心房内回響図は,心房細動の消去時に左心房のダイアストリック機能の評価のために
Jian Liang Tan1, Julio Chirinos2, Darshak Patel1
1Section for Electrophysiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
まとめ
心臓内共鳴図 (ICE) は,心房細動 (AF) 収縮時に左心房の静止機能を評価することができます. ICE測定は左心房圧と相関し,手術後の利尿薬の必要性を予測します.
科学分野:
- 心臓病科
- 医療用イメージング
- 電気生理学
背景:
- 左心室のダイアストリック機能不全は,心房細動 (AF) の発生と,アブレーション後の再発と関連しています.
- 心内エコーグラフィー (ICE) は,AF除去の手続きの際のダイアストリック機能の評価に先行して評価されていません.
研究 の 目的:
- 左心室のダイアストリック機能のICEによる測定の可行性と有用性を評価する.
- ピークトライカスピッド反吐速度,トランスミトラ流速,ミトラ環状組織ドップラー速度,肺静脈流速などのパラメータを評価する.
主な方法:
- AF切除 (2022~2024) を受けている152人の患者で,単一センターでの前向きな研究.
- 腹筋のパラメータは,シヌスリズム中のICEを用いて測定された.
- 直接左心房圧 (LAP) が記録され,LAPの上昇は≥12mmHgと定義された.
- ICEのパラメータは,トランストラシックエコーカルディオグラフィ (TTE) の測定値と比較した.
主要な成果:
- ICEのいくつかのパラメータは,ピーク三回転速度と平均E/eを含む,平均LAPと有意に相関していた.
- 多変量分析では,ICEによる異常なダイアストリック機能 (例えば,ミトラルE/ A,平均E/ e) は,処置後の静脈注射性利尿薬の必要性の増加と関連していました.
結論:
- 心内エコーグラフィー (ICE) は,AF消去の際のダイアストリック機能の評価に適しています.
- ICEで得られた腹動脈のパラメータは,TTEの発見と,直接の左心房圧測定の両方と相関しています.
- ICEによる制限的な充填の評価は,手術後の利尿剤の必要性を予測しています.
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