The effect of cold stress on right ventricular function in patients with systemic sclerosis

Yıl 2018, Cilt: 31 Sayı: 3, 94 - 100, 31.10.2018

Mustafa Yılmaztepe Meryem Aktoz Ersan Tatlı Armağan Altun

https://doi.org/10.5472/marumj.472397

Öz

Objective: Pulmonary hypertension and right heart failure are poor

prognostic factors in systemic sclerosis (SSc). The effect of cold

stress on pulmonary vasospasm was evaluated in some trials but

the results were conflicting. The aim of our study was to determine

the effect of cold stress on right ventricular (RV) functions.

Materials and Methods: Twenty-four patients with SSc and

24 age and sex-matched healthy controls were enrolled in the

study. Transthoracic echocardiography (TTE) was performed to all

patients at rest and after peripheral cold exposure. Baseline and

after cold stress test TTE were compared between the groups.

Results: Cold exposure induced changes in particularly right

venticular functions. Pulmonary acceleration time was significantly

shortened in the SSc group (118.8±11.7ms vs 111.3±13.7ms,

P<0.001). Tricuspid annular plane systolic excurison and RV

fractional area change were also decreased after cold exposure

in the SSc group. (23.3±1.6mm vs 21.9±1.9 mm, P<0.001;

46.3±5.8 vs 44.4±5.8,P= 0.007, consecutively). Left ventricular

(LV) functions did not change after cold stress (LV myocardial

performance index (0.42± 0.04 vs 0.42± 0.05), P= 0.748).

Conclusion: Peripheral cold exposure caused a reduction

in right ventricular functions indicating pulmonary Raynaud’s

phenomenon as a possible contributing factor.

Anahtar Kelimeler

Systemic sclerosis, Echocardiography, Tissue Doppler

Skleroderma hastalarında soğuk stresin sağ ventrikülün fonksiyonu üzerine etkisi

Öz

Amaç: Skleroderma (SSc)’da, pulmoner hipertansiyon ve sağ

kalp yetersizliği kötü prognoz göstergesidir. SSc’da soğuk stresin

pulmoner vazospazm üzerine etkisi ile ilgili çeşitli çalışmalar

yapılmış ancak sonuçlar çelişkili çıkmıştır. Bu çalışma ile SSc

hastalarında periferik soğuk stresin sağ ventrikül fonksiyonlarına

etkisini araştırmayı amaçladık.

Gereç ve Yöntem: Yirmi dördü sklerodermalı, 24’ü sağlıklı

toplam 48 kişi çalışmaya alındı. Her iki gruba istirahat ve periferik

soğuk stres uygulama sonrasında transtorasik ekokardiyografi

yapıldı. İstirahat ve soğuk stres sonrası sol ve sağ ventrikül

fonksiyonları karşılaştırıldı.

Bulgular: Soğuk stresin özellikle sağ ventrikül fonksiyonlarında

değişikliğe yol açtığı görüldü. Pulmoner akselerasyon zamanı

skleroderma grubunda anlamlı olarak kısaldı (118.8±11.7ms vs

111.3±13.7ms, P<0.001). Triküspid anuler düzlem sistolik hareketi

ve sağ ventrikül fraksiyonel alan değişimi de soğuk stres ile azaldı

(23.3±1.6mm vs 21.9±1.9 mm, P<0.001; 46.3±5.8 vs 44.4±5.8,P=

0.007, sırasıyla). Soğuk stres ile sol ventrikül fonksiyonlarında

değişiklik saptanmadı (sol ventrikül miyokard performans indeksi

(0.42± 0.04 vs 0.42± 0.05), P= 0.748).

Sonuç: Periferik soğuk stres, sağ ventrikül fonksyonlarında

azalmaya sebep olmuştur ve bu da pulmoner Raynaud fenomeninin

pulmoner hipertansiyon gelişmesinde etken faktörlerden biri

olabileceğini düşündürmektedir.

Anahtar Kelimeler

Sistemik skleroz, Ekokardiografi, Doku Doppler, Sağ ventrikül fonksiyonları

Kaynakça

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