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Hafif ve orta dereceli aort darlığı ciddiyeti ile global sol ventrikül yüklenme endeksi, kontraktilite rezervi ve kalp hızı toparlanmasının karşılaştırılması

Yıl 2022, Cilt: 13 Sayı: 47, 379 - 384, 15.12.2022
https://doi.org/10.17944/mkutfd.1074650

Öz

Amaç: Aort darlığı kalp kapağı hastalıkları içinde en sık görülenidir. Hastalar semptomatik olup, kapak cerrahisi uygulanamadığı durumlarda yaşam beklentisi kısalır. Hastaların asemptomatik dönemde tespiti önemlidir. Bu çalışmada daha önce ciddi aort darlığında çalışılan kalp hızı toparlanması, kontraktilite rezervi ve global sol ventrikül hacim yüklenme endeksi parametrelerinin asemptomatik hafif ve orta derece aort darlığı olan hastalarda aort kapak ciddiyeti ile ilişkisini değerlendirmek amaçlanmıştır.

Yöntem: Çalışmaya 36 hafif aort darlığı, 24 orta aort darlığı olan hasta kabul edildi. Hastaların kalp hızı toparlanması, kontraktilite rezervi ve global sol ventrikül hacim yüklenme endeksi hesaplandı ve bulunan değerler ve hasta sayıları arasındaki fark istatiksel olarak değerlendirildi.

Bulgular: Hafif ve orta aort darlığı olan hastalarda kontraktilite rezervi ortalaması arasında anlamlı farklılık saptandı (%5.31±1.21 vs %3.87±1.06, sırasıyla, p<0.05). Aynı hastalarda global sol ventrikül yüklenme endeksi ortalaması arasında anlamlı farklılık saptandı (3.08±0.42 vs 5.59±0.63 mmHg/ml/m2, sırasıyla p<0.05). Hafif ve orta aort darlığı olan hastalarda birinci dakikadaki kalp hızı toparlanması ortalaması arasında istatiksel olarak anlamlı fark saptandı (19.9±13.8 vs26.8±7.3 atım/dakika, sırasıyla p<0.05).

Sonuç: Hastaların asemptomatik olduğu bir dönemde global sol ventrikül yüklenme endeksi, kontraktilite rezervi ve kalp hızı toparlanması normal olmayan hastaları daha sık muayene etmek gerekebilir.

Kaynakça

  • Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29(3):630-634. https://doi.org/10.1016/s0735-1097(96)00563-3.
  • Lung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231-1243. https://www.doi.org/10.1016/s0195-668x(03)00201-x.
  • Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-1011. https://www.doi.org/10.1016/S0140-6736(06)69208-8.
  • Hess OM, Ritter M, Schneider J, Grimm J, Turina M, Krayenbuehl HP. Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement. Circulation. 1984;69(5):855-865. https://www.doi.org/10.1161/01.cir.69.5.855.
  • Hess OM, Villari B, Krayenbuehl HP. Diastolic dysfunction in aortic stenosis. Circulation. 1993;87(5 Suppl):IV73-IV76.
  • Tobin JR Jr, Rahimtoola SH, Blundell PE, Swan HJ. Percentage of left ventricular stroke work loss. A simple hemodynamic concept for estimation of severity in valvular aortic stenosis. Circulation. 1967;35(5):868-879. https://www.doi.org/10.1161/01.cir.35.5.86
  • Pantely G, Morton M, Rahimtoola SH. Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetence. J Thorac Cardiovasc Surg. 1978;75(3):383-391. https://doi.org/10.1016/S0022-5223(19)41265-8.
  • Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation. 1997;95(9):2262-2270. https://www.doi.org/10.1161/01.cir.95.9.2262.
  • Rosenhek R, Klaar U, Schemper M, et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur Heart J. 2004;25(3):199-205. https://www.doi.org/10.1016/j.ehj.2003.12.002.
  • Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611-617. https://www.doi.org/10.1056/NEJM200008313430903.
  • Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol. 2006;47(11):2141-2151. https://www.doi.org/10.1016/j.jacc.2006.03.002.
  • Briand M, Dumesnil JG, Kadem L, et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol. 2005;46(2):291-298. https://www.doi.org/10.1016/j.jacc.2004.10.081.
  • Kadem L, Dumesnil JG, Rieu R, Durand LG, Garcia D, Pibarot P. Impact of systemic hypertension on the assessment of aortic stenosis. Heart. 2005;91(3):354-361. https://www.doi.org/10.1136/hrt.2003.030601.
  • Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH. Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart. 2005;91(11):1407-1412. https://www.doi.org/10.1136/hrt.2004.047613.
  • Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH. Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart. 2005;91(11):1407-1412. https://www.doi.org/10.1136/hrt.2004.047613.
  • Madaric J, Watripont P, Bartunek J, et al. Effect of mitral valve repair on exercise tolerance in asymptomatic patients with organic mitral regurgitation. Am Heart J. 2007;154(1):180-185. https://www.doi.org/10.1016/j.ahj.2007.03.051.
  • Leung DY, Griffin BP, Stewart WJ, Cosgrove DM 3rd, Thomas JD, Marwick TH. Left ventricular function after valve repair for chronic mitral regurgitation: predictive value of preoperative assessment of contractile reserve by exercise echocardiography. J Am Coll Cardiol. 1996;28(5):1198-1205. https://www.doi.org/10.1016/S0735-1097(96)00281-1.
  • Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284(11):1392-1398. https://www.doi.org/10.1001/jama.284.11.1392.
  • Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999;341(18):1351-1357. https://www.doi.org/10.1056/NEJM199910283411804.
  • Pierpont GL, Voth EJ. Assessing autonomic function by analysis of heart rate recovery from exercise in healthy subjects. Am J Cardiol. 2004;94(1):64-68. https://www.doi.org/10.1016/j.amjcard.2004.03.032.
  • Matsushita T, Tanaka Y, Horinouchi O, Sonoda M, Arima T. Heart rate decline after exercise in patients with hypertrophic cardiomyopathy. J Electrocardiol. 2001;34(2):141-146. https://www.doi.org/10.1054/jelc.2001.23711.
  • Horstkotte D, Loogen F. The natural history of aortic valve stenosis. Eur Heart J. 1988;9 Suppl E:57-64. https://www.doi.org/10.1093/eurheartj/9.suppl_e.57.
  • Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice [published correction appears in J Am Soc Echocardiogr. 2009 May;22(5):442]. J Am Soc Echocardiogr. 2009;22(1):1-102. https://www.doi.org/10.1016/j.echo.2008.11.029.
  • Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359(13):1343-1356. https://www.doi.org/10.1056/NEJMoa0804602.
  • Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284(11):1392-1398. https://www.doi.org/10.1001/jama.284.11.1392.
  • Matsushita T, Tanaka Y, Horinouchi O, Sonoda M, Arima T. Heart rate decline after exercise in patients with hypertrophic cardiomyopathy. J Electrocardiol. 2001;34(2):141-146. https://www.doi.org/10.1054/jelc.2001.23711.

Comparison of mild and moderate aortic stenosis severity with global left ventricular load index, contractility reserve and heart rate recovery time

Yıl 2022, Cilt: 13 Sayı: 47, 379 - 384, 15.12.2022
https://doi.org/10.17944/mkutfd.1074650

Öz

Objective: Aortic stenosis is the most common heart valve disease. Patients are symptomatic and life expectancy is shortened in cases where valve surgery cannot be performed. It is important to detect patients in the asymptomatic period. Aim of this study was to evaluate the relationship between heart rate recovery time, contractility reserve and global left ventricular volume loading index parameters, which have been studied before in severe aortic stenosis, with aortic valve severity in patients with asymptomatic mild and moderate aortic stenosis.

Method: 36 and 24 patients with mild and moderate aortic stenosis were included in the study respectively. The patients’ heart rate recovery time, contractility reserve and global left ventricular volume load index were calculated and the difference between the values found and the number of patients was evaluated statistically.

Results: A significant difference was found between the mean contractility reserve (5.31±1.21 vs 3.87±1.06%, respectively, p<0.05), and between the mean global left ventricular load index (3.08±0.42 vs 5.59±0.63 mmHg/ml/m2, respectively, p<0.05), and between the mean heart rate recovery time in the first minute in patients with mild and moderate aortic stenosis (19.9±13.8 vs. 26.8±7.3 beats/min, p<0.05, respectively).

Conclusion: It may be necessary to examine more frequently the patients whose global left ventricular load index, contractility reserve and heart rate recovery time are not normal during a period when patients are asymptomatic.

Kaynakça

  • Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29(3):630-634. https://doi.org/10.1016/s0735-1097(96)00563-3.
  • Lung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231-1243. https://www.doi.org/10.1016/s0195-668x(03)00201-x.
  • Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-1011. https://www.doi.org/10.1016/S0140-6736(06)69208-8.
  • Hess OM, Ritter M, Schneider J, Grimm J, Turina M, Krayenbuehl HP. Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement. Circulation. 1984;69(5):855-865. https://www.doi.org/10.1161/01.cir.69.5.855.
  • Hess OM, Villari B, Krayenbuehl HP. Diastolic dysfunction in aortic stenosis. Circulation. 1993;87(5 Suppl):IV73-IV76.
  • Tobin JR Jr, Rahimtoola SH, Blundell PE, Swan HJ. Percentage of left ventricular stroke work loss. A simple hemodynamic concept for estimation of severity in valvular aortic stenosis. Circulation. 1967;35(5):868-879. https://www.doi.org/10.1161/01.cir.35.5.86
  • Pantely G, Morton M, Rahimtoola SH. Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetence. J Thorac Cardiovasc Surg. 1978;75(3):383-391. https://doi.org/10.1016/S0022-5223(19)41265-8.
  • Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation. 1997;95(9):2262-2270. https://www.doi.org/10.1161/01.cir.95.9.2262.
  • Rosenhek R, Klaar U, Schemper M, et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur Heart J. 2004;25(3):199-205. https://www.doi.org/10.1016/j.ehj.2003.12.002.
  • Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611-617. https://www.doi.org/10.1056/NEJM200008313430903.
  • Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol. 2006;47(11):2141-2151. https://www.doi.org/10.1016/j.jacc.2006.03.002.
  • Briand M, Dumesnil JG, Kadem L, et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol. 2005;46(2):291-298. https://www.doi.org/10.1016/j.jacc.2004.10.081.
  • Kadem L, Dumesnil JG, Rieu R, Durand LG, Garcia D, Pibarot P. Impact of systemic hypertension on the assessment of aortic stenosis. Heart. 2005;91(3):354-361. https://www.doi.org/10.1136/hrt.2003.030601.
  • Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH. Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart. 2005;91(11):1407-1412. https://www.doi.org/10.1136/hrt.2004.047613.
  • Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH. Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart. 2005;91(11):1407-1412. https://www.doi.org/10.1136/hrt.2004.047613.
  • Madaric J, Watripont P, Bartunek J, et al. Effect of mitral valve repair on exercise tolerance in asymptomatic patients with organic mitral regurgitation. Am Heart J. 2007;154(1):180-185. https://www.doi.org/10.1016/j.ahj.2007.03.051.
  • Leung DY, Griffin BP, Stewart WJ, Cosgrove DM 3rd, Thomas JD, Marwick TH. Left ventricular function after valve repair for chronic mitral regurgitation: predictive value of preoperative assessment of contractile reserve by exercise echocardiography. J Am Coll Cardiol. 1996;28(5):1198-1205. https://www.doi.org/10.1016/S0735-1097(96)00281-1.
  • Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284(11):1392-1398. https://www.doi.org/10.1001/jama.284.11.1392.
  • Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999;341(18):1351-1357. https://www.doi.org/10.1056/NEJM199910283411804.
  • Pierpont GL, Voth EJ. Assessing autonomic function by analysis of heart rate recovery from exercise in healthy subjects. Am J Cardiol. 2004;94(1):64-68. https://www.doi.org/10.1016/j.amjcard.2004.03.032.
  • Matsushita T, Tanaka Y, Horinouchi O, Sonoda M, Arima T. Heart rate decline after exercise in patients with hypertrophic cardiomyopathy. J Electrocardiol. 2001;34(2):141-146. https://www.doi.org/10.1054/jelc.2001.23711.
  • Horstkotte D, Loogen F. The natural history of aortic valve stenosis. Eur Heart J. 1988;9 Suppl E:57-64. https://www.doi.org/10.1093/eurheartj/9.suppl_e.57.
  • Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice [published correction appears in J Am Soc Echocardiogr. 2009 May;22(5):442]. J Am Soc Echocardiogr. 2009;22(1):1-102. https://www.doi.org/10.1016/j.echo.2008.11.029.
  • Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359(13):1343-1356. https://www.doi.org/10.1056/NEJMoa0804602.
  • Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284(11):1392-1398. https://www.doi.org/10.1001/jama.284.11.1392.
  • Matsushita T, Tanaka Y, Horinouchi O, Sonoda M, Arima T. Heart rate decline after exercise in patients with hypertrophic cardiomyopathy. J Electrocardiol. 2001;34(2):141-146. https://www.doi.org/10.1054/jelc.2001.23711.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Original Articles
Yazarlar

Ülker Kaya 0000-0002-6802-5672

Yayımlanma Tarihi 15 Aralık 2022
Gönderilme Tarihi 16 Şubat 2022
Kabul Tarihi 25 Eylül 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 13 Sayı: 47

Kaynak Göster

Vancouver Kaya Ü. Hafif ve orta dereceli aort darlığı ciddiyeti ile global sol ventrikül yüklenme endeksi, kontraktilite rezervi ve kalp hızı toparlanmasının karşılaştırılması. mkutfd. 2022;13(47):379-84.