成人先天性心疾患レジストリ構築および心機能・予後予測の簡易マーカーの探索的研究

成人先天性心脏病登记系统的构建及预测心功能和预后的简单标志物的探索性研究

• 批准号: 17K09237
• 负责人: 高崎 州亜
• 金额: $ 3万
• 依托单位: Kagoshima University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2017
• 资助国家: 日本
• 起止时间: 2017-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-17K09237/
• 关键词: 成人先天性心疾患; 心機能; 脈波時相解析; 循環器

【研究目的】鹿児島県の成人先天性心疾患患者のレジストリを構築し、心臓超音波検査による心機能評価指標と脈波時相解析指標との関連を解析し、簡便な心機能マーカーを探索すること。【対象】48名の成人先天性心疾患登録症例のうち、脈波時相解析が不適である大動脈弁疾患と心房細動例を除外した38例を対象とした。疾患の内訳は、ファロー四徴症術後9例、心房中隔欠損症8例、右室二腔症6例、修正大血管転位3例、房室中隔欠損術後3例、肺動脈弁閉鎖症2例、心室中隔欠損症２例、両大血管右室起始2例、大動脈縮窄症術後1例、大血管転位術後1例、総動脈幹1例であった。平均年齢は45±17歳、男性15例、女性23例であった。【方法】全症例に対し心臓超音波検査を施行し、収縮機能指標として左室(または体心室)の駆出率、拡張機能指標として僧帽弁E/A比・僧帽弁E波/僧帽弁輪速度E’（E/E’）、心不全指標として三尖弁逆流連続波ドプラより推定右室収縮期圧を計測した。また、血圧脈波検査を施行し、駆出前時間(PEP)、駆出時間(ET）、心機能指標：PEP/ETを算出した。【結果】平均収縮期血圧120±23 mmHg, 平均心拍数73±12 bpmであった。左室(体心室)駆出率、E/A比、E/E’、推定右室収縮期圧のそれぞれの平均値は61±14％、1.5±0.6、15±11、40±12 mmHgであった。またPEP、ET,、PEP/ETのそれぞれの平均値は112±31 ms、288±31 ms、0.39±0.12であった。PEP/ETは、E/A比・E/E’・推定右室収縮期圧とは有意な相関は認めなかったが、駆出率と有意な負の相関を認めた(R2=0.14、P<0.05)。【結論】脈波時相解析のPEP/ETは、先天性心疾患症例の簡便な心機能(収縮機能)マーカーになり得ることが示唆された。

Objective: To explore the relationship between cardiac function evaluation index and pulse time analysis index in adult congenital heart disease patients in Kagoshima Prefecture. 48 cases of congenital heart disease were recorded, except for 38 cases of atrial fibrillation 9 cases were found to have internal defect, 9 cases were found to have internal defect, 8 cases were found to have atrial septal defect, 6 cases were found to have right ventricular septal defect, 3 cases were found to have corrected the position of great vessels, 3 cases were found to have atrioventricular septal defect, 2 cases were found to have pulmonary atresia, 2 cases were found to have ventricular septal defect, 2 cases were found to have right ventricular origin of great vessels, 1 case was found to have aortic stenosis, 1 case was found to have left ventricular septal defect, and 1 case was found to have left ventricular septal defect. The average age was 45±17 years, male 15 cases, female 23 cases. [Methods] All patients were examined by echocardiography, systolic function index, left ventricular ejection rate, diastolic function index, E/A ratio, E wave/E wheel velocity, cardiac insufficiency index, tricuspid countercurrent flow rate index, and right ventricular systolic pressure were measured. The heart function index: PEP/ET was calculated. [Results] The mean systolic blood pressure was 120±23 mmHg, and the mean heart beat was 73±12 bpm. The mean values of left ventricular ejection rate, E/A ratio, E/E 'and estimated right ventricular systolic pressure were 61±14%, 1.5±0.6, 15±11 and 40±12 mmHg respectively. The average values of PEP, ET, PEP/ET were 112±31 ms, 288±31 ms, 0.39±0.12 ms respectively. PEP/ET ratio, E/A ratio, E/E ', estimated right ventricular contraction period, intentional negative correlation, ejection ratio, intentional negative correlation (R2=0.14, P<0.05). [Conclusion] PEP/ET analysis is a simple method to evaluate cardiac function in congenital heart disease.