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Kazuhide Ichikawa,
Kaoru Dohi,
Emiyo Sugiura,
Tadafumi Sugimoto, Takeshi Takamura,
Yoshito Ogihara,
Hiroshi Nakajima,
Katsuya Onishi,
Norikazu Yamada,
Mashio Nakamura,
Tsutomu Nobori,
Masaaki Ito
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ABSTRACT: BACKGROUND: The aim of this study was to noninvasively investigate right ventricular and left ventricular (LV) adaptation to right ventricular pressure overload in patients with acute pulmonary thromboembolism (APTE) and chronic pulmonary artery hypertension (CPAH). METHODS: Thirty-seven patients with APTE, 36 patients with CPAH, and 33 controls were retrospectively enrolled. Myocardial deformation and wall motion were analyzed using speckle-tracking strain and displacement imaging echocardiography in the right and left ventricles. The standard deviation of the heart rate-corrected intervals from QRS onset to peak systolic strain and peak systolic displacement (PSD) for the six segments was used to quantify right ventricular and LV mechanical dyssynchrony (peak systolic strain dyssynchrony and PSD dyssynchrony). The myocardial performance index in both ventricles was also evaluated. RESULTS: The APTE and CPAH groups had reduced ventricular performance (LV myocardial performance index, 0.40 ± 0.10, 0.66 ± 0.18 [P < .05 vs controls], and 0.58 ± 0.19 [P < .05 vs controls] in the control, APTE, and CPAH groups, respectively) and large mechanical dyssynchrony (LV longitudinal PSD dyssynchrony, 58 ± 41 msec, 119 ± 49 msec [P < .05 vs controls], and 83 ± 37 msec [P < .05 vs controls and the APTE group] in the control, APTE, and CPAH groups, respectively) in both ventricles. Multiple regression analysis indicated that LV longitudinal PSD dyssynchrony in the APTE group and the LV eccentricity index in the CPAH group were independent determinants of LV myocardial performance index. CONCLUSIONS: Pathophysiologic mechanisms that regulate ventricular performance vary depending on whether the ventricles are exposed to acute or chronic right ventricular pressure overload.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 03/2013; · 2.98 Impact Factor
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Junya Hosoda,
Toshiyuki Ishikawa,
Kohei Matsushita,
Katsumi Matsumoto,
Yuichiro Kimura,
Mihoko Miyamoto,
Hideyuki Ogawa, Takeshi Takamura,
Teruyasu Sugano,
Tomoaki Ishigami,
Kazuaki Uchino,
Kazuo Kimura,
Satoshi Umemura
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ABSTRACT: Renal insufficiency is recognized as a predictor of mortality and adverse outcome in heart failure (HF) patients. However, the long-term clinical outcome of cardiac resynchronization therapy (CRT) in Japanese HF patients with renal insufficiency remains uncertain.
We evaluated 67 consecutive patients who underwent CRT at our hospital. The patients were divided into two groups according to a baseline estimated glomerular filtration rate (e-GFR) cut-off value of 50ml/min, which is defined as the time at which patients should be referred to a nephrologist, by the Japanese Society of Nephrology. Follow-up echocardiographic findings and renal function were examined at 3-6 months after CRT. Then, we compared long-term clinical outcomes between the two groups, and analyzed the effect of CRT on renal function, echocardiographic parameters and cardiac survival.
During a mean follow-up period of 30.3 months, patients with advanced renal insufficiency (e-GFR<50ml/min) had significant higher all-cause mortality (log-rank p=0.033) and higher cardiac mortality combined with HF hospitalization (log-rank p=0.017) than patients with e-GFR≥50ml/min. Multivariate analysis revealed that advanced renal insufficiency was an independent predictor of cardiac mortality combined with HF hospitalization (odds ratio=3.01, p=0.008). Subgroup analysis in the baseline advanced renal insufficiency group revealed that patients with preserved renal function by CRT (<10% reduction in e-GFR) had a higher rate of decrease of left ventricular end-systolic diameter (-14.0% vs. -0.8%, p=0.023) and lower cardiac mortality combined with HF hospitalization (log-rank p=0.029) compared with patients with deterioration of renal function (≥10% reduction in e-GFR).
The present study suggests that advanced renal insufficiency is quite useful for the prediction of worsening clinical outcomes in HF patients treated by CRT. Preservation of renal function by CRT brings about better cardiac survival through prevention of adverse cardiac events, even in HF patients with advanced renal insufficiency.
Journal of Cardiology 07/2012; 60(4):301-5. · 1.28 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 09/2011; 69 Suppl 7:216-9.
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Takeshi Takamura,
Kaoru Dohi,
Katsuya Onishi,
Yuko Sakurai,
Kazuhide Ichikawa,
Akihiro Tsuji,
Satoshi Ota,
Masaki Tanabe,
Norikazu Yamada,
Mashio Nakamura,
Tsutomu Nobori,
Masaaki Ito
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ABSTRACT: The aim of this study was to investigate the impact of acute right ventricular pressure overload (RVPO) on left ventricular (LV) function and regional uniformity using speckle-tracking displacement and strain analyses in patients with acute pulmonary embolism (PE).
Twenty-five patients with acute PE (mean age, 59 ± 16 years) and 25 normal subjects were enrolled. Radial, longitudinal, and circumferential LV wall motion and myocardial deformation were analyzed using speckle-tracking displacement and strain imaging echocardiography, respectively, from the mid-LV short-axis and apical four-chamber views. The standard deviation of the heart rate-corrected intervals from QRS onset to peak systolic displacement (PSD) and peak systolic strain for the six segments was used to quantify LV systolic dyssynchrony. The standard deviation of regional PSD and peak systolic strain divided by their global values was used to quantify LV systolic heterogeneity. Mechanical discoordination of LV regional wall motion and myocardial deformation was assessed by averaging the frame-by-frame percentage discordance between segmental and global signal changes in the six segments.
Patients with acute PE had reduced radial PSD and peak systolic strain and a large extent of displacement-derived nonuniformities (PSD dyssynchrony, 74 ± 32 vs 40 ± 20 m sec; PSD heterogeneity, 0.39 ± 0.13 vs 0.17 ± 0.08; and PSD discoordination, 23 ± 2% vs 15 ± 3%; P < .05 vs normal subjects for all comparisons) associated with a leftward shift of the interventricular septum. In contrast, all indices of strain-derived radial LV nonuniformities were not augmented by acute RVPO in patients with acute PE. Patients with acute PE also had impaired LV systolic function and regional uniformities in the longitudinal and circumferential directions. After the amelioration of acute RVPO by primary treatment, most of the indices of LV function and regional uniformity were restored to normal values. Multiple regression analysis indicated that only radial LV wall motion discoordination was a significant determinant of cardiac index.
Acute RVPO induces reversal LV regional uniformities, which are closely associated with reduced LV function and abnormal geometry of the left ventricle, and radial LV wall motion coordination plays a key role in the short-term regulation of cardiac output in patients with acute PE.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 07/2011; 24(7):792-802. · 2.98 Impact Factor
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ABSTRACT: The aim of this study was to noninvasively quantify global left ventricular (LV) contraction and relaxation, and to investigate their relationship in normal, hypertrophic, and failing myocardium.
Fifty patients with hypertensive LV hypertrophy (LVH) (LVH group), 50 patients with dilated cardiomyopathy (DCM) (DCM group), and 50 normal subjects (control group) had echocardiographic evaluations. Global LV peak systolic strain (PSS) and peak relaxation rate (PRR) during early diastole were analyzed by speckle-tracking strain and strain rate imaging in the longitudinal and circumferential directions.
Both global PSS and PRR were reduced in the LVH group in the longitudinal direction. In the circumferential direction, global PSS was maintained and global PRR was reduced in the LVH group. The reductions in both global PSS and PRR were more pronounced in both directions in the DCM group compared with the other 2 groups. Global PSS correlated strongest with global PRR among the clinical and echocardiographic variables, which exhibited the best fit with exponential regressions in both the longitudinal and circumferential directions in all subjects (longitudinal: y=0.15e(-0.10x), r2=0.75; circumferential: y=0.21e(-0.09x), r2=0.76, P<.01, respectively). Multiple regression analysis indicated that global PSS was the most powerful determinant of global PRR in both longitudinal and circumferential directions.
Global LV function quantified using speckle-tracking echocardiography revealed strong coupling of LV contraction to relaxation sequentially from normal to failing myocardium, regardless of their heterogeneous pathophysiology. In addition, the extent of myocardial systolic shortening was the most powerful independent contributor of LV relaxation in both the longitudinal and circumferential directions. These results strongly indicate that LV myocardial systolic contraction directly regulates its relaxation.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 04/2010; 23(7):747-54. · 2.98 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the effects of acute right ventricular (RV) pressure overload (RVPO) on RV systolic function and its regional uniformity using speckle-tracking strain analysis in patients with acute pulmonary thromboembolism (APTE).
Twenty-three patients with APTE (mean age, 59 +/- 16 years) and 23 age-matched and gender-matched normal subjects (the control group) were examined using echocardiography. Global and segmental longitudinal RV peak systolic strain (PSS) was analyzed using speckle-tracking strain echocardiography. The heterogeneity of RV regional function was assessed by calculating the standard deviation from 6-segmental PSS divided by the absolute value of global PSS. The standard deviation of the heart rate-corrected intervals from QRS onset to PSS for the 6 segments was used to quantify RV dyssynchrony.
Patients with APTE had reduced regional PSS, resulting in reduced global PSS and augmented regional heterogeneity, and had delayed myocardial contraction in the basal and mid RV lateral walls, resulting in large dyssynchrony (global PSS, -14 +/- vs -25 +/- 3%; heterogeneity, 0.54 +/- 0.26 vs 0.24 +/- 0.09; dyssynchrony, 91 +/- 38 vs 25 +/- 10 ms; P < .05 vs controls for all comparisons). After the amelioration of acute RVPO by primary treatment, both RV heterogeneity and dyssynchrony returned to normal values.
Speckle-tracking strain echocardiography can effectively quantify reversible RV regional nonuniformity caused by acute RVPO and can characterize the pattern of RV regional impairment in patients with APTE.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 10/2009; 22(12):1353-9. · 2.98 Impact Factor
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ABSTRACT: Chronic kidney disease is a noteworthy pathophysiology as a risk factor of cardiovascular disease. We investigated the usefulness of combining glomerular filtration rate and 201thallium(201TI)/123iodine-beta-methyliodophenyl pentadecanoic acid (123I-BMIPP) dual myocardial scintigraphic findings for predicting cardiac events.
Seventy-five patients suspected of coronary artery disease underwent 201TI/123I-BMIPP dual myocardial scintigraphy. Clinical and nuclear variables were included in the multivariate analysis for predicting hard events (cardiac death and nonfatal myocardial infarction) and soft events (unstable angina, heart failure, and coronary revascularization). Glomerular filtration rate was estimated by the modification of diet in renal disease formula. Kaplan-Meier analysis was performed to investigate the incremental prognostic value of glomerular filtration rate.
During the mean follow-up period of 425 days, eight patients had hard events and 20 patients had soft events. Multivariate analysis revealed that glomerular filtration rate and the sum of total defect score in 123I-BMIPP image were independent predictors of total cardiac events, whereas sex, diabetes, glomerular filtration rate, and the number of abnormal segments in 201TI image were those of hard events. Kaplan-Meier analysis revealed that greater risk stratification was achieved by adding a glomerular filtration rate of lesser than 60 ml/min/1.73 m2 to the sum of the total defect score > or = 5 in the 123I-BMIPP image. Greater risk stratification for hard events was also achieved by adding a glomerular filtration rate of lesser than 30 ml/min/1.73 m2 to the number of abnormal segments > or = 2 in 201TI image.
Better risk stratification can be achieved by adding glomerular filtration rate to 201TI/123I-BMIPP dual myocardial scintigraphic findings.
Nuclear Medicine Communications 02/2009; 30(1):54-61. · 1.40 Impact Factor
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ABSTRACT: Left ventricular (LV) mechanical dyssynchrony is an important codeterminant of cardiac dysfunction in heart failure (HF) patients exhibiting either a narrow or a wide QRS complex. We hypothesized that an angiotensin converting enzyme (ACE) inhibitor would prevent LV dyssynchrony during the progression of pacing-induced HF through its beneficial effects on hemodynamic change and myocardial fibrosis.
Twenty-eight dogs were assigned to the following treatment groups; rapid ventricular pacing (HF group; n=10), concomitant ACE inhibitor and rapid pacing (enalapril 1.9 mg/kg/day: ACEI group; n=8), or sham-operated control (control group; n=10). After 4 weeks of pacing, cardiac function was evaluated using micromanometers and conductance catheters. We used indexes to quantify the temporal and spatial aspects of mechanical dyssynchrony derived from online segmental conductance catheter signals. At each time point, a segmental signal was defined as dyssynchronous if its change was opposite to the simultaneous change in the total LV volume. Mechanical dyssynchrony was calculated as the mean of the segmental dyssynchronies during systole, diastole, and throughout the cardiac cycle.
In the ACEI group, the LV ejection fraction was preserved, and total systemic resistance and end-diastolic volume were significantly decreased, while stroke volume was significantly increased compared to the HF group. The mechanical dyssynchrony index in the HF group was significantly higher compared to that of the control group, while it was significantly lower in the ACEI group. Thus, conventional therapy with an ACE inhibitor diminished LV dyssynchrony during the progression of pacing-induced HF.
International journal of cardiology 01/2009; 140(1):48-54. · 7.08 Impact Factor
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ABSTRACT: Diastolic heart failure (DHF) has different underlying pathophysiologic mechanisms. We sought to compare hemodynamic characteristics in DHF patients with or without hypertension. A conductance catheter with microtip-manometer was used to measure left ventricular (LV) function and hemodynamics in 28 DHF patients. After baseline measurements, nitroglycerin was infused to alter the loading condition and the measurements were repeated. At baseline, end-systolic pressure was higher and the time constant of LV relaxation (tau) was longer in hypertensive DHF patients. Patients in hypertensive DHF had lower LV-arterial coupling ratio than those in non-hypertensive DHF. The peak of loading sequence was in early systole in non-hypertensive DHF patients and in late systole in hypertensive DHF patients. Nitroglycerin decreased LV end-systolic pressure and end-diastolic volume in both groups. In non-hypertensive DHF, nitroglycerin significantly reduced stroke volume and shortened tau (59+/-11 vs. 54+/-10 ms, p<0.05) without any changes in the time to peak LV force, effective arterial elastance (E(a)), or LV-arterial coupling ratio. In contrast, in hypertensive DHF patients, nitroglycerin significantly reduced E(a) and shortened the time to peak LV force, resulting in an improved LV-arterial coupling ratio, preserved stroke volume and shortened tau (75+/-14 vs. 62+/-13 ms, p<0.05). In conclusion, LV relaxation was more prolonged in hypertensive DHF patients than non-hypertensive DHF patients, partly because of the different loading sequence. Changing the loading condition by nitroglycerin improved LV systolic and diastolic function in hypertensive DHF patients.
Hypertension Research 10/2008; 31(9):1727-35. · 2.58 Impact Factor
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Masaki Tanabe,
Kaoru Dohi,
Katsuya Onishi,
Tomoyuki Nakata,
Yuichi Sato,
Hiroshi Nakajima, Takeshi Takamura,
Masatoshi Miyahara,
Mashio Nakamura,
Kan Takeda,
Masaaki Ito
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ABSTRACT: The use of a biventricular pacing system for patients with complete right-bundle branch block (CRBBB) is still controversial. Although cardiac resynchronization therapy-defibrillator (CRT-D) was implanted in a heart failure patient with CRBBB, dyssynchrony worsened and stroke volume decreased, and this patient was re-admitted due to exacerbated heart failure. Therefore, evaluation of dyssynchrony and cardiac function after implantation of a biventricular pacing system may be needed in patients with atypical indications for CRT.
International journal of cardiology 09/2008; 138(3):e47-50. · 7.08 Impact Factor
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ABSTRACT: A 52-year-old woman with fulminant myocarditis had completed left bundle branch block (LBBB) and severely impaired left ventricular (LV) function. Marked mechanical dyssynchrony with septal-to-posterior delay of 389 ms was observed by echocardiographic speckle tracking radial strain imaging on admission, which was dramatically improved to 106 ms after total recovery from acute myocarditis with restoration of LV ejection fraction whereas her electrocardiogram still showed complete LBBB.
International journal of cardiology 07/2008; 127(1):e8-11. · 7.08 Impact Factor
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ABSTRACT: Definite diagnosis of infective endocarditis is impossible when all blood cultures are negative under antibiotic treatment. In this case, Streptococcus canis was identified using polymerase chain reaction from preoperative whole blood and excised valve tissue, and considered as the pathogen for infective endocarditis, despite negative blood cultures. This information was useful for diagnosis and selection of antibiotics.
International journal of cardiology 07/2008; 135(1):e13-5. · 7.08 Impact Factor
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ABSTRACT: Left ventricular (LV) deformation with ventricular septal shift is one of the most distinctive echocardiographic observations in patients with chronic right ventricular (RV) pressure overload (PO). However, little is known about the effects of RVPO on LV performance and regional synchrony. Accordingly, our objective was to test the hypothesis that chronic RVPO affects regional wall motion, synchronicity, and global LV function using a novel speckle-tracking approach to quantify and characterize regional LV wall motion dyssynchrony. Displacement and strain imaging echocardiographic studies were performed in 20 patients with RVPO from pulmonary arterial hypertension or pulmonic stenosis (mean age 53 +/- 16 years, New York Heart Association class 2.6 +/- 0.7, and peak RV systolic pressure 73 +/- 28 mm Hg) and 20 age-matched normal subjects (mean age 47 +/- 16 years). Segmental signals from 6 segments around the mid-LV short axis were defined as dyssynchronous if their changes were opposite to that of the global LV signal at each time frame, and overall LV dyssynchrony was calculated as the percentage of dyssynchrony in all 6 segments within the specified time interval from onset of QRS to the end of isovolumic relaxation. RVPO was associated with a large degree of regional dyssynchrony with paradoxical ventricular septal motion observed by displacement imaging (21 +/- 6%, p <0.05 vs control group), which was closely associated with LV eccentricity index (r = 0.79, p <0.05) and LV myocardial performance index with linear regression (r = 0.76, p <0.05). In contrast, strain imaging showed uniform segmental radial thickening in the RVPO group, which was similar to the control group, and suggests that there was no intrinsic LV contractile dyssynchrony. In conclusion, LV wall motion dyssynchrony assessed by displacement imaging, not intrinsic contractile dyssynchrony by strain imaging, coexists with LV chamber deformation with ventricular septal shift and is closely associated with impairment of LV performance.
The American Journal of Cardiology 04/2008; 101(8):1206-12. · 3.37 Impact Factor
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ABSTRACT: Systolic load elevation during exercise prolongs left ventricular (LV) relaxation, compromises filling, and raises end-diastolic pressure, leading to reduced exercise tolerance. The aim of this study was to test the hypothesis that the hypertensive response to exercise is exaggerated in patients with diastolic heart failure (DHF). Echocardiograms and treadmill testing were performed in patients with DHF (n=20) and age-matched hypertension with LV hypertrophy (HTN; n=20). The Minnesota Living with Heart Failure Questionnaire was used to estimate quality of life (QOL). There were no differences in resting blood pressure or echocardiographic parameters between the groups. The maximum exercise time was significantly shorter in the DHF group than in the HTN group (6.0+/-3.0 vs. 12.5+/-2.5 min), and the peak systolic blood pressure during exercise was significantly higher in the DHF group (212+/-18 vs. 189+/-16 mmHg, p<0.05). After 4 weeks of treatment with candesartan, an angiotensin II receptor blocker (8 mg/d), peak systolic blood pressure during exercise decreased to 191+/-13 mmHg, maximum exercise time increased (10.4+/-3.0 min; p<0.05), and QOL improved in patients with DHF, while there was no change in patients with HTN, despite the similar resting blood pressure. In patients with DHF, systolic blood pressure markedly increased during exercise, and this was accompanied by impaired exercise tolerance and a decreased QOL, both of which were partly suppressed by blocking angiotensin II.
Hypertension Research 04/2008; 31(4):679-84. · 2.58 Impact Factor
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ABSTRACT: An exaggerated increase in systolic blood pressure prolongs myocardial relaxation and increases left ventricular (LV) chamber stiffness, resulting in an increase in LV filling pressure. We hypothesize that patients with a marked hypertensive response to exercise (HRE) have LV diastolic dysfunction leading to exercise intolerance, even in the absence of resting hypertension. We recruited 129 subjects (age 63+/-9 years, 64% male) with a preserved ejection fraction and a negative stress test. HRE was evaluated at the end of a 6-min exercise test using the modified Bruce protocol. Patients were categorized into three groups: a group without HRE and without resting hypertension (control group; n=30), a group with HRE but without resting hypertension (HRE group; n=25), and a group with both HRE and resting hypertension (HTN group; n=74). Conventional Doppler and tissue Doppler imaging were performed at rest. After 6-min exercise tests, systolic blood pressure increased in the HRE and HTN groups, compared with the control group (226+/-17 mmHg, 226+/-17 mmHg, and 180+/-15 mmHg, respectively, p<0.001). There were no significant differences in LV ejection fraction, LV end-diastolic diameter, and early mitral inflow velocity among the three groups. However, early diastolic mitral annular velocity (E') was significantly lower and the ratio of early diastolic mitral inflow velocity (E) to E' (E/E') was significantly higher in patients of the HRE and HTN groups compared to controls (E': 5.9+/-1.6 cm/s, 5.9+/-1.7 cm/s, 8.0+/-1.9 cm/s, respectively, p<0.05). In conclusion, irrespective of the presence of resting hypertension, patients with hypertensive response to exercise had impaired LV longitudinal diastolic function and exercise intolerance.
Hypertension Research 03/2008; 31(2):257-63. · 2.58 Impact Factor
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Hypertension Research 02/2008; 31(7):1486. · 2.58 Impact Factor
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Tairo Kurita,
Katsuya Onishi,
Munenobu Motoyasu,
Tetsuya Kitamura, Takeshi Takamura,
Naoki Fujimoto,
Masaki Tanabe,
Kaoru Dohi,
Takashi Tanigawa,
Naoki Isaka,
Masaaki Ito,
Hajime Sakuma
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ABSTRACT: Right heart failure is prominent in some patients with dilated cardiomyopathy (DCM). In this article, we present right ventricular wall degeneration and fibrosis demonstrated by late gadolinium enhanced magnetic resonance imaging (MRI) in patients with DCM.
International journal of cardiology 09/2007; 129(1):e21-3. · 7.08 Impact Factor
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Eri Furukawa,
Kiyoshi Hibi,
Masami Kosuge,
Tomoyori Nakatogawa,
Noritaka Toda, Takeshi Takamura,
Kengo Tsukahara,
Jun Okuda,
Fumiyuki Ootsuka,
Yoshio Tahara,
Teruyasu Sugano,
Tsutomu Endo,
Kazuo Kimura,
Satoshi Umemura
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ABSTRACT: Percutaneous coronary intervention (PCI) of bifurcation lesion has been associated with a low success rate and a high incidence of procedural complications, including side branch occlusion and myocardial infarction. It remains controversial whether preintervention intravascular ultrasound (IVUS) findings can help to identify side branches likely to occlude after PCI of bifurcation lesions.
From our IVUS database we identified 81 bifurcation lesions in 72 patients. Side branches were classified into 2 groups: group 1 had ostial side branch stenosis due to atherosclerotic plaque only in the main vessel (n=61), and group 2 had plaque truly involved in the side branch ostium (n=20). There was no significant difference between the 2 groups in the extent of ostial stenosis as assessed by angiography. After PCI, 7 side branches occluded in group 2, compared with 5 side branches occluded in group 1 (35% vs 8%, p=0.003).
Ostial plaque distribution as assessed by IVUS may be one of the consistent predictors of side branch occlusion after PCI.
Circulation Journal 04/2005; 69(3):325-30. · 3.77 Impact Factor
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Kengo Tsukahara,
Kazuo Kimura,
Masami Kosuge,
Tomoaki Shimizu,
Teruyasu Sugano,
Kiyoshi Hibi,
Masahiko Kanna,
Noritaka Toda, Takeshi Takamura,
Jun Okuda,
Naoki Nozawa,
Eri Furukawa,
Satoshi Umemura
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ABSTRACT: In the reperfusion era the clinical characteristics of intermediate QRS prolongation without bundle-branch block (BBB) remain unclear in patients with ST-segment elevation myocardial infarction (STEMI).
A total of 465 patients with STEMI within 24 h of onset were classified into 3 groups according to QRS duration on presenting electrocardiograms: 338 patients had QRS duration <100 ms (group N), 71 had QRS duration >or=100 ms without BBB (group W), and 56 had BBB (group B). The frequency of Killip class >1 was higher in group W (28%) than in group N (12%), but lower than in group B (47%) (p<0.05, respectively). The percentages of patients with non-anterior infarction (69% vs 42%, 47%), 3-vessel disease (30% vs 9%, 16%), and coronary artery bypass graft surgery (24% vs 4%, 13%) were higher in group W than in groups N and B (all p<0.05). In group W, 6-month-mortality was similar to that in group N, but lower than that in group B (4%, 3% vs 25%, p<0.05 respectively).
In the reperfusion era, although patients with intermediate QRS prolongation without BBB have more severe coronary disease, 6-month-mortality is similar to those with normal conduction, but lower than those with BBB.
Circulation Journal 01/2005; 69(1):29-34. · 3.77 Impact Factor
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Tomoyori Nakatogawa,
Kiyoshi Hibi,
Eri Furukawa,
Teruyasu Sugano,
Masami Kosuge, Takeshi Takamura,
Noritaka Toda,
Kengo Tsukahara,
Jun Okuda,
Kazuo Kimura,
Satoshi Umemura
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ABSTRACT: Fifty stented lesions in 50 patients with acute myocardial infarction were studied by intravascular ultrasound (IVUS) before and just after stent implantation and at follow-up. Volumetric IVUS analyses revealed that greater peristent positive remodeling after stent implantation was associated with less neointimal proliferation and greater luminal gain at follow-up.
The American Journal of Cardiology 10/2004; 94(6):769-71. · 3.37 Impact Factor
