2018 Fiscal Year Final Research Report
The prognostic assessment of the leg positive pressure echocardiography for patients with chronic heart failure
| Project/Area Number |
16K01410
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
Medical systems
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| Research Institution | Kobe University |
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Principal Investigator |
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| Co-Investigator(Kenkyū-buntansha) |
田中 秀和 神戸大学, 医学研究科, 講師 (20590342)
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| Research Collaborator |
Matsuzoe Hiroki
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| Project Period (FY) |
2016-10-21 – 2019-03-31
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| Keywords | 心不全 / 前負荷 / 心予備能 / 前負荷予備能 / 予後推定 / 収縮予備能 / 拡張予備能 / 心室間相互作用 |
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| Outline of Final Research Achievements |
For this study, 120 consecutive patients with heart failure with reduced ejection fraction were prospectively recruited. The stroke work index was estimated as product of stroke volume index and mean blood pressure, and the E/e' ratio was calculated to estimate ventricular filling pressure. During the median follow-up period of 20 months, 30 patients developed adverse cardiovascular events. During preload stress, stroke work index increased significantly along with minimal changes in ventricular filling pressure in patients without cardiovascular events. However, patients with cardiovascular events showed impairment of Frank-Starling mechanism and a serious increase in E/e′ ratio. Both the patients without contractile reserve and those without diastolic reserve exhibited worse event-free survival than the others. In a Cox proportional-hazards analysis, the changes in stroke work index and in E/e′ were predictors of cardiovascular events.
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| Free Research Field |
心不全
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| Academic Significance and Societal Importance of the Research Achievements |
これまで負荷エコー検査では強心剤が用いられることが多かったが、安全性や検査の煩雑さの問題があり、十分に実用化されてこなかった。一方、下肢陽圧負荷心エコーは体うっ血の再現が可能であり、心不全の病態を考慮した場合、極めて合理的かつ病態生理に忠実に準拠した心負荷検査と考えることができる。下肢陽圧負荷心エコー法により前負荷増大に対する心血管系の代償反応機構やその破綻のメカニズムが明らかとなったことにより、心不全患者に対するより適切な治療のエンドポイントの設定が可能となるであろう。また心不全患者におけるリスク層別化と、見積もられたリスクに応じた医療費や医療資源の効率的な分配に貢献できると確信している。
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