瀬尾 由広

Yoshihiro SEO

名古屋市立大学大学院医学研究科循環器内科学

Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University

キーワード : heart failure, diagnostic system, elderly, echocardiography, BNP

日本は超高齢社会を迎え，心不全（heart failure: HF）患者数は大幅に増加している．特に，高齢者に広く見られる駆出率が保たれた心不全（heart failure with preserved ejection fraction: HFpEF）の増加は，過去10年に顕著なものとなっている．従来HFpEFは拡張不全心とも呼ばれていたように，心エコー図検査による左室拡張機能の評価が重要視されてきた．このため米国心エコー図学会（American Society of Echocardiography: ASE）および欧州心血管画像学会（European Association of Cardiovascular Imaging: EACVI）の左室拡張機能を評価するためのドプラ心エコー図検査アルゴリズムが，HFpEF診断に広く使用されている．一方，本総説は欧州心不全学会が2018年に提案したHFpEF診断アルゴリズム（HFA-PEFFスコア）に焦点を当てる．我々の行なった研究結果から，HFpEF患者，健常高齢者およびHF歴のない高血圧患者とを比較することでHFA-PEFFスコアの有用性と課題について解説する．また，HFA-PEFFスコアとASE/EACVIアルゴリズムとの差異についても言及する．最後に高齢者における心不全の発症と心不全の進行防止に対する心エコー診断システムの将来展望について述べ，「早期HFpEF」という概念を提案したい．

Since Japan is experiencing a super-aged society, the number of heart failure patients (HF) is increasing remarkably. In particular, the increase in heart failure with preserved ejection fraction (HFpEF), which is common in the elderly, has characterized the last decade. The diagnosis of HFpEF by assessment of left ventricular (LV) diastolic dysfunction, which is also referred to as diastolic heart failure, is an important role assigned to echocardiography. The Doppler echocardiographic algorithm for the evaluation of LV diastolic function from the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) has been widely used to diagnose HFpEF. This article will focus on the HFpEF diagnostic algorithm proposed in 2018 by the Heart Failure Association of the European Society of Cardiology (HFA-PEFF score) based on autologous elderly cases. We compared the usefulness of the HFA-PEFF score with the ASE/EACVI algorithm. By comparing HFpEF patients with healthy elderly subjects and hypertensive patients with no history of HF, this paper will identify the usefulness and challenges of the HFA-PEFF score in the assessment of the elderly. The echocardiographic findings in at-risk or early-stage elderly patients with HFpEF will also be summarized. In addition, this review will describe future prospects for echocardiographic diagnostic systems for the prevention of HF onset and HF progression in the elderly and propose the concept of “early HFpEF".