Zübeyde BAYRAM, Süleyman Çağan EFE, Ali KARAGÖZ, Cem DOĞAN, Büşra GÜVENDİ, Samet UYSAL, Rezzan Deniz ACAR, Özgür Yaşar AKBAL, Fatih YILMAZ, Hacer Ceren TOKGÖZ, Mehmet Kaan KIRALİ, Cihangir KAYMAZ, Nihal ÖZDEMİR

Son Dönem Kalp Yetmezliğinde İskemik ve İskemik Olmayan Kardiyomiyopatinin Klinik Özellikleri, Hemodinamik Bulguları ve Klinik Sonlanımları Arasındaki Farklılıklar

Giriş: Bu çalışmanın amacı, son dönem kalp yetersizliği (KY) hastalarında KY etiyolojisinin klinik, ekokardiyografik, hemodinamik bulgular, sağ ventrikül (SV) fonksiyonu ve klinik sonlanım üzerindeki etkilerini araştırmaktır. Hastalar ve Yöntem: Kalp nakli için değerlendirilen toplam 470 son dönem KY hastası iskemik kardiyomiyopati (İKMP, n= 249) ve iskemik olmayan kardiyomiyopati (NİKMP, n= 221) olmak üzere iki gruba ayrıldı. SV disfonksiyonu, triküspit anüler plan sistolik ekskürsiyonun (TAPSE) ≤ 1.5 cm olması (TAPSE-tanımlı SV disfonksiyonu) ve SV strok work indeksinin (RVSWI) < 5 g/m/beat/m2 olması (RVSWItanımlı SV disfonksiyonu) olarak tanımlandı. Sol ventriküler destek cihazı (LVAD) implantasyonu, acil kalp nakli veya ölüm primer sonlanım olarak tanımlandı. Bulgular: İKMP’li hastalar, NİKMP’li hastalara göre daha yüksek pulmoner vasküler direnç, sistolik ve ortalama pulmoner arter basınçlarına sahipti [3.0 (1.1-6.0) vs. 2.0 (1.0-5.0), p= 0.013; 53.5 (42.0-68.0) vs. 46.0 (32.5-64.5), p< 0.001 ve 35.512.9 vs. 31.812.3, p= 0.002]. RVSWI seviyeleri NİKMP hastalarında İKMP hastalarına göre daha düşüktü [5.4 (3.7-7.6) vs. 6.5 (4.6-9.6), p< 0.001]. TAPSE tanımlı SV disfonksiyonu NİKMP ve İKMP arasında benzer iken, RVSWI tanımlı SV disfonksiyonu NİKMP’de daha yüksekti (%44.3 vs. %55.0, p= 0.069 ve %45.2 vs. %31.3, p= 0.012). Çok değişkenli analizlere göre, NİKMP, RVSWI-tanımlı SV disfonksiyonu için bağımsız bir prediktörü iken TAPSE-tanımlı SV disfonksiyonu için değildi (OR: 1.79, %95 CI: 1.13-2.82, p= 0.012 ve OR: 0.63, %95 CI: 0.28-1.39, p= 0.254). 503.5 günlük medyan takip süresinde, ayarlanmamış ve düzeltilmiş modellere göre KY etiyolojisinin primer sonlanım için bir prediktör olmadığı gösterildi (OR: 0.99, %95 CI: 0.80-1.23, p= 0.936 ve OR: 0.89, %95 CI: 0.60-1.31, p= 0.542). Sonuç: Bu çalışmada, son evre KY olan hastalarda, İKMP’nin NİKMP’den daha yüksek SV artyüke ve RVSWI değerine sahip olduğu ve KY etiyolojisinin primer sonlanım prediktörü olmadığı gösterilmiştir. Ancak TAPSE-tanımlı SV disfonksiyonu ve RVSWI-tanımlı SV disfonksiyonundaki çelişkili sonuçlar nedeniyle KY etiyolojisinin SV fonksiyonu üzerinde bir etkisinin olup olmadığı kesin olarak söylenememiştir.

Differences in Clinical Features, Hemodynamic Findings and Clinical Outcomes of Ischemic and Non-ischemic Cardiomyopathy in End-Stage Heart Failure

Introduction: The aim of this study was to investigate the effect of heart failure (HF) etiology on clinical, echocardiographic, and hemodynamic findings, right ventricular (RV) function, and outcomes in patients with end-stage HF. Patients and Methods: A total of 470 end-stage HF patients who undergoing evaluation for heart transplantation (HT) were divided into two groups: ischemic cardiomyopathy (ICMP, n= 249) and nonischemic cardiomyopathy (NICMP, n= 221). RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) ≤ 1.5 cm (TAPSE-defined RV dysfunction) and right ventricular stroke work index (RVSWI) < 5 g/m/beat/m2 (RVSWI-defined RV dysfunction). The primary outcome was defined as left ventricular assist device implantation, urgent HT, or death. Results: Patients with ICMP had higher pulmonary vascular resistance, systolic and mean pulmonary artery pressures (PAPs and PAPm) than those with NICMP [3.0 (1.1-6.0) vs. 2.0 (1.0-5.0), p= 0.013; 53.5 (42.0-68.0) vs. 46.0 (32.5-64.5), p< 0.001 and 35.512.9 vs. 31.812.3, p= 0.002]. RVSWI levels were lower in NICMP patients than in ICMP patients [5.4 (3.7-7.6) vs. 6.5 (4.6-9.6), p< 0.001]. While TAPSE-defined RV dysfunction was comparable between NICMP and ICMP, RVSWI-defined RV dysfunction was higher in NICMP (44.3% vs. 55.0%, p= 0.069 and 45.2% vs. 31.3%, p= 0.012). NICMP was an independent predictor for RVSWI-defined RV dysfunction, but not for TAPSE-defined RV dysfunction, according to multivariate analyses (OR: 1.79, 95% CI: 1.13-2.82, p= 0.012 and OR: 0.63, 95% CI: 0.28-1.39, p= 0.254). Over a median follow-up of 503.5 days, it was demonstrated that HF etiology was not a predictor of primary outcome according to unadjusted and adjusted models (OR: 0.99, 95% CI: 0.80-1.23, p= 0.936 and OR: 0.89, 95% CI: 0.60-1.31, p= 0.542). Conclusion: We that demonstrated patients with end-stage HF, ICMP had greater RV afterload and RVSWI value than NICMP and HF etiology was not predictor of primary outcome. However, we couldn’t say for sure whether HF etiology has an effect on RV function because of the conflicting results in TAPSE-defined RV dysfunction and RVSWI-defined RV dysfunction.

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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