Başarılı koroner anjiyoplastinin sistolik ve diyastolik fonksiyonların kombine yeni Doppler göstergesi olan miyokardiyal performans indeksine etkisi

Doppler ile ölçülen miyokardiyal performans indeksi (MPl), invazif olmayan, basit, tekrarlanabilir bir değerlendirme yöntemi olarak yakın zamanda tanımlanmıştır. Bu çalışmada ciddi sol ventrikül işlev bozukluğu olmayan kronik iskemik kalp hastalarında, koroner anjiyoplasti He revaskularizasyon sonrası, sistolik ve diyastolik işlevlerin birleşik göstergesi olduğu düşünülen MPl nin etkilenip etkilenmediği araştırılmıştır. Çalışmaya ciddi sol ventrikül sistolik disfonksiyonu olmayan, klinik ve anjiyografik koroner arter hastalığı nedeniyle elektif Hk kez perkutan translüminal koroner anjiyoplasti (PTKA) planlanan 31 olgu alınarak işlem öncesi ve sonrası Hk 24 saatte Doppler ekokardiyografik çalışma yapılmıştır. MPl, izovolümik kontraksiyon ve izovolümik relaksasyon süreleri toplamının ejeksiyon zamanına bölümü olarak tanımlanmıştır. Transmitral akımın Doppler indeksleri, erken diyastolik dalga (E) maksimum velositesi, E dalgasının deselerasyon zamanı, geç diyastolik dalga (A) maksimum velosite ve süresi, E dalgası maksimum velositesinin A dalgası maksimum velositesine oranı, izovolümik relaksasyon zamanı işlem öncesi ve sonrasında değerlendirilmiştir. Tüm olgulara PTKA işlemi başarı He uygulanmıştır. Transmitral "pulsed" Doppler parametrelerinden izovolümik relaksasyon zamanı işlem öncesindeki 139,7±22,2 msn'den, işlem sonrasında 120 ± 15,96 msn'ye gerilemiştir (p=0,0001). E dalgası deselerasyon zamanı işlem öncesinde 279 ± 11 msn iken , işlem sonrası 248 ± 36 msnye inmiştir (p=0,005). Olgularda ejeksiyon fraksiyonu işlem sonrasında değişmezken MPl; işlem öncesi indeks ortalama 0,606 ± 0,26 iken işlem sonrası 0,47 ± 0,22 değerine gerilemiştir (p= 0,001). Bu çalışma basit, kaydedilmesi kolay, invaziv olmayan bir Doppler yöntemi olarak Miyokardiyal Performans indeksinin (MPI) başarılı bir koroner anjiyoplasti sonrası iyileştiğini göstermektedir. Bu iyileşmenin zamanlaması ve şiddetinin klinik izlemde, restenozun değerlendirilmesinde ya da medikal tedavi etkinliğinin saptanmasındaki değerini saptamaya yönelik çalışmalara gereksinim vardır.

Anahtar Kelimeler:

Ekokardiyografi, doppler, Koroner arteriyoskleroz, Anjiyoplasti, balon, Anjiyoplasti, transluminal, perkutan koroner, Miyokardiyal revaskülarizasyon

The effect of successful coronary angioplasty on myocardial performance index: A new Doppler index of combined systolic and dystolic functions

Myocardial performance Index (MPI) is a recently described simple, reproducible, noninvasive Doppler index for the assesment of overall cardiac function. The purpose of this study was to asses the effect of coronary angioplasty on a nongeometric Doppler-derived index of combined systolic and diastolic myocardial performance in patients without serious left ventricular systolic dysfunction. For this purpose 31 patients with clinical and angiographie coronary heart disease and with ejection fraction> %40 were included. Doppler echocardiographic evaluations were performed before and within 24 hours after the invasive procedure. MPI, defined as the sum of isovolumetric contraction time and relaxation time divided by ejection time, was obtained by Doppler measurement from the mitral inflow and left ventricular outflow velocity-time intervals. Transmitral Doppler parameters; the duration and peak velocity of early (E wave) and late (A wave) diastolic wave, early diastolic wave decceleration time, E/A peak velocity ratio and Isovolumic relaxation time obtained by using left ventricular outflow velocity time intervals were assessed before and after the procedure. In all included patients, PTCA were performed successfully. Transmitral pulsed-wave Doppler indices did not change significantly were early peak diastolic velocity, ratio of early peak velocity to late peak velocity. Only the both isovolumic relaxation and early diastolic wave deceleration times decreased after coronary angioplasty. Isovolumic relaxation time decreased from 139,7±22,2 msn to 120 ± 75,96 msn (p=0,0001). E wave deceleration time decreased from 279 ±11 msn to 248 ± 36 msn (p=0.005) Although the left ventricular ejection fraction did not changed after coronary angioplasty, MPI was improved significantly (before 0.606 ± 0.26 to after 0.47 ± 0.22; p=0.001). This study documents that a simple, easily recordable, noninvasive Doppler index of myocardial performance was improved with succesful coronary angioplasty. Whether the timing and magnitude of improvement of these indices have a relationship with restenosis remains to be investigated.

Keywords:

Echocardiography, Doppler, Coronary Arteriosclerosis, Angioplasty, Balloon, Angioplasty, Transluminal, Percutaneous Coronary, Myocardial Revascularization,

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