杉浦 真里¹, 野田 明子², 後藤 由実², 美濃島 慎¹, 原 祐樹¹, 宮田 聖子¹, 伊藤 理恵子³, 飯野 重夫³, 永田 浩三², 古池 保雄²

Mari SUGIURA¹, Akiko NODA², Yumi GOTOH², Makoto MINOSHIMA¹, Yuki HARA¹, Seiko MIYATA¹, Rieko ITOH³, Shigeo IINO³, Kohzou NAGATA², Yasuo KOIKE²

¹名古屋大学大学院医学系研究科, ²名古屋大学医学部保健学科, ³名古屋大学医学部附属病院検査部

¹Department of Medical Technology, Nagoya University Graduate School of Medicine, ²Department of Medical Technology, Nagoya University School of Health Sciences, ³Department of Clinical Laboratory, Nagoya University Hospital

キーワード : three-dimensional echocardiography, exercise, stroke volume, cardiac output

目的：3次元（three-dimensional: 3D）心エコー法による運動時の左心機能評価の信頼性および実用性について，パルスドプラ法および断層エコー（two-dimensional: 2D）心エコー法と比較検討した．対象と方法：健常成人18例を対象に仰臥位自転車エルゴメーターによる多段階運動負荷試験を施行し，運動時の左心機能を3D心エコー法により評価した．3D法による運動中の一回拍出量係数（stroke volume index: SVI, stroke volume / body surface area），心係数（cardiac index: CI, cardiac output / body surface area）および左室駆出率（left ventricular ejection fraction: LVEF）をパルスドプラ法および2D法によるそれらと比較した．各方法によるSVI，LVEF，左室収縮および拡張末期容積の同一者間，他者間変動を検討した．結果：運動中のSVI，CIおよびLVEFの同一者間および他者間変動はパルスドプラ法および2D法に比し3D法で小であった．また，3D法によって求めたSVIおよびCIは，運動中，心拍数の上昇と共に最大運動時まで増大した．3D法では安静時および最大運動時のdyssynchronyの評価が可能であった．結論：運動中の左心機能評価として3D心エコー法は実用的と考えられた．

Purpose: Three-dimensional (3D) echocardiography is useful for the accurate evaluation of left ventricular (LV) function, but its reliability during exercise remains unclear. We conducted an investigation to determine whether 3D echocardiography was practicable for evaluating LV function during exercise. Subjects and Methods: We studied 18 healthy subjects (12 males, 6 females: 22.7±1.8 years). All subjects underwent supine bicycle ergometer exercise tests. We compared stroke volume index (SVI, stroke volume / body surface area), cardiac index (CI, cardiac output / body surface area), and LV ejection fraction (LVEF) during exercise using pulsed wave Doppler (PWD) and two-dimensional (2D) and 3D echocardiography. The inter-observer and intra-observer variations were measured repeatedly during exercise. Results: The SVI and CI measured by 3D echocardiography continued to increase during exercise, and these were accompanied by heart rate elevation. The inter-observer and intra-observer variations in LV volume measured by 3D echocardiography were better than those for PWD and 2D echocardiography. We could evaluate the dyssynchrony at maximum exercise using 3D echocardiography. Conclusion: 3D echocardiography is a reproducible tool that could feasibly be used for the evaluation of LV function during exercise.