Allen G. Borowski, Kevin Shrestha, Bo Hu, Kenya Kusunose, Richard W. Troughton, W. H. Wilson Tang, Allan L. Klein

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY ( MOSBY-ELSEVIER )  27 ( 7 ) 726 - 732   2014年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: 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. Methods: 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. Results: 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. Conclusion: In patients with chronic systolic heart failure, worse RV strain provides prognostic value incremental to LV function.

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Relation Between Echocardiographically Estimated and Invasively Measured Filling Pressures in Constrictive Pericarditis

M. Chadi Alraies, Kenya Kusunose, Kazuaki Negishi, Hirad Yarmohammadi, Hirohiko Motoki, Wael AlJaroudi, Zoran B. Popovic, Allan L. Klein

AMERICAN JOURNAL OF CARDIOLOGY ( EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC )  113 ( 11 ) 1911 - 1916   2014年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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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. (C) 2014 Elsevier Inc. All rights reserved.

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Report of the American College of Cardiology (ACC) Scientific Sessions 2014, Washington, DC

Kenya Kusunose

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  78 ( 6 ) 1311 - 1316   2014年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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The American College of Cardiology (ACC) Scientific Session was held at the Walter E. Washington Convention Center in Washington, DC from March 29-31, 2014. The ACC Scientific Session is one of 3 major scientific cardiology meetings in the world, with over 20,000 attendees from 109 countries. There were over 2,200 oral and poster abstracts, and 22 late-breaking clinical trials (LBCTs), which are the focus of this report. Interestingly, in the CoreValve trials, transcatheter aortic valve replacement with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a higher survival rate at 1 year than surgical aortic valve replacement. Long-term results in a further study are needed. I hope the present report will encourage others to attend the ACC Scientific Session 2015 to be held in San Diego on March 14-16, 2015.

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Echocardiographic image tracker with a speckle adaptive noise reduction filter for the automatic measurement of the left atrial volume curve

Kenya Kusunose, Tomoaki Chono, Tomotsugu Tabata, Hirotsugu Yamada, Masataka Sata

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING ( OXFORD UNIV PRESS )  15 ( 5 ) 509 - 514   2014年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Aims Since tracking accuracy in left atrial (LA) images decreases due to low image quality around the LA in the apical view, a practical tracking method for LA images has not yet been proposed. The aim of this study was to assess an accurate and high-speed LA volume tracking (LAVT) method for the automatic measurement of LA volume (LAV) curves. Methods and results We used three approved protocols in this study: (i) LAV curves were measured by LAVT on computer-simulated images; (ii) in 20 healthy volunteers, we assessed the feasibility and accuracy of this method compared with experts measurements; and (iii) echocardiography and multi-detector row computed tomography (MDCT) imaging were performed on the same day in 20 patients with suspected coronary artery disease. On computer-simulated images, mean absolute percentage LAVT error in one cardiac cycle was 3 in filtered images and 16 in original images. In 20 healthy volunteers, there are strong correlations between LAVT and the experts LA measurements (LA maximum volume; R = 0.93, P < 0.001). In 400 LA images with 20 patients, an excellent correlation was obtained between LAVs using echocardiography and MDCT (R = 0.98, P < 0.001), with a small bias (14 of the mean) and narrow limits of agreement (15 of the mean). The mean time required for the LAVT analysis was 1.8 min, for the MDCT analysis was 35.8 min, and for the manual echocardiographic analysis was 14.0 min. Conclusion This LAVT method is fast, valid, accurate, and reproducible for determining LAV in both simulated images and the clinical setting.

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Decision Making in Asymptomatic Aortic Regurgitation in the Era of Guidelines Incremental Values of Resting and Exercise Cardiac Dysfunction

Kenya Kusunose, Shikhar Agarwal, Thomas H. Marwick, Brian P. Griffin, Zoran B. Popovic

CIRCULATION-CARDIOVASCULAR IMAGING ( LIPPINCOTT WILLIAMS & WILKINS )  7 ( 2 ) 352 - 362   2014年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background- 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. Methods and Results- 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 > 50%, 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 (chi(2), 20.4) was improved by resting LV strain (chi(2), 30.1; P=0.001), resting RV strain (chi(2), 49.7; P < 0.001), and further increased by exercise TAPSE (chi(2), 64.4; P < 0.001). Conclusions- In asymptomatic aortic regurgitation, resting LV strain, resting RV strain, and exercise TAPSE were independently associated with the need for earlier aortic surgery.

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