研究 慢性心不全急性増悪症例の臨床所見 左室駆出率低下の有無による相違
心不全は多種多様な心疾患の結果として生じる予後不良な症候群と考えられ,急性増悪の病態は個々の症例により様々である.今回我々は,慢性心不全の急性増悪で入院した連続448例を調査し,左室駆出率低下の有無による心不全の病態の相違について検討した. 対象はこの中から弁膜症92例,原発性肺高血圧症1例,二次性肺高血圧症5例,入院時の左室駆出率が正確に測定できなかった4例を除いた346例であり,左室駆出率が50%以上の78例(EF良好群)と50%未満の268例(EF低下群)に分類して,その基礎心疾患,心症状,血中BNP値などの臨床像を比較した.年齢は両群間で有意差は認められなかったが,基礎心疾患を比較する...
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| Published in | 心臓 Vol. 36; no. 5; pp. 334 - 339 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
15.05.2004
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.36.5_334 |
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| Abstract | 心不全は多種多様な心疾患の結果として生じる予後不良な症候群と考えられ,急性増悪の病態は個々の症例により様々である.今回我々は,慢性心不全の急性増悪で入院した連続448例を調査し,左室駆出率低下の有無による心不全の病態の相違について検討した. 対象はこの中から弁膜症92例,原発性肺高血圧症1例,二次性肺高血圧症5例,入院時の左室駆出率が正確に測定できなかった4例を除いた346例であり,左室駆出率が50%以上の78例(EF良好群)と50%未満の268例(EF低下群)に分類して,その基礎心疾患,心症状,血中BNP値などの臨床像を比較した.年齢は両群間で有意差は認められなかったが,基礎心疾患を比較すると,EF低下群には虚血性心疾患(56.7%)と拡張型心筋症(19.8%)が多く,EF良好群には高血圧性心不全(29.5%)が高率に存在した(p<0.0001).入院時NYHA心機能分類,血中BNP値はEF低下群が有意に高値であった(p<0.05,p<0.001).強心薬,β遮断薬の内服の使用率は,EF低下群で有意に高率であった.慢性心不全急性増悪症例を左室駆出率低下の有無により比較すると,患者背景には諸外国の報告と類似した相違があり,また,NYHA心機能分類および血中BNP値,心不全治療薬の使用頻度は,EF低下群がより高値であった. |
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| AbstractList | 心不全は多種多様な心疾患の結果として生じる予後不良な症候群と考えられ,急性増悪の病態は個々の症例により様々である.今回我々は,慢性心不全の急性増悪で入院した連続448例を調査し,左室駆出率低下の有無による心不全の病態の相違について検討した. 対象はこの中から弁膜症92例,原発性肺高血圧症1例,二次性肺高血圧症5例,入院時の左室駆出率が正確に測定できなかった4例を除いた346例であり,左室駆出率が50%以上の78例(EF良好群)と50%未満の268例(EF低下群)に分類して,その基礎心疾患,心症状,血中BNP値などの臨床像を比較した.年齢は両群間で有意差は認められなかったが,基礎心疾患を比較すると,EF低下群には虚血性心疾患(56.7%)と拡張型心筋症(19.8%)が多く,EF良好群には高血圧性心不全(29.5%)が高率に存在した(p<0.0001).入院時NYHA心機能分類,血中BNP値はEF低下群が有意に高値であった(p<0.05,p<0.001).強心薬,β遮断薬の内服の使用率は,EF低下群で有意に高率であった.慢性心不全急性増悪症例を左室駆出率低下の有無により比較すると,患者背景には諸外国の報告と類似した相違があり,また,NYHA心機能分類および血中BNP値,心不全治療薬の使用頻度は,EF低下群がより高値であった. |
| Author | 石川, 志保 岩瀬, 正嗣 杉本, 邦彦 宮城島, 賢二 杉浦, 厚司 植村, 晃久 大槻, 眞嗣 森本, 紳一郎 平光, 伸也 加藤, 茂 加藤, 靖周 菱田, 仁 |
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| References | 13) Aronow WS, Ahn C, Kronzon I , et al : Progno-sis of congestive heart failure in elderly pa-tients with normal versus abnormal left ventri-cular systolic function associated with coro-nary artery disease. Am J Cardiol 1990 ; 66:1257-1259 18) Yasue H, Yoshimura M, Sumida H, et al : Locali-zation and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994 ;90 :195-203 21) Packer M, Bristow MR, Cohn JN, et al : The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Car-vedilol Heart Failure Study Group. N Engl J Med 1996 ; 334 :1349-1355 15) Pernenkil R, Vinson JM, Shah AS, et al:Course and prognosis in patients > OR=70 years of age with congestive heart failure and normal versus abnomal left ventricular ejection fraction. Am J Cardiol 1997 ; 79 : 216-219 22) Effect of metoprolol CR/XL in chronic heart failure : Metoprolol CR/XL Randomised Inter-vention Trial in Congestive Heart Failure (MERIT-HF) . Lancet 1999 ; 353 : 2001-2007 2) Zile MR, Brutsaert DL : New concepts in dias-tolic dysfunction and diastolic heart failure :Part I : diagnosis, prognosis, and measure-ments of diastolic function. Circulation 2002 ;105 :1387-1393 3) Zile MR, Brutsaert DL : New concepts in dias-tolic dysfunction and diastolic heart failure:Part II : causal mechanisms and treatment.Circulation 2002 ; 105 :1503-1508 4) Garcia MJ, Thomas ID, Klein AL : New Dop-pler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998 ; 32 : 865-875 9) McKee PA, Castelli WP, McNamara PM, et al : The natural history of congestive heart failure : the Framingham study. N Engl J .Med 1971 ; 285 :1441-1446 8) Senni M, Redfield MM : Heart failure with preserved systolic function : A different natu-ral history? J Am Coll Cardiol 2001; 38 :1277-1282 12) Senni M, Tribouilloy CM, Rodeheffer RJ, et al :Congestive heart failure in the community : a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 1998 ; 98 : 2282-2289 16) Klapholz M, Mitchell J, Meisner JS, et al : Clini-cal characteristics and co-morbid conditions of patients hospitalized for heart failure with nor-mal systolic function : results of the New York heart failure consortium registry on diastolic dysfunction. Circulation 2001 ;104 (suppl II):689 17) Mukoyama M, Nakao K, Hosoda K, et al:Brain natriuretic peptide as a novel cardiac hor-mone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Cline Invest 1991; 87 :1402-1412 11) Vasan RS, Larson MG, Benjamin EJ, et al :Congestive heart failure in subjects with nor-mal versus reduced left ventricular ejection fraction. J Am Coll Cardiol 1999 ; 33 :1948-1955 1) Grossman W : Diastolic dysfunction in conges-tive heart failure. N Engl J Med 1991; 325:1557-1564 19) CIBIS Investigators Committees : A randomiz-ed trial of beta blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994 ; 90 :1765-1773 20) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II) : A randomized trial. Lancet 1999 ;353 : 9-13 7) Tsutsui H, Tsuchihashi M, Takeshita A, et al:Mortality and readmission of hospitalized pa-tients with congestive heart failure and pre-served versus depressed systolic function. Am J Cardiol 2001; 88 : 530-533 5) Vasan RS, Levy D : Defining diastolic failure. A call for standardized diagnostic criteria. Circulation 2000 ;101: 2118-2121 14) McAlister FA, Teo KK, Taher M, et al : In-sights into the contemporary epidemiology and out-patient management of congestive heart fail-ure. Am Heart J 1999 ; 138 : 87-94 6) Devereux RB, Roman MJ, Liu JE, et al : Con-gestive heart failure despite normal left sys-tolic function in a population-based sample:the Strong Heart Study. Am J Cardiol 2000 ;86 :1090-1096 23) Packer M, Coats AJ, Fowler MB, et al : Carve-dilol Prospective Randomised Cumulative Sur-vival Study Group. Effect of carvedilol on sur-vival in severe chronic heart failure. N Engl J Med 2001 ; 344 :1651-1658 10) Cohn JN, Johnson G : Heart failure with nor-mal ejection fraction. The V-Heft Study. Veter-ans Administration Cooperative Study Group. Circulation 1990 ; 81: 48-53 |
| References_xml | – reference: 12) Senni M, Tribouilloy CM, Rodeheffer RJ, et al :Congestive heart failure in the community : a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 1998 ; 98 : 2282-2289 – reference: 13) Aronow WS, Ahn C, Kronzon I , et al : Progno-sis of congestive heart failure in elderly pa-tients with normal versus abnormal left ventri-cular systolic function associated with coro-nary artery disease. Am J Cardiol 1990 ; 66:1257-1259 – reference: 21) Packer M, Bristow MR, Cohn JN, et al : The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Car-vedilol Heart Failure Study Group. N Engl J Med 1996 ; 334 :1349-1355 – reference: 18) Yasue H, Yoshimura M, Sumida H, et al : Locali-zation and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994 ;90 :195-203 – reference: 19) CIBIS Investigators Committees : A randomiz-ed trial of beta blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994 ; 90 :1765-1773 – reference: 22) Effect of metoprolol CR/XL in chronic heart failure : Metoprolol CR/XL Randomised Inter-vention Trial in Congestive Heart Failure (MERIT-HF) . Lancet 1999 ; 353 : 2001-2007 – reference: 23) Packer M, Coats AJ, Fowler MB, et al : Carve-dilol Prospective Randomised Cumulative Sur-vival Study Group. Effect of carvedilol on sur-vival in severe chronic heart failure. N Engl J Med 2001 ; 344 :1651-1658 – reference: 20) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II) : A randomized trial. Lancet 1999 ;353 : 9-13 – reference: 5) Vasan RS, Levy D : Defining diastolic failure. A call for standardized diagnostic criteria. Circulation 2000 ;101: 2118-2121 – reference: 9) McKee PA, Castelli WP, McNamara PM, et al : The natural history of congestive heart failure : the Framingham study. N Engl J .Med 1971 ; 285 :1441-1446 – reference: 6) Devereux RB, Roman MJ, Liu JE, et al : Con-gestive heart failure despite normal left sys-tolic function in a population-based sample:the Strong Heart Study. Am J Cardiol 2000 ;86 :1090-1096 – reference: 17) Mukoyama M, Nakao K, Hosoda K, et al:Brain natriuretic peptide as a novel cardiac hor-mone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Cline Invest 1991; 87 :1402-1412 – reference: 10) Cohn JN, Johnson G : Heart failure with nor-mal ejection fraction. The V-Heft Study. Veter-ans Administration Cooperative Study Group. Circulation 1990 ; 81: 48-53 – reference: 11) Vasan RS, Larson MG, Benjamin EJ, et al :Congestive heart failure in subjects with nor-mal versus reduced left ventricular ejection fraction. J Am Coll Cardiol 1999 ; 33 :1948-1955 – reference: 14) McAlister FA, Teo KK, Taher M, et al : In-sights into the contemporary epidemiology and out-patient management of congestive heart fail-ure. Am Heart J 1999 ; 138 : 87-94 – reference: 1) Grossman W : Diastolic dysfunction in conges-tive heart failure. N Engl J Med 1991; 325:1557-1564 – reference: 7) Tsutsui H, Tsuchihashi M, Takeshita A, et al:Mortality and readmission of hospitalized pa-tients with congestive heart failure and pre-served versus depressed systolic function. Am J Cardiol 2001; 88 : 530-533 – reference: 8) Senni M, Redfield MM : Heart failure with preserved systolic function : A different natu-ral history? J Am Coll Cardiol 2001; 38 :1277-1282 – reference: 4) Garcia MJ, Thomas ID, Klein AL : New Dop-pler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998 ; 32 : 865-875 – reference: 16) Klapholz M, Mitchell J, Meisner JS, et al : Clini-cal characteristics and co-morbid conditions of patients hospitalized for heart failure with nor-mal systolic function : results of the New York heart failure consortium registry on diastolic dysfunction. Circulation 2001 ;104 (suppl II):689 – reference: 3) Zile MR, Brutsaert DL : New concepts in dias-tolic dysfunction and diastolic heart failure:Part II : causal mechanisms and treatment.Circulation 2002 ; 105 :1503-1508 – reference: 2) Zile MR, Brutsaert DL : New concepts in dias-tolic dysfunction and diastolic heart failure :Part I : diagnosis, prognosis, and measure-ments of diastolic function. Circulation 2002 ;105 :1387-1393 – reference: 15) Pernenkil R, Vinson JM, Shah AS, et al:Course and prognosis in patients > OR=70 years of age with congestive heart failure and normal versus abnomal left ventricular ejection fraction. Am J Cardiol 1997 ; 79 : 216-219 |
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| Snippet | 心不全は多種多様な心疾患の結果として生じる予後不良な症候群と考えられ,急性増悪の病態は個々の症例により様々である.今回我々は,慢性心不全の急性増悪で入院した連続448... |
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| StartPage | 334 |
| SubjectTerms | 収縮不全 左室駆出 慢性心不全 拡張不全 |
| Subtitle | 左室駆出率低下の有無による相違 |
| Title | 研究 慢性心不全急性増悪症例の臨床所見 |
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