松浦 秀哲¹, 山田 晶², 高橋 礼子¹, 杉本 恵子¹, 石川 隆志¹, 岩瀬 正嗣³, 菱田 仁², 大島 久二¹

Hideaki MATSUURA¹, Akira YAMADA², Ayako TAKAHASHI¹, Keiko SUGIMOTO¹, Takashi ISHIKAWA¹, Masatsugu IWASE³, Hitoshi HISHIDA², Hisaji OHSHIMA¹

¹藤田保健衛生大学病院臨床検査部, ²藤田保健衛生大学医学部循環器内科, ³藤田保健衛生大学短期大学医療情報技術学科

¹Fujita Health University Hospital, Clinical Laboratory, ²Division of Cardiology, Fujita Health University, ³Department of Medical Information Technology in Junior College, Fujita Health University

キーワード : left atrial volume index, E/E’, pulmonary artery wedge pressure, coronary heart disease

背景：近年，心エコー図検査における左室拡張能の指標として，パルスドプラ心エコー図法を用いた僧帽弁血流速波形の拡張早期波（E波）と組織ドプラエコー法を用いた拡張早期僧帽弁輪速度（E’）の比であるE/E’の有用性が認められており，左室拡張末期圧（LVEDP）や肺動脈楔入圧（PAWP）と相関することが知られている．しかし，E/E’の上昇が軽度（8≤E/E’≤15）の場合，その意義は小さいことが報告されている．また，拡張能に関する指標として，左房容積係数（LAVI）が注目されている．目的：E/E’軽度上昇例に対しLAVIを併せて計測することでPAWP上昇を推定できるか検討した．方法：当院CCUに入院しスワンガンツカテーテルを挿入された冠動脈疾患患者のうち心房細動および高度僧帽弁閉鎖不全症例を除外した連続58例を対象に心エコー図検査を施行した（Philips社製SONOS5500および7500，S3探触子）．全症例でE/E’とLAVIの計測を行った．結果：23症例がE/E’軽度上昇に該当した．E/E’軽度上昇の23症例では，E/E’とPAWPとの間に有意の相関を認めなかった．一方，LAVIは全症例でもE/E’軽度上昇例に限定してもPAWPとの間に有意な相関関係が維持された．結論：E/E’軽度上昇例では，LAVIによりPAWPを推定でき，その測定が有用である可能性が示唆された．

Background: The ratio of early transmitral velocity to early diastolic velocity of the mitral annulus (E/E’) has been shown to be an excellent predictor of left ventricular filling pressure. However, the clinical significance of mildly elevated E/E’ (8≤E/E’≤15) remains to be clarified. Left atrial (LA) volume would reflect the duration and severity of left ventricular diastolic dysfunction. There is a graded relation between LA volume index (LAVI) and severity of diastolic dysfunction. Purpose: We hypothesized that LAVI could be useful for predicting increased PAWP in coronary heart disease patients with mildly elevated E/E’. Subjects and Methods: Patients admitted to the coronary care unit at our hospital who had indwelling pulmonary artery catheters were eligible. Fifty-eight patients without atrial fibrillation or severe mitral regurgitation underwent echocardiography (Sonos 5500 or 7500; S3 probe; Philips). Tissue Doppler imaging of the mitral annulus was also obtained. Early diastolic E’ velocity was measured from the septal mitral annulus velocity profile in the apical 4-chamber view. LA volume was assessed by the biplane Simpson’s method from apical 4- and 2-chamber views in end systole. LAVI was obtained by correcting for body surface area. PAWP was measured simultaneously in all the patients. Results: In 23 patients with mildly elevated E/E’ (8≤E/E’≤15) , there was no correlation between PAWP and E/E’ (p=0.40). However, LAVI positively correlated with PAWP in those patients (r=0.64, p<0.001). LAVI≥32ml/m² was the optimal cutoff to predict PAWP≥15mmHg (sensitivity 72%, specificity 80%). Conclusion: LAVI could be a useful adjunct measure for predicting increased PAWP in coronary heart disease patients with mildly elevated E/E’.