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It is reported that patients with obstructive sleep apnea syndrome (OSAS) show endothelial dysfunction and that treatment of OSAS by continuous positive airway pressure (CPAP) therapy improves it. In this study we evaluated coronary flow reserve (CFR), which is considered to be affected by coronary microvascular dysfunction, and the change in CFR during treatment of OSAS by CPAP. Eleven patients who were diagnosed as having OSAS by polysomnography (PSG) were studied. Phasic coronary flow velocity was obtained in the left anterior descending coronary artery at baseline and during hyperemic conditions with transthoracic 2D echocardiography. CFR was defined as the ratio of hyperemic to basal mean diastolic velocity. CFR was obtained before and after the initiation of CPAP therapy. Coronary flow reserve was decreased (

The CHADS2 score (congestive heart failure, hypertension, age >75 years, diabetes, and previous stroke/transient ischemic attack) is used for embolic risk stratification in patients with atrial fibrillation (AF). Although systemic inflammation is a known predictor of left atrial thrombus formation in patients with nonrheumatic AF, the relation between the CHADS2 score and systemic inflammation is unknown. A total of 165 patients with nonrheumatic AF were enrolled and analyzed. According to the CHADS2 score, the study patients were grouped into low- (score 0 to 1), intermediate- (score 2 to 3), or high- (score 4 to 6) risk categories. The plasma C-reactive protein levels, transesophageal echocardiographic findings, and cardiovascular events (death, stroke, and heart failure) were compared. Patients in the high-risk group had significantly greater C-reactive protein levels than those in the intermediate- and low-risk groups (0.80 mg/dl, range 0.21 to 1.50, vs 0.16 mg/dl, range 0.06 to 0.50, vs 0.08 mg/dl, range 0.04 to 0.21, p

Summary Background There is an apparent link between thrombogenesis and inflammation. We hypothesized that systemic inflammation [as indicated by C-reactive protein (CRP)] would be related to the presence of left atrial (LA) thrombus in patients with atrial fibrillation (AF). To test this hypothesis, we evaluated the relationship between CRP and LA thrombus in patients with non-rheumatic AF. Methods and results Between October 2004 and December 2008, 190 patients with non-rheumatic AF (122 males, age 71 ± 10 years) who underwent transesophageal echocardiography (TEE) were enrolled and analyzed. All patients were examined for presence or absence of LA thrombus by TEE. CRP was measured within 1 week before the TEE examination. LA thrombus was detected in 19 patients (10%). Hypertension, hypertensive heart disease (HHD), valvular heart disease, ticlopidine, and CRP were univariate correlates of LA thrombus. By multivariate analysis, HHD ( p p = 0.01), and CRP ( p = 0.03) were independently associated with LA thrombus. A cut-off CRP value for identifying LA thrombus was 0.21 mg/dl (sensitivity: 84%, specificity: 60%, positive predictive value: 19%, and negative predictive value: 97%). Conclusion A high CRP is related to LA thrombus in patients with non-rheumatic AF.

Aortic regurgitation (AR) without primary leaflet disease (functional AR) is known to occur as a result of loss of coaptation due to sinotubular junction (STJ) dilatation. However, the characteristics of change in the aortic valve coaptation length (AVCL) in 3 cusps in patients with functional AR are, as yet, unclear. The aim of this study was to measure the AVCL in 3 cusps in patients with functional AR by three-dimensional transesophageal echocardiograph (3D TEE). Thirteen patients with functional AR with or without aortic dilatation (trivial to mild AR [group A] and moderate to severe AR [group B]) and 7 controls without AR (group N) were examined. We measured the AVCL between the left coronary cusp (LCC) and right coronary cusp (RCC), the LCC and non coronary cusp (NCC), the RCC and NCC, and we also measured the cusp projection area, STJ arc length, leaflet tip–Valsalva wall distance and inter-commissural distance in each cusp by 3D TEE. The average AVCL was significantly shorter in group B than in groups N and A (P

The two-dimensional speckle tracking (2DT) method is based on the measurements of strain on two-dimensional (2D) images, ignoring actual three-dimensional (3D) myocardial movements. We sought to investigate the feasibility of the newly developed three-dimensional speckle tracking (3DT) method to assess longitudinal, circumferential, and radial strain values, and then compared the data with those measured by 2DT.Echocardiographic examinations were performed in 46 volunteers. In the apical 3D volumetric images, 3 vectors of the strains were analyzed in 16 myocardial segments. 2D longitudinal strain was assessed in apical 4-, 3-, and 2-chamber views, and circumferential and radial strains were measured in parasternal short-axis view.The average time for 3D image acquisition and 3D strain analysis by 3DT was significantly shorter than for 2DT. Longitudinal strain value by 3DT was significantly smaller than by 2DT (-17.4% +/- 5.0% vs -19.9% +/- 6.7%, P.0001), and circumferential strain value by 3DT was significantly larger than by 2DT (-30.1% +/- 7.1% vs -26.3% +/- 6.9%, P.0001). Intraobserver and interobserver variabilities were 10.1% and 10.9% in 3DT, and 9.9% and 11.1% in 2DT, respectively.3DT is a simple, feasible, and reproducible method to measure longitudinal, circumferential, and radial strains. The discordant results between 3DT and 2DT may be explained by the 3D cardiac motion that has been ignored in current 2DT.

Geometric change of the aortic valve and root in patients with aortic root aneurysm has not been well investigated. The aim of this study was to quantitatively assess the characteristics of aortic valve and root morphology in patients with aortic root aneurysm. Ten aortic root aneurysm patients (eight males, group A) with moderate to severe aortic regurgitation and ten controls with normal aortic valves (seven males, group N) were examined by transesophageal echocardiography. We measured the diameter of the aortic annulus, sinus of Valsalva, sinotubular junction (STJ) and ascending aorta, and the length of the valve coaptation and annulus to the leaflet tip. We also measured the cusp projection area, STJ arc length, leaflet tip-Valsalva wall diameter and inter-commissural diameter in each Valsalva sinus/cusp [left coronary cusp (LCC), right coronary cusp (RCC), non-coronary cusp (NCC)]. The diameters of the sinus of Valsalva (P = 0.003), STJ (P = 0.005) and ascending aorta (P = 0.008) were more significantly enlarged in group A than in group N, and the valve coaptation length was significantly shorter in group A than in group N (3.1 ± 1.1 vs. 4.9 ± 1.1 mm/m2, P = 0.007). Moreover, the annulus to leaflet tip length was significantly longer in group A than in group N (P = 0.049). There was no significant difference in the size of the LCC, RCC and NCC in group N, although there was disproportion in the size of those cusps in group A, with the largest being in RCCs. In patients with aortic root aneurysm, Valsalva sinuses disproportionately dilate with different size, causing the loss of coaptation.

Background— Positive arterial remodeling and thin fibrous cap are characteristics of rupture-prone or vulnerable plaque. The natural course of the fibrous cap thickness and the relationship between serial arterial remodeling and changes in fibrous cap thickness are unknown. Therefore, the purpose of this study was to evaluate the relationship between changes in fibrous cap thickness and arterial remodeling by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS) during 6-month follow-up. Methods and Results— Both IVUS and OCT examinations were performed on 108 vessels from 36 patients with ischemic heart disease who underwent percutaneous coronary intervention. Fifty-eight fibroatheromas were selected from 82 nonsignificant, nonculprit lesions (angiographic diameter stenosis, 25% to 75%; plaque burden, >40% by IVUS). Fibroatheroma was defined by OCT as lipid-rich plaque in >1 quadrant that has lipid. Thickness of the fibrous cap was measured by OCT. IVUS and OCT examinations were repeated at 6-month follow-up. Serial changes and relationships between IVUS indices and fibrous cap thickness were investigated. Overall, fibrous cap thickness (98.1±38.9 to 96.9±44.5 μm) as well as IVUS indices did not change significantly within 6 months. The percent changes in fibrous cap thickness correlated negatively and significantly ( r =−0.54; P r =−0.42; P =0.001) with the percent changes in external elastic membrane cross-sectional area. Conclusions— Arterial remodeling is related to changes in fibrous cap thickness. Positive arterial remodeling is not only an adaptive process, but also related to thinning of the fibrous cap.

Purpose: In cardiac 2-[F-18]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) examination, interpretation of myocardial viability in the low uptake region (LUR) has been difficult without additional perfusion imaging. We evaluated distribution patterns of FDG at the border zone of the LUR in the cardiac FDG-PET and established a novel parameter for diagnosing myocardial viability and for discriminating the LUR of normal variants. Materials and Methods: Cardiac FDG-PET was performed in patients with a myocardial ischemic event (n = 22) and in healthy volunteers (n = 22). Whether the myocardium was not a viable myocardium (not-VM) or an ischemic but viable myocardium (isch-VM) was defined by an echocardiogram under a low dose of dobutamine infusion as the gold standard. FDG images were displayed as gray scaled-bull’s eye mappings. FDG-plot profiles for LUR (= true ischemic region in the patients or normal variant region in healthy subjects) were calculated. Maximal values of FDG change at the LUR border zone (a steepness index; Smax scale/pixel) were compared among not-VM, isch-VM, and normal myocardium. Results: Smax was significantly higher for n-VM compared to those with isch-VM or normal myocardium (ANOVA). A cut-off value of 0.30 in Smax demonstrated 100% sensitivity and 83% specificity for diagnosing n-VM and isch-VM. Smax less than 0.23 discriminated LUR in normal myocardium from the LUR in patients with both n-VM and isch-VM with a 94% sensitivity and a 93% specificity. Conclusion: Smax of the LUR in cardiac FDG-PET is a simple and useful parameter to diagnose n-VM and ischVM, as well as to discriminate thr LUR of normal variants.