Higashi Tokushima National Hospital

Tokushima-shi, Japan

Higashi Tokushima National Hospital

Tokushima-shi, Japan
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Mizuguchi Y.,Higashi Tokushima National Hospital | Oishi Y.,Higashi Tokushima National Hospital | Miyoshi H.,Higashi Tokushima National Hospital | Iuchi A.,Higashi Tokushima National Hospital | And 2 more authors.
Echocardiography | Year: 2010

Background: Pulsed tissue Doppler imaging is increasingly used to record mitral annular motion (MAM) velocity pattern. A reversed MAM velocity wave (Cm) is commonly seen at the beginning of the mitral valve closure in timing, whereas the underlying mechanism and clinical significance have not been studied. Methods: Conventional, pulsed Doppler, pulsed tissue Doppler, and two-dimensional strain echocardiography were performed in 100 consecutive patients with cardiovascular risk factors. Results: There were no correlations between the peak Cm and the ratio of peak early diastolic transmitral flow velocity to peak early diastolic MAM velocity (EEm) and Tei index. The peak Cm correlated with left ventricular (LV) ejection fraction, left atrial volume index (LAVI) and left atrial ejection fraction, isovolumic relaxation time, peak LV systolic strains and strain rates during atrial systole in the longitudinal and circumferential directions, and peak LV systolic strain rates in the longitudinal, circumferential, and radial directions. Multivariate linear regression analysis revealed that LAVI is a independent predictor related to peak Cm. Conclusion: The Cm is regulated by mitral annular motion velocity toward the LA due to closing of the mitral valve, and may be used as a predictive tool for determining the "disease history" of chronic LV diastolic dysfunction in patients with no marked elevation in the LV filling pressure. (Echocardiography 2010;27:784-790) © 2010, Wiley Periodicals, Inc.


Mizuguchi Y.,Higashi Tokushima National Hospital | Oishi Y.,Higashi Tokushima National Hospital | Miyoshi H.,Higashi Tokushima National Hospital | Iuchi A.,Higashi Tokushima National Hospital | And 2 more authors.
Journal of Cardiology | Year: 2010

Background: We hypothesized that deterioration of systolic left ventricular (LV) myocardial deformation exists as an early sign of "isolated" diastolic heart failure in patients with hypertension (HT) and LV hypertrophy (LVH). Methods and results: Two-dimensional strain echocardiography was performed in 98 patients with HT and 22 age-matched normal controls. The LV mass index and relative wall thickness were used to assign patients into 3 groups with normal geometry (N-LV, n = 31), concentric hypertrophy (C-LVH, n = 25), and eccentric hypertrophy (E-LVH, n = 42). The LV ejection fraction was preserved (≥50%) in the 3 HT groups. The mean peak systolic longitudinal, circumferential, and radial strains in the C-LVH group were lower compared to the control and other 2 HT groups. The mean peak systolic strain rates in the 3 directions in the C-LVH group and those in the longitudinal and radial directions in the E-LVH and N-LV groups were lower compared to the control group. In addition, the mean peak systolic circumferential strain rate was lower in the C-LVH group than in the other 2 HT groups. There were no differences in the LV torsion and torsional rate between the control and 3 HT groups. The mean peak systolic circumferential strain was an independent predictor related to LV ejection fraction in all patients. Conclusions: C-LVH caused deterioration of the systolic longitudinal, circumferential, and radial myocardial deformation in patients with HT. LV torsion and circumferential shortening were considered to be compensatory mechanisms for maintaining LV pump function. © 2009 Japanese College of Cardiology.


Kusunose K.,Tokushima University | Yamada H.,Tokushima University | Nishio S.,Tokushima University | Mizuguchi Y.,Higashi Tokushima National Hospital | And 12 more authors.
Circulation Journal | Year: 2011

Background: Automated function imaging (AFI) is a recently developed method of calculating the longitudinal peak systolic strains (LS) of the regional left ventricular (LV) wall using speckle tracking echocardiography and displaying them on a single bull's-eye map. The feasibility of AFI in patients with regional LV wall motion abnormalities caused by myocardial infarction (MI) was evaluated by comparison with visual assessment and myocardial perfusion single-photon emission computed tomography (SPECT). Methods and Results: Segmental LS was measured by AFI in 60 patients with MI (67±11 years) and 58 controls (71±9 years). Wall thickening (WT) was measured by SPECT in 20 patients with MI. There was a strong positive linear relationship between the wall motion score index by expert visual assessment and global LS. The receiver-operating characteristic analysis revealed the best cutoff value of -11%


Mizuguchi Y.,Higashi Tokushima National Hospital | Oishi Y.,Higashi Tokushima National Hospital | Miyoshi H.,Higashi Tokushima National Hospital | Iuchi A.,Higashi Tokushima National Hospital | And 3 more authors.
European Journal of Echocardiography | Year: 2010

Aims: Left ventricular (LV) torsion may be an important component of normal LV systolic function. However, its mechanics remain unresolved. Two-dimensional (2-D) strain imaging is increasingly used to quantify LV torsion in the clinical setting. Telmisartan has cardioreparative effects, including attenuation of subendocardial myocardial fibrosis and improvement of LV remodelling. To clarify the mechanisms of LV torsion, in the present study, we evaluated changes in LV longitudinal deformation and torsion after medication with telmisartan using 2-D strain imaging in patients with hypertension (HT).Methods and results: Telmisartan (20-40 mg daily) was administered to 37 previously untreated patients with HT. Two-dimensional strain echocardiography was performed after medication had been continued for 1-2 months with normal values for blood pressure (BP) (phase I) and for 12 months (phase II). In the phase II, relative LV wall thickness, LV mass index, LV torsion, and torsional rate were reduced, whereas the mean peak systolic longitudinal strain and strain rate were increased, compared to the phase I. LV torsion correlated well with relative LV wall thickness, but not LV mass index.Conclusion: Our results obtained from cardioreparative effects of telmisartan suggested that LV torsion is associated with systolic longitudinal deformation related to subendocardial myocardial fibrosis, and/or LV concentric hypertrophy-related difference in torques between the subendocardial and subepicardial sides. © 2010 The Author.


Mizuguchi Y.,Higashi Tokushima National Hospital | Oishi Y.,Higashi Tokushima National Hospital | Miyoshi H.,Higashi Tokushima National Hospital | Iuchi A.,Higashi Tokushima National Hospital | And 2 more authors.
Echocardiography | Year: 2010

Objective: The aim of the present study was to clarify the beneficial effects of telmisartan on the morphologic and functional changes in left ventricular (LV) myocardium and carotid arterial wall in patients with hypertension (HT) using tissue Doppler imaging and carotid ultrasonography. Methods: Telmisartan (20-40 mg daily) was administered to 35 previously untreated patients with HT. Conventional and pulsed tissue Doppler echocardiography were performed after medication had been continued for 1-2 months with normal values for blood pressure (BP) (phase I) and for 12 months (phase II). Subclinical atherosclerosis also was determined by measuring the intima-media thickness (IMT) and stiffness β of the left and right common carotid arteries using B- and M-mode ultrasonography. Results: In the phase II, the LV mass index and isovolumic relaxation time were lower, the peak systolic and early diastolic mitral annular motion velocities were greater compared to the phase I. The stiffness β and mean IMT were lower in the phase II than in the phase I. On multivariate regression analyses, age, BP, and LV diastolic variables emerged as stronger predictors of carotid arterial IMT and stiffness β. Conclusions: The 1-year use of telmisartan improved LV hypertrophy, regional LV myocardial contraction and relaxation, and carotid atherosclerosis in patients with HT. Our results support cardio- and arterioprotective benefits from continuous long-term telmisartan monotherapy, and combined analysis of tissue Doppler imaging and carotid ultrasonography may be a useful tool for understanding ventriculoarterial coupling in patients with HT. (Echocardiography 2010;27:864-872) © 2010, Wiley Periodicals, Inc.


Mizuguchi Y.,Higashi Tokushima National Hospital | Oishi Y.,Higashi Tokushima National Hospital | Miyoshi H.,Higashi Tokushima National Hospital | Iuchi A.,Higashi Tokushima National Hospital | And 2 more authors.
Journal of Cardiology | Year: 2010

Background: Left ventricular (LV) untwisting is commonly seen during left atrial (LA) contraction. The purpose of this study was to test the hypothesis that this characteristic motion is associated with chronic LV diastolic dysfunction. Methods and results: Ninety-two patients with cardiovascular risk factors and 36 age-matched normal individuals were included in the present study, and were examined by echocardiography, including conventional, tissue Doppler, and two-dimensional speckle tracking methods, to clarify the predictors related to late diastolic untwisting rate (LDUTR). There was no significant difference in LV ejection fraction between patient and control groups. The ratio of peak early diastolic transmitral flow velocity to peak early diastolic mitral annular motion velocity (E/. e′) and LA volume index in the patient group were significantly greater compared to the ratio of peak early to late diastolic transmitral flow velocity (E/. A) ≥1 group of the controls. The LDUTR in the E/. A <1 group of the controls was significantly greater compared to the E/. A ≥1 group of the controls and patient group. The LDUTR correlated with end-diastolic LV diameter, LA volume index, peak A velocity, E/. e′, relative LV wall thickness, and mean peak systolic LV radial strain. Multivariate regression analysis indicated that LA volume index is defined as a strong predictor related to LDUTR. Conclusions: Late diastolic LV untwisting reduces with a gradual increase in the LA size in patients with cardiovascular risk factors, and may reflect the disease history of chronic LV diastolic dysfunction. © 2010 Japanese College of Cardiology.


We hypothesized that deterioration of systolic left ventricular (LV) myocardial deformation exists as an early sign of isolated diastolic heart failure in patients with hypertension (HT) and LV hypertrophy (LVH).Two-dimensional strain echocardiography was performed in 98 patients with HT and 22 age-matched normal controls. The LV mass index and relative wall thickness were used to assign patients into 3 groups with normal geometry (N-LV, n=31), concentric hypertrophy (C-LVH, n=25), and eccentric hypertrophy (E-LVH, n=42). The LV ejection fraction was preserved (> or =50%) in the 3 HT groups. The mean peak systolic longitudinal, circumferential, and radial strains in the C-LVH group were lower compared to the control and other 2 HT groups. The mean peak systolic strain rates in the 3 directions in the C-LVH group and those in the longitudinal and radial directions in the E-LVH and N-LV groups were lower compared to the control group. In addition, the mean peak systolic circumferential strain rate was lower in the C-LVH group than in the other 2 HT groups. There were no differences in the LV torsion and torsional rate between the control and 3 HT groups. The mean peak systolic circumferential strain was an independent predictor related to LV ejection fraction in all patients.C-LVH caused deterioration of the systolic longitudinal, circumferential, and radial myocardial deformation in patients with HT. LV torsion and circumferential shortening were considered to be compensatory mechanisms for maintaining LV pump function.


PubMed | Higashi Tokushima National Hospital
Type: Journal Article | Journal: Journal of cardiology | Year: 2010

Left ventricular (LV) untwisting is commonly seen during left atrial (LA) contraction. The purpose of this study was to test the hypothesis that this characteristic motion is associated with chronic LV diastolic dysfunction.Ninety-two patients with cardiovascular risk factors and 36 age-matched normal individuals were included in the present study, and were examined by echocardiography, including conventional, tissue Doppler, and two-dimensional speckle tracking methods, to clarify the predictors related to late diastolic untwisting rate (LDUTR). There was no significant difference in LV ejection fraction between patient and control groups. The ratio of peak early diastolic transmitral flow velocity to peak early diastolic mitral annular motion velocity (E/e) and LA volume index in the patient group were significantly greater compared to the ratio of peak early to late diastolic transmitral flow velocity (E/A) 1 group of the controls. The LDUTR in the E/A <1 group of the controls was significantly greater compared to the E/A 1 group of the controls and patient group. The LDUTR correlated with end-diastolic LV diameter, LA volume index, peak A velocity, E/e, relative LV wall thickness, and mean peak systolic LV radial strain. Multivariate regression analysis indicated that LA volume index is defined as a strong predictor related to LDUTR.Late diastolic LV untwisting reduces with a gradual increase in the LA size in patients with cardiovascular risk factors, and may reflect the disease history of chronic LV diastolic dysfunction.


PubMed | Higashi Tokushima National Hospital
Type: Journal Article | Journal: Echocardiography (Mount Kisco, N.Y.) | Year: 2010

Pulsed tissue Doppler imaging is increasingly used to record mitral annular motion (MAM) velocity pattern. A reversed MAM velocity wave (Cm) is commonly seen at the beginning of the mitral valve closure in timing, whereas the underlying mechanism and clinical significance have not been studied.Conventional, pulsed Doppler, pulsed tissue Doppler, and two-dimensional strain echocardiography were performed in 100 consecutive patients with cardiovascular risk factors.There were no correlations between the peak Cm and the ratio of peak early diastolic transmitral flow velocity to peak early diastolic MAM velocity (E/Em) and Tei index. The peak Cm correlated with left ventricular (LV) ejection fraction, left atrial volume index (LAVI) and left atrial ejection fraction, isovolumic relaxation time, peak LV systolic strains and strain rates during atrial systole in the longitudinal and circumferential directions, and peak LV systolic strain rates in the longitudinal, circumferential, and radial directions. Multivariate linear regression analysis revealed that LAVI is a independent predictor related to peak Cm.The Cm is regulated by mitral annular motion velocity toward the LA due to closing of the mitral valve, and may be used as a predictive tool for determining the disease history of chronic LV diastolic dysfunction in patients with no marked elevation in the LV filling pressure.


PubMed | Higashi Tokushima National Hospital
Type: Journal Article | Journal: European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology | Year: 2010

Left ventricular (LV) torsion may be an important component of normal LV systolic function. However, its mechanics remain unresolved. Two-dimensional (2-D) strain imaging is increasingly used to quantify LV torsion in the clinical setting. Telmisartan has cardioreparative effects, including attenuation of subendocardial myocardial fibrosis and improvement of LV remodelling. To clarify the mechanisms of LV torsion, in the present study, we evaluated changes in LV longitudinal deformation and torsion after medication with telmisartan using 2-D strain imaging in patients with hypertension (HT).Telmisartan (20-40 mg daily) was administered to 37 previously untreated patients with HT. Two-dimensional strain echocardiography was performed after medication had been continued for 1-2 months with normal values for blood pressure (BP) (phase I) and for 12 months (phase II). In the phase II, relative LV wall thickness, LV mass index, LV torsion, and torsional rate were reduced, whereas the mean peak systolic longitudinal strain and strain rate were increased, compared to the phase I. LV torsion correlated well with relative LV wall thickness, but not LV mass index.Our results obtained from cardioreparative effects of telmisartan suggested that LV torsion is associated with systolic longitudinal deformation related to subendocardial myocardial fibrosis, and/or LV concentric hypertrophy-related difference in torques between the subendocardial and subepicardial sides.

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