Arslan ÖCAL, Ümit GÜRAY, İrfan SABAH, Nurcan ARAT

Koroner kollateral dolaşımın sol ventrikül sistolik ve diyastolik fonksiyonları üzerine etkisi: Doku Doppler ekokardiyografi çalışması

Koroner arter hastalığında (KAH) koroner kollateral dolaşım (KKD) gelişmesinin, sol ventrikül (LV) sistolik fonksiyonları üzerinde koruyucu etkisinin olup olmadığı tartışmalı olup, diyastolik fonksiyonlar üzerine etkisi konusunda ise yeterli bilgimiz yoktur. Bu çalışmada KAH’da KKD varlığının LV bölgesel miyokardiyal sistolik ve diyastolik fonksiyonları üzerindeki etkilerinin doku Doppler yöntemi ile araştırılması amaçlandı. Bu amaçla 40 ardışık erkek hasta (yaş ortalaması 50,7±11) prospektif olarak incelendi. Koroner anjiyografide sadece sol ön inen koroner arterde yüzde 70 ve üzerinde lümen darlığı saptanan hastalar çalışmaya alındı. Koroner kollateral dolaşım varlığı “Rentrop” klasifikasyonuna göre belirlendi. Hastalar KKD evresine göre, KKD saptanmayanlar (evre-0), evre-1, 2 KKD ve iyi gelişmiş KKD (evre-3) bulunanlar şeklinde gruplandırıldı. İki boyutlu ekokardiyografi ile sol ventrikül volümleri ve ejeksiyon fraksiyonu ve “pulsed wave” doku Doppler ekokardiyografi yöntemi ile lateral mitral anülüsten, sol ventrikül mid inferior ve mid anterior segmentlerden alınan sistolik (S) maksimum velositesi, izovolemik kontraksiyon zamanı (İVKZ), S dalgasının süresi (kontraksiyon zamanı) (KZ), erken diyastolik (E) ve geç diyastolik (A) maksimum velositeleri, E/A oranı, izovolemik relaksasyon zamanı (İVRZ) ve E dalgasının deselerasyon zamanı (DZ) belirlendi ve gruplar arasında karşılaştırıldı. Kırk hastanın 26 tanesinde KKD vardı. On hastada Evre-1, 2 ve 16 hastada evre-3 KKD saptandı. Ondört hastada KKD saptanmadı (evre-0). İlginç olarak KKD evresi düşük olanlarda yüksek olanlara göre sol ventrikül diyastol ve sistol sonu volüm ortalamaları artmış olarak bulundu. Tüm KKD saptanan hastalarda, KKD bulunmayanlara göre sol ventrikül volümleri daha yüksek ve ejeksiyon fraksiyonu daha düşük idi. (KKD olmayan grupta EF 64,2±4,9 ve olan grupta 54,0±15,8, p

The effect of the coronary collateral circulation on left ventricular systolic and diastolic functions: Tissue Doppler imaging study

The role of coronary collateral circulation (CCC) on the improvement of left ventricular function in coronary artery disease is controversial and the effect of the CCC on the left ventricular regional myocardial systolic and diastolic function is stil not known. The aim of this study is to investigate the effect of CCC on left ventricular regional myocardial systolic and diastolic function in patients with ischemic heart disease by tissue Doppler imaging. Forty consecutive male patients (mean age 50,7±11years) who had single vessel disease with > 70% narrowing in left anterior descending coronary artery were enrolled in this study. Coronary collateral circulation was determined according to the Rentrop classification (Class 0 = no collateral circulation; class 1 = small branches of occluded vessel fill with CCC; class 2 = epicardial segment of the occluded vessel partially fills with CCC; class 3 = epicardial segment of the occluded vessel totally fills with CCC). Rentrop classification of the patients class-0, class-1, 2 and class-3 were compared with echocardiographic and clinic datas. Left ventricular ejection fraction and volumes were assessed with 2-D echocardiography and pulsed wave tissue Doppler images of mitral lateral annulus, mid region of the anterior and inferior myocardial segments were examined. Systolic (S), early diastolic (E) and late diastolic (A) maximum velocities, isovolumetric contraction time (IVCT), contraction time (CT), isovolumetric relaxation time (IVRT) and E wave deceleration time were measured. Parameters associated with global and regional myocardial systolic and diastolic function were compared in different CCC groups. Twenty six of 40 patients had collateral circulation. Ten patients had class-1,2 and 16 patients had class 3 CCS. 14 patients had no CCS (class 0) Patients with CCS had the higher left venticular volumes and lower ejection fractions compared the group without CCS (EF; patients with CCS: 54,0±15,8, without CCS: 64,2±4,9, p

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