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Biomedical subjects

R Kusukawa

Publications and source records attributed to R Kusukawa.

At least 109 records · Page 6Linked to original sources
PubMed1983

Coronary arteriography and left ventriculography during spontaneous and exercise-induced ST segment elevation in patients with variant angina.

The present study is an angiographic demonstration of coronary artery spasm during both spontaneous and exercise-induced angina in three patients with variant angina. In each case, clinical, ECG, coronary angiographic, and left ventriculographic observations were made at rest, during spontaneous angina, and during exercise-induced angina. The character of chest pain was similar during spontaneous and exercise-induced episodes. ST segment elevation was present in the anterior ECG leads during both episodes. The left anterior descending coronary artery became partially or totally obstructed during both types of attacks. When coronary spasm was demonstrated during both types of attacks, left ventriculography disclosed akinetic or dyskinetic wall motion in the area supplied by the involved artery. In those patients with reproducible exercise-induced ST segment elevation and chest pain, thallium-201 scintigraphy showed areas of reversible anteroseptal hypoperfusion. Thus in selected patients exercise-induced attacks of angina were similar to spontaneous episodes.

Angina Pectoris, Variant↗
PubMed1983

Importance of left atrial function in patients with myocardial infarction.

Left atrial function was evaluated in patients with and without remote myocardial infarction. The simultaneous left atrial pressure recording and left atrial and left ventricular cineangiograms were obtained with a catheter-tip micromanometer. The pressure-volume curve of the left atrium was composed of an A-loop and a V-loop. The ratio of active atrial emptying to left ventricular stroke volume in patients with myocardial infarction was significantly larger than that in normal subjects (42 +/- 12% vs 29 +/- 10%, p less than 0.05). The left atrial work was also significantly greater in patients with myocardial infarction (1690 +/- 717 mm Hg X ml) than in normal subjects (940 +/- 426 mm Hg X ml, p less than 0.05). The ratio of active atrial emptying to left ventricular stroke volume and left atrial work were significantly related in both normal subjects and patients with myocardial infarction (gamma = 0.72, p less than 0.01). The left ventricular ejection fraction correlated inversely with left atrial work (gamma = -0.5, p less than 0.05). Left atrial work also showed a significant linear correlation with left atrial volume before active atrial emptying (gamma = 0.82, p less than 0.01). We conclude that the left atrial contribution to left ventricular function is increased in patients with remote myocardial infarction. This left atrial contribution to the left ventricle is attributed to the Frank-Starling mechanism in the left atrium.

Adult↗
PubMed1983

Circulating anti-heart antibodies in heart diseases detected using an immunofluorescent technique.

Circulating anti-heart antibodies (C-AHAb) were examined in the sera of 132 patients with heart diseases and of 65 normal healthy controls using an indirect immunofluorescent technique. The patient groups consisted of 31 with dilated cardiomyopathy, 22 with hypertrophic cardiomyopathy, 38 with myocardial infarction, 15 with angina pectoris and 26 with rheumatic valvular disease. The indirect immunofluorescent staining patterns were classified into 4 types: "heterophile", "intracellular", "intercalated disc" and "nuclear" patterns. The positive incidence of C-AHAb was 81% in dilated cardiomyopathy, 77% in hypertrophic cardiomyopathy, 65% in rheumatic valvular disease, 58% in myocardial infarction, 40% in angina pectoris and 39% in normal healthy controls. A high rate of "heterophile" antibodies was found in the idiopathic cardiomyopathy group: 65% in dilated cardiomyopathy and 55% in hypertrophic cardiomyopathy. The intracellular staining pattern was present in 42% of rheumatic valvular disease. These findings suggest that positive C-AHAb and staining patterns may be useful in the assessment of the pathogenesis of certain types of heart diseases.

Adult↗
PubMed1983

The inhibitory effect of lipid peroxide on the activity of the membrane-bound and the solubilized lipoprotein lipase.

The effects of lipid peroxide (15-hydroperoxy arachidonic acid) on the activity of lipoprotein lipase was investigated. The activities were examined in 2 enzyme species: the lipoprotein lipase bound to the coronary vessels of the rat heart and that solubilized in the human post-heparin plasma. As a substrate, 3H-labelled human chylomicron was used. Lipid peroxide decreased the maximal velocity of the reaction between the chylomicron and lipoprotein lipase on the vascular surface. In the post-heparin plasma, the lipid peroxide decreased the maximal hydrolysis rate, but did not change the half life time in the unsaturated reaction. It is suggested that lipid peroxide directly damages a part of the membrane-bound lipoprotein lipase, and that the degeneration of cell membranes and the vasoconstriction caused by lipid peroxide will additionally disturb the hydrolysis of the plasma triglyceride on the vascular surface.

Animals↗
PubMed1983

[Clinical application of a new right subcostal approach in the evaluation of interatrial septal motion].

We developed a new echocardiographic approach to detect the interatrial septum (IAS) by tilting a transducer leftward, cephalad and backward from the right subcostal area. This technique could allow us to visualize the IAS moving perpendicularly to the ultrasonic beam. In normal subjects the IAS showed a small posterior deflection moving toward the left atrium due to atrial contraction following the P wave of the electrocardiogram. Following the onset of ventricular ejection the IAS rapidly moved anteriorly. During diastole the IAS showed an initial rapid posterior displacement and then a more gradual slope, reflecting rapid and slow filling phases, respectively. The magnitude and configuration of IAS motion showed variations dependent on atrial conditions of cardiac diseases. In atrial fibrillation there were f waves on the IAS echogram and in mitral stenosis a septal notch was recorded at the timing of a mitral opening snap. In mitral valve prolapse there was also a midsystolic notch of the IAS echogram almost coincident in time with the onset of a late systolic murmur. On the other hand, the IAS revealed a systolic increased excursion or paradoxical motion in mitral or tricuspid regurgitation, respectively. In hypertension and myocardial infarction the atrial kick of the IAS echogram showed an exaggerated excursion. In 125 out of the consecutive 150 cases (83.3%) we could record satisfactory IAS echograms by this new approach.

Adolescent↗
PubMed1982

Assessment of left ventricular relaxation in the diseased heart in man.

To examine the exponential nature of the left ventricular pressure (LVP) fall during isovolumic relaxation (IRP) in 59 patients (normal (N), 6; angina pectoris (AP), 13; myocardial infarction (MI), 24; and congestive (CCM, 6) and hypertrophic (HCM, 10) cardiomyopathies), LVP and dP/dt were measured by a Millar's catheter-tipped transducer. In P vs time relation during IRP was reasonably fitted by a straight line (r greater than 0.97) in all cases. Time constant (msec) in CCM (56.9 +/- 10.7), HCM (44.8 +/- 12.4) and MI (43.8 +/-7.4 higher (p less than 0.05) than in N (30.3 +/- 5.5), and peak (-) dP/dt (mmHg/sec) was lower (841 +/- 171, 1152 +/- 397 and 1270 +/- 211, respectively; p less than 0.05) than in N (1885 +/- 150), suggesting impaired LV relaxation in these groups. However, (-) dP/dt upstroke pattern was exponential only in both N and 8 of the AP. The (-) dP/dt upstroke in the remaining groups lost its exponential nature, showing rather a down ward-convex curvature which was especially prominent in CCM. This indicates non-exponential fall of LVP during IRP. Thus, the present results suggest that impaired relaxation disturbs the exponential nature of LV relaxation.

Adult↗
PubMed1982

[Study on right and left atrial dynamics in chronic constrictive pericarditis by esophageal echocardiography].

In 9 normal subjects (N) and 4 patients with chronic constrictive pericarditis (CP) with normal sinus rhythm, esophageal echocardiography was performed to obtain simultaneous echograms of the right atrial free wall and the interatrial septum, and both atrial dynamics were evaluated. In spite of increased mean right atrial and mean pulmonary arterial wedge pressures in CP, there were no significant differences in left, right and total atrial end-diastolic dimensions between N and CP. This indicates that there is a decrease in compliance of atrio-pericardial system in CP. Atrial shortening of both atria during active atria contraction was decreased in CP, while there was no significant difference in atrial dimension measured at the beginning of the active atrial shortening between N and CP. This impaired pump function might be due to increased ventricular late-diastolic pressure or organic change in the atrial muscle. The passive enlargement of both atria was impaired during atrial filling phase in CP. Thus, it was concluded that in CP the active shortening and passive enlargement of the right and left atria are decreased, and the atria tend to be a conduit.

Adult↗
PubMed1982

[Diagnosis of right atrial infarction by esophageal echocardiography].

Atrial infarction is rare and its ante mortem diagnosis is difficult by electrocardiography. There has been no report concerning the diagnosis of atrial infarction by echocardiography because it is difficult to observe atrial motion by conventional echocardiography. This report deals with a case of probable right atrial infarction diagnosed by esophageal echocardiography. A 50-year-old man was admitted to our hospital under the diagnosis of acute infero-posterior myocardial infarction. Swan-Ganz catheterization data revealed dip and plateau pattern with elevated right atrial pressure suggesting complicated right ventricular infarction. In the esophageal echocardiograms recorded one month later, the motion of the right atrial anterior wall was akinetic and right atrial dimension did not change during both atrial contraction phase and atrial filling phase. These findings suggest impairment of pump function and reservoir function of the right atrium. Amplitudes of the interatrial septum during atrial filling phase and atrial contraction phase were in the lower limit of normal range. Total occlusion of the right coronary artery was proven by coronary arteriography. Hypokinesis of the upper right atrial appendage was suspected by right atriography and maximal right atrial volume was as large as 116 ml. In the right atrial volume curve by cardiac scintigraphy, fractional emptying was as low as 28%. The patient had an uneventful recovery and returned to full-time works, so that pathological diagnosis was not obtained, but the clinical diagnosis of right atrial infarction was strongly suspected by the clinical findings mentioned above. It was concluded that the esophageal echocardiography is mandatory to observe atrial wall motion abnormality whenever atrial infarction is suspected.

Echocardiography↗
PubMed1981

Esophageal echocardiographic left ventricular anterolateral wall motion in normal subjects and patients with coronary artery disease.

Esophageal echocardiography was developed for recording left ventricular anterolateral wall (LVAW) echocardiograms and was applied clinically to 14 normal subjects and 21 patients with coronary artery disease. LVAW echocardiograms were obtained satisfactorily in 11 of 14 normal subjects (75%) and 20 of 21 patients (95%) with coronary artery disease. LVAW echocardiograms were obtained by conventional anterior echocardiography in eight of 21 patients (38%) with coronary artery disease. In 11 normal subjects, mm/sec (mean 34.3 +/- 5.2 mm/sec); and diastolic wall thickness ranged from 9-12.5 mm (mean 11.2 +/- 0.7 mm). In 20 patients with coronary artery disease, LVAW motion obtained by esophageal echocardiography was classified into five groups according to the excursion, and the findings were in good agreement (80%) with those obtained by left ventriculography. Classification of LVAW motion by conventional echocardiography agreed with that of left ventriculography in only three of eight patients, although all eight patients had abnormal LVAW motion by the conventional method. In all patients except one, whose LVAW echocardiograms were obtained by conventional echocardiography, excursion was much less than that obtained by esophageal echocardiography. We conclude that the projection of an ultrasonic beam from the intraesophageal transducer is a better approach for accurate measurement of LVAW motion.

Adult↗
PubMed1981

Experimental myocarditis. II. Cardiac lesions in rats induced by immunization with heterologous heart extracts.

The production of myocardial lesions and circulating anti-heart antibodies has been studied in the present experiment. Twenty-one of Wistar rats were divided into 3 groups: 9 rats immunized with heterologous heart extracts, Freund's complete adjuvant and diphtheria-tetanus-pertussis (DTP) vaccine, 8 rats injected phosphate buffered saline adjuvant mixture with DTP vaccine and 4 rats untreated as control. Injection of heterologous heart extracts emulsified with Freund's complete adjuvant and DTP vaccine developed focal myocardial lesions in all of the subjected rats. The lesions were characterized by focal and diffuse interstitial cellular infiltration with myocardial necrosis. The circulating antibodies reacted to rat heart extracts were detected in 77.8% of the subjects. The antigen, reacted with the antibodies, located intracellular spaces in myocardium. The severity of cardiac lesions were not functional to the titer of circulating anti-heart antibodies may play little role in the pathogenesis of myocardial damage at least in this experimental myocarditis.

Animals↗
PubMed1981

[Echocardiographic findings of pulsus paradoxus: cardiovascular changes due to respiration (author's transl)].

Echocardiographic studies were performed in two cases with pulsus paradoxus (Case 1: a 13-year-old boy, acute viral pericarditis with massive pericardial effusion; Case 2: a 25-year-old woman, status asthmaticus) and in a normal subject when his intra-airway pressure rapidly fell on a deep negative level, e.g., during Mueller maneuver. During inspiration in both clinical cases, the anterior mitral leaflet showed a diminished diastolic excursion, and the right ventricular dimension increased accompanied by a reciprocal decrease in the left ventricular dimension. In Case 2, in addition, an abrupt downward motion of the ventricular septum was present in early diastole during inspiration. In experimental study of a normal subject, similar respiratory changes in mitral ans septal motions and the similar respiratory interaction between the right and left ventricles were also observed during Mueller maneuver. Our observations suggest left ventricular filling and left ventricular end-diastolic volume decrease during inspiration in the presence of pulsus paradoxus. These are compatible with the pulmonary pooling hypothesis, and also support the hypothesis that pulsus paradoxus may be caused by competition of the ventricles for filling within a relatively fixed pericardial space. The mechanism of the abrupt downward septal motion in early diastole was also discussed.

Adolescent↗
PubMed1981

[Exercise echocardiography: interventricular septal thickness and motion in patients with effort angina during ergometer exercise (author's transl)].

To detect abnormal interventricular septal (IVS) motion during exercise-induced ischemia, ergometer exercise echocardiography was performed using a specially devised transducer in 12 patients (pts) with effort angina (left anterior descending artery disease) and 10 normal subjects (N) at rest, and during exercise and recovery. During exercise, percent systolic IVS thickening (% delta T) and IVS excursion (Ex) increased from 52 +/- 13% at rest to 73 +/- 19% and from 7.0 /- 1.3 mm at rest to 10.6 +/- 1.9 mm, respectively, in N, and also from 52 +/- 23% to 67 +/- 36% and from 7.3 +/- 1.9 mm to 9.7 +/- 2.1 mm in all of 3 pts with distal left anterior descending artery disease. On the other hand, in 9 pts with proximal left anterior descending artery disease, % delta T and Ex during exercise decreased from 41 +/- 17+ at rest to 26 +/- 25% and from 7.7 +/- 1.2 mm to 5.1 +/- 4.6 mm. The late systolic wall thickening of IVS was observed during peak exercise in 2 of the 9 pts, one of whom exhibited systolic IVS thinning and a decrease in diastolic thickness (from 6 mm to 4.5 mm). In 5 pts with IVS asynergy during exercise diastolic IVS thickness increased maximally from 10.2 +/- 3.3 mm at rest to 11.4 +/- 3.5 mm during recovery (reactive hyperemia). Exercise echocardiography is useful to predict the location of left anterior descending artery disease and to evaluate IVS performance during exercise-induced ischemia.

Adult↗