岸田 由香里¹, 田中 伸明^{1, 3}, 江角 智子¹, 波多野 靖幸², 赤川 英三², 橋本 亮², 國近 英樹², 村田 和也^{2, 3}, 日野田 裕治^{1, 3}, 松崎 益徳²

Yukari KISHIDA¹, Nobuaki TANAKA^{1, 3}, Tomoko EZUMI¹, Yasuyuki HADANO², Eizo AKAGAWA², Ryo HASHIMOTO², Hideki KUNICHIKA², Kazuya MURATA^{2, 3}, Yuji HINODA^{1, 3}, Masunori MATSUZAKI²

¹山口大学医学部附属病院検査部, ²山口大学大学院器官病態内科学, ³山口大学医学部附属病院超音波センター

¹Department of Clinical Laboratory, Yamaguchi University Hospital, ²Division of Cardiovascular Medicine, Graduate School of Medicine, Yamaguchi University, ³Medical Ultrasound Center, Yamaguchi University Hospital

キーワード : hypertension, Doppler echocardiography, transmitral flow, aging

目的：近年，僧帽弁血流波形（TMF）は左室拡張機能評価の第一歩としてルーチンに記録される．健常者のTMFは，若年者ではE>Aだが加齢とともにE/Aは小さくなり，やがてE<Aとなることが知られている．また，高血圧患者では左室コンプライアンスの低下により左室充満における心房収縮の寄与が高まり，より若い年齢でE/Aが小さくなると考えられるが，これに関する国内のデータは少ない．そこで高血圧患者のTMFにおけるE/Aの加齢による変化を明らかにしたいと考えた．対象と方法：当院の心エコー検査報告書のデータベースを検索し，高血圧患者（n＝553）および対照群（n＝394）を対象とした．各群で年齢による区分けをし，E/Aを群間また年齢別に比較検討した．結果：対照群では加齢とともに緩やかなE/Aの低下を認め，60歳代でE/Aの平均値が1以下となった．一方，高血圧患者ではE/Aの低下が早期に認められ，50歳代でE/Aの平均値が1以下となった．結論：高血圧患者では対照群に比べてE/Aの平均値としては約10歳早くE/Aの逆転が見られた．

Purpose: Currently, the transmitral flow (TMF) pattern is routinely recorded as the first step in the assessment of left ventricular diastolic function. In young, healthy subjects, it is known that the early diastolic flow (E wave) of TMF is larger than the late diastolic flow (A wave). The E/A ratio then gradually decreases with age. This change in the pattern of TMF can be expected to occur earlier in patients with systemic hypertension than in healthy subjects. However, data pertaining to this matter are limited for Japanese patients. The purpose of this study was to investigate the changing pattern of TMF with age in Japanese patients with systemic hypertension. Methods: A database of echocardiographic examination reports was surveyed. A total of 553 patients with systemic hypertension (HT group) and 394 patients without hypertension or organic heart disease (control group) were included in this study. The patients were subdivided according to age, after which the E/A ratio was compared for different patient categories and age groups. Results: The E/A ratio gradually decreased with age in the control group, and the mean value of E/A was < 1 in the sixth decade. On the other hand, the E/A ratio rapidly decreased and was < 1 in the fifth decade in the HT group. Conclusion: In patients in the HT group, the E/A ratio decreased about a decade earlier compared with patients in the control group.