Ultrasonic diagnostic equipment, medical information service system, and method and program for aiding cardiac amyloidosis diagnosis

Abstract

To provide ultrasonic diagnostic equipment which has high general versatility and practicality in a general practice and which can more reliably make diagnoses of diseases such as cardiac amyloidosis, a medical information service system, and a method and a program for aiding a cardiac amyloidosis diagnosis.SOLUTION: Ultrasonic diagnostic equipment 5 comprises a determination part 54 that determines whether or not cardiac amyloidosis is developed, on the basis of at least one of left ventricular posterior wall thickness d1 on the rear side of the left ventricle in a view from an ultrasound probe 50 and right ventricular anterior wall thickness d2 in front of the sinus of Valsalva in a view from the ultrasound probe 50, in a parasternal long-axis section image of echocardiography.SELECTED DRAWING: Figure 5

Description

[Technical Field]

[0001] The present invention relates to an ultrasound diagnostic apparatus, a medical information providing system, and a method and program for assisting in the diagnosis of cardiac amyloidosis. [Background technology]

[0002] There are various types of cardiac amyloidosis, including the AL (Amyloid Light-chain) type associated with plasma cell abnormalities, wild-type transthyretin amyloidosis (ATTRwt; wild-type ATTR amyloidosis), hereditary (ATTRv; hereditary ATTR amyloidosis), and the AA (Amyloid A protein) type associated with inflammatory diseases (see, for example, Non-Patent Document 1). [Prior art documents] [Non-patent literature]

[0003] [Non-Patent Document 1] Hiroaki Kitaoka et al., "2020 Cardiac Amyloidosis Clinical Practice Guidelines," [online], published March 13, 2020, Japanese Circulation Society, [searched April 21, 2024], Internet<URL: https: / / www.j-circ.or.jp / cms / wp-content / uploads / 2020 / 02 / JCS2020_Kitaoka.pdf> Summary of the Invention [Problem to be solved by the invention]

[0004] For AL and AA types, treatment of the underlying disease is the top priority, as it determines the prognosis. In recent years, the development of specific treatments using tafamidis has enabled slowing disease progression, making early detection particularly important for the treatment of ATTR amyloidosis. However, because diagnosing cardiac amyloidosis requires specialized tests such as myocardial scintigraphy, many cases are overlooked and not diagnosed. Furthermore, ATTRwt cardiac amyloidosis is often preceded by orthopedic conditions such as carpal tunnel syndrome, leading to frequent oversight due to non-specialist follow-up. When diagnosing cardiac amyloidosis, it is important to make an appropriate diagnosis based on the expertise and facilities of each medical institution and refer patients to a hospital that can provide treatment.

[0005] Many diagnostic flowcharts have been developed for ATTR cardiac amyloidosis, such as the Red Flag or Kumamoto criteria. However, these diagnostic flowcharts contain content that is somewhat difficult for non-specialists to understand, such as the lack of specific criteria for diagnosis, such as BNP cutoff values, and the complicated procedures, making them unsuitable and impractical for general practice.

[0006] The present invention has been made in light of the above-mentioned circumstances, and aims to provide an ultrasound diagnostic apparatus, a medical information provision system, and a method and program for assisting in the diagnosis of cardiac amyloidosis that are highly versatile and practical in general medical practice and that can more reliably diagnose diseases such as cardiac amyloidosis. [Means for solving the problem]

[0007] In order to achieve the above object, an ultrasonic diagnostic apparatus according to a first aspect of the present invention comprises: The device is provided with a determination unit that determines whether or not cardiac amyloidosis has developed based on at least one of the left ventricular posterior wall thickness at the rear of the left ventricle as viewed from the ultrasound probe and the right ventricular anterior wall thickness at the anterior of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis cross-sectional image of the heart.

[0008] The determination unit If at least one of the following conditions is satisfied in the parasternal long axis cross-sectional image: the left ventricular posterior wall thickness is 13 mm or more, and the right ventricular anterior wall thickness is 2.5 mm or more, the patient is determined to have developed cardiac amyloidosis. This may also be the case.

[0009] a measurement unit that measures the left ventricular posterior wall thickness and the right ventricular anterior wall thickness based on a position on the parasternal long axis cross-sectional image that is specified by an operation input; This may also be the case.

[0010] a measurement unit that measures the left ventricular posterior wall thickness and the right ventricular anterior wall thickness by performing machine learning on the parasternal long axis cross-sectional image; This may also be the case.

[0011] A medical information providing system according to a second aspect of the present invention comprises: a display unit for displaying an image; a selection unit for selecting a part of the image displayed on the display unit; a storage unit that stores data on a diagnostic flow chart in which medical procedures are organized into processes by type and the processes are connected in the order of medical examinations, and data on medical procedures associated with the processes; a control unit that displays the diagnostic flowchart stored in the storage unit on the display unit, and when any process in the diagnostic flowchart displayed on the display unit is selected by the selection unit, reads data on a medical procedure corresponding to the selected process from the storage unit and displays the data on the display unit; Equipped with.

[0012] The data relating to the medical procedure includes at least one of the content, significance, procedure, and diagnostic criteria of the medical procedure; This may also be the case.

[0013] the process includes echocardiography to diagnose cardiac amyloidosis; The diagnostic criteria for the medical procedure corresponding to the echocardiography include at least one of the left ventricular posterior wall thickness at the rear side of the left ventricle as viewed from the ultrasound probe and the right ventricular anterior wall thickness at the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis cross-sectional image of the echocardiogram. This may also be the case.

[0014] The criteria are: At least one of the left ventricular posterior wall thickness being 13 mm or more and the right ventricular anterior wall thickness being 2.5 mm or more. This may also be the case.

[0015] The process prior to the echocardiogram includes at least one of a motion check and a blood test to determine bilateral carpal tunnel syndrome. This may also be the case.

[0016] The post-echocardiography process includes at least one of myocardial scintigraphy and myocardial biopsy for amyloid deposits. This may also be the case.

[0017] The data regarding the medical procedure includes data regarding at least one medical institution where the medical procedure can be performed. This may also be the case.

[0018] The data relating to the medical institutions includes a list of the medical institutions or map data showing the locations of the medical institutions. This may also be the case.

[0019] A method for assisting in the diagnosis of cardiac amyloidosis according to a third aspect of the present invention comprises: The method includes correlating at least one of the left ventricular posterior wall thickness, which is located behind the left ventricle as viewed from the ultrasound probe, and the right ventricular anterior wall thickness, which is located in front of the sinuses of Valsalva as viewed from the ultrasound probe, in a parasternal long axis echocardiographic image of the subject with the presence or absence of cardiac amyloidosis in the subject.

[0020] The subject has a blood BNP concentration of 18.4 pg / mL or more or a blood NT-proBNP concentration of 55 pg / mL or more. This may also be the case.

[0021] In the parasternal long axis cross-sectional image, at least one of whether the left ventricular posterior wall thickness is 13 mm or more and whether the right ventricular anterior wall thickness is 2.5 mm or more is considered to be correlated with the presence or absence of cardiac amyloidosis. This may also be the case.

[0022] A program according to a fourth aspect of the present invention comprises: Computer, a measuring unit that measures at least one of a left ventricular posterior wall thickness on the posterior side of the left ventricle as viewed from an ultrasound probe and a right ventricular anterior wall thickness on the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis cross-sectional image of an echocardiogram; a determination unit that determines whether or not cardiac amyloidosis has developed based on the left ventricular posterior wall thickness or the right ventricular anterior wall thickness; Function as.

[0023] A program according to a fifth aspect of the present invention comprises: Computer, a display unit for displaying an image; a selection unit for selecting a part of the image displayed on the display unit; a storage unit that stores data on a diagnostic flow chart in which medical procedures are organized into processes by type and the processes are connected in the order of medical examinations, and data on medical procedures associated with the processes; a control unit that displays the diagnostic flowchart stored in the storage unit on the display unit, and when any process in the diagnostic flowchart displayed on the display unit is selected by the selection unit, reads data on the medical practice corresponding to the selected process from the storage unit and displays the data on the display unit; Function as. [Effects of the Invention]

[0024] The present invention is highly versatile and practical in general medical practice, and enables more reliable diagnosis of diseases such as cardiac amyloidosis. [Brief explanation of the drawings]

[0025] [Figure 1] 1 is a block diagram showing a configuration of a medical information providing system according to an embodiment of the present invention. [Figure 2] FIG. 10 is a diagram showing an example of a diagnostic flowchart provided by a medical information providing system. [Figure 3] 10(A) to 10(C) are diagrams showing the medical procedure (operation check) shown in STEP 0. FIG. [Figure 4] FIG. 1 is a diagram showing the criteria for medical procedures (blood tests) shown in STEP 1. [Figure 5] FIG. 10 is a diagram showing a system configuration related to the medical procedure (echocardiography) shown in STEP 2. [Figure 6] (A) is an example of an echocardiogram of a patient with cardiac amyloidosis, and (B) is an enlarged view of the echocardiogram in (A). [Figure 7] (A) is an example of an echocardiogram from a patient without cardiac amyloidosis, and (B) is an enlarged view of the echocardiogram from (A). [Figure 8] 10 is a flowchart of a wall thickness determination process executed by the ultrasound diagnostic device. [Figure 9] FIG. 2 is a diagram illustrating an example of a data structure of a medical information DB. [Figure 10] FIG. 10 is a diagram showing an example of a list of medical institutions and a map of their locations. [Figure 11] FIG. 1 is a block diagram showing the hardware configuration of a medical information providing system. [Figure 12] 10 is a flowchart of a process executed in the medical information providing system. [Figure 13] FIG. 10 is a distribution diagram of the measurement results of left ventricular posterior wall thickness and right ventricular anterior wall thickness. [Figure 14](A) and (B) are diagrams showing the evaluation results of two-class classification based on the left ventricular posterior wall thickness alone and the right ventricular anterior wall thickness alone. [Figure 15] 10(A) and 10(B) are diagrams showing the evaluation results of two-class classification based on left ventricular posterior wall thickness and right ventricular anterior wall thickness. DETAILED DESCRIPTION OF THE INVENTION

[0026] Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. In each drawing, the same or equivalent parts are denoted by the same reference numerals. In the following embodiments, the terms "have," "include," or "contain" also mean "consist of" or "consist of."

[0027] 1, a medical information providing system 1 according to an embodiment of the present invention includes a server computer 2 and a plurality of terminal devices 3. The server computer 2 and the terminal devices 3 are capable of data communication with each other via a communication network 4.

[0028] The server computer 2 stores medical information. The server computer 2 provides the medical information in response to a request from the terminal device 3. The terminal device 3 is a computer terminal installed in each medical institution and used by medical professionals or owned by medical personnel working at the medical institution. The terminal device 3 requests medical information from the server computer 2 in response to an operation input by an operator, and displays the medical information sent from the server computer 3.

[0029] [Server Computer] The server computer 2 includes a providing unit 20 and a storage unit 21. In response to a request transmitted from the terminal device 3, the providing unit 20 reads out medical information stored in the storage unit 21 and provides the medical information to the terminal device 3.

[0030] The memory unit 21 stores flowchart data 22 and a medical practice DB 23. The flowchart data 22 is data for displaying, for example, the diagnostic flowchart shown in FIG. 2. The diagnostic flowchart shown in FIG. 2 is a diagnostic flowchart showing the medical practices, i.e., the flow of diagnosis and treatment, across multiple medical institutions related to cardiac amyloidosis. In this diagnostic flowchart, the medical practices related to cardiac amyloidosis are grouped as processes of STEP0 to 5 for each type thereof. Each of the processes of STEP0 to 5 is connected by an arrow in the order of receiving medical treatment, i.e., the order of medical visits.

[0031] <STEP0: Bilateral carpal tunnel syndrome> Carpal tunnel syndrome is a disease in which the median nerve responsible for bending fingers and wrists, etc. is compressed in a narrow tube called the carpal tunnel in the wrist, causing numbness and pain. Carpal tunnel syndrome is a disease in the orthopedic field that may occur prior to ATTRwt cardiac amyloidosis.

[0032] For bilateral carpal tunnel syndrome, for example, the following three motion checks are performed. (1) OK sign As shown in FIG. 3(A), it is a motion check for examining whether an OK sign in which the fingertips of the thumbs and index fingers of both hands are stuck together can be made. If a circle cannot be made with the fingers, the onset of bilateral carpal tunnel syndrome is suspected. (2) Tinel's sign As shown in FIG. 3(B), it is a motion check for examining whether pain radiates to the fingertips when the wrist is tapped. If pain radiates to the fingertips, the onset of bilateral carpal tunnel syndrome is suspected. (3) Phalen test As shown in FIG. 3(C), it is a motion check for examining whether numbness worsens when the wrist is bent to the palm side and observed for a while. If the numbness worsens, the onset of bilateral carpal tunnel syndrome is suspected.

[0033] If any one of the above three movement checks is applicable, the onset of bilateral carpal tunnel syndrome is suspected. Thus, since the onset of carpal tunnel syndrome can be determined by a low-cost and simple self-movement check by the patient, it is positioned as STEP0, which is the first process in the diagnostic flowchart.

[0034] <STEP1: Blood Test> As a medical act of STEP1 following STEP0, a blood test is prescribed. In this step, a diagnosis is made based on BNP (brain natriuretic peptide; blood BNP concentration) or NT-proBNP (N-terminal pro-B-type natriuretic peptide; blood NT-proBNP concentration) in the blood. Such a blood test can be performed at the patient's regular hospital.

[0035] Figure 4 shows a graph indicating the relationship between blood BNP, NT-proBNP, and the diagnosis result. As shown in Figure 4, generally, when BNP is 18.4 (pg / mL) or less or NT-proBNP is 55 (pg / mL) or less, the patient is diagnosed as being in a normal state. Also, when BNP is 18.4 - 35 (pg / mL) or NT-proBNP is 55 - 125 (pg / mL), it is diagnosed as requiring follow-up observation. When BNP is 35 - 100 (pg / mL) or NT-proBNP is 125 - 300 (pg / mL), it is diagnosed that there may be a possibility of pre-heart failure or heart failure. Furthermore, when BNP is 100 - 200 (pg / mL) or NT-proBNP is 300 - 900 (pg / mL), it is diagnosed that there may be a possibility of heart failure, and when BNP is 200 (pg / mL) or more or BNP-proBNP is 900 (pg / mL) or more, it is diagnosed that there may be a possibility of high-risk heart failure.

[0036] <STEP2: Echocardiogram> As a medical act of STEP2 following STEP0 and 1, an echocardiogram is prescribed. In this step, a determination of cardiac amyloidosis is made based on the thickness of the heart membranes in the echocardiogram image.

[0037] Echocardiography is performed using an ultrasound diagnostic device 5 shown in Fig. 5. The ultrasound diagnostic device 5 has an ultrasound probe 50, and takes an echocardiogram by pointing the ultrasound probe 50 at the heart, which is the imaging target. In this embodiment, as shown in Fig. 5, a parasternal long axis image (left ventricular long axis cross-sectional image at the left parasternal border) is taken as the echocardiogram.

[0038] The patient is usually positioned in the left lateral position during the examination to avoid the influence of air trapped in the lungs. In this position, the ultrasound probe 50 is placed on the left border of the sternum at the third or fourth intercostal space, and the heart is visualized along the left ventricular long axis. The parasternal long axis image is the largest left ventricular diameter and is visualized so that the interventricular septum and anterior aortic wall are at approximately the same height. The parasternal long axis image is the most basic and versatile echocardiographic image, and allows simultaneous imaging of the posterior left ventricular wall and the right ventricular wall anterior to the sinus of Valsalva, as described below, and allows easy measurement of the thickness of each wall.

[0039] The ultrasound diagnostic device 5 includes an echo image processing unit 51, a display unit 52, a measurement unit 53, and a determination unit 54. The echo image processing unit 51 generates an echocardiogram based on ultrasound waves received by the ultrasound probe 50. The display unit 52 displays the echocardiogram generated by the echo image processing unit 51.

[0040] As shown in Figure 5, the measurement unit 53 measures at least one of the left ventricular posterior wall thickness d1 on the posterior side of the left ventricle as seen from the ultrasound probe 50 and the right ventricular anterior wall thickness d2 in front of the sinuses of Valsalva as seen from the ultrasound probe in an echocardiogram (parasternal long axis cross-sectional image) taken in the parasternal long axis direction.

[0041] The determination unit 54 determines whether or not cardiac amyloidosis has occurred based on at least one of the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2 measured in an echocardiogram captured in the parasternal long axis direction (parasternal long axis cross-sectional image). In this embodiment, the determination unit 54 determines that cardiac amyloidosis has occurred when the left ventricular posterior wall thickness d1 is 13 mm or more or the right ventricular anterior wall thickness d2 is 2.5 mm or more in this parasternal long axis cross-sectional image.

[0042] In parasternal long-axis views, the right ventricular outflow tract wall is located anterior to the sinus of Valsalva, and if right ventricular wall thickening occurs, a thickened right ventricular wall is observed in this area, as shown in Figure 6(A). Specifically, the measurement unit 53 measures the thickness of the thin right ventricular outflow tract wall anterior to the sinus of Valsalva wall, i.e., the right ventricular anterior wall thickness d2 (the thickness between the triangles in Figure 6(B)). The evaluation unit 54 determines the result as positive if this thickness is 2.5 mm or greater. In a normal heart, as shown in Figures 7(A) and 7(B), the right ventricular anterior wall thickness d2 is, for example, approximately 0.5 mm, which may be too thin to measure. When amyloid deposition increases brightness, the right ventricular outflow tract wall appears whitish, making it easier to measure the right ventricular anterior wall thickness d2. Although thickening of the same area may be observed in patients with a long history of pulmonary hypertension, thickening of the left heart system is not observed in pulmonary hypertension, making it possible to distinguish between cardiac amyloidosis and pulmonary hypertension.

[0043] As indicated by the double arrow in FIG. 6(A), the measurement unit 53 measures the left ventricular wall thickness (left ventricular posterior wall thickness d1) at the left ventricular base level using the same parasternal long axis image as for the right ventricular wall thickness. The left ventricular posterior wall thickness d1 is measured in a typical echocardiographic routine. However, the anterior septal wall of the left ventricle is often measured as being thicker in elderly people, particularly the sigmoid septum. Because cardiac amyloidosis is a common disease in elderly people, in this embodiment, it is desirable for the measurement unit 53 to measure the left ventricular posterior wall thickness d1, which is relatively less affected by aging.

[0044] The measurement unit 53 measures the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2 based on positions on the parasternal long axis cross-sectional image specified by operational input. When two points on the front and back of the left ventricular posterior wall (for example, the points at both ends of the double arrow in FIG. 6(A)) and two points on the front and back of the right ventricular anterior wall (for example, the opposing vertices of the two triangles in FIGS. 6(B) and 7(B)) are specified by operational input, the measurement unit 53 measures the distance between the two specified points as the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2.

[0045] The measurement unit 53 may measure the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2 by performing machine learning on the parasternal long axis cross-sectional image. The measurement unit 53 has a machine learning machine (not shown) that has performed pre-learning using as training data echocardiographic images that have been linked in advance to the measurement positions of the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2, and the machine learning machine identifies the left ventricular posterior wall and the right ventricular anterior wall and measures the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2.

[0046] The measuring unit 53 may also display the measured left ventricular posterior wall thickness d1 and right ventricular anterior wall thickness d2 on the display unit 52. If a positive determination is made based on the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2, the determining unit 54 may also send an alarm. The alarm may be displayed on the display unit 52 or output as sound.

[0047] <Wall thickness determination process> The wall thickness determination process performed by the ultrasound diagnostic device 5 shown in Fig. 5 will be described. First, as shown in Fig. 8, in the ultrasound diagnostic device 5, the echo image processor 51 acquires an echocardiogram (parasternal long axis cross-sectional image) (step S11), and the display unit 52 displays the acquired echocardiogram (step S12). Furthermore, the measurement unit 53 measures the left ventricular posterior wall thickness d1 on the posterior side of the left ventricle as seen from the ultrasound probe 50 in the echocardiogram (step S13), and measures the right ventricular anterior wall thickness d2 on the anterior side of the sinus of Valsalva as seen from the ultrasound probe 50 (step S14), as described above. Note that steps S13 and S14 may be performed in reverse order, or only one of them may be performed.

[0048] The determination unit 54 determines whether or not cardiac amyloidosis has occurred based on at least one of the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2 (step S15; determination procedure). Specifically, the determination unit 54 determines that cardiac amyloidosis has occurred when the left ventricular posterior wall thickness d1 is 13 mm or more or the right ventricular anterior wall thickness is 2.5 mm or more. If cardiac amyloidosis has been determined to have occurred (step S15; Yes), the determination unit 54 outputs an alarm (step S16). On the other hand, if the left ventricular posterior wall thickness d1 is not 13 mm or more and the right ventricular anterior wall thickness d2 is not 2.5 mm or more (step S15; No), the determination unit 54 outputs a signal indicating normal (step S17). After executing steps S16 and S17, the ultrasound diagnostic apparatus 5 ends the wall thickness determination process. This wall thickness determination process corresponds to a method for assisting in the diagnosis of cardiac amyloidosis.

[0049] As described above, any of the following four conditions can be used as a criterion for determining whether cardiac amyloidosis is present. (1) Left ventricular posterior wall thickness d1 is 13 mm or more (2) Right ventricular anterior wall thickness d2 is 2.5 mm or more (3) Left ventricular posterior wall thickness d1 is 13 mm or more, or right ventricular anterior wall thickness d2 is 2.5 mm or more (4) Left ventricular posterior wall thickness d1 is 13 mm or more, and right ventricular anterior wall thickness d2 is 2.5 mm or more. Which of the conditions (1) to (4) to select can be determined depending on the desired indicator. For example, if a high positive predictive value is desired, condition (2) can be used as the judgment condition. Furthermore, if it is desired to thoroughly determine the onset of cardiac amyloidosis, condition (3) can be used as the judgment condition. Furthermore, if a high negative predictive value is desired, condition (4) can be used as the judgment condition. Conditions (1) to (4) can be summarized as conditions including at least one of the following: the left ventricular posterior wall thickness d1 is 13 mm or more, and the right ventricular anterior wall thickness d2 is 2.5 mm or more.

[0050] The parasternal long-axis image is the first image obtained in a normal echocardiogram examination. In the present embodiment, the diagnosis of cardiac amyloidosis can be made simply by measuring the wall thickness at two locations using this cross-sectional image. The measurement of the wall thickness is performed automatically. If it is determined to be positive exceeding the reference value, the ultrasonic diagnostic apparatus 5 issues an alarm or the like. Thereby, cardiac amyloidosis can be easily screened. Note that there are hospitals where echocardiogram examinations can be performed even in hospitals that are not specialized in cardiology. Note that after it is determined in this STEP2 that it is cardiac amyloidosis, an operation check similar to that in STEP0 may be performed.

[0051] Note that this ultrasonic diagnostic apparatus 5 can be used alone for the determination of cardiac amyloidosis without being incorporated into the medical information providing system 1.

[0052] <STEP3: Myocardial scintigraphy examination> As the medical act of STEP3 following STEP0, 1, and 2, a myocardial scintigraphy examination is defined. Here, as the myocardial scintigraphy examination, 99mTc [[ID= twelve]]Pyrophosphate scintigraphy is performed. Pyrophosphate is a substance having an affinity for calcium and is used as a tracer for bone scintigraphy. 99mTc Pyrophosphate accumulates in the myocardial necrosis site and is also effective for the diagnosis of cardiac amyloidosis. 99mTc Pyrophosphate scintigraphy is not performed in general hospitals and is a high-cost examination, and it is possible in specific facilities specialized in the heart where nuclear medicine examinations are possible. Also, 99mTc The technicians who can handle pyrophosphate scintigraphy are limited.

[0053] <STEP4: Biopsy examination of amyloid deposition> As a medical procedure in STEP4 following STEP0 to 3, an examination of amyloid deposition by biopsy (endomyocardial biopsy) is defined. Endomyocardial biopsy is a test method in which a part of the endocardial side myocardium is collected using a bioptome and the presence or absence of myocardial disease is histologically examined. If it can be proven that amyloid is deposited in the myocardium, a definitive diagnosis is made. When amyloid deposition is recognized, further detailed analysis is performed to determine the disease type such as AL amyloidosis or ATTR amyloidosis. The biopsy test for amyloid deposition is a high-cost test and is only possible at advanced cardiovascular specialty facilities where endomyocardial biopsy is feasible.

[0054] <STEP5: Treatment> The medical procedures of STEP0 to 4 described above are examinations for cardiac amyloidosis. As the final medical procedure in STEP5 following STEP0 to 4, treatment at a treatable facility is defined. Regarding which type of cardiac amyloidosis has developed among the four types of cardiac amyloidosis, a final diagnosis is made during the course of this treatment. Treatment for cardiac amyloidosis is only possible at designated specific facilities, and there are very few such facilities.

[0055] As described above, cardiac amyloidosis is diagnosed according to the diagnostic flowchart shown in FIG. 2. According to this diagnostic flowchart, for example, in STEP 0, an orthopedic surgeon performs the motion check shown in FIGS. 3(A) to 3(C). If the motion check is positive, the procedure proceeds to STEP 5, where treatment is performed, or to STEP 1, where a blood test is performed. If the blood test in STEP 1 is positive, the procedure proceeds to STEP 5, where treatment is performed, or to STEP 2, where an echocardiogram is performed. If the echocardiogram in STEP 2 is positive, the procedure proceeds to STEP 0, where treatment is performed, or to STEP 4, where a myocardial biopsy is performed. If the myocardial biopsy in STEP 4 is positive, the procedure proceeds to STEP 5, where treatment is performed. If a diagnosis of cardiac amyloidosis is not made in any of STEPs 0 to 4, the diagnosis may be terminated. This diagnostic flowchart is basically ordered so that tests that are inexpensive, available at many facilities, and easy to perform are performed first. This reduces the financial burden on patients and facilitates their consultation.

[0056] For example, this diagnostic flowchart includes at least one of a motion check (STEP 0) to determine bilateral carpal tunnel syndrome and a blood test (STEP 1) as a process preceding the echocardiogram. Furthermore, this diagnostic flowchart includes at least one of a myocardial scintigraphy test (STEP 3) and a myocardial biopsy for amyloid deposits (STEP 4) as a process following the echocardiogram. The diagnostic flowchart is configured so that the overall diagnostic flow is performed in descending order of medical costs and the number of facilities capable of diagnosis. This diagnostic flow may be modified as appropriate depending on the legislation of each country.

[0057] Returning to FIG. 1, the medical procedure DB 23 stores data on medical procedures for each type of medical procedure, i.e., each process, in the diagnostic flowchart shown in FIG. 2. As shown in FIG. 9, the data on medical procedures stored in the medical procedure DB 23 can include at least one of the content, significance, procedure, and criteria for the medical procedure. For example, for a medical procedure corresponding to the blood test process in STEP 1, a BNP level of 100 pg / mL or NT-proBNP level of 300 pg / mL or higher is registered as a criterion. For a medical procedure corresponding to the echocardiography process in STEP 2, at least one of a left ventricular posterior wall thickness of 13 mm or higher on the posterior side of the left ventricle as viewed from the ultrasound probe 50 in a parasternal long-axis echocardiographic image and a right ventricular anterior wall thickness of 2.5 mm or higher on the anterior side of the sinus of Valsalva as viewed from the ultrasound probe 50 is registered as a criterion. In addition, criteria for medical procedures corresponding to the processes in STEPs 3 and 4 can also be registered.

[0058] As shown in Figure 9, in the medical procedure DB23, as part of the data related to medical procedures, for example, data related to medical institutions that can perform medical procedures corresponding to the processes in the diagnostic flowchart shown in Figure 2 is registered for each type of medical procedure, i.e., for each process in the diagnostic flowchart shown in Figure 2. The data related to medical procedures registered in the medical procedure DB23 includes data related to at least one medical institution that can perform the medical procedure, and the data related to the medical institution can include at least one of the name, address, contact information, website, and information related to the creation of a referral letter of the medical institution.

[0059] In the flowchart data 22 of Fig. 1, link information for accessing the medical practices of STEPs 0 to 5 of the medical practice DB 23 is embedded in each process of the diagnostic flowchart shown in Fig. 2. When any process is selected in the diagnostic flowchart, data on the medical practice corresponding to the selected process can be obtained from the medical practice DB 23 based on the link information.

[0060] When multiple medical institutions are registered for one medical procedure, the providing unit 20 may transmit list information in which the multiple medical institutions are arranged in a predetermined order to the terminal device 3, and the terminal device 3 may display the list as shown in Fig. 10. The order may be alphabetical, or may be arranged in order of proximity to the current location of the terminal device 3.

[0061] When providing information about medical institutions to the terminal device 3, the providing unit 20 of the server computer 2 may read map data from the map server 6 and provide the map data indicating the locations of the medical institutions to the terminal device 3, as shown in Fig. 10. In this case, the locations of multiple medical institutions may be displayed on a map with the current location of the terminal device 3 at the center. Alternatively, only the nearest medical institution may be displayed.

[0062] Furthermore, when one of the medical institutions displayed on the terminal device 3 is selected, the address information of the medical institution's homepage may be sent to the terminal device 3, and the homepage may be displayed on the display unit 30 of the terminal device 3.

[0063] [Terminal Device] 1, each terminal device 3 includes a display unit 30, a selection unit 31, and a control unit 32. The display unit 30 can be a browser that displays images. The selection unit 31 selects a portion of the image displayed on the display unit 30, for example, in response to an operation input by an operator.

[0064] The control unit 32 controls the display unit 30 and the selection unit 31. Specifically, the control unit 32 transmits a request to display a diagnostic flowchart to the server computer 2, and displays the diagnostic flowchart transmitted from the server computer 2 on the display unit 30. Furthermore, when any process in the flowchart displayed on the display unit 30 is selected by the selection unit 31, the control unit 32 reads data related to the medical procedure corresponding to the selected process from the server computer 2 and displays the data on the display unit 30.

[0065] For example, in the flowchart shown in FIG. 2, when the process of STEP 0 is selected, the medical procedure of STEP 0 in the medical procedure DB shown in FIG. 9, i.e., the details, significance, procedures, and criteria for the operation check, are read into the terminal device 3. As a result, the procedure for the operation check is displayed, for example, as shown in FIGS. 3(A) to 3(C). Furthermore, when STEP 1 is selected, the details, significance, procedures, and criteria for the blood test are read into the terminal device 3, and the criteria are displayed, for example, as shown in FIG. 4. Furthermore, when STEP 2 is selected, the details, significance, procedures, and criteria for the echocardiogram, as well as the list of medical institutions shown in FIG. 10, map data, and the like, are displayed on the terminal device 3. Similarly, when STEPs 3, 4, and 5 are selected, the details, significance, and criteria for the respective medical procedures, the list of medical institutions, map data, and the like are read out and displayed on the terminal device 3.

[0066] [Hardware configuration] The medical information provision system 1 shown in Fig. 1 is realized, for example, by a server computer 2 and a terminal device 3 having the hardware configuration shown in Fig. 11 executing a software program. Specifically, the server computer 2 includes a CPU (Central Processing Unit) 61, which is a processor that controls the entire device, a main memory 62 such as a RAM (Random Access Memory), an external memory 63 configured from a non-volatile memory such as a flash memory or a hard disk, a communication interface 66 that performs data communication with the terminal device 3, and an internal bus 68 that connects these.

[0067] The program 69 is loaded from the external memory 63 into the main memory 62 and executed by the CPU 61. This realizes the functions of the server computer 2. When executing the program 69, the CPU 61 performs data communication with an external computer via the communication interface 66 as necessary.

[0068] The functions of the server computer 2 can be implemented in a computer system consisting of one or more computers, each including one or more processors and one or more storage devices, including a non-transitory storage medium. The multiple computers communicate with each other via a communications network, thereby realizing the functions of the server computer 2. For example, some of the functions of the server computer 2 may be implemented in one computer, and other parts may be implemented in other computers. The functions of the server computer 2 may also be realized by a cloud computer.

[0069] Similarly, the terminal device 3 shown in Fig. 1 is realized by a computer having the hardware configuration shown in Fig. 11 executing a software program. Specifically, the terminal device 3 includes a CPU (Central Processing Unit) 71, a main memory 72 of the CPU 71, an external memory 73 that stores a program 79, an operation unit 74 that is a device such as a keyboard and a mouse, a display 75 that is a display device such as a CRT (Cathode Ray Tube) or a liquid crystal monitor, a communication interface 76 that performs data communication with other computers, and an internal bus 78 that connects these.

[0070] The program 79 is loaded from the external memory 73 into the main memory 72 and executed by the CPU 71. The execution content of the program 79 is controlled by operation inputs from the operation unit 74, and data communication with an external computer is performed via the communication interface 76 as needed, and images are displayed on the display 75. In this way, the functions of the terminal device 3 are realized.

[0071] Next, the operation of the medical information providing system 1 according to this embodiment, that is, the medical information providing method, will be described.

[0072] 12, first, the terminal device 3 transmits a request to display a diagnostic flowchart to the server computer 2 (step S1). In response, the server computer 2 transmits flowchart data 22 of the diagnostic flowchart to the terminal device 3 (step S2). The terminal device 3 displays the flowchart (step S3).

[0073] Thereafter, the terminal device 3 determines whether or not to terminate according to the operation input (step S4). If not to terminate (step S4; No), the terminal device 3 determines whether or not a process has been selected (step S5). If no process has been selected (step S5; No), the terminal device 3 makes a termination determination again (step S4). In this way, the terminal device 3 repeats steps S4 to S5 unless an operation input for termination is made (step S4; No) or a process is selected (step S5; No).

[0074] When a process or the like is selected by the selection unit in the terminal device 3 (step S5; Yes), the terminal device 3 transmits a request for the selected process data to the server computer 2 (step S6). The server computer 2 transmits process data (data related to medical procedures) to the terminal device 3 (step S7). The terminal device 3 displays the received process data (step S8). Such process data includes data related to medical procedures registered in the medical procedure DB 23, such as the content, significance, and evaluation criteria of the medical procedures, or data related to medical institutions. Thereafter, the terminal device 3 again repeats the termination determination (step S4) and the process selection determination (step S5).

[0075] Thereafter, if a process or the like is selected (step S5; Yes), the terminal device 3 transmits a process data request (step S6), receives the process data (step S7), and displays the process data (step S7). Such process data includes a list of multiple medical institutions, map data of their locations, and an overview of the medical institutions. Thereafter, the terminal device 3 repeats an end determination (step S4) and a process selection determination (step S5). If it is determined that the process is to be ended by an operation input (step S4; Yes), the terminal device 3 ends the processing.

[0076] For example, for a patient at an orthopedic hospital whose movement check in STEP 0 is positive, the orthopedic surgeon at that hospital looks at the diagnostic flowchart and confirms that the patient should proceed to STEP 0 or STEP 5. To do this, by clicking STEP 1 or STEP 5, a list or map of medical institutions that the patient should visit next is displayed, and the patient can select the medical institution. For STEPs 2 to 4, a process in the diagnostic flowchart can be selected to display data related to the medical procedure in that process, and the next process can be selected to obtain information about the medical institution that the patient should visit next, thereby creating a diagnostic flow.

[0077] 2, an upper block and a lower block are formed in STEPs 2 and 3. In this case, when an upper block is selected, data related to the medical institution corresponding to that process may be displayed on the terminal device 3, and when a lower block is selected, data related to the medical procedure corresponding to that process may be displayed on the terminal device 3.

[0078] Furthermore, when a medical institution is selected from the list of medical institutions displayed on the terminal device 3, a pop-up may be displayed with more detailed information about the medical institution.

[0079] As explained in detail above, the medical information provision system 1 according to this embodiment allows appropriate medical procedures to be performed according to the expertise and facilities of each medical institution, making it highly versatile and practical in general medical practice and enabling more reliable diagnosis of diseases such as cardiac amyloidosis.

[0080] Specifically, the diagnostic criteria for each medical procedure are clearly defined, enabling appropriate diagnoses at each medical institution. In addition, the diagnostic flow chart shows the diagnostic process across multiple medical institutions, allowing each medical institution to appropriately guide patients to the next medical institution they should visit.

[0081] Furthermore, the medical information providing system 1 according to this embodiment semi-automatically or automatically measures the left ventricular posterior wall thickness and the right ventricular anterior wall thickness, which is located in front of the sinuses of Valsalva, in a parasternal long-axis echocardiographic image, and outputs an alarm if the left ventricular posterior wall thickness or the right ventricular anterior wall thickness exceeds a criterion. This reduces the workload during echocardiographic examination and shortens the examination time.

[0082] In the above embodiment, a diagnostic flowchart for medical treatment for cardiac amyloidosis has been described. However, the diagnostic flowchart may be a diagnostic flowchart for medical treatment for other diseases. Also, the diagnostic flowchart may be a diagnostic flowchart for diagnosing multiple types of diseases without specifying a specific disease.

[0083] In the higher-level embodiment, the medical information providing system 1 is configured with a server computer 2 and a terminal device 3. However, this is not limited to this. The medical information providing system 1 may be configured with a single computer by incorporating into the terminal device 3 a component equivalent to the storage unit 21 of the server computer 2.

[0084] The hardware and software configurations of the server computer 2 and the terminal device 3 are merely examples and can be changed and modified as desired.

[0085] The core processing parts of the server computer and terminal device 3, which are composed of CPUs 61, 71, main memories 62, 72, external memories 63, 73, operation units 74, displays 75, communication interfaces 66, 76, and internal buses 68, 78, can be realized using an ordinary computer system rather than a dedicated system. For example, a computer program for executing the above operations may be stored and distributed on a computer-readable recording medium (such as a flexible disk, CD-ROM, or DVD-ROM), and the computer program may be installed on a computer to configure the server computer 2 and terminal device 3 that executes the above processing. Alternatively, the computer program may be stored in a storage device of a server device on a communication network such as the Internet, and the server computer 2 and terminal device 3 may be configured by downloading the computer program to an ordinary computer system.

[0086] When the functions of the server computer 2 and the terminal device 3 are realized by sharing the functions between an OS (operating system) and an application program, or by cooperation between the OS and the application program, only the application program portion may be stored on a recording medium or storage device.

[0087] It is also possible to superimpose a computer program on a carrier wave and distribute it over a communications network. For example, the computer program may be posted on a bulletin board system (BBS) on the communications network and distributed over the network. The computer program may then be started and executed under the control of an operating system in the same way as any other application program, thereby enabling the above-mentioned processing to be performed.

[0088] [Diagnostic methods and diagnostic support methods] The method for assisting diagnosis in this embodiment relates to a method for diagnosing the onset of cardiac amyloidosis in a subject, or a method for assisting in said diagnosis, based on at least one of the left ventricular posterior wall thickness d1 on the posterior side of the left ventricle as viewed from the ultrasound probe 50 and the right ventricular anterior wall thickness d2 on the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe 50 in a parasternal long axis cross-sectional image of an echocardiogram of the subject.

[0089] The diagnostic support method according to this embodiment can be performed on any subject (examinee), but for example, measurement of the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2 in a parasternal long-axis echocardiographic image can be performed on subjects whose blood BNP concentration is 18.4 pg / mL or higher or whose blood NT-proBNP concentration is 55 pg / mL or higher in a pre-existing blood test, preferably subjects whose blood BNP concentration is 35 pg / mL or higher or whose blood NT-proBNP concentration is 125 pg / mL or higher, and more preferably subjects whose blood BNP concentration is 100 pg / mL or higher or whose blood NT-proBNP concentration is 300 pg / mL or higher. Furthermore, subjects who may be at high risk for heart failure and whose blood BNP concentration is 200 pg / mL or higher or whose blood BNP-proBNP concentration is 900 pg / mL or higher may also be used as subjects for measuring the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2. That is, the conditions for the blood test in STEP 1 of FIG. 2 can be changed as appropriate.

[0090] In the method for assisting diagnosis according to this embodiment, preferably, when at least one of the following conditions is met in a parasternal long axis echocardiographic image of a subject: the left ventricular posterior wall thickness is 13 mm or more, and the right ventricular anterior wall thickness is 2.5 mm or more, a correlation is found between the onset of cardiac amyloidosis and the presence or absence of cardiac amyloidosis, or the subject is diagnosed as having cardiac amyloidosis.

[0091] A subject diagnosed as having a correlation with the onset of cardiac amyloidosis or as having cardiac amyloidosis by the diagnostic method according to this embodiment may be further subjected to detailed examinations to make a definitive diagnosis of the onset of cardiac amyloidosis. 99mTcThese include pyrophosphate scintigraphy and confirmation of amyloid deposits by biopsy.

[0092] <Example> (1) Examination of the correlation between cardiac amyloidosis and left ventricular posterior wall thickness d1 and right ventricular anterior wall thickness d2 Left ventricular posterior wall thickness and right ventricular anterior wall thickness were measured on echocardiographic images of 116 subjects, 58 with cardiac amyloidosis and 58 without. The results are shown in Figure 13. Based on the actual measurement data for left ventricular posterior wall thickness d1 for all 116 subjects, correlations between left ventricular posterior wall thickness d1 and right ventricular anterior wall thickness d2 and cardiac amyloidosis were examined using t-tests, chi-square tests, and Fisher's exact tests (left-sided, right-sided, and two-sided). Significant differences were observed between subjects with and without cardiac amyloidosis (p<0.05). Similar comparisons were performed on right ventricular anterior wall thickness d2, and similar results were obtained. These results confirmed that it is possible to classify cardiac amyloidosis patients from non-cardiac amyloidosis patients based on the left ventricular posterior wall thickness d1 and the right ventricular anterior wall thickness d2.

[0093] (2) Examination of the cutoff value for left ventricular posterior wall thickness d1 Furthermore, a cutoff value for the left ventricular posterior wall thickness d1 was set to classify subjects into those with cardiac amyloidosis (positive subjects) and those without cardiac amyloidosis (negative subjects). When the cutoff value for left ventricular posterior wall thickness d1 was set at 13 mm, the number of true positive subjects was 49, the number of false positive subjects was 9, the number of false negative subjects was 2, and the number of true negative subjects was 56. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.5%, 96.6%, 96.1%, and 86.2%, respectively (Figure 14(A)).

[0094] (3) Examination of the cutoff value for right ventricular anterior wall thickness d2 Similarly, a cutoff value for the right ventricular anterior wall thickness d2 was set to classify subjects with cardiac amyloidosis (positive subjects) from those without cardiac amyloidosis (negative subjects). When the cutoff value for right ventricular anterior wall thickness d2 was set at 2.5 mm, the number of true positive subjects was 53, the number of false positive subjects was 5, the number of false negative subjects was 0, and the number of true negative subjects was 58. The sensitivity, specificity, positive predictive value, and negative predictive value were 91.4%, 100%, 100%, and 92.1%, respectively (Figure 14(B)).

[0095] (4) Examination of a method for determining left ventricular posterior wall thickness d1 and right ventricular anterior wall thickness d2 Using both the left ventricular posterior wall thickness (d1) and the right ventricular anterior wall thickness (d2), subjects were classified into those with cardiac amyloidosis (positive subjects) and those without cardiac amyloidosis (negative subjects). The cutoff values ​​set in (2) and (3) above were used. When a cutoff value of 13 mm for the left ventricular posterior wall thickness (d1) or 2.5 mm for the right ventricular anterior wall thickness (d2) was defined as a positive result, the number of true positives was 49, the number of false positives was 9, the number of false negatives was 2, and the number of true negatives was 56. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.5%, 96.6%, 96.1%, and 86.2%, respectively (Figure 15(A)). When a positive result was determined to be a result that met both the cutoff values ​​of 13 mm for left ventricular posterior wall thickness d1 and 2.5 mm for right ventricular anterior wall thickness d2, the number of true positives was 45, the number of false positives was 13, the number of false negatives was 2, and the number of true negatives was 56. The sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 96.6%, 95.7%, and 94.9%, respectively (Figure 15(B)). Note that these cutoff values ​​can be fine-tuned.

[0096] This invention allows various embodiments and modifications without departing from the broad spirit and scope of this invention. Furthermore, the above-described embodiments are intended to explain this invention and do not limit the scope of this invention. That is, the scope of this invention is defined by the claims, not the embodiments. Various modifications made within the scope of the claims and the meaning of the invention equivalent thereto are considered to be within the scope of this invention. [Explanation of symbols]

[0097] 1 medical information provision system, 2 server computer, 3 terminal device, 4 communication network, 5 ultrasound diagnostic device, 6 map server, 20 provision unit, 21 memory unit, 22 flowchart data, 23 medical procedure database (DB), 30 display unit, 31 selection unit, 32 control unit, 50 ultrasound probe, 51 echo image processing unit, 52 display unit, 53 measurement unit, 54 judgment unit, 61 CPU, 62 main memory, 63 external memory, 66 communication interface, 68 internal bus, 69 program, 71 CPU, 72 main memory, 73 external memory, 74 operation unit, 75 display, 78 internal bus, 79 program

Claims

1. a determination unit that determines whether or not cardiac amyloidosis has occurred based on at least one of a left ventricular posterior wall thickness at the rear side of the left ventricle as viewed from an ultrasound probe and a right ventricular anterior wall thickness at the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis cross-sectional image of an echocardiogram; Ultrasound diagnostic equipment.

2. The determination unit When at least one of the following conditions is satisfied in the parasternal long axis cross-sectional image: the left ventricular posterior wall thickness is 13 mm or more, and the right ventricular anterior wall thickness is 2.5 mm or more, the patient is determined to have developed cardiac amyloidosis. The ultrasonic diagnostic apparatus according to claim 1 .

3. a measurement unit that measures the left ventricular posterior wall thickness and the right ventricular anterior wall thickness based on a position on the parasternal long axis cross-sectional image that is specified by an operation input; The ultrasonic diagnostic apparatus according to claim 2 .

4. a measurement unit that measures the left ventricular posterior wall thickness and the right ventricular anterior wall thickness by performing machine learning on the parasternal long axis cross-sectional image; The ultrasonic diagnostic apparatus according to claim 2 .

5. a display unit for displaying an image; a selection unit for selecting a part of the image displayed on the display unit; a storage unit that stores data on a diagnostic flow chart in which medical procedures are organized into processes by type and the processes are connected in the order of medical examinations, and data on medical procedures associated with the processes; a control unit that displays the diagnostic flowchart stored in the storage unit on the display unit, and when any process in the diagnostic flowchart displayed on the display unit is selected by the selection unit, reads data on a medical procedure corresponding to the selected process from the storage unit and displays the data on the display unit; A medical information provision system comprising:

6. The data regarding the medical procedure includes at least one of the content, significance, procedure, and diagnostic criteria of the medical procedure. The medical information providing system according to claim 5 .

7. the process includes echocardiography to diagnose cardiac amyloidosis; The diagnostic criteria for the medical procedure corresponding to the echocardiography include at least one of the left ventricular posterior wall thickness at the rear side of the left ventricle as viewed from the ultrasound probe and the right ventricular anterior wall thickness at the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis cross-sectional image of the echocardiogram. The medical information providing system according to claim 6.

8. The criteria are: At least one of the left ventricular posterior wall thickness being 13 mm or more and the right ventricular anterior wall thickness being 2.5 mm or more. The medical information providing system according to claim 7.

9. The process prior to the echocardiogram includes at least one of a motion check and a blood test to determine bilateral carpal tunnel syndrome. The medical information providing system according to claim 7 or 8.

10. The post-echocardiography process includes at least one of myocardial scintigraphy and myocardial biopsy for amyloid deposits. The medical information providing system according to claim 7 or 8.

11. The data regarding the medical procedure includes data regarding at least one medical institution where the medical procedure can be performed. The medical information providing system according to claim 5 .

12. The data relating to the medical institutions includes a list of the medical institutions or map data showing the locations of the medical institutions. The medical information providing system according to claim 11.

13. Correlating at least one of a left ventricular posterior wall thickness at the rear side of the left ventricle as viewed from an ultrasound probe and a right ventricular anterior wall thickness at the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis echocardiographic image of the subject with the presence or absence of cardiac amyloidosis in the subject. A method to aid in the diagnosis of cardiac amyloidosis.

14. The subject has a blood BNP concentration of 18.4 pg / mL or more or a blood NT-proBNP concentration of 55 pg / mL or more.

14. A method for assisting in the diagnosis of cardiac amyloidosis according to claim 13.

15. In the parasternal long axis cross-sectional image, at least one of whether the left ventricular posterior wall thickness is 13 mm or more and whether the right ventricular anterior wall thickness is 2.5 mm or more is considered to be correlated with the presence or absence of cardiac amyloidosis.

14. A method for assisting in the diagnosis of cardiac amyloidosis according to claim 13.

16. Computer, a measuring unit that measures at least one of a left ventricular posterior wall thickness on the posterior side of the left ventricle as viewed from an ultrasound probe and a right ventricular anterior wall thickness on the anterior side of the sinuses of Valsalva as viewed from the ultrasound probe in a parasternal long axis cross-sectional image of an echocardiogram; a determination unit that determines whether or not cardiac amyloidosis has developed based on the left ventricular posterior wall thickness or the right ventricular anterior wall thickness; A program that functions as a

17. Computer, a display unit for displaying an image; a selection unit for selecting a part of the image displayed on the display unit; a storage unit that stores data on a diagnostic flow chart in which medical procedures are organized into processes by type and the processes are connected in the order of medical examinations, and data on medical procedures associated with the processes; a control unit that displays the diagnostic flowchart stored in the storage unit on the display unit, and when any process in the diagnostic flowchart displayed on the display unit is selected by the selection unit, reads data on the medical practice corresponding to the selected process from the storage unit and displays the data on the display unit; A program that functions as a

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