Ali DOĞAN

İleri Kronik Kalp Yetmezliğinde Kardiyak Mortalitenin Ön Gördürücüsü Olarak Pulmoner Arter Pulsatilite İndeksi: Sağ Atrial Basıncın Ötesinde mi?

Amaç: İleri kronik kalp yetmezliği (KY) hastalarında pulmoner arter pulsatilite indeksinin (PAPi) mortalite üzerine etkisi Yöntemler: Çalışmaya ileri evre kronik KY olan ejeksiyon fraksiyonu %30’un altında, sağ ve sol kateterizasyon işlemi yapılmış 53 hasta alındı. Kardiyak mortalite gelişimine göre iki grup oluşturuldu. Bulgular: Çalışma grubunda bulunan 53 hastadan, 18 hastada kardiyak mortalite gelişti (%33,9). Erkek cinsiyet ve periferik arter hastalığı kardiyak mortalite grubunda daha çok iken, CRP düzeyi de yine bu grupta daha fazla görüldü. Atım hacmi, aortik basınçlar, sol ventrikül sistolik basıncı kardiyak mortalite grubunda daha düşük iken, sağ atrium basıncı (SAB) daha yüksek saptandı. PAPi, kardiyak mortalite ile ilişkili olup, bu grupta daha düşük izlendi (p:0.001). Tek değişkenli analize göre, PAPi ve SAB kardiyak mortalitenin ön gördürücüleri arasındaydı. Ancak, çok değişkenli analiz sadece SAB’nin bağımsız bir ön gördürücü olduğunu göstermiştir. Kardiyak mortalite için PAPi eşik değeri 2.9 olarak hesaplandı (%88,9 duyarlılık ve %74,3 özgüllük ). Sonuç: PAPi, ileri KY’de kardiyak mortalite ile ilişkilidir. Ancak, bağımsız bir ön gördürücü değildir. PAPi çoğunlukla sağ atrial basınca bağımlıdır.

Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?

Objective: The effect of pulmonary artery pulsatility index (PAPi) on mortality in patients with advanced chronic heartfailure (HF).Methods: The study included 53 patients with advanced chronic HF, with ejection fraction below 30%, who underwentright and left catheterization. Two groups were formed according to the development of cardiac mortality.Results: Of 53 patients in the study group, 18 patients developed cardiac mortality (33.9%). While male gender andperipheral artery disease were more in the cardiac mortality group, CRP level was also seen more in this group. As strokevolume, aortic pressures, left ventricular systolic pressure were lower in the cardiac mortality group, right atriumpressure (RAP) was higher. PAPi was associated with cardiac mortality and lower in this group (P = 0.001). According tounivariate analysis, PAPi and RAP were among predictors of cardiac mortality. However, multivariate analysis indicatedthat only RAP was an independent predictor. PAPi threshold value for cardiac mortality was calculated as 2.9 (88.9%sensitivity and 74.3% specificity).Conclusion: PAPi is related with cardiac mortality in advanced HF. However, it is not an independent predictor. PAPi ismostly dependent on right atrial pressure.

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