Hasan GÖK, Kurtuluş ÖZDEMİR, Halil İbrahim ERDOĞAN, Murat ERER, Mehmet KAYRAK, Hakan AKILLI, Alpay ARIBAŞ, Mustafa KARANFİL

Sol Ventrikül Diyastol Sonu Basıncı Tahmininde Mitral A Sol Ventrikül Diyastol Sonu Basıncı Tahmininde Mitral A Dalga Yükselme Zamanının Değeri Dalga Yükselme Zamanının Değeri

Amaç: Bu çalışmada sol ventrikül ejeksiyon fraksiyonunun korunduğu hastalarda (ejeksiyon fraksiyonu >%50), mitral A dalga yükselme zamanının, sol ventrikül diyastol sonu basıncını öngörmedeki yerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Mayıs 2012 ile Ekim 2013 tarihleri arasında koroner anjiyografi yapılmasına karar verilen 121 hasta çalışmaya dahil edildi. Ekokardiyografi kayıtları alındıktan sonra, ölçümlerden habersiz başka bir araştırmacı tarafından sol kalp kateterizasyonu ile sol ventrikül diyastol sonu basıncı ölçüldü. Basınç değerlerine göre hastalar üç gruba ayrıldı. Sol ventrikül diyastol sonu basıncı 0 ile 10 mmHg arası olanlar grup 1, 11 ile 15 mmHg arasında olanlar grup 2, 16 mmHg ve üzeri olanlar ise grup 3'e dahil edildi. Demografi k özellikler, vital bulgular ve ekokardiyografi k parametreler gruplar arasında karşılaştırıldı.Bulgular: Çalışmamıza dahil edilen 121 hastadan 60 (%49,5) tanesi grup 1'e, 30 (%24,7) tanesi grup 2 ye, 31 (%25,6) tanesi grup 3 içerisine alındı. Gruplar arası yapılan analizde yaş, cinsiyet, vücut kitle indeksi, komorbit durumlar ve vital bulgular arasında anlamlı bir fark izlenmedi. Gruplar arasında mitral A dalga yükselme zamanında anlamlı bir fark izlenmedi. (Sırasıyla, 79,3±19,6 cm/sn, 83,9±12,5 cm/sn, 80,2±20,1 cm/sn p=0,51).Sonuç: Tüm bu bulgulara rağmen net veriler için daha fazla hasta katılımının olduğu çalışmalara ihtiyaç olduğu açıktır.

Value of Mitral A-Wave Acceleration Time on Estimation of Left Ventricular End-Diastolic Pressure

Objective: Our aim in this study was to evaluate the value of the acceleration time of the mitral A wave in predicting left ventricle end diastolic pressure of patients with preserved left ventricle ejection fraction (ejection fraction >%50).Material and Methods: 121 patients who were about to undergo coronary angiography between May 2012 and October 2013 were included in our study. After receiving the echocardiographic records, cardiac catheterization and left ventricular end-diastolic pressure measurements were done by another investigator who was unaware of the echocardiographic measurements. Patients were divided into three groups according to the pressure values. Patients whose left ventricular end diastolic pressure was between 0 and 10 mmHg were included in group 1, those whose pressure was between 11-15 mmHg were included in group 2 and those whose pressure was over 15 mmHg were included in group 3. Demographic characteristics, vital signs, and echocardiographic parameters were compared between groups.Results: 60 (49.5%) of the 121 patients were enrolled in group 1, 30 (24.7%) them were enrolled in group 2, and 31 (%25.6) were enrolled in group 3. There was no signifi cant difference between the groups regarding age, gender, body mass index, comorbid conditions and vital signs. There was no signifi cant difference between the groups according to mitral A wave acceleration time (respectively, 79.3±19.6 cm/sec, 83.9±12.5 cm/sec, 80.2±20.1 cm/sec, p=0.51). Conclusion: Despite our fi ndings, studies with a larger number of participants are needed to clarify the data.

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Stevenson LW, Couper G, Natterson B, Fonarow G, Hamilton MA, Woo M. Target heart failure populations for newer therapies. Circulation 1995;92(9 Suppl):II174-81.
Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL. Heart failure with a normal ejection fraction: Is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation 2001;104(7):779-82.
Lipp-Ziff EL, Kawanishi DT. A technique for improving accuracy of the pulmonary artery diastolic pressure as an estimate of left ventricular end-diastolic pressure. Heart Lung 1991;20(2):107-15.
Lew WY. Evaluation of left ventricular diastolic function. Circulation 1989;79(6):1393-7.
Briguori C, Betocchi S, Losi MA, Manganelli F, Piscione F, Pace L, et al. Noninvasive evaluation of left ventricular diastolic function in hypertrophic cardiomyopathy. Am J Cardiol 1998;81(2):180-7.
Yamamoto K, Nishimura RA, Chaliki HP, Appleton CP, Holmes DR Jr, Redfi eld MM. Determination of left ventricular fi lling pressure by Doppler echocardiography in patients with coronary artery disease: Critical role of left ventricular systolic function. J Am Coll Cardiol 1997;30(7):1819-26.
Nishimura RA, Appleton CP, Redfi eld MM, Ilstrup DM, Holmes DR Jr, Tajik AJ. Noninvasive doppler echocardiographic evaluation of left ventricular fi lling pressures in patients with cardiomyopathies: A simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 1996 ;28(5):1226-33.
Abd-El-Aziz TA. Noninvasive prediction of left ventricular end-diastolic pressure in patients with coronary artery disease and preserved ejection fraction. Can J Cardiol 2012;28(1):80-6.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two- Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67.
Paraskevaidis IA, Tsiapras DP, Karavolias GK, Cokkinos P, Kremastinos DT. Doppler-derived left ventricular end- diastolic pressure prediction model using the combined analysis of mitral and pulmonary A waves in patients with coronary artery disease and preserved left ventricular systolic function. Am J Cardiol 2002;90(7):720-4.
Abd El-Aziz TA. A-wave acceleration: A new Doppler echocardiographic index for evaluation of left ventricular diastolic dysfunction in elderly patients. Angiology 2008;59(4):435-41.
Olsson LG, Swedberg K, Ducharme A, Granger CB, Michelson EL, McMurray JJ, et al. Atrial fi brillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: Results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program. J Am Coll Cardiol 2006;47(10):1997-2004.
Tsang TS, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, et al. Left ventricular diastolic dysfunction as a predictor of the fi rst diagnosed nonvalvular atrial fi brillation in 840 elderly men and women. J Am Coll Cardiol 2002;40(9):1636-44.
Caudron J, Fares J, Bauer F, Dacher JN. Evaluation of left ventricular diastolic function 4th cardiac MR imaging. Radiographics 2011;31(1):239-59.
Neumann A, Soble JS, Anagnos PC, Kagzi M, Parrillo JE. Accurate noninvasive estimation of left ventricular end- diastolic pressure: Comparison with catheterization. J Am Soc Echocardiogr 1998;11(2):126-31.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009;10(2):165-93.
Appleton CP, Hatle LK, Popp RL. Relation of transmitral fl ow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988;12(2):426-40.
Pai RG, Varadarajan P. Relative duration of transmitted mitral A wave as a measure of left ventricular end-diastolic pressure and stiffness. Echocardiography 2004;21(1):27-31.
Schwammenthal E, Popescu BA, Popescu AC, Di Segni E, Kaplinsky E, Rabinowitz B, et al. Noninvasive assessment of left ventricular end-diastolic pressure by the response of the transmitral a-wave velocity to a standardized Valsalva maneuver. Am J Cardiol 2000;86(2):169-74.
Stork T, Piske G, Ewert C, Muller R, Hochrein H. Non-invasive Doppler sonographic measurement of left ventricular end-diastolic pressure. Z Kardiol 1988;77(12):767-73.
Ettles DF, Davies J, Williams GJ. Can left ventricular end-diastolic pressure be estimated non-invasively? Int J Cardiol 1988;20(2):239-45.
Okamoto M, Sakura E, Shimamoto H, Yokote Y, Hashimoto M, Fujii H, Ohshima T, Tsuchioka Y, Matsuura H, Kajiyama G. Analysis of mitral infl ow velocity pattern in relation to left ventricular end-diastolic pressure. J Cardiogr. 1986 Dec;16(4):941-8.
Channer KS, Culling W, Wilde P, Jones JV. Estimation of left ventricular end-diastolic pressure by pulsed Doppler ultrasound. Lancet 1986;1(8488):1005-7.
Mulvagh S, Quinones MA, Kleiman NS, Cheirif J, Zoghbi WA. Estimation of left ventricular end-diastolic pressure from Doppler transmitral fl ow velocity in cardiac patients independent of systolic performance. J Am Coll Cardiol 1992;20(1):112-9.
Appleton CP, Galloway JM, Gonzalez MS, Gaballa M, Basnight MA. Estimation of left ventricular fi lling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral fl ow velocity at atrial contraction. J Am Coll Cardiol 1993;22(7):1972-82.
Firstenberg MS, Levine BD, Garcia MJ, Greenberg NL, Cardon L, Morehead AJ, Zuckerman J, Thomas JD. Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol. 2000 Nov 1;36(5):1664-9.
Caiani EG, Weinert L, Takeuchi M, Veronesi F, Sugeng L, Corsi C, Capderou A, Cerutti S, Vaïda P, Lang RM. Evaluation of alterations on mitral annulus velocities, strain, and strain rates due to abrupt changes in preload elicited by parabolic fl ight. J Appl Physiol (1985). 2007 Jul;103(1):80-7.
Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfi eld MM, Tajik AJ. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular fi lling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000 Oct 10;102(15):1788-94.