Melih BÜYÜKŞİRİN, Filiz GÜLDAVAL, Nigar DİRİCAN, Eylem YILDIRIM, Hüseyin HALİLÇOLAR

İLERİ EVRE KOAH HASTALARINDA SOL VENTRİKÜL FONKSİYONLARININ EKOKARDİYOGRAFİ BULGULARI İLE DEĞERLENDİRİLMESİ

KOAH hastalarında pulmoner hipertansiyon (PH) ve sağ kalp fonksiyonları sıkça değerlendirilmiş ancak sol ventrikül fonksiyonları üzerine çalışmalar daha az sayıdadır. KOAH ve solunum yetmezliği ile başvuran hastaların sol kalp fonksiyonları ekokardiyografi (EKO) ile değerlendirildi. KOAH ve solunum yetmezliği tanısı ile hastanede takip edilen 38 hasta çalışmaya dahil edildi. Hastaların 34'ü erkek, 4'ü kadın, yaş ortalaması 65 ± 9.9 yıl idi. Oguların hepsinde sigara içme öyküsü vardı. Hastalar klinik olarak stabil duruma gelince (yatışın ortalama olarak 5-7. günler) SFT, kan gazları ve 2 Boyutlu M-Mod EKO ile değerlendirildi. Hastaların dağılımı Kolmogorov Simirnov testi ile incelendi. Otuzsekiz hastanun 24'ünde (%63.15) Pulmoner hipertansiyon mevcuttu. 32 hastada (%84.2) sol ventrikül diyastolik disfonksiyonu, 11 hastada (%29) sol ventrikül konsantrik hipertrofi saptandı. KOAH ve solunum yetmezliğinde sol ventrikül diyastolik disfonksiyonu sık görülmektedir. Ek olarak kalp kapak hastalıklarının da bulunması takip ve tedaviyi etkilediğinden hastalar EKO ile değerlendirilmelidir.

Anahtar Kelimeler:

Kronik obstrüktif akciğer hastalığı, sol ventrikül, ekokardiyografi

EVALUATION OF ECHOCARDIOGRAPHY FINDINGS OF LEFT VENTRICLE FUNCTIONS IN ADVANCED COPD CASES

In COPD cases, pulmonary hypertension (PH) and right heart functions have been frequently studied however, studies on the left ventricle functions have not been studied as extensively. 38 cases, who were followed at hospital with COPD and respiratory failure were included in this study. Of these cases, 34 were male and 4 were female, average age was 65±9.9 years. All cases were smokers. When the cases were clinically stabilized (average hospitalization 5-7 days), they were examined with pulmonary function test, blood gasses and 2 dimensional M-mod echocardiography. The outcomes were analyzed with a Kolmogorov Simirnov test. Of the 38 cases, 24 (63.1%) had pulmonary hypertension. 32 (84.2%) cases had left ventricle diastolic dysfunction and 11 (29%) cases had left ventricle concentrated hypertrophy. Left ventricle diastolic dysfunction is commonly seen in COPD and respiratory failure. Furthermore, as most of these cases also have heart valve diseases and these problems affect the diagnosis and treatment, all cases must be analyzed along with echocardiography.

Keywords:

Chronic obstructive lung disease, left ventricle, echocardiography,

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1. Fabbri LM, Luppi F, Beghe B and Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J 2008; 31: 204-12.
2. Rutten FH, Cramer MJM, Lammers JWJ. Heart failure and chronic obstructive pulmonary disease: An ignored combination? Eur J Heart F 2006; 8: 706-11.
3. Kaplan A and Mayo PH. Echocardiography perform by the pulmonary/critical care medicine physician. Chest 2009; 135: 529-35.
4. Weitzenblum E. Chronic cor pulmonale. Heart 2003; 89: 225-30.
5. Naeije R. Pulmonary hypertension and right heart failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2005; 2: 20-22.
6. Pauwels RA, Buist AS, Ma P. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD); executive summary. Respir Care 2001; 46: 798-825.
7. Remme WJ, Swedberg K. Guidelines fort he diagnosis and treatment of chronic heart failure. Eur Heart J 2001; 22: 1527-60.
8. Rutten FH, Cramer Maarten-Jan M, Grobbee DE. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 2005; 26: 1887-94.
9. Karabulut A, ‹ltümür K, Durak D, Toprak N. Sa¤ ventrikül diastolik fonksiyonlar›n›n kronik obstrüktif akci¤er hastal›¤›n›n evrelerine göre de¤erlendirilmesi. Dicle T›p Dergisi 2005; 32: 143-8.
10. Render ML, Weinstein AS, Blaustein AS. Left ventricular dysfunction in deteriorating patients with chronic obstructive pulmonary disease. Chest 1995; 107: 162-8.
11. Vizza CD, Lynch JP, Ochoa LL. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 1998; 113: 576-83.
12. Aç›kel M, Y›lmaz M, Gürlertop Y. Kronik kor pulmonalede sol ventrikül diyastolik fonksiyonunun doppler ekokardiyografi ve doku doppler görüntüleme yöntemi ile de¤erlendirilmesi. Türk Kardiyol Dern Arfl 2003; 31: 384-91.
13. Funk GC, Lang I, Schenk P. Left ventricular diastolic dysfunction in patients with COPD in the presence and abscence of elevated pulmonary arterial pressure. Chest 2008; 133: 1354-59.
14. Butler J. The heart is not always in good hands. Chest 1990; 97: 453-60.
15. Barr RG, Bluemke DA, Ahmed FS. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 2010; 362: 217-27.