Stephen Ishihara | University of Utah (original) (raw)
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Papers by Stephen Ishihara
Transplantation Proceedings, Dec 1, 2011
Limited and conflicting data exist on the diagnosis of cardiac allograft rejection with the use o... more Limited and conflicting data exist on the diagnosis of cardiac allograft rejection with the use of echocardiography. The purpose of our study was to evaluate various systolic and diastolic indices, including newer tissue Doppler imaging techniques, in diagnosing cardiac allograft rejection. We prospectively performed 426 echocardiography studies at the time of endomyocardial biopsy in 54 cardiac transplant patients. We measured left ventricular (LV) systolic and diastolic dimensions, mitral inflow pattern and annular velocities, and the myocardial performance index. Biopsies were assessed for cellular rejection and antibody-mediated rejection (AMR). Mild cellular rejection was diagnosed in 74 biopsy specimens and significant cellular rejection in 10 biopsy specimens. AMR was diagnosed in 30 biopsy specimens. In patients with mild or significant cellular rejection, no significant differences in echocardiographic parameters were observed. In patients with AMR, LV fractional shortening was significantly reduced compared with those with no AMR (mean±SD 31.8±8.9% vs 36.0±7.1%; P=.02). Although 1 echocardiographic parameter was statistically different in the setting of rejection, lack of consistency and overlap between nonrejection and rejection groups does not permit definitive noninvasive diagnosis of cardiac allograft rejection using this imaging modality.
Journal of the American College of Cardiology, Mar 1, 2010
Background: Candidacy for heart transplantation is influenced by the severity of pulmonary hypert... more Background: Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. We compared hemodynamics by right heart catheterization (RHC) with values obtained by validated equations from Doppler 2D transthoracic echocardiography. Method: This prospective study was conducted in 23 patients evaluated for cardiac transplantation. Transthoracic echocardiography and RHC were performed within 4 hours. From continuous wave Doppler of tricuspid regurgitation (TR) jet, measured in 22 patients, pulmonary artery systolic pressure (PASP) was calculated as peak gradient across tricuspid valve plus right atrial pressure estimated from IVC filling and mean PAP as (0.61xPASP)+2. Pulmonary vascular resistance (PVR) was calculated from TR velocity (TRV) and right ventricular outflow tract time-velocity integral as (TRV/TVIRVOT x10)+0.16 and pulmonary capillary wedge pressure (PCWP) from equation 1.91+(1.24xE/E'). Results: The patients were 54 ± 11 years old, in Stage D heart failure and included 22% women. Pearson correlation and Bland-Altman analysis of mean difference between echocardiographic and RHC measurements were significant (figure). Conclusion: Echocardiographic estimation of cardiopulmonary hemodynamics is reliable in end-stage cardiomyopathy patients awaiting transplantation. After initial RHC evaluation for assessment of reversibility of pulmonary hypertension, patients may be monitored by echocardiography.
We report a case of a 27-year-old man with Senning repair of D-transposition of the great arterie... more We report a case of a 27-year-old man with Senning repair of D-transposition of the great arteries. A dual-chamber pacemaker was placed for syncope due to sinoatrial node dysfunction 3 years before this presentation. He had no further syncope but complained of dyspnea on exertion and mild exercise intolerance. A routine chest x-ray and transthoracic echocardiography suggested the presence of a pacing lead in the systemic ventricle (anatomic right ventricle). To better define the anatomy and lead position, he underwent a gated computed tomography scan. This showed an appropriately positioned atrial lead in the nonsystemic atrium (anatomic left atrium), but the ventricular lead had perforated through the atrial baffle, coursing into the systemic ventricle (Figure, A and B; online-only Data Supplement Movies I and II). A small systemic-to-venous baffle shunt was seen in the region of the perforation. The systemic ventricle had mildly reduced systolic function. Inadvertent placement of ...
The Journal of Heart and Lung Transplantation, 2021
Purpose The complex anatomy and different contraction patterns of the different right ventricular... more Purpose The complex anatomy and different contraction patterns of the different right ventricular (RV) wall segments has made it challenging to predict acute RV failure (ARVF) in patients receiving a left ventricular assist device (LVAD). We sought to improve the prediction of ARVF after LVAD by performing a comprehensive 18-segment strain (e) analysis of the RV. Methods Prospectively enrolled LVAD recipients had a right heart catheterization and echocardiogram prior to implant. From RV-focused views (Figure 1A), 18-segment e was performed and indexed to pulmonary arterial elastance (Ea [PV]). ARVF was defined as need for RVAD, inotropes for >14 days or pulmonary vasodilator for >48 hours post-LVAD. Logistic regression was used to identify associations between specific parameters and ARVF. Results ARVF occurred in 15 of 30 patients enrolled. Lower pulmonary artery pulsatility index (PAPi), TAPSE and basal free wall (FW) (basal anterior, lateral and posterior FW) segmental e/Ea (PV) were significantly associated with ARVF. Indexed basal FW segmental strain provided incremental predictive value over PAPi and TAPSE (Figure 1B). Conclusion Prediction of ARVF in LVAD candidates can be improved by adding comprehensive RV segmental strain analysis to traditional echocardiographic and hemodynamics parameters.
The American Journal of Cardiology, 2010
Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In t... more Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In this study, invasive hemodynamics from right-sided cardiac catheterization were compared with values obtained by validated equations from Doppler 2-dimensional transthoracic echocardiography. This prospective study was conducted in 40 patients with end-stage heart failure evaluated for heart transplantation or ventricular assist device implantation. Transthoracic echocardiography and right-sided cardiac catheterization were performed within 4 hours. From continuous-wave Doppler of the tricuspid regurgitation jet, pulmonary artery systolic pressure was calculated as the peak gradient across the tricuspid valve plus right atrial pressure estimated from inferior vena cava filling. Mean pulmonary artery pressure was calculated as (0.61 ؋ pulmonary artery systolic pressure) ؉ 2. Pulmonary vascular resistance (PVR) was calculated as (tricuspid regurgitation velocity/right ventricular outflow tract time-velocity integral ؋ 10) ؉ 0.16. Pulmonary capillary wedge pressure was calculated as 1.91 ؉ (1.24 ؋ E/E=). Pearson's correlation and Bland-Altman analysis of mean differences between echocardiographic and right-sided cardiac catheterization measurements were statistically significant for all hemodynamic parameters (
Echocardiography, 2010
A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair i... more A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle. The lead was extracted, and a new lead was placed in the pulmonary (anatomic left) ventricle. A bidirectional baffle shunt persisted. The iatrogenic baffle leak was percutaneously closed with an Amplatzer septal occluder device using both intracardiac echocardiography (ICE) and three-dimensional transesophageal echocardiography (3D-TEE). We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure.
Journal of Cardiac Failure, 2009
Echocardiography, 2010
A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair i... more A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle. The lead was extracted, and a new lead was placed in the pulmonary (anatomic left) ventricle. A bidirectional baffle shunt persisted. The iatrogenic baffle leak was percutaneously closed with an Amplatzer septal occluder device using both intracardiac echocardiography (ICE) and three-dimensional transesophageal echocardiography (3D-TEE). We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure. (Echocardiography 2010;27:E90-E93) Key words: intracardiac echocardiography, baffle leak closure, congenital heart disease Atrial switch (Mustard or Senning) opera-
The American Journal of Cardiology, 2010
Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In t... more Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In this study, invasive hemodynamics from right-sided cardiac catheterization were compared with values obtained by validated equations from Doppler 2-dimensional transthoracic echocardiography. This prospective study was conducted in 40 patients with end-stage heart failure evaluated for heart transplantation or ventricular assist device implantation. Transthoracic echocardiography and right-sided cardiac catheterization were performed within 4 hours. From continuous-wave Doppler of the tricuspid regurgitation jet, pulmonary artery systolic pressure was calculated as the peak gradient across the tricuspid valve plus right atrial pressure estimated from inferior vena cava filling. Mean pulmonary artery pressure was calculated as (0.61 ؋ pulmonary artery systolic pressure) ؉ 2. Pulmonary vascular resistance (PVR) was calculated as (tricuspid regurgitation velocity/right ventricular outflow tract time-velocity integral ؋ 10) ؉ 0.16. Pulmonary capillary wedge pressure was calculated as 1.91 ؉ (1.24 ؋ E/E=). Pearson's correlation and Bland-Altman analysis of mean differences between echocardiographic and right-sided cardiac catheterization measurements were statistically significant for all hemodynamic parameters (pulmonary artery systolic pressure: r ؍ 0.82, p <0.05, mean difference 3.1 mm Hg, 95% confidence interval [CI] ؊0.2 to 6.3; mean pulmonary artery pressure: r ؍ 0.80, p <0.05, mean difference 2.5 mm Hg, 95% CI 0.3 to 4.6; PVR: r ؍ 0.52, p <0.05, mean difference 0.8 Wood units, 95% CI 0.3 to 1.4; pulmonary capillary wedge pressure: r ؍ 0.65, p <0.05, mean difference 2.2 mm Hg, 95% CI 0.1 to 4
Transplantation Proceedings, Dec 1, 2011
Limited and conflicting data exist on the diagnosis of cardiac allograft rejection with the use o... more Limited and conflicting data exist on the diagnosis of cardiac allograft rejection with the use of echocardiography. The purpose of our study was to evaluate various systolic and diastolic indices, including newer tissue Doppler imaging techniques, in diagnosing cardiac allograft rejection. We prospectively performed 426 echocardiography studies at the time of endomyocardial biopsy in 54 cardiac transplant patients. We measured left ventricular (LV) systolic and diastolic dimensions, mitral inflow pattern and annular velocities, and the myocardial performance index. Biopsies were assessed for cellular rejection and antibody-mediated rejection (AMR). Mild cellular rejection was diagnosed in 74 biopsy specimens and significant cellular rejection in 10 biopsy specimens. AMR was diagnosed in 30 biopsy specimens. In patients with mild or significant cellular rejection, no significant differences in echocardiographic parameters were observed. In patients with AMR, LV fractional shortening was significantly reduced compared with those with no AMR (mean±SD 31.8±8.9% vs 36.0±7.1%; P=.02). Although 1 echocardiographic parameter was statistically different in the setting of rejection, lack of consistency and overlap between nonrejection and rejection groups does not permit definitive noninvasive diagnosis of cardiac allograft rejection using this imaging modality.
Journal of the American College of Cardiology, Mar 1, 2010
Background: Candidacy for heart transplantation is influenced by the severity of pulmonary hypert... more Background: Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. We compared hemodynamics by right heart catheterization (RHC) with values obtained by validated equations from Doppler 2D transthoracic echocardiography. Method: This prospective study was conducted in 23 patients evaluated for cardiac transplantation. Transthoracic echocardiography and RHC were performed within 4 hours. From continuous wave Doppler of tricuspid regurgitation (TR) jet, measured in 22 patients, pulmonary artery systolic pressure (PASP) was calculated as peak gradient across tricuspid valve plus right atrial pressure estimated from IVC filling and mean PAP as (0.61xPASP)+2. Pulmonary vascular resistance (PVR) was calculated from TR velocity (TRV) and right ventricular outflow tract time-velocity integral as (TRV/TVIRVOT x10)+0.16 and pulmonary capillary wedge pressure (PCWP) from equation 1.91+(1.24xE/E'). Results: The patients were 54 ± 11 years old, in Stage D heart failure and included 22% women. Pearson correlation and Bland-Altman analysis of mean difference between echocardiographic and RHC measurements were significant (figure). Conclusion: Echocardiographic estimation of cardiopulmonary hemodynamics is reliable in end-stage cardiomyopathy patients awaiting transplantation. After initial RHC evaluation for assessment of reversibility of pulmonary hypertension, patients may be monitored by echocardiography.
We report a case of a 27-year-old man with Senning repair of D-transposition of the great arterie... more We report a case of a 27-year-old man with Senning repair of D-transposition of the great arteries. A dual-chamber pacemaker was placed for syncope due to sinoatrial node dysfunction 3 years before this presentation. He had no further syncope but complained of dyspnea on exertion and mild exercise intolerance. A routine chest x-ray and transthoracic echocardiography suggested the presence of a pacing lead in the systemic ventricle (anatomic right ventricle). To better define the anatomy and lead position, he underwent a gated computed tomography scan. This showed an appropriately positioned atrial lead in the nonsystemic atrium (anatomic left atrium), but the ventricular lead had perforated through the atrial baffle, coursing into the systemic ventricle (Figure, A and B; online-only Data Supplement Movies I and II). A small systemic-to-venous baffle shunt was seen in the region of the perforation. The systemic ventricle had mildly reduced systolic function. Inadvertent placement of ...
The Journal of Heart and Lung Transplantation, 2021
Purpose The complex anatomy and different contraction patterns of the different right ventricular... more Purpose The complex anatomy and different contraction patterns of the different right ventricular (RV) wall segments has made it challenging to predict acute RV failure (ARVF) in patients receiving a left ventricular assist device (LVAD). We sought to improve the prediction of ARVF after LVAD by performing a comprehensive 18-segment strain (e) analysis of the RV. Methods Prospectively enrolled LVAD recipients had a right heart catheterization and echocardiogram prior to implant. From RV-focused views (Figure 1A), 18-segment e was performed and indexed to pulmonary arterial elastance (Ea [PV]). ARVF was defined as need for RVAD, inotropes for >14 days or pulmonary vasodilator for >48 hours post-LVAD. Logistic regression was used to identify associations between specific parameters and ARVF. Results ARVF occurred in 15 of 30 patients enrolled. Lower pulmonary artery pulsatility index (PAPi), TAPSE and basal free wall (FW) (basal anterior, lateral and posterior FW) segmental e/Ea (PV) were significantly associated with ARVF. Indexed basal FW segmental strain provided incremental predictive value over PAPi and TAPSE (Figure 1B). Conclusion Prediction of ARVF in LVAD candidates can be improved by adding comprehensive RV segmental strain analysis to traditional echocardiographic and hemodynamics parameters.
The American Journal of Cardiology, 2010
Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In t... more Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In this study, invasive hemodynamics from right-sided cardiac catheterization were compared with values obtained by validated equations from Doppler 2-dimensional transthoracic echocardiography. This prospective study was conducted in 40 patients with end-stage heart failure evaluated for heart transplantation or ventricular assist device implantation. Transthoracic echocardiography and right-sided cardiac catheterization were performed within 4 hours. From continuous-wave Doppler of the tricuspid regurgitation jet, pulmonary artery systolic pressure was calculated as the peak gradient across the tricuspid valve plus right atrial pressure estimated from inferior vena cava filling. Mean pulmonary artery pressure was calculated as (0.61 ؋ pulmonary artery systolic pressure) ؉ 2. Pulmonary vascular resistance (PVR) was calculated as (tricuspid regurgitation velocity/right ventricular outflow tract time-velocity integral ؋ 10) ؉ 0.16. Pulmonary capillary wedge pressure was calculated as 1.91 ؉ (1.24 ؋ E/E=). Pearson's correlation and Bland-Altman analysis of mean differences between echocardiographic and right-sided cardiac catheterization measurements were statistically significant for all hemodynamic parameters (
Echocardiography, 2010
A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair i... more A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle. The lead was extracted, and a new lead was placed in the pulmonary (anatomic left) ventricle. A bidirectional baffle shunt persisted. The iatrogenic baffle leak was percutaneously closed with an Amplatzer septal occluder device using both intracardiac echocardiography (ICE) and three-dimensional transesophageal echocardiography (3D-TEE). We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure.
Journal of Cardiac Failure, 2009
Echocardiography, 2010
A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair i... more A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle. The lead was extracted, and a new lead was placed in the pulmonary (anatomic left) ventricle. A bidirectional baffle shunt persisted. The iatrogenic baffle leak was percutaneously closed with an Amplatzer septal occluder device using both intracardiac echocardiography (ICE) and three-dimensional transesophageal echocardiography (3D-TEE). We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure. (Echocardiography 2010;27:E90-E93) Key words: intracardiac echocardiography, baffle leak closure, congenital heart disease Atrial switch (Mustard or Senning) opera-
The American Journal of Cardiology, 2010
Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In t... more Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In this study, invasive hemodynamics from right-sided cardiac catheterization were compared with values obtained by validated equations from Doppler 2-dimensional transthoracic echocardiography. This prospective study was conducted in 40 patients with end-stage heart failure evaluated for heart transplantation or ventricular assist device implantation. Transthoracic echocardiography and right-sided cardiac catheterization were performed within 4 hours. From continuous-wave Doppler of the tricuspid regurgitation jet, pulmonary artery systolic pressure was calculated as the peak gradient across the tricuspid valve plus right atrial pressure estimated from inferior vena cava filling. Mean pulmonary artery pressure was calculated as (0.61 ؋ pulmonary artery systolic pressure) ؉ 2. Pulmonary vascular resistance (PVR) was calculated as (tricuspid regurgitation velocity/right ventricular outflow tract time-velocity integral ؋ 10) ؉ 0.16. Pulmonary capillary wedge pressure was calculated as 1.91 ؉ (1.24 ؋ E/E=). Pearson's correlation and Bland-Altman analysis of mean differences between echocardiographic and right-sided cardiac catheterization measurements were statistically significant for all hemodynamic parameters (pulmonary artery systolic pressure: r ؍ 0.82, p <0.05, mean difference 3.1 mm Hg, 95% confidence interval [CI] ؊0.2 to 6.3; mean pulmonary artery pressure: r ؍ 0.80, p <0.05, mean difference 2.5 mm Hg, 95% CI 0.3 to 4.6; PVR: r ؍ 0.52, p <0.05, mean difference 0.8 Wood units, 95% CI 0.3 to 1.4; pulmonary capillary wedge pressure: r ؍ 0.65, p <0.05, mean difference 2.2 mm Hg, 95% CI 0.1 to 4