Published Papers - Kusunose Kenya

Low serum levels of eicosapentaenoic acid and docosahexaenoic acid are risk factors for cardiogenic syncope in patients with brugada syndrome

Shusuke Yagi, Takeshi Soeki, Ken-ichi Aihara, Daiju Fukuda, Takayuki Ise, Muneyuki Kadota, Sachiko Bando, Tomomi Matsuura, Takeshi Tobiume, Koji Yamaguchi, Kenya Kusunose, Hirotsugu Yamada, Tetsuzo Wakatsuki, Michio Shimabukuro, Masashi Akaike, Masataka Sata

International Heart Journal ( International Heart Journal Association )  58 ( 5 ) 720 - 723   2017.09 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

The n-3 polyunsaturated fatty acids (PUFAs), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have antiarrhythmic effects, possibly via modulation of the cardiac ion channels. Nevertheless, it is unknown whether low serum levels of n-3 PUFAs are risk factors for ventricular fibrillation in patients with Brugada syndrome (BrS). We retrospectively reviewed data from 62 men with BrS and evaluated their serum levels of EPA and DHA, and the risk factors for sudden cardiac death, including a history of cardiogenic syncope. Nineteen patients had a history of cardiogenic syncope, and their EPA and DHA levels were significantly lower than those of the patients without syncope. Multivariate logistic regression analysis revealed that low EPA and DHA levels were associated with the incidence of syncope. The receiver-operator characteristic curve showed the area under the curves of EPA and DHA for history of syncope were 0.84 and 0.72, respectively. In conclusion, low levels of EPA and DHA are risk factors for cardiogenic syncope in patients with BrS, which suggests that n-3 PUFAs play important roles in preventing ventricular fibrillation in BrS.

• Access this article

  DOI
• Search related information
  PubMed

Echocardiographic Predictors for Worsening of Six-Minute Walk Distances in Patients With Systemic Sclerosis (Scleroderma)

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

AMERICAN JOURNAL OF CARDIOLOGY ( EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC )  120 ( 2 ) 315 - 321   2017.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Change in 6-minute walk distance (6MWD) has been used as a clinical marker in pulmonary hypertension. Determinants and worsening of 6MWD remain a matter of debate because nonpulmonary factors have an impact on the 6MWD. We hypothesized that future reduction of 6MWD in patients with systemic sclerosis (SSc) was more closely associated with cardiac dysfunction. We prospectively performed standard clinical and echocardiographic evaluations in SSc patients with the 6-minute walk test at enrollment. Features associated with the 6MWD were sought in a multiple linear regression analysis and compared using standardized beta. Worsening of the 6MWD was defined as a 15% reduction and served as the primary outcome. Eighty-one patients were included. In the multivariate analysis, baseline 6MWD was related to SSc severity score (beta = -0.250, p = 0.024), left atrial volume index (beta = -0.222, p = 0.046), right ventricular fractional area change (beta = 0.252, p = 0.025), and the ratio of mean pulmonary artery pressure and cardiac output (beta = -0.31, p = 0.002). During follow-up, 20 patients reached the primary outcome. In sequential Cox models, a model based on right ventricular fractional area change at baseline (chi-square 4.8) was improved by left atrial volume index (chi-square 10.3, p = 0.007). In conclusion, determinants and worsening of 6MWD are explained by cardiac factors. When using the 6MWD as a clinical marker in pulmonary hypertension patients, their left ventricular diastolic function and right ventricular systolic function should be taken into consideration. (C) 2017 Elsevier Inc. All rights reserved.

• Access this article

  DOI
• Search related information
  PubMed

Plasma brain natriuretic peptide levels are elevated in patients with cancer

Sachiko Bando, Takeshi Soeki, Tomomi Matsuura, Takeshi Tobiume, Takayuki Ise, Kenya Kusunose, Koji Yamaguchi, Shusuke Yagi, Daiju Fukuda, Takashi Iwase, Hirotsugu Yamada, Tetsuzo Wakatsuki, Michio Shimabukuro, Naoki Muguruma, Tetsuji Takayama, Ichiro Kishimoto, Kenji Kangawa, Masataka Sata

PLOS ONE ( PUBLIC LIBRARY SCIENCE )  12 ( 6 ) e0178607 - e0178607   2017.06 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Background Natriuretic peptides have been proposed as biomarkers of cardiovascular disease, especially heart failure. Brain natriuretic peptide (BNP) has also been shown to be upregulated at the transcriptional and translational levels by pro-inflammatory cytokines in cardiac myocytes. Although we often measure plasma BNP levels in cancer patients, it remains unknown whether cancer-related inflammation affects the plasma BNP levels. We investigated the relationship between the BNP and human cancers. Methods We retrospectively studied 2,923 patients in whom the plasma BNP levels and serum Creactive protein (CRP) were measured and echocardiography was performed. Patients with clinically evident heart failure (NYHA II or higher), heart disease requiring medical treatment or surgery, renal dysfunction, and inflammatory disease were excluded. There were 234 patients in the final analysis. Blood sampling was performed before surgery and chemotherapy. In addition, we evaluated the relationship between the inflammation and plasma BNP levels in mouse models of colon cancer. Results Of the 234 patients, 80 were diagnosed with cancer. Both the plasma BNP and serum CRP levels were significantly higher in cancer patients than those without. There were no significant differences in the echocardiographic parameters. There was a significant positive correlation between the plasma BNP and serum CRP levels in cancer patients (r = 0.360, P < 0.01) but not in those without. In cancer patients, only the CRP correlated with the BNP independent of the age, creatinine level, hypertension, and body mass index. In addition, in nude mice with subcutaneous colon cancer, the plasma BNP level was elevated compared with that in non-cancer mice, and there was a significant relationship between the plasma BNP and serum levels of the inflammatory markers. Conclusions In cancer patients, as well as colon cancer model mice, the plasma BNP levels were elevated, possibly due to cancer-related inflammation. The effect of cancer on the BNP levels should be considered when using BNP as an indicator of heart failure in cancer patients.

• Access this article

  DOI
• Search related information
  PubMed

Effect of sitagliptin on the echocardiographic parameters of left ventricular diastolic function in patients with type 2 diabetes: a subgroup analysis of the PROLOGUE study

Hirotsugu Yamada, Atsushi Tanaka, Kenya Kusunose, Rie Amano, Munehide Matsuhisa, Hiroyuki Daida, Masaaki Ito, Hiroyuki Tsutsui, Mamoru Nanasato, Haruo Kamiya, Yasuko K. Bando, Masato Odawara, Hisako Yoshida, Toyoaki Murohara, Masataka Sata, Koichi Node

CARDIOVASCULAR DIABETOLOGY ( BIOMED CENTRAL LTD )  16 ( 1 ) 63 - 63   2017.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Background: Diabetes is associated closely with an increased risk of cardiovascular events, including diastolic dysfunction and heart failure that leads to a shortening of life expectancy. It is therefore extremely valuable to evaluate the impact of antidiabetic agents on cardiac function. However, the influence of dipeptidyl peptidase 4 inhibitors on cardiac function is controversial and a major matter of clinical concern. We therefore evaluated the effect of sitagliptin on echocardiographic parameters of diastolic function in patients with type 2 diabetes as a sub-analysis of the PROLOGUE study. Methods: Patients in the PROLOGUE study were assigned randomly to either add-on sitagliptin treatment or conventional antidiabetic treatment. Of the 463 patients in the overall study, 115 patients ( 55 in the sitagliptin group and 60 in the conventional group) who had complete echocardiographic data of the ratio of peak early diastolic transmitral flow velocity (E) to peak early diastolic mitral annular velocity (e') at baseline and after 12 and 24 months were included in this study. The primary endpoint of this post hoc sub-analysis was a comparison of the changes in the ratio of E to e' (E/e') between the two groups from baseline to 24 months. Results: The baseline-adjusted change in E/e' during 24 months was significantly lower in the sitagliptin group than in the conventional group (-0.18 +/- 0.55 vs. 1.91 +/- 0.53, p = 0.008), irrespective of a higher E/e' value at baseline in the sitagliptin group. In analysis of covariance, sitagliptin treatment was significantly associated with change in E/e' over 24 months (beta = -9.959, p = 0.001), independent of other clinical variables at baseline such as blood pressure, HbA1c, and medications for diabetes. Changes in other clinical variables including blood pressure and glycemic parameters, and echocardiographic parameters, such as cardiac structure and systolic function, were comparable between the two groups. There was also no significant difference in the serum levels of N-terminal-pro brain natriuretic peptide and high-sensitive C-reactive protein between the two groups during the study period. Conclusions: Adding sitagliptin to conventional antidiabetic regimens in patients with T2DM for 24 months attenuated the annual exacerbation in the echocardiographic parameter of diastolic dysfunction (E/e') independent of other clinical variables such as blood pressure and glycemic control.

• Access this article

  DOI
• Search related information
  PubMed

Correlation between right ventricular T₁ mapping and right ventricular dysfunction in non-ischemic cardiomyopathy.

Jellis CL, Yingchoncharoen T, Gai N, Kusunose K, Popović ZB, Flamm S, Kwon D

The international journal of cardiovascular imaging     2017.03 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

• Access this article

  DOI
• Search related information
  PubMed

Clinical Utility of Longitudinal Strain to Predict Functional Recovery in Patients With Tachyarrhythmia and Reduced LVEF.

Kusunose K, Torii Y, Yamada H, Nishio S, Hirata Y, Seno H, Saijo Y, Ise T, Yamaguchi K, Tobiume T, Yagi S, Soeki T, Wakatsuki T, Sata M

JACC. Cardiovascular imaging ( ELSEVIER SCIENCE INC )  10 ( 2 ) 118 - 126   2017.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Objectives: The aim of this study was to assess the time course of presumptive TIC and the predictors of LV functional recovery in such patients.Background: Tachycardia-induced cardiomyopathy (TIC) is a potentially reversible cardiomyopathy with effective treatment of the tachyarrhythmia. However, cases without improvement of left ventricular (LV) systolic function were found occasionally. The diagnosis of TIC can be challenging, and the role of echocardiographic imaging in the prediction of LV functional recovery is limited.Methods: LV segmental longitudinal strains (LS) were evaluated by 2-dimensional speckle tracking in 71 consecutive patients (65±16 years; 61% men) with tachyarrhythmia and reduced LV ejection fraction (EF) without any other known cardiovascular disease, and 30 age and gender matched control subjects. Relative apical LS ratio (RALSR) was defined using the equation: average apical LS / (average basal LS + average mid LS) as a marker of strain distribution.Results: Compared to control subjects, patients with tachyarrhythmia had significantly lower global LS. Improvement in LVEF within 6 months after treatment of index arrhythmia was observed in 41 patients, and LVEF did not improve in 30 patients. In univariate analysis, lower LVEF at baseline (hazard ratio: HR: 0.59 per 1SD, p=0.04) and higher RALSR (HR: 11.2 per 1SD, p <0.001) were associated with no recovery in LVEF during follow-up. In a multivariate logistic regression model, the significant predictor of LV systolic functional recovery was RALSR (HR: 22.9 per 1SD, p=0.001). A RALSR of 0.61 was sensitive (71%) and specific (90%) in differentiating LV systolic functional recovery (area under the curve: 0.88).Conclusions: The RALSR was associated with LV systolic functional recovery. This information might be useful for clinical evaluation and follow-up in patients with reduced LVEF.

• Access this article

  DOI
• Search related information
  PubMed

局所心臓周囲脂肪厚の臨床的意義 冠動脈疾患での検討

Maimaituxun Gulinu, 島袋 充生, 平田 有紀奈, 岩瀬 俊, 高尾 正一郎, 松浦 朋美, 伊勢 孝之, 楠瀬 賢也, 飛梅 威, 山口 浩司, 八木 秀介, 福田 大受, 山田 博胤, 添木 武, 若槻 哲三, 原田 雅史, 佐田 政隆

Anti-aging Science ( (株)メディカルレビュー社 )  8 ( 1 ) 61 - 61   2016.12 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

Effect of Direct Oral Anticoagulants on Carotid Artery Sclerosis in Patients With Atrial Fibrillation

Torii Yuta, Yamada Hirotsugu, Kusunose Kenya, Seno Hiromitsu, Saijyo Yoshihito, Okushi Yuichiro, Nishio Susumu, Hirata Yukina, Amano Rie, Sata Masataka

CIRCULATION   134   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

Longitudinal Strain Distribution is a Powerful Predictor for Functional Recovery in Patients With Tachycardia-induced Cardiomyopathy

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

CIRCULATION   134   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

Longitudinal Strain Distribution is a Powerful Predictor for Functional Recovery in Patients With Tachycardia-induced Cardiomyopathy

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

CIRCULATION   134   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

Impact of Age on the Morphology of Left Atrial Appendage in Atrial Fibrillation

Hirata Yukia, Yamada Hirotsugu, Kusunose Kenya, Shimizu Rikuto, Torii Yuta, Nishio Susumu, Seno Hiromitsu, Saijo Yoshihito, Hayashi Shuji, Soeki Takeshi, Wakatsuki Tetsuzo, Sata Masataka

CIRCULATION   134   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

Effect of Sitagliptin on Left Ventricular Function in Patients With Type 2 Diabetes a Sub Analysis of the PROLOGUE Study

Hiromitsu Seno, Yamada Hirotsugu, Kusunose Kenya, Amano Rie, Matsushita Munehide, Nanasato Mamoru, Murohara Toyoaki, Kamiya Haruo, Sata Masataka, Node Koichi

CIRCULATION   134   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

Purulent Pericarditis Accompanying Pericardial Abscess Induced by Nocardia in an Immunocompromised Patient

Akira Takashima, Shusuke Yagi, Koji Yamaguchi, Syunsuke Watanabe, Nobuaki Yamamoto, Hiroyuki Ito, Muneyuki Kadota, Tomoya Hara, Hiromu Yamazaki, Takayuki Ise, Kenya Kusunose, Takeshi Tobiume, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  80 ( 11 ) 2409 - 2411   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

• Access this article

  DOI
• Search related information
  PubMed

Relationship between local production of microRNA-328 and atrial substrate remodeling in atrial fibrillation

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

JOURNAL OF CARDIOLOGY ( ELSEVIER SCIENCE BV )  68 ( 5-6 ) 472 - 477   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Background: The underlying mechanism of atrial substrate remodeling in atrial fibrillation (AF) remains unknown. In this study, we investigated whether local and systemic levels of microRNA (miR) might be associated with the presence of AF and with left atrial (LA) substrate properties. Methods: Blood from the periphery, pulmonary vein (PV), and left atrial appendage (LAA) was sampled from 30 patients with AF undergoing PV isolation, and from 10 control subjects with Wolff-Parkinson White syndrome and without AF. We measured peripheral, PV, and LAA plasma levels of miR-1,-26, -133a, -328, and -590 by reverse transcription-polymerase chain reaction. LA global contact mapping during sinus rhythm was performed before PV isolation. Results: Plasma levels of miR-328 were higher in patients with AF than in control subjects. Plasma miR-328 levels were significantly higher in the LAA than in the periphery and PV in patients with AF, but not in control subjects. Plasma miR-1 levels were also higher in the LAA than in the PV in AF patients. Interestingly, LAA plasma levels of miR-328 showed a positive correlation with the LA voltage zone index (area with voltage <0.5 mV divided by total LA surface area) and a weak correlation with LA volume. Conclusion: Local production of miR-328 in the left atrium may be involved in the process of atrial remodeling in patients with AF. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

• Access this article

  DOI
• Search related information
  PubMed

Relation of Echocardiographic Characteristics of the Right-Sided Heart With Incident Heart Failure and Mortality in Patients With Sleep-Disordered Breathing and Preserved Left Ventricular Ejection Fraction

Kenya Kusunose, Dermot Phelan, Sinziana Seicean, Andreea Seicean, Patrick Collier, Kaeleen A. Bodena, Reena Mehrad, Brian P. Griffin

AMERICAN JOURNAL OF CARDIOLOGY ( EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC )  118 ( 8 ) 1268 - 1273   2016.10 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Sleep-disordered breathing (SDB) has been associated with right-sided heart dysfunction and adverse cardiovascular outcomes. Longitudinal data are sparse in terms of understanding the prognostic implications of right ventricular remodeling in SDB on cardiovascular risk. We therefore investigated the predictive value of right-sided cardiac functional alterations on incident heart failure (HF) or death in SDB. Patients with SDB who underwent echocardiography within 1 month of index polysomnogram from January 2002 to July 2011 with normal left ventricular ejection fraction were included. Cox proportional prognostic hazard models predicting HF or death were used. Of a potential 375 subjects, 202 fulfilled the inclusion criteria (58 +/- 14 years; 50% men). Subjects were followed for 3.1 +/- 2.4 years with a total of 34 (16.8%) developing HF or death. Right ventricular end-systolic area (hazard ratio [HR] 1.3, 95% CI 1.01 to 1.6, p = 0.038), pulmonary vascular resistance (PVR; HR 1.4, 95% CI 1.1 to 1.7, p = 0.005) and also left atrial volume index (HR 1.7, 95%, CI 1.3 to 2.3, p <0.001) and E/A ratio (HR 1.4, 95% CI 1.1 to 1.7; p <0.001), were predictive of HF or death. Patients with increased PVR had significantly shorter event-free survival than without increased PVR (p = 0.04). In sequential Cox models, a model based on clinical data and left ventricular ejection fraction (chi(2), 5.4) was improved by left atrial volume index (chi(2), 12.7; p = 0.011) and further increased by PVR (chi(2), 19.7; p = 0.015). In conclusion, right-sided heart dysfunction provides important prognostic information in SDB and may aid in identifying those at highest risk to target for closer follow-up. (C) 2016 Elsevier Inc. All rights reserved.

• Access this article

  DOI
• Search related information
  PubMed

解剖学的異常を認めない膝窩動脈捕捉症候群の1例

鳥居 裕太, 西尾 進, 玉井 佑里恵, 山崎 宙, Shoichiro Takao, Kenya Kusunose, Koji Yamaguchi, Tetsuzo Wakatsuki, Hirotsugu Yamada, Masataka Sata

超音波検査技術   Vol.41 ( No.5 ) 513 - 520   2016.10 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

• Access this article

  DOI

Predictors and Prognostic Significance of Right Ventricular Ejection Fraction in Patients With Ischemic Cardiomyopathy

Marwa A. Sabe, Sharif A. Sabe, Kenya Kusunose, Scott D. Flamm, Brian P. Griffin, Deborah H. Kwon

CIRCULATION ( LIPPINCOTT WILLIAMS & WILKINS )  134 ( 9 ) 656 - 665   2016.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

BACKGROUND: Decreased right ventricular (RV) ejection fraction (RVEF) portends poor prognosis in patients with ischemic cardiomyopathy, and previous studies have suggested an association between mitral regurgitation (MR) and RVEF. We sought to evaluate this association and whether mitral valve repair or replacement affects the relationship between RV function and mortality. METHODS: We included 588 patients (mean age, 63 +/- 11 years; 75% male) with ischemic cardiomyopathy who underwent cardiac magnetic resonance imaging between 2002 and 2008. Baseline characteristics, left ventricular ejection fraction, MR severity, treatment modality, scar burden, and RVEF were assessed. Multivariable linear regression and Cox proportional hazards models were used to assess the association between MR and RVEF and between RVEF and mortality, respectively. RESULTS: After adjustment for age, sex, left ventricular ejection fraction, right bundle-branch block, and RV scar, MR severity was found to be associated independently with RVEF. There were a total of 240 deaths during a median follow-up time of 5.7 years. After multivariable adjustment, every 10% decrease in RVEF was associated with a 17% increased risk of death (P=0.008). Although decreasing RVEF was associated with a poor prognosis in the nonrepair group (hazard ratio, 1.28; 95% confidence interval, 1.12-1.47; P<0.001), it was not associated with death in the mitral valve repair or replacement group (P for interaction=0.046). CONCLUSIONS: MR severity was found to be an independent predictor of RVEF, as were right bundle-branch block, left ventricular ejection fraction, and the presence of RV scar. Decreasing RVEF is associated with increased mortality in patients with ischemic cardiomyopathy; however, this association may be mitigated in patients who undergo mitral valve repair or replacement.

• Access this article

  DOI
• Search related information
  PubMed

表在エコー図検査と心エコー図検査のコラボレーションにより感染性心内膜炎が迅速に診断できた僧帽弁逸脱症の1例:Staphylococcus warneriによる自己弁への感染性心内膜炎

Hirotsugu Yamada, 田中 秀和, 宮原 俊介, 尾形 竜郎, Kenya Kusunose, 西尾 進, 鳥居 裕太, 平田 有紀奈, 大北 裕, Masataka Sata

Japanese Journal of Medical Ultrasonics ( The Japan Society of Ultrasonics in Medicine )  Vol.43 ( No.4 ) 581 - 586   2016.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

症例は,46歳男性,循環器内科医師,主訴は左足関節内果部と上腕の疼痛である.僧帽弁逸脱症による僧帽弁逆流と発作性心房細動の既往がある.足関節の疼痛は蜂窩織炎を疑って,血液検査と表在エコー図検査を行った.疼痛部は皮下浮腫が著明であったが,軟部組織の血流シグナルが乏しく,後脛骨動脈の血管壁を主体とした炎症と,同動脈の閉塞が確認された.一方,左手関節近位の尺骨動脈は逆行性血流を示しており,左尺骨動脈分岐部直後で閉塞していた.これらの所見から多発性血管閉塞性動脈炎と診断し,その原因究明のために直ちに心エコー図検査を施行した.その結果,僧帽弁に可動性を有する棍棒状の異常構造物を認め,僧帽弁逆流は高度に増悪しており,感染性心内膜炎と診断された.頭部MRI検査で異常を認めなかったため,外科的加療(疣腫摘除術,僧帽弁形成術,左房縫縮術,左心耳閉鎖術,Maze手術)が行われた.血液培養は陰性であったが,摘出した疣腫の培養からStaphylococcus warneriが同定された.Staphylococcus warneriは皮膚常在菌であり,本病原体による自己弁の感染性心内膜炎は報告が少ない.術後の経過は良好であり,抗生剤を6週間静脈投与した後に社会復帰した.患者が循環器内科医であり,自身の足関節および上腕の疼痛を契機に,表在エコー図検査と心エコー図検査を用いることで,感染性心内膜炎を迅速に診断した稀有な症例であり,かつ,感染性心内膜炎の起炎菌としては稀なStaphylococcus warneriが同定されたので,文献的な考察を加えて報告する.

• Access this article

  DOI

Predictors and Prognostic Impact of Progressive Ischemic Mitral Regurgitation in Patients With Advanced Ischemic Cardiomyopathy A Multimodality Study

Deborah H. Kwon, Kenya Kusunose, Nancy A. Obuchowski, Joao L. Cavalcante, Zoran B. Popovic, James D. Thomas, Milind Y. Desai, Scott D. Flamm, Brian P. Griffin

Circulation-Cardiovascular Imaging ( LIPPINCOTT WILLIAMS & WILKINS )  9 ( 7 )   2016.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

　View Summary

Background-Ischemic mitral regurgitation (IMR) is associated with poor outcomes. It is unknown what factors contribute to progression of IMR and how progressive IMR affects outcomes. We sought to determine imaging predictors of IMR progression and to determine if progressive IMR is an independent predictor of survival in patients with advanced ischemic cardiomyopathy. Methods and Results-Consecutive advanced ischemic cardiomyopathy patients who underwent cardiac magnetic resonance and echocardiograms at baseline with echocardiographic follow-up were studied. Cardiac magnetic resonance was used to assess left ventricular volumes, infarct size, and mitral valve geometry. The effective regurgitant orifice area (EROA) was calculated from the proximal isovelocity surface area by echocardiography. Repeated measures mixed effects and Cox proportional hazards regression models were built to identify predictors of IMR progression and survival. We evaluated 336 patients (age, 62 +/- 11 years) over a median follow-up time of 54 months: 154 patients were subsequently revascularized, and 182 patients were medically treated. Ninety-eight patients (29%) demonstrated an increase in EROA values of >= 0.1 cm(2). There were 87 adverse events (death or transplant). On multivariable analysis, infarct size (P<0.001), progression in IMR (P=0.008), age (P=0.003), and baseline EROA (P=0.010) were independently associated with adverse events. Independent predictors of IMR progression were as follows: baseline EROA (P<0.001), left ventricular end-systolic volume index (P=0.014), and total scar (P=0.036). Conclusions-IMR frequently increases in severity, and progression is independently associated with adverse left ventricular remodeling and infarct size, as assessed by cardiac magnetic resonance. Furthermore, IMR progression is a powerful independent predictor of adverse events, even after controlling for the severity of IMR at baseline.

• Access this article

  DOI
• Search related information
  PubMed

Association of Abnormal Postoperative Left Ventricular Global Longitudinal Strain With Outcomes in Severe Aortic Stenosis Following Aortic Valve Replacement

Rami Kafa, Kenya Kusunose, Andrew L. Goodman, Lars G. Svensson, Joseph F. Sabik, Brian P. Griffin, Milind Y. Desai

JAMA CARDIOLOGY ( AMER MEDICAL ASSOC )  1 ( 4 ) 494 - 496   2016.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

• Access this article

  DOI
• Search related information
  PubMed