ID | 116465 |
タイトル別表記 | 全身性強皮症における6分間歩行負荷心エコー図検査での左室予備能の評価
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著者 |
荒瀬, 美晴
徳島大学大学院医科学教育部(医学専攻)
Morita, Sae
Tokushima University
Yamaguchi, Natsumi
Tokushima University
Hirata, Yukina
Tokushima University
Nishio, Susumu
Tokushima University
Okushi, Yuichiro
Tokushima University
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キーワード | left ventricular diastolic dysfunction
pulmonary hypertension
exercise echocardiography
systemic sclerosis
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資料タイプ |
学位論文
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抄録 | Objectives
There is a high prevalence of left ventricular diastolic dysfunction (LVDD) in systemic sclerosis (SSc) which is associated with high mortality. Thus, early detection of LVDD could be important in management of SSc. We hypothesised that exercise echocardiography in SSc patients with normal resting haemodynamics may expose early phase LVDD, which could affect its prognosis, defined as cardiovascular death and unplanned hospitalisation for heart failure. Methods Between January 2014 and December 2018, we prospectively enrolled 140 patients with SSc who underwent 6-minute walk (6MW) stress echocardiographic studies with normal range of estimated mean pulmonary arterial pressure (mPAP) (<25 mm Hg) and mean pulmonary artery wedge pressure (mPAWP) (<15 mm Hg) at rest. We used ΔmPAP/Δcardiac output (CO) to assess pulmonary vascular reserve and ΔmPAWP/ΔCO to assess LV cardiac reserve between resting and post-6MW. Results During a median period of 3.6 years (IQR 2.0–5.1 years), 25 patients (18%) reached the composite outcome. Both ΔmPAP/ΔCO and ΔmPAWP/ΔCO in patients with events were significantly greater than in those without events (8.9±3.8 mm Hg/L/min vs 3.0±1.7 mm Hg/L/min; p=0.002, and 2.2±0.9 mm Hg/L/min vs 0.9±0.5 mm Hg/L/min; p<0.001, respectively). Patients with both impaired LV cardiac reserve (ΔmPAWP/ΔCO>1.4 mm Hg/L/min) and impaired pulmonary vascular reserve (ΔmPAP/ΔCO>3.0 mm Hg/L/min) had worse outcomes compared with those without these abnormalities (p<0.001). Conclusion The 6MW stress echocardiography revealed impaired LV cardiac reserve in SSc patients with normal resting haemodynamics. Furthermore, LV cardiac reserve independently associates with clinical worsening in SSc, providing incremental prognostic utility, in addition to pulmonary vascular parameters. |
掲載誌名 |
Open Heart
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ISSN | 20533624
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出版者 | BMJ Publishing Group|British Cardiovascular Society
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巻 | 8
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号 | 1
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開始ページ | e001559
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発行日 | 2021-02-19
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備考 | 内容要旨・審査要旨・論文本文の公開
本論文は,著者Miharu Araseの学位論文として提出され,学位審査・授与の対象となっている。 |
権利情報 | This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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EDB ID | |
出版社版DOI | |
出版社版URL | |
フルテキストファイル | |
言語 |
eng
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著者版フラグ |
博士論文全文を含む
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文科省報告番号 | 甲第3596号
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学位記番号 | 甲医第1525号
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学位授与年月日 | 2022-03-23
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学位名 |
博士(医学)
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学位授与機関 |
徳島大学
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部局 |
医学系
病院
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