Korunmuş ejeksiyon fraksiyonlu kalp yetmezliği hastalarında sol atriyum mekaniğinin kardiyovasküler sonuçlar üzerine etkisi: Tek merkezli çalışma

Amaç Sol atrium mekaniği, temelde iletim zamanı, kalp yetmezliği patofizyolojisinde özellikle de korunmuş ejeksiyon fraksiyonlu kalp yetmezliğinde (KEFKY), diyastolik fonksiyonların bozulmasına bağlı olarak değişmiştir, fakat hastalığın sonlanım noktası üzerine etkisi bilinmemektedir. Bundan dolayı, KEFKY hastalarında, doku Doppler görüntüleme ile elde edilen sol atrial iletim zamanı (SEMG) ile kalp yetmezliğine bağlı hastane yatışları arasındaki ilişkiyi araştırdık.Yöntem: Retrospektif olarak 112 ardışık KEFKY hastası (48 erkek, ortalama yaş 59.9±5) çalışmaya dahil edildi. KEFKY’li hastalar, kalp yetmezliği semptomu olan, diyastolik disfonksiyonu izlenen ve EF ≥50% olanlar olarak tanımlandı. Sonlanma noktası olarak kalp yetmezliğine bağlı hastane yatışı belirlendi, ve bu bilgi 12 ay boyunca retrospektif olarak izlenen hastalardan elde edildi. Hasta popülasyonu SRMG değerleri baz alınarak istatiksel olarak 3 tertil gruba ayrıldı. 1. Tertil <22 ms, 2. Tertil 22-42 ms, ve 3. Tertil >42 ms olarak tanımlandı.Bulgular: Grupların demografik özellikleri arasında büyük oranda anlamlı farklılık saptanmadı, sol ventrikül boyutları ve EF gruplar arasında benzerdi (p>0.05). Hastalar 12 ay izlendi, toplam 41 olay kaydedildi. SEMG, olay gerçekleşen bireylerde diğer bireylere göre daha uzundu. Bunun yanında DDG ile kaydedilen diyastolik disfonksiyon parametreleri SEMG ile pozitif korelasyon içindeydi (r=0.627, p<0.001). Bunlara ek olarak, Kaplan-Meier eğrisinde SEMG’i en uzun olan 3. Tertil grubun, kalp yetmezliği bağlı hastane yatışları ile yüksek derecede ilişkili olduğu gözlendi (P log rank < 0,001), ve bağımsız risk faktörü olarak gözlendi (Tertil 3 ile 1 arası tehlike oranı (TO): 18.7, 95% güven aralığı (GA) 2.6-61, p<0.001; Tertil 3 ile 2 arası TO:6.17, 95% GA 1.78-21.2, p<0.001).Sonuç KEFKY olan hastalarda, SAiz kalp yetmzliğine bağlı yatışları öngörebilmede kolay ulaşılabilir non-invaziv bir yöntem olabilir.

Anahtar Kelimeler:

Ekokardiyografi, Doku Doppler, atriyal ileti zamanı, Korunmuş ejeksiyon fraksiyonlu kalp yetmezliği

The impact of left atrial mechanics on cardiovascular outcome in HFpEF patients: A single center study

Objective Left atrial (LA) mechanics, particularly conduction time is mostly altered in heart failure (HF), especially in preserved ejection fraction type (HFpEF) due to deterioration in diastolic features (DF), but the impact on outcomes remains unknown. Therefore, we sought to investigate the association of LA conduction by coupling obtained from tissue Doppler imaging (TDI) and HF-related hospitalization in patients with HFpEF.Method: We retrospectively included 112 consecutive patients (48 men; mean age 59±5 years) with HFpEF. HFpEF was defined as the presence of at least one symptom, diastolic dysfunction with TDI and EF>50% by transthoracic echocardiography. The primary outcome was HF-related hospitalization, and hospitalization data from over 12-month period were retrospectively obtained on all HFpEF patients. The cohort was stratified based on the tertiles of their LA –electromechanical delay (EMD) duration: Tertile 1 (<22 ms); Tertile 2 (22 – 42 ms); Tertile 3 (>42 ms).Results: Demographic features were mostly similar between all tertile groups, and there were no significant differences in left ventricular (LV) diameters and EF (p>0.05). The patients were followed for 12-month, and a total of 41 events occurred as a primary outcome. LA-EMD duration was significantly longer in patients with cardiac events than in those without. Also, DF parameters were significantly correlated with LA-EMD (r=0.627, p<0.001). Additionally, Kaplan-Meier analysis showed that the highest tertile of LA-EMD duration was associated with hospital admission (P log rank < 0.001), and it was found to be an independent risk factor for HF-related hospitalization HR for tertile 3 vs. 1: 18.7, 95% CI: 2.46-61.1, p<0.001; HR for tertile 3 vs. 2: 6.17, 95% CI: 1.78-21.2, p<0.001).Conclusion Among HFpEF patients, the LA-EMD may be a feasible non-invasive parameter for predicting HF-related hospitalization.

Keywords:

Echocardiography, Tissue Doppler, Atrial conduction time, Heart failure with preserved ejection fraction,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez