Erdem TÜRKYILMAZ, Taylan AKGÜN, Mehmet Mustafa CAN, İbrahim Halil TANBOĞA, Can Yücel KARABAY, Cihangir KAYMAZ

Kalıcı Kalp Pili Olan Hastalarda Sağ Ventrikül Apeksinden Yapılan Uyarının Farklı Kalp Hızlarında Doku Doppler Görüntüleme ile Elde Edilen Asenkroni Parametrelerine Etkisi

Giriş: Sağ ventrikül apeksinden yapılan ilerleme hızının sol ventrikül fonksiyonları üzerine olan olumsuz etkisi çeşitli çalışmalarda gösterilmiştir. Bu çalışmada, en düşük ve en yüksek kalp hızlarında sistolik ve diyastolik asenkroni parametrelerinde meydana gelen dinamik değişikliklerin değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntem: Çalışmaya, 23 kalıcı kalp pili hastası dahil edildi. Doku Doppler ve iki boyutlu görüntüleme ile artan kalp hızlarında asenkroni parametrelerinde ve volümetrik parametrelerde meydana gelen dinamik değişiklikler değerlendirildi. Bulgular: Bazal kalp hızlarında sistolik asenkroni sıklığı TsSd ve SLD ile sırasıyla %61 ve %56 idi. TeSD ile diyastolik asenkroni sıklığı %44 bulunmuştur. EF ile asenkroni parametreleri arasında ilişki bulunmamıştır. Kalp pili yaşı ile sistolik asenkroni arasında korelasyon tespit edilmiştir. TsSD ve SLD ölçümleri tüm çalışma grubunda bazal ve kalp hızlarında benzer bulunmuştur ancak değişimlerde hem yön hem de miktar bakımından belirgin farklılıklar mevcuttur. TsSD ve SLD ölçümleri arasında bazal ve pik kalp hızlarında sırasıyla 0.99 ve 0.83 oranında korelasyon tespit edilmiştir. Sonuç: Çalışmamızda kalp pili hastalarında EF’den bağımsız olarak sistolik asenkroni ve diyastolik asenkroni oldukça sık görülmüştür. Farklı kalp hızlarında asenkroni parametrelerinde meydana gelen dinamik değişiklikler bireysel farklılıklar göstermektedir. Kalıcı kalp pili hastalarının rutin değerlendirmesi EF yanında asenkroni parametrelerini mutlaka içermelidir. SLD asenkroni değerlendirilmesinde göreceli olarak kolay ve doğru bir yöntemdir. Semptomatik ve istirahat halinde normal veya normale yakın ekokardiyografik bulguları olan hastalarda asenkroni parametrelerinin değerlendirilmesi sistolik disfonksiyon meydana gelmeden ilerleme hızı modalitesinin değiştirilmesi konusunda yardımcı olabilir.

The Effect of Right Ventricular Apical Pacing on Asynchrony Parameters in Different Heart Rates Detected By Tissue Doppler Imaging in Patients with Permanent Pacemaker

Introduction: The detrimental effects of right ventricular apical pacing on left ventricular function has been demonstrated by several studies. In this study we aimed to evaluate the dynamic alterations in systolic and diastolic asynchrony parameters in the slowest and fastest paced rhythm. Patients and Methods: We included 23 permanent pacemaker patients to this study. We assessed dynamic changes in asynchrony and volumetric parameters with increasing heart rates by tissue Doppler and two dimensional imaging. Results: In basal heart rates systolic asynchrony frequency was 61% and 56% by TsSD and SLD respectively. Frequency of diastolic asynchrony was 44% by TeSD. EF was not associated with asynchrony parameters. There was positive correlation between pacemaker age and systolic asynchrony. Both TsSD and SLD values were similar at basal and peak heart rates in overall study population but there was remarkable individual variability in alterations both in directions and quantities. Correlation between TsSD and SLD was 0.99 and 0.83 at basal and peak heart rate, respectively. Conclusion: In our study systolic asynchrony and diastolic asynchrony was found to be very frequent independent from EF in pacemaker population. Dynamic changes with different heart rates in asynchrony parameters revealed individual variability. Routine evaluation of pacemaker population must consist asynchrony parameters beside EF. SLD measurement is a relatively easy and accurate method for asynchrony evaluation. Evaluation of asynchrony parameters in different heart rates in symptomatic patients with normal or near normal resting echocardiographic findings can help early modification of pacing modality before systolic dysfunction development.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi