Mecnun ÇETİN, Mustafa ÇAĞLAYAN, Münevver YILDIRIMER, Baran Serdar KIZILYILDIZ, Murat DEVECİ, Şenol COŞKUN

Obez çocuklarda sol ventrikül fonksiyonlarının değerlendirilmesinde doku doppler ekokardiyografi

Amaç: Bu çalışmada obez çocuklarda transtorasik doku Doppler ekokardiyografik yöntemle sol ventrikül sistolik ve diyastolik fonksiyonlarının değerlendirilmesi amaçlandı. Gereç ve yöntem: Mitral doku Doppler sinyalleri, mitral annulus lateral duvarlarına yerleştirilen örnek hacmi ile apikal dört boşluktan kaydedildi. Pulse Doppler örneği apikal dört boşluk görüntüde mitral kapak uçlarına, akıma paralel olacak şekilde yerleştirilerek mitral akım trasesi elde edildi. Çalışmaya 20 obez (161,50±25.78 ay) ve 20 (151,15±33.48 ay) sağlıklı çocuk alınarak gerçekleştirildi. Bulgular: Vücut kitle indeksi (VKİ) obez grupta belirgin yüksekti (30,92±6,87). Sol ventrikül (LV) diyastolik fonksiyon parametrelerinden izovolemik relaksasyon zamanı (IVRT) obez grupta 66,10±7,30 msn, kontrol grubunda ise 58,70±9,06 msn ile obez grupta anlamlı artış saptandı (p=0,007). Obez grubunda mitral anulus doku Doppler E akım hızı azalmış, A akım hızı artmış ve Em/Am oranının anlamlı derecede azalmış olduğu görüldü. VKİ ile LV Em/ Am oranı arasında anlamlı negatif ilişki saptandı. Miyokardiyal performans indeksi (MPİ) obez grupta 0,50±0,07, kontrol grubunda ise 0,41±0,04 (p=0.000) bulundu. MPİ ile LV Em/Am oranı arasında anlamlı negatif ilişki saptandı. MPİ ile VKİ arasında anlamlı pozitif ilişki saptandı. Obez grupta kontrol grubuna göre interventriküler septum ve LV arka duvar kalınlığının önemli derecede artmış olduğu gösterildi. Sonuç: Bu bulgular, pediatrik yaş grubunda obezite ve kardiyovasküler risk faktörleri arasındaki ilişkiyi belirlemek için önemli bulgular olabilir. Doku Doppler ekokardiyografik görüntüleme yöntemi ise aralarındaki bu ilişkinin belirlenmesinde yararlı olabilir.

Anahtar Kelimeler:

Obezite, doppler ekokardiyografi, ventriküler disfonksiyon

Tissue doppler echocardiography for evaluating left ventricular functions in obese children

Objective: The aim of this study was to investigate the impact of childhood obesity on ventricular functions using tissue Doppler echocardiography. Materials and methods: The mitral tissue Doppler signals were recorded in the apical four-chamber view, with the sample volume placed at the lateral walls of mitral annulus. The mitral flow was examined with the sample Pulse Doppler positioned parallely to flow just at the orifice of the mitral leaflets. Twenty obese (161.50±25.78 months) and 20 healthy children (151.15±33.48 months) were included to this study. Results: Body mass index (BMI) was significantly higher in obese group (30.92±6.87). Isovolumic relaxation time (IVRT) which is one of the left ventricular (LV) diastolic function parameters was 66.10±7.30 ms in obese group, and 58.70±9.06 ms in the control group. IVRT was significantly higher in the obese group (p=0.007). In obese group, the mitral annulus tissue Doppler E velocity was decreased, flow velocity was increased and decrement in Em/Am ratio was significant. We found significant negative correlation between BMI and LV Em/Am ratio. Myocardial performance index (MPI) in obese group and control group was 0.50±0.07 and 0.41±0.04, respectively (p=0.000). Between MPI and LV Em/Am ratio there was a significant negative correlation while MPI showed positive correlation with BMI. In obese group septal and LV posterior wall thickness was shown to be significantly increased compared to the control group (p=0.000). Conclusion: Our findings, may be important for determination of the relationship between obesity and cardiovascular risk factors in children. Tissue Doppler echocardiographic imaging may be useful in revealing this relationship.

Keywords:

obesity, doppler echocardiography, ventricular dysfunction,

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