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 Ⅳ．鑑別診断編—鑑別診断に活かすために

拡張障害を示す疾患の鑑別

著者： 鳥居裕太¹ 山田博胤²

所属機関： ¹徳島大学病院超音波センター ²徳島大学大学院医歯薬学研究部地域循環器内科学

ページ範囲：P.256 - P.267

Point
・問診・視診・聴診・触診で得られた情報に，心エコー図検査を加えることで，総合的に診断する．
・新しいASE左室拡張能ガイドラインは旧ガイドラインに比べて，簡便かつ精度が高くなり，日常臨床において用いやすくなった．
・左室拡張能は複数の心エコー図指標を組み合わせて評価する．
・拡張障害を来す各疾患の特徴について理解しておく．

参考文献

1) Zile MR, Brutsaert DL:New concepts in diastolic dysfunction and diastolic heart failure:part Ⅱ. Causal mechanisms and treatment. Circulation 105:1503-1508, 2002

2) De Keulenaer GW, Brutsaert DL:Systolic and diastolic heart failure are overlapping phenotypes within the heart failure spectrum. Circulation 123:1996-2004, 2011

3) Lenzen MJ, Scholte op Reimer WJ, Boersma E, et al:Differences between patients with a preserved and a depressed left ventricular function:a report from the EuroHeart Failure Survey. Eur Heart J 25:1214-1220, 2004

4) Borlaug BA, Redfield MM:Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation 123:2006-2013, 2011

5) Nagueh SF, Smiseth OA, Appleton CP, et al:Recommendations 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

6) Torii Y, Kusunose K, Yamada H, et al:Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization. J Am Soc Echocardiogr 32:1286-1297, 2019

7) Obokata M, Olson TP, Reddy YNV, et al:Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction. Eur Heart J 39:2810-2821, 2018

8) Obokata M, Kane GC, Reddy YN, et al:Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction:A Simultaneous Invasive-Echocardiographic Study. Circulation 135:825-838, 2017

Pathway Analysis. Circulation 137:148-161, 2018

10) Yamada H, Kusunose K, Nishio S, et al:Pre-load stress echocardiography for predicting the prognosis in mild heart failure. JACC Cardiovasc Imaging 7:641-649, 2014

11) Shah AM, Claggett B, Sweitzer NK, et al:Prognostic Importance of Impaired Systolic Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circulation 132:402-414, 2015

12) Potter E, Marwick TH:Assessment of Left Ventricular Function by Echocardiography:The Case for Routinely Adding Global Longitudinal Strain to Ejection Fraction. JACC Cardiovasc Imaging 11:260-274, 2018

13) Hamada-Harimura Y, Seo Y, Ishizu T, et al:Incremental Prognostic Value of Right Ventricular Strain in Patients With Acute Decompensated Heart Failure. Circ Cardiovasc Imaging 11:e007249, 2018

14) Shah SJ, Lam CSP, Svedlund S, et al:Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction:PROMIS-HFpEF. Eur Heart J 39:3439-3450, 2018

15) Thomas L, Marwick TH, Popescu BA, et al:Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction:JACC State-of-the-Art Review. J Am Coll Cardiol 73:1961-1977, 2019