Funda COŞKUN, Esra UZASLAN, Dilber YILMAZ, Aysel KADERLİ AYDIN, Sümeyye GÜLLÜLÜ

Sarkoidozda bozulmuş miyokard performansı

Otopsi serlerinde %20-27 sıklıkta miyokardiyal sarkoid tutulum raporlanmasına rağmen olguların sadece %5inde klinik bulgular ortaya çıkmaktadır. Bu çalışma, kardiyak tutulumu bulunmayan evre I-II pulmoner sarkoidozlu olgularda, ventriküllerin sistolik ve diyastolik fonksiyonlarını global olarak gösteren Tei indeksi ile hem sağ hem de sol ventrikül fonksiyonlarını değerlendirmek amacıyla planlandı. Çalışmaya sarkoidoz nedeniyle takip edilmekte olan, kardiyak tutulumu olmayan 72 (53 kadın, 19 erkek; ortalama yaş 49.1 ± 10.3 yıl) hasta ve hastane personelinden yaşı uyumlu 19 sağlıklı gö- nüllü (14 kadın, 5 erkek; ortalama yaş 48.7 ± 6.5 yıl) dahil edildi. Olguların tümüne iki boyutlu ve Doppler ekokardiyografik değerlendirme yapıldı. Ölçülen Doppler parametrelerinden sol ve sağ ventrikül Tei indeksleri (miyokard performans indeksi) hesaplandı. Sarkoidozlu olgularda mitral A dalgasının zirve hızı (A) daha yüksek, mitral E dalgasının zirve hızı (E), E/A oranı daha düşük ve ejeksiyon zamanı daha kısa idi (p< 0.05). Triküspit A dalgasının zirve hızı daha yüksek, deselerasyon zamanı daha uzun ve E/A oranı daha düşüktü (p< 0.05). Sol ventrikül Tei indeks sarkoidozlu olgularda daha yüksek saptanırken (p= 0.021), sağ ventrikül Tei indeks sağlıklı gönüllülerle benzer olarak bulundu (p> 0.05). Erken evre kardiyak tutulum olmayan sarkoidozlu olgularda sol ventrikülde miyokard performansı bozulmuştur. Bu durum subklinik bir sarkoid tutulumla ilişkili olabilir

Impaired myocardial performance in sarcoidosis

Despite myocardial sarcoid involvement has been reported in 20 27% in autopsy series, only 5% of the patients are clinically symptomatic. This study was planned to evaluate right and left ventricular functions in patients with early stage sarcoidosis (stage I and II) without any findings of cardiac involvement with Tei index which globally shows systolic and diastolic functions of the ventricles was used. Seventy-two patients under follow-up for sarcoidosis without cardiac involvement (53 women, 19 men; mean age 49.1 ± 10.3 years) and nineteen age-matched healthy control subjects (14 women, 5 men; mean age 48.7 ± 6.5 years) were enrolled in the study. All subjects were evaluated with two-dimensional and Doppler echocardiography. Right and left ventricle Tei indices (myocardial performance index) were calculated from measured Doppler parameters. Peak velocity of the mitral A wave (A) was higher, peak velocity of the mitral E wave, E/A ratio were lower; and ejection time was shorter in patients with sarcoidosis (p< 0.05) compare to controls. Peak velocity of the tricuspid A wave was higher, E wave deceleration time was longer and E/A ratio was lower (p< 0.05) in sarcoidosis group. While left ventricular Tei index was higher in patients with sarcoidosis (p= 0.021), right ventricular Tei index was similar to healthy controls (p>0.05). Left ventricular myocardial performance is disturbed in patients with early stage sarcoidosis. This can be related to a subclinical involvement of sarcoidosis.

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