Yaşın önemi: izole mitral darlıkta atriyal fibrilasyon için bağımsız risk faktörü

Year 2020, Volume: 10 Issue: 2, 186 - 189, 25.06.2020

Arslan Ocal , Ersin Saricam , Hakan Kartal , Taner Sarak

https://doi.org/10.16899/jcm.738502

Cited By: 1

Abstract

Amaç: Atriyal fibrilasyon ritmi romatizmal mitral darlıklı hastalarda sık görülür. Mitral darlıkta AF nin oluşumunda pek çok faktörün etkili olduğu öne sürülmüştür. En önde gelen ölümcül ritim bozukluğu olması nedeniyle, bağımsız risk faktörlerinin bilinmesi atriyal fibrilasyonun tedavisi ve önlenmesi için çok önemlidir. Mevcut çalışmada orta ve ileri mitral darlıklı hastalar için atriyal fibrilasyon yönünden risk faktörlerini araştırılmıştır.
Gereç ve Yöntem: Bu çalışma geriye dönük olarak orta ve ileri romatizmal mitral darlık tanılı 307 hastayı (217 kadın, 90 erkek) içerir. Çalışma grupları atriyal fibrilasyon varlığına göre sınıflandırılmıştır. Hastalar iki gruba ayrılmışlardır, grup 1 (atriyal fibrilasyonlu hastalar, 188 hasta), grup 2 (atriyal fibrilasyon olmayan hastalar, 119 hasta). İki grubun karşılaştırılması yaş, ortalama kapak alanı (MVA), ortalama kapak gradiyent (MVG), sistolik pulmoner arter basıncı ( SPAP), sol atriyum çapı ve ortalama kapak skora göre yapıldı.
Bulgular: Sol atriyum çapı 4.60±0.61 cm ve 4.73±0.71 cm; p=0.132) idi. MVA 1.09±0.18 cm2 ve 1.20±0.85 cm2; p=0.360 idi. MVG 11.31±3.86 mmHg ve 10.78±3.32 mmHg; p=0.251 idi. SPAP 48.41± 14.83 mmHg ve 47.80±13,45 mmHg; p=0.813 idi. Ortalama kapak skor 7.60±1.77 ve 7.72± 1.66; p=0.613 idi. Yaş ise atriyal fibrilasyonlu hastalarda belirgin olarak daha yüksekti (42.45±12.37 ve 34.77±10.50; p<0.001).
Sonuç: Bu çalışma atriyal fibrilasyonun oluşumunda yaşın önemli bir etken olduğunu göstermiştir.

Keywords

Yaş, , atriyal fibrilasyon, , atriyal fibrilasyon

The importance of age: independent risk factor for atrial fibrillation in isolated rheumatic mitral stenosis

Abstract

Aim: Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS). Numerous factors have been proposed to support the pathogenesis of AF in mitral stenosis. Because of the most leading rhythm for morbidity and mortality, the identification of independent risk factors is very important for the prevention, and treatment of AF. The present study investigated the risk factors for atrial fibrillations with moderate to severe mitral stenosis.
Material and Methods: This retrospective study included 307 patients (217 female, 90 male) with isolated moderate to severe rheumatic mitral stenosis. The populations were organized according to the existence of atrial fibrillation. The patients separated into two groups; as Group 1 with atrial fibrillation (188 patients), as Group II without atrial fibrillation (119 patients). A comparison of two groups was made according to age, MVA, MVG, SPAP, left atrium diameter and mean valve score.
Results: According to group1 (atrial fibrillation group) and group 2 (no atrial fibrillation), left atrium diameter was 4.60±0.61 vs. 4.73±0.71; respectively, p=0.132, MVA was 1.09±0.18 vs. 1.20±0.85; respectively, p=0.360), MVG was 11.31±3.86 vs. 10.78±3.32; respectively, p=0.251, SPAP was 48.41± 14.83 vs. 47.80±13,45; respectively, p=0.813, and mean mitral valve score was 7.60±1.77 vs. 7.72±1.66; respectively, p=0.613. All of them were similar in both groups. Age was significantly higher in patients with atrial fibrillation (42.45±12.37 vs. 34.77±10.50; p<0.001, respectively)
Conclusion: This study presented that the age is an important factor for genesis of AF.

Keywords

Age, atrial fibrillation, , mitral stenosis

References

• Referans1 Iung B, Leenhardt A, Extramiana F. Management of atrial fibrillation in patients with rheumatic mitral stenosis. Heart. 2018; 104: 1062-8.
• Referans2 Marcus RH, Sareli P, Pocock WA, Barlow JB. The spectrum of severe rheumatic mitral valve disease in a developing country. Correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. Ann Intern Med 1994; 120: 177-83.
• Referans3 Chesebro JH, Fuster V, Halperin JL. Atrial fibrillation--risk marker for stroke. N Engl J Med 1990; 323: 1556-8.
• Referans4 Lubitz SA, Yin X, McManus DD, et al. Stroke as the initial manifestation of atrial fibrillation: The Framingham Heart Study. Stroke 2017; 48: 490-2.
• Referans5 Hinton RC, Kistler JP, Fallon JT, Friedlich AL, Fisher CM. Influence of etiology of atrial fibrillation on incidence of systemic embolism.Am J Cardiol 1977; 40: 509-13.
• Referans6 Moreyra AE, Wilson AC, Deac R, et al. Factors associated with atrial fibrillation in patients with mitral stenosis: a cardiac catheterization study. Am Heart J 1998; 135: 138-45.
• Referans7 Kabukçu M, Arslantas E, Ates I, Demircioglu F, Ersel F. Clinical, echocardiographic, and hemodynamic characteristics of rheumatic mitral valve stenosis and atrial fibrillation. Angiology 2005; 56: 159-63.
• Referans8 Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P. ACC/AATS/AHA/ASE/ASNC/ HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 2017; 70: 1647-72.
• Referans9 Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988; 60: 299-308.
• Referans10 Levy S. Atrial fibrillation, the arrhythmia of the elderly, causes and associated conditions. Anadolu Kardiyol Derg 2002; 2: 55-60.
• Referans11 Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-5.
• Referans12 Diker E, Aydogdu S, Ozdemir M, et al. Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease. Am J Cardiol 1996; 77: 96-8.
• Referans13 Boldt A, Wetzel U, Lauschke J,et al. Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease. Heart 2004; 90: 400-5.
• Referans14 Kostin S, Klein G, Szalay Z, Hein S, Bauer EP, Schaper J. Structural correlate of atrial fibrillation in human patients. Cardiovasc Res 2002; 54: 361-79.
• Referans15 Schotten U, Ausma J, Stellbrink C, et al. Cellular mechanisms of depressed atrial contractility in patients with chronic atrial fibrillation. Circulation 2001; 103: 691-8.
• Referans16 Mitrofanova LB, Orshanskaya V, Ho SY, Platonov PG. Histological evidence of inflammatory reaction associated with fibrosis in the atrial and ventricular walls in a case-control study of patients with history of atrial fibrillation. Europace 2016; 18 (suppl 4):iv156-iv162
• Referans17 Pourafkari L, Baghbani-Oskouei A, Aslanabadi N, et al. Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance. Ann Noninvasive Electrocardiol 2018; 23: e12540.
• Referans18 O'Neal WT, Efird JT, Nazarian S, Alonso A, Heckbert SR, Soliman EZ. Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis. Europace 2015; 17: 358-63
• Referans19 Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014;114(9): 1453-1468.