Burak ERER, Betül ERER, Hüseyin OFLAZ, Şevket GÖRGÜLÜ, Sevil KAMALI, Özcan KARAMAN, Murat İNANÇ

Diffüz Skleroderma Hastalarında Subklinik Kardiyak Fonksiyonların Değerlendirilmesi

Amaç: Asemptomatik diffüz skleroderma (SSc) hastalarında sağ ve sol ventrikül fonksiyonlarının değişik ekokardiyografik yöntemler ile değerlendirilmesi amaç- lanmıştır. Hastalar ve Yöntemler: Çalışmaya kardiyak açıdan asemptomatik olan 20 diffüz SSc tanılı ayaktan hasta ile 20 sağlıklı kontrol dahil edildi. Konvansiyonel ekokardiyografik yöntemler ile sol (LV) ve sağ (RV) ventrikül ölçümleri, doku Doppler görüntüleme (TDI) ve miyokard performans indeksleri (MPI) değerlendirildi. Bulgular: Skleroderma tanılı hastalarda hem sol hem de sağ ventrikül diyastolik fonksiyonları belirgin olarak azalmış olmakla birlikte, LV sistolik fonksiyonları her iki grupta benzer bulundu. SSc hastalarının %25’inde pulmoner arter basıncının artmış olduğu gözlendi (31.1±5.2 ve 24.7±2.7 mmHg, p < 0.001). TDI ile mitral ve triküspid anüler sistolik hızlarının her iki grupta benzer olduğu saptanırken, SSc hastalarında diyastolik fonksiyonların azaldığı görüldü. Tei indeksinin SSc grubunda her iki ventrikül için de istatistiki olarak artmış olduğu saptandı (LV-MPI: p < 0.03 ve RV-MPI: p < 0.007). Sonuç: Kardiyak açıdan asemptomatik diffüz SSc hastalarında, farklı ekokardiyografik yöntemler ile, her iki ventrikül diyastolik disfonksiyonun bulunduğu gözlenmiştir.

Anahtar Kelimeler:

Skleroderma, kardiyak disfonksiyon, ekokardiyografi, doku Doppler görüntüleme (TDI), miyokard performans indeksi (MPI)

Assessment of Subclinical Cardiac Dysfunction in Diffuse Scleroderma Patients

Objectives: We aimed to evaluate left and right ventricular functions with different echocardiographic methods in asymptomatic patients with diffuse scleroderma (SSc). Patients and Methods: Twenty diffuse SSc outpatients, asymptomatic with regard to cardiac symptoms and twenty healthy control subjects were enrolled. Conventional left ventricular (LV) and right ventricular (RV) echocardiographic measurements, pulsed wave tissue Doppler imaging (TDI) and myocardial performance indexes (MPI) were evaluated. Results: Both left (LV early to atrial peak velocity ratio: p&lt;0.02, LV isovolumic relaxation time: p&lt;0.03, LV deceleration time: p&lt;0.02) and right ventricle (RV early to atrial peak velocity ratio: p&lt;0.02) diastolic functions were significantly reduced in SSc group while the parameters assessing LV systolic function were similar in both groups. Pulmonary artery pressure was significantly higher in 25% of SSc patients (31.1&plusmn;5.2 and 24.7&plusmn;2.7 mmHg, p&lt;0.001). Although mitral and tricuspid annular systolic velocities with TDI (Sm, St) were similar between two groups, obtained diastolic functions showed a decrease in SSc patients. Tei index was statistically higher in SSc group (left ventricle MPI (LV-MPI): p&lt;0.03 and right ventricle MPI (RV-MPI): p&lt;0.007). Conclusion: Diastolic dysfunction of both ventricles with different echocardiographic methods was observed in diffuse SSc patients even without cardiac symptoms. Amaç: Asemptomatik diffüz skleroderma (SSc) hastalarında sağ ve sol ventrikül fonksiyonlarının değişik ekokardiyografik yöntemler ile değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntemler: Çalışmaya kardiyak açıdan asemptomatik olan 20 diffüz SSc tanılı ayaktan hasta ile 20 sağlıklı kontrol dahil edildi. Konvansiyonel ekokardiyografik yöntemler ile sol (LV) ve sağ (RV) ventrikül ölçümleri, doku Doppler görüntüleme (TDI) ve miyokard performans indeksleri (MPI) değerlendirildi. Bulgular: Skleroderma tanılı hastalarda hem sol hem de sağ ventrikül diyastolik fonksiyonları belirgin olarak azalmış olmakla birlikte, LV sistolik fonksiyonları her iki grupta benzer bulundu. SSc hastalarının %25&#39;inde pulmoner arter basıncının artmış olduğu gözlendi (31.1&plusmn;5.2 ve 24.7&plusmn;2.7 mmHg, p&lt;0.001). TDI ile mitral ve triküspid anüler sistolik hızlarının her iki grupta benzer olduğu saptanırken, SSc hastalarında diyastolik fonksiyonların azaldığı görüldü. Tei indeksinin SSc grubunda her iki ventrikül için de istatistiki olarak artmış olduğu saptandı (LV-MPI: p&lt;0.03 ve RV-MPI: p&lt;0.007). Sonuç: Kardiyak açıdan asemptomatik diffüz SSc hastalarında, farklı ekokardiyografik yöntemler ile, her iki ventrikül diyastolik disfonksiyonun bulunduğu gözlenmiştir.

Keywords:

Systemic sclerosis; cardiac dysfunction; echocardiography; tissue Doppler imaging (TDI); myocardial performance indexes (MPI),

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