1 獨協医科大学埼玉医療センター超音波センターDokkyo Medical University Saitama Medical Center, Center of Medical Ultrasonics
2 獨協医科大学埼玉医療センター循環器内科Dokkyo Medical University Saitama Medical Center, Department of Cardiology
目的：心アミロイドーシス（CA）はアミロイド線維が心筋間質や微小血管周囲に沈着することにより，形態的，機能的障害を引き起こす病態である．近年，CAに有効な治療法が確立され，早期診断がより重要となってきている．本研究はCAの診断のために，心エコー図検査時に心エコー図所見に加えて，確認すべき臨床背景や身体所見，心電図の所見を明らかにすることを目的とした．
対象と方法：対象は当院でCAの精査が施行された48例（男性37例，年齢70±13歳）である．CA確定群（25例），否定群（23例）の2群に分類し，患者背景，CA関連疾患，心電図指標，心エコー図指標について比較検討した．また，CAの可能性を系統的に評価するためのアルゴリズムを作成した．
結果と考察：年齢，血液透析の有無，CA関連疾患の有無，心電図電位，心室中隔壁厚，左室後壁壁厚，平均壁厚，心房中隔・右室壁肥厚の有無，左室拡張末期径，基部平均LS（longitudinal strain: LS），心尖部平均LS／基部平均LSに有意差を認めた．また，統計上有意差はなかったが心電図の偽梗塞パターンは確定群にのみ認めた．得られたデータよりCAの可能性を指摘するためのアルゴリズムを作成した．CAの可能性を低，中，高に分類し，48例を当てはめると，可能性高に振り分けられた15例は全例CA確定群であり，低に振り分けられた11例はすべて否定群であった．
結論：心エコー図検査時に，心エコー図所見に加え心電図所見やCA関連疾患の有無を加味することで，CAの精査，ひいては診断につなげることができる．
Purpose: Cardiac amyloidosis (CA) is a morphological and functional disorder caused by the deposition of amyloid fibers in the myocardial interstitium. Effective treatments for CA have been established in recent years, making an early diagnosis more important. The aim of this study was to clarify the clinical background, physical, and electrocardiogram (ECG) findings that should be confirmed for the diagnosis in addition to the echocardiographic findings of CA.
Subjects and Methods: The subjects were 48 patients (37 men, age 69 ± 13 years) who had undergone a close examination for CA at our hospital. Patients were classified into two groups: a CA-confirmed group (25 patients) and a CA-negative group (23 patients). We compared the age, gender, medical history, CA-related diseases, electrocardiographic indices, and echocardiographic indices between the two groups. In addition, we created an algorithm to systematically evaluate the potential for CA.
Results and Discussion: We observed significant differences in age, presence of hemodialysis, CA-related diseases, ECG potential, ventricular septal wall thickness, left ventricular posterior wall thickness, mean wall thickness, presence of atrial septal or right ventricular wall thickening, left ventricular end-diastolic diameter, mean longitudinal strain (LS) at the base, and mean LS at the apical area/basal LS. We observed a false infarction pattern on the electrocardiogram only in the definite group, although the difference was not statistically significant. We created an algorithm to identify the possibility of CA from the obtained data. The 48 cases were classified as low, medium, and high probability of CA. All 15 cases classified as high probability had confirmed CA, whereas all 11 cases classified as low were in the negative group.
Conclusion: During the echocardiographic examination, the presence or absence of electrocardiographic findings and related diseases in addition to echocardiographic findings during echocardiography can lead to the diagnosis of CA.
Key words: cardiac amyloidosis; echocardiogram; electrocardiogram; related diseases
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