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 47(4): 353-362 (2022)
doi:10.11272/jss.364

若手研究奨励賞－研究Young Investigator's Award - Research Paper

Dual Gate Doppler法による左房収縮時の肺静脈血流と経僧帽弁血流の時相解析Usefulness of Dual Gate Doppler in Assessing the Time Interval Between Pulmonary Venous and Transmitral Flows During Atrial Contraction

岡田 一範1，岡田 由佳1，村山 迪史2，加賀 早苗1，政氏 伸夫1，西野 久雄2，横山 しのぶ2，中鉢 雅大2，西田 睦2，本居 昂3，石坂 傑3，千葉 泰之3，辻永 真吾3，岩野 弘幸3，安斉 俊久3Kazunori Okada1, Yuka Okada1, Michito Murayama2, Sanae Kaga1, Nobuo Masauzi1, Hisao Nishino2, Shinobu Yokoyama2, Masahiro Nakabachi2, Mutsumi Nishida2, Ko Motoi3, Suguru Ishizaka3, Yasuyuki Chiba3, Shingo Tsujinaga3, Hiroyuki Iwano3, Toshihisa Anzai3

1 北海道大学大学院保健科学研究院Faculty of Health Sciences, Hokkaido University

2 北海道大学病院超音波センターDiagnostic Center for Sonography, Hokkaido University Hospital

3 北海道大学大学院医学研究院循環病態内科学Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University

受付日：2021年10月12日Received: October 12, 2021
受理日：2022年3月8日Accepted: March 8, 2022
発行日：2022年8月1日Published: August 1, 2022
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目的：肺静脈血流（PVF）と経僧帽弁血流（TMF）の心房収縮期（A）波の持続時間の差（ΔAdur）は拡張後期の左室硬さを反映する指標として知られるが，再現性に問題がある．最近，我々は，PVF全体に占める逆行性A波の割合とTMF全体に占めるA波の割合との比（FPVA/FA）が，侵襲的左室硬さ指標ときわめてよく対応することを報告したが，この計測はやや煩雑である．今回，Dual Gate Doppler（DD）法によるPVFとTMFの同時記録から得られる指標の有用性を検討した．

対象と方法: DD法が施行された80例において，通常のパルスドプラ法でΔAdur（S-ΔAdur）を計測するとともにFPVA/FAを算出した．また，DD法によるPVFとTMFの同時記録から，ΔAdur（D-ΔAdur）と各々のA波の終了時相差（D-ΔAend）を計測した．

結果: S-ΔAdur，D-ΔAdurおよびD-ΔAendはいずれもFPVA/FAと有意に相関した（順にr＝0.50, 0.51, 0.71）．このうち，D-ΔAendとFPVA/FAとの相関は，他2者より有意に良好であった．対象中の20例における検者間および検者内再現性は，S-ΔAdurよりもD-ΔAdurとD-ΔAendで良好であった．

結論: DD法によるD-ΔAendは，通常のΔAdurよりも再現性よく拡張後期左室硬さを評価できると考えられた．

Purpose: The difference in duration between pulmonary venous (PV) atrial systolic reversal wave (PVA) and atrial systolic wave (A) of transmitral flow (ΔAdur) reflects the late-diastolic left ventricular (LV) operating stiffness and has a limitation on reproducibility. Using the Dual Gate Doppler technique, simultaneous recording of PV and transmitral flows can be obtained, which may contribute to improving the accuracy and reproducibility of ΔAdur measurements.

Methods and Results: We examined 80 patients who underwent echocardiography using Dual Gate Doppler recording. Using the conventional Doppler recording, we measured the difference in duration between the PVA and transmitral A-wave (S-ΔAdur). Additionally, the ratio of the time–velocity integral (TVI) of the PVA to that of the whole PV flow (FPVA) and the ratio of the TVI in transmitral A-wave of the whole transmitral flow (FA) were calculated, and FPVA/FA was obtained as an index of LV operating stiffness. From the Dual Gate Doppler recording of PV and transmitral flows, we measured ΔAdur (D-ΔAdur) and time from the end of transmitral A-wave to the end of PVA (D-ΔAend).

Results: Each of S-ΔAdur, D-ΔAdur, and D-ΔAend significantly correlated with FPVA/FA (r＝0.50, 0.51, and 0.71, respectively), and the correlation between FPVA/FA and D-ΔAend was significantly greater than that between FPVA/FA and S-ΔAdur and between FPVA/FA and D-ΔAdur (p＜0.001 for both). The intraclass correlation coefficients for the inter- and intra-observer comparisons were excellent for D-ΔAend, adequate for D-ΔAdur, and fair for S-ΔAdur.

Conclusion: Dual Gate Doppler-derived D-ΔAend has higher reproducibility and usefulness for assessing late-diastolic LV operating stiffness than the conventional Doppler-derived S-ΔAdur.

Key words: pulmonary venous flow; Dual Gate Doppler; left ventricular operating stiffness

© 2022 一般社団法人日本超音波検査学会© 2022 Japanese Society of Sonographers

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