全身性エリテマトーデスにおける左室流入動態および僧帽弁逆流の評価—パルス・ドプラ法を用いた検討

Clinical evaluation of diastolic properties of the left ventricle and mitral incornpetence in patients with systemic lupus erythematosus:A study with pulsed Doppler technique

　全身性エリテマトーデス（SLE）はこれまで主に剖検にて心内膜，心筋，心外膜病変など心病変を高率に合併すると報告され^1〜11），最近，心エコー図による報告も散見されてきている^12〜15）。しかし，これまでSLEの心機能から見た検討は少なく^16〜18），特に心内血流動態からの解析はなされていない。そこで今回，パルス・ドプラ法を用いて，SLEの心機能異常を特に左室拡張期流入血流より評価し，また心内膜病変に基づくと考えられる僧帽弁逆流の検索を試みた。

A mitral inflow pattern and mitral regurgitation were examined in 17 patients with systemic lupus erythematosus (SLE) and 25 age-matched healthy women, using pulsed Doppler echocardiography. The patients had neither significant heart murmur nor hirtory of hypertension.

1) Isovolumetric relaxation time (the time interval from the aortic closing component of the second heart sound to the onset of the diastolic flow velocity waveform) showed a significant prolongation in SLE, compared with that of normal controls. The integra-tion, peak flow velocity and mean acceleration rate of rapid filling were significantly smaller in SLE than in normal controls. The mean deceleration rate of rapid filling had a tendency to be smaller. The integration and peak fiow velocity of atrial filling were rather large in SLE.

2) Mitral valve seemed to be normal, as assessed with two-dimensional echocardiography. However, mitral regurgitation was detected in 10 of 17 patients with SLE and in 2 of 25 normal controls. The grade of regurgitation was mild in all cases. These results indicate that impaired relaxation of the left ventricle and frequent mitral incompetence are present even in asymptomatic patients with SLE.