1 山形大学医学部附属病院検査部Division of Clinical Laboratory, Yamagata University Hospital
2 山形大学医学部附属病院第一内科Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
目的：経胸壁心臓超音波検査における一般的計測指標である上行大動脈径が腹部大動脈瘤の予測因子として有用か検討した．
対象と方法：2016年1月から2017年8月の間に当院で経胸壁心臓超音波検査を施行した4,154例（男性2,526名，女性1,628名，平均年齢67±14歳）を対象に上行大動脈径と腹部大動脈径の関係を検討した．腹部大動脈径は30 mm以上を腹部大動脈瘤と定義した．
結果と考察：全4,154例中168例（4.0%）に腹部大動脈瘤を認めた．腹部大動脈瘤群は非腹部大動脈瘤群と比較して高齢で，男性が多く，虚血性心疾患および高血圧性心疾患の合併が多かった．腹部大動脈瘤群では非腹部大動脈瘤群と比較して有意に上行大動脈径，左房径および左室心筋重量係数が高値であった．多変量ロジスティック解析では，上行大動脈径が腹部大動脈瘤の独立した予測因子であった．ROC曲線解析では，上行大動脈径のカットオフ値は31 mm, ROC曲線下面積，感度および特異度はそれぞれ0.675, 69%および59%であった．年齢，性別，心疾患，左室心筋重量係数を含めた腹部大動脈瘤の予測モデルに上行大動脈径を加えると，ROC曲線下面積，総再分類改善度および統合判別改善度が有意に上昇した（p＜0.0001）．従来の危険因子に上行大動脈径を加えることで，腹部大動脈瘤の予測能が改善した．
結論：上行大動脈径は積極的に腹部大動脈瘤を検索するかを判断し得る有用な計測指標であり，腹部大動脈瘤の早期発見および早期治療に繋がる可能性が示唆された．
Purpose: The purpose of this study was to determine whether the ascending aortic root dimension (AscAOD), measured by echocardiography, could be a predictor for the presence of abdominal aortic aneurysm (AAA).
Methods: From January 2016 to August 2017, AscAOD and abdominal aortic dimension were measured by transthoracic echocardiogram in 4,154 patients. AAA was defined as an abdominal aortic dimension ＞30 mm.
Results: One hundred sixty-eight patients (4.0%) had AAA. Patients with AAA were older, more frequently males, and had a greater prevalence of heart disease than those without AAA. AscAOD, left atrial dimension, and left ventricular mass index were larger in patients with AAA than in those without it. Multivariate logistic analysis demonstrated that AscAOD was significantly associated with the presence of AAA after adjusting for confounding variables. A receiver operating characteristic curve for the presence of AAA found the cutoff value of AscAOD, area under the curve, sensitivity, and specificity were 31.0 mm, 0.675, 69%, and 59%, respectively. Net reclassification index, integrated discrimination improvement, and area under the curve were improved by the addition of AscAOD to the baseline model including age, gender, heart disease, and left ventricular mass index.
Conclusion: AscAOD could serve as an indicator of AAA in high-risk patients, leading to earlier management and treatment for AAA.
Key words: abdominal aortic aneurysm; transthoracic echocardiography; ascending aortic root dimension
© 2020 一般社団法人日本超音波検査学会© 2020 Japanese Society of Sonographers
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This page was last modified on 2020-01-27T17:26:55.000+09:00
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