Nimura lecture: "Three EBMs".

The three EBMs in the title refer to the following concepts: evidence-based medicine, experience-based medicine, and echo-based medicine. Evidence-based medicine: I have carried out the following clinical research using transthoracic Doppler echocardiography: (1) noninvasive pulsed-wave Doppler echocardiographic detection of the direction of shunt flow in patients with atrial septal defect: usefulness of the right parasternal approach (1985), (2) significance of laminar systolic regurgitant flow in patients with tricuspid regurgitation: a combined pulsed-wave, continuous-wave, and two-dimensional echocardiography (1990), (3) obstruction of the inferior vena caval orifice by the giant left atrium in patients with mitral stenosis: a Doppler echocardiographic study from the right parasternal approach (1992), and (4) demonstration of a localized acceleration flow signal in the transmural penetrating coronary artery using transthoracic color and pulsed-wave Doppler echocardiography in patients with hypertrophic cardiomyopathy (1996-2017). Experience-based medicine: Dr.

Effects of valsartan on fibrinolysis in hypertensive patients with metabolic syndrome.

Background: The purpose of this study was to analyze the effect of valsartan on abnormal adipocyte metabolism and prothrombotic state in hypertensive patients with metabolic syndrome (MetS).

Methods And Results: We conducted a multicenter, prospective, randomized, parallel-group controlled trial in 150 hypertensive patients with MetS. They were randomly assigned to receive either 80-160 mg valsartan per day (valsartan group, n=79) or other conventional treatment without a renin-angiotensin system (RAS) inhibitor (non-RAS inhibitor group, n=71).

Gender differences in age-related changes in left and right ventricular geometries and functions. Echocardiography of a healthy subject group.

Background: The purpose of the present study was to investigate gender differences in age-related changes of left ventricular (LV) and right ventricular (RV) geometries and functions throughout the entire adult age range using the Japanese Normal Values for Echocardiographic Measurements Project (JAMP) study database.

Methods And Results: Seven hundred healthy volunteers (aged 20-79 years) underwent 2-dimensional and Doppler echocardiography. The subjects were stratified into 6 different age groups and then stratified by gender in each age group.

Normal values of echocardiographic parameters in relation to age in a healthy Japanese population: the JAMP study.

Background: Normal values for echocardiographic measurements and the relationship between these parameters and age in a large Japanese population are still unknown.

Methods And Results: A total of 700 healthy Japanese aged 20-79 years underwent 2-dimensional and Doppler echocardiography at collaborating institutions. The respective mean values obtained in men and women were as follows: septal wall thickness, 0.

No reflow-like pattern in intramyocardial coronary artery suggests myocardial ischemia in patients with hypertrophic cardiomyopathy.

Background And Purpose: To evaluate intramyocardial coronary flow velocity pattern by transthoracic Doppler echocardiography and its clinical significance in patients with hypertrophic cardiomyopathy (HCM).

Methods And Results: In 48 patients with HCM who had angiographically normal coronary artery, coronary flow velocity in the left anterior descending coronary artery (LAD) and intramyocardial coronary artery (IMCA) derived from LAD were evaluated using transthoracic Doppler echocardiography. Two clearly different flow patterns in the IMCA were observed in patients with HCM.

Terminal stage cardiac findings in patients with cardiac Fabry disease: an electrocardiographic, echocardiographic, and autopsy study.

Objectives: Fabry disease is caused by deficiency of alpha-galactosidase A, and typically causes multi-organ dysfunction. Patients with manifestations limited to the heart, mainly left ventricular hypertrophy (LVH), have been reported as a disease variation. We have reported a 3% prevalence of this cardiac variant in men with LVH, which we designated 'cardiac Fabry disease'.

Cardiotrophin-1 stimulates intercellular adhesion molecule-1 and monocyte chemoattractant protein-1 in human aortic endothelial cells.

Intercellular adhesion molecule-1 (ICAM-1) and monocyte chemoattractant protein-1 (MCP-1) play critical roles in mediating monocyte adhesion to the vascular endothelium and monocyte migration into the subendothelial regions of the vessels. Inasmuch as cardiotrophin-1 (CT-1), an IL-6-type cytokine, was expressed in human atherosclerotic plaque, we examined whether CT-1 induces monocyte adhesion and migration by stimulating gene and protein expressions of ICAM-1 and MCP-1 in human aortic endothelial cells (HAECs). Immunocytochemistry revealed that CT-1 increased intensity of ICAM-1 and MCP-1 immunoreactivity in HAECs.

Plasma levels of soluble glycoprotein 130 in acute myocardial infarction.

Objectives: Soluble glycoprotein 130 (sgp130), a circulating form of receptor subunit for the interleukin (IL) -6 cytokine family, modulates the biological actions of its ligands as an inhibitory regulator. The role of sgpl30 in cardiovascular diseases such as acute coronary syndrome remains unknown.

Methods: Plasma levels of sgp130 were examined by enzyme-linked immunosorbent assay in 33 patients with acute myocardial infarction (AMI; mean age 67 +/- 2 years, 21 males and 12 females), who were admitted to our hospital within 24 hr of onset of AMI and survived for 4 weeks.

Intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism in a patient with Behçet's disease: a case report and literature review.

A 26-year-old woman with intermittent fever was admitted to our hospital, and gradually developed facial edema. Examinations including computed tomography, transesophageal echocardiography, digital subtraction angiography, and pulmonary perfusion scintigraphy revealed intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism. Clinical findings and laboratory data led us to make a diagnosis of Behçet's disease.

Noninvasive quantitative evaluation of the patency of internal mammary artery grafts to the left anterior descending coronary artery by transthoracic Doppler echocardiography.

Objectives: Evaluation of left anterior descending coronary artery (LAD) flow by transthoracic Doppler echocardiography (TTDE) may allow assessment of anastomosis of the internal mammary artery (IMA) grafted to the LAD. This study tested the feasibility of TTDE to evaluate anastomotic stenosis of the IMA grafted to the LAD.

Methods: TTDE was performed in 66 patients (48 men and 18 women, mean age 67 +/- 10 years) with left or right IMA grafts to the LAD.

Significance of asymmetric basal posterior wall thinning in patients with cardiac Fabry's disease.

Although classic Fabry's disease results in multiple causes of death, the cardiac variant of Fabry's disease affects only the cardiac system and results in initial symmetric left ventricular (LV) hypertrophy and later LV dysfunction, asymmetric basal posterior LV wall thinning, restrictive mitral flow, and functional mitral regurgitation with end-stage chronic heart failure (CHF), leading to death. The purpose of this study was to investigate whether these findings predict prognoses in patients with cardiac Fabry's disease. In 13 consecutive men with cardiac Fabry's disease, LV wall thickness, the ejection fraction, mitral E-wave deceleration time, the LV Tei index, and functional mitral regurgitation were measured by echocardiography.

Usefulness of a novel ultrasound transducer for continuous monitoring treadmill exercise echocardiography to assess coronary artery disease.

Background: The feasibility of a novel ultrasound probe, which can be attached to the left ventricular (LV) apex chest wall and allows free rotation around its long axis direction for the continuous monitoring of LV wall motion, was tested.

Methods And Results: There were 36 subjects who had coronary artery disease (CAD). By attaching a novel ultrasound probe to the chest wall, the LV apical views were recorded during treadmill exercise stress echocardiography (Echo).

Different effects of propranolol, phenylephrine, and saline volume loading on catecholamine-induced left ventricular outflow tract obstruction in acute coronary syndrome.

Hemodynamic deterioration due to left ventricular outflow tract (LVOT) obstruction can occur during catecholamine infusion in patients with acute coronary syndrome (ACS). The purpose of the present study was to compare the utility of propranolol, phenylephrine infusion, and rapid saline loading for reversal of dobutamine-induced LVOT obstruction in a canine model of ACS. ACS was induced via left anterior descending artery ligation in 21 open-chest anesthetized dogs, and LVOT obstruction, defined as an LVOT gradient > 30 mmHg, was induced by dobutamine infusion (20 to 40 microg/kg/min).

Increased Tei index suggests absence of adequate coronary reperfusion in patients with first anteroseptal acute myocardial infarction.

Background: The estimation of coronary reperfusion in acute myocardial infarction (AMI) is important. The left ventricular (LV) Tei index is a noninvasive and sensitive parameter expressing overall LV function. We hypothesized that patients without good coronary reperfusion have worse LV function with a higher or worse Tei index compared to those with good reperfusion.

Mechanism of persistent ischemic mitral regurgitation after annuloplasty: importance of augmented posterior mitral leaflet tethering.

Background: We hypothesized that surgical annuloplasty for ischemic mitral regurgitation (MR) that displaces the posterior annulus anteriorly can potentially augment posterior leaflet (PML) tethering, leading to persistent MR. Relationships between leaflet configurations and persistent ischemic MR after the annuloplasty were investigated.

Methods And Results: In 31 patients with surgical annuloplasty for ischemic MR and 20 controls, posterior and apical displacement of the leaflet coaptation, the anterior leaflet (AML) and PML tethering angles relative to the line connecting annuli, coaptation length (CL), and the MR grade were quantified before and early after surgery in echocardiographic left ventricular long-axis views.

Correlation between distal left anterior descending artery flow velocity by transthoracic Doppler echocardiography and corrected TIMI frame count before mechanical reperfusion in patients with anterior acute myocardial infarction.

Background: This study was designed to determine the utility of transthoracic Doppler echocardiography (TTDE) in evaluating angiographic Thrombolysis in Myocardial Infarction (TIMI) frame count as a quantitative index of coronary reperfusion in patients with anterior acute myocardial infarction (AMI) before mechanical reperfusion.

Methods And Results: Color and pulsed TTDE was performed to evaluate distal left anterior descending coronary artery (LAD) reperfusion in 56 consecutive patients with a first anterior AMI before coronary intervention, and these findings were compared with the corrected TIMI frame count (cTFC) by subsequent angiography. Twenty-four of the 56 patients had LAD reperfusion (TIMI 2 or 3) by angiography.

The effects of repeated thermal therapy for patients with chronic pain.

Background: It has been reported that local thermal therapy with a hot pack or paraffin relieves pain. We hypothesized that systemic warming may decrease pain and improve the outcomes in patients with chronic pain. The purpose of this study was to clarify the effects of systemic thermal therapy in patients with chronic pain.

Repeated thermal therapy diminishes appetite loss and subjective complaints in mildly depressed patients.

Objective: We observed that repeated thermal therapy improved appetite loss and general well-being in patients with chronic heart failure. The purpose of this study is to clarify the effects of repeated thermal therapy in mildly depressed patients with appetite loss and subjective complaints.

Methods: Twenty-eight mildly depressed inpatients with general fatigue, appetite loss, and somatic and mental complaints were randomly assigned to thermal therapy group (n = 14) or nonthermal therapy group (n = 14).

Prediction of prognosis in the UM-X7.1 hamster model of congestive heart failure using the Tei index.

Background: Cardiac function is difficult to evaluate in small animal models of heart disease. The Doppler Tei index is a simple and non-invasive measure that can express global cardiac function even in small animal models of congestive heart failure. However, its ability to predict prognosis has not been evaluated.

Papillary muscle dysfunction attenuates ischemic mitral regurgitation in patients with localized basal inferior left ventricular remodeling: insights from tissue Doppler strain imaging.

Objectives: The purpose of this research was to test whether papillary muscle (PM) dysfunction attenuates ischemic mitral regurgitation (MR) in patients with left ventricular (LV) remodeling of a similar location and extent.

Background: Papillary muscle dysfunction could attenuate tethering and MR because of PM elongation. However, variability in the associated LV remodeling, which exaggerates tethering, can influence the relationship between PM dysfunction and MR.

The effects of repeated thermal therapy for two patients with chronic fatigue syndrome.

Objective: This paper describes the successful treatment of two patients with chronic fatigue syndrome (CFS) using repeated thermal therapy.

Methods: Two patients with CFS underwent treatment with prednisolone (PSL), with no satisfactory effect. They were subjected to thermal therapy that consisted of a far-infrared ray dry sauna at 60 degrees C and postsauna warming.

Repeated sauna therapy increases arterial endothelial nitric oxide synthase expression and nitric oxide production in cardiomyopathic hamsters.

Background: Vascular endothelial dysfunction is involved in the pathophysiology of chronic heart failure (CHF). It has been reported that sauna therapy, which allows thermal vasodilation, improves vascular endothelial dysfunction in patients with CHF. The present study investigates the mechanisms through which sauna therapy improves endothelial dysfunction induced by CHF.