ID | 116465 |
Title Alternative | 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
|
Author |
Arase, Miharu
Tokushima University
Kusunose, Kenya
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Morita, Sae
Tokushima University
Yamaguchi, Natsumi
Tokushima University
Hirata, Yukina
Tokushima University
Nishio, Susumu
Tokushima University
Okushi, Yuichiro
Tokushima University
Ise, Takayuki
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Yamaguchi, Koji
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Yagi, Shusuke
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Yamada, Hirotsugu
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Soeki, Takeshi
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Wakatsuki, Tetsuzo
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
Sata, Masataka
Tokushima University
Tokushima University Educator and Researcher Directory
KAKEN Search Researchers
|
Keywords | left ventricular diastolic dysfunction
pulmonary hypertension
exercise echocardiography
systemic sclerosis
|
Content Type |
Thesis or Dissertation
|
Description | 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. |
Journal Title |
Open Heart
|
ISSN | 20533624
|
Publisher | BMJ Publishing Group|British Cardiovascular Society
|
Volume | 8
|
Issue | 1
|
Start Page | e001559
|
Published Date | 2021-02-19
|
Remark | 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。 |
Rights | 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/.
|
EDB ID | |
DOI (Published Version) | |
URL ( Publisher's Version ) | |
FullText File | |
language |
eng
|
TextVersion |
ETD
|
MEXT report number | 甲第3596号
|
Diploma Number | 甲医第1525号
|
Granted Date | 2022-03-23
|
Degree Name |
Doctor of Medical Science
|
Grantor |
Tokushima University
|
departments |
Medical Sciences
University Hospital
|