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ID 112877
タイトル別表記
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
著者
西條, 良仁 徳島大学大学院医科学教育部(医学専攻)
Nishio, Susumu Tokushima University
Torii, Yuta Tokushima University
Hirata, Yukina Tokushima University
Seno, Hiromitsu Tokushima University
キーワード
Diastolic function
Doppler echocardiography
heart failure
stress echocardiography
資料タイプ
学位論文
抄録
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.
掲載誌名
Echocardiography
ISSN
15408175
出版者
Wiley Periodicals
35
10
開始ページ
1587
終了ページ
1595
発行日
2018-07-13
備考
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
出版社版DOI
出版社版URL
フルテキストファイル
言語
eng
著者版フラグ
博士論文全文を含む
文科省報告番号
甲第3215号
学位記番号
甲医第1383号
学位授与年月日
2018-09-27
学位名
博士(医学)
学位授与機関
徳島大学
部局
病院
医学系