研究者データベース

研究者情報

マスター

アカウント(マスター)

  • 氏名

    加賀 早苗(カガ サナエ), カガ サナエ

所属(マスター)

  • 保健科学研究院 保健科学部門 病態解析学分野

所属(マスター)

  • 保健科学研究院 保健科学部門 病態解析学分野

独自項目

syllabus

  • 2021, 循環機能検査学演習, Seminar on Comprehensive Assessment of Cardiovascular Function, 修士課程, 保健科学院, 超音波検査、超音波装置、循環機能計測
  • 2021, 循環機能検査学特論, Comprehensive Assessment of Cardiovascular Function, 修士課程, 保健科学院, 循環器疾患、血行動態、左室機能、心不全
  • 2021, 医用画像科学特講, Advanced Study of Medical Imaging Science, 博士後期課程, 保健科学院, 画像診断 単純写真 超音波 CT MRI
  • 2021, 医用画像科学特講演習, Advanced Seminar on Medical Imaging Science, 博士後期課程, 保健科学院, 画像診断 単純写真 超音波 CT MRI
  • 2021, 臨床生理学Ⅰ, Clinical Physiology Ⅰ, 学士課程, 医学部, 呼吸機能、換気機能検査、肺胞機能検査、肺胞気-動脈酸素分圧較差、換気血流不均等、心雑音、心音図検査、末梢動脈検査
  • 2021, 臨床生理画像学実習Ⅰ, Practice in Clinical Physiology and Imaging Ⅰ, 学士課程, 医学部, 超音波検査、脈波検査、眼底検査、心音図検査
  • 2021, 生体機能学, Medical Physiology, 学士課程, 医学部, 生理学、病態生理学、心不全、不整脈、呼吸機能、酸塩基平衡、生理機能検査学
  • 2021, 一般教育演習(フレッシュマンセミナー), Freshman Seminar, 学士課程, 全学教育, 健康、医学、検査、画像診断、がん、血球形態検査、臨床化学、寄生虫、細菌、細胞検査、免疫検査、食品、細菌・共生と感染、心疾患、低比重リポタンパク質、硬さ, 脂質化学
  • 2021, 臨床生理画像学実習Ⅱ, Practice in Clinical Physiology and Imaging Ⅱ, 学士課程, 医学部, 呼吸機能検査、心電図検査、脳波検査、超音波検査
  • 2021, 臨床生理学Ⅲ, Clinical Physiology Ⅲ, 学士課程, 医学部, 脳神経系、運動系、感覚系、脳波検査、誘発脳波検査、筋電図検査、誘発筋電図検査、神経伝導検査、感覚機能検査、眼底検査、熱画像検査(サーモグラフィ)
  • 2021, 生体機能学実習, Practice in Medical Physiology, 学士課程, 医学部, 患者接遇、患者移動法、救急蘇生法、脳波検査、十二誘導心電図検査、モニター心電図検査、呼吸機能検査、平衡機能検査、感覚機能検査
  • 2021, 画像検査学Ⅱ, Medical Imaging Ⅱ, 学士課程, 医学部, 超音波検査、心臓、消化器、泌尿器、体表臓器、血管
  • 2021, 臨床生理学Ⅱ, Clinical Physiology Ⅱ, 学士課程, 医学部, 心臓電気生理、12誘導心電図、心電図波形異常、不整脈、ホルター心電図検査、運動負荷心電図検査
  • 2021, 画像検査学Ⅰ, Medical Imaging Ⅰ, 学士課程, 医学部, 超音波検査、消化器領域、乳腺・甲状腺領域、循環器領域、産婦人科領域、MRI
  • 2021, 臨床病態学Ⅰ, Clinical Pathophysiology Ⅰ, 学士課程, 医学部, 感染症、心臓系、血管系、肝臓系疾患の病態(病因、症候、検査、治療などを含む)

researchmap

プロフィール情報

学位

  • 博士(医学)(北海道大学)

プロフィール情報

  • 加賀, カガ
  • 早苗, サナエ
  • ID各種

    201201060340475336

対象リソース

業績リスト

研究キーワード

  • 心エコー   超音波検査   

研究分野

  • その他 / その他 / 病態検査学

受賞

  • 2015年03月 日本心エコー図学会 海外学会発表優秀論文賞
     Practical Role of Continuous-Wave Doppler Measurements of Diastolic Velocities of Pulmonary Regurgitation for the Assessment of Pulmonary Hypertension. 
    受賞者: 加賀 早苗
  • 2010年05月 日本心エコー図学会 2009 Best Manuscript Award, J Echocardiogr.
     Right ventricular diastolic dysfunction in patients with left ventricular hypertrophy: analysis of right ventricular myocardial relaxation using two-dimensional speckle tracking imaging 
    受賞者: 加賀 早苗
  • 2008年04月 日本心エコー図学会 第19回日本心エコー図学会学術集会Sonographer's Session最優秀賞
     左室肥大における右室機能障害の機序: 2Dスぺックルトラッキング法による検討. 
    受賞者: 加賀 早苗

論文

  • Michito Murayama, Sanae Kaga, Airi Onoda, Hisao Nishino, Shinobu Yokoyama, Mana Goto, Yukino Suzuki, Yusuke Yanagi, Yui Shimono, Kosuke Nakamura, Hiroyuki Aoyagi, Yoji Tamaki, Suguru Ishizaka, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Ultrasound in medicine & biology 2024年06月03日 
    OBJECTIVE: Blood flow in the hepatic veins and superior vena cava (SVC) reflects right heart filling; however, their Doppler profiles are often not identical, and no studies have compared their diagnostic efficacies. We aimed to determine which venous Doppler profile is reliable for detecting elevated right atrial pressure (RAP). METHODS: In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker. RESULTS: HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = -0.350, p < 0.001; r = -0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = -0.211, p = 0.013) and mean RAP (β = -0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = -0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP. CONCLUSIONS: SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF.
  • 肺動脈弁逆流速度計測に基づく右室一回仕事係数の非侵襲的推定法
    立石 優太, 村山 迪史, 加賀 早苗, 塚本 真帆, 後藤 真奈, 鈴木 ゆき乃, 柳 裕介, 横山 しのぶ, 西野 久雄, 石坂 傑, 岩野 弘幸, 安斉 俊久
    超音波検査技術 49 3 271 - 271 (一社)日本超音波検査学会 2024年06月
  • Kazunori Okada, Akiko Kamiya, Yusuke Yanagi, Masahiro Nakabachi, Yasuhiro Hayashi, Michito Murayama, Sanae Kaga
    WFUMB Ultrasound Open 100052 - 100052 2024年06月
  • Michito Murayama, Hiroyuki Sugimori, Takaaki Yoshimura, Sanae Kaga, Hideki Shima, Satonori Tsuneta, Aoi Mukai, Yui Nagai, Shinobu Yokoyama, Hisao Nishino, Junichi Nakamura, Takahiro Sato, Ichizo Tsujino
    Echocardiography (Mount Kisco, N.Y.) 41 4 e15812  2024年04月 
    BACKGROUND: Precapillary pulmonary hypertension (PH) is characterized by a sustained increase in right ventricular (RV) afterload, impairing systolic function. Two-dimensional (2D) echocardiography is the most performed cardiac imaging tool to assess RV systolic function; however, an accurate evaluation requires expertise. We aimed to develop a fully automated deep learning (DL)-based tool to estimate the RV ejection fraction (RVEF) from 2D echocardiographic videos of apical four-chamber views in patients with precapillary PH. METHODS: We identified 85 patients with suspected precapillary PH who underwent cardiac magnetic resonance imaging (MRI) and echocardiography. The data was divided into training (80%) and testing (20%) datasets, and a regression model was constructed using 3D-ResNet50. Accuracy was assessed using five-fold cross validation. RESULTS: The DL model predicted the cardiac MRI-derived RVEF with a mean absolute error of 7.67%. The DL model identified severe RV systolic dysfunction (defined as cardiac MRI-derived RVEF < 37%) with an area under the curve (AUC) of .84, which was comparable to the AUC of RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) measured by experienced sonographers (.87 and .72, respectively). To detect mild RV systolic dysfunction (defined as RVEF ≤ 45%), the AUC from the DL-predicted RVEF also demonstrated a high discriminatory power of .87, comparable to that of FAC (.90), and significantly higher than that of TAPSE (.67). CONCLUSION: The fully automated DL-based tool using 2D echocardiography could accurately estimate RVEF and exhibited a diagnostic performance for RV systolic dysfunction comparable to that of human readers.
  • Hiroyuki Aoyagi, Hiroyuki Iwano, Yoji Tamaki, Michito Murayama, Suguru Ishizaka, Ko Motoi, Kosuke Nakamura, Mana Goto, Yukino Suzuki, Shinobu Yokoyama, Hisao Nishino, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Echocardiography (Mount Kisco, N.Y.) 41 4 e15808  2024年04月 
    BACKGROUND: The assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently-proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score. METHODS: We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LV FP. LV diastolic dysfunction (DD) was graded according to the ASE/EACVI guidelines. The VMT score was defined as follows: time sequence of opening of mitral and tricuspid valves was scored to 0-2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava was dilated, one point was added and VMT score was finally calculated as 0-3. RESULTS: Of the 116 patients, 29 patients showed elevated PAWP. Ninety patients (93%) and 67 patients (63%) showed increased values for left atrium volume index (LAVI) and E/e', respectively when the cut-off values recommended by the guidelines were applied and thus the algorism predicted elevated PAWP with a low specificity and positive predictive value (PPV). VMT ≥ 2 predicted elevated PAWP with a sensitivity of 59%, specificity of 90%, PPV of 59%, and negative predictive value of 89%. An alternative algorithm that applied tricuspid regurgitation velocity and VMT scores was tested, and its predictive ability was markedly improved. CONCLUSION: VMT score was applicable for AS patients. Alternative use of VMT score improved diagnostic accuracy of guideline-recommended algorism.
  • Yui Nagai, Michito Murayama, Sanae Kaga, Hideki Shima, Satonori Tsuneta, Shinobu Yokoyama, Hisao Nishino, Mana Goto, Yukino Suzuki, Yusuke Yanagi, Suguru Ishizaka, Hiroyuki Iwano, Junichi Nakamura, Takahiro Sato, Ichizo Tsujino
    The international journal of cardiovascular imaging 2024年03月27日 
    Right ventricular (RV) diastolic stiffness is an independent predictor of survival and is strongly associated with disease severity in patients with precapillary pulmonary hypertension (PH). Therefore, a fully validated echocardiographic method for assessing RV diastolic stiffness needs to be established. This study aimed to compare echocardiography-derived RV diastolic stiffness and invasively measured pressure-volume loop-derived RV diastolic stiffness in patients with precapillary PH. We studied 50 consecutive patients with suspected or confirmed precapillary PH who underwent cardiac catheterization, magnetic resonance imaging, and echocardiography within a 1-week interval. Single-beat RV pressure-volume analysis was performed to determine the gold standard for RV diastolic stiffness. Elevated RV end-diastolic pressure (RVEDP) was defined as RVEDP ≥ 8 mmHg. Using continuous-wave Doppler and M-mode echocardiography, an echocardiographic index of RV diastolic stiffness was calculated as the ratio of the atrial-systolic descent of the pulmonary artery-RV pressure gradient derived from pulmonary regurgitant velocity (PRPGDAC) to the tricuspid annular plane movement during atrial contraction (TAPMAC). PRPGDAC/TAPMAC showed significant correlation with β (r = 0.54, p < 0.001) and RVEDP (r = 0.61, p < 0.001). A cut-off value of 0.74 mmHg/mm for PRPGDAC/TAPMAC showed 83% sensitivity and 93% specificity for identifying elevated RVEDP. Multivariate analyses indicated that PRPGDAC/TAPMAC was independently associated with disease severity in patients with precapillary PH, including substantial PH symptoms, stroke volume index, right atrial size, and pressure. PRPGDAC/TAPMAC, based on pulmonary regurgitation velocity waveform analysis, is useful for the noninvasive assessment of RV diastolic stiffness and is associated with prognostic risk factors in precapillary PH.
  • Kae Yasuda, Inaho Shishido, Michito Murayama, Sanae Kaga, Rika Yano
    Journal of physiological anthropology 43 1 9 - 9 2024年02月13日
  • Kae Yasuda, Inaho Shishido, Michito Murayama, Sanae Kaga, Rika Yano
    Journal of physiological anthropology 42 1 23 - 23 2023年10月19日 
    BACKGROUND: Heat application before peripheral intravenous catheterization is recommended for venous dilation. Hot pack application enlarges the venous diameter in healthy adults; however, hot towels (moist and dry heat) are used often in some medical cases. However, it is unclear whether hot towel application promotes venous dilation better than hot pack application. This study compared the venous dilation effect of using a hot towel (moist and dry heat) to a hot pack before applying the tourniquet at an access site for peripheral intravenous catheterization. METHODS: Eighty-eight healthy females aged 18-29 years were recruited for this quasi-experimental study. They underwent three types of heat applications (hot pack, moist hot towel, and dry hot towel [moist hot towel wrapped in a dry plastic bag], all of which were warmed to 40 ± 2 °C and performed for 7 min) to their forearm and tourniquet application for 30 s after each heating. Venous diameter and depth were measured using ultrasonography, and venous palpability and visibility (venous assessment score) was observed as venous dilatation effects. In addition, the skin temperature, stratum corneum hydration, and subjective evaluation of the warmth were measured. RESULTS: There were no significant differences in venous diameter and assessment scores after intervention between the dry hot towel and the hot pack groups, and the effect size was negligible (Cohen's d < 0.20). However, these measurements were significantly lower for the moist hot towel than for the other two heat applications (P < .001). Although there was no significant difference in skin temperature and warmth rating score between the dry hot towel and the hot pack, these were significantly lower for the moist hot towel than for the other two heat applications (P < .001). The amount of change in stratum corneum hydration of the dry hot towel was not significantly different from that of the hot pack; however, that of the moist hot towel was significantly larger than that of the other two heat applications (P < . 001.) CONCLUSIONS: A method in which a towel warmed in hot water is wrapped in a dry barrier may be an alternative to a hot pack. TRIAL REGISTRATION: This study was registered with University Hospital Medical Information Network in Japan (Registration No.: UMIN000048308. Registered on July 7, 2022).
  • Ko Motoi, Hiroyuki Iwano, Suguru Ishizaka, Kosuke Nakamura, Yoji Tamaki, Hiroyuki Aoyagi, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Michito Murayama, Sanae Kaga, Toshihisa Anzai
    Echocardiography (Mount Kisco, N.Y.) 40 8 810 - 821 2023年07月14日 
    BACKGROUND: Although global longitudinal strain (GLS) is recognized as a sensitive marker of intrinsic left ventricular (LV) dysfunction, its afterload dependency has also been pointed. We hypothesized that decrease in GLS during handgrip exercise could be more sensitive marker of intrinsic myocardial dysfunction. METHODS: Handgrip exercise-stress echocardiography was performed in 90 cardiovascular disease patients with preserved LV ejection fraction. LV diastolic function was graded according to the guidelines. Diastolic wall stress (DWS) and ratio of left atrial (LA) volume index to late-diastolic mitral annular velocity (LAVI/a') were measured at rest as LV stiffness. As well, LA strains were measured to assess LA function. GLS was expressed as absolute value and significant changes in GLS by handgrip exercise was defined as changes over prespecified mean absolute test-retest variability (2.65%). RESULTS: While mean value of GLS did not change by the exercise, substantial patients showed significant changes in GLS: decreased (group I, n = 28), unchanged (group II, n = 34), and increased (group III, n = 28). Unexpectedly, patients in group I did not show any clinical and echocardiographic characteristics, while those in group III were characterized by elevated natriuretic peptide levels, blunted heart rate response to handgrip exercise, and advanced LV diastolic dysfunction. Multivariable analyses revealed that DWS, left atrial booster strain, and grade II or more diastolic dysfunction determined the increase in GLS even after adjustment for elevated natriuretic peptides and the changes in heart rate by the exercise. CONCLUSION: In contrast to our hypothesis, paradoxical increase in GLS by handgrip exercise could be associated with advanced LV diastolic dysfunction in cardiovascular patients with preserved LV ejection fraction. Our findings suggest that HG exercise for heart failure patients does not enhance the afterload straightforward, resulting in variable changes of GLS according to the individual conditions.
  • Yoji Tamaki, Hiroyuki Iwano, Michito Murayama, Suguru Ishizaka, Ko Motoi, Hiroyuki Aoyagi, Kosuke Nakamura, Mana Goto, Yukino Suzuki, Shinobu Yokoyama, Hisao Nishino, Masahiro Nakabachi, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Journal of cardiology 82 1 62 - 68 2023年04月27日 
    BACKGROUND: Dyspnea is a common symptom in acute heart failure (AHF) patients. Although an accurate and rapid diagnosis of AHF is essential to improve prognosis, estimation of left ventricular (LV) filling pressure (FP) remains challenging, especially for noncardiologists. We evaluated the usefulness of a recently-proposed parameter of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, to detect AHF in patients complaining of dyspnea. METHODS: Echocardiography and lung ultrasonography (LUS) were performed in 121 consecutive patients (68 ± 14 years old, 75 males) presenting with dyspnea. The VMT score was determined from the atrioventricular valve opening phase (tricuspid valve first: 0, simultaneous: 1, mitral valve first: 2) and inferior vena cava dilatation (absent: 0, present: 1), and VMT ≥2 was judged as positive. LUS was performed with the 8 zones method and judged as positive if 3 or more B-lines were observed in bilateral regions. The AHF diagnosis was performed by certified cardiologists according to recent guidelines. RESULTS: Of the 121 patients, 33 were diagnosed with AHF. The sensitivity and specificity for diagnosing AHF were 64 % and 84 % for LUS and 94 % and 88 % for VMT score. In logistic regression analysis, VMT score showed a significantly higher c-index than LUS (0.91 vs 0.74, p = 0.002). In multivariable analyses, VMT score was associated with AHF independently of clinically relevant covariates and LUS. In addition, serial assessment of VMT score followed by LUS provided a diagnostic flow chart to diagnose AHF (VMT 3: AHF definitive, VMT 2 and LUS positive: AHF highly suspicious; VMT 2 and LUS negative: further investigation is needed; VMT ≤ 1: AHF rejected). CONCLUSIONS: VMT score showed high diagnostic accuracy in diagnosing AHF. Combined assessment of the VMT score and LUS could become a reliable strategy for diagnosis of AHF by non-cardiologists.
  • 静脈血流速度波形分析に基づく右房圧推定に肝静脈と上大静脈のどちらが優れるか
    村山 迪史, 加賀 早苗, 境田 ひな, 小野田 愛梨, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 石坂 傑, 岩野 弘幸, 安斉 俊久
    超音波医学 50 Suppl. S740 - S740 (公社)日本超音波医学会 2023年04月
  • 静脈血流速度波形分析に基づく右房圧推定に肝静脈と上大静脈のどちらが優れるか
    村山 迪史, 加賀 早苗, 境田 ひな, 小野田 愛梨, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 石坂 傑, 岩野 弘幸, 安斉 俊久
    超音波医学 50 Suppl. S740 - S740 (公社)日本超音波医学会 2023年04月
  • Ko Motoi, Hiroyuki Iwano, Satonori Tsuneta, Suguru Ishizaka, Yoji Tamaki, Hiroyuki Aoyagi, Kosuke Nakamura, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Sanae Kaga, Atsuhito Takeda, Toshihisa Anzai
    The international journal of cardiovascular imaging 39 6 1133 - 1142 2023年03月17日 
    BACKGROUND: Accurate detection of significant pulmonary regurgitation (PR) is critical in management of patients after right ventricular (RV) outflow reconstruction in Tetralogy of Fallot (TOF) patients, because of its influence on adverse outcomes. Although pressure half time (PHT) of PR velocity is one of the widely used echocardiographic markers of the severity, shortened PHT is suggested to be seen in conditions with increased RV stiffness with mild PR. However, little has been reported about the exact characteristics of patients showing discrepancy between PHT and PR volume in this population. METHODS: Echocardiography and cardiac magnetic resonance imaging (MRI) were performed in 74 TOF patients after right ventricular outflow tract (RVOT) reconstruction [32 ± 10 years old]. PHT was measured from the continuous Doppler PR flow velocity profile and PHT < 100 ms was used as a sign of significant PR. Presence of end-diastolic RVOT forward flow was defined as RV restrictive physiology. By using phase-contrast MRI, forward and regurgitant volumes through the RVOT were measured and regurgitation fraction was calculated. Significant PR was defined as regurgitant fraction ≥ 25%. RESULTS: Significant PR was observed in 54 of 74 patients. While PHT < 100 ms well predicted significant PR with sensitivity of 96%, specificity of 52%, and c-index of 0.72, 10 patients showed shortened PHT despite regurgitant fraction < 25% (discordant group). Tricuspid annular plane systolic excursion and left ventricular (LV) ejection fraction were comparable between discordant group and patients showing PHT < 100 ms and regurgitant fraction ≥ 25% (concordant group). However, discordant group showed significantly smaller mid RV diameter (30.7 ± 4.5 vs. 39.2 ± 7.3 mm, P < 0.001) and higher prevalence of restrictive physiology (100% vs. 42%, P < 0.01) than concordant group. When mid RV diameter ≥ 32 mm and presence of restrictive physiology were added to PHT, the predictive value was significantly improved (sensitivity: 81%, specificity: 90%, and c-index: 0.89, P < 0.001 vs. PHT alone by multivariable logistic regression model). CONCLUSION: Patients with increased RV stiffness and non-enlarged right ventricle showed short PHT despite mild PR. Although it has been expected, this was the first study to demonstrate the exact characteristics of patients showing discrepancy between PHT and PR volume in TOF patients after RVOT reconstruction.
  • 大動脈弁狭窄症患者に対する左室充満圧の心エコースコアリングシステムの適用(Application of an Echocardiographic Scoring System of Left Ventricular Filling Pressure for Patients with Aortic Stenosis)
    青柳 裕之, 岩野 弘幸, 後藤 真奈, 鈴木 ゆき乃, 村山 迪史, 横山 しのぶ, 西野 久雄, 中鉢 雅大, 中村 公亮, 玉置 陽生, 本居 昂, 石坂 傑, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久
    日本循環器学会学術集会抄録集 87回 PJ065 - 2 2023年03月
  • 心不全患者における複数の超音波指標を組み合わせたうっ血肝診断モデルの確立
    小野田 愛梨, 村山 迪史, 加賀 早苗, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 石坂 傑, 本居 昴, 青柳 裕之, 玉置 陽生, 中村 公亮, 岩野 弘幸, 安斉 俊久
    日本循環器学会学術集会抄録集 87回 CO1 - 3 (一社)日本循環器学会 2023年03月
  • 巨細胞性動脈炎の診断に寄与する新たな超音波所見 生検所見との比較に基づく検討
    工藤 悠輔, 原 花梨, 村山 迪史, 加賀 早苗, 表原 里実, 岩井 孝仁, 進藤 由衣香, 菊池 桃佳, 加藤 将, 外丸 詩野, 松野 吉宏, 石津 明洋
    脈管学 63 1 16 - 16 (一社)日本脈管学会 2023年02月
  • 巨細胞性動脈炎の診断に寄与する新たな超音波所見 生検所見との比較に基づく検討
    工藤 悠輔, 原 花梨, 村山 迪史, 加賀 早苗, 表原 里実, 岩井 孝仁, 進藤 由衣香, 菊池 桃佳, 加藤 将, 外丸 詩野, 松野 吉宏, 石津 明洋
    脈管学 63 1 16 - 16 (一社)日本脈管学会 2023年02月
  • 村山 迪史, 加賀 早苗, 小野田 愛梨, 岡田 一範, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 青柳 裕之, 玉置 陽生, 本居 昂, 石坂 傑, 岩野 弘幸, 永井 利幸, 辻野 一三, 安斉 俊久
    超音波検査技術 advpub 一般社団法人 日本超音波検査学会 2023年 
    目的:アメリカ心エコー図学会のガイドラインには,下大静脈計測に基づく右房圧推定の精度を補完するものとして,拘束型の右室流入血流速波形,拡張早期の右室流入血流速度と三尖弁輪運動速度との比,肝静脈血流速波形のsystolic filling fractionが示されている.本研究では,これらの副次的指標が右房圧上昇の予測能を改善させるかを明らかにするとともに,右房面積計測の付加的価値を検討する. 対象と方法:心疾患患者128例において右心カテーテル検査で平均右房圧を計測し,≧8 mmHgを上昇とした.下大静脈の径とsniffによる虚脱率から,推定右房圧を3, 8,15 mmHgに分類した(モデル1).右室流入血流速波形の拘束型パターン,拡張早期の右室流入血流速度と三尖弁輪運動速度との比,systolic filling fractionを評価に加えて,推定右房圧の再分類を行った(モデル2).右房の最小と最大面積および容積を計測し,それぞれのexpansion indexを算出した. 結果:右房圧の上昇を29例に認めた.ロジスティック回帰分析で,モデル1における推定右房圧とsystolic filling fractionは,平均右房圧上昇と有意に関連した(ともにp<0.05).拘束型パターンを呈した例はなく,拡張早期の右室流入血流速度と三尖弁輪運動速度との比は右房圧上昇と関連しなかった.右房の形態・機能指標は,いずれも右房圧上昇と関連し(すべてp<0.05),最小右房面積が最も強く関連した(右室面積変化率で補正後のオッズ比:10.64, p<0.01).尤度比検定では,モデル2の右房圧上昇の予測能はモデル1と同等であったが,systolic filling fractionと最小右房面積を用いた新しいモデルは,モデル1より良好に右房圧上昇を予測できた. 結論:従来の副次的指標を用いた再分類により右房圧上昇の予測能は改善しなかった.肝静脈血流速波形のsystolic filling fractionと最小右房面積を右房圧の評価に加えると,右房圧上昇の予測能は改善した.
  • Suguru Ishizaka, Hiroyuki Iwano, Shingo Tsujinaga, Michito Murayama, Satonori Tsuneta, Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Yasuyuki Chiba, Asuka Tanemura, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Brett A Meyers, Pavlos P Vlachos, Takuma Sato, Kiwamu Kamiya, Masaya Watanabe, Sanae Kaga, Toshiyuki Nagai, Noriko Oyama-Manabe, Toshihisa Anzai
    Journal of cardiology 81 1 33 - 41 2023年01月 
    BACKGROUND: Determinants of exercise intolerance in a phenotype of heart failure with preserved ejection fraction (HFpEF) with normal left ventricular (LV) structure have not been fully elucidated. METHODS: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 44 HFpEF patients without LV hypertrophy. Exercise capacity was determined by peak oxygen consumption (peak VO2). Doppler-derived cardiac output (CO), transmitral E velocity, systolic (LV-s') and early diastolic mitral annular velocities (e'), systolic pulmonary artery (PA) pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and peak systolic right ventricular (RV) free wall velocity (RV-s') were measured at rest and exercise. E/e' and TAPSE/SPAP were used as an LV filling pressure parameter and RV-PA coupling, respectively. RESULTS: During exercise, CO, LV-s', RV-s', e', and SPAP were significantly increased (p < 0.05 for all), whereas E/e' remained unchanged and TAPSE/SPAP was significantly reduced (p < 0.001). SPAP was higher and TAPSE/SPAP was lower at peak exercise in patients showing lower-half peak VO2. In univariable analyses, LV-s' (R = 0.35, p = 0.022), SPAP (R = -0.40, p = 0.008), RV-s' (R = 0.47, p = 0.002), and TAPSE/SPAP (R = 0.42, p = 0.005) were significantly correlated with peak VO2. In multivariable analyses, not only SPAP, but also TAPSE/SPAP independently determined peak VO2 even after the adjustment for clinically relevant parameters. CONCLUSIONS: In HFpEF patients without LV hypertrophy, altered RV-PA coupling by exercise could be associated with exercise intolerance, which might not be caused by elevated LV filling pressure.
  • Yasuyuki Chiba, Hiroyuki Iwano, Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Suguru Ishizaka, Michito Murayama, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Journal of cardiology 81 4 404 - 412 2022年12月08日 
    BACKGROUND: Although left ventricular (LV) cardiac power output (CPO) is a powerful prognostic indicator in heart failure (HF), the significance of right ventricular (RV) CPO is unknown. In contrast, RV pulsatile load is a key prognostic marker in HF. We investigated the impact of RV-CPO and pulsatile load on cardiac outcome and the prognostic performance of the combined systemic and pulmonary circulation parameters in HF. METHODS: Right heart catheterization and echocardiography were performed in 231 HF patients (62 ± 16 years, LV ejection fraction 42 ± 18 %). Invasive and noninvasive CPOs were calculated from mean systemic or pulmonary arterial pressure and cardiac output. LV-CPO was then normalized to LV mass (LV-P/M). Pulmonary arterial capacitance and the ratio of acceleration time to ejection time (AcT/ET) of RV outflow were used as parameters of RV pulsatile load. The primary endpoints, defined as a composite of cardiac death, HF hospitalization, ventricular arrythmia, and LVAD implantation after the examination, were recorded. RESULTS: Noninvasive CPOs were moderately correlated with invasive ones (LV: ρ = 0.787, RV: ρ = 0.568, and p < 0.001 for both). During a median follow-up period of 441 days, 57 cardiovascular events occurred. Lower LV-P/M and higher RV pulsatile load were associated with cardiovascular events; however, RV-CPO was not associated with the outcome. Echocardiographic LV-P/M and AcT/ET showed significant incremental prognostic value over the clinical parameters. CONCLUSIONS: RV pulsatile load assessed by AcT/ET may be a predictor of clinical events in HF patients. The combination of echocardiographic LV-P/M and AcT/ET could be a novel noninvasive prognostic indicator in HF patients.
  • Iori Nakamura, Haruhi Ida, Mayu Yabuta, Wataru Kashiwa, Maho Tsukamoto, Shigeki Sato, Syuichi Ota, Naoki Kobayashi, Hiromi Masauzi, Kazunori Okada, Sanae Kaga, Keiko Miwa, Hiroshi Kanai, Nobuo Masauzi
    Scientific Reports 12 1 2022年10月06日 
    Abstract Differential bone marrow (BM) cell counting is an important test for the diagnosis of various hematological diseases. However, it is difficult to accurately classify BM cells due to non-uniformity and the lack of reproducibility of differential counting. Therefore, automatic classification systems have been developed in which deep learning is used. These systems requires large and accurately labeled datasets for training. To overcome this, we used semi-supervised learning (SSL), in which learning proceeds while labeling. We used three methods: self-training (ST), active learning (AL), and a combination of these methods, and attempted to automatically classify 16 types of BM cell images. ST involves data verification, as in AL, before adding them to the training dataset (confirmed self-training: CST). After 25 rounds of CST, AL, and CST + AL, the initial number of training data increased from 425 to 40,518; 3682; and 47,843, respectively. Accuracies for the test data of 50 images for each cell type were 0.944, 0.941, and 0.976, respectively. Data added with CST or AL showed some imbalances between classes, while CST + AL exhibited fewer imbalances. We suggest that CST + AL, when combined with two SSL methods, is efficient in increasing training data for the development of automatic BM cells classification systems.
  • 岡田 一範, 岡田 由佳, 村山 迪史, 加賀 早苗, 政氏 伸夫, 西野 久雄, 横山 しのぶ, 中鉢 雅大, 西田 睦, 本居 昂, 石坂 傑, 千葉 泰之, 辻永 真吾, 岩野 弘幸, 安斉 俊久
    超音波検査技術 47 4 353 - 362 一般社団法人 日本超音波検査学会 2022年08月01日 
    目的:肺静脈血流(PVF)と経僧帽弁血流(TMF)の心房収縮期(A)波の持続時間の差(ΔAdur)は拡張後期の左室硬さを反映する指標として知られるが,再現性に問題がある.最近,我々は,PVF全体に占める逆行性A波の割合とTMF全体に占めるA波の割合との比(FPVA/FA)が,侵襲的左室硬さ指標ときわめてよく対応することを報告したが,この計測はやや煩雑である.今回,Dual Gate Doppler(DD)法によるPVFとTMFの同時記録から得られる指標の有用性を検討した. 対象と方法: DD法が施行された80例において,通常のパルスドプラ法でΔAdur(S-ΔAdur)を計測するとともにFPVA/FAを算出した.また,DD法によるPVFとTMFの同時記録から,ΔAdur(D-ΔAdur)と各々のA波の終了時相差(D-ΔAend)を計測した. 結果: S-ΔAdur,D-ΔAdurおよびD-ΔAendはいずれもFPVA/FAと有意に相関した(順にr=0.50, 0.51, 0.71).このうち,D-ΔAendとFPVA/FAとの相関は,他2者より有意に良好であった.対象中の20例における検者間および検者内再現性は,S-ΔAdurよりもD-ΔAdurとD-ΔAendで良好であった. 結論: DD法によるD-ΔAendは,通常のΔAdurよりも再現性よく拡張後期左室硬さを評価できると考えられた.
  • Takehiro Abe, Kazunori Okada, Michito Murayama, Sanae Kaga, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Yasuyuki Chiba, Suguru Ishizaka, Shingo Tsujinaga, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    The International Journal of Cardiovascular Imaging 2022年07月16日
  • Michito Murayama, Hiroyuki Iwano, Masaru Obokata, Tomonari Harada, Kazunori Omote, Kazuki Kagami, Shingo Tsujinaga, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Yoji Tamaki, Hiroyuki Aoyagi, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Asuka Tanemura, Kazunori Okada, Sanae Kaga, Mutsumi Nishida, Toshiyuki Nagai, Masahiko Kurabayashi, Toshihisa Anzai
    European heart journal. Cardiovascular Imaging 23 5 616 - 626 2022年04月18日 
    AIMS: Elevated left ventricular filling pressure (LVFP) is a powerful indicator of worsening clinical outcomes in heart failure with preserved ejection fraction (HFpEF); however, detection of elevated LVFP is often challenging. This study aimed to determine the association between the newly proposed echocardiographic LVFP parameter, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, and clinical outcomes of HFpEF. METHODS AND RESULTS: We retrospectively investigated 310 well-differentiated HFpEF patients in stable conditions. VMT was scored from 0 to 3 using two-dimensional echocardiographic images, and VMT ≥2 was regarded as a sign of elevated LVFP. The primary endpoint was a composite of cardiac death or heart failure hospitalization during the 2 years after the echocardiographic examination. In all patients, Kaplan-Meier curves showed that VMT ≥2 (n = 54) was associated with worse outcomes than the VMT ≤1 group (n = 256) (P < 0.001). Furthermore, VMT ≥2 was associated with worse outcomes when tested in 100 HFpEF patients with atrial fibrillation (AF) (P = 0.026). In the adjusted model, VMT ≥2 was independently associated with the primary outcome (hazard ratio 2.60, 95% confidence interval 1.46-4.61; P = 0.001). Additionally, VMT scoring provided an incremental prognostic value over clinically relevant variables and diastolic function grading (χ2 10.8-16.3, P = 0.035). CONCLUSIONS: In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it could also predict clinical outcomes in HFpEF patients with AF.
  • 前毛細管性肺高血圧症における心筋遅延造影像と左室収縮障害との関連
    新川 未緒, 加賀 早苗, 岩野 弘幸, 千葉 泰之, 宮本 知佳, 岡田 一範, 村山 迪史, 中鉢 雅大, 常田 慧徳, 辻野 一三
    超音波医学 49 Suppl. S706 - S706 (公社)日本超音波医学会 2022年04月
  • Yusuke Yanagi, Kazunori Okada, Sanae Kaga, Taisei Mikami, Miho Aiba, Nobuo Masauzi, Michito Murayama, Asuka Tanemura, Shinobu Yokoyama, Hisao Nishino, Masahiro Nakabachi, Yoji Tamaki, Hiroyuki Aoyagi, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Shingo Tsujinaga, Hiroyuki Iwano, Toshihisa Anzai
    INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022年04月 
    We aimed to investigate left atrial (LA) myocardial dynamics during reservoir phase using three-dimensional speckle-tracking echocardiography (3DSTE) focusing on its longitudinal-circumferential relationship in patients with left ventricular (LV) hypertrophy and clarifying the difference in LA myocardial reservoir dynamics between hypertrophic cardiomyopathy (HCM) and hypertension with LV hypertrophy (HT-LVH). We studied 4 age-matched groups consisting of 27 patients with HCM, 16 with HT-LVH, 22 hypertensive patients without LV hypertrophy (HT), and 18 normal controls. Using 3DSTE, we measured LA global longitudinal strain (LA-LSR), global circumferential strain (LA-CSR), and global area strain (LA-AS(R)) during the reservoir phase, as well as LV global longitudinal strain (LV-LS), global circumferential strain (LV-CS), and global area strain (LV-AS). LA-LSR was significantly lower in the HCM and HT-LVH groups than in the controls, but there was no significant difference between the HCM and HT-LVH groups. LA-CSR and LA-AS(R) were significantly lower in the HCM group than in the other three groups, among which no significant difference was detected. In all subjects, LA-LSR was significantly correlated with LV-LS but not with LV-CS. LA-CSR was correlated with neither LV-LS nor LV-CS. In conclusion, both longitudinal and circumferential LA myocardial expansion during reservoir phase were reduced in HCM, while only the longitudinal one was reduced in HT-LVH. Reduction of LA circumferential expansion may reflect a more serious and intrinsic impairment of LA myocardial distensibility in HCM. Measuring LA-CSR and LA-AS(R) using 3DSTE would contribute to a more accurate understanding of LA reservoir function abnormality in HCM.
  • Ryosuke Fujisawa, Kazunori Okada, Sanae Kaga, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Asuka Tanemura, Nobuo Masauzi, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Shingo Tsujinaga, Hiroyuki Iwano, Toshihisa Anzai
    Heart and vessels 37 4 583 - 592 2022年04月 
    PURPOSE: We recently reported a noninvasive method for the assessment of right ventricular (RV) operating stiffness that is obtained by dividing the atrial-systolic descent of the pulmonary artery-RV pressure gradient (PRPGDAC) derived from the pulmonary regurgitant velocity by the tricuspid annular plane movement during atrial contraction (TAPMAC). Here, we investigated whether this parameter of RV operating stiffness, PRPGDAC/TAPMAC, is useful for predicting the prognosis of patients with heart failure (HF). METHODS: We retrospectively included 127 hospitalized patients with HF who underwent an echocardiographic examination immediately pre-discharge. The PRPGDAC/TAPMAC was measured in addition to standard echocardiographic parameters. Patients were followed until 2 years post-discharge. The endpoint was the composite of cardiac death, readmission for acute decompensation, and increased diuretic dose due to worsening HF. RESULTS: 58 patients (46%) experienced the endpoint during follow-up. Univariable and multivariable Cox regression analyses demonstrated that the PRPGDAC/TAPMAC was associated with the endpoint. In a Kaplan-Meier analysis, the event rate of the greater PRPGDAC/TAPMAC group was significantly higher than that of the lesser PRPGDAC/TAPMAC group. In a sequential Cox analysis for predicting the endpoint's occurrence, the addition of PRPGDAC/TAPMAC to the model including age, sex, NYHA functional classification, brain natriuretic peptide level, and several echocardiographic parameters including tricuspid annular plane systolic excursion significantly improved the predictive power for prognosis. CONCLUSION: A completely noninvasive index of RV operating stiffness, PRPGDAC/TAPMAC, was useful for predicting prognoses in patients with HF, and it showed an incremental prognostic value over RV systolic function.
  • Michito Murayama, Sanae Kaga, Kazunori Okada, Hiroyuki Iwano, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Shingo Tsujinaga, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Kiwamu Kamiya, Mutsumi Nishida, Toshiyuki Nagai, Toshihisa Anzai
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 7 727 - 737 2022年02月09日 
    BACKGROUND: The superior vena cava (SVC) flow velocity waveform from the supraclavicular window reflects right atrial pressure (RAP) status. Recent guidelines have stated that the subcostal window is an alternative view for recording SVC flow, but the validity of this approach remains unclear. The aim of this study was to determine the usefulness of SVC flow evaluation from the subcostal window for estimating RAP. METHODS: Differences in SVC flow characteristics between opposite approaches were examined in 38 healthy adults. In 115 patients with cardiovascular diseases who underwent cardiac catheterization and echocardiography within 48 hours, the ratio of peak systolic to diastolic forward SVC flow (SVC-S/D) was measured, and the diagnostic ability of SVC-S/D for elevated RAP was tested. A validation cohort was used to confirm the diagnostic ability of SVC-S/D in 48 patients who underwent both cardiac catheterization and echocardiography within 24 hours. In 59 patients in the derivation and validation cohorts, the relationship between SVC flow and RAP was compared between the opposite windows. RESULTS: Both systolic and diastolic SVC flow velocities were higher in the subcostal than in the supraclavicular approach, and effect of position change on subcostal SVC-S/D was smaller than that on supraclavicular SVC-S/D in healthy adults. Measurement of SVC-S/D from the subcostal window was feasible in 98 patients (85%). RAP was inversely correlated with SVC-S/D (r = -0.50, P < .001) and was an independent determinant of SVC-S/D after adjustment for right ventricular systolic function (β = -0.48, P < .001). A cutoff value of 1.9 for SVC-S/D showed 85% sensitivity and 74% specificity in identifying elevated RAP. Additionally, SVC-S/D showed an incremental diagnostic value combined with inferior vena cava size and collapsibility (P = .006). When a cutoff value of SVC-S/D < 1.9 was applied to the validation cohort, it showed acceptable accuracy of 72% and incremental diagnostic value combined with inferior vena cava parameters (P = .033). SVC-S/D from the subcostal window correlated better with RAP than that from the supraclavicular window (P < .001, Meng's test). CONCLUSIONS: Measurement of SVC flow velocity from the subcostal window was feasible, and SVC-S/D from the subcostal window could be an additive parameter for estimating RAP.
  • Yasuyuki Chiba, Hiroyuki Iwano, Satonori Tsuneta, Shingo Tsujinaga, Brett Meyers, Pavlos Vlachos, Suguru Ishizaka, Ko Motoi, Hiroyuki Aoyagi, Yoji Tamaki, Asuka Tanemura, Michito Murayama, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Sanae Kaga, Kiwamu Kamiya, Hiroshi Ohira, Ichizo Tsujino, Toshihisa Anzai
    European heart journal. Cardiovascular Imaging 23 10 1399 - 1406 2022年01月10日 
    AIMS: Although the left ventricular (LV) dysfunction in pre-capillary pulmonary hypertension (PH) has been recently recognized, the mechanism of LV dysfunction in this entity is not completely understood. We thus aimed to elucidate the determinants of intraventricular pressure difference (IVPD), a measure of LV suction, in pre-capillary PH. METHODS AND RESULTS: Right heart catheterization and echocardiography were performed in 86 consecutive patients with pre-capillary PH (57 ± 18 years, 85% female). IVPD was determined using colour M-mode Doppler to integrate the Euler equation. In overall, IVPD was reduced compared to previously reported value in normal subjects. In univariable analyses, QRS duration (P = 0.028), LV ejection fraction (P = 0.006), right ventricular (RV) end-diastolic area (P < 0.001), tricuspid annular plane systolic excursion (P = 0.004), and LV early-diastolic eccentricity index (P = 0.009) were associated with IVPD. In the multivariable analyses, RV end-diastolic area and LV eccentricity index independently determined the IVPD. CONCLUSION: Aberrant ventricular interdependence caused by RV enlargement could impair the LV suction. This study first applied echocardiographic IVPD, a reliable marker of LV diastolic suction, to investigate the mechanism of LV diastolic dysfunction in pre-capillary PH.
  • ドプラ心エコー法による肺動脈弁逆流重症度の過大評価の要因に関する検討
    本居 昂, 岩野 弘幸, 常田 慧徳, 村山 迪史, 加賀 早苗, 青柳 裕之, 玉置 陽生, 石坂 傑, 千葉 泰之, 辻永 真吾, 種村 明日香, 横山 しのぶ, 中鉢 雅大, 西野 久雄, 岡田 一範, 武田 充人, 安斉 俊久
    日本成人先天性心疾患学会雑誌 11 1 216 - 216 日本成人先天性心疾患学会 2022年01月
  • Suguru Ishizaka, Hiroyuki Iwano, Ko Motoi, Yasuyuki Chiba, Shingo Tsujinaga, Asuka Tanemura, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Journal of cardiology 78 4 322 - 327 2021年10月 
    BACKGROUND: Although the time difference between peak of left ventricular (LV) and aortic systolic pressures (TLV-Ao), which is considered to in part reflect pulsus tardus, is reported to be associated with clinical outcome in aortic stenosis (AS), its physiological determinants remain to be elucidated. We hypothesized that not only AS severity but also LV systolic dysfunction could be associated with occurrence of pulsus tardus. METHODS: TLV-Ao was measured by simultaneous LV and aortic pressure tracing in 74 AS patients and prolonged TLV-Ao was defined as ≥66 ms according to the previous report. Mean transaortic valvular pressure gradient (mPG) and effective orifice area index (EOAI) were estimated by Doppler echocardiography and severe AS was defined as EOAI ≤0.60 cm2/m2. Global longitudinal strain (GLS) was measured by using speckle-tracking method. RESULTS: Although a weak correlation was observed between EOAI and TLV-Ao, there was substantial population showing discordance between the parameters: severe AS despite normal TLV-Ao (10 of 47 patients) and moderate AS despite prolonged TLV-Ao (9 of 17 patients). In severe AS, mPG was significantly higher in patients showing prolonged TLV-Ao (57±20 vs 36±10 mmHg, p<0.0001) whereas GLS was comparable between the groups (-15.2±3.5% vs -14.8±3.2%). In contrast, in moderate AS, GLS was significantly smaller in patients showing prolonged TLV-Ao (-12.6±4.7% vs -17.4±3.4%, p=0.0271) while mPG was comparable (34±7 mmHg vs 35±8 mmHg). Multivariable analysis revealed that not only mPG but also GLS was an independent determinant of TLV-Ao. CONCLUSIONS: The occurrence of pulsus tardus could be associated with not only AS severity but also LV systolic dysfunction in AS patients.
  • Masahiro Nakabachi, Hiroyuki Iwano, Michito Murayama, Hisao Nishino, Shinobu Yokoyama, Shingo Tsujinaga, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Kazunori Okada, Sanae Kaga, Mutsumi Nishida, Takanori Teshima, Toshihisa Anzai
    Heart and vessels 37 4 638 - 646 2021年09月25日 
    Although the echocardiographic effective orifice area (EOA) calculated using the continuity equation is widely used for the assessment of severity in aortic stenosis (AS), the existence of high flow velocity at the left ventricular outflow tract (LVOT) potentially causes its overestimation. The proximal isovelocity surface area (PISA) method could be an alternative tool for the estimation of EOA that limits the influence of upstream flow velocity. EOA was calculated using the continuity equation (EOACont) and PISA method (EOAPISA), respectively, in 114 patients with at least moderate AS. The geometric orifice area (GOA) was also measured using the planimetry method in 51 patients who also underwent three-dimensional transesophageal echocardiography. Patients were divided into two groups according to the median LVOT flow velocity. EOAPISA could be obtained in 108 of the 114 patients (95%). Although there was a strong correlation between EOACont and EOAPISA (r = 0.78, P < 0.001), EOACont was statistically significantly larger than EOAPISA (0.86 ± 0.33 vs 0.75 ± 0.29 cm2, P < 0.001). Both EOACont and EOAPISA similarly correlated with GOA (r = 0.70, P < 0.001 and r = 0.77, P < 0.001, respectively). However, a fixed bias, which is hydrodynamically supposed to exist between EOA and GOA, was not observed between EOACont and GOA. In contrast, there was a negative fixed bias between EOAPISA and GOA with smaller EOAPISA than GOA. The difference between EOACont and GOA was significantly greater with a larger EOACont relative to GOA in patients with high LVOT flow velocity than in those without (0.16 ± 0.25 vs - 0.07 ± 0.10 cm2, P < 0.001). In contrast, the difference between EOAPISA and GOA was consistent regardless of the LVOT flow velocity (- 0.07 ± 0.12 vs - 0.07 ± 0.15 cm2, P = 0.936). The PISA method was applied to estimate EOA in patients with AS. EOAPISA could be an alternative parameter for AS severity grading in patients with high LVOT flow velocity in whom EOACont would potentially overestimate the orifice area.
  • 慢性心不全における右室cardiac power outputの意義
    千葉 泰之, 岩野 弘幸, 本居 昂, 石坂 傑, 辻永 真吾, 村山 迪史, 横山 しのぶ, 中鉢 雅大, 西野 久雄, 岡田 一範, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久
    日本心臓病学会学術集会抄録 69回 O - 029 (一社)日本心臓病学会 2021年09月
  • Michito Murayama, Hiroyuki Iwano, Hisao Nishino, Shingo Tsujinaga, Masahiro Nakabachi, Shinobu Yokoyama, Miho Aiba, Kazunori Okada, Sanae Kaga, Miwa Sarashina, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Mutsumi Nishida, Hitoshi Shibuya, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 34 7 723 - 734 2021年07月 
    BACKGROUND: When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure. METHODS: One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) ≥ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography. RESULTS: In the derivation cohort, PAWP was elevated with higher VMT scores (score 0, 10 ± 5; score 1, 12 ± 4; score 2, 22 ± 8; score 3, 28 ± 4 mm Hg; P < .001, analysis of variance). VMT score ≥ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guideline-recommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score ≥ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores ≥ 2 were at higher risk for cardiac events than those with VMT scores ≤ 1 (P < .001). CONCLUSIONS: VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure.
  • Miwa Sarashina-Motoi, Hiroyuki Iwano, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Shingo Tsujinaga, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Toshihisa Anzai
    Journal of clinical ultrasound : JCU 49 4 358 - 367 2021年05月 
    PURPOSE: To investigate the influence of changes in vortices within the left ventricle (LV) on energy efficiency (EE) in normal and diseased hearts. METHODS: We performed vector flow mapping echocardiography in 36 normal participants (N), 36 patients with dilated cardiomyopathy (D), and 36 patients with LV hypertrophy (H). The circulation of the main anterior vortex was measured as a parameter of vortex strength. Energy loss (EL) was measured for one cardiac cycle, and EE was calculated as EL divided by stroke work (SW), which represents the loss of kinetic energy per unit of LV external work. RESULTS: Circulation increased in the order of N, H, and D (N: 15 ± 4, D: 19 ± 8, H: 17 ± 6 × 10-3 m2 /s; analysis of variance [ANOVA] P < .01). Conversely, EE increased in the order of N, D, and H (N: 0.22 ± 0.07, D: 0.26 ± 0.16, H: 0.30 ± 0.16 10-5 J/mm Hg mL m s; ANOVA P = .04), suggesting worst EE in group H. We found a positive correlation between circulation and SW only in group N, and positive correlation between circulation and EE only in diseased groups (D: R = 0.55, P < .01; H: R = 0.44, P < .01). Multivariable analyses revealed that circulation was the independent determinant of EE in groups D and H. CONCLUSIONS: Enhanced vortices could be associated with effective increase in LV external work in normal hearts. Conversely, they were associated with loss of EE without an optimal increase in external work in failing hearts, regardless of the LV morphology.
  • 拡張機能学再考:beyond E/E' 時相解析に基づく新たな左室充満圧推定指標 僧帽弁輪石灰化例、心房細動例への適用
    岩野 弘幸, 村山 迪史, 辻永 真吾, 千葉 泰之, 石坂 傑, 本居 昂, 中鉢 雅大, 加賀 早苗, 安斉 俊久
    超音波医学 48 Suppl. S205 - S205 (公社)日本超音波医学会 2021年04月
  • 小野田 愛梨, 村山 迪史, 加賀 早苗, 岡田 一範, 相庭 美穂, 藤澤 亮介, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 西田 睦, 岩野 弘幸, 安斉 俊久
    超音波検査技術抄録集 46 S197 - S197 一般社団法人 日本超音波検査学会 2021年
  • 村山 迪史, 加賀 早苗, 岡田 一範, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 種村 明日香, 石坂 傑, 千葉 泰之, 辻永 真吾, 西田 睦, 岩野 弘幸
    超音波検査技術抄録集 46 S136 - S136 一般社団法人 日本超音波検査学会 2021年
  • 後藤 真奈, 加賀 早苗, 岡田 一範, 相庭 美穂, 藤澤 亮介, 村山 迪史, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 種村 明日香, 辻永 真吾, 岩野 弘幸
    超音波検査技術抄録集 46 S135 - S135 一般社団法人 日本超音波検査学会 2021年
  • 種村 明日香, 村山 迪史, 岩野 弘幸, 西野 久雄, 横山 しのぶ, 中鉢 雅大, 本居 昂, 辻永 真吾, 岡田 一範, 加賀 早苗, 西田 睦, 豊嶋 崇徳
    超音波検査技術抄録集 46 S132 - S132 一般社団法人 日本超音波検査学会 2021年
  • Mayu Yabuta, Iori Nakamura, Haruhi Ida, Hiromi Masauzi, Kazunori Okada, Sanae Kaga, Keiko Miwa, Nobuo Masauzi
    The Tohoku Journal of Experimental Medicine 254 3 199 - 206 2021年
  • Yasuyuki Chiba, Hiroyuki Iwano, Sanae Kaga, Mio Shinkawa, Michito Murayama, Hiroshi Ohira, Suguru Ishizaka, Miwa Sarashina, Shingo Tsujinaga, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Kazunori Okada, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Pulmonary Circulation 11 1 204589402098372 - 204589402098372 2021年01月 
    Evaluation of left ventricular filling pressure plays an important role in the clinical management of pulmonary hypertension. However, the accuracy of echocardiographic parameters for the determination of left ventricular filling pressure in the presence of pulmonary vascular lesions has not been fully addressed. We retrospectively investigated 124 patients with pulmonary hypertension due to pulmonary vascular lesions (noncardiac pulmonary hypertension group) and 113 patients with ischemic heart disease (control group) who underwent right heart catheterization and echocardiography. The noncardiac pulmonary hypertension group was subdivided into less-advanced and advanced groups according to median pulmonary vascular resistance. Pulmonary artery wedge pressure was determined as left ventricular filling pressure. As echocardiographic parameters of left ventricular filling pressure, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e′), and left atrial volume index were measured. In the less-advanced noncardiac pulmonary hypertension and control groups, positive correlations were observed between pulmonary artery wedge pressure and late-diastolic transmitral flow velocity ( R = 0.41, P = 0.002 and R = 0.71, P < 0.001, respectively) and left atrial volume index ( R = 0.53, P < 0.001 and R = 0.41, P < 0.001), whereas in the advanced noncardiac pulmonary hypertension group, pulmonary artery wedge pressure was only correlated with left atrial volume index ( R = 0.27, P = 0.032). In the controls, only pulmonary artery wedge pressure determined E (β = 0.48, P < 0.001), whereas both pulmonary artery wedge pressure and pulmonary vascular resistance were independent determinants of E (β = 0.29, P < 0.001 and β = –0.28, P = 0.001, respectively) in the noncardiac pulmonary hypertension group. In conclusion, in the presence of advanced pulmonary vascular lesions, conventional echocardiographic parameters may not accurately reflect left ventricular filling pressure. Elevated pulmonary vascular resistance would lower the E, even when pulmonary artery wedge pressure is elevated, resulting in blunting of echocardiographic parameters for the detection of elevated left ventricular filling pressure.
  • Yasuyuki Chiba, Hiroyuki Iwano, Michito Murayama, Sanae Kaga, Ko Motoi, Suguru Ishizaka, Shingo Tsujinaga, Asuka Tanemura, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Kazunori Okada, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
    Journal of the American Society of Echocardiography 2020年12月
  • 三次元スペックルトラッキング法による右室機能解析に関する初期検討
    岡田 一範, 加賀 早苗, 上田 龍一郎, 柳 裕介, 相庭 美穂, 政氏 伸夫, 三神 大世, 中鉢 雅大, 岩野 弘幸, 安斉 俊久
    超音波医学 47 Suppl. S221 - S221 (公社)日本超音波医学会 2020年11月
  • 肺静脈血流速度波形を用いたリザーバ期の左房硬さの非侵襲的評価法の検討
    阿部 剛大, 岡田 一範, 加賀 早苗, 政氏 伸夫, 三神 大世, 村山 迪史, 中鉢 雅大, 辻永 真吾, 岩野 弘幸, 安斉 俊久
    超音波医学 47 Suppl. S246 - S246 (公社)日本超音波医学会 2020年11月
  • 房室弁開放時相差の視覚的評価に基づいたスコアリングによる左室充満圧推定と予後予測
    村山 迪史, 岩野 弘幸, 辻永 真吾, 西野 久雄, 中鉢 雅大, 横山 しのぶ, 西田 睦, 渋谷 斉, 加賀 早苗, 安斉 俊久
    超音波医学 47 Suppl. S165 - S165 (公社)日本超音波医学会 2020年11月
  • 収縮期の右房容量負荷が三尖弁輪収縮期移動距離と右室駆出率との関係に及ぼす影響
    村山 迪史, 加賀 早苗, 岡田 一範, 三神 大世, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 西田 睦, 岩野 弘幸, 安斉 俊久
    超音波医学 47 Suppl. S222 - S222 (公社)日本超音波医学会 2020年11月
  • Shingo Tsujinaga, Hiroyuki Iwano, Yasuyuki Chiba, Suguru Ishizaka, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Kazunori Okada, Sanae Kaga, Toshihisa Anzai
    Circulation Reports 2 5 271 - 279 2020年05月08日 [査読有り][通常論文]
  • 村山 迪史, 加賀 早苗, 岡田 一範, 三神 大世, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 西田 睦, 澁谷 斉, 辻永 真吾, 岩野 弘幸, 安斉 俊久
    超音波検査技術 45 2 217 - 217 (一社)日本超音波検査学会 2020年04月
  • Hiroyuki Iwano, Shinobu Yokoyama, Kiwamu Kamiya, Toshiyuki Nagai, Shingo Tsujinaga, Miwa Sarashina, Suguru Ishizaka, Yasuyuki Chiba, Masahiro Nakabachi, Hisao Nishino, Michito Murayama, Kazunori Okada, Sanae Kaga, Toshihisa Anzai
    Heart and vessels 2020年03月11日 [査読有り][通常論文]
     
    BACKGROUND: A v wave on pulmonary artery wedge (PAW) pressure sometimes augments and appears on pulmonary artery (PA) pressure wave in patients with heart failure (HF). However, the significance of PA v wave in HF remains to be elucidated. METHODS: We retrospectively analyzed pressure waveforms in 61 HF patients (left ventricular ejection fraction 35 ± 15%). On the PAW and PA pressure waveforms, mean pressure as well as peak and amplitude of v waves (ampPAWv and ampPAv, respectively) were measured. Occurrence of worsening HF and cardiac death was recorded for 2 years after the catheterization. RESULTS: The ampPAWv did not correlate with ampPAv. When the patients were divided into 4 groups: I (high-ampPAWv/high-ampPAv), II (high-ampPAWv/low-ampPAv), III (low-ampPAWv/high-ampPAv), and IV (low-ampPAWv/low-ampPAv), the prevalence of group III was low (I: 13, II: 17, III: 4, IV: 27). Mean pressures of PAW and PA were similarly elevated in groups I and II. Cardiac index was lowest (I: 2.0 ± 0.4, II: 2.8 ± 0.6, III: 2.2 ± 0.2, IV: 2.4 ± 0.6 L/min/m2, ANOVA P < 0.01, P < 0.01 for I vs II) and tricuspid annular plane systolic excursion / systolic PA pressure was impaired (I: 0.27 ± 0.07, II: 0.48 ± 0.22, III: 0.59 ± 0.35, IV: 0.68 ± 0.35 mm/mmHg, ANOVA P < 0.01) in group I. During the follow-up, 13 events were observed. Kaplan-Meier analysis showed that patients in group I were at highest risk of cardiac events. CONCLUSIONS: PA v was observed mainly in patients with augmented PAW v wave and decreased cardiac index, suggesting an advanced stage of HF. Moreover, augmented PAv was associated with worse outcome in HF patients.
  • 岡田 一範, 岡田 由佳, 加賀 早苗, 村山 迪史, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 三神 大世, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久
    超音波検査技術抄録集 45 S110 - S110 一般社団法人 日本超音波検査学会 2020年
  • 岡田 一範, 神谷 明子, 加賀 早苗, 柳 裕介, 相庭 美穂, 藤澤 亮介, 村山 迪史, 岡田 由佳, 政氏 伸夫, 三神 大世
    超音波検査技術抄録集 45 S212 - S212 一般社団法人 日本超音波検査学会 2020年
  • Kazunori Okada, Sanae Kaga, Minami Araki, Kosuke Tsujita, Ayaka Yoshikawa, Mizuki Hara, Yoichi Sakamoto, Nobuo Masauzi, Taisei Mikami
    Journal of medical ultrasonics (2001) 47 1 91 - 96 2020年01月 
    PURPOSE: The purpose of this study was to test whether the fractional change in the endocardial border length between end-diastole and end-systole as manually traced in left ventricular ejection fraction (LVEF) measurement using the biplane method of disks (MOD) was consistent with the global longitudinal strain derived from speckle-tracking echocardiography. METHODS: For 105 patients who underwent echocardiography, two- and four-chamber images with manually traced endocardial lines for LVEF measurement by MOD were stored. LV endocardial lengths at end-diastole and at end-systole were measured on both images to calculate the fractional length changes, which were averaged (GLSMOD). Speckle-tracking analysis was performed to measure global longitudinal strains in the apical two- and four-chamber and long-axis images, and the three values were averaged (GLSSTE) according to the ASE and EACVI guidelines. RESULTS: There was no significant difference between GLSMOD and GLSSTE. GLSMOD correlated well with GLSSTE (r = 0.81, p < 0.001), and there was no fixed bias in the Bland-Altman analysis. The intraclass correlations for the intra- and inter-observer comparisons for GLSSTE were excellent, and those for GLSMOD were adequate. CONCLUSION: The fractional LV endocardial border length change, GLSMOD, showed sufficient agreement with GLSSTE to justify its use as a substitute for the STE-derived global longitudinal strain.
  • 心エコー法とMRIによる肺動脈弁逆流重症度に乖離を認めた総動脈幹症の術後症例
    岩野 弘幸, 村山 迪史, 山澤 弘州, 武田 充人, 真鍋 徳子, 石森 直樹, 千葉 泰之, 石坂 傑, 更科 美羽, 辻永 真吾, 中鉢 雅大, 加賀 早苗, 安斉 俊久
    日本成人先天性心疾患学会雑誌 9 1 288 - 288 日本成人先天性心疾患学会 2020年01月 [査読有り][通常論文]
  • Shingo Tsujinaga, Hiroyuki Iwano, Suguru Ishizaka, Yasuyuki Chiba, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Takuma Sato, Toshihisa Anzai
    CIRCULATION 140 2019年11月 [査読有り][通常論文]
     
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  • Michito Murayama, Kazunori Okada, Sanae Kaga, Hiroyuki Iwano, Shingo Tsujinaga, Miwa Sarashina, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Mutsumi Nishida, Hitoshi Shibuya, Nobuo Masauzi, Toshihisa Anzai, Taisei Mikami
    The international journal of cardiovascular imaging 35 10 1871 - 1880 2019年10月 [査読有り][通常論文]
     
    It was recently shown that invasively determined right ventricular (RV) stiffness was more closely related to the prognosis of patients with pulmonary hypertension than RV systolic function. So far, a completely noninvasive method to access RV stiffness has not been reported. We aimed to clarify the clinical usefulness of our new echocardiographic index of RV operating stiffness using atrial-systolic descent of the pulmonary artery-RV pressure gradient derived from pulmonary regurgitant velocity (PRPGDAC) and tricuspid annular plane movement during atrial contraction (TAPMAC). We studied 81 consecutive patients with various cardiac diseases who underwent echocardiography and cardiac catheterization. We measured PRPGDAC and TAPMAC using continuous-wave Doppler and M-mode echocardiography, respectively, and calculated PRPGDAC/TAPMAC. RV end-diastolic pressure (RVEDP) and RV pressure increase during atrial contraction (ΔRVPAC) were invasively measured, and RV volume change during atrial contraction (ΔVAC) was calculated from echocardiographic late-diastolic transtricuspid flow time-velocity integral and tricuspid annular area; thus ΔRVPAC/ΔVAC was used as the standard index for RV operating stiffness. PRPGDAC/TAPMAC well correlated with ΔRVPAC/ΔVAC (r = 0.84, p < 0.001) and RVEDP (r = 0.80, p < 0.001), and the area under the receiver operating characteristic curve to discriminate RVEDP > 12 mmHg was 0.94. Multivariate regression analysis revealed that PRPGDAC/TAPMAC was the single independent determinant of ΔRVPAC/ΔVAC (β = 0.86, p < 0.001). PRPGDAC/TAPMAC is useful to estimate RV operating stiffness and a good practical indicator of RVEDP.
  • 岡田 一範, 加賀 早苗, 政氏 伸夫, 三神 大世, 中鉢 雅大, 村山 迪史, 横山 しのぶ, 西野 久雄, 西田 睦, 澁谷 斉, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久
    臨床検査学教育 11 2 219 - 226 (一社)日本臨床検査学教育協議会 2019年09月 
    かつては医師が担ってきた超音波(エコー)検査は、現在、そのほとんどを臨床検査技師を中心とする技師(ソノグラファー)が担うようになってきた。ソノグラファーは、検査装置の管理・調整、検査手技、計測・画像法に習熟することはもちろん、検査対象となる疾患や病態についての十分な知識に基づき、個々例の所見や病態に応じて検査を自ら組み立てる必要がある。このため、超音波検査の検者依存性は、他の検査に比べてたいへん大きい。本学院・研究院の心血管エコー研究室では、超音波検査の実技に精通したうえで、その研究者としても活躍できる指導的な人材の育成を目的とし、北海道大学病院検査・輸血部、超音波センターならびに医学研究院循環病態内科学教室の協力を得つつ、教育・研究活動を行っている。本稿では、その取り組みの一端を紹介する。(著者抄録)
  • 心不全における肺動脈圧波形上のv波出現の意義に関する検討
    岩野 弘幸, 横山 しのぶ, 石坂 傑, 千葉 泰之, 更科 美羽, 辻永 真吾, 中鉢 雅大, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久
    日本心臓病学会学術集会抄録 67回 O - 281 (一社)日本心臓病学会 2019年09月
  • Michito Murayama, Hiroyuki Iwano, Shingo Tsujinaga, Miwa Sarashina, Suguru Ishizaka, Yasuyuki Chiba, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Hitoshi Shibuya, Mutsumi Nishida, Toshihisa Anzai
    Echocardiography (Mount Kisco, N.Y.) 36 9 1771 - 1775 2019年09月 [査読有り][通常論文]
     
    Although the presence and physiological significance of late-diastolic tricuspid regurgitation (TR) have been reported, those in TR occurring in early diastole have not been well known. We herein first presented a case of heart failure due to dilated cardiomyopathy showing functional TR occurring in the early-diastolic phase in whom the mechanism for its genesis could be precisely assessed from echocardiographic findings and intra-cardiac pressure recordings.
  • Nishino H, Iwano H, Kaga S, Nishida M, Akizawa K, Teshima T, Anzai T
    Journal of echocardiography 19 1 53 - 55 2019年08月 [査読有り][通常論文]
  • Okada K, Kaga S, Tsujita K, Sakamoto Y, Masauzi N, Mikami T
    Int J Cardiovasc Imaging 35 7 1211 - 1219 2019年07月 [査読有り][通常論文]
     
    Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤ 120°) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r = 0.67), followed by RV mid-cavity diameter (r = 0.58). When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume.
  • Shingo Tsujinaga, Hiroyuki Iwano, Miwa Sarashina, Taichi Hayashi, Michito Murayama, Ayako Ichikawa, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Arata Fukushima, Takashi Yokota, Kazunori Okada, Sanae Kaga, Pavlos P Vlachos, Toshihisa Anzai
    Journal of cardiac failure 25 4 268 - 277 2019年04月 [査読有り][通常論文]
     
    BACKGROUND: Although the enhancement of early-diastolic intra-left ventricular pressure difference (IVPD) during exercise is considered to maintain exercise capacity, little is known about their relationship in heart failure (HF). METHODS AND RESULTS: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 50 HF patients (left ventricular [LV] ejection fraction 39 ± 15%). Echocardiographic images were obtained at rest and submaximal and peak exercise. Color M-mode Doppler images of LV inflow were used to determine IVPD. Thirty-five patients had preserved exercise capacity (peak oxygen consumption [VO2] ≥14 mL·kg-1·min-1; group 1) and 15 patients had reduced exercise capacity (group 2). During exercise, IVPD increased only in group 1 (group 1: 1.9 ± 0.9 mm Hg at rest, 4.1 ± 2.0 mm Hg at submaximum, 4.7 ± 2.1 mm Hg at peak; group 2: 1.9 ± 0.8 mm Hg at rest, 2.1 ± 0.9 mm Hg at submaximum, 2.1 ± 0.9 mm Hg at peak). Submaximal IVPD (r = 0.54) and peak IVPD (r = 0.69) were significantly correlated with peak VO2. Peak IVPD determined peak VO2 independently of LV ejection fraction. Moreover, submaximal IVPD could well predict the reduced exercise capacity. CONCLUSION: Early-diastolic IVPD during exercise was closely associated with exercise capacity in HF. In addition, submaximal IVPD could be a useful predictor of exercise capacity without peak exercise in HF patients.
  • 心不全患者における運動中の換気効率のメカニズム 駆出率の保たれた心不全と駆出率が低下した心不全の比較(Mechanisms of Ventilatory Efficiency during Exercise in Heart Failure: Comparison between Heart Failure with Preserved Ejection Fraction and Reduced Ejection Fraction)
    辻永 真吾, 岩野 弘幸, 更科 美羽, 村山 迪史, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 岡田 一範, 加賀 早苗, 福島 新, 横田 卓, 安斉 俊久
    日本循環器学会学術集会抄録集 83回 OJ08 - 2 2019年03月
  • 心不全患者における左室動作時スティフネスに関する新規心エコー指標の予後に対する価値(Prognostic Value of Novel Echocardiographic Index of Left Ventricular Operating Stiffness in Patients with Heart Failure)
    岡田 一範, 藤澤 亮介, 加賀 早苗, 政氏 伸夫, 三神 大世, 村山 迪史, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久
    日本循環器学会学術集会抄録集 83回 OJ08 - 7 2019年03月
  • Kazunori Okada, Sanae Kaga, Rika Abiko, Michito Murayama, Takuma Hioka, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Ayako Ichikawa, Ayumu Abe, Mutsumi Nishida, Naoya Asakawa, Shingo Tsujinaga, Taichi Hayashi, Hiroyuki Iwano, Satoshi Yamada, Nobuo Masauzi, Taisei Mikami
    European heart journal cardiovascular Imaging 19 11 1260 - 1267 2018年11月01日 [査読有り][通常論文]
     
    Aims: The detection of increased left ventricular (LV) chamber stiffness may play an important role in assessing cardiac patients with potential but not overt heart failure. A non-invasive method to estimate it is not established. We investigated whether the echocardiographic backward/forward flow volume ratio from the left atrium (LA) during atrial contraction reflects the LV chamber stiffness. Methods and results: We studied 62 patients who underwent cardiac catheterization and measured their left ventricular end-diastolic pressure (LVEDP) and pressure increase during atrial contraction (ΔPa) from the LV pressure waveform. Using the echocardiographic biplane method of disks, we measured the LV volume change during atrial contraction indexed to the body surface area (ΔVa), and ΔPa/ΔVa was calculated as a standard for the LV operating chamber stiffness. Using pulsed Doppler echocardiography, we measured the time-velocity integral (TVI) of the backward pulmonary venous (PV) flow during atrial contraction (IPVA) and the ratio of IPVA to the PV flow TVI throughout a cardiac cycle (FPVA). We also measured the TVI of the atrial systolic forward transmitral flow (IA) and the ratio of the IA to the transmitral TVI during a cardiac cycle (FA) and calculated IPVA/IA and FPVA/FA. IPVA/IA and FPVA/FA were well correlated with ΔPa/ΔVa (r = 0.79 and r = 0.81) and LVEDP (r = 0.73 and r = 0.77). The areas under the ROC curve to discriminate LVEDP >18 mmHg were 0.90 for IPVA/IA and 0.93 for FPVA/FA. Conclusion: The FPVA/FA, the backward/forward flow volume ratio from the LA during atrial contraction, is useful for non-invasive assessments of LV chamber stiffness and elevated LVEDP.
  • Kudo Y, Mikami T, Nishida M, Okada K, Kaga S, Masauzi N, Omotehara S, Shibuya H, Kahata K, Shimizu C
    Journal of medical ultrasonics (2001) 45 1 197 - 197 2018年01月 [査読有り][通常論文]
     
    In the original publication of this paper the legend of Fig. 1 should read as: Fig. 1 Pulsed Doppler flow velocity recordings of the aorta (a), right renal artery (b), right renal interlobar artery (c), inferior vena cava (d), right renal vein (e), and right renal interlobar vein (f). PSV peak systolic velocity, EDV end-diastolic velocity, V MAX maximum velocity, V MIN minimum velocity.
  • Yamamoto M, Kono K, Kuroki M, Murakami S, Hayata R, Nanato K, Shao M, Miwa K, Tsutsumi Y, Okada K, Kaga S, Masauzi N
    Clin Lab 63 11 1851 - 1868 2017年11月 [査読有り][通常論文]
  • Yusuke Kudo, Taisei Mikami, Mutsumi Nishida, Kazunori Okada, Sanae Kaga, Nobuo Masauzi, Satomi Omotehara, Hitoshi Shibuya, Kaoru Kahata, Chikara Shimizu
    JOURNAL OF MEDICAL ULTRASONICS 44 4 305 - 314 2017年10月 [査読有り][通常論文]
     
    Flow velocity oscillation rate (FVOR) of the renal interlobar vein has been reported to be decreased in patients with urinary obstruction or diabetic nephropathy, and increased in those with hypertension during pregnancy. To clarify the clinical role of the renal interlobar venous FVOR, we investigated the flow velocity patterns of the renal vessels in patients with hypertension (HT) and/or diabetes (DM). Pulsed-wave Doppler sonography was performed in 34 patients: 15 with HT, 10 with DM, and nine with both HT and DM (HT-DM). Each FVOR of the right and left interlobar veins was closely and positively correlated with the ipsilateral interlobar arterial resistive index (RI), especially in the HT group, but not with the estimated glomerular filtration rate. The right interlobar venous FVOR was decreased in the DM and HT-DM groups compared to the HT group. The renal interlobar venous FVOR is strongly influenced by the arterial RI in HT patients, and is reduced in DM patients without an obvious relationship with diabetic nephropathy. These findings should be noted for the clinical application of renal interlobar venous flow analysis.
  • Takuma Hioka, Sanae Kaga, Taisei Mikami, Kazunori Okada, Michito Murayama, Nobuo Masauzi, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Mutsumi Nishida, Hiroyuki Iwano, Mamoru Sakakibara, Satoshi Yamada, Hiroyuki Tsutsui
    HEART AND VESSELS 32 7 833 - 842 2017年07月 [査読有り][通常論文]
     
    We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)-right atrial (RA) pressure gradient (RV-RA(CATH)), peak early diastolic PA-RV pressure gradient (PA-RVCATH), and mean PA pressure (MPAP(CATH)). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VCTR). The difference between the TRPG and RV-RA(CATH) was significantly greater in the very severe TR group (VCTR > 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VCTR ae<currency> 11 mm) than in the mild TR group. The overestimation of the pressure gradient > 10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAP(CATH) ae<yen> 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RA(CATH) when VCTR was > 11 mm and sometimes did when VCTR was > 7 mm, where EMPAP using PRPG was useful for estimating PA pressure.
  • Daisuke Murai, Satoshi Yamada, Taichi Hayashi, Kazunori Okada, Hisao Nishino, Masahiro Nakabachi, Shinobu Yokoyama, Ayumu Abe, Ayako Ichikawa, Kota Ono, Sanae Kaga, Hiroyuki Iwano, Taisei Mikami, Hiroyuki Tsutsui
    HEART AND VESSELS 32 5 574 - 583 2017年05月 [査読有り][通常論文]
     
    Whether and how left ventricular (LV) strain and strain rate correlate with wall stress is not known. Furthermore, it is not determined whether strain or strain rate is less dependent on the afterload. In 41 healthy young adults, LV global peak strain and systolic peak strain rate in the longitudinal direction (LS and LSR, respectively) and circumferential direction (CS and CSR, respectively) were measured layer-specifically using speckle tracking echocardiography (STE) before and during a handgrip exercise. Among all the points before and during the exercise, all the STE parameters significantly correlated linearly with wall stress (LS: r = -0.53, p < 0.01, LSR: r = -0.28, p < 0.05, CS in the inner layer: r = -0.72, p < 0.01, CSR in the inner layer: r = -0.47, p < 0.01). Strain more strongly correlated with wall stress than strain rate (r = -0.53 for LS vs. r = -0.28 for LSR, p < 0.05; r = -0.72 for CS vs. r = -0.47 for CSR in the inner layer, p < 0.05), whereas the interobserver variability was similar between strain and strain rate (longitudinal 6.2 vs. 5.2 %, inner circumferential 4.8 vs. 4.7 %, mid-circumferential 7.9 vs. 6.9 %, outer circumferential 10.4 vs. 9.7 %), indicating that the differences in correlation coefficients reflect those in afterload dependency. It was thus concluded that LV strain and strain rate linearly and inversely correlated with wall stress in the longitudinal and circumferential directions, and strain more strongly depended on afterload than did strain rate. Myocardial shortening should be evaluated based on the relationships between these parameters and wall stress.
  • Kazunori Okada, Sanae Kaga, Taisei Mikami, Nobuo Masauzi, Ayumu Abe, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Ayako Ichikawa, Mutsumi Nishida, Daisuke Murai, Taichi Hayashi, Chikara Shimizu, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    HEART AND VESSELS 32 5 591 - 599 2017年05月 [査読有り][通常論文]
     
    We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular (LV) myocardial contraction pattern in patients with hypertrophic cardiomyopathy (HCM), and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension (HT). From global strain and strain-rate curves in the longitudinal and circumferential directions, the time from mitral valve closure to the peak strains (T-LS and T-CS, respectively) and the peak systolic strain rates (T-LSSR and T-CSSR, respectively) were measured in 34 patients with HCM, 30 patients with HT, and 25 control subjects. The systolic strain-rate waveform was classified into 3 patterns ("V", "W", and "root" pattern). In the HCM group, T-LS was prolonged, but T-LSSR was shortened; consequently, T-LSSR/TLS ratio was distinctly lower than in the HT and control groups. The "root" pattern of longitudinal strain-rate waveform was more frequently seen in the HCM group (74 %) than in the control (4 %) and HT (20 %) groups. Similar but less distinct results were obtained in the circumferential direction. To differentiate HCM from HT, the sensitivity and specificity of the T-LSSR/TLS ratio <0.34 and the "root"-shaped longitudinal strain-rate waveform were 85 and 63 %, and 74 and 80 %, respectively. In conclusion, in patients with HCM, a reduced T-LSSR/T-LS ratio and a characteristic "root"- shaped waveform of LV systolic strain rate was seen, especially in the longitudinal direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT.
  • Michito Murayama, Taisei Mikami, Sanae Kaga, Kazunori Okada, Takuma Hioka, Nobuo Masauzi, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Mutsumi Nishida, Hiroyuki Iwano, Mamoru Sakakibara, Satoshi Yamada, Hiroyuki Tsutsui
    ULTRASOUND IN MEDICINE AND BIOLOGY 43 5 958 - 966 2017年05月 [査読有り][通常論文]
     
    In our new echocardiographic method, pulmonary regurgitant velocity immediately before right atrial (RA) contraction is used to estimate pulmonary artery diastolic pressure (PADP) and mean PA wedge pressure (MPAWP). Our aim here was to compare the usefulness of this new method with that of the conventional method, which uses pulmonary regurgitant velocity at end diastole. We studied 55 consecutive patients who underwent echocardiography and right-sided heart catheterization. The pulmonary regurgitant velocities just before RA contraction and at end diastole were measured to obtain echocardiographic estimates of PADP (EPADP(preA) and EPADP(ED), respectively) by adding the pressure gradients to the echocardiographically estimated RA pressure. Compared with EPADP(ED), EPADP(preA) correlated better with PADP (r = 0.87) and MPAWP (r = 0.80), and direct fixed biases were detected for EPADP(ED) but not for EPADP(preA). The area under the receiver operating characteristic curve distinguishing patients with MPAWP > 18 mm Hg was greater for EPADP(preA) (0.97) than for E/e' (0.94) and E/A (0.83). EPADP(preA) is thus useful in estimating PADP and MPAWP in patients with heart disease. (C) 2017 World Federation for Ultrasound in Medicine & Biology.
  • Kono K, Hayata R, Murakami S, Yamamoto M, Kuroki M, Nanato K, Takahashi K, Miwa K, Okada K, Kaga S, Mikami T, Masauzi N
    J Clin Lab Anal 32 1 2017年02月 [査読有り][通常論文]
  • Kanae Sugano, Kotomi Hashi, Misaki Goto, Kiyotaka Nishi, Rie Maeda, Keigo Kono, Mai Yamamoto, Kazunori Okada, Sanae Kaga, Keiko Miwa, Taisei Mikami, Nobuo Masauzi
    JOURNAL OF CLINICAL LABORATORY ANALYSIS 31 1 2017年01月 [査読有り][通常論文]
     
    Background: The neutrophil alkaline phosphatase (NAP) score is a valuable test for the diagnosis of myeloproliferative neoplasms, but it has still manually rated. Therefore, we developed a semi-automatic rating method using Photoshop (R) and Image-J, called NAP-PS-IJ. Methods: Neutrophil alkaline phosphatase staining was conducted with Tomonaga's method to films of peripheral blood taken from three healthy volunteers. At least 30 neutrophils with NAP scores from 0 to 5+ were observed and taken their images. From which the outer part of neutrophil was removed away with Image-J. These were binarized with two different procedures (P1 and P2) using Photoshop (R). NAP-positive area (NAP-PA) and granule (NAP-PGC) were measured and counted with Image-J. Results: The NAP-PA in images binarized with P1 significantly (P < 0.05) differed between images with NAP scores from 0 to 3+ (group 1) and those from 4+ to 5+ (group 2). The original images in group 1 were binarized with P2. NAP-PGC of them significantly (P < 0.05) differed among all four NAP score groups. The mean NAP-PGC with NAP-PS-IJ indicated a good correlation (r = 0.92, P < 0.001) to results by human examiners. Conclusions: The sensitivity and specificity of NAP-PS-IJ were 60% and 92%, which might be considered as a prototypic method for the full-automatic rating NAP score. (C) 2016 Wiley Periodicals, Inc.
  • Sanae Kaga, Taisei Mikami, Michito Murayama, Kazunori Okada, Nobuo Masauzi, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Mutsumi Nishida, Taichi Hayashi, Daisuke Murai, Hiroyuki Iwano, Mamoru Sakakibara, Satoshi Yamada, Hiroyuki Tsutsui
    INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 33 1 31 - 38 2017年01月 [査読有り][通常論文]
     
    Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in patients with heart failure, especially when the pulmonary arterial pressure is lower due to reduced stroke volume. Several echocardiographic methods to estimate PVR have been proposed, but their applications in patients with organic left-sided heart diseases have been limited. The aim of the present study was to examine the usefulness of our new method to estimate PVR (PVRPR) based on the continuous-wave Doppler velocity measurements of pulmonary regurgitation in these patients. In 43 patients who underwent right heart catheterization, PVRPR was calculated as the difference between the Doppler-derived early- and end-diastolic pulmonary artery (PA)-right ventricular (RV) pressure gradients divided by the cardiac output measured in the left ventricular outflow tract by echocardiography. The PVRPR correlated well with invasive PVR (PVRCATH) (r = 0.81, p < 0.001) without any fixed bias in Bland-Altman analysis. The conventional echocardiographic PVRs showed inadequate correlations with PVRCATH, or a obvious overestimation of PVRCATH. In the receiver operating characteristic analyses to determine the patients with abnormal elevation of PVRCATH (> 3 Wood units, WU), the area under the curve was the greatest for PVRPR (0.964) compared to the conventional PVRs (0.649-0.839). PVRPR had 83 % sensitivity and 100 % specificity at the optimal cut-off value of 3.10 WU in identifying patients with PVRCATH > 3 WU. Our simple and theoretical PVRPR is useful for the noninvasive estimation of PVR.
  • Iwano Hiroyuki, Yamada Satoshi, Okada Kazunori, Hayashi Taichi, Tsujinaga Shingo, Yokoyama Shinobu, Nakabachi Masahiro, Nishino Hisao, Ichikawa Ayako, Abe Ayumu, Kaga Sanae, Mikami Taisei, Tsutsui Hiroyuki
    CIRCULATION 134 2016年11月11日 [査読有り][通常論文]
  • Maki Mizukami, Misaki Yamada, Sayaka Fukui, Nao Fujimoto, Shigeru Yoshida, Sanae Kaga, Keiko Obata, Shigeki Jin, Keiko Miwa, Nobuo Masauzi
    JOURNAL OF CLINICAL LABORATORY ANALYSIS 30 6 918 - 923 2016年11月 [査読有り][通常論文]
     
    BackgroundMorphological observation of blood or marrow film is still described nonquantitatively. We developed a semiautomatic method for segmenting vacuoles from the cytoplasm using Photoshop (PS) and Image-J (IJ), called PS-IJ, and measured the relative entire cell area (rECA) and relative areas of vacuoles (rAV) in the cytoplasm of neutrophil with PS-IJ. MethodsWhole-blood samples were stored at 4 degrees C with ethylenediaminetetraacetate and in two different preserving manners (P1 and P2). Color-tone intensity levels of neutrophil images were semiautomatically compensated using PS, and then vacuole portions were automatically segmented by IJ. The rAV and rECA were measured by counting pixels by IJ. For evaluating the accuracy in segmentations of vacuoles with PS-IJ, the rAV/rECA ratios calculated with results from PS-IJ were compared with those calculated with human eye and IJ (HE-IJ). ResultsThe rECA and rAV/ in P1 significantly (P < 0.05, P < 0.05) were enlarged and increased, but did not significantly (P = 0.46, P = 0.21) change in P2. The rAV/rECA ratios by PS-IJ were significantly correlated (r = 0.90, P < 0.01) with those by HE-IJ. ConclusionPS-IJ method can successfully segment vacuoles and measure the rAV and rECA, becoming a useful tool for quantitative description of morphological observation of blood and marrow film.
  • Yokoyama S, Iwano H, Yamada S, Takeda M, Kaga S, Nakabachi M, Nishino H, Ichikawa A, Abe A, Okada K, Murai D, Hayashi T, Nishida M, Shibuya H, Kahata K, Shimizu C, Mikami T, Tsutsui H
    J Cardiol Cases 14 3 82 - 86 2016年09月 [査読有り][通常論文]
     
    Nonbacterial thrombotic endocarditis (NBTE) is characterized by the deposition of thrombi on previously undamaged heart valves in the absence of bacteremia and predominantly affects patients with hypercoagulable state. Although the diagnosis is usually based on transthoracic echocardiography, little is known about the serial changes of the vegetation in response to treatment. We experienced a 42-year-old woman with advanced uterine cancer and asymptomatic cerebral embolization. Plasma d-dimer level was markedly elevated and echocardiography showed highly mobile masses attached to the anterior and posterior mitral leaflets with moderate regurgitation. Based on these findings, she was diagnosed as having NBTE associated with uterine cancer and intravenous administration of heparin and chemotherapy were performed. Follow-up echocardiography revealed the disappearance of the vegetation and reduction of mitral regurgitation. Uterine cancer was successfully treated by surgery and recurrence of the valvular lesion did not occur. .
  • 喜田 真由子, 加賀 早苗, 岡田 一範, 村山 迪史, 阿部 歩, 市川 絢子, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 西田 睦, 山田 聡, 三神 大世
    超音波検査技術 41 3 314 - 314 (一社)日本超音波検査学会 2016年06月
  • 村山 迪史, 加賀 早苗, 岡田 一範, 樋岡 拓馬, 阿部 歩, 市川 絢子, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 西田 睦, 山田 聡, 三神 大世
    超音波検査技術 41 3 314 - 314 (一社)日本超音波検査学会 2016年06月
  • Mutsuko Muraki, Taisei Mikami, Tetsuyuki Yoshimoto, Shin Fujimoto, Zmayumi Kitaguchi, Sanae Kaga, Tomoko Sugawara, Kouichi Tokuda, Sadao Kaneko, Takeshi Kashiwaba
    ULTRASOUND IN MEDICINE AND BIOLOGY 42 2 358 - 364 2016年02月 [査読有り][通常論文]
     
    We investigated the feasibility of using sonography of abnormal plaque motion to diagnose high-risk carotid lesions ranging from plaque rupture to ulcer formation. Fifty consecutive carotid arteries of 49 patients (71 +/- 7 y, 37 males) who underwent carotid endarterectomy were investigated by carotid sonography to find a plaque concavity (sonographic ulcer [SU]), fine trembling motion inside the plaque (FTMI) and systolic retractive motion of the plaque surface (SRMS). Plaque rupture or ulcer, necrotic core and intra-plaque hemorrhage were determined at carotid endarterectomy. Twenty-two SUs, 41 cases of FTMI and 20 cases of SRMS were detected by carotid sonography. The sensitivity and specificity of SU in diagnosing plaque rupture or ulcer at carotid endarterectomy were 48% and 90%, and those of FTMI were 93% and 60%. Plaques with SRMS more frequently had both a necrotic core and intra-plaque hemorrhage than those without SRMS (80% vs. 30%, p = 0.0005). Abnormal plaque motion detected by carotid sonography is useful in detecting a ruptured or ulcerated plaque with a necrotic core and/or hemorrhage. (C) 2016 World Federation for Ultrasound in Medicine & Biology.
  • Kazunori Okada, Satoshi Yamada, Hiroyuki Iwano, Hisao Nishino, Masahiro Nakabachi, Shinobu Yokoyama, Ayumu Abe, Ayako Ichikawa, Sanae Kaga, Mutsumi Nishida, Taichi Hayashi, Daisuke Murai, Taisei Mikami, Hiroyuki Tsutsui
    CIRCULATION JOURNAL 79 11 2471 - 2479 2015年11月 [査読有り][通常論文]
     
    Background: Although longitudinal strain (LS) is known to be reduced in patients with hypertrophic cardiomyopathy (HCM), it has not been elucidated whether or not circumferential strain (CS) is reduced. We aimed to determine whether multidirectional and layer-specific myocardial strain is reduced in patients with nonobstructive HCM. Methods and Results: Speckle-tracking echocardiography was performed in 41 HCM patients and 27 control subjects. Segmental and global LS and CS were measured in the inner, mid, and outer layers. Global LS was significantly lower in the HCM group than in controls in the inner (-10.3 +/- 2.9 vs. -14.8 +/- 2.0%, P<0.001), mid (-8.7 +/- 2.6 vs. -13.8 +/- 1.9%, P<0.001), and outer (-7.2 +/- 2.6 vs. -11.9 +/- 1.9%, P<0.001) layers. Global CS was preserved in the inner layer (-23.8 +/- 4.7 vs. -24.3 +/- 3.3%, P=0.69) but reduced in the mid (-10.3 +/- 3.1 vs. -13.3 +/- 2.5%, P<0.001) and outer layers (-6.7 +/- 2.3 vs. -8.6 +/- 2.3%, P=0.002). Differences in CS between the inner and outer layers correlated with segmental relative wall thickness (r=-0.20, P=0.002). Furthermore, only the absolute value of global CS in the inner layer positively correlated with left ventricular ejection fraction (r=0.32, P<0.01) among these multidirectional and layer-specific strains. Conclusions: In patients with HCM, not only the LS in all layers but also CS in the mid and outer layers was reduced, presumably reflecting impaired myocardial function. In contrast, CS in the inner layer was preserved, being associated with maintenance of chamber function.
  • Sanae Kaga, Taisei Mikami, Yuka Takamatsu, Ayumu Abe, Kazunori Okada, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Mutsumi Nishida, Chikara Shimizu, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY 27 11 1223 - 1229 2014年11月 [査読有り][通常論文]
     
    Background: Many echocardiographic features of constrictive pericarditis (CP) have been reported, but each alone has a limitation either in sensitivity or in specificity. Continuous-wave Doppler-derived flow velocity of pulmonary regurgitation can reflect the diastolic right ventricular pressure pattern characteristic of CP and be useful for its detection. Methods: Fifteen patients with CP, 18 patients with restrictive cardiomyopathy, and 20 normal subjects were studied retrospectively. Using continuous-wave Doppler echocardiography, pulmonary regurgitation velocities were measured at the early diastolic peak (V-MAx), mid-diastolic inflection point (V-IFL), and late diastolic minimal point (V-MIN). Results: V-IFL, V-IFL/V-MAx, V-MIN, and V-MIN/V-MAx were significantly lower in the CP group compared with the restrictive cardiomyopathy and normal groups. Prevalence rates of patients with early mid-diastolic inflection, V-IFL/V-MAx < 0.5, V-MIN < 50 cm/sec, and V-MIN/V-MAx < 0.33 were significantly greater in the CP group compared with the other groups. Sensitivity and specificity for the diagnosis of CP were 93% and 74%, respectively, for the presence of early mid-diastolic inflection, 73% and 100% for V-IFL/V-MAx < 0.5, 73% and 97% for V-MIN < 50 cm/sec, and 93% and 92% for V-MIN/V-MAx < 0.33. Conclusions: The quantitative and pattern analyses of continuous-wave Doppler-derived pulmonary regurgitation velocity could enhance the accuracy of echocardiographic detection of CP.
  • Kazunori Okada, Taisei Mikami, Sanae Kaga, Masahiro Nakabachi, Ayumu Abe, Shinobu Yokoyama, Hisao Nishino, Mutsumi Nishida, Chikara Shimizu, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    JOURNAL OF CLINICAL ULTRASOUND 42 6 341 - 347 2014年07月 [査読有り][通常論文]
     
    Background. Left ventricular (LV) diastolic dysfunction is often observed in healthy older subjects without structural heart disease, although its exact mechanisms have not been established. A decrease in the aorto-septal angle (ASA), an alteration of LV shape due to aortic elongation, is also frequently seen in elderly subjects. The objective of this study was to evaluate whether it can contribute to LV diastolic dysfunction in healthy subjects. Methods. Echocardiography was performed in 77 healthy subjects (42 men, mean age 43.2 +/- 13.8 years) to measure the ASA, early diastolic transmitral flow velocity (E), isovolumic relaxation time (IRT), and early diastolic mitral annular velocity (e'). The LV peak early diastolic longitudinal strain rate (GSR(E)) was measured using a two-dimensional speckle tracking imaging technique. Results. ASA was significantly correlated with E (r=0.54, p<0.001), IRT (r=-0.41, p<0.001), e' (r=0.57, p<0.001), and GSRE (r=0.63, p<0.001) and shown by stepwise multivariate analysis to be the strongest independent determinant of E, IRT, and GSRE, and one of the independent determinants of e'. Conclusions. The alteration of LV shape associated with reduced ASA may be one of the causes of LV diastolic dysfunction independently of age in otherwise healthy subjects. (C) 2014 Wiley Periodicals, Inc.
  • 西田 睦, 佐藤 恵美, 工藤 悠輔, 井上 真美子, 表原 里実, 堀江 達則, 和田 妙子, 岩井 孝仁, 石坂 欣也, 加賀 早苗
    超音波検査技術 38 Suppl. S75 - S76 (一社)日本超音波検査学会 2013年06月
  • Ayumu Abe, Taisei Mikami, Sanae Kaga, Kanako Tsuji, Kazunori Okada, Shinobu Yokoyama, Hisao Nishino, Masahiro Nakabachi, Mutsumi Nishida, Chikara Shimizu, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    Journal of Echocardiography 11 2 41 - 49 2013年06月 [査読有り][通常論文]
     
    Background: Assessing left ventricular (LV) hypertrophy (LVH) is an important step in the echocardiographic diagnosis of aortic stenosis (AS). We aimed to investigate the causes of discrepancies between the degrees of AS and LVH. Methods: The study subjects consisted of 149 consecutive patients with AS having aortic valve area < 2.0 cm2 (mean age 72.5 ± 11.9 years, 67 men and 82 women). Coexisting cardiac diseases were determined based on echocardiographic findings and comprehensive clinical judgment. Echocardiographic measurements included LV mass index (LVMI), aortic valve area index (AVAI), transaortic mean pressure gradient (MPG), valvulo-arterial impedance (Zva), energy loss coefficient (ELCo), and energy loss index (ELI). Results: LVMI was not significantly correlated with AVAI and Zva, and had a weak correlation with MPG (r = 0.305, p = 0.0001). There were 55 patients in group A (non-severe AS without significant LVH), 58 in group B (non-severe AS with significant LVH), 7 in group C (severe AS without significant LVH), and 29 in group D (severe AS with significant LVH). Coexisting cardiac diseases were more frequently observed (p = 0.0003) in group B (50 %) than in group A (18 %). In group C, ELCo and (ELI - AVAI)/ELI were significantly greater than in group D (p = 0.043 and 0.007, respectively). Conclusion: Significant LVH seen in less than moderate AS is often due to coexisting cardiac diseases, and there may be an overestimation of AS severity due to pressure recovery among patients with apparently severe AS who do not have significant LVH. © 2013 Japanese Society of Echocardiography.
  • Ayumu Abe, Taisei Mikami, Sanae Kaga, Kanako Tsuji, Kazunori Okada, Shinobu Yokoyama, Hisao Nishino, Masahiro Nakabachi, Mutsumi Nishida, Chikara Shimizu, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    Journal of Echocardiography 11 2 41 - 49 2013年06月 [査読有り][通常論文]
     
    Background: Assessing left ventricular (LV) hypertrophy (LVH) is an important step in the echocardiographic diagnosis of aortic stenosis (AS). We aimed to investigate the causes of discrepancies between the degrees of AS and LVH. Methods: The study subjects consisted of 149 consecutive patients with AS having aortic valve area < 2.0 cm2 (mean age 72.5 ± 11.9 years, 67 men and 82 women). Coexisting cardiac diseases were determined based on echocardiographic findings and comprehensive clinical judgment. Echocardiographic measurements included LV mass index (LVMI), aortic valve area index (AVAI), transaortic mean pressure gradient (MPG), valvulo-arterial impedance (Zva), energy loss coefficient (ELCo), and energy loss index (ELI). Results: LVMI was not significantly correlated with AVAI and Zva, and had a weak correlation with MPG (r = 0.305, p = 0.0001). There were 55 patients in group A (non-severe AS without significant LVH), 58 in group B (non-severe AS with significant LVH), 7 in group C (severe AS without significant LVH), and 29 in group D (severe AS with significant LVH). Coexisting cardiac diseases were more frequently observed (p = 0.0003) in group B (50 %) than in group A (18 %). In group C, ELCo and (ELI - AVAI)/ELI were significantly greater than in group D (p = 0.043 and 0.007, respectively). Conclusion: Significant LVH seen in less than moderate AS is often due to coexisting cardiac diseases, and there may be an overestimation of AS severity due to pressure recovery among patients with apparently severe AS who do not have significant LVH. © 2013 Japanese Society of Echocardiography.
  • Hiroyuki Iwano, Satoshi Yamada, Masaya Watanabe, Hirofumi Mitsuyama, Kazuya Mizukami, Hisao Nishino, Shinobu Yokoyama, Sanae Kaga, Kazunori Okada, Mutsumi Nishida, Hisashi Yokoshiki, Taisei Mikami, Hiroyuki Tsutsui
    Circulation Journal 77 11 2757 - 2765 2013年 [査読有り][通常論文]
     
    Background: We previously reported that the strain rate dispersion index (SRDI), an index of left ventricular (LV) contractility loss because of mechanical dyssynchrony, better predicted the acute response to cardiac resynchronization therapy (CRT) than time-delay indices. However, it remains unclear whether the SRDI can predict the chronic response. Additionally, the SRDI needs to be simplified for use in clinical practice. Methods and Results: Echocardiography was performed in 40 heart failure patients who underwent CRT. The SRDI, the average of segmental peak systolic strain rates minus global peak systolic strain rate, was calculated, together with strain-derived time-delay indices (St-SD) in the longitudinal, circumferential and radial directions using a speckle-tracking method. As simplified indices, the longitudinal parameters were calculated from the apical 4-chamber view in addition to 3 apical views. LV end-systolic volume (ESV) significantly decreased 6 months after CRT. Although circumferential St-SD and all SRDIs correlated with the changes in ESV (ΔESV), multivariate analysis revealed that the circumferential SRDI was the single independent determinant of ΔESV. During the 20±14 months after CRT, cardiac events occurred in 14 patients. Kaplan-Meier analyses revealed that all SRDIs were significant predictors of cardiac events whereas none of St-SDs was. Conclusions: The SRDI predicted the reduction in both LV volume and cardiac events after CRT better than timedelay indices. Additionally, a simplified SRDI could be as good a predictor of CRT response as the original.
  • Masahiro Nakabachi, Taisei Mikami, Kazunori Okada, Hisao Onozuka, Sanae Kaga, Mamiko Inoue, Shinobu Yokoyama, Mutsumi Nishida, Chikara Shimizu, Kazuhiko Matsuno, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    Journal of Echocardiography 10 3 83 - 89 2012年09月 [査読有り][通常論文]
     
    Background: Left ventricular (LV) diastolic dysfunction is often observed in healthy subjects and can be a cause of heart failure with preserved ejection fraction (EF). We aimed to investigate the role of LV diastolic asynchrony as a cause of diastolic dysfunction in healthy subjects. Methods: In 40 healthy subjects, two-dimensional speckle tracking imaging (2DSTI) was performed to measure the peak early diastolic longitudinal strain rates (Esr) of the apical, mid-ventricular, and basal segments of the septum and posterior wall. A mean value of the Esr of the 6 segments (mEsr) was calculated. The time from aortic valve closure to the Esr was measured for each segment, and the standard deviation (SDTEsr) was calculated. The peak global early diastolic strain rate (gEsr) was measured with a region of interest (ROI) on the whole LV myocardium. LV flow propagation velocity (FPV) was measured using conventional Doppler techniques. Results: SDTEsr was not correlated with age, but was significantly correlated with body mass index (BMI) (r = 0.41, p < 0.01). Although no significant correlation was observed between mEsr and FPV, gEsr and SDTEsr significantly correlated with FPV (r = 0.41, p < 0.01 r = -0.54, p < 0.001). As a result of the multiple regression analysis, SDTEsr was the single determinant of FPV. Conclusions: Diastolic asynchrony, associated with overweight but not with aging, may contribute to diastolic dysfunction in healthy subjects. © 2012 Japanese Society of Echocardiography.
  • Kazunori Okada, Taisei Mikami, Sanae Kaga, Hisao Onozuka, Mamiko Inoue, Shinobu Yokoyama, Hisao Nishino, Mutsumi Nishida, Kazuhiko Matsuno, Hiroyuki Iwano, Satoshi Yamada, Hiroyuki Tsutsui
    EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 12 12 917 - 923 2011年12月 [査読有り][通常論文]
     
    Aims Early diastolic mitral annular velocity (e') obtained by tissue Doppler imaging (TDI) is widely used to evaluate left ventricular (LV) diastolic function based on the assumption that it reflects myocardial relaxation in the long-axis direction. In this study, we aimed to determine whether or not e' truly reflects early diastolic longitudinal myocardial relaxation, and which is the most useful for evaluating LV diastolic function among e' measured at the interventricular-septal annulus (IS-e'), that measured at the lateral annulus (LW-e') or their mean value (M-e'). Methods and results IS-e', LW-e', and M-e' were measured using colour TDI in 15 patients with hypertrophic cardiomyopathy, 13 patients with hypertension, and 19 control subjects. Using two-dimensional speckle-tracking imaging, early diastolic myocardial strain rates (SR(E)) were measured for the IS (IS-SR(E)), LW(LW-SR(E)), and entire LV myocardium (G-SR(E)). IS-e' was excellently correlated with IS-SR(E) (r = 0.90, P < 0.001); the correlation was better than that between LW-e' and LW-SR(E) (r = 0.75, P < 0.001). IS-e' and M-e' were well correlated with G-SR(E) (r = 0.88, P < 0.001 and r = 0.86, P < 0.001, respectively) and with LV early diastolic flow propagation velocity (FPV) (r = 0.77, P < 0.001 and r = 0.78, P < 0.001, respectively). The correlations of LW-e' to G-SRE (r = 0.80, P < 0.001) and FPV (r = 0.75, P < 0.001) did not reach this level. Conclusion IS-e' well reflected LV longitudinal myocardial relaxation and LV diastolic function, and was found to be more useful in evaluating LV diastolic function than LW-e'.
  • Hiroyuki Iwano, Satoshi Yamada, Masaya Watanabe, Hirofumi Mitsuyama, Hisao Nishino, Shinobu Yokoyama, Sanae Kaga, Mutsumi Nishida, Hisashi Yokoshiki, Hisao Onozuka, Taisei Mikami, Hiroyuki Tsutsui
    CIRCULATION JOURNAL 75 9 2167 - 2175 2011年09月 [査読有り][通常論文]
     
    Background: Time-delay indexes are limited in predicting the response to cardiac resynchronization therapy (CRT), partly because they do not reflect the residual left ventricular (LV) contractility. We computed a novel index of LV contractility loss due to dyssynchrony (the strain rate (SR) dispersion index: SRDI) by using the speckle-tracking SR and compared the efficacy of the SRDI, time-delay indexes, and strain delay index (SDI), the previously reported index of wasted energy due to dyssynchrony, for predicting the acute response to CRT. Methods and Results: Echocardiography was performed in 19 heart failure patients (LV ejection fraction (EF) 25 +/- 6%) before and 2 weeks after CRT. The standard deviation of time to peak velocity, or strain, was calculated as time-delay indexes. The SRDI was calculated as the average of segmental peak systolic SR minus global peak systolic SR. Longitudinal SDI (L-SDI), longitudinal SRDI (L-SRDI), and circumferential SRDI (C-SRDI) significantly correlated with the change in global longitudinal strain (Delta global LSt), whereas the time-delay indexes did not. Although the time-delay indexes were comparable between responders (Delta global LSt >= 0.3%) and nonresponders, the L-SDI, L-SRDI, and C-SRDI were greater in responders. The area under the receiver operating characteristic curve of the L-SRDI, L-SDI, and C-SRDI for predicting responders was 0.89, 0.81, and 0.78, respectively. Conclusions: The SRDI correlated fairly well with an improvement in global LV systolic function after CRT. (Circ J 2011; 75: 2167-2175)
  • 造影超音波検査はIgG4関連硬化性胆管炎と胆管癌の鑑別に有用か
    西田 睦, 佐藤 恵美, 工藤 悠輔, 井上 真美子, 表原 里実, 堀江 達則, 加賀 早苗, 河上 洋, 清水 力, 松野 一彦
    超音波医学 38 Suppl. S410 - S410 (公社)日本超音波医学会 2011年04月
  • 上腕駆血によるFMD検査の再現性の検討
    井上 真美子, 西田 睦, 吉永 恵一郎, 佐藤 恵美, 石坂 香織, 工藤 悠輔, 表原 里実, 堀江 達則, 加賀 早苗, 横山 しのぶ, 西野 久雄, 鈴木 春樹, 清水 力, 松野 一彦
    超音波医学 38 2 160 - 161 (公社)日本超音波医学会 2011年03月
  • 僧帽弁輪石灰化により拡張早期僧帽弁輪運動速度が低下する機序
    柿本 悠太, 三神 大世, 岡田 一範, 小野塚 久夫, 加賀 早苗, 西田 睦, 松野 一彦, 岩野 弘幸, 山田 聡, 筒井 裕之
    超音波医学 38 2 161 - 162 (公社)日本超音波医学会 2011年03月
  • 左室収縮障害患者における左室後壁屈曲の機序とその意義
    三谷 麻子, 三神 大世, 岩井 孝仁, 小野塚 久夫, 加賀 早苗, 西田 睦, 松野 一彦, 岩野 弘幸, 山田 聡, 筒井 裕之
    超音波医学 38 2 162 - 162 (公社)日本超音波医学会 2011年03月
  • 乳腺腫瘍の良・悪性鑑別におけるstrain ratioの有用性
    工藤 悠輔, 西田 睦, 石坂 香織, 佐藤 恵美, 井上 真美子, 表原 里実, 堀江 達則, 加賀 早苗, 横山 しのぶ, 西野 久雄, 細田 充主, 高橋 弘昌, 鈴木 春樹, 清水 力, 松野 一彦
    超音波医学 38 2 162 - 163 (公社)日本超音波医学会 2011年03月
  • 3Dスペックルトラッキング法による左室拡張機能評価 Area tracking rate計測の意義
    加賀 早苗, 小野塚 久夫, 山田 聡, 三神 大世, 岩野 弘幸, 横山 しのぶ, 西野 久雄, 西田 睦, 清水 力, 筒井 裕之, 松野 一彦
    日本心臓病学会誌 5 Suppl.I 266 - 266 (一社)日本心臓病学会 2010年08月
  • 山田 聡, 岩野 弘幸, 小室 薫, 岡田 昌子, 小松 博史, 加賀 早苗, 西田 睦, 小野塚 久夫, 三神 大世, 筒井 裕之
    Japanese journal of medical ultrasonics = 超音波医学 37 4 491 - 497 2010年07月15日 [査読無し][通常論文]
  • 拡張早期の僧帽弁輪運動速度と左室心筋伸展との関係 健常例と肥大心における検討
    岡田 一範, 三神 大世, 加賀 早苗, 小野塚 久夫, 横山 しのぶ, 西田 睦, 松野 一彦, 岩野 弘幸, 山田 聡, 筒井 裕之
    超音波医学 37 4 533 - 533 (公社)日本超音波医学会 2010年07月
  • 健常人における左室拡張機能障害の機序の二次元スペックルトラッキング法による分析
    中鉢 雅大, 三神 大世, 小野塚 久夫, 中村 安岐, 岡田 一範, 加賀 早苗, 西田 睦, 岩野 弘幸, 山田 聡, 筒井 裕之
    超音波医学 37 4 533 - 533 (公社)日本超音波医学会 2010年07月
  • 3Dグローバルストレインレートによる左室拡張機能評価
    加賀 早苗, 小野塚 久夫, 三神 大世, 佐々木 洸太, 西野 久雄, 横山 しのぶ, 西田 睦, 松野 一彦, 山田 聡, 筒井 裕之
    超音波医学 37 4 533 - 533 (公社)日本超音波医学会 2010年07月
  • 大動脈弁口部圧較差への圧力回復現象補正の要否についての検討
    西野 久雄, 三神 大世, 山田 聡, 佐藤 陽子, 岩野 弘幸, 筒井 裕之, 横山 しのぶ, 加賀 早苗, 西田 睦, 松野 一彦
    超音波医学 37 4 534 - 535 (公社)日本超音波医学会 2010年07月
  • 西野 久雄, 三神 大世, 山田 聡, 佐藤 陽子, 岩野 弘幸, 筒井 裕之, 小野塚 久夫, 横山 しのぶ, 加賀 早苗, 西田 睦, 松野 一彦
    超音波検査技術 35 2 257 - 257 (一社)日本超音波検査学会 2010年04月
  • 非協調運動による左室全体収縮能の損失分を表す新しいストレインレート指標
    岩野 弘幸, 山田 聡, 佐藤 陽子, 西野 久雄, 横山 しのぶ, 加賀 早苗, 西田 睦, 小野塚 久夫, 三神 大世, 筒井 裕之
    超音波医学 37 Suppl. S312 - S312 (公社)日本超音波医学会 2010年04月
  • 慢性心房細動患者における機能的僧帽弁逆流の機序の心エコーによる分析
    小泉 遥香, 三神 大世, 岩井 孝仁, 小野塚 久夫, 岡田 一範, 横山 しのぶ, 加賀 早苗, 井上 真美子, 西田 睦, 鈴木 春樹, 清水 力, 松野 一彦, 佐藤 陽子, 岩野 弘幸, 山田 聡, 筒井 裕之
    超音波医学 37 1 41 - 41 (公社)日本超音波医学会 2010年01月
  • 左室充満圧推定における肺動脈弁逆流血流速度計測の臨床的意義の検討
    高松 由佳, 小野塚 久夫, 三神 大世, 井上 真美子, 佐々木 洸太, 加賀 早苗, 横山 しのぶ, 表原 里実, 西野 久雄, 西田 睦, 松野 一彦, 佐藤 陽子, 岩野 弘幸, 山田 聡, 筒井 裕之
    超音波医学 37 1 41 - 42 (公社)日本超音波医学会 2010年01月
  • 健常人における左室拡張機能障害の分析 二次元スペックルトラッキング法による心筋弛緩速度とその同期性の分析に基づく検討
    中村 安岐, 三神 大世, 中鉢 雅大, 岡田 一範, 加賀 早苗, 井上 真美子, 横山 しのぶ, 表原 里実, 西田 睦, 松野 一彦, 佐藤 陽子, 岩野 弘幸, 山田 聡, 小野塚 久夫, 筒井 裕之
    超音波医学 37 1 43 - 44 (公社)日本超音波医学会 2010年01月
  • Hiroshi Komatsu, Satoshi Yamada, Hiroyuki Iwano, Masako Okada, Hisao Onozuka, Taisei Mikami, Shinobu Yokoyama, Mamiko Inoue, Sanae Kaga, Mutsumi Nishida, Chikara Shimizu, Kazuhiko Matsuno, Hiroyuki Tsutsui
    CIRCULATION JOURNAL 73 11 2098 - 2103 2009年11月 [査読有り][通常論文]
     
    Background: Although a reduction in myocardial blood volume (MBV), an in vivo index of the myocardial microvasculature, measured by myocardial contrast echocardiography in patients with hypertension (HT), can be demonstrated, it is still unknown whether a decreased MBV call be improved by antihypertensive treatment. Methods and Results: Eleven HT patients (mean age 58 years, 7 men) with left ventricular hypertrophy (LVH) and 10 age- and sex-matched normal controls were studied. Harmonic power Doppler images were acquired at end-diastole of every 6(th) beat and MBV was calculated as 10(X/10)X100%. where X (dB) is myocardial contrast intensity minus the contrast intensity of the adjacent intracavity blood pool. Baseline blood pressure (BP) and left ventricular mass index (LVMI) in the HT patients were higher and MBV was lower than in the controls (252 +/- 0.37% vs 3.31 +/- 0.61%. P<0.01). MBV did not correlate with mean BP. but was inversely correlated with LVMI (r=-0.61, P<0.01). After treatment with valsartan for 6 months, LVMI significantly decreased and MBV increased (2.72 +/- 0.26%, P<0.05 vs baseline) in the patients With HT. There wits a significant inverse correlation between the changes in MBV and those of LVMI (r=-0.62, P<0.05), but not between MBV and mean BP. Conclusions: Valsartan, an angiotensin II receptor blocker, corrected the decreased MBV in association with regression of LVH in patients with HT. (Circ J 2009: 73: 2098-2103)
  • 岡田 一範, 三神 大世, 小野塚 久夫, 本田 舞, 加賀 早苗, 井上 真美子, 横山 しのぶ, 西田 睦, 鈴木 春樹, 清水 力, 松野 一彦, 佐藤 陽子, 岩野 弘幸, 山田 聡, 筒井 裕之
    臨床病理 57 補冊 150 - 150 (一社)日本臨床検査医学会 2009年07月
  • 岩井 孝仁, 三神 大世, 小野塚 久夫, 小泉 遥香, 岡田 一範, 横山 しのぶ, 加賀 早苗, 井上 真美子, 西田 睦, 鈴木 春樹, 清水 力, 松野 一彦, 佐藤 陽子, 岩野 弘幸, 山田 聡, 筒井 裕之
    臨床病理 57 補冊 150 - 150 (一社)日本臨床検査医学会 2009年07月
  • 工藤 悠輔, 西田 睦, 石坂 香織, 佐藤 恵美, 井上 真美子, 加賀 早苗, 横山 しのぶ, 表原 里美, 鈴木 春樹, 清水 力, 松野 一彦
    超音波検査技術 34 3 361 - 361 (一社)日本超音波検査学会 2009年06月
  • Sanae Kaga, Taisei Mikami, Hisao Onozuka, Satomi Omotehara, Ayumu Abe, Satoshi Yamada, Masako Okada, Hiroshi Komatsu, Mamiko Inoue, Shinobu Yokoyama, Mutsumi Nishida, Chikara Shimizu, Kazuhiko Matsuno, Hiroyuki Tsutsui
    Journal of Echocardiography 7 2 25 - 33 2009年06月 [査読有り][通常論文]
     
    Background: Although several previous studies have suggested the presence of right ventricular (RV) diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM) and those with hypertensive left ventricular hypertrophy (HT-LVH), the mechanisms are still unclear. This study aimed to clarify the relationship between the RV global diastolic dysfunction in these patients and the regional myocardial diastolic function, including synchronicity of the interventricular septum and RV free wall. Methods: In 20 age-matched patients with HT-LVH, 20 patients with HCM and 22 control subjects without pulmonary hypertension, RV isovolumic relaxation time (IRTR) was measured using continuous-wave Doppler echocardiography. The early diastolic peak strain rate (ESR) and time from QRS to ESR (T-ESR) were measured in the apical, mid-ventricular and basal segments of the interventricular septum and RV free wall using two-dimensional speckle tracking imaging (2DST). Results: IRTR was more prolonged both in HT-LVH and in HCM than in the controls. The averaged septal ESR was reduced both in HT-LVH and in HCM (P < 0.0001, respectively), but the averaged RV free wall ESR was decreased only in HCM (P = 0.0007). ESR averaged for six septal and RV free wall segments was correlated with IRTR (r = -0.46, P = 0.0001). Neither intergroup difference nor correlation with IRTR was observed in a coefficient of variation of T-ESR for the six segments. Conclusions: RV global diastolic function is impaired in patients with HT-LVH and HCM due to relaxation abnormalities, not an asynchrony, of the myocardium surrounding the RV cavity. The detection of RV free wall relaxation abnormality using 2DST may be useful to differentiate HCM from HT-LVH. © 2009 Japanese Society of Echocardiography.
  • 表原 里実, 三神 大世, 小野塚 久夫, 加賀 早苗, 井上 真美子, 横山 しのぶ, 西田 睦, 清水 力, 松野 一彦, 山田 聡, 筒井 裕之
    超音波検査技術 34 2 214 - 214 (一社)日本超音波検査学会 2009年04月
  • 二次元スペックルトラッキング法による短軸心筋ストレイン計測の心臓再同期療法適応判定における意義
    加賀 早苗, 小野塚 久夫, 三神 大世, 井上 真美子, 横山 しのぶ, 西田 睦, 鈴木 春樹, 清水 力, 松野 一彦, 岩野 弘幸, 小松 博史, 岡田 昌子, 山田 聡, 筒井 裕之
    超音波医学 35 4 460 - 460 (公社)日本超音波医学会 2008年07月
  • CT/MRIにて確定診断に至らなかった結節に対する造影超音波(CEUS)の位置づけ
    西田 睦, 増田 香織, 佐藤 恵美, 溝口 恵美, 小野寺 祐也, 尾松 徳彦, 神島 保, 加藤 扶美, 加賀 早苗, 井上 真美子, 横山 しのぶ, 鈴木 春樹, 清水 力, 松野 一彦, 玉木 長良, 白土 博樹
    超音波医学 35 4 463 - 463 (公社)日本超音波医学会 2008年07月
  • 心房収縮期の僧帽弁輪運動速度と左室スティッフネスとの関係
    吉原 明日香, 三神 大世, 山田 聡, 小室 薫, 小松 博史, 岡田 昌子, 井上 真美子, 加賀 早苗, 横山 しのぶ, 西田 睦, 松野 一彦, 阿部 歩, 小野塚 久夫, 筒井 裕之
    超音波医学 35 1 69 - 69 (公社)日本超音波医学会 2008年01月
  • 左室肥大が右室全体機能に与える影響とその機序:血流ドプラ法と二次元スペックルトラッキング法による検討
    表原 里実, 三神 大世, 加賀 早苗, 小野塚 久夫, 阿部 歩, 井上 真美子, 横山 しのぶ, 西田 睦, 鈴木 春樹, 清水 力, 松野 一彦, 小松 博史, 岡田 昌子, 山田 聡, 筒井 裕之
    超音波医学 35 1 69 - 70 (公社)日本超音波医学会 2008年01月
  • 肥大型心筋症における左右両心室の局所心筋機能 二次元スペックルトラッキング法による評価
    加賀 早苗, 三神 大世, 小野塚 久夫, 井上 真美子, 横山 しのぶ, 西田 睦, 鈴木 春樹, 清水 力, 松野 一彦, 小松 博史, 岡田 昌子, 山田 聡, 筒井 裕之
    臨床化学 36 Suppl.2 193 - 193 (一社)日本臨床化学会 2007年10月
  • 左室収縮不全のない心疾患患者におけるE/E'の意義 左室充満圧と血流伝播速度との比較に基づく検討
    井上 真美子, 山田 聡, 三神 大世, 小室 薫, 小松 博史, 岡田 昌子, 横山 しのぶ, 加賀 早苗, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 小野塚 久夫, 筒井 裕之
    超音波医学 34 4 471 - 472 (公社)日本超音波医学会 2007年07月
  • 肥大心における右室局所機能 2次元スペックルトラッキング法に基づく検討
    加賀 早苗, 三神 大世, 小野塚 久夫, 井上 真美子, 横山 しのぶ, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 小松 博史, 岡田 昌子, 山田 聡, 筒井 裕之
    超音波医学 34 4 472 - 472 (公社)日本超音波医学会 2007年07月
  • 井上 真美子, 三神 大世, 岡田 昌子, 小松 博史, 山田 聡, 小野塚 久夫, 筒井 裕之, 横山 しのぶ, 加賀 早苗, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 松居 喜郎
    超音波検査技術 32 3 386 - 386 (一社)日本超音波検査学会 2007年06月
  • 西田 睦, 増田 香織, 佐藤 恵美, 溝口 恵美, 加賀 早苗, 井上 真美子, 横山 しのぶ, 北村 忠代, 清水 力, 千葉 仁志
    超音波検査技術 32 2 200 - 200 (一社)日本超音波検査学会 2007年04月
  • 加賀 早苗, 三神 大世, 小野塚 久夫, 井上 真美子, 横山 しのぶ, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 岡田 昌子, 山田 聡, 筒井 裕之
    超音波検査技術 32 2 206 - 206 (一社)日本超音波検査学会 2007年04月
  • 溝口 恵美, 西田 睦, 佐藤 恵美, 増田 香織, 横山 しのぶ, 井上 真美子, 加賀 早苗, 北村 忠代, 清水 力, 千葉 仁志
    超音波検査技術 32 2 228 - 228 (一社)日本超音波検査学会 2007年04月
  • 心房細動患者におけるE/E'の1心拍計測は可能か?
    横山 しのぶ, 三神 大世, 加賀 早苗, 井上 真美子, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 小松 博史, 岡田 昌子, 山田 聡, 小野塚 久夫, 筒井 裕之
    超音波医学 33 6 693 - 693 (公社)日本超音波医学会 2006年11月
  • 2次元スペックルトラッキング法を用いて方向別にみた心筋局所収縮様式の部位差 正常心と高血圧性肥大心における検討
    加賀 早苗, 三神 大世, 井上 真美子, 横山 しのぶ, 阿部 歩, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 後藤 数智, 小松 博史, 岡田 昌子, 山田 聡, 小野塚 久夫, 筒井 裕之
    超音波医学 33 6 694 - 694 (公社)日本超音波医学会 2006年11月
  • 造影超音波が有用であった消化管急性腹症の2例
    西田 睦, 清水 力, 千葉 仁志, 今井 希一, 木村 もと子, 新山 智美, 佐川 直美, 北村 忠代, 井上 真美子, 加賀 早苗, 横山 しのぶ
    超音波医学 33 6 698 - 699 (公社)日本超音波医学会 2006年11月
  • 横山 しのぶ, 三神 大世, 加賀 早苗, 井上 真美子, 西田 睦, 北村 忠代, 清水 力, 千葉 仁志, 小松 博史, 岡田 昌子, 山田 聡, 小野塚 久夫, 筒井 裕之
    臨床病理 54 補冊 218 - 218 (一社)日本臨床検査医学会 2006年10月
  • Kazutomo Goto, Taisei Mikami, Hisao Onozuka, Sanae Kaga, Mamiko Inoue, Hiroshi Komatsu, Kaoru Komuro, Satoshi Yamada, Hiroyuki Tsutsui, Akira Kitabatake
    JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY 19 7 857 - 864 2006年07月 [査読有り][通常論文]
     
    Background: The usefulness of Doppler strain rate imaging for assessment of left ventricular regional diastolic function has not been fully determined. Objective: We aimed to clarify the relationships between diastolic strain rates and global diastolic function and find a useful index for regional diastolic function in patients with hypertrophic cardiomyopathy (HCM). Methods: Strain rate curves were obtained using an apical approach at 12 different sites of the left ventricular myocardium in 25 patients with HCM and 20 control subjects, and peak early diastolic strain rate (E-SR), peak late diastolic strain rate, and the time from QRS to E-SR were measured. The flow propagation velocity was measured using color M-mode Doppler echocardiography as a global diastolic index. Results: Each of the spatially averaged values of E-SR and E-SR/peak late diastolic strain rate and the coefficients of variation of time from QRS to E-SR was significantly correlated with flow propagation velocity, but the best correlation was observed in E-SR. Although both E-SR and peak late diastolic strain rate of each myocardial segment of patients with HCM tended to decrease as the wall thickness increased, only E-SR significantly decreased even in the segments without apparent hypertrophy. Conclusions: In patients with HCM, the reduction of E-SR was more closely associated with global diastolic dysfunction than asynchrony, and E-SR may be a useful and sensitive index for regional diastolic function.
  • T Furumoto, S Fujii, T Mikami, M Inoue, K Nishihara, S Kaga, S Imagawa, K Goto, K Komuro, S Yamada, H Onozuka, A Kitabatake, BE Sobel
    CORONARY ARTERY DISEASE 17 1 45 - 50 2006年02月 [査読有り][通常論文]
     
    Background The potential use of assays of N-terminal pro-brain natriuretic peptide for detection of diastolic abnormalities associated with alterations in blood pressure has not been elucidated. This study was designed to determine whether increased plasma concentrations of N-terminal pro-brain natriuretic peptide sensitively reflect abnormal diastolic function associated with hypertension. Methods Concentrations of N-terminal pro-brain natriuretic peptide in plasma were assayed in 40 previously untreated hypertensive patients without overt congestive heart failure and in 20 age and sex-matched controls. Hypertensive patients were studied with the use of pulsed Doppler and color M-mode Doppler echocardiography for the evaluation of left ventricular diastolic function. Results Concentrations of N-terminal pro-brain natriuretic peptide were elevated in hypertensive patients [75.1 +/- 75.2 (SD) pg/ml compared with 37.9 +/- 38.5 in controls, P < 0.051. In hypertensive patients, concentrations of N-terminal pro-brain natriuretic peptide were negatively correlated with the ratio of color M-mode flow propagation velocity to transmitral E velocity consistent with the view that increased concentrations of N-terminal pro-brain natriuretic peptide are indicative of alterations in diastolic function. Hypertensive patients with N-terminal pro-brain natriuretic peptide values above the mean value in the control group exhibited significantly increased brachial intimal-medial thickness and reduced wall stress, consistent with the view that increased N-terminal pro-brain natriuretic peptide was associated with favorable peripheral arterial remodeling. Conclusions Elevated concentrations of N-terminal pro-brain natriuretic peptide in plasma reflect the presence of left ventricular diastolic abnormalities and peripheral arterial remodeling in asymptomatic patients with hypertension.
  • Mamiko Inoue, Satoshi Fujii, Taisei Mikami, Tomoo Furumoto, Sanae Kaga, Hiroshi Komatsu, Kazutomo Goto, Kaoru Komuro, Satoshi Yamada, Hisao Onozuka, Akira Kitabatake, Hiroyuki Tsutsui
    Journal of Cardiology 47 1 9 - 14 2006年 [査読有り][通常論文]
     
    Objectives. The efficacy of antihypertensive agents can vary in patients. Four to 8 weeks may be required before antihypertensive agents become fully effective. Predicting the efficacy can help agent selection and dose setting. This study determined whether nitroglycerin-induced vasodilation of brachial arteries can predict the antihypertensive action of angiotensin II receptor antagonist. Methods. Untreated uncomplicated patients with essential hypertension, who gave informed consent, were studied (n = 20, mean age 55 years). Before antihypertensive treatment, nitroglycerin-induced vasodilation of the brachial arteries was measured using a novel method of 15 MHz high-frequency high-frame-rate ultrasound imaging (Hitachi EUB8000). Diameter of the brachial artery at the end-systolic phase was measured before and after 0.3 mg nitroglycerin sublingual spray and percentage vasodilation (%D-N) was calculated. The reduction of mean blood pressure after nitroglycerin (%BP-N) was calculated. Valsartan monotherapy (40-80 mg/day) was administered for 3-6 months (mean 132 days). Reduction of mean blood pressure after valsartan monotherapy (%BP-V) was calculated. Results. Valsartan decreased systolic blood pressure from 138 ± 13 to 130 ± 17mmHg, and diastolic blood pressure from 83 ± 11 to 78 ± 11 mmHg (p < 0.05). %D-N was correlated closely with %BP-V (r = -0.70, p < 0.001). %BP-N had no correlation with %BP-V (r = 0.13, p = 0.58). Conclusions. Direct vasodilatory action of nitroglycerin on vascular smooth muscle cells may predict the chronic antihypertensive effect of angiotensin II receptor antagonist.
  • Hisao Onozuka, Taisei Mikami, Sanae Kaga, Satoshi Yamada, Keiko Nishihara, Kaoru Kamuro, Mamiko Inoue, Jun-ichi Teranishi, Kazushi Urasawa, Hiroyuki Tsutsui, Akira Kitabatake
    Journal of Echocardiography 3 4 140 - 147 Japanese Society of Echocardiography 2005年 [査読有り][通常論文]
     
    Background. The apical approach (ApA) has been usually employed for the continuous-wave Doppler (CWD) measurement of pressure gradient in the left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM). This study aimed to assess the usefulness of a left parasternal approach (LPA) using the most cranial part of the echo-window for the measurement of the LVOT pressure gradient.
    Methods. CWD using LPA and ApA was performed in 19 patients with HOCM to measure LVOT peak pressure gradients (PGLPA and PGApA, respectively) and record a signal of mitral regurgitation (MR). The beam incident angles to LVOT flow in LPA (θLPA) and in ApA (θApA) were measured using color Doppler flow imaging.
    Results. PGLPA was distinctly greater (>= 10mmHg) than PGApA in 7 patients (37%); they were similar in 6 (32%); and PGLPA was distinctly smaller (<= -10mmHg) than PGApA in 6 (32%). All patients had MR. While all the MR jets in ApA shifted away from the probe, i.e. to the same side of the LVOT flow, 18 of the 19 MR jets shifted to the opposite side of the LVOT flow, when using LPA. Cos θLPA was significantly smaller and Cos θApA was significantly greater in the HOCM patients than 10 control subjects (p<0.001 for both). Both PGLPA and PGApA correlated with the invasive pressure gradient (r=0.99 and r=0.97) in 7 patients who underwent invasive study. PGLPA was closer to the invasive pressure gradient than PGApA in 6 patients.
    Conclusions. LPA provided a more accurate measurement of pressure gradient than ApA in about one third of HOCM patients, probably due to the altered direction of LVOT flow in HOCM. LPA is also useful in distinguishing LVOT flow from MR jet commonly seen in these patients.
  • Norifumi Hirao, Hisao Onozuka, Satoshi Yamada, Kaoru Komuro, Hiroshi Okamoto, Akira Kitabatake, Taisei Mikami, Sanae Kaga, Mamiko Inoue
    Journal of Echocardiography 2 3 68 - 77 2004年 [査読有り][通常論文]
     
    Background. Color M-mode Doppler echocardiography provides accurate evaluation of LV diastolic function noninvasively and is reportedly preload independent compared with pulsed Doppler transmitral velocity indexes. This study aimed to determine the prognostic significance of left ventricular (LV) diastolic function in patients with different degrees of chronic LV systolic dysfunction using color M-mode Doppler echocardiography. Methods. A total of 98 consecutive subjects (mean age 57 years, 78 males) with LV systolic dysfunction (61 with previous myocardial infarction and 37 with dilated cardiomyopathy) underwent clinical and echocardiographic evaluation to determine functional status. Measurements of LV and left atrial dimensions, LV ejection fraction (EF), the peak of early and late diastolic transmitral velocities (E and A, respectively), the E/A ratio, deceleration time of E velocity and isovolu-mic relaxation time using conventional echo-Doppler techniques, and LV flow propagation velocity (FPV) and FPV/E using color M-mode Doppler echocardiography were taken. Results. During the mean follow-up period of 37±28 months, 26 patients had cardiovascular events (death in 4, congestive heart failure in 13, ventricular tachycardia in 6, and cerebral infarction in 3). EF was the single independent predictor of cardiovascular events. While, in the subgroup with EF < 0.35, the functional class was the single significant predictor of cardiovascular events, FPV/E was the single best predictor of cardiovascular events in the subgroup with EF > 0.35. Conclusions. The evaluation of LV diastolic function using color M-mode Doppler-derived FPV/E contributes to predicting clinical outcomes of patients with mildly depressed LV systolic function. © 2004, Japanese Society of Echocardiography. All rights reserved.

MISC

書籍等出版物

  • 心不全治療に心エコーを生かすQ&A115
    加賀 早苗 (担当:分担執筆)
    メジカルビュー 2017年04月
  • JAMT技術教本シリーズ 超音波検査症例集
    加賀 早苗 (担当:分担執筆範囲:僧帽弁狭窄症)
    じほう 2016年

講演・口頭発表等

  • 右心系を極める~右心機能評価の断面設定と計測のポイント~  [招待講演]
    加賀 早苗
    日本心エコー図学会第29回学術集会 2018年04月 シンポジウム・ワークショップパネル(指名)
  • 心不全患者の生理機能検査データを読み解こう  [招待講演]
    加賀 早苗
    北海道臨床衛生検査技師会第14回しばれセミナー 2018年02月 公開講演,セミナー,チュートリアル,講習,講義等
  • 基礎疾患で考える:膠原病  [招待講演]
    加賀 早苗
    第26回日本心エコー図学会学術集会 2015年03月 シンポジウム・ワークショップパネル(指名)
  • 拡張機能Update  [招待講演]
    加賀 早苗
    第63回日本医学検査学会 2014年05月 シンポジウム・ワークショップパネル(指名)
  • 肺高血圧症の心エコー検査の実際  [招待講演]
    加賀 早苗
    講演会「肺高血圧症と心エコー」 2012年07月 公開講演,セミナー,チュートリアル,講習,講義等

共同研究・競争的資金等の研究課題

  • 日本学術振興会:科学研究費助成事業
    研究期間 : 2019年04月 -2023年03月 
    代表者 : 加賀 早苗
     
    心不全は、心疾患による死亡の大半に関わる重篤かつ頻度の高い合併症であるが、最近、左心不全患者の予後が右室機能の良否に左右されることが注目されている。これは肺循環系が右室に与える後負荷に起因すると考えられる。従って、肺循環動態を精密に把握する意義は大きいと考えられる。本研究の目的は、左心不全患者の肺循環系が右室に与える後負荷を、非侵襲的な心エコー法で包括的に評価するための方法論を確立し、その右室機能や患者予後との関係を明らかにすることである。 肺循環動態指標のひとつである肺血管抵抗(PVR)と肺動脈キャパシタンスの積である抵抗-コンプライアンス時間(RCT)の算出法として、対数法と積算法とではRCT計測値に差があることが問題点として指摘されている。本研究では、簡易的な対数法と積算法で求めたRCTを、時定数τとして標準的に求めたRCTとの比較に基づき、その妥当性を検討した。右心カテーテル検査が施行され、良好な記録が得られた洞調律例46例を対象に、肺動脈圧波形から平均肺動脈楔入圧(PAWP)を差し引いた圧曲線を作成し、拡張期時定数τを求め、これを標準RCTとした。また、簡易的対数法により、拡張早期と心房収縮直前の二点の圧とその間の時間およびPAWPから簡易RCTを算出した。さらに、肺動脈収縮期圧、肺動脈拡張期圧、平均肺動脈圧、PAWP、1回拍出量および心拍出量から、PVRとPACをそれぞれ求め、それらの積を積算RCTとした。 全46例における標準RCTは0.28±0.14秒であり、簡易RCTは標準RCTとよく相関し(r=0.93、p<0.01)、標準RCTに対する加算誤差を示さなかった。積算RCTも標準RCTとよく対応したが(r=0.76、p<0.01)、標準RCTに対して正の加算誤差を認め、RCTを過大評価した。


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