Dec. 2023, キヤノンメディカルシステムズ株式会社, 画論31st The Best Image 優秀賞(超音波 心臓部門)　　　　　　　　　　　　　　　
村山迪史, 石坂 傑

2021, 北海道心臓協会, 研究開発調査助成　　　　　　　　　　　　　　　

Intermittent Mechanical Aortic Valve Sticking Due to Pannus Formation Complicated by Coronary Embolism and Cardiac Arrest.
Yu Agata, Atsushi Tada, Hiroshi Sugiki, Koji Sato, Rui Katano, Kenta Otsuka, Yutaro Yasui, Suguru Ishizaka, Toshiyuki Nagai, Satoru Wakasa, Toshihisa Anzai
The Canadian journal of cardiology, 14 Jan. 2026, [International Magazine]
English, Scientific journal

Echocardiographic Estimation of right ventricular stroke work index based on pulmonary regurgitant velocity in heart failure with reduced ejection fraction.
Yuta Tateishi, Michito Murayama, Sanae Kaga, Kie Yamazaki, Fuka Ando, Mana Goto, Yusuke Yanagi, Shinobu Yokoyama, Hisao Nishino, Makoto Kambayashi, Yui Shimono, Kosuke Nakamura, Yoji Tamaki, Suguru Ishizaka, Hiroyuki Iwano, Toshiyuki Nagai, Toshihisa Anzai
Journal of echocardiography, 04 Dec. 2025, [Domestic magazines]
English, Scientific journal, BACKGROUND: Right ventricular (RV) dysfunction is a key determinant of mortality in heart failure with reduced left ventricular ejection fraction (HFrEF). RV stroke work index (RVSWI) is an established invasive parameter of RV function; however, echocardiographic methods for estimating RVSWI have not yet been fully established. We hypothesized that the pulmonary regurgitant (PR) velocity waveform-derived early-diastolic pulmonary artery-RV pressure gradient (PRPG) would allow an accurate estimation of RVSWI because of its fidelity to the original formula. This study aimed to investigate whether non-invasive estimation of RVSWI is feasible in patients with HFrEF. METHODS: In this retrospective study, 120 adult patients with HFrEF who underwent right heart catheterization within 24 h of echocardiography were included. RVSWI was calculated as (mean pulmonary artery pressure - mean right atrial pressure) × stroke volume index (SVI). Based on the continuous-wave Doppler velocity measurements of PR, echocardiographic estimation of RVSWI was calculated as PRPG × pulsed-wave Doppler-derived SVI (RVSWIPR). RESULTS: The RVSWIPR was significantly correlated with RVSWI (ρ = 0.670, p < 0.001). Bland-Altman analysis showed no direct fixed bias. Sensitivity analysis performed in 21 patients with HFrEF and severe tricuspid regurgitation, which is a challenging subgroup for non-invasive RV function assessment, showed similar results. In the receiver operating characteristic curve analyses to detect the patients with RVSWI < 250 mmHg∙mL/m2, the area under the curve was 0.954, and a cut-off value of 371 mmHg∙mL/m2 showed 100% sensitivity and 82% specificity. CONCLUSIONS: RVSWIPR, based on PR velocity waveform analysis, was useful for the non-invasive assessment of RVSWI in HFrEF.

Blood Flow Dynamics of Self-expanding vs Balloon-expandable Transcatheter Aortic Valve Replacement in Patients With a Small Aortic Annulus.
Takeshi Hamaya, Kiwamu Kamiya, Toshiyuki Nagai, Satonori Tsuneta, Noriko Oyama-Manabe, Hirokazu Komoriyama, Yuki Takahashi, Akinori Takahashi, Yuki Mori, Yoshifumi Mizuguchi, Sakae Takenaka, Suguru Ishizaka, Takuma Sato, Taro Temma, Yasushige Shingu, Kohsuke Kudo, Satoru Wakasa, Toshihisa Anzai
The Canadian journal of cardiology, 41, 12, 2364, 2377, Dec. 2025, [International Magazine]
English, Scientific journal, BACKGROUND: A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). METHODS: We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm2. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR. RESULTS: In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups. CONCLUSIONS: In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.

Left Ventricular Stroke Work Index as a Predictor of Aortic Stenosis After Transcatheter Aortic Valve Implantation.
Hiroyuki Iwano, Kimi Sato, Noor Albakaa, Shingo Tsujinaga, Suguru Ishizaka, Yasuyuki Chiba, Hisao Nishino, Sanae Kaga, Tomoko Ishizu, Yoshihiro Seo
Echocardiography (Mount Kisco, N.Y.), 42, 9, e70281, Sep. 2025, [International Magazine]
English, Scientific journal, PURPOSE: Evaluation of left ventricular (LV) myocardial contractility to predict outcome in aortic stenosis (AS) is challenging because global longitudinal strain (GLS) does not take afterload into account. We thus tested prognostic value of an echocardiographic index of LV external work, stroke work index (SWI) in AS patients undergoing transcatheter aortic valve implantation (TAVI). METHODS: We evaluated 1583 patients who underwent TAVI from database of a multicenter retrospective study. As an index of LV external work, echocardiographic LV SWI was calculated as 0.0136 × [stroke volume index × (mean aortic pressure + mean transvalvular pressure gradient-LV end-diastolic pressure)] [g × min/m2], where LV end-diastolic pressure was estimated as 4.9 + (0.62 × E/e') [mmHg]. GLS data was available in 902 patients. Primary endpoint was defined as cardiac death or worsening heart failure. RESULTS: During a median follow-up period of 725 days, 262 patients experienced primary endpoint. Kaplan-Meyer analysis showed that patients having lower LV SWI had lower event-free survival. Furthermore, Cox regression analysis showed that LV SWI was associated with primary endpoint independently of other clinically relevant factors. When influence of LV SWI on outcome was tested in preserved and reduced GLS groups respectively, LV SWI discriminated event-free survival in patients showing reduced GLS. CONCLUSION: Reduced LV SWI before TAVI was associated with poorer outcomes in AS patients. Furthermore, combined assessment of LV SWI and GLS is expected to improve prognostic risk stratification in AS patients undergoing TAVI.

Role of Passive Leg Raise Stress Echocardiography in Latent Stiff Left Atrial Syndrome.
Michito Murayama, Hiroyuki Iwano, Satonori Tsuneta, Noriyuki Otsuka, Makoto Kambayashi, Yui Shimono, Yoji Tamaki, Suguru Ishizaka, Shinobu Yokoyama, Hisao Nishino, Sanae Kaga, Toshiyuki Nagai, Toshihisa Anzai
Circulation. Cardiovascular imaging, e018662, 06 Aug. 2025, [International Magazine]
English, Scientific journal

Clinical Phenotyping and Treatment Response in Patients With Chronic Heart Failure.
Daishiro Tatsuta, Motoki Nakao, Toshiyuki Nagai, Yoshifumi Mizuguchi, Isao Yokota, Taro Koya, Atsushi Tada, Suguru Ishizaka, Fusako George, Yoshiya Kato, Shogo Imagawa, Ko Motoi, Yusuke Tokuda, Masashige Takahashi, Junichi Matsumoto, Masaharu Machida, Hiroshi Okamoto, Takahiko Saito, Toshihisa Anzai
JACC. Advances, 4, 8, 101972, 101972, Aug. 2025, [International Magazine]
English, Scientific journal, BACKGROUND: There are little data on clinically meaningful heart failure (HF) phenogroups, which are associated with treatment response across the wide spectrum of left ventricular (LV) ejection fraction. OBJECTIVES: The authors aimed to identify the phenotypes of patients with HF with different prognoses and responses to medical therapies. METHODS: We examined consecutive 2,301 chronic HF patients from the ELMSTAT-HF (EpidemioLogical Multicenter Study for Tailored Treatment in Heart Failure) registry, a prospective multicenter cohort in which 2,317 patients were enrolled between January 2020 and September 2024. Latent class analysis was performed using 99 clinical features. The primary outcome was a composite of all-cause death and hospitalization for worsening HF. RESULTS: The analysis subclassified the patients into 8 phenogroups: group 1, characterized by younger age with obesity; 2, less structural abnormality and comorbidity; 3, younger age with LV dilation; 4, LV hypertrophy; 5, older age with small LV and diastolic dysfunction; 6, ischemic cardiomyopathy; 7, advanced LV remodeling and ventricular arrhythmias; and 8, atrial myopathy. During a median follow-up of 597 (IQR: 302-932) days, the incidence of the primary outcome significantly differed between the phenogroups (P < 0.001). In phenogroup 5, patients taking beta-blockers or sodium-glucose cotransporter 2 inhibitors had a significantly higher rate of hospitalization for worsening HF (HR: 2.20; 95% CI: 1.04-4.68; HR: 4.27; 95% CI: 2.02-9.05, respectively). CONCLUSIONS: We identified 8 phenogroups with distinct clinical outcomes in patients with HF. This phenotyping provides appropriate risk stratification and may aid clinical decision-making in patients with HF.

Cirrhotic Cardiomyopathy: Prevalence and Clinical Impact on Liver Cirrhosis Outcomes.
Takashi Kitagataya, Goki Suda, Takatsugu Tanaka, Shoichi Kitano, Naohiro Yasuura, Akimitsu Meno, Takashi Sasaki, Risako Kohya, Qingjie Fu, Shunichi Hosoda, Sonoe Yoshida, Osamu Maehara, Shunsuke Ohnishi, Masatsugu Ohara, Masato Nakai, Takuya Sho, Kosuke Nakamura, Suguru Ishizaka, Naoya Sakamoto
Hepatology research : the official journal of the Japan Society of Hepatology, 55, 10, 1367, 1375, 19 Jun. 2025, [International Magazine]
English, Scientific journal, AIM: Cirrhotic cardiomyopathy (CCM) is a significant complication of liver cirrhosis; however, its prevalence and impact in Asian populations remain unclear. The aim of this study was to assess the prevalence of CCM in Japanese patients with liver cirrhosis and to evaluate its impact on clinical outcomes. METHODS: In this retrospective study, 80 patients with liver cirrhosis confirmed using transient elastography (liver stiffness ≥ 12.5 kPa) were included. Study was performed at Hokkaido University Hospital between January 2014 and April 2024. CCM was diagnosed using the 2019 Cirrhotic Cardiomyopathy Consortium criteria. Subsequently, patient characteristics, survival, and the incidences of decompensation and cardiovascular events were analyzed. RESULTS: The prevalence of CCM was 46.3% (37/80), with 78.4% of patients with CCM showing isolated systolic dysfunction based on global longitudinal strain. Patients with CCM were significantly older, had lower serum ammonia and bilirubin levels, and had higher platelet counts. CCM was associated with a significantly higher incidence of decompensation events (hazard ratio 3.97, 95% confidence interval 1.64-9.61, p = 0.003) and was an independent risk factor for decompensation in the multivariate analysis (hazard ratio 3.24, 95% confidence interval 1.29-8.11, p = 0.012). Patients with and without CCM showed no significant differences in overall survival or cardiovascular events. CONCLUSIONS: CCM is prevalent among Japanese patients with liver cirrhosis and is associated with an increased risk of hepatic decompensation. These findings highlight the importance of cardiac evaluation in patients with cirrhosis and suggest that CCM should be considered in the management of liver cirrhosis to improve patient outcomes.

Impact of right ventricular reserve function during exercise on aortic valve opening in patients with left ventricular assist device.
Sakae Takenaka, Takuma Sato, Toshiyuki Nagai, Atsushi Tada, Yuta Kobayashi, Sho Kazui, Yutaro Yasui, Takeshi Hamaya, Yuki Mori, Akinori Takahashi, Suguru Ishizaka, Takao Konishi, Taro Temma, Kiwamu Kamiya, Tomonori Ooka, Satoru Wakasa, Toshihisa Anzai
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 44, 11, 1776, 1785, 31 May 2025, [International Magazine]
English, Scientific journal, BACKGROUND: Although aortic valve (AV) opening during exercise has fewer adverse events in patients with a left ventricular (LV) assist device (LVAD), factors associated with it remain unclear. We hypothesized that right ventricular (RV) reserve function is associated with the AV opening status. This study aimed to explore the hemodynamic parameters observed at rest and during maximal exercise and investigate the association between the RV reserve function and AV opening status in patients with an LVAD. METHODS: We prospectively examined 25 consecutive patients with an LVAD who underwent invasive exercise right heart catheterization with simultaneous echocardiography in the supine position. The AV opening status was assessed at rest and during exercise. The change in RV stroke work index (RVSWI) from rest to peak exercise (ΔRVSWI) was calculated to assess the RV reserve function. Patients were divided into three groups according to AV opening: AV opening both at rest and during exercise (n = 7), AV opening during exercise only (n = 8), and closed AV (n = 10). RESULTS: Patients with a closed AV had significantly lower ΔRVSWI and ΔRV dP/dt max than those with AV opening both at rest and during exercise and AV opening during exercise only, whereas changes in pulmonary artery wedge pressure and pulmonary vascular resistance were comparable across the groups. In a multivariable logistic regression analysis, ΔRVSWI was independently associated with AV opening even after adjustment for the change in LV ejection fraction from rest to peak exercise. During a median follow-up period of 743 (interquartile range, 483-1037) days, the incidence of adverse events was higher in patients in the closed AV group than in those in the AV opening groups (p = 0.002). CONCLUSIONS: RV reserve function is associated with AV opening status in patients with an LVAD. CLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp/ctr/index.htm. Unique Identifier: UMIN000039001.

Prognostic Value of Reticulocyte Production Ability in Patients with Chronic Heart Failure.
Motoki Nakao, Toshiyuki Nagai, Atsushi Tada, Taro Koya, Suguru Ishizaka, Yoshifumi Mizuguchi, Fusako George, Yoshiya Kato, Shogo Imagawa, Yusuke Tokuda, Masashige Takahashi, Junichi Matsumoto, Ko Motoi, Hiroshi Okamoto, Masaharu Machida, Takahiko Saito, Toshihisa Anzai
The Canadian journal of cardiology, 41, 7, 1274, 1284, 07 Feb. 2025, [International Magazine]
English, Scientific journal, BACKGROUND: Anemia is frequently observed and associated with mortality in patients with heart failure (HF). Although the quality of erythropoiesis is an intrinsic aspect of anemia's pathophysiology, its prognostic value in HF patients is unclear. METHODS: Between January 2020 and October 2023, 1,328 symptomatic patients with chronic HF from a multicenter registry were prospectively examined. The reticulocyte production ability was evaluated by calculating the reticulocyte production index (RPI) using reticulocyte counts and serum hematocrit level. Patients were divided into four groups based on the presence or absence of anemia and the median RPI. The primary outcome was a composite of all-cause death and hospitalization for worsening HF. RESULTS: During a median follow-up of 551 (interquartile range 321-712) days, the primary outcome occurred in 219 patients. The incidence of the primary outcome was high among patients in the anemia and higher RPI group (≥ 0.978) (P <0.001). Higher RPI was independently associated with a higher risk of the primary outcome, even after adjusting for prognostic covariates (adjusted HR 1.37; 95% CI 1.05-1.78). Erythrocyte counts were significantly higher in patients with higher RPI in the groups without anemia (P <0.001); however, no significant differences were observed between the groups with anemia (P = 0.923). Serum iron levels and transferrin saturation did not significantly differ between the RPI groups with or without anemia. CONCLUSIONS: Higher RPI, which may reflect impaired maturation or a shortened lifespan of erythrocytes, was associated with worse clinical outcomes in HF patients irrespective of iron status.

Optimal Cut Plane for Tricuspid Annular Plane Systolic Excursion Measurement.
Michito Murayama, Sanae Kaga, Hisao Nishino, Yusuke Yanagi, Mana Goto, Fuka Ando, Shinobu Yokoyama, Marina Yamaguchi, Kazunori Okada, Masahiro Nakabachi, Makoto Kambayashi, Yui Shimono, Kosuke Nakamura, Yoji Tamaki, Suguru Ishizaka, Hiroyuki Iwano, Toshiyuki Nagai, Toshihisa Anzai
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 14 Jan. 2025, [International Magazine]
English, Scientific journal

Usefulness of frailty assessment using the revised Japanese version of the Cardiovascular Health Study on the prediction of clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
Takahiro Abe, Toshiyuki Nagai, Atsunori Yuasa, Yusuke Tokuda, Suguru Ishizaka, Sakae Takenaka, Yoshifumi Mizuguchi, Motoki Nakao, Takuma Sato, Taro Temma, Kiwamu Kamiya, Toshihisa Anzai
Cardiovascular intervention and therapeutics, 40, 1, 144, 151, Jan. 2025, [Domestic magazines]
English, Scientific journal, Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.

Role of anatomical regurgitant orifice area of the tricuspid valve measurements in patients with beyond severe tricuspid regurgitation.
Michito Murayama, Suguru Ishizaka, Keita Sakaguchi, Rion Ando, Hisao Nishino, Sanae Kaga, Toshihisa Anzai
Journal of echocardiography, 24 Dec. 2024, [Domestic magazines]
English, Scientific journal

Validation of Left Ventricular Filling Pressure Evaluation by Order of Tricuspid and Mitral Valve Opening in Patients With Atrial Fibrillation.
Hisao Nishino, Michito Murayama, Hiroyuki Iwano, Nobuyuki Kagiyama, Yutaka Nakamura, Yuka Akama, Misako Toki, Sachiko Takamatsu, Taiji Okada, Yasuyuki Chiba, Masahiro Nakabachi, Shinobu Yokoyama, Mana Goto, Yukino Suzuki, Suguru Ishizaka, Ko Motoi, Yoji Tamaki, Hiroyuki Aoyagi, Kosuke Nakamura, Sanae Kaga, Chiaki Watanabe, Kiwamu Kamiya, Toshiyuki Nagai, Takanori Teshima, Toshihisa Anzai
Circulation. Cardiovascular imaging, 17, 11, e017134, Nov. 2024, [International Magazine]
English, Scientific journal, BACKGROUND: Accurate assessment of left ventricular filling pressure in patients with atrial fibrillation or flutter (AF) remains difficult. A novel 2-dimensional scoring system, visually assessing time difference between mitral valve and tricuspid valve opening (VMT) score, based on temporal analysis of early diastolic valve opening, could be applied to these patients. We aimed to determine the usefulness of the VMT score in patients with AF. METHODS: We analyzed 119 consecutive patients with AF who underwent cardiac catheterization as a derivation cohort. The diagnostic performance of the VMT score was further evaluated in an external data set containing 189 patients with AF. Elevated left ventricular filling pressure was defined as a mean pulmonary arterial wedge pressure ≥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 the VMT score was finally graded as 0 to 3. Conventional Doppler parameters to estimate left ventricular filling pressure were also measured. RESULTS: Pulmonary arterial wedge pressure was elevated with an increase in the VMT score (0: 10±3, 1: 13±5, 2: 22±7, 3: 27±6 mm Hg; P<0.001), resulting in a significant rise in pulmonary arterial wedge pressure from VMT score 1 to 2. VMT≥2 predicted elevated pulmonary arterial wedge pressure with an accuracy of 87%, and the diagnostic accuracy of the VMT score was significantly higher than that of conventional Doppler parameters (C index, 0.88 versus 0.54-0.68; P<0.001). In addition, VMT ≥2 showed an incremental predictive value over plasma brain natriuretic peptide levels (C index, 0.79-0.93; P<0.001). In the external validation cohort, VMT≥2 demonstrated acceptable accuracy of 72%. CONCLUSIONS: VMT scoring was a useful echocardiographic marker of elevated left ventricular filling pressure and had an incremental benefit over practical biomarkers in patients with AF.

Differential impacts of self-care behavior on clinical outcomes in patients with and without recent heart failure hospitalization.
Taro Koya, Toshiyuki Nagai, Atsushi Tada, Motoki Nakao, Suguru Ishizaka, Yoshifumi Mizuguchi, Hiroyuki Aoyagi, Fusako George, Shogo Imagawa, Yusuke Tokuda, Yoshiya Kato, Masashige Takahashi, Hiroto Sakai, Masaharu Machida, Kenichi Matsutani, Takahiko Saito, Hiroshi Okamoto, Toshihisa Anzai
International journal of cardiology, 132452, 132452, 14 Aug. 2024, [International Magazine]
English, Scientific journal, BACKGROUND: Although clinical guidelines recommend self-care assessment for patients with chronic heart failure (CHF), its prognostic significance remains controversial. This study aimed to compare the prognostic significance of self-care behavior on mortality between patients with and without a history of recent hospitalization for heart failure (HF). METHODS: We analyzed consecutive 1907 CHF patients from a Japanese multicenter registry (January 2020-June 2023) using the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9) at enrolment. Suboptimal self-care behavior was defined as a score < 70 on the EHFScBS-9. Patients were divided into recent (within 30 days post-discharge, n = 664) and no recent hospitalization for HF groups (n = 1263), respectively. The primary outcome was a composite of all-cause death and rehospitalization for HF. RESULTS: During a median follow-up period of 427 (interquartile range 273-630) days, the primary outcome occurred in 100 patients. Patients with suboptimal self-care behavior exhibited a higher incidence of the primary outcome in the recent hospitalization for HF group (p = 0.020) but not in the no recent hospitalization for HF group (P = 0.16). Multivariable regressions showed suboptimal self-care behavior was independently associated with the primary outcome in the recent hospitalization for HF group with a significant interaction (P = 0.029). CONCLUSION: In patients recently hospitalized for HF, but not in those without a recent hospitalization history for HF, suboptimal self-care behavior was associated with adverse events. This indicates the importance of self-care education for these patients.

Head-to-Head Comparison of Hepatic Vein and Superior Vena Cava Flow Velocity Waveform Analyses for Predicting Elevated Right Atrial Pressure.
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, 03 Jun. 2024, [International Magazine]
English, Scientific journal, 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, Jun. 2024
Japanese

Acute onset of constrictive pericarditis due to acute myelomonocytic leukemia: A case and literature review.
Naoki Kosaka, Takanori Uchiyama, Masahiro Onozawa, Jun Nagai, Jiro Koya, Suguru Ishizaka, Toshiyuki Nagai, Yohei Ikebe, Kenjiro Kato, Zen-Ichi Tanei, Jun Sakakibara-Konishi, Yuta Hasegawa, Hiroyuki Ohigashi, Hideki Goto, Daigo Hashimoto, Hideki Ujiie, Satoshi Hirano, Satoshi Konno, Toshihisa Anzai, Koji Taniguchi, Shinya Tanaka, Takanori Teshima
Internal medicine (Tokyo, Japan), 16 Apr. 2024, [Domestic magazines]
English, Scientific journal, We herein present a fatal case of constrictive pericarditis (CP) due to acute myelomonocytic leukemia (AMML) in a patient who initially complained of an acute onset of chest pain two days after COVID-19 vaccination. An autopsy revealed pericardial infiltration of leukemic cells. CP is rarely associated with leukemia and only 14 cases have been reported in the literature. The etiology of CP in previous reports included leukemic infiltration, graft-versus-host disease, drug-induced, post-radiation, autoimmune, and otherwise unidentified. This case indicates that leukemic infiltration can cause CP and that clinicians should include leukemia in the differential diagnosis of CP.

Non-invasive assessment of left ventricular filling pressure in aortic stenosis.
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, Apr. 2024, [International Magazine]
English, Scientific journal, 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.

Echocardiographic estimation of right ventricular diastolic stiffness based on pulmonary regurgitant velocity waveform analysis in precapillary pulmonary hypertension.
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, 27 Mar. 2024, [International Magazine]
English, Scientific journal, 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.

TAVRを受ける重症大動脈弁狭窄症患者のリスク層別化における改訂日本語版Cardiovascular Health Study基準(改訂J-CHS基準)の有用性(Usefulness of Revised Japanese Version of Cardiovascular Health Study for Risk Stratification in Patients with Severe Aortic Stenosis Undergoing TAVR)　　　　　　　　　　　　　　　
阿部 隆宏, 永井 利幸, 湯浅 敦智, 徳田 裕輔, 石坂 傑, 竹中 秀, 水口 賢史, 中尾 元基, 佐藤 琢真, 天満 太郎, 神谷 究, 安斉 俊久
日本循環器学会学術集会抄録集, 88回, PJ017, 6, (一社)日本循環器学会, Mar. 2024
English

Exercise Capacity and Clinical Outcomes in Chronic Heart Failure Patients with Mild Tricuspid Regurgitation.
Kosuke Nakamura, Suguru Ishizaka, Kazunori Omote, Yutaro Yasui, Yoshifumi Mizuguchi, Sakae Takenaka, Yui Shimono, Ko Motoi, Hiroyuki Aoyagi, Yoji Tamaki, Sho Kazui, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Atsushi Tada, Yuta Kobayashi, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
Journal of clinical medicine, 12, 23, 01 Dec. 2023, [International Magazine]
English, Scientific journal, AIM: The present study aimed to investigate the impact of mild tricuspid regurgitation (TR) on the exercise capacity or clinical outcomes in patients with chronic heart failure (CHF). METHODS AND RESULTS: The study enrolled 511 patients with CHF who underwent cardiopulmonary exercise testing (CPET) between 2013 and 2018. The primary outcome was a composite of heart failure hospitalization and death. Patients with mild TR (n = 324) or significant TR (moderate or greater; n = 60) displayed worse NHYA class and reduced exercise capacity on CPET than those with non-TR (n = 127), but these were more severely impaired in patients with significant TR. A total of 90 patients experienced events over a median follow-up period of 3.3 (interquartile range 0.8-5.5) years. Patients with significant TR displayed a higher risk of events, while patients with mild TR had a 3.0-fold higher risk of events than patients with non-TR (hazard ratio (HR) 3.01; 95% confidence interval (CI), 1.50-6.07). Multivariate Cox regression analysis showed that, compared with non-TR, mild TR was associated with increased adverse events, even after adjustment for co-variates (HR 2.97; 95% CI, 1.35-6.55). CONCLUSIONS: TR severity was associated with worse symptoms, reduced exercise capacity, and poor clinical outcomes. Even patients with mild TR had worse clinical characteristics than those with non-TR.

Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement.
Yuki Takahashi, Kiwamu Kamiya, Toshiyuki Nagai, Satonori Tsuneta, Noriko Oyama-Manabe, Takeshi Hamaya, Sho Kazui, Yutaro Yasui, Kohei Saiin, Seiichiro Naito, Yoshifumi Mizuguchi, Sakae Takenaka, Atsushi Tada, Suguru Ishizaka, Yuta Kobayashi, Kazunori Omote, Takuma Sato, Yasushige Shingu, Kohsuke Kudo, Satoru Wakasa, Toshihisa Anzai
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 25, 1, 60, 60, 26 Oct. 2023, [International Magazine]
English, Scientific journal, BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR). METHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR. RESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups. CONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.

Impact of Cardiac Power Output on Exercise Capacity and Clinical Outcome in Patients With Chronic Heart Failure.
Yui Shimono, Suguru Ishizaka, Kazunori Omote, Kosuke Nakamura, Yutaro Yasui, Yoshifumi Mizuguchi, Sakae Takenaka, Hiroyuki Aoyagi, Yoji Tamaki, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
The American journal of cardiology, 206, 4, 11, 05 Sep. 2023, [International Magazine]
English, Scientific journal, Less data are available regarding the impact of cardiac power output on exercise capacity or clinical outcome in patients with chronic heart failure (CHF). The study enrolled 280 consecutive patients with CHF referred for cardiopulmonary exercise testing and right-sided heart catheterization between 2013 and 2018. The primary outcome was composite of heart failure hospitalization or death. Cardiac power output was calculated as (mean arterial pressure × CO) ÷ 451. Patients with low cardiac power output (<0.53 W, n = 99) were older and had a higher brain natriuretic peptide level than patients with high cardiac power output (≥0.53W, n = 181). Cardiac power output was correlated with peak oxygen consumption (peak V̇O2), peak workload achievement, and ventilatory efficiency (V̇E/V̇CO2 slope) in cardiopulmonary exercise testing, whereas each of cardiac output or mean arterial pressure was not. There were 48 patients with events over a median follow-up period of 3.5 (interquartile range 1.0 to 6.0) years. Patients with low cardiac power output had about a 2-fold higher risk of events than those with a high cardiac power output (hazard ratio 1.97, 95% confidence interval 1.12 to 3.48). In the multivariable Cox regression, a 0.1-W decrease in cardiac power output was associated with 19% increased adverse events (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). In conclusion, cardiac power output was associated with reduced exercise capacity and poor clinical outcome, suggesting that cardiac power output is useful for risk stratification in patients with CHF. Further study is required to identify therapies targeting cardiac power output to improve the exercise capacity or clinical outcome in patients with CHF.

Prognostic Value of Liver Fibrotic Markers in Patients With Heart Failure.
Atsushi Tada, Toshiyuki Nagai, Yoshiya Kato, Noriko Oyama-Manabe, Satonori Tsuneta, Michikazu Nakai, Yutaro Yasui, Sho Kazui, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Sakae Takenaka, Yoshifumi Mizuguchi, Yuta Kobayashi, Suguru Ishizaka, Kazunori Omote, Takuma Sato, Takao Konishi, Kiwamu Kamiya, Kohsuke Kudo, Toshihisa Anzai
The American journal of cardiology, 200, 115, 123, 01 Aug. 2023, [International Magazine]
English, Scientific journal, Several liver fibrotic markers are associated with prognosis in patients with heart failure (HF). However, the optimal markers for outcome prediction remain unclear. This study aimed to simultaneously investigate the prognostic value of liver fibrotic markers and the associations between these markers and clinical parameters in patients with HF without organic liver disease. We prospectively examined 211 consecutive patients with chronic HF between April 2018 and August 2021, excluding those with organic liver disease, using liver magnetic resonance imaging and ultrasound. A total of 7 representative liver fibrotic markers were measured in all patients. The primary outcome of interest was the composite of all-cause death and hospitalization for worsening HF. During a median follow-up period of 747 (interquartile range 465 to 1,042) days, the primary outcome occurred in 45 patients. Patients with higher hyaluronic acid and type III procollagen N-terminal peptide (P-III-P) levels showed a significantly higher incidence of the primary outcome than those without (p <0.001 and p = 0.005, respectively). The multivariable Cox regression analysis revealed that hyaluronic acid and P-III-P levels were independently associated with the risk of adverse events (hazard ratio 1.84, 95% confidence interval 1.18 to 2.87 and hazard ratio 2.89, 95% confidence interval 1.32 to 6.34, respectively) even after adjustment for a mortality prediction model, whereas the other 5 markers were not associated with the primary outcome. In conclusion, among the representative liver fibrotic markers, hyaluronic acid and P-III-P might be the optimal markers for outcome prediction in patients with HF.

Paradoxical increase in global longitudinal strain by handgrip exercise despite left ventricular diastolic dysfunction.
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, 14 Jul. 2023, [International Magazine]
English, Scientific journal, 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.

Application of an echocardiographic scoring system of left ventricular filling pressure to diagnose acute heart failure in patients complaining dyspnea.
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, 27 Apr. 2023, [International Magazine]
English, Scientific journal, 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, Apr. 2023
Japanese

Multimodal Imaging of Constrictive Pericarditis Induced by Long-term Pergolide Treatment for Parkinson's Disease.
Hiroyuki Aoyagi, Shingo Tsujinaga, Yuki Takahashi, Seiichiro Naito, Takuma Sato, Takuya Otsuka, Yoji Tamaki, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Kiwamu Kamiya, Hiroyuki Iwano, Toshiyuki Nagai, Satoru Wakasa, Toshihisa Anzai
Internal medicine (Tokyo, Japan), 31 Mar. 2023, [Domestic magazines]
English, Scientific journal, We herein report the first case of constrictive pericarditis (CP) induced by long-term pergolide treatment for Parkinson's disease that was assessed using multimodal imaging in a 72-year-old patient with leg edema and dyspnea. The patient was correctly diagnosed with CP using multimodal imaging and successfully treated with pericardiectomy. The treatment history of Parkinson's disease and pathological findings of the removed pericardium suggested that long-term pergolide was the cause of CP. Properly recognizing pergolide as the cause of CP and accurately diagnosing CP using multimodal imaging may contribute to the early detection and treatment of pergolide-induced CP.

Impact of right ventricular stiffness on discordance between hemodynamic parameter and regurgitant volume in patients with pulmonary regurgitation.
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, 17 Mar. 2023, [International Magazine]
English, Scientific journal, 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, (一社)日本循環器学会, Mar. 2023
English

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, Mar. 2023
Japanese

Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device.
Sakae Takenaka, Takuma Sato, Toshiyuki Nagai, Kazunori Omote, Yuta Kobayashi, Kiwamu Kamiya, Takao Konishi, Atsushi Tada, Yoshifumi Mizuguchi, Yuki Takahashi, Seiichiro Naito, Kohei Saiin, Suguru Ishizaka, Satoru Wakasa, Toshihisa Anzai
American journal of physiology. Heart and circulatory physiology, 324, 3, H355-H363, 01 Mar. 2023, [International Magazine]
English, Scientific journal, Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o2) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/dt than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD (r = 0.59, P = 0.003) and peak V̇o2 (r = 0.56, P = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS (r = 0.44, P = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD (r = -0.34, P = 0.88), peak V̇o2 (r = 0.074, P = 0.74), or EQ-VAS (r = 0.127, P = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD.NEW & NOTEWORTHY The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.

Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure.
Yutaro Yasui, Kosuke Nakamura, Kazunori Omote, Suguru Ishizaka, Sakae Takenaka, Yoshifumi Mizuguchi, Yui Shimono, Sho Kazui, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Atsushi Tada, Yuta Kobayashi, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai
The American journal of cardiology, 193, 37, 43, 01 Mar. 2023, [International Magazine]
English, Scientific journal, The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p = 0.008). Low hemoglobin concentration was strongly related to impaired PWR (β coefficient = 0.43, per 1 g/100 ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.

Validation of Echocardiographic Estimation of Right Atrial Pressure: Reconsideration of Guideline-Based Secondary Indices
Murayama Michito, Kaga Sanae, Onoda Airi, Okada Kazunori, Nakabachi Masahiro, Yokoyama Shinobu, Nishino Hisao, Aoyagi Hiroyuki, Tamaki Yoji, Motoi Ko, Ishizaka Suguru, Iwano Hiroyuki, Nagai Toshiyuki, Tsujino Ichizo, Anzai Toshihisa
Japanese Journal of Medical Ultrasound Technology, advpub, Japanese Society of Sonographers, 2023
Japanese, Purpose: Sonographic measurements of the inferior vena cava parameters are common noninvasive methods for estimating right atrial pressure. In intermediate cases in which the inferior vena cava parameters showed indeterminate value, the current guidelines of the American Society of Echocardiography recommended using secondary indices, which include restrictive right-sided diastolic filling pattern, the ratio of early-diastolic transtricuspid flow velocity to tricuspid annular velocity, and the hepatic venous systolic filling fraction. We aimed to clarify whether the above secondary indices improve the diagnostic ability of elevated right atrial pressure using inferior vena cava parameters and to test the incremental predictive value of right atrial area measurement.

Subjects and Methods: In 128 consecutive patients with various cardiac diseases referred for cardiac catheterization, the elevated right atrial pressure was defined as greater than or equal to 8 mmHg. Based on the inferior vena cava morphology, the estimated right atrial pressure was determined as 3, 8, and 15 mmHg (model 1). Additionally, the restrictive filling pattern, the ratio of early-diastolic transtricuspid flow velocity to tricuspid annular velocity, and the systolic filling fraction were evaluated to reclassify the intermediate value of 8 mmHg (model 2). The right atrial minimum and maximum area and volume were measured at ventricular end diastole and end systole, respectively, and the expansion indices were calculated.

Results: Elevated right atrial pressure was observed in 29 patients. Logistic regression analysis showed that estimated right atrial pressure based on the inferior vena cava indices and systolic filling fraction were significantly associated with elevated right atrial pressure (p＜0.05). Restrictive filling pattern was not observed in any of the patients, and the ratio of early-diastolic transtricuspid flow velocity to tricuspid annular velocity was not associated with elevated right atrial pressure. Right atrial morphological and functional parameters were significantly associated with elevated right atrial pressure (p＜0.05). Notably, the minimum right atrial area demonstrated the strongest association with right atrial pressure elevation (odds ratio adjusted for right ventricular systolic function: 10.64, p＜0.01). The predictive ability of model 2 was comparable to that of model 1 (global χ² value＝9 for model 1, 11 for model 2; p＝0.28). In contrast, incorporated with systolic filling fraction and minimal right atrial area as secondary indices, the predictive ability of the new model was improved compared to that of model 1 (global χ² value＝9 for model 1, 25 for the new model; p＜0.01).

Conclusion: Reclassification using guideline-recommended secondary indices failed to improve the predictive ability of elevated right atrial pressure. In contrast, a combination of systolic filling fraction and minimal right atrial area with inferior vena cava indices improved the predictive ability of elevated right atrial pressure.

Applicability of new proposed criteria for iron deficiency in Japanese patients with heart failure.
Atsushi Tada, Toshiyuki Nagai, Taro Koya, Motoki Nakao, Suguru Ishizaka, Yoshifumi Mizuguchi, Hiroyuki Aoyagi, Shogo Imagawa, Yusuke Tokuda, Masashige Takahashi, Yoshiya Kato, Masaharu Machida, Kenichi Matsutani, Takahiko Saito, Toshihisa Anzai
ESC heart failure, 10 Dec. 2022, [International Magazine]
English, Scientific journal, AIMS: Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). A recent study showed that ID defined by the current guideline criteria was not associated with worse clinical outcomes, and new ID criteria was proposed in patients with HF. However, the external applicability of the new proposed criteria is unclear. We sought to investigate the applicability of the proposed ID criteria in Japanese patients with HF. METHODS AND RESULTS: We prospectively examined 763 patients with chronic HF from a Japanese multicentre registry. The proposed ID criteria were transferrin saturation (TSAT) < 20% and serum iron ≤13 mmol/L and the guideline ID criteria were serum ferritin <100 ng/mL or, when ferritin was 100-299 ng/mL, TSAT <20%. Among all patients (456 male, mean age 71 ± 13 years), 213 (28%) and 444 (58%) met the proposed and guideline ID criteria, respectively. During a median follow-up period of 436 days (interquartile range 297-565), the primary outcome of all-cause mortality occurred in 56 (7%) patients. There was no significant difference in the primary outcome between the patients with and without guideline ID criteria (P = 0.32), whereas patients with serum iron ≤10 μmol/L showed higher mortality (P = 0.002). In multivariable Cox regressions, the proposed ID criteria, but not guideline ID criteria, were independently associated with the risk of all-cause mortality (HR 2.01, 95% CI 1.16-3.51 and HR 1.32, 95% CI 0.76-2.28, respectively), even after adjustment for covariates. CONCLUSIONS: When defined by the proposed criteria and not the guideline criteria, ID was associated with higher mortality in patients with chronic HF, suggesting that the proposed ID criteria is applicable to the Japanese population.

Associations of right ventricular pulsatile load and cardiac power output to clinical outcomes in heart failure: Difference from systemic circulation.
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, 08 Dec. 2022, [International Magazine]
English, Scientific journal, 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.

Beneficial effects of nintedanib on cardiomyopathy in patients with systemic sclerosis: a pilot study.
Keita Ninagawa, Masaru Kato, Satonori Tsuneta, Suguru Ishizaka, Hideyuki Ujiie, Ryo Hisada, Michihito Kono, Yuichiro Fujieda, Yoichi M Ito, Tatsuya Atsumi
Rheumatology (Oxford, England), 62, 7, 2550, 2555, 02 Dec. 2022, [International Magazine]
English, Scientific journal, OBJECTIVES: Nintedanib is an inhibitor of tyrosine kinases that has been shown to slow the progression of interstitial lung disease (ILD), including ILD associated with systemic sclerosis (SSc). The aim of this study was to explore the effect of nintedanib on cardiomyopathy associated with SSc. METHODS: Twenty consecutively hospitalized patients with SSc-ILD were enrolled and prospectively followed. The rate of change at six months in cardiac magnetic resonance (CMR) parametric mapping, including myocardial extracellular volume, was primarily evaluated. Other endpoints included changes in CMR functional parameters, echocardiographic parameters, modified Rodnan skin score, serum biomarkers, and pulmonary function test. RESULTS: Nintedanib was administered in 10 patients, whereas the other 10 were treated without nintedanib or watched, according to ILD severity and progression. Baseline values of CMR parametric mapping were not different between the two groups. The rate of change at six months in myocardial extracellular volume was largely different, almost divergent between the nintedanib group and the control group (-1.62% vs. +2.00%, p= 0.0001). Among other endpoints, the change in right ventricular ejection fraction was significantly different between the two groups (p= 0.02), with a preferential change in the nintedanib group. CONCLUSION: Our data indicate beneficial signals of nintedanib on cardiomyopathy associated with SSc. The anti-fibrotic effect of nintedanib might not be limited to the lung.

Determinants of exercise capacity in patients with heart failure without left ventricular hypertrophy.
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, 16 Sep. 2022, [International Magazine]
English, Scientific journal, 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.

Usefulness of Dual Gate Doppler in Assessing the Time Interval Between Pulmonary Venous and Transmitral Flows During Atrial Contraction
Okada Kazunori, Okada Yuka, Murayama Michito, Kaga Sanae, Masauzi Nobuo, Nishino Hisao, Yokoyama Shinobu, Nakabachi Masahiro, Nishida Mutsumi, Motoi Ko, Ishizaka Suguru, Chiba Yasuyuki, Tsujinaga Shingo, Iwano Hiroyuki, Anzai Toshihisa
Japanese Journal of Medical Ultrasound Technology, 47, 4, 353, 362, Japanese Society of Sonographers, 01 Aug. 2022
Japanese, Purpose: The difference in duration between pulmonary venous (PV) atrial systolic reversal wave (PVA) and atrial systolic wave (A) of transmitral flow (ΔA_dur) reflects the late-diastolic left ventricular (LV) operating stiffness and has a limitation on reproducibility. Using the Dual Gate Doppler technique, simultaneous recording of PV and transmitral flows can be obtained, which may contribute to improving the accuracy and reproducibility of ΔA_dur measurements.

Methods and Results: We examined 80 patients who underwent echocardiography using Dual Gate Doppler recording. Using the conventional Doppler recording, we measured the difference in duration between the PVA and transmitral A-wave (S-ΔA_dur). Additionally, the ratio of the time–velocity integral (TVI) of the PVA to that of the whole PV flow (F_PVA) and the ratio of the TVI in transmitral A-wave of the whole transmitral flow (F_A) were calculated, and F_PVA/F_A was obtained as an index of LV operating stiffness. From the Dual Gate Doppler recording of PV and transmitral flows, we measured ΔA_dur (D-ΔA_dur) and time from the end of transmitral A-wave to the end of PVA (D-ΔA_end).

Results: Each of S-ΔA_dur, D-ΔA_dur, and D-ΔA_end significantly correlated with F_PVA/F_A (r＝0.50, 0.51, and 0.71, respectively), and the correlation between F_PVA/F_A and D-ΔA_end was significantly greater than that between F_PVA/F_A and S-ΔA_dur and between F_PVA/F_A and D-ΔA_dur (p＜0.001 for both). The intraclass correlation coefficients for the inter- and intra-observer comparisons were excellent for D-ΔA_end, adequate for D-ΔA_dur, and fair for S-ΔA_dur.

Conclusion: Dual Gate Doppler-derived D-ΔA_end has higher reproducibility and usefulness for assessing late-diastolic LV operating stiffness than the conventional Doppler-derived S-ΔA_dur.

Usefulness of the pulmonary venous flow waveform for assessing left atrial stiffness
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, Springer Science and Business Media LLC, 16 Jul. 2022
Scientific journal

MitraClip実施後にたこつぼ症候群を呈した1例　　　　　　　　　　　　　　　
甲谷 次郎, 神谷 究, 立田 大志郎, 西野 広太郎, 高橋 勇樹, 斎院 康平, 内藤 正一郎, 竹中 秀, 多田 篤司, 水口 賢史, 石坂 傑, 小林 雄太, 佐藤 琢真, 永井 利幸, 安斉 俊久
日本心血管インターベンション治療学会抄録集, 30回, [YIA4, 2], (一社)日本心血管インターベンション治療学会, Jul. 2022
English

Two cases showing alterations of the order of tricuspid and mitral valve opening during loading manipulations: a new approach for quick assessment of stress-induced left ventricular filling pressure elevation.
Michito Murayama, Hiroyuki Iwano, Ko Motoi, Suguru Ishizaka, Shingo Tsujinaga, Toshiyuki Nagai, Toshihisa Anzai
Journal of medical ultrasonics (2001), 49, 3, 489, 491, 30 May 2022, [Domestic magazines]
English, Scientific journal

Difference in left atrial myocardial dynamics during reservoir phase between hypertrophic cardiomyopathy and hypertensive heart determined using three-dimensional speckle tracking echocardiography
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, Apr. 2022
English, Scientific journal

Clinical utility of superior vena cava flow velocity waveform measured from the subcostal window for estimating right atrial pressure1.
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, 09 Feb. 2022, [International Magazine]
English, Scientific journal, BACKGROUND: Superior vena cava (SVC) flow velocity waveform from the supraclavicular window reflects the 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. This study aimed 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 h, the ratio of peak systolic to diastolic forward SVC flows was measured (SVC-S/D), and the diagnostic ability of SVC-S/D for elevated RAP was tested. A validation cohort was conducted to confirm the diagnostic ability of SVC-S/D in 48 patients who underwent both cardiac catheterization and echocardiography within 24 h. In 59 patients of 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 the subcostal SVC-S/D was smaller than that on the 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 the 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 the cutoff value, SVC-S/D<1.9, was applied to the validation cohort, it showed an acceptable accuracy of 72%, and an 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.

Determinants of altered left ventricular suction in pre-capillary pulmonary hypertension.
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, 10 Jan. 2022, [International Magazine]
English, Scientific journal, 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.

Visual echocardiographic scoring system of the left ventricular filling pressure and outcomes of heart failure with preserved ejection fraction.
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, 25 Oct. 2021, [International Magazine]
English, Scientific journal, 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.

Prognostic value of an echocardiographic index reflecting right ventricular operating stiffness in patients with heart failure.
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, 16 Oct. 2021, [Domestic magazines]
English, Scientific journal, 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.

Influence of left ventricular systolic dysfunction on occurrence of pulsus tardus in patients with aortic stenosis.
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, Oct. 2021, [International Magazine]
English, Scientific journal

Application of the proximal isovelocity surface area method for estimation of the effective orifice area in aortic stenosis.
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, 25 Sep. 2021, [Domestic magazines]
English, Scientific journal, 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, Sep. 2021
Japanese

Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure.
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, Jul. 2021, [International Magazine]
English, Scientific journal

Presence and Relevance of Midsystolic Notching on Right Ventricular Outflow Tract Flow Velocity Envelopes in Pulmonary Hypertension due to Heart Failure.
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 : official publication of the American Society of Echocardiography, 34, 6, 690, 692, Jun. 2021, [International Magazine]
English, Scientific journal

Functional significance of intra-left ventricular vortices on energy efficiency in normal, dilated, and hypertrophied hearts.
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, May 2021, [International Magazine]
English, Scientific journal

負荷心エコー図検査の現状と未来 負荷心エコー図検査を活かす 検査導入後5年間の取り組み　　　　　　　　　　　　　　　
辻永 真吾, 岩野 弘幸, 青柳 裕之, 玉置 陽生, 本居 昂, 石坂 傑, 千葉 泰之, 永井 利幸, 安斉 俊久
超音波医学, 48, Suppl., S212, S212, (公社)日本超音波医学会, Apr. 2021
Japanese

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, Apr. 2021
Japanese

上大静脈血流速度波形計測における心窩部アプローチの有用性
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
Japanese

Influence of advanced pulmonary vascular remodeling on accuracy of echocardiographic parameters of left ventricular filling pressure
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, Jan. 2021
English, Scientific journal

Reversible Cancer Therapeutics-related Cardiac Dysfunction Complicating Intra-cardiac Thrombi.
Shingo Tsujinaga, Hiroyuki Iwano, Tomohiro Oshino, Takahide Kadosaka, Yoshifumi Mizuguchi, Ko Motoi, Yasuyuki Chiba, Taro Koya, Taro Temma, Kiwamu Kamiya, Arata Fukushima, Takuya Koizumi, Tomoya Sato, Sakae Takenaka, Atsushi Tada, Suguru Ishizaka, Miwa Sarashina, Kazunori Omote, Rui Kamada, Takao Konishi, Takuma Sato, Toshiyuki Nagai, Hiroko Yamashita, Toshihisa Anzai
Internal medicine (Tokyo, Japan), 59, 17, 2155, 2160, 01 Sep. 2020, [Domestic magazines]
English, Scientific journal

Significance and prognostic impact of v wave on pulmonary artery pressure in patients with heart failure: beyond the wedge pressure
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, 35, 8, 1079, 1086, Aug. 2020
English, Scientific journal

Heart Failure With Preserved Ejection Fraction vs. Reduced Ejection Fraction - Mechanisms of Ventilatory Inefficiency During Exercise in Heart Failure.
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, 07 Apr. 2020, [Domestic magazines]
English, Scientific journal, Background: Ventilatory inefficiency during exercise assessed using the lowest minute ventilation/carbon dioxide production (V̇E/V̇CO2) ratio was recently proven to be a strong prognostic marker of heart failure (HF) regardless of left ventricular ejection fraction (LVEF). Its physiological background, however, has not been elucidated. Methods and Results: Fifty-seven HF patients underwent cardiopulmonary exercise testing and exercise-stress echocardiography. The lowest V̇E/V̇CO2 ratio was assessed on respiratory gas analysis. Echocardiography was obtained at rest and at peak exercise. LVEF was measured using the method of disks. Cardiac output (CO) and the ratio of transmitral early filling velocity (E) to early diastolic tissue velocity (e') were calculated using the Doppler method. HF patients were divided into preserved EF (HFpEF) and reduced EF (HFrEF) using the LVEF cut-off 40% at rest. Twenty-four patients were classified as HFpEF and 33 as HFrEF. In HFpEF, age (r=0.58), CO (r=-0.44), e' (r=-0.48) and E/e' (r=0.45) during exercise correlated with the lowest V̇E/V̇CO2 ratio (P<0.05 for all). In contrast, in HFrEF, age (r=0.47) and CO (r=-0.54) during exercise, but not e' and E/e', correlated with the lowest V̇E/V̇CO2 ratio. Conclusions: Loss of CO augmentation was associated with ventilatory inefficiency in HF regardless of LVEF, although lung congestion determined ventilatory efficiency only in HFpEF.

Tricuspid regurgitation occurring in the early-diastolic phase in a case of heart failure: Insights from echocardiographic and invasive hemodynamic findings.
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, Sep. 2019, [International Magazine]
English

[Surgery for Flail Chest with Titanium Plates after Cardiopulmonary Resuscitation;Report of a Case].
Kohdai Tsuruta, Tohru Mawatari, Kouhei Narayama, Tsuyoshi Shibata, Masami Shingaki, Toshio Baba, Kiyofumi Morishita, Suguru Ishizaka, Atsushi Watanabe
Kyobu geka. The Japanese journal of thoracic surgery, 72, 4, 318, 320, Apr. 2019, [Domestic magazines]
Japanese, Scientific journal, A 74-year-old woman was admitted for the management of nausea with hyponatremia. On the 19th day of hospitalization, the patient developed cardiac arrest and needed cardiopulmonary resuscitation (CPR). CPR was successful but the patient developed multiple rib fractures with flail chest by CPR. Because of persistent dyspnea, surgery for fixing of the fractured ribs was performed using 4 titanium plates, with prompt improvement of the flail chest after the operation.

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, Apr. 2023
(公社)日本超音波医学会, Japanese

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(Web), 87th, 2023

Head-to-head comparison between hepatic vein flow and superior vena cava flow patterns analysis for predicting elevated right atrial pressure
村山迪史, 村山迪史, 加賀早苗, 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, 岩野弘幸, 安斉俊久, 超音波医学 Supplement, 50, 2023

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(Web), 87th, 2023

超音波法を用いたスコアリングによるうっ血肝診断と予後予測
小野田愛梨, 村山迪史, 村山迪史, 加賀早苗, 加賀早苗, 工藤悠輔, 岩井孝仁, 中鉢雅大, 横山しのぶ, 西野久雄, 西田睦, 石坂傑, 岩野弘幸, 岩野弘幸, 安斉俊久, 日本超音波検査学会学術集会講演抄録集(Web), 48th, 2023

Closed VSDを合併した右室二腔症の手術症例　　　　　　　　　　　　　　　
齋藤 翔太, 石坂 傑, 下野 裕依, 甲谷 太郎, 神谷 究, 阿部 慎司, 加藤 伸康, 永井 利幸, 若狭 哲, 安斉 俊久, 日本成人先天性心疾患学会雑誌, 12, 1, 200, 200, Jan. 2023
(一社)日本成人先天性心疾患学会, Japanese

Influencing factors for the overestimation of severity of pulmonary regurgitation by Doppler echocardiography
本居昂, 岩野弘幸, 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(Web), 11, 1, 2022

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, 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(Web), 69th, 2021

心エコー法による新たな左房圧指標を用いたHFpEFの予後予測に関する検討
村山迪史, 岩野弘幸, 岩野弘幸, 岩野弘幸, 表和徳, 原田智成, 小保方優, 加藤寿光, 中鉢雅弘, 西野久雄, 横山しのぶ, 辻永真吾, 千葉泰之, 石坂傑, 本居昂, 西田睦, 安斉俊久, 日本心不全学会学術集会プログラム・抄録集, 25th, 2021

Usefulness of a parameter based on visually assessed atrioventricular valve opening delay for prediction of left ventricular filling pressure in atrial fibrillation and mitral annular calcification
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 Supplement, 48, 2021

Clinical utility of stress echocardiography: summary of 5 years’ experience
辻永真吾, 岩野弘幸, 青柳裕之, 玉置陽生, 本居昂, 石坂傑, 千葉泰之, 永井利幸, 安斉俊久, 超音波医学 Supplement, 48, 2021

経カテーテル的大動脈弁置換術による左室機能の変化と左室外的仕事量との関連　　　　　　　　　　　　　　　
辻永 真吾, 岩野 弘幸, 石坂 傑, 千葉 泰之, 更科 美羽, 中鉢 雅大, 神谷 究, 永井 利幸, 安斉 俊久, 超音波医学, 47, Suppl., S208, S208, Nov. 2020
(公社)日本超音波医学会, Japanese

LVADって何ですか?心エコーで何を診れば良いですか?
石坂 傑, 岩野 弘幸, 心エコー, 21, 1, 76, 81, Jan. 2020
(株)文光堂, Japanese

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, Jan. 2020
日本成人先天性心疾患学会, Japanese

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, Sep. 2019
(一社)日本心臓病学会, Japanese

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, Sep. 2019
(一社)日本心臓病学会, Japanese

難治性右心不全に合併した肝肺症候群の1例　　　　　　　　　　　　　　　
石坂 傑, 今川 正吾, 小熊 響子, 千葉 泰之, 松村 尚哉, 日本心臓病学会学術集会抄録, 64回, O, 215, Sep. 2016
(一社)日本心臓病学会, Japanese

心機能正常化まで経過観察できた周産期心筋症の1例　　　　　　　　　　　　　　　
石坂 傑, 羽根 佑真, 斉藤 尚孝, 牛島 桂司, 浅島 弘志, 道南医学会大会並びに総会プログラム・抄録集, 66回, 31, 31, Nov. 2013
道南医学会, Japanese

最新の臨床Web　　　　　　　　　　　　　　　
永井 利幸, 心臓腫瘍, バルサルバ洞動脈瘤破裂, マルファン症候群・大動脈弁輪拡張症
Apr. 2024, [Contributor]

腫瘍循環器診療実践トレーニング
小室, 一成, 日本腫瘍循環器学会, 心臓腫瘍の診断治療をどう行う?
メジカルビュー社, Mar. 2024, 9784758322140, xiii, 225p, Japanese, [Contributor]

循環器診療コンプリート 心不全　　　　　　　　　　　　　　　
急性心不全の薬物療法・非薬物療法
学研メディカル秀潤社, Mar. 2021, [Contributor]

実は知らない循環器希少疾患　　　　　　　　　　　　　　　
安斉俊久, その他 - 脚気心
南江堂, Sep. 2019, [Contributor]

マルチモダリティ時代における心エコーの立ち位置を再考する　　　　　　　　　　　　　　　
石坂 傑
日本超音波医学会 第33回北海道地方会講習会, 13 Sep. 2025

心不全を識る　　　　　　　　　　　　　　　
石坂 傑
第18回 北海道大学病院 検査・輸血部 市民フォーラム, 06 Sep. 2025

心膜疾患の診かた　　　　　　　　　　　　　　　
石坂 傑
日本超音波医学会教育委員会主催 第24回教育セッション, 30 May 2025
[Invited]

マルチモダリティによる病態把握〜ACHD診療を中心に　　　　　　　　　　　　　　　
石坂 傑
函館循環器病懇談会, 19 Mar. 2025
[Invited]

北海道大学病院におけるACHD診療の現状と課題　　　　　　　　　　　　　　　
石坂 傑
第26回 日本成人先天性心疾患学会 総会・学術集会 シンポジウム, 12 Jan. 2025

循環器内科の立場からみた移行期診療の現状と課題　　　　　　　　　　　　　　　
石坂 傑
日本循環器学会 第132回北海道支部地方会 北海道ACHDセミナー, 23 Nov. 2024
[Invited]

循環器診療における心エコーの役割を再考する　　　　　　　　　　　　　　　
石坂 傑
The Echo WEB 北の国からフェス, 31 Aug. 2024
[Invited]

心膜疾患のみかた　　　　　　　　　　　　　　　
石坂 傑
第86回 The Echo WEB Biweekly Conference, 25 Oct. 2023
[Invited]

運動時の血行動態評価を用いたATTR 型心アミロイドーシスの病期検討
科学研究費助成事業
01 Apr. 2025 - 31 Mar. 2027
石坂 傑
日本学術振興会, 若手研究, 北海道大学, 25K19406