超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 45(1): 11-20 (2020)
doi:10.11272/jss.302

原著Original Article

冠動脈疾患の予測における心外膜下脂肪厚計測の有用性について：多施設共同研究Validation of Epicardial Adipose Tissue Thickness by Echocardiography for Predicting Coronary Artery Disease: a Multicenter Study

平田 有紀奈1，西尾 進1，原田 修2，宮里 尚美3，原國 督3，楠瀬 賢也4，伊藤 敦彦5，山田 博胤6，佐田 政隆4Yukina Hirata1, Susumu Nishio1, Osamu Harada2, Naomi Miyazato3, Atsushi Harakuni3, Kenya Kusunose4, Nobuhiko Ito5, Hirotsugu Yamada6, Masataka Sata4

1 徳島大学病院超音波センターUltrasound Examination Center, Tokushima University Hospital

2 関東中央病院検査部Clinical Laboratory Center, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers

3 翔南病院検査科Clinical Laboratory Center, Shonan Hospital

4 徳島大学病院循環器内科Department of Cardiovascular Medicine, Tokushima University Hospital

5 関東中央病院循環器内科Department of Cardiovascular Medicine, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers

6 徳島大学大学院医歯薬学研究部地域循環器内科学Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences

受付日：2018年5月28日Received: May 28, 2018
受理日：2018年10月18日Accepted: October 18, 2018
発行日：2020年2月1日Published: February 1, 2020
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目的：心外膜下脂肪（Epicardial adipose tissue: EAT）は心臓周囲に付着した異所性内臓脂肪であり，冠動脈疾患（Coronary artery disease: CAD）進展と密接な関連がある．我々は過去に，リニア型探触子を使用して前室間溝（Anterior Interventricular Groove: AIG）でEAT厚を測定する手法（EAT-AIG厚）を考案した．また，EAT-AIG厚のカットオフ値を7.1 mmと設定した場合，最も感度・特異度高くCADの有無を判別できることを単施設で報告した．そこで本研究では，EAT-AIG厚のカットオフ値7.1 mmを用いた場合のCAD予測の有用性について，多施設における新たなコホートを対象として検証することを目的とした．

対象と方法：多施設前向き研究として，2017年4月1日～2018年3月31日までに心臓カテーテル検査が施行された216例（平均年齢67±12歳，男性134例）を対象とした．EAT-AIG厚は，心臓カテーテル検査を施行する前に，リニア型探触子を用いて計測した．EAT-AIG厚のカットオフ値7.1 mmに基づいて2群に分類した．

結果と考察：CADを有した症例は97例（45%）であった．EAT-AIG厚＞7.1 mmの患者では，EAT-AIG厚≦7.1 mmと比較して有意にCADの罹患率が大であった（66% vs. 23%，p＜0.001）．EAT-AIG厚＞7.1 mmは，感度75%，特異度68%でCADの有無を予測できた．陽性的中率，陰性的中率および正診率はそれぞれ66%，77%，71%であった．EAT- AIG厚＞7.1 mmは，従来の冠危険因子（年齢，性別，Body mass index, 高血圧，脂質異常症，糖尿病，喫煙歴）に加えてCADを予測する指標である．

結語：EAT-AIG厚のカットオフ値7.1 mmは，CADの予測に有用であることを多施設共同研究でも確認できた．

Purpose: Epicardial adipose tissue (EAT), the ectopic visceral fat surrounding the heart, is associated with the presence of coronary heart disease (CAD). Previously, we reported that EAT thickness in the anterior interventricular groove (EAT-AIG), measured using a high-frequency linear probe during echocardiography, can be a marker for CAD. Based on receiver operating characteristic analysis, EAT-AIG thickness ＞7.1 mm had the highest sensitivity and specificity for association with CAD. However, that was a single center study. This study is a validation trial to confirm our cut off value of EAT-AIG thickness.

Subjects and Methods: In this multicenter prospective cohort study, we enrolled 216 subjects (mean age 67±12 years, 134 males) who underwent coronary angiography (CAG) for the first time from April 1, 2017, to March 31, 2018. EAT-AIG thickness was measured before CAG by echocardiography, using a high-frequency linear probe. The cohort was divided into 2 groups based on a cut off value of EAT-AIG thickness ＞7.1 mm and any value ≤7.1 mm.

Results and Discussion: A total of 97 (45%) subjects were diagnosed with CAD by CAG. Patients with EAT-AIG thickness ＞7.1 mm had a significantly greater incidence of CAD (66% vs. 23%, p＜0.001). EAT-AIG thickness ＞7.1 mm predicted the presence of CAD with 75% sensitivity and 68% specificity. Positive predictive value, negative predictive value, and accuracy were 66%, 77%, and 71%, respectively. EAT-AIG thickness had a better diagnostic value compared with other conventional risk factors (age, male gender, body mass index, hypertension, dyslipidemia, and smoking).

Conclusion: EAT-AIG thickness ＞7.1 mm, measured by echocardiography, is a useful, noninvasive marker for predicting CAD.

Key words: epicardial adipose tissue; multicenter study; anterior interventricular groove; coronary artery disease; validation cohort

© 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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