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ID 112877
Title Alternative
早期心不全患者における心不全増悪のリスク層別化に対する前負荷心エコー図法の臨床応用
Preload stress echocardiography for heart failure
Author
Saijo, Yoshihito Tokushima University
Nishio, Susumu Tokushima University
Torii, Yuta Tokushima University
Hirata, Yukina Tokushima University
Seno, Hiromitsu Tokushima University
Keywords
Diastolic function
Doppler echocardiography
heart failure
stress echocardiography
Content Type
Thesis or Dissertation
Description
Aim: To improve the prognosis of patients with heart failure, risk stratification in their early stage is important. We assessed whether the change in transmitral flow (TMF) velocity pattern during preload augmentation can predict future hemodynamic worsening in early-stage heart failure patients with impaired relaxation TMF pattern.
Methods: We designed a prospective cohort study that included 155 consecutive patients with impaired relaxation (IR) pattern at rest. Preload stress echocardiography was achieved using leg positive pressure (LPP), and changes of TMF pattern during the LPP was observed during baseline echocardiographic examination. The patients whose TMF pattern developed to pseudonormal (PN) pattern throughout the study period were classified into the change to PN group, and patients whose TMF pattern stayed in IR pattern were classified into the stay in IR group.
Results: The median follow-up period was 17 months. The average age was 68 ± 11 years old, and 97 patients (63%) were male. Among 155 patients, 27 were classified into the change to PN group. A Cox proportional hazard analysis confirmed that the change in the peak atrial systolic TMF velocity during the LPP (ΔA, hazard ratio = 0.58 per 1SD; 95% CI = 0.39 - 0.88, P = 0.010) was the powerful independent predictor of change into PN pattern. Kaplan-Meier analysis revealed that the patients with ΔA ≤ -7 cm/s had more likely to develop into PN pattern than patients with ΔA > -7 cm/s (P = 0.001).
Conclusions: Evaluation of a response in TMF during the LPP might provide an incremental diagnostic value to detect future overt heart failure in patients with early-stage heart failure.
Journal Title
Echocardiography
ISSN
15408175
Publisher
Wiley Periodicals
Volume
35
Issue
10
Start Page
1587
End Page
1595
Published Date
2018-07-13
Remark
内容要旨・審査要旨・論文本文の公開
This is the peer reviewed version of the following article: Saijo Y, Yamada H, Kusunose K, et al. A clinical application of preload stress echocardiography for predicting future hemodynamic worsening in patients with early‐stage heart failure. Echocardiography. 2018;35:1587–1595, which has been published in final form at https://doi.org/10.1111/echo.14098. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
本論文は,著者Yoshihito Saijo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。
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
ETD
MEXT report number
甲第3215号
Diploma Number
甲医第1383号
Granted Date
2018-09-27
Degree Name
Doctor of Medical Science
Grantor
Tokushima University
departments
University Hospital
Medical Sciences