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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecause of the rapid increase in cases of calcific aortic stenosis (AS) in industrialized countries, there are increasing numbers of symptomatic elderly patients who do not undergo aortic valve surgery because the surgical intervention poses significant risks related to coexisting comorbidities. 1,2 As a result, there are growing concerns regarding the poor prognosis of these patients and the increased associated medical costs. 3 Transcatheter aortic valve implantation (TAVI) has recently emerged as an alternative to surgery in high-risk patients with AS. 4-7 Detailed anatomical information regarding the aortic root geometry is important for selecting candidates for successful TAVI while avoiding associated complications. Recent studies have reported that multidetector computed tomography (MDCT) provides 3-dimensional (D) morphological information on the geometry of the aortic root, as well as the spatial relationship between the aortic annulus and the ostia of the left and right coronary arteries (LCA and RCA, respectively). 8-11 However, because of its known limitations, MDCT cannot be performed in all patients.Real-time 3D transesophageal echocardiography (3DTEE) has the potential to provide 3D information regarding aortic root morphology. We hypothesized that real-time 3DTEE could be a useful alternative for assessing aortic root geometry. Accordingly, the aims of this study were: (1) to validate 3DTEE measurements of aortic root using MDCT measurements as a reference, and (2) to examine whether the aortic root geometry differs between patients with and without AS. Methods Study PopulationProtocol 1 We retrospectively enrolled 35 patients referred for MDCT coronary angiography who underwent Background: Precise evaluation of the aortic root geometry prior to transcatheter aortic valve implantation is important for procedural success in patients with aortic stenosis (AS). To determine the potential for 3-dimensional transesophageal echocardiography (3DTEE), the aims of the present study were: (1) to assess the accuracy of 3DTEE measurements of the aortic root using multidetector computed tomography (MDCT) as a reference, and (2) to examine whether aortic root geometry differs between patients with and without AS.

Obstructive apnea during sleep elevates the set point for efferent sympathetic outflow during wakefulness. Such resetting is attributed to hypoxia-induced upregulation of peripheral chemoreceptor and brain stem sympathetic function. Whether recurrent arousal from sleep also influences daytime muscle sympathetic nerve activity is unknown. We therefore tested, in a cohort of 48 primarily nonsleepy, middle-aged, male (30) and female (18) volunteers (age: 59±1 years, mean±SE), the hypothesis that the frequency of arousals from sleep (arousal index) would relate to daytime muscle sympathetic burst incidence, independently of the frequency of apnea or its severity. Polysomnography identified 24 as having either no or mild obstructive sleep apnea (apnea–hypopnea index <15 events/h) and 24 with moderate-to-severe obstructive sleep apnea (apnea–hypopnea index >15 events/h). Burst incidence correlated significantly with arousal index ( r =0.53; P <0.001), minimum oxygen saturation ( r =−0.43; P =0.002), apnea–hypopnea index ( r =0.41; P =0.004), age ( r =0.36; P =0.013), and body mass index ( r =0.33; P =0.022) but not with oxygen desaturation index ( r =0.28; P =0.056). Arousal index was the single strongest predictor of muscle sympathetic nerve activity burst incidence, present in all best subsets regression models. The model with the highest adjusted R 2 (0.456) incorporated arousal index, minimum oxygen saturation, age, body mass index, and oxygen desaturation index but not apnea–hypopnea index. An apnea- and hypoxia-independent effect of sleep fragmentation on sympathetic discharge during wakefulness could contribute to intersubject variability, age-related increases in muscle sympathetic nerve activity, associations between sleep deprivation and insulin resistance or insomnia and future cardiovascular events, and residual adrenergic risk with persistence of hypertension should therapy eliminate obstructive apneas but not arousals.

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LAVIs by both 2DE and 3DE are powerful predictors of future cardiac events. 3D LAVImin tended to have a stronger and additive prognostic value than 3D LAVImax.

AimsThe aim of this study was to determine differences in the acute and chronic impact of adaptive servo-ventilation (ASV) on left chamber geometry and function in patients with chronic heart failure (CHF). Methods and resultsAn acute ASV study was performed to measure echocardiographic parameters before and 30 min after the initiation of ASV therapy in 30 CHF patients (mean age: 69 years, 23 male). The chronic effects of ASV therapy were also evaluated in 26 of these 30 patients over a mean follow-up period of 24 weeks. Patients were divided into two groups according to the status of ASV therapy [ASV group (n ¼ 15) and withdrawal group (n ¼ 11)]. In the acute study, heart rate and blood pressure were significantly decreased 30 min after the ASV therapy compared with baseline. Stroke volume and cardiac output were significantly increased in conjunction with a reduction in systemic vascular resistance. Multivariate regression analysis revealed baseline E/e ′ to be an independent predictor for absolute increase in cardiac output. In the chronic study, a significant reduction of left ventricular (LV)/left atrial (LA) volumes and the severity of mitral regurgitation (MR), and improved LV diastolic function parameters were noted in the ASV group. These beneficial effects were not observed in the withdrawal group. ConclusionThe acute beneficial impact of ASV is mainly associated with the reduction of afterload resulting in an increase in stroke volume and cardiac output. In contrast, chronic ASV therapy produces LV and LA reverse remodelling resulting in an improvement in LV function and the severity of MR in patients with CHF.--

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