TANER ULUS, Sayyed Hamed MOGHANCHIZADEH, Muhammed DURAL, KADİR UĞUR MERT, FEZAN MUTLU, Muzaffer BİLGİN

Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği Hastalarında Spironolaktonun Atriyal İleti Üzerine Etkisi

Atriyal fibrilasyon (AF) kronik kalp yetersizliği (KY) hastalarında sık görülen bir ritim bozukluğu olup, kötü prognoz ile ilişkilidir. Mineralokortikoid reseptör antagonistlerinin KY olan hastalarda AF gelişme riskini azaltabileceği yönünde bazı bulgular olmasına rağmen, bu konudaki kanıtlar yetersizdir. Elektrokardiyografide (EKG) atriyal ileti zamanının ölçümü AF gelişme riskini değerlendirmede sık kullanılan bir yöntemdir. Bu çalışma düşük ejeksiyon fraksiyonlu (EF) KY hastalarında spironolaktonun EKG’de ölçülen atriyal ileti üzerine olan etkisini değerlendirmeyi amaçlamaktadır. Çalışmaya kompanse, sinüs ritminde, düşük EF’li KY olan 23 hasta alındı ve altı ay boyunca takip edildi (spironolakton grubu: 12 hasta, kontrol grubu: 11 hasta). Hastaların temel klinik ve laboratuar özellikleri saptandı. Başlangıç ve altı aylık takip sonunda EKG ve ekokardiyografik özellikler hem grup içi, hem de gruplar arasında karşılaştırıldı. Spironolakton grubunda altı aylık takip sonunda P maksimum ve P dispersiyon değerlerinde başlangıca göre anlamlı azalmalar bulundu (sırasıyla p=0.001 ve <0.001). Kontrol grubunda ise bu ölçümler başlangıçta ve altı aylık takip süresi sonunda benzerdi. İki yönlü tekrarlı ölçüm sonuçlarına göre spironolakton grubunda altı aylık takip süresi sonunda P maksimum ve P dispersiyonu değerleri kontrol grubu ile karşılaştırıldığında anlamlı azalmalar gösterdi (sırasıyla p=0.011 ve 0.002). Sinüs ritmindeki kompanse düşük EF’li KY hastalarında spironolakton AF için artmış riski gösteren atriyal ileti zamanında önemli iyileşmeler sağlar.

Anahtar Kelimeler:

Kalp yetersizliği, spironolakton, atriyal ileti

The Effect of Spironolactone on Atrial Conduction in Patients with Heart Failure with Reduced Ejection Fraction

Atrial fibrillation (AF) is a common arrhythmia in patients with chronic heart failure (HF), and it is associated with worse prognosis. Although there is some evidence that mineralocorticoid receptor antagonists may reduce the risk of developing AF in such patients, the evidence in this regard is insufficient. Measurement of atrial conduction time on electrocardiography (ECG) is a commonly used method to evaluate the risk of developing AF. This study aims to evaluate the effect of spironolactone on atrial conduction in ECG in patients with HF with reduced ejection fraction (EF). Twenty-three patients with compensated HF with reduced EF and sinus rhythm were included and they were monitored for six months (spironolactone group: 12 patients, control group: 11 patients). The basic clinical and laboratory characteristics of the patients were detected. At baseline and at the end of six-month follow-up, ECG and echocardiographic characteristics were compared within and between the groups. After six-month follow-up in the spironolactone group, P maximum and P dispersion values decreased significantly compared to baseline (p=0.001 and <0.001, respectively). In the control group, these measurements were similar at baseline and at the end of the six-month follow-up period. According to the two-way repeated measurement results, P max and P dispersion values decreased significantly compared to the control group at the end of the six-month follow-up period in the spironolactone group (p=0.011 and 0.002, respectively). In patients with compensated HF with reduced EF and sinus rhythm, spironolactone provides significant improvements in atrial conduction time, which presents an increased risk for AF.

Keywords:

Heart failure, spironolactone, atrial conduction,

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