1 昭和大学病院超音波センターUltrasound Examination Center, Showa University Hospital
2 昭和大学医学部内科学講座循環器内科学部門Division of Cardiology, Department of Medicine, Showa University School of Medicine
目的：大動脈弁狭窄症（Aortic Stenosis; AS）の経時的な進行に関して大動脈弁硬化症や軽症まで含めたASの自然経過および左室リモデリング形態との関連性について検討した．
対象と方法：当院において3回以上経胸壁心エコー検査で経過を追えたAS患者501症例を初回検査時の最大大動脈弁通過血流速度（Vmax）からA群（Vmax ＜2 m/s），B群（2≦ Vmax ＜3 m/s），C群（3≦ Vmax ＜4 m/s），D群（4 m/s≦ Vmax）の4群に分類した．予後に影響を与えるとされる0.3 m/s/年を超える進行速度を基準とし4群間で比較検討した．また左室形態を4群（正常，遠心性肥大，求心性リモデリング，求心性肥大）に分類し左室形態がASの進行に与える影響も検討した．
結果と考察：進行速度は4群間で有意な差を認め，より重症のカテゴリーの患者で0.3 m/s/年という進行速度を超える患者が有意に多かった．ロジスティック回帰分析ではA群を基準とした時，B群（オッズ比2.08, p＝0.021），C群（オッズ比3.79, p＜0.001），D群（オッズ比6.41, p＜0.001）とASの重症度が高いほど進行するリスクが高いことが示された．また，左室肥大パターンに関しても解析したところ，正常パターンを基準にした場合，求心性肥大は有意な進行速度の規定因子であった（オッズ比2.12, p＝0.001）．さらに進行速度で3群に分けて検討した結果，最も進行の早い群（0.2 m/s/年以上）では求心性肥大を呈した患者が有意に他の2群に比して多かった．
結語：AS患者ではより重症の患者で進行が速く，また左室求心性肥大を呈した症例ではASの進行速度が速いことが示唆された．
Purpose: This study aimed to investigate the progression and natural course of aortic stenosis (AS), including aortic valve sclerosis and mild AS, and its relationship with the morphology of left ventricular hypertrophy.
Subjects and Method: We included 501 patients with aortic valve sclerosis and AS, including those classified as mild to severe, along with patients who had undergone ＞3 transthoracic echocardiography recordings. According to the maximum AS jet velocity (Vmax) at the first examination, all patients were classified into the following four groups: group A (Vmax ＜2 m/s), group B (2≤ Vmax ＜3 m/s), group C (3≤ Vmax ＜4 m/s), and group D (Vmax ≥4 m/s). The left ventricular (LV) morphology was classified into four groups based on the relative wall thickness and LV mass index. We then evaluated the relationship between LV morphology and AS progression.
Results and Discussion: Intergroup (A–D) progression rates differed significantly; furthermore, significantly more number of patients presenting with a progression of ＞0.3 m/s/year being allocated in the more severe category. A logistic regression analysis demonstrated that a higher AS severity was associated with a higher the risk of progression in the following three groups: group B (odds ratio 2.08, p＝0.021), group C (odds ratio 3.79, p＜0.001), and group D (odds ratio 6.41, p＜0.001). The LV concentric hypertrophic pattern was also considered a significant factor (odds ratio 2.12, p＝0.001). In addition, the AS progression was divided into three groups based on the tertiles, and the fastest progressing group (≥0.2 m/s/year) had a significantly higher percentage of patients with LV concentric hypertrophy than that in the other two groups.
Conclusion: These results suggest that AS may progress more rapidly in patients with severe AS and in those with LV concentric hypertrophy.
Key words: aortic stenosis; echocardiography; progression; left ventricular concentric hypertrophy
© 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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