Shinji JINNO

OBJECTIVES: This study aimed to measure right atrial (RA) strain in the reservoir, conduit, and contraction phases and examine its clinical utility in detecting pulmonary hypertension (PH). METHODS: One hundred and thirteen patients hospitalized in the intensive or coronary care units of our institution who underwent echocardiography and measurements of RA/right ventricular (RV) strain were retrospectively examined. RA strain was measured in the reservoir, conduit, and contraction phases of one cardiac cycle. PH was defined as peak tricuspid regurgitation velocity >2.8 m/s. Patients were grouped according to PH status (PH, no PH) and statistically compared. Logistic regression and receiver operating characteristic analyses were also performed. RESULTS: Mean age was 71.1±15.4 years and 72 were men (63.7%). The PH and no PH groups comprised 40 and 73 patients, respectively. Among the RA strain parameters, RA strain in the conduit phase was significantly lower in the PH group (-8.1±4.2% vs. -17.4±7.7%; p<0.001). In the receiver operating characteristic analysis for PH, RA strain in the conduit phase had the highest area under the curve among the RA/RV strain parameters (area under the curve, 0.88; sensitivity, 92.5%; specificity, 71.2%; p<0.001). CONCLUSIONS: RA strain is an echocardiographic parameter that can detect PH and should be considered when RV strain parameters are not measurable.

INTRODUCTION: Coronary computed tomography angiography (CCTA) is known to have a high negative predictive value (NPV) in identifying coronary artery disease (CAD). This study aimed to examine whether resting echocardiographic parameters could exclude significant CAD on CCTA. METHODS: We recruited 142 patients who had undergone both CCTA and echocardiography within a 3-month window. Based on the CCTA findings, patients were divided into two groups: Group A (non-significant CAD, defined as all coronary segments having <50% stenosis) and Group B (significant CAD). Resting echocardiographic parameters were compared between the two groups to identify predictors of non-significant CAD on CCTA. RESULTS: A total 92 patients (mean age, 68 ± 13 years; males, 62%) were eligible for this study; 50 in Group A and 42 in Group B. Among the various echo parameters, left atrial volume index (LAVI) and left ventricular (LV) global longitudinal strain (GLS) were significantly lower in Group A (23.5 ± 7.6 vs. 33.6 ± 7.4 mL/m2 , p < .001; -20.2 ± 1.8% vs. -16.8 ± 2.0%, p < .001, respectively). Analysis of the receiver operating characteristic curve revealed that the cutoff value to exclude significant CAD on CCTA was 29.0 mL/m2 for LAVI (NPV 80.8%) and -18.1% for GLS (NPV 80.7%). The NPV increased to 95.0% when these parameters were combined (LAVI < 29.0 mL/m2 and GLS < -18.1%). CONCLUSION: The combination of resting LAVI and GLS was clinically useful in excluding significant CAD via CCTA.

Our diagnostic center for sonography holds an echocardiographic conference once a week with cardiologists and sonographers (echocardiographic team). However, since April 2020, owing to the spread of COVID-19 infection, we have refrained from holding conferences to prevent the spread of infection. We developed the question format used in the conference and created clinical case questions on the World Wide Web (Web). We delivered a Web-based joint educational program named “FUJITA Echocardiography Webinar” for our hospital and affiliated hospitals on the Web using information technology (IT). Unlike conventional conferences, web seminars or webinars can be attended at any time and place, and the number of participants has increased. Without holding a conference, we were able to provide a fulfilling educational environment not only to our hospital but also to affiliated hospitals. By quantifying the correct answer rate, we were able to clarify the degree of understanding for each disease. For the question with the lowest correct answer rate, it was confirmed that its correct answer rate was significantly improved by distributing the educational program. Another advantage was that the description of free comments clarified the problems and led to improvements. In the future, it is expected that the educational environment on the Web using IT will become more diverse. We believe that it will be possible to collaborate not only with affiliated hospitals but also with regional medical facilities in education and quality control. Furthermore, we believe that the program we developed can be used for recurrent education through collaboration with universities.