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

Year 2020, Volume: 12 Issue: 1, 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

References

• 1.Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J. 2011;32(6):670-9. Epub 2010/12/09. doi: 10.1093/eurheartj/ehq426. PubMed PMID: 21138935; PMCID: PMC3056204.
• 2.McHugh K, DeVore AD, Wu J, Matsouaka RA, Fonarow GC, Heidenreich PA, Yancy CW, Green JB, Altman N, Hernandez AF. Heart Failure With Preserved Ejection Fraction and Diabetes. Journal of the American College of Cardiology. 2019;73(5):602-11. doi: 10.1016/j.jacc.2018.11.033.
• 3.Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002 Aug 1;347(5):305-13.
• 4.Michalska-Kasiczak M, Bielecka-Dabrowa A, von Haehling S, Anker SD, Rysz J, Banach M. Biomarkers, myocardial fibrosis and co-morbidities in heart failure with preserved ejection fraction: an overview. Arch Med Sci. 2018;14(4):890-909. Epub 2018/07/14. doi: 10.5114/aoms.2018.76279. PubMed PMID: 30002709; PMCID: PMC6040115.
• 5.Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015;8(2):295-303. Epub 2015/01/17. doi: 10.1161/CIRCHEARTFAILURE.114.001667. PubMed PMID: 25593126.
• 6.Zakeri R, Moulay G, Chai Q, Ogut O, Hussain S, Takahama H, Lu T, Wang XL, Linke WA, Lee HC, Redfield MM. Left Atrial Remodeling and Atrioventricular Coupling in a Canine Model of Early Heart Failure With Preserved Ejection Fraction. Circ Heart Fail. 2016;9(10). Epub 2016/10/21. doi: 10.1161/CIRCHEARTFAILURE.115.003238. PubMed PMID: 27758811; PMCID: PMC5082983.
• 7.Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2(1):10-5. Epub 2009/10/08. doi: 10.1161/CIRCIMAGING.108.813071. PubMed PMID: 19808559.
• 8.Pathak R, Lau DH, Mahajan R, Sanders P. Structural and Functional Remodeling of the Left Atrium: Clinical and Therapeutic Implications for Atrial Fibrillation. J Atr Fibrillation. 2013 Dec 31;6(4):986. doi: 10.4022/jafib.986.
• 9.Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ Arrhythm Electrophysiol. 2008;1(1):62-73. Epub 2008/04/01. doi: 10.1161/CIRCEP.107.754564. PubMed PMID: 19808395.
• 10.Masarone D, Limongelli G, Ammendola E, Verrengia M, Gravino R, Pacileo G. Risk Stratification of Sudden Cardiac Death in Patients with Heart Failure: An update. J Clin Med. 2018;7(11). Epub 2018/11/15. doi: 10.3390/jcm7110436. PubMed PMID: 30423853; PMCID: PMC6262425.
• 11.Antoni ML, Bertini M, Atary JZ, Delgado V, ten Brinke EA, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Bax JJ, van de Veire NR. Predictive value of total atrial conduction time estimated with tissue Doppler imaging for the development of new-onset atrial fibrillation after acute myocardial infarction. Am J Cardiol. 2010;106(2):198-203. Epub 2010/07/06. doi: 10.1016/j.amjcard.2010.02.030. PubMed PMID: 20599003.
• 12.den Uijl DW, Gawrysiak M, Tops LF, Trines SA, Zeppenfeld K, Schalij MJ, Bax JJ, Delgado V. Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace. 2011;13(11):1533-40. Epub 2011/06/30. doi: 10.1093/europace/eur186. PubMed PMID: 21712264.
• 13.Sanchis L, Vannini L, Gabrielli L, Duchateau N, Falces C, Andrea R, Bijnens B, Sitges M. Interatrial Dyssynchrony May Contribute to Heart Failure Symptoms in Patients with Preserved Ejection Fraction. Echocardiography. 2015;32(11):1655-61. Epub 2015/03/04. doi: 10.1111/echo.12927. PubMed PMID: 25732145.
• 14.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Group ESCSD. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200. Epub 2016/05/22. doi: 10.1093/eurheartj/ehw128. PubMed PMID: 27206819.
• 15.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6):776-803. Epub 2017/05/04. doi: 10.1016/j.jacc.2017.04.025. PubMed PMID: 28461007.
• 16.Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. Epub 2016/04/03. doi: 10.1016/j.echo.2016.01.011. PubMed PMID: 27037982.
• 17.Liu S, Guan Z, Zheng X, Meng P, Wang Y, Li Y, Zhang Y, Yang J, Jia D, Ma C. Impaired left atrial systolic function and inter-atrial dyssynchrony may contribute to symptoms of heart failure with preserved left ventricular ejection fraction: A comprehensive assessment by echocardiography. Int J Cardiol. 2018;257:177-81. Epub 2018/03/07. doi: 10.1016/j.ijcard.2017.12.042. PubMed PMID: 29506691.
• 18.Erdem FH, Erdem A, Ozlu F, Ozturk S, Ayhan SS, Caglar SO, Yazici M. Electrophysiological validation of total atrial conduction time measurement by tissue doppler echocardiography according to age and sex in healthy adults. J Arrhythm. 2016;32(2):127-32. Epub 2016/04/20. doi: 10.1016/j.joa.2015.11.006. PubMed PMID: 27092194; PMCID: PMC4823567.
• 19.Emiroglu MY, Bulut M, Sahin M, Acar G, Akcakoyun M, Kargin R, Kayancicek H, Karapinar H, Aung SM. Assessment of atrial conduction time in patients with essential hypertension. J Electrocardiol. 2011;44(2):251-6. Epub 2011/03/01. doi: 10.1016/j.jelectrocard.2010.09.012. PubMed PMID: 21353068.
• 20.Bulut M, Evlice M, Celik M, Eren H, Savluk OF, Acar RD, Tabakci M, Emiroglu MY, Otcu Nurse O, Kargin R, Balkanay M, Akcakoyun M. Atrial electromechanical delay in patients undergoing heart transplantation. J Arrhythm. 2017;33(2):122-6. Epub 2017/04/19. doi: 10.1016/j.joa.2016.07.015. PubMed PMID: 28416978; PMCID: PMC5388059.
• 21.Mahfouz RA, Moustafa TM, Goda M, Gad M. Atrial electromechanical delay, and left ventricular strain in pre-diabetic patients. IJC Metabolic & Endocrine. 2017;14:1-5. doi: 10.1016/j.ijcme.2016.11.003.
• 22.Demir K, Avci A, Kaya Z, Marakoglu K, Ceylan E, Yilmaz A, Ersecgin A, Armutlukuyu M, Altunkeser BB. Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus. J Cardiol. 2016;67(4):378-83. Epub 2015/07/15. doi: 10.1016/j.jjcc.2015.06.003. PubMed PMID: 26164686.
• 23.Abed HS, Samuel CS, Lau DH, Kelly DJ, Royce SG, Alasady M, Mahajan R, Kuklik P, Zhang Y, Brooks AG, Nelson AJ, Worthley SG, Abhayaratna WP, Kalman JM, Wittert GA, Sanders P. Obesity results in progressive atrial structural and electrical remodeling: implications for atrial fibrillation. Heart Rhythm. 2013;10(1):90-100. Epub 2012/10/16. doi: 10.1016/j.hrthm.2012.08.043. PubMed PMID: 23063864.
• 24.Ulus T, Isgandarov K, Moghanchızadeh SH, Bozkurt M, Mutlu F, Yıldırım N. Psödoeksfoliasyon Sendromlu Hastalarda Atriyal İleti Zamanı. Osmangazİ Journal of Medicine. 2019;41(1):31-8. doi: 10.20515/otd.412143.
• 25.Ermiş N, Açıkgöz N, Yaşar E, et al. Evaluation of atrial conduction time by P wave dispersion and tissue Doppler echocardiography in prehypertensive patients. Turk Kardiyol Dern Ars. 2010 Dec;38(8):525-30.
• 26.Acar G, Sayarlioğlu M, Akçay A, et al. Evaluation of atrial electromechanical delay and left atrial mechanical functions in patients with rheumatoid arthritis. Turk Kardiyol Dern Ars. 2009 Oct;37(7):447-53.
• 27.Nar G, Calis AG. Astım Hastalarında Sol Atriyal Mekanik Fonksiyonların ve Atriyal Elektromekanik Gecikmenin Değerlendirilmesi. MN Kardiyoloji 2016;23(2):70-76
• 28.Pytkowski M, Jankowska A, Maciag A, Kowalik I, Sterlinski M, Szwed H, Saumarez RC. Paroxysmal atrial fibrillation is associated with increased intra-atrial conduction delay. Europace. 2008;10(12):1415-20. Epub 2008/10/22. doi: 10.1093/europace/eun282. PubMed PMID: 18936043.
• 29.De Vos CB, Weijs B, Crijns HJ, Cheriex EC, Palmans A, Habets J, Prins MH, Pisters R, Nieuwlaat R, Tieleman RG. Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation. Heart. 2009;95(10):835-40. Epub 2008/12/17. doi: 10.1136/hrt.2008.148528. PubMed PMID: 19074923.
• 30.Leung M, Abou R, van Rosendael PJ, van der Bijl P, van Wijngaarden SE, Regeer MV, Podlesnikar T, Ajmone Marsan N, Leung DY, Delgado V, Bax JJ. Relation of Echocardiographic Markers of Left Atrial Fibrosis to Atrial Fibrillation Burden. Am J Cardiol. 2018;122(4):584-91. Epub 2018/07/28. doi: 10.1016/j.amjcard.2018.04.047. PubMed PMID: 30049466.