İbrahim RENCÜZOĞULLARI, Mehmet Necdet AKKUŞ

Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi

Amaç: Kalp yetmezliği (KY), fonksiyonel kapasite ve hayat kalitesinin azalması, morbidite ve mortalitenin artışı ile karakterize progresif, kronik bir sendromdur. Korunmuş ejeksiyon fraksiyonlu (EF) kalp yetmezliği, KY olgularının yaklaşık yarısını temsil eder. Diyabetes mellitus (DM), KY ile yakından ilişkilidir ve DM hastalarında KY, iki-sekiz kat daha sıktır. Prediyabet, diyabetten önceki aşama olup, bozulmuş glukoz toleransı (BGT), bozulmuş açlık glukozu (BAG) veya her ikisinin varlığı olarak tanımlanmıştır. DM’nin, korunmuş EF’li kalp yetmezliği ve diyastolik disfonksiyonla ilişkisi ortaya konmuşsa da, prediyabetik evrenin diyastolik disfonksiyonla ilişkisi net değildir. Bu çalışma prediyabet ile diyastolik disfonksiyon arasındaki ilişkiyi ortaya koymayı amaçlamaktadır. Materyal ve Metot: Bu çalışma tek merkezli, prospektif, kesitsel bir çalışmadır. Çalışmaya, başvuru sırasında 75 gr glukoz ile yapılan oral glukoz tolerans testi (OGTT) ile normal, yeni diyabet veya prediyabet tanısı konulan 110 hasta alındı. Hastaların sistolik, diyastolik ve diğer kardiyak parametleri konvansiyonel ekokardiyografi ve doku Doppler ekokardiyografi ile değerlendirildi. Kontrol, prediyabet ve diyabet grupları, mitral kapak akım hızları ve doku Doppler bulguları ile diyastolik fonksiyonlar açısından karşılaştırıldı. Bulgular: Prediyabetiklerde, Mitral E/A oranı (kontrol: 1,10±0,26; prediyabet: 0,90±0,16; diyabet: 0,93±0,24; p=0,001), ortalama doku Doppler Em/Am oranı (kontrol: 1,13±0,33; prediyabet: 0,94±0,33; diyabet: 0,92±0,26; p=0,001), diyabetiklerde olduğu gibi azalmış olarak izlendi. Ayrı-ca deselerasyon zamanı, izovolumik relaksasyon zamanı, ve miyokardiyal performans indeksi prediyabetiklerde de diyabetiklerde olduğu gibi yüksek izlendi. Ayrıca bu çalışmada açlık kan şekeri ve OGTT ikinci saat kan şekeri ile mitral akım E/A oranı ve Doppler global Em/Am oranı arasında korelasyon saptandı. Sonuç: Diyastolik disfonksiyon indekslerini ve MPI’yı diyabetik hastalarla ve kontrol grubu ile karşılaştı-ran bu çalışmada, prediyabetik hastalarda, diyastolik disfonksiyon olduğu tespit edildi. Bu çalış-ma, diyabet komplikasyonlarının bu glukoz seviyelerinde dahi başladığını ve diyastolik disfonksi-yonun kan şeker seviyeleri korele olduğunu ortaya koymuştur.

Anahtar Kelimeler:

prediyabet, diyastolik disfonksiyon; miyokardiyal performans indeksi

Assessment of Left Ventricular Diastolic Functions and Myocardial Performance Index in Patients with Prediabetes

Aim: Heart failure (HF) is a progressive chronic syndrome characterized by a decreased in functional capacity and quality of life, and an increased in morbidity and mortality. Prediabetes is the first phase of DM and defined as presence of impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both. Although the association between DM and diastolic dysfunction has been established previously, the association between newly diagnosed prediabetes and diastolic functions is unclear. This study aims to reveal the relationship between prediabetes and diastolic dys-function. Material and Method: The present study is a single-center, prospective, cross-sectional study. 110 patients who were performed oral glucose tolerance test (OGTT) and newly diagnosed of prediabetes, diabetes or normal glucose metabolism (control) were included in the study. Systolic, diastolic and other cardiac parameters of patients were assessed by conventional echocardiography and tissue Doppler imaging. Control, prediabetes and diabetes groups were compared via mitral valve flow velocities and tissue Doppler findings, in terms of diastolic functions. Results: Mean mitral valve E/A (control: 1.10±0.26; prediabetes: 0.90±0.16; and diabetes: 0.93±0.24; p=0.001) and global tissue Doppler Em/Am ratios (control: 1.13±0.33; prediabet: 0.94±0.33; dia-betes: 0.92±0.26; p=0.001) were found to be decreased in prediabetic group, as similar to diabetic patients. Additionally deceleration times, isovolumic relaxation times and myocardial perfor-mance index were found to be significantly increased in prediabetic and diabetic groups when compared to control group. In addition a correlation between fasting blood glucose and OGTT 2nd hr blood glucose and mitral flow E/A and Doppler global Em/Am ratios was observed. Conclusion: In this study comparing diastolic dysfunction indices and MPI with diabetic patients and control group, it was determined that diastolic dysfunction was present in prediabetic patients. This study found that diabetic complications even started at these glucose levels and that diastolic dysfunction correlated with blood glucose levels.

Keywords:

prediabetes, diastolic dysfunction; myocardial performance index,

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