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The Accurate Measurement of Pulmonary Vascular Resistance Using Echocardiography in Patients with Mild Left Heart Failure
S196 Journal of Cardiac Failure Vol. 21 No. 10S October 2015 OP45-1 Change in Renal Perfusion by Treatment of Congestive Heart Failure Using Contrastenhanced Ultrasonography KAORU KOMURO1, KAZUYUKI SOUTOME2, NORIKO YOKOYAMA2, MISAKI SHIBUYA2, KYOU SHIMAZU1, YUMI TAKAHASI1, KAZUKI KAGAMI1, MASANORI HIROSE1, KAZUYA YONEZAWA3, TEISUKE ANZAI1 1 Department of Cardiology, National Hospital Organization Hakodate Hospital, Hakodate, Japan; 2Clinical Laboratory, National Hospital Organization Hakodate Hospital, Hakodate, Japan; 3Department of Clinical Research, National Hospital Organization Hakodate Hospital, Hakodate, Japan Background: Renal congestion decreases glomerular filtration by increased renal interstitial pressure. We sought to evaluate renal congestion with contrast-enhanced ultrasonography (CEUS) of kidney in patients with congestive heart failure (CHF). Methods: CEUS was performed with Sonazoid before and after treatment of venous congestion in 4 CHF patients with right-side HF symptoms and without renal impairment. Contrast intensity (CI) in segmental artery, renal cortex and medulla were measured in dB. Each relative CI (RCI) in cortex and medulla was calculated by subtracting the peak CI of segmental artery from that in cortex and medulla to estimate renal blood volume fraction (RBVF), which can be derived as 10RCI/10. Time to peak intensity (TPI) of cortex and medulla also were measured. Results: Both RCI (RBVF) in the cortex and medulla were increased after improvement of right-side HF symptoms [-16.362.5 to -11.063.3dB (2.761.8 to 9.665.7%); -21.563.4 to 16.561.7dB, (0.960.5 to 2.460.9%, respectively)]. Also, TPI were shorted after treatment (9.764.1 to 6.060.9sec, 9.965.0 to 7.664.8sec, respectively). Conclusions: CEUS revealed the change of renal perfusion by treatment of venous congestion in patients with CHF.
OP45-2 The Accurate Measurement of Pulmonary Vascular Resistance Using Echocardiography in Patients with Mild Left Heart Failure TAKASHI KANDA, MASASHI FUJITA, OSAMU IIDA, MASAHARU MASUDA, SHIN OKAMOTO, TAKAYUKI ISHIHARA, KIYONORI NANTO, TATSUYA SHIRAKI, MASAAKI UEMATSU Kansai Rosai Hospital Cardiovascular Center Background: Several noninvasive methods for measuring pulmonary vascular resistance (PVR) have been proposed to date, but they remain empirical, lacking sufficient accuracy to be used in clinical practice. The aims of this study were to propose a novel echocardiographic measurement of PVR based on a theotetical formula and investigate the feasibilty and accuracy of this method comparing with previous reports. Methods and Results: Echocardiography was performed in 27 patients with mild heart failure before right heart catheterization. Peak tricuspid regurgitation pressure gradient (TRPG), pulmonary regurgitation pressure gradient in end-diastole (PRPGed), and cardiac output derived from the timevelocity integral and the diameter in the left ventricular outflow tract (COLVOT) were measured. PVR based on a theoretical formula (PVRtheo) was calculated as (TRPG - PRPGed)/3COLVOT in Wood units (WU). The results were compared with PVR obtained by right heart catheterization (PVRcath) using the linear regression and Bland-Altman analyses. The mean PVRcath was 2.4 6 1.4 WU. PVRtheo correlated well with PVRcath (r 5 0.83, P ! 0.001). Bland Altman analysis showed that the mean difference was 0.1 6 0.7 WU. The limits of agreements were smaller than other noninvasive estimations previously reported. Conclusions: The new echocardiographic approach based on a theoretical formula provides a noninvasive and accurate assessment of PVR in patients.
OP45-3 Left Ventricular Anatomy and Geometry by 64-slice Multi-Detector Computed Tomography in Patients with Low Left Ventricular Function SHOHEI YOSHIDA, KOICHI TODA, SATSUKI FUKUSHIMA, YASUSHI YOSHIKAWA, TERUYA NAKAMURA, SHIGERU MIYAGAWA, SHUNSUKE SAITO, DAISUKE YOSHIOKA, TORU KURATANI, YOSHIKI SAWA Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine Background: Accurate left ventricular morphologic assessment is important in clarifying mechanisms of ischemic mitral regurgitation (IMR). Two-dimensional echocardiography has been widely used, however, reproducibility between examiners and three-dimensional upscaling have remained inconsistent. We investigated morphologic assessments of ischemic cardiomyopathies (ICM) using 64-slice Multi-Detector Computed Tomography (MDCT) superior in its spatial resolution. Methods: Left ventricular anatomy was assessed by 64-slice MDCT in 8 ICM patients, consisting of 4 IMR patients and 4 without IMR, compared to 8 normal heart patients. Results: In ICM patients, the long-axis diameter was longer than that in normal heart patients. IMR patients had longer distance between the mitral annulus plane and the tip of the papillary muscle, while ICM patients without IMR was similar to normal patients. ICM patients exhibited higher sphericity indexes, where the short-axis diameter is divided by the long-axis diameter. ICM patients had longer mitral annulus perimeters and anterior mitral leaflets, which was remarkable in the patients with IMR, although the size of their posterior mitral leaflets was similar
to normal patients. In ICM patients, the distance between the mitral leaflet and the tip of the papillary muscle in the systolic phase was longer, suggesting chordae remodeling. Conclusions: MDCT allows detailed assessment of left ventricular anatomy. It is important to clarify the relation between morphologic assessment and left ventricular function, including mitral regurgitation.
OP45-4 Aspect Ratio of Left Ventricle in Cardiac Magnetic Resonance Predicts a Future Reverse Remodeling in Non-ischemic Dilated Cardiomyopathy NAOAKI KANO, TAKAHIRO OKUMURA, HIROAKI HIRAIWA, TORU KONDO, NAOKI WATANABE, KENJI FUKAYA, AKINORI SAWAMURA, RYOTA MORIMOTO, YASUKO BANDO, TOYOAKI MUROHARA Department of Cardiology, Nagoya University Graduate School of medicine, Nagoya, Japan Background: Left ventricular reverse remodeling (LVRR) is a marker of favorable prognosis in patients with non-ischemic dilated cardiomyopathy (NIDCM). However, little is known about the relationship between cardiac shape assessed by cardiac magnetic resonance (CMR) and LVRR. Purpose: The purpose of this study was to investigate the relationship between the aspect ratio of LV measured by CMR and LVRR in patients with NIDCM. Methods: Thirty-one patients with NIDCM (22 males, mean age 54 years) were enrolled. Cardiac shape was assessed by aspect ratio of end-diastolic 4-chamber view in CMR; aspect ratio 5 long-axis length/short-axis length. The definition of LVRR was both an absolute increase of LVEF O10% and a decrease of LV end-diastolic diameter O 5 mm in echocardiography at 1year follow-up. Results: Mean LVEF was 31% and the median of BNP levels was 83.8 pg/ml. LVRR was observed in 14 patients (45%). Multivariate logistic regression analysis demonstrated that aspect ratio was an independent predictor of LVRR (p50.0021). The area under the receiver operating characteristic curve of aspect ratio for LVRR was 0.76 and we defined the optimal cutoff value as 1.55. The aspect ratio O 1.55 measured by CMR was an independent predictor of LVRR (odds ratio: 9.23, 95% confidence interval: 1.71-71.7, p50.009). Conclusion: Aspect ratio of left ventricle in CMR predicts a future reverse remodeling in NIDCM.
OP45-5 Discrimination between 67Ga Scintigraphy and F-FDG PET Findings for the Diagnosis of Cardiac Sarcoidosis and the Evaluation of Inflammatory Activities MAI MURATA, TOMOKO KATO, KENJI KUWAKI, TAIRA YAMAMOTO, KAN KAJIMOTO, AKIE SHIMADA, YUICHIRO SATO, DAISUKE SHINOHARA, SUGURU MIYAZAKI, ATSUSHI AMANO Department of Cardiovascular Surgery, Juntendo University School of Medicine Background: Cardiac involvement in sarcoidosis can cause fatal complications. Accurate evaluation of cardiac involvement and disease activity assessed using 67Ga scintigraphy or 18F-FDG PET allow early intervention. However, since these findings sometimes contradict, serial assessments using multiple imaging tools are recommended. We present 3 cases, assessed using serial 67Ga scintigraphy/18FFDG PET/cardic MRIs. Methods and Results (Cases): Case 1: 50-year-old man with a history of lung sarcoidosis presented with LVEF of 45%. Cardiac biopsy showed diffuse fibrosis but no granuloma. 18F-FDG PET showed cardiac inflammation, but 67Ga scintigraphy did not. He was received steroid therapy after developing arrhythmia. Case 2: 54-year old woman with a history of ocular sarcoidosis developed acute decompensated heart failure. Cardiac biopsy showed diffuse fibrosis and non-caseating granuloma, and both imaging modalities indicated cardiac inflammation. After steroid therapy, 67 Ga scintigraphy showed complete resolution, while 18F-FDG PET showed a suspicion of recurrent active inflammation. Case 3: 39-year old woman with decreased LV function, whose cardiac MRI suggested possible cardiac sarcoidosis, was evaluated. 18 F-FDG PET showed cardiac inflammation but 67Ga scintigraphy did not. Steroid therapy was prescribed since repeated cardiac MRI was compatible with sarcoidosis. Conclusions: 18F-FDG PET is more sensitive than 67Ga imaging in cardiac sarcoidosis evaluation but requires pre-exam fasting and sometimes shows false-positive findings. Combination of several imaging modalities is preferred for cardiac sarcoidosis management.
OP45-2 The Accurate Measurement of Pulmonary Vascular Resistance Using Echocardiography in Patients with Mild Left Heart Failure TAKASHI KANDA, MASASHI FUJITA, OSAMU IIDA, MASAHARU MASUDA, SHIN OKAMOTO, TAKAYUKI ISHIHARA, KIYONORI NANTO, TATSUYA SHIRAKI, MASAAKI UEMATSU Kansai Rosai Hospital Cardiovascular Center Background: Several noninvasive methods for measuring pulmonary vascular resistance (PVR) have been proposed to date, but they remain empirical, lacking sufficient accuracy to be used in clinical practice. The aims of this study were to propose a novel echocardiographic measurement of PVR based on a theotetical formula and investigate the feasibilty and accuracy of this method comparing with previous reports. Methods and Results: Echocardiography was performed in 27 patients with mild heart failure before right heart catheterization. Peak tricuspid regurgitation pressure gradient (TRPG), pulmonary regurgitation pressure gradient in end-diastole (PRPGed), and cardiac output derived from the timevelocity integral and the diameter in the left ventricular outflow tract (COLVOT) were measured. PVR based on a theoretical formula (PVRtheo) was calculated as (TRPG - PRPGed)/3COLVOT in Wood units (WU). The results were compared with PVR obtained by right heart catheterization (PVRcath) using the linear regression and Bland-Altman analyses. The mean PVRcath was 2.4 6 1.4 WU. PVRtheo correlated well with PVRcath (r 5 0.83, P ! 0.001). Bland Altman analysis showed that the mean difference was 0.1 6 0.7 WU. The limits of agreements were smaller than other noninvasive estimations previously reported. Conclusions: The new echocardiographic approach based on a theoretical formula provides a noninvasive and accurate assessment of PVR in patients.
OP45-3 Left Ventricular Anatomy and Geometry by 64-slice Multi-Detector Computed Tomography in Patients with Low Left Ventricular Function SHOHEI YOSHIDA, KOICHI TODA, SATSUKI FUKUSHIMA, YASUSHI YOSHIKAWA, TERUYA NAKAMURA, SHIGERU MIYAGAWA, SHUNSUKE SAITO, DAISUKE YOSHIOKA, TORU KURATANI, YOSHIKI SAWA Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine Background: Accurate left ventricular morphologic assessment is important in clarifying mechanisms of ischemic mitral regurgitation (IMR). Two-dimensional echocardiography has been widely used, however, reproducibility between examiners and three-dimensional upscaling have remained inconsistent. We investigated morphologic assessments of ischemic cardiomyopathies (ICM) using 64-slice Multi-Detector Computed Tomography (MDCT) superior in its spatial resolution. Methods: Left ventricular anatomy was assessed by 64-slice MDCT in 8 ICM patients, consisting of 4 IMR patients and 4 without IMR, compared to 8 normal heart patients. Results: In ICM patients, the long-axis diameter was longer than that in normal heart patients. IMR patients had longer distance between the mitral annulus plane and the tip of the papillary muscle, while ICM patients without IMR was similar to normal patients. ICM patients exhibited higher sphericity indexes, where the short-axis diameter is divided by the long-axis diameter. ICM patients had longer mitral annulus perimeters and anterior mitral leaflets, which was remarkable in the patients with IMR, although the size of their posterior mitral leaflets was similar
to normal patients. In ICM patients, the distance between the mitral leaflet and the tip of the papillary muscle in the systolic phase was longer, suggesting chordae remodeling. Conclusions: MDCT allows detailed assessment of left ventricular anatomy. It is important to clarify the relation between morphologic assessment and left ventricular function, including mitral regurgitation.
OP45-4 Aspect Ratio of Left Ventricle in Cardiac Magnetic Resonance Predicts a Future Reverse Remodeling in Non-ischemic Dilated Cardiomyopathy NAOAKI KANO, TAKAHIRO OKUMURA, HIROAKI HIRAIWA, TORU KONDO, NAOKI WATANABE, KENJI FUKAYA, AKINORI SAWAMURA, RYOTA MORIMOTO, YASUKO BANDO, TOYOAKI MUROHARA Department of Cardiology, Nagoya University Graduate School of medicine, Nagoya, Japan Background: Left ventricular reverse remodeling (LVRR) is a marker of favorable prognosis in patients with non-ischemic dilated cardiomyopathy (NIDCM). However, little is known about the relationship between cardiac shape assessed by cardiac magnetic resonance (CMR) and LVRR. Purpose: The purpose of this study was to investigate the relationship between the aspect ratio of LV measured by CMR and LVRR in patients with NIDCM. Methods: Thirty-one patients with NIDCM (22 males, mean age 54 years) were enrolled. Cardiac shape was assessed by aspect ratio of end-diastolic 4-chamber view in CMR; aspect ratio 5 long-axis length/short-axis length. The definition of LVRR was both an absolute increase of LVEF O10% and a decrease of LV end-diastolic diameter O 5 mm in echocardiography at 1year follow-up. Results: Mean LVEF was 31% and the median of BNP levels was 83.8 pg/ml. LVRR was observed in 14 patients (45%). Multivariate logistic regression analysis demonstrated that aspect ratio was an independent predictor of LVRR (p50.0021). The area under the receiver operating characteristic curve of aspect ratio for LVRR was 0.76 and we defined the optimal cutoff value as 1.55. The aspect ratio O 1.55 measured by CMR was an independent predictor of LVRR (odds ratio: 9.23, 95% confidence interval: 1.71-71.7, p50.009). Conclusion: Aspect ratio of left ventricle in CMR predicts a future reverse remodeling in NIDCM.
OP45-5 Discrimination between 67Ga Scintigraphy and F-FDG PET Findings for the Diagnosis of Cardiac Sarcoidosis and the Evaluation of Inflammatory Activities MAI MURATA, TOMOKO KATO, KENJI KUWAKI, TAIRA YAMAMOTO, KAN KAJIMOTO, AKIE SHIMADA, YUICHIRO SATO, DAISUKE SHINOHARA, SUGURU MIYAZAKI, ATSUSHI AMANO Department of Cardiovascular Surgery, Juntendo University School of Medicine Background: Cardiac involvement in sarcoidosis can cause fatal complications. Accurate evaluation of cardiac involvement and disease activity assessed using 67Ga scintigraphy or 18F-FDG PET allow early intervention. However, since these findings sometimes contradict, serial assessments using multiple imaging tools are recommended. We present 3 cases, assessed using serial 67Ga scintigraphy/18FFDG PET/cardic MRIs. Methods and Results (Cases): Case 1: 50-year-old man with a history of lung sarcoidosis presented with LVEF of 45%. Cardiac biopsy showed diffuse fibrosis but no granuloma. 18F-FDG PET showed cardiac inflammation, but 67Ga scintigraphy did not. He was received steroid therapy after developing arrhythmia. Case 2: 54-year old woman with a history of ocular sarcoidosis developed acute decompensated heart failure. Cardiac biopsy showed diffuse fibrosis and non-caseating granuloma, and both imaging modalities indicated cardiac inflammation. After steroid therapy, 67 Ga scintigraphy showed complete resolution, while 18F-FDG PET showed a suspicion of recurrent active inflammation. Case 3: 39-year old woman with decreased LV function, whose cardiac MRI suggested possible cardiac sarcoidosis, was evaluated. 18 F-FDG PET showed cardiac inflammation but 67Ga scintigraphy did not. Steroid therapy was prescribed since repeated cardiac MRI was compatible with sarcoidosis. Conclusions: 18F-FDG PET is more sensitive than 67Ga imaging in cardiac sarcoidosis evaluation but requires pre-exam fasting and sometimes shows false-positive findings. Combination of several imaging modalities is preferred for cardiac sarcoidosis management.