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三好　達也 （ミヨシ　タツヤ）

  • 医学科　医学部講師
Last Updated :2024/04/25

コミュニケーション情報 byコメンテータガイド

  • コメント

    弁膜症、心筋症、心エコー診断

研究者情報

学位

  • 博士 (医学)（2014年03月 神戸大学）

ホームページURL

ORCID ID

J-Global ID

研究キーワード

  • 循環器内科学   心エコー   腫瘍循環器学   心臓弁膜症   心筋症   心不全   

現在の研究分野（キーワード）

    弁膜症、心筋症、心エコー診断

研究分野

  • ライフサイエンス / 循環器内科学 / 心エコー
  • ライフサイエンス / 循環器内科学 / 心筋症
  • ライフサイエンス / 循環器内科学 / 腫瘍循環器学
  • ライフサイエンス / 循環器内科学 / 弁膜症
  • ライフサイエンス / 循環器内科学 / 心不全

研究活動情報

論文

  • Naoko Sawada; Koki Nakanishi; Tomoko Nakao; Tatsuya Miyoshi; Masaaki Takeuchi; Federico M Asch; Roberto M Lang; Masao Daimon
    Circulation reports 5 11 424 - 429 2023年11月 
    Background: Although accurate assessment of right ventricular (RV) morphology and function is clinically important, data regarding reference values for echocardiographic measurements of the right ventricle in the Japanese population are limited. Methods and Results: The World Alliance Society of Echocardiography (WASE) Normal Values Study was conducted to examine normal echocardiographic values in 15 countries. Using the WASE study database, we analyzed 2-dimensional echocardiographic parameters of RV size and systolic function in 192 healthy Japanese individuals and compared them with those obtained from 153 healthy American individuals. In the Japanese population, the absolute values of RV dimensions were smaller for women than men, although the difference disappeared after the data were adjusted for body surface area. RV dimensions, RV length and RV area were smaller in the elderly, but age did not affect RV systolic function. The absolute value, but not the adjusted value, of RV size tended to be smaller in Japanese than American individuals for both sexes. For men, RV systolic function parameters were lower in the Japanese population. This trend was not seen in women. Conclusions: The present study identified normal reference values for RV size and systolic function in a healthy Japanese population. Sex, age, and race had a significant impact on RV size; however, this trend was weak for RV systolic function.
  • Kazuyoshi Kakehi; Masafumi Ueno; Takayuki Kawamura; Nobuhiro Yamada; Kuniaki Takahashi; Kosuke Fujita; Masakazu Yasuda; Koichiro Matsumura; Tatsuya Miyoshi; Kazuki Mizutani; Toru Takase; Genichi Sakaguchi; Gaku Nakazawa
    Journal of cardiology 2023年08月 
    BACKGROUND: Early prediction of aorta-related events is important for determining subsequent treatment strategies in patients with acute aortic dissection. However, most studies evaluated long-term aortic growth rates by annual assessment. The purpose of our study was to determine whether the in-hospital growth rate of aortic volume was associated with aorta-related events. METHODS: We studied 116 patients with uncomplicated type B acute aortic dissection. We analyzed whether changes in aortic volume were associated with aorta-related events during a 5-year follow-up. According to the growth rate from admission to discharge, patients were divided into two groups: Increase >0 (aortic volume: n = 59, aortic diameter: n = 43) and Reduction ≤0 (aortic volume: n = 57, aortic diameter: n = 73) in maximum aortic diameter or aortic volume. The primary endpoint was the discriminative ability of the growth rate of aortic volume for aorta-related events. RESULTS: According to the evaluation of aortic volume changes, the Increase group had significantly higher aorta-related event rates than those in the Reduction group (49.2 % vs. 3.5 %, respectively; p < 0.001). Receiver operating characteristics analysis showed that the growth rate of aortic volume had a clearly useful discrimination, with an area under the curve of 0.84, whereas the discriminative ability of the growth rate of maximum aortic diameter was poor (area under the curve: 0.53). Multivariate analysis showed that the growth rate of aortic volume from admission to discharge was an independent predictor of aorta-related events (hazard ratio, 26.3; 95 % confidence interval, 2.04-286.49; p = 0.001). CONCLUSIONS: In-hospital evaluation of aortic volume was helpful to predict long-term aorta-related events in patients with uncomplicated type B acute aortic dissection.
  • Kosuke Fujita; Masafumi Ueno; Masakazu Yasuda; Kazuki Mizutani; Tatsuya Miyoshi; Gaku Nakazawa
    European heart journal. Case reports 7 8 ytad369  2023年08月 
    BACKGROUND: Recently, mechanical support obtained with the combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella device, together referred to as ECPELLA, has been shown to be effective for acute myocardial infarction with cardiogenic shock. However, methods for withdrawing VA-ECMO in acute myocardial infarction cases complicated by right ventricular dysfunction are yet to be established. Here, we report the effective use of inhaled nitric oxide during the weaning of VA-ECMO from the ECPELLA management of a patient with acute myocardial infarction with cardiogenic shock. CASE SUMMARY: An 81-year-old man with an acute extensive anterior wall myocardial infarction with cardiogenic shock was supported with ECPELLA to improve his haemodynamics. During ECPELLA, the Impella device could not maintain sufficient flow. Echocardiography revealed a small left ventricle and an enlarged right ventricle, indicating acute right heart failure. Inhaled nitric oxide was initiated to reduce right ventricle afterload, which decreased pulmonary artery pressure from 34/20 to 27/13 mmHg, improved right and left ventricle sizes, and stabilized the Impella support. Afterward, VA-ECMO could be withdrawn because the Impella alone was sufficient for haemodynamic support. DISCUSSION: Inhaled nitric oxide improved right ventricle performance in a patient with severe myocardial infarction with right heart failure supported by ECPELLA. Thus, we suggest that inhaled nitric oxide facilitates the weaning of VA-ECMO from patients with refractory right ventricular dysfunction who are supported by ECPELLA.
  • Karima Addetia; Tatsuya Miyoshi; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutierrez Fajardo; Ravi R Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ricardo E Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Ana Clara Tude Rodrigues; Yun Zhang; Cristiane C Singulane; Niklas Hitschrich; Michael Blankenhagen; Markus Degel; Marcus Schreckenberg; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 36 8 858 - 866 2023年04月 
    BACKGROUND: Normal values for 3D right ventricular (RV) size and function are not well established, as they originate from small studies that involved predominantly white North American and European populations, did not use RV-focused views and relied on older 3D RV analysis software . The World Alliance of Societies of Echocardiography (WASE) study was designed to generate reference ranges for normal subjects around the world. In this study, we sought to assess the world-wide capability of 3D imaging of the right ventricle and report size and function measurements, including their dependency on age, sex and ethnicity. METHODS: Healthy subjects free of cardiac, pulmonary and renal disease were prospectively enrolled at 19 centers in 15 countries, including 6 continents. 3D wide-angle RV datasets were obtained and analyzed using dedicated RV software (Tomtec) to measure end-diastolic and end-systolic volumes (EDV, ESV), stroke volume (SV) and ejection fraction (EF). Results were categorized by sex, age (18-40, 41-65 and >65 years) and ethnicity. RESULTS: Of the 2007 subjects with attempted 3D RV acquisitions, 1051 had adequate image quality for confident measurements. Upper and lower limits for BSA-indexed EDV (mL/m2) and ESV (mL/m2) and EF (%) were [48, 95], [19, 43] and [44, 58] for men and [42, 81], [16, 36] and [46, 61] for women. Men had significantly larger EDV, ESV and SV (even after BSA indexing) and lower EF than women (p<0.05). EDV and ESV did not show any meaningful differences between age groups. 3D RV volumes were smallest in Asians. CONCLUSIONS: Reliability of 3D RV acquisition is low worldwide underscoring the importance for future improvements in imaging techniques. Sex and race must be taken into consideration in the assessment of both RV volumes and EF.
  • Cristiane Carvalho Singulane; Tatsuya Miyoshi; Victor Mor-Avi; Juan I Cotella; Marcus Schreckenberg; Michael Blankenhagen; Niklas Hitschrich; Karima Addetia; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutiérrez-Fajardo; Ravi Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ana Clara Tude Rodrigues; Ricardo Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Yun Zhang; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 36 6 581 - 590 2022年12月 
    BACKGROUND: Left ventricular (LV) circumferential strain has received less attention than longitudinal deformation, which has recently become part of routine clinical practice. Among other reasons, this is because of the lack of established normal values. Accordingly, we aimed to establish normative values for LV circumferential strain and determine sex-, age- and race-related differences in a large cohort of healthy adults. METHODS: Complete 2D transthoracic echocardiograms were obtained in 1572 healthy subjects (51% male), enrolled in the World Alliance of Societies of Echocardiography (WASE) Study. Subjects were divided into 3 age groups (<35, 35-55, >55 years) and stratified by sex and by race. Vendor-independent semi-automated speckle tracking software was used to determine LV regional and global circumferential strain (GCS) values. Limits of normal for each measurement were defined as 95% of the corresponding sex and age group falling between the 2.5th and 97.5th percentiles. Intergroup differences were analyzed using unpaired t-tests. RESULTS: Circumferential strain showed a gradient, with lower magnitude at the mitral valve level, increasing progressively towards the apex. Compared to men, women had statistically higher magnitude of regional and global strain. Older age was associated with a stepwise increase in GCS despite an unaffected EF, a decrease in LV volume and a relatively stable GLS in men with a small gradual decrease in women. Asian subjects demonstrated significantly higher GCS magnitudes than whites of both sexes and blacks in women only. In contrast, no significant differences in GCS were found between white and black subjects of either sex. Importantly, despite statistical significance of the above differences across sex-, age- and races, circumferential strain values were similar in all groups, with variations of the order of magnitude of 1-2%. Notably, no differences in GCS were found between brands of imaging equipment. CONCLUSIONS: This study established normal values of LV regional and global circumferential strain, and identified sex-, age- and race-related differences, where present.
  • Linda Lee; Juan I Cotella; Tatsuya Miyoshi; Karima Addetia; Marcus Schreckenberg; Niklas Hitschrich; Michael Blankenhagen; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutiérrez-Fajardo; Ravi Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ana Clara Tude Rodrigues; Ricardo Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Mei Zhang; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 36 5 533 - 542 2022年12月 
    BACKGROUND: Although increased left ventricular mass (LVM) is associated with adverse outcomes, measured values vary widely depending on the specific technique used. Moreover, the impact of sex, age, and race on LVM remains controversial, further limiting the clinical use of this parameter. Accordingly, we studied LVM using a variety of 2D and 3D echocardiographic techniques in a large population of normal subjects encompassing a wide range of ages. METHODS: Transthoracic echocardiograms obtained in 1885 healthy adult subjects (52% men) enrolled in the World Alliance of Societies of Echocardiography (WASE) normal values study, were divided into three age groups (young, 18-35 years; middle aged, 36-55 years; and old, >55 years). LVM was obtained using 5 conventional techniques, including linear and 2D methods, as well as direct 3D measurement. All LVM values were indexed to body surface area (BSA), and differences according to sex, age, and race were analyzed for each technique. RESULTS: LVM values differed significantly between the 5 techniques. 3D measurements were considerably smaller than those obtained using the other techniques and were closer to MRI normal values reported in the literature. For all techniques, LVM in men was significantly larger than in women, with and without BSA indexing. These technique- and sex-related differences were larger than measurement variability. In women, age differences in LVM were more pronounced and depicted significantly larger values in older age groups for all techniques, except 3D echocardiography (3DE) that showed essentially no differences. LV mass was overall larger in black subjects than in white or Asian subjects. CONCLUSION: Significant differences in LVM values exist across echocardiographic techniques, which are therefore not interchangeable. Sex-, race-, and age-related differences underscore the need for separate population specific normal values.
  • Juan I Cotella; Tatsuya Miyoshi; Victor Mor-Avi; Karima Addetia; Marcus Schreckenberg; Deyu Sun; Jeremy A Slivnick; Michael Blankenhagen; Niklas Hitschrich; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutiérrez-Fajardo; Ravi Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ana Clara Tude Rodrigues; Ricardo Ronderos; Anita Sadeghpour; Gregory Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Mei Zhang; Aldo D Prado; Federico M Asch; Roberto M Lang
    European heart journal. Cardiovascular Imaging 24 4 415 - 423 2022年11月 
    AIMS: Aortic valve area (AVA) used for echocardiographic assessment of aortic stenosis (AS) has been traditionally interpreted independently of sex, age and race. As differences in normal values might impact clinical decision-making, we aimed to establish sex-, age- and race-specific normative values for AVA and Doppler parameters using data from the World Alliance Societies of Echocardiography (WASE) Study. METHODS AND RESULTS: Two-dimensional transthoracic echocardiographic studies were obtained from 1903 healthy adult subjects (48% women). Measurements of the left ventricular outflow tract (LVOT) diameter and Doppler parameters, including AV and LVOT velocity time integrals (VTIs), AV mean pressure gradient, peak velocity, were obtained according to ASE/EACVI guidelines. AVA was calculated using the continuity equation. Compared with men, women had smaller LVOT diameters and AVA values, and higher AV peak velocities and mean gradients (all P < 0.05). LVOT and AV VTI were significantly higher in women (P < 0.05), and both parameters increased with age in both sexes. AVA differences persisted after indexing to body surface area. According to the current diagnostic criteria, 13.5% of women would have been considered to have mild AS and 1.4% moderate AS. LVOT diameter and AVA were lower in older subjects, both men and women, and were lower in Asians, compared with whites and blacks. CONCLUSION: WASE data provide clinically relevant information about significant differences in normal AVA and Doppler parameters according to sex, age, and race. The implementation of this information into clinical practice should involve development of specific normative values for each ethnic group using standardized methodology.
  • Koichiro Matsumura; Yasuhiro Kakiuchi; Takahiro Tabuchi; Toru Takase; Masafumi Ueno; Masahiro Maruyama; Kazuki Mizutani; Tatsuya Miyoshi; Kuniaki Takahashi; Gaku Nakazawa
    European journal of cardiovascular nursing 22 4 392 - 399 2022年07月 
    AIM: Psychological distress is associated with poor prognosis in patients with cardiovascular disease (CVD). However, factors related to psychological distress in elderly patients with CVD is less understood. We aimed to investigate the rate of psychological distress in elderly patients with CVD in comparison with that of patients without CVD and to examine the clinical, socioeconomic, and lifestyle factors associated with this condition. METHODS AND RESULTS: Data from a nationwide population-based study in Japan of patients aged ≥ 60 years were extracted, and 1:1 propensity score matching was conducted of patients with and without CVD. Psychological distress was assessed using the K6 scale, on which a score ≥ 6 was defined as psychological distress. Of the 24,388 matched patients, the rate of psychological distress was significantly higher among patients with CVD compared to those without CVD (29.8% vs. 20.5%, p < 0.0001). The multivariate analysis revealed that female sex, comorbidities except hypertension, current smoking, daily sleep duration of < 6  h versus ≥ 8  h, home renter versus owner, retired status, having a walking disability, and lower monthly household expenditure were independently associated with psychological distress. Walking disability was observed in greatest association with psychological distress (odds ratio 2.69, 95% confidence interval 2.46-2.93). CONCLUSION: Elderly patients with CVD were more likely to have psychological distress compared to those without CVD. Multiple factors, including clinical, socioeconomic, and lifestyle variables, were associated with psychological distress. These analyses may help health care providers to identify high risk patients with psychological distress in a population of older adults with CVD.
  • Michael P Henry; Juan Cotella; Victor Mor-Avi; Karima Addetia; Tatsuya Miyoshi; Marcus Schreckenberg; Michael Blankenhagen; Niklas Hitschrich; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutiérrez-Fajardo; Ravi Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ana Clara Tude Rodrigues; Ricardo Ronderos; Anita Sadeghpour; Gregory Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Mei Zhang; Roberto M Lang; Federico M Asch
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 7 738 - 751 2022年07月 
    BACKGROUND: Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved using three-dimensional echocardiography. Understanding normal valve size, structure, and function is essential for differentiation of healthy from disease states. The aims of this study were to establish normative values for MV apparatus size and morphology and to determine how they vary across age, sex, and race groups using data from the World Alliance Societies of Echocardiography Normal Values Study. METHODS: Three-dimensional volumetric data sets obtained on transthoracic echocardiography in 748 normal subjects (51% men) were analyzed using commercial MV analysis software (TomTec Imaging Systems) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age (18 to 40 years [n = 266], 41 to 65 years [n = 249], and >65 years [n = 233]) to identify sex- and age-related differences. In addition, differences among black, white, and Asian populations were studied. Inter- and intraobserver variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements. RESULTS: Compared with women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared with the black and white populations, the Asian population showed significantly smaller mitral annular size. Although many of the age, sex, and race differences in MV parameters were statistically significant, they were comparable with or smaller than the corresponding measurement variability. Indexing to body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality. CONCLUSIONS: This analysis of the World Alliance Societies of Echocardiography data provides normative values of mitral apparatus size and morphology. Although sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability.
  • Karima Addetia; Tatsuya Miyoshi; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutierrez Fajardo; Ravi R Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ricardo E Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Ana Clara Tude Rodrigues; Yun Zhang; Niklas Hitschrich; Michael Blankenhagen; Markus Degel; Marcus Schreckenberg; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 5 449 - 459 2022年05月 
    BACKGROUND: Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using two-dimensional (2D) echocardiography. However, three-dimensional (3D) echocardiography has been shown to be more accurate and reproducible than 2D echocardiography. Current normative reference values for 3D LV analysis are based predominantly on data from North America and Europe. The World Alliance Societies of Echocardiography study was designed to sample normal subjects from around the world to provide more universal global reference ranges. The aim of this study was to assess the worldwide feasibility of LV 3D echocardiography and report on size and functional measurements. METHODS: A total of 2,262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. Three-dimensional LV full-volume data sets were obtained and analyzed offline using vendor-neutral software. Measurements included LV end-diastolic and end-systolic volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), and global circumferential strain. Results were categorized by age (18-40, 41-65, and >65 years), sex, and race. RESULTS: A total of 1,589 subjects (feasibility 70%) had adequate LV data sets for analysis. Mean normal values for indexed end-diastolic volume, end-systolic volume, and LVEF in men and women were 70 ± 15 and 65 ± 12 mL/m2, 28 ± 7 and 25 ± 6 mL/m2, and 60 ± 5% and 62 ± 5%, respectively. Men had larger LV volumes and lower LVEFs than women. GLS and global circumferential strain were higher in magnitude in women. In both sexes, LV volumes were lower and LVEF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. Although GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS compared with the oldest age group. Global circumferential strain was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher LVEFs and absolute strain values than both blacks and whites. CONCLUSIONS: Age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters obtained by 3D echocardiography.
  • Yohei Funauchi; Toru Takase; Tatsuya Miyoshi; Naoya Miyashita; Masatomo Kimura; Gaku Nakazawa
    Internal Medicine 61 5 667 - 671 2022年03月
  • Tatsuya Miyoshi; Hidekazu Tanaka
    Journal of Medical Ultrasonics 49 1 21 - 33 2022年01月 [査読有り][招待有り]
  • Cristiane Carvalho Singulane; Amita Singh; Tatsuya Miyoshi; Karima Addetia; Laurie Soulat-Dufour; Marcus Schreckenberg; Michael Blankenhagen; Niklas Hitschrich; Vivekanandan Amuthan; Rodolfo Citro; Masao Daimon; Pedro Gutiérrez-Fajardo; Ravi Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ana Clara Tude Rodrigues; Ricardo Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Yun Zhang; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 4 426 - 434 2021年10月 
    BACKGROUND: Though the assessment of right ventricular (RV) diastolic function is feasible, it has garnered far less momentum for use compared to its left ventricular counterpart. The scarcity of data defining normative RV diastolic function and the fact that implications of RV diastolic dysfunction in different disease states on outcomes are less well known, both hinder integration into routine clinical assessment. We sought to establish normal values of RV diastolic parameters stratified by sex, age and race using data from the World Alliance of Societies of Echocardiography (WASE) Study. METHODS: We analyzed a subset of 888 normal subjects from the WASE database, including measurements of tricuspid valve (TV) inflow E- and A-wave velocities, E-wave deceleration time, TV annular tissue Doppler e' and a' velocities. Additionally, right atrial (RA) maximal volume and RA peak reservoir strain were measured. Patients were grouped by age (<40, 41-65, >65 years), and stratified by sex and race. Differences were analyzed using unpaired t-tests. RESULTS: When compared to men, women had significantly higher TV e', E-wave and A-wave velocities, though differences were modest. Increasing age was associated with stepwise lower TV E-wave, e' velocities and TV E/A, higher a' velocities and E/e' ratios. RA peak reservoir strain was also lower and RA ESV trended towards being smaller for older age groups. Asian subjects demonstrated significantly higher a' velocities, lower E-wave, smallest RA ESV and lowest RA peak strain values, compared to whites of both sexes. CONCLUSIONS: This study provides normal values for parameters used in the assessment of RV diastolic function stratified by race, sex and age. Our results demonstrate significant differences in RV diastolic parameters between age groups, which manifest in both the individual parameters and composite ratios of TV inflow and annular velocities. While limited sex- and race-related differences were also noted, age appears to have the most significant impact on RV diastolic parameters. These findings may aid in refining the current normative values.
  • Hena N Patel; Tatsuya Miyoshi; Karima Addetia; Rodolfo Citro; Masao Daimon; Pedro Gutierrez Fajardo; Ravi R Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ricardo E Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Ana Clara Tude Rodrigues; Vivekanandan Amuthan; Yun Zhang; Marcus Schreckenberg; Michael Blankenhagen; Markus Degel; Niklas Hitschrich; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 3 267 - 274 2021年10月 
    BACKGROUND: Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography study, the authors sought to establish normal ranges of aortic dimensions across sexes, races, and a wide range of ages. METHODS: Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18-40 years), middle aged (41-65 years) and old (>65 years). Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 ± 17 years; 50.4% men; mean body surface area [BSA], 1.77 ± 0.22 m2) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva, and sinotubular junction. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. RESULTS: All aortic root dimensions were larger in men compared with women. After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. CONCLUSIONS: There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.
  • Amita Singh; Cristiane Carvalho Singulane; Tatsuya Miyoshi; Aldo D Prado; Karima Addetia; Michele Bellino; Masao Daimon; Pedro Gutierrez Fajardo; Ravi R Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ricardo E Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Ana Clara Tude Rodrigues; Amuthan Vivekanandan; Yun Zhang; Marcus Schreckenberg; Michael Blankenhagen; Markus Degel; Niklas Hitschrich; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 2 154 - 164 2021年08月 
    BACKGROUND: Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual patients, but previous reports have yielded mixed conclusions regarding the effects of age, sex and/or race. The current report from the World Alliance Societies of Echocardiography (WASE) study focuses on 2D and 3D measures of LA structure and function, with subgroup analysis by age-, sex- and race. METHODS: Transthoracic 2D and 3D echocardiographic images were obtained in 1,765 healthy individuals (901 males, 864 females) evenly distributed among age subgroups: 18-40 years (n=745), 41-65 years (n=618) and >65 years (n=402); 38.4% white, 39.9% Asian, 9.7% black. Images were analyzed using dedicated LA analysis software to measure LA volumes and phasic function from 3D volume and 2D strain curves. RESULTS: 3D maximal and minimum LA volumes adjusted for BSA were nearly identical for men and women, but women demonstrated higher 3D total and passive EF. 2D reservoir strain was similar for both sexes. Age was associated with an incremental rise in LA volumes alongside characteristic shifts in functional indices. Total 2D EF, reservoir and conduit strain varied inversely with age, counteracted by higher booster strain, with a greater magnitude of effect in women. Active 3D EF was significantly higher, while total and passive EF decreased with age. Inter-racial differences were noted in LA volumes without substantial differences in functional indices. CONCLUSIONS: While similar normal values for LA volumes and strain can be applied to both sexes, meaningful differences in LA size occur with aging. Indices of function also shift with age with a compensatory rise in booster function, which may serve to counteract observed lower total and passive EF. Defining age-associated normal values may help differentiate age-associated "healthy" LA aging from pathological processes.
  • Karima Addetia; Tatsuya Miyoshi; Rodolfo Citro; Masao Daimon; Pedro Gutierrez Fajardo; Ravi R Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ricardo E Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Ana Clara Tude Rodrigues; Amuthan Vivekanandan; Yun Zhang; Marcus Schreckenberg; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 34 11 1148 - 1157 2021年07月 
    BACKGROUND: Echocardiographic assessment of right ventricular (RV) systolic function is an important component of clinical decision making. Although professional societies have worked to define normal ranges of RV size and function, their guidelines have not included the impacts of age, sex, and ethnicity on these parameters, as they have for the left ventricle. The World Alliance of Societies of Echocardiography study was designed to investigate the effects of age, sex, and ethnicity on all cardiac chambers. The aim of this study was to explore whether these differences exist for RV systolic parameters. METHODS: Adequate two-dimensional RV-focused views for the measurement of systolic parameters, including fractional area change and global and free wall longitudinal strain, were available in 1,913 subjects (mean age, 47 ± 17 years; 51% men). Basal and mid-RV dimensions, length, tricuspid annular peak systolic excursion, tissue Doppler S' velocity, and myocardial performance index were also measured. Subjects were grouped by age (<40, 41-65, and >65 years), with results also stratified by sex and ethnicity (Asian, black, or white) and analyzed using vendor-independent software. Differences among groups were evaluated using analysis of variance. RESULTS: Women had smaller absolute and indexed RV areas and absolute RV dimensions and higher magnitudes of fractional area change, free wall strain, and global longitudinal strain compared to men. With respect to age, most of the statistically significant differences were noted between the <40- and >65-year age groups, with RV areas and lengths smaller in older age groups and RV functional parameters (S', fractional area change, tricuspid annular plane systolic excursion, global longitudinal strain, free wall strain, and myocardial performance index) showing minimal decreases or no changes with age. Although there were no meaningful differences in functional parameters among ethnic groups, RV size was smallest in Asians. CONCLUSIONS: These findings suggest that although two-dimensional RV parameters are age and sex dependent, association with race is less apparent, excepting that the Asian population appears to have smaller chamber sizes compared with whites and blacks.
  • Hena N Patel; Tatsuya Miyoshi; Karima Addetia; Michael P Henry; Rodolfo Citro; Masao Daimon; Pedro Gutierrez Fajardo; Ravi R Kasliwal; James N Kirkpatrick; Mark J Monaghan; Denisa Muraru; Kofo O Ogunyankin; Seung Woo Park; Ricardo E Ronderos; Anita Sadeghpour; Gregory M Scalia; Masaaki Takeuchi; Wendy Tsang; Edwin S Tucay; Ana Clara Tude Rodrigues; Amuthan Vivekanandan; Yun Zhang; Marcus Schreckenberg; Michael Blankenhagen; Markus Degel; Alexander Rossmanith; Victor Mor-Avi; Federico M Asch; Roberto M Lang
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 34 10 1077 - 1085 2021年05月 
    BACKGROUND: Assessment of cardiac output (CO) and stroke volume (SV) is essential to understand cardiac function and hemodynamics. These parameters can be examined by three echocardiographic techniques (pulsed wave Doppler, 2D and 3D). Whether these methods can be used interchangeably is unclear. The influence of age, sex, and ethnicity on CO and SV has also not been examined in-depth. In this report from the World Alliance of Societies of Echocardiography (WASE) Normal Values study, we aim to compare CO and SV in healthy adults according to age, sex, ethnicity and measurement techniques. METHODS: 1450 adult subjects (53% males) free from heart, lung and kidney disease were prospectively enrolled in 15 countries with even distribution among age groups and sex. Subjects were divided into three age groups: young (18-40), middle (41-65) and old (>65 years), and three main racial groups: whites, blacks, and Asians. CO and SV were indexed (CI and SVI, respectively) to body surface area (BSA) and height and measured using three echocardiographic methods: Doppler, 2D, and 3D. Images were analyzed in two core laboratories (one for each 2D and 3D). RESULTS: CI and SVI were significantly lower by 2D compared to both Doppler and 3D methods in both sexes. SVI was significantly lower in females versus males by all 3 methods, while CI only differed by 2D. SVI decreased with aging by all three techniques, whereas CI declined only with 2D and 3D. CO and SV were smallest in Asians and largest in whites, and the differences persisted after normalization for BSA. CONCLUSION: Our results provide normal reference values for CO and SV, which differ by age, sex and race. Further, CI and SVI measurements by the different echocardiographic techniques are not interchangeable. All these factors need to be taken into account when evaluating cardiac function and hemodynamics in individual patients.
  • Lang, R.M.; Addetia, K.; Miyoshi, T.; Kebed, K.; Blitz, A.; Schreckenberg, M.; Hitschrich, N.; Mor-Avi, V.; Asch, F.M.
    Journal of the American Society of Echocardiography 34 4 2021年
  • Soulat-Dufour, L.; Addetia, K.; Miyoshi, T.; Citro, R.; Daimon, M.; Fajardo, P.G.; Kasliwal, R.R.; Kirkpatrick, J.N.; Monaghan, M.J.; Muraru, D.; Ogunyankin, K.O.; Park, S.W.; Ronderos, R.E.; Sadeghpour, A.; Scalia, G.M.; Takeuchi, M.; Tsang, W.; Tucay, E.S.; Tude Rodrigues, A.C.; Vivekanandan, A.; Zhang, Y.; Diehl, M.; Schreckenberg, M.; Mor-Avi, V.; Asch, F.M.; Lang, R.M.; Prad, A.D.; Kwon, A.; Hoschke-Edwards, S.; Afonso, T.R.; Thampinathan, B.; Sooriyakanthan, M.; Zhu, T.; Wang, Z.; Alagesan, R.; Alizadehasl, A.; Badano, L.; Nakao, T.; Kawata, T.; Hirokawa, M.; Sawada, N.; Yun, H.R.; Hwang, J.-W.
    Journal of the American Society of Echocardiography 34 3 286 - 300 2021年 
    BACKGROUND: The World Alliance Societies of Echocardiography study is a multicenter, international, prospective, cross-sectional study whose aims were to evaluate healthy adult individuals to establish age- and sex-normative values of echocardiographic parameters and to determine whether differences exist among people from different countries and of different ethnicities. The present report focuses on two-dimensional (2D) and three-dimensional (3D) right atrial (RA) size and function. METHODS: Transthoracic 2D and 3D echocardiographic images were obtained in 2,008 healthy adult individuals evenly distributed among subgroups according to sex (1,033 men, 975 women) and age 18 to 40 years (n = 854), 41 to 65 years (n = 653), and >65 years (n = 501). For ethnicity, 34.9% were white, 41.6% Asian, and 9.7% black. Images were analyzed in a core laboratory according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. RA measurements included 2D dimensions, 2D and 3D RA volumes (RAVs) indexed to body surface area (BSA), emptying fraction (EmF), and global longitudinal strain, including total/reservoir, passive/conduit, and active/contractile phases. Differences among age and sex categories and among countries were also examined. RESULTS: RAVs were larger in men (even after BSA indexing), while 3D total EmF and global longitudinal strain magnitudes were higher in women. For both sexes, there were no significant age-related differences in 2D RAV measurements, but 3D RAV values differed minimally with age, remaining significant after BSA indexing. RA total EmF and reservoir strain and passive EmF and conduit strain magnitude were lower in older groups for both sexes. Interestingly, whereas RA active EmF increased with age, contractile strain magnitude decreased. Considerable geographic variations were identified: Asians of both sexes had significantly lower BSA than non-Asians, and their 2D and 3D end-systolic RAVs were significantly smaller even after BSA indexing. Of note, 2D end-systolic RAVs in this group were considerably lower than normal values provided in the current guidelines. CONCLUSIONS: There is significant sex, age, and geographic variability in normal RA size and function parameters. Current guideline-recommended normal ranges for RA size and function parameters should be adjusted geographically on the basis of the results of this study.
  • Matsue, Y.; Kagiyama, N.; Yamaguchi, T.; Kuroda, S.; Okumura, T.; Kida, K.; Mizuno, A.; Oishi, S.; Inuzuka, Y.; Akiyama, E.; Matsukawa, R.; Kato, K.; Suzuki, S.; Naruke, T.; Yoshioka, K.; Miyoshi, T.; Baba, Y.; Yamamoto, M.; Mizutani, K.; Yoshida, K.; Kitai, T.
    Heart Lung and Circulation 29 9 1328 - 1337 2020年 
    BACKGROUND: Although liver dysfunction is one of the common complications in patients with acute heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. We investigated the utility of the ALBI score in patients with AHF compared to that for a preexisting liver dysfunction score, the Model of End-Stage Liver Disease Excluding prothrombin time (MELD XI) score. METHODS: We evaluated ALBI and MELD XI scores in 1,190 AHF patients enrolled in the prospective, multicentre Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure study. The associations between the two scores and the clinical profile and prognostic predictive ability for 1-year mortality were evaluated. RESULTS: The mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher ALBI score, but not higher MELD XI score, was associated with findings of fluid overload. After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95% CI: 1.60-2.79, p<0.001), but not the MELD XI score (HR 1.02, 95% CI: 0.99-1.06, p=0.242), was associated with 1-year mortality. Likewise, area under the receiver-operator-characteristic curves for 1-year mortality significantly increased when the ALBI score (0.71 vs. 0.74, p=0.020), but not the MELD XI score (0.71 vs. 0.72, p=0.448), was added to the pre-existing risk factors. CONCLUSIONS: The ALBI score is potentially a suitable liver dysfunction marker that incorporates information on fluid overload and prognosis in patients with AHF. These results provide new insights into heart-liver interactions in AHF patients.
  • Medvedofsky, D.; Koifman, E.; Jarrett, H.; Miyoshi, T.; Rogers, T.; Ben-Dor, I.; Satler, L.F.; Torguson, R.; Waksman, R.; Asch, F.M.
    Journal of the American Society of Echocardiography 33 4 2020年
  • Miyoshi, T.; Addetia, K.; Citro, R.; Daimon, M.; Desale, S.; Fajardo, P.G.; Kasliwal, R.R.; Kirkpatrick, J.N.; Monaghan, M.J.; Muraru, D.; Ogunyankin, K.O.; Park, S.W.; Ronderos, R.E.; Sadeghpour, A.; Scalia, G.M.; Takeuchi, M.; Tsang, W.; Tucay, E.S.; Tude Rodrigues, A.C.; Vivekanandan, A.; Zhang, Y.; Blitz, A.; Lang, R.M.; Asch, F.M.; Prado, A.D.; Filipini, E.; Kwon, A.; Hoschke-Edwards, S.; Regina Afonso, T.; Thampinathan, B.; Sooriyakanthan, M.; Zhu, T.; Wang, Z.; Wang, Y.; Zhang, M.; Zhang, Y.; Yin, L.; Li, S.; Alagesan, R.; Balasubramanian, S.; Ananth, R.V.A.; Bansal, M.; Badano, L.P.; Palermo, C.; Bossone, E.; Di Vece, D.; Bellino, M.; Nakao, T.; Kawata, T.; Hirokawa, M.; Sawada, N.; Nabeshima, Y.; Yun, H.R.; Hwang, J.-W.; Fasawe, D.
    Journal of the American Society of Echocardiography 33 10 1223 - 1233 2020年 
    Background: The World Alliance Societies of Echocardiography (WASE) study was conducted to describe echocardiographic normal values in adults and to compare races and nationalities using a uniform acquisition and measurement protocol. This report focuses on left ventricular (LV) diastolic function. Methods: WASE is an international, cross-sectional study. Participants were enrolled with equal distribution according to age and gender. Echocardiograms were analyzed in a core laboratory based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Left ventricular diastolic function was assessed by E, E/A, e' velocities, E/e', left atrial volume index (LAVI), and tricuspid regurgitation velocity. Determination of LV diastolic function was made using the algorithm proposed by the guidelines. Results: A total of 2,008 subjects from 15 countries were enrolled. The majority were of white or Asian race (42.8%, 41.8%, respectively). E and E/e' were higher in female patients, while LAVI was similar in both genders. Consistent increase in E/e' and decrease in E/A, E, and e' were found as age increased. The upper limit of normal for LAVI was higher in WASE compared with the guidelines. The lower limits of normal for e' were smaller in elder groups than those in the guidelines, while the upper limits of normal for E/e' were below the guideline values. These findings suggest that the cutoff value for LAVI should be shifted upward and age-specific cutoff values for e' should be considered. In WASE, <93.6% of patients were classified as normal LV diastolic function using the guidelines' algorithm, and the proportion increased to 97.4% when applying the revised cutoff values for LAVI obtained in our study. Conclusions: Guideline-recommended normal values for e' velocities and LAVI should be reconsidered. The algorithm for the determination of LV diastolic function proposed by the guidelines is useful, but adjustments to LAVI could further improve it.
  • Asch, F.M.; Miyoshi, T.; Addetia, K.; Citro, R.; Daimon, M.; Desale, S.; Fajardo, P.G.; Kasliwal, R.R.; Kirkpatrick, J.N.; Monaghan, M.J.; Muraru, D.; Ogunyankin, K.O.; Park, S.W.; Ronderos, R.E.; Sadeghpour, A.; Scalia, G.M.; Takeuchi, M.; Tsang, W.; Tucay, E.S.; Tude Rodrigues, A.C.; Vivekanandan, A.; Zhang, Y.; Blitz, A.; Lang, R.M.; Prado, A.D.; Filipini, E.; Kwon, A.; Hoschke-Edwards, S.; Afonso, T.R.; Thampinathan, B.; Sooriyakanthan, M.; Zhu, T.; Wang, Z.; Wang, Y.; Zhang, M.; Zhang, Y.; Yin, L.; Li, S.; Alagesan, R.; Balasubramanian, S.; Ananth, R.V.A.; Bansal, M.; Badano, L.P.; Palermo, C.; Bossone, E.; Di Vece, D.; Bellino, M.; Nakao, T.; Kawata, T.; Hirokawa, M.; Sawada, N.; Nabeshima, Y.; Yun, H.R.; Hwang, J.-W.; Fasawe, D.; Schreckenberg, M.; Ronderos, R.; Scalia, G.; Amuthan, V.; Kasliwal, R.; Gutierrez-Fajardo, P.; Woo Park, S.; Kirkpatrick, J.
    Journal of the American Society of Echocardiography 32 11 2019年
  • Kondo, T.; Okumura, T.; Matsue, Y.; Shiraishi, A.; Kagiyama, N.; Yamaguchi, T.; Kuroda, S.; Kida, K.; Mizuno, A.; Oishi, S.; Inuzuka, Y.; Akiyama, E.; Matsukawa, R.; Kato, K.; Suzuki, S.; Naruke, T.; Yoshioka, K.; Miyoshi, T.; Baba, Y.; Yamamoto, M.; Murai, K.; Mizutani, K.; Yoshida, K.; Kitai, T.; Murohara, T.
    Circulation Journal 83 1 174 - 181 2019年 
    BACKGROUND: The aim of this study was to assess specialty-related differences in the treatment for patients with acute heart failure (AHF) in the acute phase and subsequent prognostic differences. Methods and Results: We analyzed hospitalizations for AHF in REALITY-AHF, a multicenter prospective registry focused on very early presentation and treatment in patients with AHF. All patients were classified according to the medical specialty of the physicians responsible for contributed most to decisions regarding the initial diagnosis and treatment after the emergency department (ED) arrival. Patients initially managed by emergency physicians (n=614) or cardiologists (n=911) were analyzed. After propensity-score matching, vasodilators were used less often by emergency physicians than by cardiologists at 90 min after ED arrival (29.8% vs. 46.1%, P<0.001); this difference was also observed at 6, 24, and 48 h. Cardiologists administered furosemide earlier than emergency physicians (67 vs. 102 min, P<0.001). However, the use of inotropes, noninvasive ventilation, and endotracheal intubation were similar between groups. In-hospital mortality did not differ between patients managed by emergency physicians and those managed by cardiologists (4.1% vs. 3.8%, odds ratio 1.12; 95% confidence interval 0.58-2.14). CONCLUSIONS: Despite differences in initial management, no prognostic difference was observed between emergency physicians and cardiologists who performed the initial management of patients with AHF.
  • Medvedofsky, D.; Koifman, E.; Miyoshi, T.; Rogers, T.; Wang, Z.; Goldstein, S.A.; Ben-Dor, I.; Satler, L.F.; Torguson, R.; Waksman, R.; Asch, F.M.
    American Journal of Cardiology 124 2 2019年
  • Matsue, Y.; Damman, K.; Voors, A.A.; Kagiyama, N.; Yamaguchi, T.; Kuroda, S.; Okumura, T.; Kida, K.; Mizuno, A.; Oishi, S.; Inuzuka, Y.; Akiyama, E.; Matsukawa, R.; Kato, K.; Suzuki, S.; Naruke, T.; Yoshioka, K.; Miyoshi, T.; Baba, Y.; Yamamoto, M.; Murai, K.; Mizutani, K.; Yoshida, K.; Kitai, T.
    Journal of the American College of Cardiology 69 25 3042 - 3051 2017年 
    BACKGROUND: Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. OBJECTIVES: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. METHODS: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time <60 min were pre-defined as the early treatment group. Primary outcome was all-cause in-hospital mortality. RESULTS: Among 1,291 AHF patients treated with intravenous furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006). CONCLUSIONS: In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105).
  • Motoji, Y.; Tanaka, H.; Fukuda, Y.; Sano, H.; Ryo, K.; Sawa, T.; Miyoshi, T.; Imanishi, J.; Mochizuki, Y.; Tatsumi, K.; Matsumoto, K.; Emoto, N.; Hirata, K.-I.
    Echocardiography 33 2 2016年
  • Matsumoto, K.; Tanaka, H.; Onishi, A.; Motoji, Y.; Tatsumi, K.; Sawa, T.; Miyoshi, T.; Imanishi, J.; Mochizuki, Y.; Hirata, K.-I.
    European Heart Journal Cardiovascular Imaging 16 11 2015年
  • Yoshida, N.; Miyoshi, T.; Ninomaru, T.; Nagamatsu, Y.; Tamada, N.; Hiranuma, N.; Sasaki, Y.; Kitamura, A.; Kanda, G.; Kobayashi, N.; Nakagiri, K.; Fujii, T.
    Journal of Cardiology Cases 12 3 87 - 90 2015年 [査読有り]
  • Imanishi, J.; Tanaka, H.; Sawa, T.; Motoji, Y.; Miyoshi, T.; Mochizuki, Y.; Fukuda, Y.; Tatsumi, K.; Matsumoto, K.; Okita, Y.; Hirata, K.-I.
    Echocardiography 32 5 2015年
  • Hiraishi Mana; Tanaka Hidekazu; Motoji Yoshiki; Sawa Takuma; Tsuji Takayuki; Miyoshi Tatsuya; Imanishi Junichi; Kaneko Akihiro; Matsumoto Kensuke; Shinke Toshiro; Hirata Ken-ichi
    International Heart Journal 56 5 516 - 521 International Heart Journal Association 2015年 
    Worsening of mitral regurgitation (MR) is sometimes observed after closure of an atrial septal defect (ASD). However, since the mechanism of this deterioration remains unclear, the aim of our study was to investigate the effect of left (LV) and right ventricular (RV) geometry on MR after transcatheter closure of ASD.
    We studied 27 patients with ASD who underwent transcatheter closure. Echocardiography was performed before and 6 ± 2 months after the procedure. In addition to conventional echocardiographic parameters, full volume data of the whole LV and RV heart was obtained with 3-dimensional echocardiography. MR was quantified by measuring the width of the vena contracta, and was graded as mild (< 3.0 mm), moderate (3.0 to 6.9 mm), or severe (≥ 7.0 mm).
    Ten patients (37%) were classified as having worsening MR and the remaining 17 (63%) as not having worsening MR. The two groups showed similar baseline characteristics, except for patients with worsening MR being more likely to be older (P = 0.009) and having a larger left-to-right shunt of pulmonary and systemic blood flow ratio (P = 0.02). It is noteworthy that the horizontal-to-vertical ratio of basal-RV at end-systole for patients with worsening MR was significantly smaller than that for patients without worsening MR (1.0 ± 0.2 versus 1.4 ± 0.2, P < 0.0001). Furthermore, multivariate analysis showed that the horizontal-to-vertical ratio of basal-RV at end-systole was the independent predictor of worsening MR during follow-up (P < 0.001).
    RV geometry may affect MR after closure of ASD. The pre-operative horizontal-to-vertical ratio of basal-RV is considered useful for predicting worsening of MR after closure of ASD.
  • Yoshida, N.; Hiranuma, N.; Ninomaru, T.; Nagamatsu, Y.; Tamada, N.; Miyoshi, T.; Sasaki, Y.; Kanda, G.; Kobayashi, N.; Fujii, T.
    Journal of Cardiology Cases 11 6 178 - 180 2015年 
    Essential thrombocythemia (ET) has been reported to cause acute coronary disease. However, the efficacy of anti-platelet therapy for ET is unclear since there are individual differences in the platelet function of ET patients. Here we report a case of a 62-year-old man with ET who was admitted to our hospital because of acute coronary syndrome. He underwent coronary angioplasty. Dual anti-platelet therapy with aspirin (81 mg/day) and clopidogrel (75 mg/day) was subsequently initiated. We evaluated platelet reactivity in P2Y12 reaction units, and subsequently determined anti-platelet drugs and corresponding doses. .
  • Motoji, Y.; Tanaka, H.; Fukuda, Y.; Sano, H.; Ryo, K.; Imanishi, J.; Miyoshi, T.; Sawa, T.; Mochizuki, Y.; Matsumoto, K.; Emoto, N.; Hirata, K.-I.
    International Journal of Cardiovascular Imaging 31 4 2015年
  • Matsumoto, K.; Tanaka, H.; Imanishi, J.; Tatsumi, K.; Motoji, Y.; Miyoshi, T.; Onishi, T.; Kawai, H.; Hirata, K.-I.
    Journal of the American Society of Echocardiography 27 4 2014年
  • Fukuda, Y.; Tanaka, H.; Motoji, Y.; Ryo, K.; Sawa, T.; Imanishi, J.; Miyoshi, T.; Mochizuki, Y.; Tatsumi, K.; Matsumoto, K.; Shinke, T.; Emoto, N.; Hirata, K.-I.
    International Journal of Cardiovascular Imaging 30 7 2014年
  • Imanishi, J.; Tanaka, H.; Sawa, T.; Motoji, Y.; Miyoshi, T.; Mochizuki, Y.; Fukuda, Y.; Tatsumi, K.; Matsumoto, K.; Okita, Y.; Hirata, K.-I.
    International Journal of Cardiovascular Imaging 30 2 2014年
  • Tatsumi, K.; Tanaka, H.; Matsumoto, K.; Miyoshi, T.; Hiraishi, M.; Tsuji, T.; Kaneko, A.; Ryo, K.; Fukuda, Y.; Norisada, K.; Onishi, T.; Yoshida, A.; Kawai, H.; Hirata, K.-I.
    Echocardiography 31 4 2014年
  • Tanaka, H.; Matsumoto, K.; Sawa, T.; Miyoshi, T.; Motoji, Y.; Imanishi, J.; Mochizuki, Y.; Tatsumi, K.; Hirata, K.-I.
    International Journal of Cardiovascular Imaging 30 7 2014年
  • Tatsumi, K.; Tanaka, H.; Matsumoto, K.; Sawa, T.; Miyoshi, T.; Imanishi, J.; Motoji, Y.; Mochizuki, Y.; Fukuda, Y.; Shinke, T.; Hirata, K.-I.
    International Journal of Cardiovascular Imaging 30 8 2014年
  • Tatsuya Miyoshi
    Echocardiography (Mount Kisco, N.Y.) 31 7 2013年12月 

    Background

    Anthracycline chemotherapy generates progressive dose-dependent left ventricular (LV) dysfunction associated with a poor prognosis. Early detection of minor LV myocardial dysfunction caused by the cardiotoxicity of anthracycline is thus important for predicting global LV dysfunction.

    Methods

    Fifty patients with preserved ejection fraction (all ≥55%) after receiving anthracycline chemotherapy were recruited for this study. Two-dimensional speckle tracking was used to assess global radial and circumferential strains from mid-LV short-axis views and global longitudinal strain from the apical four- and two-chamber view as peak global strain curves. Three-dimensional (3D) radial, circumferential, and longitudinal myocardial function was quantified as a peak global strain curve using 3D speckle tracking from all 16 LV segments. 3D speckle tracking imaging was used to evaluate LV endocardial area change ratio (area strain) quantified as peak global area strain curve (3D-GAS) to determine LV endocardial function. Twenty age-, gender-, and EF-matched normal volunteers were studied for comparisons.

    Results

    Only 3D-GAS and peak 3D global circumferential strains of the anthracycline group were significantly worse than those of the control group (-43.3 ± 3.1 vs. -45.8 ± 4.3% and -31.6 ± 3.5% vs. -34.4 ± 4.2%, respectively; P = 0.008, P = 0.004) even though global LV systolic and diastolic functions were similar. 3D-GAS correlated significantly with the cumulative doxorubicin dose (r = 0.316, P = 0.026). It was noteworthy that multivariate analysis showed only 3D-GAS (β = 0.323, P = 0.025) was independently associated with cumulative doxorubicin dose.

    Conclusions

    Three-dimensional speckle tracking area strain was found useful for early detection of minor LV endocardial dysfunction associated with the use of anthracycline, and may thus prove to be clinically useful for predicting global LV dysfunction.
  • Tsuji, T.; Tanaka, H.; Matsumoto, K.; Miyoshi, T.; Hiraishi, M.; Kaneko, A.; Ryo, K.; Fukuda, Y.; Tatsumi, K.; Onishi, T.; Kawai, H.; Hirata, K.-I.
    International Journal of Cardiovascular Imaging 29 2 2013年
  • MATSUMOTO Kensuke; TANAKA Hidekazu; MIYOSHI Tatsuya; HIRAISHI Mana; KANEKO Akihiro; FUKUDA Yuko; TATSUMI Kazuhiro; KAWAI Hiroya; HIRATA Ken-ichi
    Circulation journal : official journal of the Japanese Circulation Society 77 7 1750 - 1759 The Japanese Circulation Society 2013年 
    Background: Left ventricular (LV) dyssynchrony is not a stable phenomenon, but rather, changes dynamically. Given that the prognostic impact of dynamic dyssynchrony has not yet been elucidated, the objective was to investigate the clinical impact of dynamic dyssynchrony on patients with dilated cardiomyopathy (DCM). Methods and Results: Seventy DCM patients with ejection fraction 32±9% were retrospectively recruited, and 3-dimensional speckle-tracking area strain was used to measure both contractile reserve and changes in dyssynchrony during dobutamine stress. The standard deviation of time-to-peak area strain was adopted as the systolic dyssynchrony index. Event-free survival was then tracked over a 13-month period. A ≥7.55% increase in systolic dyssynchrony index during dobutamine stress (Δsystolic dyssynchrony index) was the best predictor of cardiovascular events with 77% sensitivity and 88% specificity. Multivariate Cox analysis indicated that not only the absence of contractile reserve (Δglobal area strain ≤21.1%: hazard ratio [HR], 15.29; P=0.01), but the presence of dynamic dyssynchrony (ΔLV dyssynchrony ≥7.55%: HR: 7.591; P=0.003) was an independent predictor of cardiovascular events. Importantly, absence of dynamic dyssynchrony and presence of contractile reserve were associated with the most favorable outcome (98%), whereas the reverse condition was associated with the worst outcome (20%, P<0.001). Conclusions: Dynamic dyssynchrony is a potential predictor of cardiovascular events in patients with DCM, while assessment of dynamic dyssynchrony in combination with contractile reserve may further improve prognostic risk stratification.  (Circ J 2013; 77: 1750–1759)
  • OMAR Alaa Mabrouk Salem; TANAKA Hidekazu; MATSUMOTO Kensuke; TATSUMI Kazuhiro; MIYOSHI Tatsuya; HIRAISHI Mana; TSUJI Takayuki; KANEKO Akihiro; RYO Keiko; FUKUDA Yuko; KAWAI Hiroya; HIRATA Ken-ichi
    Circulation journal : official journal of the Japanese Circulation Society 76 6 1399 - 1408 The Japanese Circulation Society 2012年 
    Background: Tissue Doppler imaging-obtained isovolumetric myocardial acceleration (IVA) is load independent, reportedly predicts systolic functions, and correlates with exercise capacity in patients with reduced ejection fraction (EF). We hypothesized that IVA correlates with the pulmonary capillary wedge pressure (PCWP) in patients with reduced EF. Methods and Results: Of 113 patients, correlations between PCWP and IVA were done for all patients, 48 patients with EF ≥55%, and 65 patients with EF <55%. Results were compared to the correlation between PCWP and other echocardiographic predictors. IVA correlated moderately with PCWP in all patients (r=0.54, P<0.0001) and was comparable to the E/A and E/e' ratios. In patients with EF ≥55%, IVA lost correlation and the only predictor was the E/e' ratio (r=0.08, 0.58, P=0.58, <0.0001). In patients with EF <55%, IVA was better than E/A and E/e' (r=0.72, 0.61, 0.51, P<0.0001), especially for atrial fibrillation or when E/e' fell between 8 and 15. Furthermore, IVA >1.60m/s2 can predict PCWP ≥15mmHg, with a sensitivity of 95%, specificity of 73%, and an area under the curve of 0.867 (P<0.0001). Conclusions: IVA can predict PCWP in patients with reduced EF, and can be considered an alternative to the E/e' ratio for patients with atrial fibrillation or E/e' ratio between 8 and 15. (Circ J 2012; 76: 1399-1408)
  • Imanishi, J.; Tanaka, H.; Matsumoto, K.; Tatsumi, K.; Miyoshi, T.; Hiraishi, M.; Kaneko, A.; Ryo, K.; Fukuda, Y.; Yoshida, A.; Yokoyama, M.; Kawai, H.; Hirata, K.-I.
    American Journal of Cardiology 110 12 2012年
  • Tanaka, H.; Matsumoto, K.; Hiraishi, M.; Miyoshi, T.; Kaneko, A.; Tsuji, T.; Ryo, K.; Fukuda, Y.; Tatsumi, K.; Yoshida, A.; Kawai, H.; Hirata, K.-I.
    European Heart Journal Cardiovascular Imaging 13 10 2012年
  • Yamawaki, K.; Tanaka, H.; Matsumoto, K.; Hiraishi, M.; Miyoshi, T.; Kaneko, A.; Tsuji, T.; Ryo, K.; Norisada, K.; Fukuda, Y.; Tatsumi, K.; Onishi, T.; Okada, K.; Okita, Y.; Kawai, H.; Hirata, K.
    Circulation Journal 76 3 744 - 51 2012年 
    BACKGROUND: The purpose of this study was to investigate whether patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) have dyssynchrony and whether it improves after aortic valve replacement (AVR). METHODS AND RESULTS: We studied 30 consecutive patients with severe AS and preserved EF undergoing AVR. For baseline comparison, we studied 17 EF-matched patients with mild-to-moderate AS, and 18 EF-matched normal volunteers. Longitudinal dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain in apical 4- and 2-chamber views at the basal- and mid-levels. Radial and circumferential dyssynchrony was determined as the difference for time-to-peak strain between the anteroseptum and posterior wall from the mid-left ventricular (LV) short-axis view. Each of the myocardial functions was also evaluated by averaging each peak systolic strain. Longitudinal dyssynchrony and function in patients with severe AS was significantly worse than in the patients with mild-to-moderate AS and the controls (94 ± 46 vs. 66 ± 18 ms* and 52 ± 17 ms*, and 12.5 ± 3.7% vs. 16 ± 3.5%* and 18.7 ± 3.7%*, respectively, *P<0.05, vs. severe AS). In contrast, radial and circumferential dyssynchrony were similar for the 3 groups. Importantly, the dyssynchrony of patients with severe AS significantly improved after AVR from 94 ± 46 ms to 68 ± 22 ms (P<0.005). CONCLUSIONS: Significant longitudinal dyssynchrony was present in patients with severe AS and preserved EF, and it improved after AVR.
  • MOTOJI Yoshiki; TANAKA Hidekazu; MIYOSHI Tatsuya; IMANISHI Junichi; HIRAISHI Mana; TSUJI Takayuki; KANEKO Akihiro; RYO Keiko; FUKUDA Yuko; TATSUMI Kazuhiro; MATSUMOTO Kensuke; KAWAI Hiroya; HIRATA Ken-ichi
    Journal of echocardiography : official publication of the Japanese Society of Echocardiography 10 1 35 - 37 2012年
  • Matsumoto, K.; Tanaka, H.; Tatsumi, K.; Miyoshi, T.; Hiraishi, M.; Kaneko, A.; Tsuji, T.; Ryo, K.; Fukuda, Y.; Yoshida, A.; Kawai, H.; Hirata, K.-I.
    American Journal of Cardiology 109 8 2012年
  • Tatsumi, K.; Tanaka, H.; Matsumoto, K.; Hiraishi, M.; Miyoshi, T.; Tsuji, T.; Kaneko, A.; Ryo, K.; Yamawaki, K.; Fukuda, Y.; Norisada, K.; Onishi, T.; Kawai, H.; Hirata, K.-I.
    American Journal of Cardiology 108 6 2011年
  • Tanaka, H.; Hiraishi, M.; Miyoshi, T.; Tsuji, T.; Kaneko, A.; Ryo, K.; Yamawaki, K.; Fukuda, Y.; Norisada, K.; Tatsumi, K.; Matsumoto, K.; Kawai, H.; Hirata, K.-I.
    Cardiovascular Ultrasound 9 1 2011年
  • Matsumoto, K.; Tanaka, H.; Hiraishi, M.; Miyoshi, T.; Tsuji, T.; Kaneko, A.; Ryo, K.; Yamawaki, K.; Fukuda, Y.; Norisada, K.; Tatsumi, K.; Okita, Y.; Kawai, H.; Hirata, K.-I.
    Echocardiography 28 8 2011年

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