三尖弁輪収縮期移動距離 tricuspid annular plane systolic excursion

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/09 11:38:46」(JST)

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Ejection fraction (EF) is the fraction of outbound blood pumped from the heart with each heartbeat. It is commonly measured by echocardiogram and serves as a general measure of a person's cardiac function. Ejection fraction is typically low in patients with Systolic congestive heart failure.

Ejection fraction is a similar but distinct mathematical model when compared to stroke volume, which (along with heart rate) determines cardiac output, which is the amount of blood the heart pumps per minute. Mathematical models of Volume vs. Time are well documented in the encyclopedia.

Medical uses

Ejection fraction is an important determinant of the severity of systolic heart failure. Causes and etiologies of systolic heart failure include coronary artery disease, congenital heart disease, valvular heart disease, conduction disease, infectious disease, and granulomatous disease among others.

Unlike heart rate, which can be high or low in a healthy person and can vary over the course of the day, a low ejection fraction is always associated with disease.^{[citation needed]}

Measurement

Ejection fraction is commonly measured by echocardiography, in which the volumes of the heart's chambers are measured during the cardiac cycle. Ejection fraction can then be obtained by dividing the volume ejected by the heart (stroke volume) by the volume of the filled heart (end-diastolic volume). ^[1]

Ejection fraction can also be measured by computed tomography (CT scan), magnetic resonance imaging (MRI), ventriculography, gated SPECT and radionuclide angiography (MUGA) scanning. A MUGA scan involves the injection of a radioisotope into the blood and detecting its flow through the left ventricle. Historically, the gold standard for measurement of the ejection fraction is ventriculography.

Physiology

Normal values

Measure view talk edit	Typical value	Normal range
end-diastolic volume (EDV)	120 mL^[2]^{[non-primary source needed]}	65–240 mL^[2]^{[non-primary source needed]}
end-systolic volume (ESV)	50 mL^[2]^{[non-primary source needed]}	16–143 mL^[2]^{[non-primary source needed]}
stroke volume (SV)	70 mL	55–100 mL
ejection fraction (E_f)	58%	55–70%^[3]
heart rate (HR)	75 bpm	60–100 bpm^[4]
cardiac output (CO)	5.25 L/minute	4.0–8.0 L/min^[5]

In a healthy 70-kilogram (150 lb) man, the SV is approximately 70 mL and the left ventricular EDV is 120 mL, giving an ejection fraction of ⁷⁰⁄₁₂₀, or 0.58 (58%).

Right ventricular volumes being roughly equal to those of the left ventricle, the ejection fraction of the right ventricle physiologically matches that of the left ventricle within mathematically narrow beat-to-beat limits.

Healthy individuals typically have ejection fractions between 50% and 65%.^[6] However, normal values depend upon the modality being used to calculate the ejection fraction, and some sources consider an ejection fraction of 55% to 75% to be normal. Damage to the muscle of the heart (myocardium), such as that sustained during myocardial infarction or in atrial fibrillation or a plurality of etiologies of cardiomyopathy, compromises the heart's ability to perform as an efficient pump (ejecting blood) and, therefore, reduces ejection fraction. This reduction in the ejection fraction can manifest itself clinically as heart failure. A low ejection fraction has its cutoff below 40% with symptomatic manifestations constant at 25%.^[7] In the USA, a chronically low ejection fraction less than 30% is qualifying support for eligibility of disability benefits from the Social Security Administration.^[8]

Healthy older adults favorably adapt as the ventricles become less compliant and are routinely echocardiographically proven to have an EF from 55–85% with the help of good genetics and a healthy lifestyle. Compliance, defined as

is a property of the heart that allows contractility. Encyclopedic documentation of the commonly documented "hyperdynamic" ventricle remains sparse.

The ejection fraction is one of the most important predictors of prognosis; those with significantly reduced ejection fractions typically have poorer prognoses. However, recent studies have indicated that a preserved ejection fraction does not mean freedom from risk.^[9]^{[non-primary source needed]}^[10]^{[non-primary source needed]}

The QT interval as recorded on a standard electrocardiogram (EKG) represents ventricular depolarazation and ventricular repolarazation and is rate-dependent.^[11]^{[non-primary source needed]}

Physics

In mathematics allowed by medical imaging, EF is applied to both the right ventricle, which ejects blood via the pulmonary valve into the pulmonary circulation, and the left ventricle, which ejects blood via the aortic valve into the cerebral and systemic circulation.

EF is essentially a ratio; a mathematical expression of forward movement of blood out of the heart contrasted to the amount retained in a single cardiac cycle. One important mathematical expression involves easily reproduced volumetrics.

By definition, the volume of blood within a ventricle immediately before a contraction is known as the end-diastolic volume (EDV). Likewise, the volume of blood left in a ventricle at the end of contraction is end-systolic volume (ESV). The difference between EDV and ESV represents a ratio between the ventricles full and emptied. This ratio allows many variables such as stroke volume (SV) and Cardiac Output (CO). SV describes the volume of blood ejected from the right and left ventricles with each heartbeat. Ejection fraction is the fraction of the end-diastolic volume that is ejected with each beat; that is, it is stroke volume (SV) divided by end-diastolic volume (EDV):^[12]

Where the stroke volume is given by:

History

As a mathematical term, ejection fraction is an extension of well documented work by Adolph Fick entitled Cardiac Output. Fick's theory was gradually merged to fit the precision of wall motion mathematics first defined by Laplace. This led to the application of compliance or Delta V (volume)/ Delta P (pressure) to mathematics known at that time. Myocardial compliance represents a generic variable ratio between Pressure and Volume. Applied to the heart, this appreciation led to further progress represented by length-tension constructs I.e. the Frank–Starling law of the heart. Youngs' Modulus leant itself to Elasticity, another important ratio of Stress and Strain. The gathered mathematics eventually birthed medical imaging, gradually followed by Cardiac Imaging.

Other animals

References

^ William F. Armstrong; Thomas Ryan; Harvey Feigenbaum (2010). Feigenbaum's Echocardiography. Lippincott Williams & Wilkins. ISBN 978-0-7817-9557-9.
^ ^a ^b ^c ^d Schlosser, Thomas; Pagonidis, Konstantin; Herborn, Christoph U.; Hunold, Peter; Waltering, Kai-Uwe; Lauenstein, Thomas C.; Barkhausen, Jörg (2005). "Assessment of Left Ventricular Parameters Using 16-MDCT and New Software for Endocardial and Epicardial Border Delineation". Am J Roentgenol 184 (3): 765–73. doi:10.2214/ajr.184.3.01840765. PMID 15728595. Values:
- End-diastolic volume (left ventricular) – average 118 and a range of 68 – 239mL and
- End-systolic volume (left ventricular) – average 50.1 and range, 16 – 143 mL:
- Also, ejection fraction was estimated in this study to be average 59.9% ± 14.4%; range, 18 – 76%, but secondary source (see above) is used in this article instead.
^ O'Connor, Simon (2009). Examination Medicine (The Examination). Edinburgh: Churchill Livingstone. p. 41. ISBN 0-7295-3911-3.
^ Normal ranges for heart rate are among the narrowest limits between bradycardia and tachycardia. See the Bradycardia and Tachycardia articles for more detailed limits.
^ Edwards Lifesciences LLC > Normal Hemodynamic Parameters – Adult 2009
^ Kumar, Vinay; Abbas, Abul K; Aster, Jon. (2009). Robbins and Cotran pathologic basis of disease (8th ed.). St. Louis, Mo: Elsevier Saunders. p. 574. ISBN 1-4160-3121-9.
^ "Heart2008;94:426-428 doi:10.1136/hrt.2007.123877".
^ "Ejection fraction and SSA disability benefit eligibility.".
^ Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (July 2006). "Trends in prevalence and outcome of heart failure with preserved ejection fraction". N. Engl. J. Med. 355 (3): 251–9. doi:10.1056/NEJMoa052256. PMID 16855265.
^ Bhatia RS, Tu JV, Lee DS et al. (July 2006). "Outcome of heart failure with preserved ejection fraction in a population-based study". N. Engl. J. Med. 355 (3): 260–9. doi:10.1056/NEJMoa051530. PMID 16855266.
^ Bazett, H. C. (1920). "An analysis of the time-relations of electrocardiograms". Heart 7: 353–370.
^ Morton Kern 5th edition page 180

UpToDate Contents

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1. 右心の心エコー評価 echocardiographic assessment of the right heart
2. 三尖弁の心エコー評価 echocardiographic evaluation of the tricuspid valve
3. 機能性僧帽弁閉鎖不全症 functional mitral regurgitation
4. 心筋症の心エコーによる認識 echocardiographic recognition of cardiomyopathies
5. 右室心筋梗塞 right ventricular myocardial infarction

English Journal

Change of right heart size and function by long-term therapy with riociguat in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.

Marra AM1, Egenlauf B2, Ehlken N2, Fischer C3, Eichstaedt C2, Nagel C2, Bossone E4, Cittadini A5, Halank M6, Gall H7, Olsson KM8, Lange TJ9, Grünig E10.
International journal of cardiology.Int J Cardiol.2015 Sep 15;195:19-26. doi: 10.1016/j.ijcard.2015.05.105. Epub 2015 May 19.
BACKGROUND: Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to evaluate the change of right heart size and function assessed by echocardiography during lo
PMID 26011408

Prevalence and Prognostic Value of Right Ventricular Systolic Dysfunction in Patients With Constrictive Pericarditis Who Underwent Pericardiectomy.

Choudhry MW1, Homsi M1, Mastouri R1, Feigenbaum H1, Sawada SG2.
The American journal of cardiology.Am J Cardiol.2015 Aug 1;116(3):469-73. doi: 10.1016/j.amjcard.2015.04.044. Epub 2015 May 7.
Impaired right ventricular systolic function (RVSF) may complicate the treatment of constrictive pericarditis (CP) by pericardiectomy, which is a procedure that remains with significant morbidity and mortality. We evaluated RVSF in patients with CP who underwent pericardiectomy to determine the prog
PMID 26048852

Tricuspid Annular Plane Systolic Excursion and Its Association with Mortality in Critically Ill Patients.

Gajanana D1, Seetha Rammohan H1, Alli O2, Romero-Corral A1, Purushottam B3, Ponamgi S4, Figueredo VM1, Pressman GS1.
Echocardiography (Mount Kisco, N.Y.).Echocardiography.2015 Aug;32(8):1222-7. doi: 10.1111/echo.12926. Epub 2015 Mar 1.
BACKGROUND: Transient left ventricular dysfunction can occur under conditions of extreme emotional or physiological stress. There is little data on right ventricular function in such situations.METHODS: One hundred twenty patients admitted to an ICU with a noncardiac illness were studied. Those with
PMID 25728401

Japanese Journal

Efficacy of Right Ventricular Free-Wall Longitudinal Speckle-Tracking Strain for Predicting Long-Term Outcome in Patients With Pulmonary Hypertension

Motoji Yoshiki,Tanaka Hidekazu,Fukuda Yuko,Ryo Keiko,Emoto Noriaki,Kawai Hiroya,Hirata Ken-ichi
Circulation Journal 77(3), 756-763, 2013
… For comparison, tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, RV index of myocardial performance, and tissue Doppler-derived tricuspid lateral annular systolic velocity were also studied. … Importantly, the co-occurrence of RV-free ≤19.4% and TAPSE <16mm was associated with the highest frequency of cardiovascular events. … Combining RV-free with TAPSE may be more effective for predicting long-term cardiovascular events. (Circ J 2013; …
NAID 130002491316

Validation Study on the Accuracy of Echocardiographic Measurements of Right Ventricular Systolic Function in Pulmonary Hypertension

Sato Takahiro,Tsujino Ichizo,Ohira Hiroshi,Oyama-Manabe Noriko,Yamada Asuka,Ito Yoichi M.,Goto Chisa,Watanabe Taku,Sakaue Shinji,Nishimura Masaharu
Journal of the American Society of Echocardiography 25(3), 280-286, 2012-03
… tricuspid annular plane systolic excursion (TAPSE): r=0.86, p<0.0001, RV myocardial performance index: r=-0.59, p<0.0001; … When compared with the other indices, TAPSE exhibited the highest correlation coefficient. … Of the 5 echocardiographic measurements, only TAPSE significantly predicted CMRI-derived RVEF in multiple regression analysis (p<0.0001). …
NAID 120003898284

心エコー法による右心機能と肺血行動態評価法 (第1土曜特集肺高血圧症診療の進歩) -- (肺高血圧症の診断法)

神崎秀明
医学のあゆみ 240(1), 43-47, 2012-01-07
NAID 40019072207

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