菅原 政貴¹, 中坊 亜由美¹, 合田 亜希子¹, 正木 充¹, 藤原 昌平¹, 福井 美保¹, 廣谷 信一¹, 川端 正明², 辻野 健³, 増山 理¹

Masataka SUGAHARA¹, Ayumi NAKABO¹, Akiko GODA¹, Mitsuru MASAKI¹, Shohei FUJIWARA¹, Miho FUKUI¹, Shinichi HIROTANI¹, Masaaki KAWABATA-LEE², Takeshi TSUJINO³, Tohru MASUYAMA¹

¹兵庫医科大学循環器内科, ²兵庫医科大学ささやま医療センター循環器内科, ³兵庫医療大学薬学部医療薬学科

¹Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Japan, ²Department of Cardiology, Sasayama Medical Center Hyogo College of Medicine, Japan, ³Department of Pharmacy, Hyogo University of Health Sciences, Japan

キーワード :

【Background】
Most of conventional Doppler indexes are limited to assess LV diastolic dysfunction in patients with chronic atrial fibrillation （AF）. LA enlarges the more, the severer is LV diastolic dysfunction; however, long-standing AF may likely enlarge both LA and RA by itself. If the longevity of AF enlarges both atria, the area ratio of LA to RA （LA/RA ratio） should reflect LV diastolic dysfunction because LV diastolic dysfunction should enlarge LA but not RA. We examined whether LV diastolic function may be used to assess LA/RA ratio in patients with chronic AF.
【Methods】
Echocardiographic study was performed in 100 patients with chronic AF （age, 72±10 years）. Exclusion criteria were moderate to severe mitral regurgitation or mitral stenosis, post cardiac surgery, congenital heart disease, pacemaker implantation, collagen disease and hemodialysis. LV mass index （LVMI） was calculated by the ASE/EAE-recommended formula and measurement convention from LV linear dimensions indexed to body surface area. LA and RA area were measured in apical four- chamber view to determine LA/RA ratio. LV diastolic dysfunction was considered present if either of LV hypertrophy （LVMI of＞100 g/m2 in females and＞110 g/m2 in males）, LV systolic dysfunction （LVEF of＜50％） or decreased mitral annulus early diastolic velocity （E’＜8） was present.
【Results】
LV diastolic dysfunction was present in 60 of 100 patients with AF （60％）. LA/RA ratio was higher in patients with LV diastolic dysfunction than in those without LV diastolic dysfunction （1.42±0.03 vs. 1.27±0.04, p＜0.01）, whereas there was no significant difference in LA area between the subsets （32.3±7.2 vs 29.5±7.1, p=0.06）．There was a modest correlation between LA/RA ratio and E’ （r=-0.23, p＜0.05）.
【Conclusions】
The gradient of LA/RA ratio appeared to be related to the presence of LV diastolic dysfunction. LA/RA ratio is some possibility to assess LV diastolic dysfunction in patients with chronic AF.