Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 39(3): 116-125 (2023)


心室拡張障害の病態と診断Pathophysiology and Diagnosis of Ventricular Diastolic Dysfunction

徳島大学病院 小児科・地域小児科診療部Department of Pediatrics, Tokushima University Hospital ◇ Tokushima, Japan

発行日:2023年12月1日Published: December 1, 2023

小児循環器の臨床現場において心不全の病態評価を要する場面は多いが,血行動態の重要な部分を占める拡張能を正確に測定評価することは簡単ではない.心室の拡張障害は拡張早期の弛緩能低下と拡張後期のStiffness上昇(コンプライアンス低下)に分類される.心室拡張早期の弛緩能は,収縮した心筋の弾性力・復元力によるElastic recoil, ミオシンとアクチンによる収縮の不活化であるActive relaxation, 心房圧に反映される前負荷Preloadに影響を受ける.拡張後期の心室Stiffness上昇は,タイチンのIsoformsや心筋間質組織のコラーゲン増生が関与するが,一方でこれらは拡張早期のElastic recoil・Restoring forceを形成する因子でもある.本総説では心エコー検査を中心とした拡張能の評価に加えて,Pressure phase plane (PPP),Pressure-Volume loop (P-V loop)を駆使した心室拡張能の病態把握の重要性を解説していく.

Although many events in clinical pediatric cardiology require the evaluation of the pathophysiology of heart failure, accurate measurement and evaluation of diastolic function, which is an important aspect of hemodynamics, remain difficult. Ventricular diastolic function can be classified into early diastolic relaxation and late diastolic stiffness. Early ventricular diastolic relaxation is affected by the viscoelastic and restorative forces of the contracted myocardium (elastic recoil), myosin and actin inactivation of contraction (active relaxation), and preload reflected in the atrial pressure. The increase in ventricular stiffness in late diastole is related to titin isoforms and collagen production in myocardial interstitial tissues, and these factors also contribute to early diastolic elastic recoil and restoring force. This review explains the importance of understanding the pathophysiology and components of ventricular diastolic function using the concept of pressure phase plane and pressure-volume loop, in addition to the evaluation of diastolic function by echocardiography.

Key words: diastolic function; ventricular relaxation; echocardiography; elastic recoil; time constant

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