Korunmuş ejeksiyon fraksiyonlu kalp yetmezliği hastalarında sol atriyum mekaniğinin kardiyovasküler sonuçlar üzerine etkisi: Tek merkezli çalışma

Year 2020, , 27 - 33, 02.03.2020

Selçuk Küçükseymen

https://doi.org/10.18521/ktd.590819

Abstract

Amaç Sol atrium mekaniği, temelde iletim zamanı, kalp yetmezliği
patofizyolojisinde özellikle de korunmuş ejeksiyon fraksiyonlu kalp
yetmezliğinde (KEFKY), diyastolik fonksiyonların bozulmasına bağlı olarak
değişmiştir, fakat hastalığın sonlanım noktası üzerine etkisi bilinmemektedir.
Bundan dolayı, KEFKY hastalarında, doku Doppler görüntüleme ile elde edilen sol
atrial iletim zamanı (SEMG) ile kalp yetmezliğine bağlı hastane yatışları
arasındaki ilişkiyi araştırdık.

Yöntem: Retrospektif olarak 112 ardışık KEFKY hastası (48 erkek, ortalama yaş 59.9±5)
çalışmaya dahil edildi. KEFKY’li hastalar, kalp yetmezliği semptomu olan,
diyastolik disfonksiyonu izlenen ve EF ≥50% olanlar olarak tanımlandı. Sonlanma
noktası olarak kalp yetmezliğine bağlı hastane yatışı belirlendi, ve bu bilgi
12 ay boyunca retrospektif olarak izlenen hastalardan elde edildi. Hasta
popülasyonu SRMG değerleri baz alınarak istatiksel olarak 3 tertil gruba
ayrıldı. 1. Tertil <22 ms, 2. Tertil 22-42 ms, ve 3. Tertil >42 ms olarak
tanımlandı.

Bulgular: Grupların demografik özellikleri arasında büyük oranda anlamlı farklılık
saptanmadı, sol ventrikül boyutları ve EF gruplar arasında benzerdi
(p>0.05). Hastalar 12 ay izlendi, toplam 41 olay kaydedildi. SEMG, olay
gerçekleşen bireylerde diğer bireylere göre daha uzundu. Bunun yanında DDG ile
kaydedilen diyastolik disfonksiyon parametreleri SEMG ile pozitif korelasyon
içindeydi (r=0.627, p<0.001). Bunlara ek olarak, Kaplan-Meier eğrisinde SEMG’i
en uzun olan 3. Tertil grubun, kalp yetmezliği bağlı hastane yatışları ile
yüksek derecede ilişkili olduğu gözlendi (P log rank < 0,001), ve bağımsız
risk faktörü olarak gözlendi (Tertil 3 ile 1 arası tehlike oranı (TO): 18.7,
95% güven aralığı (GA) 2.6-61, p<0.001; Tertil 3 ile 2 arası TO:6.17, 95% GA
1.78-21.2, p<0.001).

Sonuç KEFKY olan hastalarda, SAiz kalp yetmzliğine bağlı yatışları öngörebilmede
kolay ulaşılabilir non-invaziv bir yöntem olabilir. 

Keywords

Ekokardiyografi, Doku Doppler, atriyal ileti zamanı, Korunmuş ejeksiyon fraksiyonlu kalp yetmezliği

The impact of left atrial mechanics on cardiovascular outcome in HFpEF patients: A single center study

Abstract

Objective Left atrial (LA) mechanics, particularly conduction time is mostly altered
in heart failure (HF), especially in preserved ejection fraction type (HFpEF)
due to deterioration in diastolic features (DF), but the impact on outcomes
remains unknown. Therefore, we sought to investigate the association of LA
conduction by coupling obtained from tissue Doppler imaging (TDI) and HF-related
hospitalization in patients with HFpEF.

Method: We retrospectively included 112 consecutive patients (48 men; mean age 59±5
years) with HFpEF. HFpEF was defined as the presence of at least one symptom, diastolic
dysfunction with TDI and EF>50% by transthoracic echocardiography. The
primary outcome was HF-related hospitalization, and hospitalization data from
over 12-month period were retrospectively obtained on all HFpEF patients. The
cohort was stratified based on the tertiles of their LA –electromechanical
delay (EMD) duration: Tertile 1 (<22 ms); Tertile 2 (22 – 42 ms); Tertile 3
(>42 ms).

Results: Demographic features were mostly similar between all tertile groups, and
there were no significant differences in left ventricular (LV) diameters and EF
(p>0.05). The patients were followed for 12-month, and a total of 41 events
occurred as a primary outcome. LA-EMD duration was significantly longer in
patients with cardiac events than in those without. Also, DF parameters were
significantly correlated with LA-EMD (r=0.627, p<0.001). Additionally,
Kaplan-Meier analysis showed that the highest tertile of LA-EMD duration was associated
with hospital admission (P log rank < 0.001), and it was found to be an
independent risk factor for HF-related hospitalization HR for tertile 3 vs. 1:
18.7, 95% CI: 2.46-61.1, p<0.001; HR for tertile 3 vs. 2: 6.17, 95% CI:
1.78-21.2, p<0.001).

Conclusion Among HFpEF patients, the LA-EMD may be a feasible non-invasive parameter
for predicting HF-related hospitalization.

Keywords

Echocardiography, Tissue Doppler, Atrial conduction time, Heart failure with preserved ejection fraction

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