HİPERTROFİK KARDİYOMİYOPATİLİ HASTALARDA EGZERSİZ EKOKARDİYOGRAFİ VE NT-PROBNP DÜZEYLERİNİN DEĞERLENDİRİLMESİ

Year 2023, , 118 - 122, 03.01.2023

Erol Gürsoy , Onur Baydar

https://doi.org/10.18229/kocatepetip.1192797

Abstract

AMAÇ: Hipertrofik kardiyomiyopatili (HKM) hastalarda anormal sol ventrikül diyastolik fonksiyonu ve NT-proBNP seviyeleri gösterilmiştir, ancak egzersiz hemodinamiği hakkında bilgi eksikliği vardır. Bu prospektif çalışmada, HKM hastalarında diyastolik fonksiyonun prognostik değerini ve NT-proBNP düzeylerinin egzersize yanıtını incelemeyi amaçladık.
GEREÇ VE YÖNTEM: Nonobstrüktif HKM tanısı almış 20 hasta (yaş: 52,6±11,3 yıl; n=12 (%60) erkek) ve 11 gönüllüye (yaş: 46,4±13,0 yıl; n=8 (%72,7) erkek) bisiklet ergometrisi ile egzersiz (25 –W, 2 dakika) testi yapıldı. Mitral akım (E/A oranı), septal mitral akım hızları (E/E' oranı) ve NT-proBNP seviyeleri istirahatte ve submaksimal egzersizde ölçüldü. Ayrıca hastalar dört yıl boyunca takip edildi.
BULGULAR: HKM hastalarında istirahatte daha yüksek E/E' oranı ve NT-proBNP seviyeleri tespit edildi (E/E'oran: 15,36 ±4,90 vs 7,97± 1, 44; p< 0,001, NT-proBNP: 348,25±215,71 pg/ml vs 37,27±11,93 pg/ml; p<0,001). Egzersiz ile kontrollerde anlamlı bir yükselme olmadı, ancak HKM'li hastalarda E/E' oranı ve NT-proBNP seviyeleri anlamlı olarak arttı (E/E' oranı: 23,83±10,85 vs 8,01±2,22 p<0,001, NT-proBNP: 591,25±276,28 pg/ml vs 40,0± 12,03 pg/ml; p<0,001). Ayrıca dört yıllık takipte hiçbir hastada ölüm gözlenmedi.
SONUÇ: Nonobstrüktif HKM hastalarında diyastolik disfonksiyon, yüksek dolum basınçları ve NT-proBNP seviyeleri gözlendi ve bu anormalliklerin maksimum egzersiz sırasında kötüleştiği saptandı. Fakat bu bulgularımız mortaliteyi öngörmedi.

Keywords

Hipertrofik kardiyomiyopati, Stres ekokardiyografi, Beyin natriüretik peptid, Hypertrophic cardiomyopathy, Stress echocardiography, Brain natriuretic peptide

EVALUATION OF EXERCISE ECHOCARDIOGRAPHY AND NT-PROBNP LEVELS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

Abstract

OBJECTIVE: Abnormal left ventricular diastolic function, and NT-proBNP levels have been demonstrated in patients with hypertrophic cardiomyopathy (HCM), but there is lack of information about exercise hemodynamics. In this prospective study, we aimed to examine the prognostic value of diastolic function, and NT-proBNP levels response to exercise in HCM patients.
MATERIAL AND METHODS: Twenty patients (age: 52.6±11.3 years; n=12 (60%) men) with diagnosis of nonobstructive HCM and 11 volunteers (age: 46.4±13.0 years; n=8 (72.7%) men) serving as controls performed incremental cycle ergometry (25 –W, 2 minutes). Mitral inflow (E/A ratio), septal mitral annulus velocities (E/E’ ratio), and NT-proBNP levels were measured at rest and at submaximal exercise. Furthermore, patients were followed for four years.
RESULTS: Higher E/E’ ratio and NT-proBNP levels were detected at rest in HCM patients (E/E’ratio : 15.36 ±4.90 vs 7.97± 1, 44; p< 0.001, NT-proBNP: 348,25±215.71 pg/ml vs 37.27±11.93 pg/ml; p< 0.001). With exercise there was no significant elevation in controls, however E/E’ ratio and, NT-proBNP levels incresed significantly in patients with HCM ( E/E’ ratio: 23.83±10.85 vs 8.01±2.22; p< 0.001, NT-proBNP: 591.25±276.28 pg/ml vs 40.0± 12.03 pg/ml; p<0.001 ). Also, four-year follow-up, none of the patients had died.
CONCLUSIONS: Nonobstructive HCM patients have diastolic dysfunction, elevated filling pressures and NT-proBNP levels and these abnormalities worsen during maximal exercise. but our findings did not predict mortality.

Keywords

Hypertrophic cardiomyopathy, Stress Echocardiography, Nt-proBnp, Hipertrofik kardiyomiyopati, Stres ekokardiyografi, Beyin natriüretik peptid, Hypertrophic cardiomyopathy, Stress echocardiography, Brain natriuretic peptide

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