Emrah KAYA, Yalın Tolga YAYLALI, Eylem TEKE, Hande ŞENOL, Gokay NAR

Kaynağı belirlenemeyen embolik inmede sol atriyal ve ventriküler longitudinal strain

Amaç: Sol atriyal ve sol ventriküler yeniden şekillenme inmeye neden olabilir. Bu çalışmanın amacı, kaynağıbelirsiz embolik inme (ESUS) hastalarında sol atriyum fonksiyonlarını ve sol ventrikül strain değerlerini analizetmektir.Gereç ve yöntem: Bu prospektif çalışma cinsiyet ve yaş açısından benzer olan 35 adet ESUS’lu hasta (61±10yaşında) ve 37 adet kontrol grubunu (60±10 yaşında) içeriyordu. Tüm hastalara beyin bilgisayarlı tomografisi (BT),konvansiyonel ve difüzyon manyetik rezonans görüntüleme (MRG), BT veya MR anjiyografi, 12 derivasyonluEKG, transtorasik ekokardiyografi ve 48 saat Holter EKG monitörizasyonu yapıldı. Sol atriyum hacimleri vefonksiyonları ekokardiyografi ile belirlendi. Sol atriyum rezervuar ve ventrikül strain değerleri speckle-trackingmetoduyla longitudinal olarak ölçüldü. CHA2DS2-VASc, Amerikan Ulusal Sağlık Enstitüsü İnme Skalası(NIHSS), Modifiye Rankin Skalası (mRS) skorları hesaplandı.Bulgular: Major kardiyovasküler risk faktörleri iki grup arasında da benzerdi. ESUS’lu hastaların ortalamaCHA2DS2-VASc skoru 2,6±1,2, NIHSS 3,9±3,0 ve mRS 1,3±0,8 saptandı. Atrial elektromekanik süreler vegecikme zamanları, sol atriyum boşalma fraksiyonu ve hacim indeksleri 2 grup arasında benzer bulundu. Solatriyal rezervuar strain, kontrol grubuna göre düşük saptandı (25,2±%7,2 vs. 29,7±%8,8, p=0.019). Sol ventrikülglobal longitudinal strain kontrol grubuna göre düşük saptandı (-14,7±%4,2 vs -16,4±%3,9, p=0.031). Solatriyum rezervuar ve sol ventrikül strain değerleri ile skorlar arasında korelasyon saptanmadı (CHA2DS2-VASc,NIHSS, mRS).Sonuç: ESUS’lu hastalar, kontrol grubuna göre daha düşük sol atriyal rezervuar ve sol ventriküler globallongitudinal straine sahipti. Sol atriyal hacim indeksleri, sol atriyum boşalma fraksiyonu ve elektromekanik süreler2 grup arasında farklılık göstermemektedir. Sol atriyal ve ventriküler yeniden şekillenmesinin ekokardiyografikölçümü, ESUS’tan ikincil koruma için büyük bir potansiyele sahiptir. Bulgularımızın doğrulanması için daha fazlaçalışmaya ihtiyaç vardır.

Anahtar Kelimeler:

Embolik inme, sol atriyal fonksiyon, sol ventriküler fonksiyon, sol atriyal strain, sol ventriküler strain

Left atrial and ventricular longitudinal strain in embolic stroke of undetermined source

Purpose: Left atrial (LA) and left ventricular (LV) remodelling may lead to stroke. The aim of this study was toanalyze LA function and LV strain in patients with embolic stroke of undetermined source (ESUS).Material and methods: This prospective study included 35 ESUS patients and 37 age and sex-matchedcontrols. All participants underwent brain computed tomography (CT), conventional and diffusion-weightedmagnetic resonance imaging (MRI), CT or MR angiography, 12 lead ECG, transthoracic echocardiography, and48 hour Holter ECG monitoring. LA volume and function were determined by echocardiography. LA reservoir andLV strains were measured longitudinally by speckle-tracking method. CHA2DS2-VASc, The National Institutesof Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) scores were calculated.Results: Major cardiovascular risk factors were similar between the two groups. The mean CHA2DS2-VAScscore was 2.6±1.2. NIHSS was 3.9±3.0 and mRS was 1.3±0.8. Atrial electromechanical coupling intervals anddelays, LA emptying fraction and volumes were similar between the two groups. LA reservoir strain was lower thancontrols (25.2±7.2% vs. 29.7±8.8%, p=0,019). LV global longitudinal strain was lower than controls (-14.7±4.2%vs -16.4±3.9%, p=0,031). There was no correlation between LA, LV strains and the scores (CHA2DS2-VASc,NIHSS, mRS).Conclusions: ESUS patients had lower LA reservoir and LV longitudinal global strains than controls. Left atrialvolume index, LA emptying fraction did not differ between the two groups. Echocardiographic quantification ofLA and LV remodelling has great potential for secondary prevention from ESUS. Further studies are needed toconfirm our findings.

Keywords:

Embolic stroke, left atrial function, left ventricular function, left atrial strain, left ventricular strain,

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