, Murat Tulmaç, Hatice Özdemir, Ömer Şahin, Fatih POYRAZ, Vedat ŞİMŞEK, Derya CANLI, Haksun EBİNÇ

Depresyon Hastalarında Endotel Fonksiyonları, Ekokardiyografik Parametreler ve Damar Sertliğine Antidepresan Tedavinin Etkisi

Giderek artan bilgiler depresyonun bağımsız bir kardiyovasküler hastalık (KVH) risk faktörü olduğunu ortaya koymaktadır. Bu çalışmamızda seratonin geri alım inhibitörleri (SSRI) ile tedavinin kalbin sistolik ve diyastolik fonksiyonları ve kardiyovasküler hastalık gelişimi için bağımsız öngördürücüler olan aortik sertlik ve endotel fonksiyon parametreleri üzerine etkisini araştırdık. Çalışmaya 16-65 yaş arası bilinen KVH öyküsü olmayan ve major depresyon nedeni ile ilk defa SSRI tedavisi başlanan 41 hasta dâhil edildi. Tedavi başlangıcında ve 8 haftalık tedavi sonunda hastaların ekokardiyografik olarak sistolik ve diyastolik fonksiyon parametreleri, miyokard performans indeksi (MPI) ve aortikgerilim (Ao strain) değerlendirildi. Otomatik analizör ile parmaktan pletismografik yöntemle yapılan nabız dalga analizi ile belirlenen nabız ilerleme zamanı (PPT), sertlik indeksi (SI) ve Refleksiyon indeksi (RI) hesaplandı. Endotel fonksiyonları akıma bağlı dilatasyon yöntemi ile değerlendirildi. Sekiz haftalık tedavi sonunda 19 hasta kontrole geldi (%46,3) ve nihai değerlendirmeye bu hastaların sonuçları dâhil edildi. Analiz yapılan hastaların tedavi öncesine göre tedavi sonunda sol ventrikül ejeksiyon fraksiyonunun (%64,83±4,54 vs %66,80±3,3, p=0,020) ve fraksiyonel kısalmasının arttığı (%35,39±3,53 vs %37,11±2,49, p=0,013), MPI değerinin düştüğü gözlendi (0,60±0,21 vs 0,45±0,15, p=0,004). Bunun dışında diyastolik fonksiyon parametreleri,aortik strain, endotel fonksiyon ve aortik sertlik parametreleri açısından tedavi sonrasında anlamlı farklılık izlenmedi. Çalışmamız yeni tanı konmuş depresyonlu hastaların SSRI inhibitörü ile kısa dönem tedavilerinin sol ventrikül sistolik fonksiyonlarını olumlu yönde etkileyebileceğini, diyastolik fonksiyonlarda, endotel fonksiyonlarında ve büyük arter sertliğinde ise değişiklik yapmadığını gösterdi.

Anahtar Kelimeler:

Depresyon, endotel fonksiyonları, damar sertliği, ekokardiyografi

Pages 15-22

Increasing evidence reveals that depression is emerging as an independent cardiovascular disease (CVD) risk factor. We investigated whether treating depression with seratonin reuptake inhibitors (SSRI) would effect echocardiographic systolic and diastolic functions, in addition endothelial function and arterial stiffnes indexes which are known CVD risk factors Fourtyone patients who were prescribed SSRI therapy for the first time due to major depression without known CVD and between 16-65 years of age were included. At the beginning of the study and after 8 weeks of SSRI therapy patients were underwent echocardiographic analysis of systolic and diastolic parameters, myocardial performance index (MPI) and aortic strain (Ao strain). Also by finger plethysmography with the aid of an auto-analyser pulse wave analysis were done and pulse propagation time (PPT), stiffness index (SI) and reflection index (RI) were measured. Endothelial functions were estimated with flow mediated dilatation method. Nineteen patients (46.3%) came to control visit after 8 weeks of therapy and the final analysis was done with their results. Compared to beginning, 8 weeks of therapy with SSRI resulted in an increase in systolic ejection fraction (%64,83±4,54 vs %66,80±3,3, p=0,020) and fractional shortening (%35,39±3,53 vs %37,11±2,49, p=0,013) and decrease in MPI (0,60±0,21 vs 0,45±0,15, p=0,004). The other parameters including left ventricular diastolic functions, aortic strain, endothelial function and aortic stiffness parameters were not significantly effected. Our results imply that short term therapy with SSRI in patients with newly diagnosed depression might favorably effect the left ventricular systolic functions whereas left ventricular diastolic functions, endothelial functions and aortic stifness parameters remain unchanged.

Keywords:

Depression, endothelial function, srterial stiffness, echocardiography,

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