İnvaziv Olmayan Ventilasyon Kullanan Kronik Solunum Yetersizlikli Kifoskolyoz Hastalarının Kardiyak Fonksiyonlarının ve Total Mortalitenin Değerlendirilmesi

Yıl 2015, Cilt: 18 Sayı: 1, 19 - 28, 06.04.2015

Yusuf Karavelioğlu , Hekim Karapınar Zuhal Karakurt Göksel Açar Özlem Yazıcıoğlu Moçin Nalan Adıgüzel Murat Yüksel Gökay Güngör Ali Metin Esen

Öz

Giriş: Biz bu
çalışmada kronik solunum yetersizliği nedeniyle uzun dönem invaziv olmayan
ventilasyon tedavisi alan kifoskolyoz hastalarında kardiyak fonksiyonlar ve
mortalite oranları değerlendirmeyi amaçladık.

Hastalar ve Yöntem: İnvaziv
olmayan ventilasyon kullanan kifoskolyoz hastaları bu çalışmaya alındı. Hasta
özellikleri ve kardiyovasküler risk faktörleri kaydedildi. Tüm hastalara
ambulatuvar ritim monitorizasyonu ve ekokardiografi yapıldı. Sonuçlar 26
yaş-cinsiyet ayarlanmış dispnesi olmayan gönüllüler ile karşılaştırıldı.
Hastalar beş yıl süreyle takip edildi.

Bulgular: Yirmi üç
kifoskolyoz hastası (54 ± 13 yaş, 15 erkek) çalışmaya alındı. Hipertansiyon ve
paroksismal atrial fibrilasyon hasta grubunda daha sık izlendi. Sol ventrikül
sistolik fonksiyonları normal iken diastolik fonsiyonları bozulmuş izlendi. Sağ
ventrikül çapları normal iken sistolik/diyastolik fonksiyonları ortalama
pulmoner arter basınçları kifoskolyoz hastalarında yüksek idi. Dört hasta
takipte öldü. Ölümlerin ikisi ciddi hipoksemi nedeniyle diğer ikisi de sepsis
nedeniyle gerçekleşti. Klinik, laboratuvar, ekokardiografi ve kardiyovasküler
risk parametreler açısında ölenler ile hayatta kalanlar arasında fark
izlenmedi.

Sonuç: Kifoskolyoz hastalarında
hipertansiyon ve aritmi sık izlendi. Sol ventrikül hafif derecede fakat sağ
ventrikül ciddi ölçüde etkilendiği ve pulmoner arter basınçlarının arttığı
gözlendi. Uzun dönem invaziv olmayan ventilasyon tedavisi alan kifoskolyoz
hastalarında kardiyovasküler fonksiyonlar mortaliteyi öngörmediği tespit
edildi.

Anahtar Kelimeler

Kifoskolyoz, mekanik ventilasyon, iki-düzeyli pozitif hava yolu basıncı, kardiyak fonksiyon testleri, pulmoner hipertansiyon

Cardiac Functions and All-Cause Mortality in Kyphoscoliosis Patients with Chronic Respiratory Failure Using Non-invasive Ventilation

Öz

Introduction: We aimed to evaluate
cardiac functions and mortality rate in kyphoscoliosis patients with chronic
respiratory failure under long term non-invasive ventilation (NIV).

Patients and Methods: Kyphoscoliosis patients,
who used NIV, were included in the study. Patients’ characteristics and
cardiovascular risk factors were recorded. Ambulatory rhythm monitoring and
echocardiography were performed for all patients. Results were compared with 26
age-gender matched volunteers without dyspnea. Patients had been followed for
five years.

Results: Twenty-three
kyphoscoliosis patients (54 ± 13 years, 15 male) were included in the study.
Hypertension and paroxysmal atrial fibrillation were more frequent in patients.
Left ventricular systolic functions were normal but diastolic functions were
worsened. Right ventricular sizes were normal but systolic and diastolic
functions were worsened and the mean pulmonary artery pressure was higher in
kyphoscoliosis patients. Four patients were died in follow up. Two of patients
died due to severe hypoxia and two of them died due to sepsis. Clinical and
laboratory properties including cardiovascular risk factors, echocardiographic
examination were not different between the survived patients and dying ones.

Conclusion:
Hypertension and arrhythmia are more frequent. The left
ventricle is slightly affected but the right ventricle is severely affected and
pulmonary pressure is increased in kyphoscoliosis. Cardiovascular functions do
not predict mortality in kyphoscoliosis patients under long term NIV treatment.

Anahtar Kelimeler

Kyphoscoliosis, mechanical ventilation, bi-level continucus positive airway pressure, cardiac function tests, pulmonary hypertension

Kaynakça

• 1. Consensus Conference. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation - a consensus conference report. Chest 1999;116:521-34.
• 2. Buyse B, Meersseman W, Demedts M. Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation? Eur Respir J 2003;22:525-8.
• 3. Karakurt Z, Güven AO, Moçin OY, Karavelioğlu Y, Güngör G, Altınöz H, et al. Six minute walking distance in kyphoscoliosis patients with chronic respiratory failure. Multidiscip Respir Med 2010;5:244-9.
• 4. Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, AllÞe A, et al. Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 1987;59:662-8.
• 5. Budev MM, Arroliga AC, Wiedemann HP, Matthay RA. Cor pulmonale: an overview. Semin Respir Crit Care Med 2003;24:233-44.
• 6. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23:685-713; quiz 786-8.
• 7. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-119.
• 8. American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995;152:1107-36.
• 9. Clair WK, Wilkinson WE, McCarthy EA, Page RL, Pritchett EL. Spontaneous occurrence of symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia in untreated patients. Circulation 1993;87:1114-22.
• 10. Heindl S, Lehnert M, Criée CP, Hasenfuss G, Andreas S. Marked sympathetic activation in patients with chronic respiratory failure. Am J Respir Crit Care Med 2001;164:597-601.
• 11. Tug T, Terzi SM, Yoldas TK. Relationship between the frequency of autonomic dysfunction and the severity of chronic obstructive pulmonary disease. Acta Neurol Scand 2005;112:183-8.
• 12. Stewart S, Hart CL, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 2001;86:516-21.
• 13. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-53.
• 14. de Lucas-Ramos P, Izquierdo-Alonso JL, Rodríguez-González Moro JM, Bellón-Cano JM, Ancochea-Bermúdez J, Calle-Rubio M, et al. [Cardiovascular risk factors in chronic obstructive pulmonary disease: Results of the ARCE study]. Arch Bronconeumol 2008;44:233-8.
• 15. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: A European Society of Hypertension Task Force document. Blood Press 2009;18:308-47.
• 16. Tonelli AR, Plana JC, Heresi GA, Dweik RA. Prevalence and prognostic value of left ventricular diastolic dysfunction in idiopathic and heritable pulmonary arterial hypertension. Chest 2012;141:1457-65.
• 17. Gale CP, White JE, Hunter A, Owen J, Allen J, Watson J, et al. Predicting mortality and hospital admission in patients with COPD: significance of NT pro-BNP, Clinical and echocardiographic assessment. J Cardiovasc Med 2011;12:613-8.
• 18. Dursun D, Dursunoğlu N, Kuru Ö, Özkurt S, Gür Ş, Kiter G, et al. The effect of continuous positive airway pressure on blood pressure and left ventricular structure in male patients with obstructive sleep apnea. Turk Kardiyol Dern Ars 2006;34:496-503.
• 19. Han MK, McLaughlin VV, Criner GJ, Martinez FJ. Pulmonary diseases and the heart. Circulation 2007;116:2992-3005.
• 20. Weitzenblum E, Chaouat A. Cor pulmonale. Chron Respir Dis 2009;6:177-85.
• 21. Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 1998;113:576-83.
• 22. Noble JS, Davidson JA. Cor pulmonale presenting in a patient with congenital kyphoscoliosis following intercontinental air travel. Anaesthesia 1999;54:361-3.
• 23. Ye YQ. [Kyphoscoliosis and cor pulmonale (report of 5 cases and review of the literature]. Zhonghua Jie He He Hu Xi Xi Ji Bing Za Zhi 1986;9:335-7, 381-2.
• 24. Coccagna, G, Lugaresi, E. Arterial blood gases and pulmonary and systemic arterial pressure during sleep in chronic obstructive pulmonary disease. Sleep 1978;1:117-24.
• 25. Sawicka EH, Branthwaite MA. Respiration during sleep in kyphoscoliosis. Thorax 1987;42:801-8.
• 26. Midgren B, Petersson K, Hansson L, Eriksson L, Airikkala P, Elmqvist D. Nocturnal hypoxaemia in severe scoliosis. Br J Dis Chest 1988;82:226-36.
• 27. Hoeppner VH, Cockcroft DW, Dosman JA, Cotton DJ. Invasive nighttime ventilation improves respiratory failure in secondary kyphoscoliosis. Am Rev Respir Dis 1984;129:240-3.
• 28. Gonzalez C, Ferris G, Diaz J, Fontana I, Nuñez J, Marín J. Kyphoscoliotic ventilatory insufficiency: effects of long-term intermittent positive-pressure ventilation. Chest 2003;124:857-62.
• 29. Adıgüzel N, Karakurt Z, Güngör G, Moçin O, Balcı M, Saltürk C, et al. Management of kyphoscoliosis patients with respiratory failure in the intensive care unit and during long term follow up. Multidiscip Respir Med 2012;7:30.
• 30. Esquinas AM, Matsuoka Y, Adıgüzel N, Karakurt Z. Intensive care and non-invasive mechanical ventilation in kyphoscoliosis: Are new perspectives still needed? Multidiscip Respir Med 2013;8:31.
• 31. Hill NS, Eveloff SE, Carlisle CC, Goff SG. Efficacy of nocturnal nasal ventilation in patients with restrictive thoracic disease. Am Rev Respir Dis 1992;145:365-71.
• 32. Schönhofer B, Köhler D. Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure. Thorax 2000;55:308-13.
• 33. Jackson M, Kinnear W, King M, Hockley S, Shneerson J. The effects of five years of nocturnal cuirass-assisted ventilation in chest wall disease. Eur Respir J 1993;6:630-5.
• 34. Zaccaria S, Zaccaria E, Zanaboni S, Patessio A, Braghiroli A, Spada EL, et al. Home mechanical ventilation in kyphoscoliosis. Monaldi Arch Chest Dis 1993;48:161-4.
• 35. Schönhofer B, Barchfeld T, Wenzel M, Köhler D. Long term effects of non-invasive mechanical ventilation on pulmonary haemodynamics in patients with chronic respiratory failure. Thorax 2001;56:524-8.
• 36. Sin DD, Wong E, Mayers I, Lien DC, Feeny D, Cheung H, et al. Effects of nocturnal noninvasive mechanical ventilation on heart rate variability of patients With Advanced COPD. Chest 2007;131:156-63.
• 37. Naughton MT, Benard DC, Liu PP, Rutherford R, Rankin F, Bradley TD. Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 1995;152:473-9.
• 38. Raupach T, Bahr F, Herrmann P, Luethje L, Heusser K, Hasenfuss G, et al. Slow breathing reduces sympathoexcitation in COPD. Eur Respir J 2008;32:387-92.
• 39. Tkacova R, Dajani HR, Rankin F, Fitzgerald FS, Floras JS, Douglas Bradley T. Continuous positive airway pressure improves nocturnal baroreflex sensitivity of patients with heart failure and obstructive sleep apnea. J Hyperters 2000;18:1257-62.
• 40. Hoeper MM, Galie N, Murali S, Olschewski H, Rubenfire M, Robbins IM, et al. Outcome after cardiopulmonary resuscitation in patients with pulmonary arterial hypertension. Am J Respir Crit Care Med 2002;165:341-4.