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英文誌(2004-)

Journal of Medical Ultrasonics

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1985 - Vol.12

Vol.12 No.04

Original Article(原著)

(0282 - 0290)

僧帽弁狭窄症の左心機能

Assessment of Left Ventricular Systolic Performance in Patients with Mitral Stenosis Using Dynamic Exercise Echocardiography

北村 浩一1, 古川 啓三1, 西田 和夫1, 辻 光1, 海老沢 哲也1, 樋上 雅一1, 幸田 正明1, 盛川 洋一1, 中川 博昭1, 杉原 洋樹1, 朝山 純1, 勝目 紘1, 伊地知 浜夫1, 斎藤 良夫2, 国重 宏2

Hirokazu KITAMURA1, Keizo FURUKAWA1, Kazuo NISHIDA1, Hikari TSUJI1, Tetuya EBIZAWA1, Masaichi HIGAMI1, Masaaki KOHDA1, Yohichi MORIKAWA1, Hiroaki NAKAGAWA1, Hiroki SUGIHARA1, Jun ASAYAMA1, Hiroshi KATSUME1, Hamao IJICHI1, Yoshio SAITO2, Hiroshi KUNISHIGE2

1京都府立医科大学第二内科, 2松下病院第三内科

1The Second Department of Internal Medicine, Kyoto Prefectural University of Medicine, 2The Third Department of Internal Medicine, Matsushita Hospital

キーワード : Mitral stenosis, Left ventricular systolic performance, Dynamic exercise echocardiography

 To assess the correlation among exercise tolerance, mitral valve are (MVA) and the left ventricular (LV) systolic performance, dynamic exercise echocardiography was performed on 21 patients with mitral stenosis (MS). The patients were divided into 3 groups by the attained work load and exercise time: 6 patients whose attained work load was 25 watts and exercise time was less than 6 minutes (group I); 7 patients, 50 watts and less than 9 minutes (group II); and 8 patients, 75 watts and 9 minutes (group III). MVA in group I was smaller than that in group III, however, the correlation between exercise time and MVA was poor (r=0.48). Resting LV end-diastolic and end systolic dimensions (EDD, ESD) and systolic functions (% shortening fraction, mean Vcf) showed no statistical differences among three groups. During exercise EDD decreased significantly in all three groups, but at peak exercise it did not show significant differences among three groups. ESD, whereas, decreased significantly with exercise in all three groups, but at peak exercise ESD in group I was significantly larger than that in group III (p<0.01).
 Per cent shortening fraction (% SF) decreased or unchanged with exercise in group I and in group II, while it increased significantly in group III (p<0.01). Mean Vcf in group I did not increase significantly with exercise, either. The extent of the increase in % SF and mean Vcf at peak exercise correlated well with exercise time (r=0.83, r=0.79).
 We conclude that exercise tolerance in MS patients is dependent not only MVA but also LV systolic function, and thus, exercise echocardiography is a useful method to evaluate the LV functional reserve in MS patients.