Diyastolik Disfonksiyonu Olan Hastalarda Kalp Yetmezliği Gelişimini Öngörmede Sağ Ventrikül Deformasyon Değerinin Önemi

Amaç: Korunmuş ejeksiyon fraksiyonlu (EF) kalp yetmezliği (KY) nedeniyle hastaneye başvuruların önemli bir bölümünü oluşturmaktadır. Bu sebeple günümüzde diyastolik disfonksiyonu olan hastalarda kalp yetmezliği gelişimini belirleyebilmek ve önleyebilmek için birçok çalışma yapılmaktadır. Çalışmalar öncelikle sol ventrikül ve sol atriyum fonksiyonlarını değerlendiren parametreler üzerine yoğunlaşmakla birlikte bu hasta grubunda sağ ventrikül fonksiyonlarının kalp yetmezliği gelişimi üzerine etkisini araştıran bir çalışma bulunmamaktadır. Biz çalışmamızda diyastolik disfonksiyonu olan hastalarda sağ ventrikül serbest duvar uzunlamasına deformasyon ölçüsü ile belirlenmiş sağ ventrikül sistolik fonksiyonunun kalp yetmezliğini öngörmedeki yerini araştırmak istedik. Gereç ve Yöntem: Çalışmamıza transtorasik ekokardiyografide (TTE) diyastolik disfonksiyon tespit edilen ve görüntüleri sağ ventrikül serbest duvar uzunlamasına deformasyon ölçümü için uygun olan 51 hasta dahil edildi. Çalışmaya dahil edilen hastalar geriye dönük olarak tarandılar. Sonlanım noktası kalp yetmezliği gelişimi olarak belirlendi. Hastalar kalp yetmezliği gelişimine göre iki gruba ayrıldılar. Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 63,1±9,5 yıldı. İki grubun demografik özellikleri ile laboratuvar verileri arasında istatistiksel olarak anlamlı bir fark saptanmadı. İki grubun TTE sonuçları değerlendirildiğinde sol atriyal reservuar gerilme (LASr) ve sağ ventrikül serbest duvar uzunlamasına deformasyon değerlerinin kalp yetmezliği grubunda belirgin olarak bozulduğu belirlendi. Çok değişkenli regresyon analizinde sağ ventrikül serbest duvar uzunlamasına deformasyon değerinin diyastolik disfonksiyonda kalp yetmezliği gelişiminin bağımsız öngördürücüsü olduğu saptandı. ROC analizinde sağ ventrikül serbest duvar uzunlamasına deformasyon cut-off değeri -%15,5 olarak belirlendi. Sonuç: Bu çalışmada sağ ventrikül serbest duvar uzunlamasına deformasyon değerinin diyastolik disfonksiyonda kalp yetmezliği gelişiminin bağımsız öngördürücüsü olduğu belirlendi. Sağ ventrikül serbest duvar uzunlamasına deformasyon ölçüsünün kalp yetmezliği gelişimini belirlemedeki gücünün daha büyük, prospektif çalışmalarla değerlendirilmesi gerektiğini düşünmekteyiz.

Significance of the Right Ventricle Strain Value for Prediction of Heart Failure Development in Patients with Diastolic Dysfunction

Objectives: Heart failure with preserved ejection fraction (HFpEF) is the leading cause of the hospital admission due to heart failure. Therefore, several studies have investigated the development of heart failure and the prevention of heart failure in patients with diastolic dysfunction. Although studies primarily concentrate upon the left ventricle and left atrial functions, there have been no studies to evaluate right ventricle function on the effect of heart failure development in this patient group. In this study, we sought to investigate whether right ventricle systolic function measured by right ventricle free wall longitudinal strain could predict heart failure in patients with diastolic dysfunction. Materials and Methods: Our study included 51 patients with diastolic dysfunction in transthoracic echocardiography (TTE) and whose images were suitable for right ventricular free wall longitudinal strain measurement. All study populations were observed retrospectively. Developing heart failure was determined as the end point. All patients were divided into two groups according to the presence of heart failure. Results: The mean age of the study population was 63.1±9.5 years. No statistical difference was determined between the groups’ demographic and laboratory characteristics. When the echocardiographic parameters were evaluated. The left atrial reservoir strain (LASr) and the right ventricle free wall longitudinal strain (RV FWLS) were found as highly impaired in the heart failure group. In multivariate analysis, RV FWLS was an independent predictor of heart failure development in diastolic dysfunction. A cut-off value of RV FWLS was found as -15.5% using ROC analysis. Conclusion: In this study RV FWLS was demonstrated as an independent predictor of heart failure in diastolic dysfunction. Larger, prospective studies are necessary to determine the impact of RV FWLS on predicting heart failure.

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