近藤 修二, 細合 浩司, 藤原 聡子, 横山 雅子, 山下 毅, 船津 和夫, 中村 治雄

Shuji KONDO, Hiroshi HOSOAI, Satoko FUJIWARA, Masako YOKOYAMA, Tuyosi YAMASHITA, Kazuo FUNATSU, Haruo NAKAMURA

三越厚生事業団三越診療所内科

Mitsukoshi Health and Welfare Foundation

キーワード : gender difference, left ventricular diastolic function, E wave velocity, left ventricular ejection time, Tei index

左室収縮機能だけでなく拡張機能には性差があるという報告がある．しかし日本人の左室拡張機能についても同様の性差が存在するかどうかについての報告は見当たらない．この研究の目的は左室駆出率正常者で心エコー所見ほぼ正常者の左室拡張機能を含めた男女差について検討することである．左室駆出率65%以上で心エコー所見正常の，60歳以下の男108例，女55例，計163例を対象にした．さらに高血圧や糖尿病の影響を除くため，これらの症例を除いた134例（男85例，女49例）でも結果を解析した．左室駆出率（LVEF），拡張早期波（E），心房収縮期波（A），E/A比，E波の減速時間deceleration time（DcT），Tei index，駆出時間（ET），等容拡張時間（IRT），等容収縮時間（ICT）および左室心筋重量係数（LV mass index）を求めた．残りの134例ではLVEFには男女で有意差は無かった．E波（79±19 vs 69±15 cm/s）は女性が男性に比べ有意（p<0.005）に速かった．しかしA波，E/A比，DcTには有意差は無かった．ET（311±23 vs 292±31 ms）は女性が男性に比べ有意（p<0.005）に長かったが，ICT, IRTに有意差は無かった．そのためか，Tei index（0.38±0.11 vs 0.44±0.12）は女性が男性に比べ有意（p<0.005）に小さかった．LV mass index（102±29 vs 119±25 g/m²）は女性が男性に比べ有意（p<0.005）に小さかった．心機能の評価には性差に注意する必要がある．

Several studies indicated that there were gender differences in left ventricular (LV) systolic function. Gender differences in left ventricular diastolic function were also reported. However, there has been no study about gender differences in left ventricular diastolic function in Japanese. The purpose of this study is to assess gender differences in left ventricular function including diastolic function in patients with normal left ventricular ejection fraction and normal echocardiographic findings. Subjects were 163 patients under 60 years of age, including 108 men and 55 women, with LV ejection fraction (EF) over 65%. LVEF, both mitral E and A wave velocities, mitral E/A ratio, deceleration time of E wave (DcT), Tei index, ejection time (ET), isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT) and left ventricular mass index (LVMI) were measured using Doppler echocardiography. Patients with hypertension and diabetes mellitus were then excluded from the 163 patients, which left 134 patients including 85 men and 49 women to be analyzed. There was no difference in LVEF between genders. E wave velocity (79±19 vs 69±15 cm/s, p<0.005) was higher in women than in men, but A wave velocity, DcT and E/A ratio were not different between genders. ET (311±23 vs 292±31 ms, p<0.005) was longer in women than in men, but ICT and IRT were not different between genders. Tei index (0.38±0.11 vs 0.44±0.12, p<0.005) was smaller in women than in men, probably because of a gender difference in ET. LVMI (102±29 vs 119±25g/m², p<0.005) was smaller in women than in men. We conclude that it is necessary to pay attention to these gender differences when evaluating left ventricular function.