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大学・研究所にある論文を検索できる 「肺動脈弁逆流を有するファロー四徴症心内修復術後患者における経胸壁心エコー二次元スペックルトラッキング法による右室自由壁ストレインの有用性に関する研究」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。

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肺動脈弁逆流を有するファロー四徴症心内修復術後患者における経胸壁心エコー二次元スペックルトラッキング法による右室自由壁ストレインの有用性に関する研究

藤原 淳子 東北大学

2022.03.25

概要

1. 背景
慢性肺動脈弁閉鎖不全(Pulmonary regurgitation;PR)による右心機能低下は、ファロー四徴症心内修復術後(Repaired tetralogy of Fallot;rTOF)患者の臨床的予後の主要な決定因子である。しかし正確な右心機能の評価は、従来の心エコー指標では困難である。

2. 目的
本研究の目的は、rTOF 患者における経胸壁心エコー2 次元スペックルトラッキング法(Two-dimensional speckle-tracking echocardiography;2D STE)による右室自由壁ストレイン計測の実用性評価および心臓 MRI(Cardiac magnetic resonance;CMR)との比較による右心機能評価に対する有用性の検証である。

3. 方法
2016 年 7 月から 2019年の 6月までの間に東北大学病院にて経胸壁心エコー検査が施行された連続22例の rTOF 症例 (男性/女性、8/14;年齢中央値25.0歳) を対象とした。2D STEを用いて計測した右室自由壁ストレインを、22例の血行動態上正常である正常対照(NOR) (男性/女性、9/13;年齢中央値 32.0歳)と比較した。また右室自由壁ストレインとCMRで計測した右室駆出率 (Right ventricular ejection fraction;CMR-RVEF) および肺動脈弁逆流率 (Pulmonary valve regurgitant fraction;CMR-PRF) の相関を求めた。

4. 結果
全てのrTOF 患者は中等度以上のPRを有していたがほぼ無症候性であった。右室自由壁長軸方向のストレイン(Right ventricular free wall longitudinal strain;RVFW-LS)は NOR 群に比べ rTOF 群において有意に低下していた(-19.6 vs -24.7 P < 0.01)。また rTOF 群において、RVFW-LS と CMR-PRF の間に有意な相関があり(r = 0.44, P < 0.05)、一方、中部レベルの右室自由壁円周方向のストレイン(Right ventricular free wall circumferential strain;RVFW-CS)は CMR-RVEFとの間に有意な相関が認められた(r = 0.57, P <0.01)。右室自由壁ストレイン計測の検者内変動は許容範囲であった。

5. 結語
これらの結果から、2D STE によって計測された右室自由壁側ストレインにより、 rTOF における右室収縮機能や PR 重症度の評価が可能であることが示唆された。本法は、実行可能性があり、CMR 検査の補完的な役割が期待される。

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