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ABSTRACT: AIMS: The diagnostic performance of cardiac magnetic resonance (CMR) has not been compared with that of other imaging modalities. Therefore, this study investigated the diagnostic capabilities of CMR and endomyocardial biopsy (EMB) in patients with heart failure (HF). METHODS AND RESULTS: We studied 136 patients with cardiomyopathy who underwent both CMR and EMB. Independent diagnoses were made according to the results of (i) CMR alone; (ii) EMB alone; (iii) clinical data plus echocardiogram; (iv) clinical data, echocardiogram, plus CMR; and (v) clinical data, echocardiogram, plus EMB. These diagnoses were then compared with the final diagnosis (gold standard) that was made using the complete clinical data, including EMB and CMR. The sensitivities of the diagnosis strategies of (i-v) relative to the final diagnosis were 67, 79, 86, 97, and 100%, respectively. CMR alone demonstrated better sensitivity for cardiac sarcoidosis and greater specificity for dilated cardiomyopathy than EMB alone. CMR also tended to show better sensitivity for hypertensive heart disease. There was no difference between the diagnostic capability of CMR and EMB for hypertrophic cardiomyopathy (HCM). However, CMR showed excellent sensitivity (100%) for apical and obstructive HCM, whereas EMB displayed better sensitivity for dilated HCM. Moreover, combined diagnosis with clinical data, echocardiogram, plus CMR achieved superior agreement with the final diagnosis in comparison with EMB alone. CONCLUSION: Non-invasive CMR demonstrated excellent diagnostic capability for patients with HF and was as effective as or superior to EMB. In particular, the use of CMR in combination with clinical data unrelated to EMB may provide excellent diagnostic accuracy for HF.
European Journal of Heart Failure 02/2013; 15(2):166-175. · 4.90 Impact Factor
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Hiroyuki Takahama,
Hiroyuki Yokoyama,
Akiko Kada,
Kenichi Sekiguchi,
Masashi Fujino,
Akira Funada, Makoto Amaki,
Takuya Hasegawa,
Masanori Asakura,
Hideaki Kanzaki,
Toshihisa Anzai,
Masafumi Kitakaze
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ABSTRACT: AIM: It has been uncertain whether patients with acute heart failure syndromes (AHFSs) benefit from a lower heart rate (HR) itself or from treatment for heart failure (HF) that reduces sympathetic tone with consequent HR reduction (HRR). The present study investigated the influence of HRR during hospitalization on the prognosis of AHFS patients. METHODS AND RESULTS: In 421 AHFS patients, we analyzed the relationship between HRR during hospitalization and the prognosis after discharge. During a mean follow-up period of 1.9years, 76 and 55 patients died or were re-hospitalized for HF, respectively. Although HR at discharge did not influence cardiac events (hazard ratio [HR]: 1.00 [95% CI; 0.99-1.02], p=0.22), the extent of HRR was a predictor of cardiac events (HR: 0.89 [0.84-0.96], p<0.001). Kaplan-Meier analysis revealed that the cardiac event rate of the HRR-positive group (≥27bpm reduction of HR from 114±24at admission to 65±11bpm at discharge) was significantly lower than that of the HRR-negative group (≤26bpm (=median value) reduction of HR from 74±14 to 71±14bpm). In the HRR-positive group, the cardiac event rate was significantly lower in patients receiving beta-blockers. Furthermore, the extent of HR change was an important predictor of cardiac events among other markers, compared with the change in systolic blood pressure or B-type natriuretic peptide. CONCLUSION: The HR itself at discharge was not associated with the prognosis, but the extent of HRR achieved by treatment of HF with beta-blockers was a strong predictor for the clinical outcome in AHFS patients.
Journal of Cardiology 11/2012; · 1.28 Impact Factor
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Chun-Yen Chen,
Akemi Yoshida,
Masanori Asakura,
Takuya Hasegawa,
Hiroyuki Takahama, Makoto Amaki,
Akira Funada,
Hiroshi Asanuma,
Hiroyuki Yokoyama,
Jiyoong Kim,
Hideaki Kanzaki,
Masafumi Kitakaze
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ABSTRACT: Background: Patients with heart failure (HF) have a high risk of cardiovascular (CV) death and re-hospitalization. The purpose of the present study was therefore to investigate predictors of CV death and re-hospitalization for acute decompensated HF (ADHF). Methods and Results: A total of 225 patients aged 67.2±15.2 years, including 134 men (59.6%), who were hospitalized for ADHF between 2008 and 2009, were followed up. After discharge, the relationship between clinical parameters and CV events (ie, CV death or re-hospitalization for HF) was examined. Follow-up was continued until 30 April 2011. The most important predictors of re-hospitalization were serum blood urea nitrogen (BUN; adjusted hazard ratio [HR], 1.02; 95% confidence interval [CI]: 1.00-1.03, P=0.01), plasma brain natriuretic peptide (BNP; adjusted HR, 1.85; 95% CI: 1.12-3.04, P=0.02), and diastolic blood pressure (DBP; adjusted HR, 0.97; 95% CI: 0.94-1.00, P=0.049). The only predictor of CV mortality was a high BUN (adjusted HR, 1.05; 95% CI: 1.01-1.09, P=0.01). Conclusions: High serum BUN (≥22.5mg/dl), high plasma BNP (≥250pg/ml), and low DBP (<60mmHg) predict CV events in patients hospitalized for ADHF. These factors may identify high-risk patients for CV events and provide therapeutic targets for managing HF. (Circ J 2012; 76: 2372-2379).
Circulation Journal 07/2012; 76(10):2372-9. · 3.77 Impact Factor
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ABSTRACT: Mitral annular calcification (MAC) is a generally asymptomatic abnormality found commonly in aged hearts. Some clinical studies have suggested that MAC should be considered an independent risk factor for stroke; however, whether the abnormality is indeed a risk factor remains controversial. We report a case in which debris from a vulnerable caseous MAC contributed to lethal embolisms in multiple organs. Postmortem examination revealed that caseous materials originating from a collapsed MAC were trapped in stenosed atherosclerotic cerebral and coronary arteries. Our findings support the notion at that subtle debris from collapsed vulnerable MACs can trigger major and even lethal embolic events in patients with severe atherosclerotic stenosis in vital organs.
Pathology International 07/2012; 62(7):496-9. · 1.62 Impact Factor
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Chun-Yen Chen,
Masanori Asakura,
Hiroshi Asanuma,
Takuya Hasegawa,
Jun Tanaka,
Norihisa Toh,
Kyung-Duk Min,
Hideaki Kanzaki,
Hiroyuki Takahama, Makoto Amaki,
Yumi Itoh,
Go Ichien,
Yoko Okumoto,
Toru Funahashi,
Jiyoong Kim,
Masafumi Kitakaze
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ABSTRACT: As the plasma level of adiponectin is related to metabolic syndrome and cardiovascular events, a low plasma adiponectin level may either cause or trigger cardiovascular disorders. The purpose of this study was to determine whether a low adiponectin level contributes to cardiovascular events, and to investigate the factors influencing adiponectin in the Japanese Arita-cho cohort study.We followed about 2000 subjects in Arita-cho, Saga, Japan as a cohort study, and we enrolled 637 subjects (205 men; 65.1±8.3 years old) who participated in annual health checks from 2005 to 2008 and underwent measurement of the plasma adiponectin level and an oral glucose tolerance test. We monitored the incidence of cardiovascular or cerebrovascular events in these subjects until the end of 2010, discontinuing follow-up at 3 years after the start of enrollment. Subjects with low plasma adiponectin levels (<10.5 ng ml(-1)) had a higher incidence of newly diagnosed cardiovascular diseases such as acute heart failure or acute myocardial infarction than those with high plasma adiponectin levels (≥10.5 ng ml(-1)) over an average of 2.95 years of follow-up. Multivariate analysis showed that the adiponectin level was predicted by the following parameters in all subjects: age (β=0.16), male gender (β=-0.267), homeostasis model assessment of insulin resistance (β=-0.140) and the plasma levels of high-density lipoprotein cholesterol (β=0.104), uric acid (β=-0.13), triglycerides (β=-0.169) and brain natriuretic peptide (β=0.151). The difference in plasma glucose before and 120 min after the intake of a 75-g glucose load did not influence the plasma adiponectin level. The plasma adiponectin level is useful for predicting cardiovascular events, and is a measure of the risk of lifestyle-related diseases.
Hypertension Research 04/2012; 35(8):843-8. · 2.58 Impact Factor
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Takahiro Ohara,
Kazuhiko Hashimura,
Masanori Asakura,
Akiko Ogai, Makoto Amaki,
Takuya Hasegawa,
Hideaki Kanzaki,
Mina Sonoda,
Hitoshi Nishizawa,
Tohru Funahashi,
Masafumi Kitakaze
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ABSTRACT: Elevated levels of total plasma adiponectin (APN) and high molecular weight (HMW)-APN have been observed in chronic heart failure (HF) and are associated with poor prognosis, however, the response of APN levels in acute HF is not known. The purpose of this study was to clarify the dynamic changes of the plasma total APN, HMW-APN levels, and the ratio of HMW-APN to total APN (HMWR) in acute HF.
From February 2006 to January 2007, 20 patients with acute HF (non-ischemic and non-valvular origin, 17 men, aged 63±11 years) were enrolled, and blood was sampled before the onset of the treatment and at discharge. Ten patients admitted for the treatment of supraventricular arrhythmia (8 men, aged 45±13 years) were included as controls.
The medians and interquartile ranges of the plasma total APN, HMW-APN levels, and HMWR at admission were 20.8 (14.5-38.9) μg/mL, 12.4 (7.7-23.3) μg/mL, and 0.60 (0.50-0.69), respectively. The total APN and HMW-APN values were significantly higher than the values of the control. The plasma total APN, HMW-APN, and HMWR values at discharge decreased to 19.4 (7.2-27.3)μg/mL, 10.5 (3.2-12.8) μg/mL, and 0.52 (0.46-0.57), respectively. An exploratory survival analysis showed that the higher HMWR values at admission and the larger decrease in HMWR were associated with a better prognosis after discharge.
Plasma total APN and HMW-APN values are elevated at the admission for acute HF. Plasma total APN, HMW-APN, and HMWR values decrease following treatment. Higher HMWR at admission and its larger decrease may be the signs of favorable treatment responsiveness in acute HF.
Journal of Cardiology 08/2011; 58(2):181-90. · 1.28 Impact Factor
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International journal of cardiology 06/2011; 154(2):e42-4. · 7.08 Impact Factor
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Mika Mori,
Hideaki Kanzaki, Makoto Amaki,
Takahiro Ohara,
Takuya Hasegawa,
Hiroyuki Takahama,
Kazuhiko Hashimura,
Tetsuo Konno,
Kenshi Hayashi,
Masakazu Yamagishi,
Masafumi Kitakaze
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ABSTRACT: Atrial fibrillation is commonly associated with impaired reservoir and booster functions of the left atrium (LA). Recent advances in two-dimensional speckle tracking technique (2DST) enabled automatic analysis of the time-LA volume curve representing these functions. Our objective was to evaluate LA function in patients with or without paroxysmal atrial fibrillation (PAF) using 2DST.
We studied 111 patients (68 men, age 62 ± 16 years) with (n = 53) or without (n = 58) PAF. After constructing time-LA volume curves from the apical four and two chamber views (iE33, Philips with QLAB 6.0, Philips Medical Systems, Bothell, WA, USA), maximal LA volume (LAVmax), preatrial contraction LA volume (LAVpreA), and minimum LA volume (LAVmin) were obtained. Then, LA reservoir volume (ARV=LAVmax-LAVmin) and active emptying volume (AEV=LAVpreA-LAVmin) were calculated to determine ARV/LAVmax as reservoir function and AEV/LAVpreA as booster pump function.
PAF was associated with greater LAVmax than that in controls (80 ± 21 ml versus 65 ± 16 ml, p < 0.001) and with reduced reservoir and booster functions (ARV/LAVmax 46 ± 9% versus 52 ± 7%; AEV/LAVpreA 29 ± 10% versus 36 ± 6%, p < 0.001). Multivariate logistic analysis demonstrated that ARV/LAVmax and AEV/LAVpreA were closely associated with the existence of PAF.
These results demonstrate that the present 2DST enables determining LA reservoir and booster functions, providing insights into the diagnosis of PAF.
Journal of Cardiology 10/2010; 57(1):89-94. · 1.28 Impact Factor
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Takahiro Sato,
Hideaki Kanzaki,
Yoshio Ishida, Makoto Amaki,
Takahiro Ohara,
Takuya Hasegawa,
Kazuhiko Hashimura,
Satoshi Nakatani,
Naoaki Yamada,
Yoshihiko Ikeda,
Hatsue Ueda-Ishibashi,
Masafumi Kitakaze
Circulation Journal 09/2010; 74(11):2477-8. · 3.77 Impact Factor
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ABSTRACT: Although right ventricular (RV) function is an important determinant of morbidity and mortality in patients with primary pulmonary hypertension (PPH), there have been no clinically validated quantification methods to date. The first derivative of RV pressure (dP/dt) is a good index of contractility, but it depends on preload. dP/dt divided by end-diastolic volume (EDV), that is, dP/dt/EDV, on the other hand, is an index of contractility relatively independent of preload. However, the measurement of accurate RV EDV is difficult because of RV complex geometry. Real-time three-dimensional (3D) echocardiography allows us to measure ventricular volume irrespective of its shape. To investigate the clinical feasibility and significance of 3D echocardiography in evaluating RV function in patients with PPH by measuring RV EDV and dP/dt/EDV, 13 patients with PPH (41+/-20 years, four men) underwent echocardiography, a 6-min walk distance (mWD) test and blood sampling within 1 week of invasive hemodynamic measurements. RV dP/dt was estimated from a continuous wave Doppler-determined tricuspid regurgitant velocity. RV EDV was measured by both two-dimensional (2D) biplane Simpson method (EDV(2D)) and real-time 3D echocardiography (EDV(3D)). RV dP/dt/EDV was calculated using EDV(2D) and EDV(3D). EDV(3D) showed better correlations than EDV(2D) with the invasive and non-invasive parameters of RV function, suggesting the validity of volume measurement by 3D echocardiography. RV dP/dt/EDV(3D) correlated well with disease severity, whereas dP/dt and dP/dt/EDV(2D) did not. In patients with PPH, 3D-echocardiography-determined RV dP/dt/EDV and EDV seem to be potential markers of disease severity.
Hypertension Research 04/2009; 32(5):419-22. · 2.58 Impact Factor
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Tetsuhiro Yamano,
Satoshi Nakatani,
Hideaki Kanzaki,
Norihisa Toh, Makoto Amaki,
Jun Tanaka,
Haruhiko Abe,
Takuya Hasegawa,
Takahisa Sawada,
Hiroaki Matsubara,
Masafumi Kitakaze
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ABSTRACT: It has remained unclear why functional mitral regurgitation (MR), even if it is of a mild degree, has prognostic importance in patients with idiopathic dilated cardiomyopathy (IDC). Exercise-induced changes in functional MR, which might be a clue to this question, have not been fully clarified. Thus, in this study, semisupine exercise echocardiography was performed on 32 asymptomatic or mildly symptomatic patients with IDC (29 men, mean age 45 +/- 14 years). The mean ejection fraction was 28 +/- 10% (range 13% to 45%). The effective regurgitant orifice (ERO) area of MR was measured, as well as echocardiographic parameters including mitral valve geometry. ERO at rest was associated best with systolic mitral tenting area (r(S) = 0.85, p <0.001). Functional MR did not newly appear during exercise in 9 subjects without MR at rest. In the remaining 23 subjects with functional MR at rest, all showed exacerbations of MR, with a median ERO of 10.5 mm(2) (interquartile range 6.3 to 16.5) to 18.7 mm(2) (interquartile range 9.5 to 29.3) (p <0.001). An increase in ERO was correlated best with the enlargement of tenting area (r(S) = 0.90, p <0.001) and was the strongest independent determinant of exercise duration (beta = -0.55, p = 0.002, multiple R(2) = 0.46). In conclusion, functional MR complicated with IDC was significantly exacerbated during exercise, with mitral valve deformation, which was strongly related to exercise intolerance; thus, the clinical impact of functional MR in patients with IDC could be more serious than can be expected by its degree at rest.
The American Journal of Cardiology 08/2008; 102(4):481-5. · 3.37 Impact Factor
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ABSTRACT: A 69-year-old man had been suffering from recurrent syncope induced by laughter since the age of 58. His syncope was reproduced by head-up tilt testing with isoproterenol infusion and we concluded that his laughter-induced syncope was one type of neurally mediated syndrome (NMS). His daughter also had NMS and her syncope was treated with propranolol. Propranolol and midodrine hydrochloride, an alpha(1)-adrenergic stimulant, were effective at preventing his laughter-induced syncope. This is a case report of laughter-induced syncope with a familial predisposition successfully treated with the combination of the nonselective beta-blocker propranolol and the alpha(1)-stimulator midodrine.
International Heart Journal 02/2007; 48(1):123-7. · 1.16 Impact Factor
