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英文誌(2004-)

Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.Supplement

特別プログラム 循環器
シンポジウム 循環器 Joint(JSUM・AFSUMB Joint Session)(English) 右心・肺高血圧の評価における心エコー法の役割

(S271)

肺高血圧症患者における心エコー図法を用いた統合的右心系評価の有用性

Utility of Echocardiography in Right-sided Heart for Better Management of Patients with Pulmonary Hypertension

田中 秀和

Hidekazu TANAKA

神戸大学大学院循環器内科学分野

Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

キーワード :

Right ventricular(RV)systolic function is a major determinant of prognosis for patients with pulmonary hypertension(PH), but it has remained unclear what is the best available noninvasive method for measuring RV systolic function. One of these methods, tricuspid annular plane systolic excursion(TAPSE)by means of the conventional echocardiography, is easily obtainable and is a measure of RV systolic function, and the American Society of Echocardiography(ASE)guidelines recommend the routine use of TAPSE as a simple method of estimating RV systolic function1). However, TAPSE is angle dependent and may be load dependent as well. Moreover, TAPSE can be overestimated in PH patients with apical clockwise rotation2). Recently, we and other investigators have reported the utility of RV free-wall longitudinal strain by means of two-dimensional speckle-tracking strain rather than TPASE in PH patients3-6). In addition, RV free-wall strain was newly described in the current ASE guideline, with a lower reference value for impaired RV systolic function of 20%7).
Although there is no doubt about the utility of RV systolic function in the management of PH patients, prognosis in PH patients can be associated with multiple factors. Thus, not only assessing RV systolic function, but a more comprehensive approach might result in more accurate prediction of long-term outcome after the initiation of treatment of PH patients. We previously showed that a combined assessment of RV free-wall strain and right atrial(RA)area results in more accurate prediction of long-term outcome8). Furthermore, we also published that the combined echocardiographic assessment of baseline RV systolic function as assessed by RV free-wall strain and mid-term RV and RA reverse remodeling leads to more accurate prediction of long-term outcomes than such parameters alone after PH-specific drug administration for PH patients9).
This lecture reviews the strengths of echocardiographic approaches in right-sided heart, and their current potential for clinical use in PH patients.
1ASE Guidelines. J Am Soc Echocardiogr. 2010;23:685-713.
2Motoji Y, Tanaka H et al. Echocardiography.(In Press).
3Fukuda Y. Tanaka H. et al. J Am Soc Echocardiogr. 2011;24:1101-1108.
4Motoji Y. Tanaka H. et al. Circ J. 2013;77:756-763.
5Haeck MLA et al. Circ Cardiovasc Imaging. 2012;5:628-636.
6Fine NM, et al. Circ Cardiovasc Imaging. 2013;6:711-721.
7ASE Guideline. J Am Soc Echocardiogr. 2015; 28:1-39.
8Fukuda Y, Tanaka H et al. Int J Cardiovasc Imaging. 2014:30;1269-1277.
9Sano H, Tanaka H et al. Can J Cardiol. 2015;31:529-536.