Symposium 9
3月27日［土］08:00-09:30
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Structural and functional abnormalities of the atria in heart failure - from diagnosis to therapy -
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心房は心室の陰に隠れその重要性が過小評価されがちであるが、様々な病態に心房の異常が寄与している。心房筋や間質の器質的・機能的な変化と電気的異常が相互に連関し、心房のreservoir function, conduit function, booster pump functionの異常を招き血行動態の破綻に向かう原因の一つとなっている。これまでに心房機能障害が心不全重症度と関連することを示す研究結果が散見されている。心房細動はそのような心房の変化の結果でもあり、また原因、増悪因子にもなる。HFrEFでは心房細動の有無でβ遮断薬の効果に差異があるとする研究結果は注目を集めた。最近の疫学調査では、HFpEFの半数以上に心房細動を認めるとされており、心房機能がその病態形成に大きな役割を担っていることが裏付けられている。さらに、心不全の原因のひとつとして心室の拡大や収縮機能障害を伴わず心房の拡大が主因となる心房性機能性僧帽弁ないし三尖弁閉鎖不全という病態も注目を集めている。Atrial cardiomyopathyという用語も用いられているが、心不全における心房の構造的および機能的異常に関しては、これまで十分な研究が行われてきたとは言い難い。そこで、本セッションでは、心不全における心房の構造的、機能的異常の病態、臨床的評価法および治療介入について最新の知見をもとに議論を深めたいと考えている。
Although the importance of the atria is often underestimated in the shadow of the ventricles, atrial abnormalities contribute to a variety of pathophysiologies. Organic and/or functional changes of the atrial muscle and interstitium and electrical abnormalities have interaction with one another, induce the impairment of reservoir function, conduit function, or booster pump function of the atria, and result in hemodynamic deterioration. There have been scattered studies showing that atrial dysfunction is related to heart failure severity. Atrial fibrillation is both a result of, and a cause or exacerbator of, such atrial changes. The results of a study showing a difference in the effect of beta-blockers in HFrEF with and without atrial fibrillation have received much attention. Recent epidemiological studies found that more than a half of HFpEF patients have atrial fibrillation, suggesting that atrial function plays a major role in the pathogenesis of HFpEF. Furthermore, atrial functional mitral or tricuspid regurgitation caused by the enlarged atria without ventricular dilatation or dysfunction is getting a lot of attention as one of causes of heart failure.
Although the term, atrial cardiomyopathy, is advocated, structural and functional abnormalities of the atria in heart failure have not been well studied to date. In this session, we want to discuss the pathogenesis, clinical assessment methods and therapeutic interventions of the structural and functional abnormalities of the atria in heart failure based on the latest findings.
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Kazuhiro Yamamoto
Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University, Yonago
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Barry Borlaug
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
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Barry Borlaug
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
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Masaru Obokata
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi
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Takanao Mine
Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya
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Shuichi Kitada
Department of Cardiology, Nagoya City University, Nagoya
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Masashi Amano
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita
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