2024 Fiscal Year Final Research Report

Evaluation of left atrial function for individualized managements of heart failure with preserved ejection fraction

Research Project

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Project/Area Number	22K08118
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 53020:Cardiology-related
Research Institution	National Cardiovascular Center Research Institute
Principal Investigator	Izumi Chisato 国立研究開発法人国立循環器病研究センター, 病院, 部門長 (70768100)
Co-Investigator(Kenkyū-buntansha)	森田佳明国立研究開発法人国立循環器病研究センター, 病院, 医長 (80628074) 天野雅史国立研究開発法人国立循環器病研究センター, 病院, 医師 (10826134) 森内健史国立研究開発法人国立循環器病研究センター, 病院, 医師 (50872941)
Project Period (FY)	2022-04-01 – 2025-03-31
Keywords	左房機能 / 心不全 / 心エコー / MRI / 利尿ペプチド
Outline of Final Research Achievements	Left atrial function has been attracting attention in the pathology of heart failure with preserved ejection fraction (HFpEF), but method for its evaluation has not been established. To establish an evaluation method for left atrial function and stratify HFpEF patients, we performed an analysis on HFpEF patients at our hospital. Left atrial function was evaluated using the speckle tracking method in echocardiography, and in cases where exercise stress echocardiography was performed, various parameters were measured before and after stress, and the detection of stiff LA and its relationship to prognosis were investigated. Among HFpEF patients, there were cases with reduced left atrial strain despite no reduced left ventricular strain, and cases of HFpEF in which left atrial dysfunction is the central pathology were identified. Furthermore, it was shown that these cases have a particularly poor prognosis among HFpEF patients. Future analysis will include biomarkers and cardiac MRI data.
Free Research Field	循環器内科学
Academic Significance and Societal Importance of the Research Achievements	高齢者の増加に伴い左室駆出率の保たれた心不全（HFpEF）が増加しているが、有効な治療法は未だ確立されていない。その一因として、病態の多様性が挙げられる。近年、HFpEFの病態において左房機能が注目されている。HFpEFに対する薬物治療において、SGLT2阻害薬の有効性が示されているが、サクビトリルバルサルタンはBNPよりもむしろANPに基質特異性が高く、左房機能低下が主病態である症例においては、よりARNIが有効である可能性がある。左房機能の観点からHFpEF患者の治療薬に対する反応性や予後を見直すことが、HFpEFの個別化治療へとつながり、患者の予後改善・医療経済の負担軽減が期待できる。