Mehmet HURŞİTOĞLU, Tülin KURT, Bülent CANBAZ, Neslihan KURTULMUŞ, Mehmet Ali ÇIKRIKÇIOĞLI, Tufan TÜKEK

İleri konjestif kalp yetersizlikli hastalarda karvedilolün sol ventrikül fonksiyonları ve aritmi üzerine etkisi

Amaç: İleri evre kalp yetersizliği(KY) olan hastalarda sempatik sistemde artışa bağlı aritmi ve ani ölüm sıkdır. Beta bloker ve alfa-bloker özelliği olan karvedilol, KY tedavisinde beklentilere neden olmuştur. Çalışmamızın amacı ileri evre KY olan hastalarda tedaviye eklenen karvedilolün sol ventrikül fonksiyonları ve aritmi gelişimine etkisini araştırmaktır. Gereç ve yöntem: Çalışmaya sinüs ritminde ileri evre KY olan, beta bloker kullanmayan 31 hasta (ortalama yaş: 60 ± 10 yıl, K /E:11/20) alındı. Hastalara ekokardiyografi, 24 saatlik ritm Holteri ve kalp hızı değişkenlik analizi (HRV), sinyal ortalamalı EKG analizi yapıldıktan sonra, almakta oldukları (diüretik ve ACEI) tedaviye ilaveten, karvedilol 2 x 3.125 başlandı. Karvedilol dozu tolere edebildikleri üst sınıra çıkıldı, 12. ve 24. haftada tetkikler tekrarlandı.Bulgular: 12.ve 24. haftanın sonunda sol ventrikül sistolik fonksiyonlarında belirgin düzelme saptandı (sırasıyla; EF %30, 1 ± 6, 3 vs 33, 8 ± 6, 8, p:0, 005, Tei index: 0, 50 ± 0, 21 vs 0, 40 ± 0, 15, p:0, 006 ve EF % 30, 1 ± 6, 3 vs 33, 7 ± 6, 6, p:0, 01, Tei index: 0, 50 ± 0, 21 vs 0, 41 ± 0, 19, p:0, 03). Holterde 8 hastada saptanan VT dahil kompleks aritmi, 12. haftada 5 hastada saptandı. Sinyal ortalamalı EKG'de 10 hastada saptanan geç potansiyel pozitifliği 12. haftada 8, 24. haftada 7 hastada gözlendi. Total QRS de anlamlı azalma olduğu saptandı(120, 6 ± 28, 8 vs 116, 3 ± 24, 3, p:0, 03). HRV parametrelerinden SDNN (12. haftada, 64, 2 ± 30, 3 vs 89, 5 ± 36, 2, p

The effects of carvedilol on left ventricular functions and arrhythmias in patients with severe cardiac failure

Objective: Arrhythmia are seen frequently in patients with heart failure (HF). Carvedilol which has both beta-blocker and alfa-blocker properties has led to new expectations in the treatment of HF. Our aim is to explore the effect of carvedilol on left ventricular (LV) function and development of arrhythmia in patients with HF. Materials and method: Thirty-one patients (60±10 years, F/M:11/20) were enrolled for the study who had advanced HF in sinus rhythm. After echocardiography, 24 hour Holter, heart rate variability analysis (HRV), signal averaged ECG, carvedilol was added to their treatment(diuretic and ACEI). Carvedilol dosage was increased to the upper tolerable limit. The same analysis were repeated in 12th and 24th week.Results: Marked improvement was found in LV function in 12 and 24th week (respectively; EF %30.1 ± 6.3 vs 33.8 ± 6.8, p:0.005, Tei index: 0.50 ± 0.21 vs 0.40 ± 0.15, p:0.006 and EF % 30.1 ± 6.3 vs 33.7 ± 6.6, p:0.01, Tei index: 0.50 ± 0.21 vs 0.41 ± 0.19, p:0.03). Before carvedilol, arrhythmias including VT were found in eight patients in holter, whereas they were observed in five patients at 12th week. While late potential positivity was found in 10 patients initially and was found in 7 patients at 24th week. Total QRS was decreased significantly (120.6 ± 28.8 vs 116.3 ± 24.3, p:0.03). Significant increases were observed in SDNN both at 12th week and 24th week (respectively 64.2±30.3, 89.5±36.2, 93.5±37, p

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