Gülten TAÇOY, Murat ÖZDEMIR, Yusuf TAVIL, Sedat TÜRKOGLU, Atiye ÇENGEL

Kronik, Orta-Ciddi Aort Yetmezliginde Felodipin Ve Lisinopril Vazodilatör Tedavisinin Etkinliginin Ve Güvenilirliginin Karsilastirilmasi

Amaç: Aort Yetmezligi varliginda ciddi hacim yüküne karsi çalismak zorunda olan sol ventrikül (LV) kompansatuar mekanizmalar ile pompa fonksiyonunu uzun süre normal düzeylerde tutabilir. Fakat ileri dönemlerde ventrikül fonksiyonlarindaki bozulma beklenen sonuçtur. Ciddi AY’nde vazodilatör tedavinin uygulanma nedeni de LV dilatasyonu ve operasyon gerekliligini mümkün oldugunca geciktirebilmektir. Bu çalisma ciddi, izole, asemptomatik, kronik AY olan olgularda farkli iki ajan ile saglanan vazodilatör tedavinin etkinligini karsilastirmak üzere yapilmistir. Gereç ve Yöntem: Kronik, asemptomatik ve transtorasik ekokardiyografi ile en az 2. AY olan yas ort. 48,4±17 olan 21 erkek ( %51) , 20 kadin (%49) toplam 41 olgu çalismaya alindi.Transtorasik ekokardiyografi ile EDV (Diastol sonu volüm), ESV(Sistol sonu volüm), EF, FSV (Ileriye dogru atim volümü), LVSV (Sol ventrikülün toplam atim volümü), RV (Geriye kaçan volüm), RF (Geriye kaçan volüm fraksiyonu), FCO (Ileriye dogru kardiyak output), LVCO (Sol ventrikül toplam kardiyak outputu), SW (Sistolik is yükü) , CW (Kardiyak yük), LVWS(Sol ventrikül duvar stresi) parametreleri ve noninvaziv olarak SKB (sistolik kan basinci), DKB (diastolik kan basinci), SVR (Sistemik vasküler rezistans)ölçümleri yapilarak hastalar felodipin veya lisinopril tedavi grubuna alindi. Maksimum 10 mg felodipin veya 20 mg lisinopril olacak sekilde toplam 6 ay uygulanan vazodilatör tedavi sonras i ekokardiyografi tekrarlandi. 6 aylik tedavi periyodu boyunca ortaya çikan major klinik olaylar (ölüm, AVR gereksinimi, semptom gelisimi) ve ilaç yan etkileri kaydedildi. Bulgular: Toplam 36 olgu çalismayi tamamladi. Felodipin grubunda 2 olgu ilaç yan etkisi nedeniyle, 2 olgu yeni baslayan atrial fibrilasyon sebebiyle çalisma disi birakildi. Her iki ilaç grubunda da major klinik olay gözlenmedi. Çalismanin sonunda lisinopril grubunda SKB’da %8.9 , DKB’da %5.9 , SVR’da %16.7 azalma, FSV’de %11.2, LVSV’de % 3 artma, RV’de %8.4 , RF’da %11, SW’de %6 ve CW’de %7.2 azalma saptandi (p < 0.05).Felodipin grubunda SKB’da %11.3, DKB’da %9.4 , SVR’da %17.3 azalma, FSV’de %5.6 artma, RF’da %9.7, SW’de %10.8 ve CW’de %8.9 azalma saptandi (p

Anahtar Kelimeler:

kronik aort yetmezligi, felodipin, lisinopril, ekokardiyografi

The Comparison of The Efficacy and The Confidence of The Vasodilator Therapy With Felodipine And Lisinopril in Chronic, Moderate to Severe Aortic Regurgitation

Purpose: Afterload reduction decreases volume overload on the left ventricle in chronic asymptomatic aortic regurgitation (AR). In this prospective, randomized trial, we aimed to compare the effects of a 6-months long treatment with lisinopril versus felodipine on left ventricular function and hemodynamic parameters. Methods: 41 asymptomatic patients with moderate to severe chronic, isolated AR were randomly assigned to treatment with either lisinopril (20 mg) or felodipin (10 mg). Echocardiographic ([ESV], [EDV], [EF], [FSV], [LVSV], [RV], [RF], [FCO], [LVCO], [SW], [CW], [LVWS]) and hemodynamic parameters [SBP], [DBP], [SVR]) at baseline and at 6 months were compared. Results: At 6 months, with lisinopril, SBP 8,9 %, DBP 5,9 %, SVR 16,7 %, RV 8,4 %, RF 11 %, SW 6 %, CW 7.2 % decreased and FSV 11,2 %, LVSV 3 % increased (p

Keywords:

Chronic aortic regurgitationi, felodipine, lisinopril, echocardiography,

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