循環器ジャーナル68巻2号

2020年04月発行

特集 心エコー図で何を見る？—スクリーニングから精査まで Ⅱ．基礎編

—基本的計測をするために②—EFとLV inflowに始まる心不全管理指標

著者： 大西俊成¹

所属機関： ¹桜橋渡辺病院心臓血管センター内科

ページ範囲：P.230 - P.236

Point
・心エコー図の心不全管理指標として，心臓の収縮能評価はEFから，拡張能，左室充満圧評価はLV inflowから始まる．
・心不全は，大きく，収縮不全型心不全（HFrEF）と左室駆出率保持型心不全（HFpEF）に分けられ，心エコー図で計測したEFによって分類される．
・心不全の評価には，収縮能だけでなく拡張能評価も重要であり，治療方針の決定や予後予測の指標となりうる．

参考文献

1) Lang RM, Badano LP, Mor-Avi V, et al:Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1-39, 2015

2) Vasan RS, Larson MG, Benjamin EJ, et al:Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction:prevalence and mortality in a population-based cohort. J Am Coll Cardiol 33:1948-1955, 1999

3) Wong M, Staszewsky L, Latini R, et al:Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure:Valsartan heart failure trial（Val-HeFT）echocardiographic data. J Am Coll Cardiol 43:2022-2027, 2004

4) Solomon SD, Anavekar N, Skali H, et al:Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 112:3738-3744, 2005

5) Owan TE, Hodge DO, Herges RM:Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251-259, 2006

6) McMurray JJ, Adamopoulos S, Anker SD, et al:ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012:The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association（HFA）of the ESC. Eur Heart J 33:1787-1847, 2012

7) Yancy CW, Jessup M, Bozkurt B, et al:2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147-239, 2013

8) Ponikowski P, Voors AA, Anker SD, et al:2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）Developed with the special contribution of the Heart Failure Association（HFA）of the ESC. Eur Heart J 37:2129-2200, 2016

9) 日本循環器学会：急性・慢性心不全診療ガイドライン（2017年改訂版）．2018

10) Masuyama T, Popp RL:Doppler evaluation of left ventricular filling in congestive heart failure. Eur Heart J 18:1548-1556, 1997

11) Redfield MM, Jacobsen SJ, Burnett JC Jr, et al:Burden of systolic and diastolic ventricular dysfunction in the community:appreciating the scope of the heart failure epidemic. JAMA 289:194-202, 2003

12) Rossi A, Loredana L, Cicoira M, et al:Additional value of pulmonary vein parameters in defining pseudonormalization of mitral inflow pattern. Echocardiography 18:673-679, 2001

13) Nagueh SF, Appleton CP, Gillebert TC, et al:Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107-133, 2009

14) Rudski LG, Lai WW, Afilalo J, Hua L, et al:Guidelines for the echocardiographic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685-713, 2010

15) Nagueh SF, Appleton CP, Gillebert TC, et al:Recommendation for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107-133, 2009

16) Nagueh SF, Smiseth OA, Appleton CP, et al:Recommendation for the evaluation of left ventricular diastolic function by echocardiography:An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277-314, 2016