건강인에서의 좌심실 구형지수
Left Ventricular Sphericity Index in Asymptomatic Population
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목 적 좌심실 재형성은 많은 심장질환들의 원인과 결과로서 밀접한 연관이 되어 있음이 여러 연구에서 알려졌으며 그 중 좌심실 구 형화는 승모판판막 역류증, 심근 경색 등과 상관 관계가 있다고 알려져 있다. 그러나 건강인의 좌심실 구형화에 대해서는 잘 알 려져 있지 않아 본 연구에선 건강인의 노령화에 따른 좌심실 구 형지수를 조사하고 기타 여려 요인과의 관계를 조사하여 향후 좌 심실 기능 저하의 예측 인자가 될 수 있는지 알아보고자 하였다. 방 법 2005년 3월부터 2005년 7월까지 삼성서울병원에서 건강검진 을 위해 심초음파를 시행한 무증상의 건강인을 대상으로 수축기 및 확장기 시의 구형지수를 구했으며 운동부하 심폐기능검사 및 임상적 특성들과 혈액검사 등의 결과와 비교 분석하였다. 결 과 심초음파를 시행한 대상 인원 중 좌심실 구형지수에 영향을 줄 가능성 있는 환자들을 모두 제외한 261명에서 확장기 시 좌심실 구형지수와 좌심실 질량지수가 연령에 따른 상관 관계를 보여 연 령이 증가할수록 좌심실이 구형이 되는 경향을 보였다. 운동부하 검사를 시행한 209명에서 최고산소섭취량과의 관계는 의미 있는 상관 관계를 보여 주지 않았다. HOMA-IR을 구할 수 있는 182 명에서 평가한 인슐린 저항성과도 의미 있는 연관은 없었다. 결 론 기하학적 척도들 중 좌심실 질량지수 뿐만 아니라 확장기 시 좌 심실의 구형지수 역시 건강인에서 노령화에 따른 심장의 구조적 변화를 보여주는 지표가 될 가능성을 보여주었으나 운동능력의 지표 및 기타 임상적 특징들과의 연관은 뚜렷하지 않았다. 따라 서, 경시적인 추적관찰을 통하여 좌심실 구형지수가 좌심실 부전 의 발병을 예측하는 지표가 될 수 있을 것인지에 대한 검증이 필 요할 것으로 보인다
Abstract
Background: Left ventricular (LV) remodeling manifests as an increase in LV end-diastolic and end-systolic volumes, an increase in myocardial mass, and a change in chamber geometry to a more spherical shape, and has been considered to be a consequence of heart failure, myocardial infarction or mitral regurgitation. However, less is known about change of LV geometry, especially LV sphericity, in asymptomatic population according to aging. Methods: We investigated 261 asymptomatic subjects who volunteered for health screening and underwent transthoracic echocardiography. Those with poor echo image, significant coronary artery disease, LV dysfunction, hypertension, and diabetes mellitus were excluded. LV sphericity index is defined as the ratio of the long-axis length divided by LV short-axis length, both during systole and diastole. LV mass was calculated from septal and posterior wall thickness and LV internal dimension at enddiastole and then divided by body surface area to calculate LV mass index. Results: The mean age of subjects was 49.6±6.7 years and the percentage of male was 81%. LV sphericity index at diastole showed significant correlation with age (r=-0.17, p value＜0.01), but LV sphericity index at systole did not. Both indices did not showed significant association with aerobic fitness, blood pressure, glucose, insulin resistance and LV function. LV mass index showed significant correlation with age (r=0.14, p value＜0.05). Conclusion: Among the parameters of LV geometry, sphericity index showed decrease with aging in healthy population, meaning LV becoming more spherical with aging. Longitudinal follow-up study is needed to determine its usefulness as a predictor of future LV dysfunction in asymptomatic population.
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