広江 貴美子¹, 太田 哲郎², 吉冨 裕之², 河田 良子¹, 角 隆¹, 鹿島 由史², 岡田 清治², 木下 順久², 越野 佑司¹, 松野 好男²

Kimiko HIROE¹, Tetsuro OHTA², Hiroyuki YOSHITOMI², Ryoko KAWATA¹, Takashi SUMI¹, Yoshifumi KASIMA², Seiji OKADA², Yoshihisa KINOSHITA², Yuji KOSHINO¹, Yoshio MATSUNO²

¹松江市立病院中央検査科, ²松江市立病院第二内科

¹Division of Cardiology Laboratory of Clinical Medicine, Matsue City Hospital, ²The Second Department of Internal Medicine, Matsue City Hospital

キーワード : hand-carried echocardiography, left ventricular ejection fraction, Simpson's method, visual estimation

本研究の目的は視覚的左室駆出率(Visual EF)の信頼性と有用性を検討することである. 方法及び結果: 1) 経験者5名と初心者2名により70例のVisual EFを評価した. 経験者では観察者内変動はr=0.92〜0.97, 95% CI (Bland-Altman)=-0.3〜2.9±7.2〜13.0%, 観察者間変動はr=0.87〜0.97, 95% CI=-4.2〜2.1±6.8〜16.0%, また, Simpson EFとの比較はr=0.91〜0.94, 95% CI=-0.6〜4.3±10.2〜13.4% と良好であったが, 初心者では不良であった. 2) 局所的壁運動異常のある31例ではSimpson EFとの比較はVisual EFでr=0.80〜0.89, 95% CI=-3.3〜2.0± 10.6〜15.1%と良好であったが, Teichholz EFでは不良であった. 局所的壁運動異常のない71例では両方法は同等に良好であった. 3) 携帯型装置による61例のVisual EFとSimpson EFの比較はr=0.90, 95% CI=-0.1±10.0%と良好であった. 結論: Visual EF は, 1) 心エコー図検査に経験を積んだ検者が行えば再現性が良好でSimpson EFと良く一致し, 2) 局所的壁運動異常の有無にかかわらず評価できる方法である. 3) また, 携帯型装置での検査時においても有用な方法と考えられた.

Background: Visual estimation of left ventricular ejection fraction (Visual EF) and the modified biplane Simpson’s method provide valuable clinical measurements of left ventricular function. Hand-carried ultrasound devices have been developed for point-of-care cardiac assessment at bedside or in the emergency room, and a quick estimation of left ventricular function in real time is still required. This study aims to demonstrate the reliability and usefulness of Visual EF by evaluating its reproducibility and comparing its results with those obtained using the modified Simpson’s method. Method and Result: (1) Five experienced observers (A, B, C, D, and E) as experts and two inexperienced observers (F and G) as novices measured the Visual EF of 70 patients by blinded repeat analysis. Intraobserver variability of the experts was r=0.92 to-0.97, 95% CI (Bland-Altman analysis)=-0.3 to 2.9±7.2% to 13.0%. Interobserver variability between experts was r=0.87 to 0.97, 95% CI=-4.2 to 2.1±6.8% to 16.0%. The intraobserver and interobserver variability of the novices showed poor results. Comparison between Visual EF and Simpson’s EF by experts was r=0.91 to 0.94, 95% CI=-0.6 to 4.3±10.2% to 13.4%. (2) Three observers (A, D, and E) measured the Visual EF and Teichholz’s EF of 31 patients with and 71 patients without localized wall motion abnormality by blinded analysis. Comparison between Visual EF and Simpson’s EF in patients with localized wall motion abnormality was r=0.80 to 0.89, 95% CI=-3.3 to 2.0±10.6% to 15.1%. Comparison between Teichholz’s EF and Simpson’s EF of patients with localized wall motion abnormality was r=0.59 to 0.62, 95% CI=-3.0 to 7.1±22.2% to 26.0%. These two methods were comparable in patients without localized wall motion abnormality. (3) Expert measured the Visual EF of 61 patients using a hand-carried ultrasound device by blinded analysis. Comparison between Visual EF and Simpson’s EF was r=0.90, 95% CI=-0.1±10.0%. Conclusion: Visual EF estimated by an expert is (1) reproducible and agrees well with Simpson’s EF and (2) feasible in patients with and without localized wall motion abnormality. (3) This method can be utilized for point-of-care echocardiography with hand-held ultrasound devices.