Mitral Darlığı Olan Hastalarda Atriyal Elektiriksel ve Elektromekanik Özellikler

Abstract

Giriş: Mitral darlığı olan hastalarda atriyal fibrilasyon (AF) önemli bir mortalite ve morbidite nedenidir ve bu hastalarda perkütan mitral balon valvüloplasti (PMBV) semptomlarda ve ekokardiyografik parametrelerde önemli düzelme sağlayan başarılı bir girişimdir. Bu çalışmada mitral darlıklı hastalarda PMBV’nin AF gelişimini predikte edebilen yeni ekokardiyografik ve elektrokardiyografik parametreler üzerindeki bir yıllık dönemdeki etkisinin gösterilmesi amaçlanmıştır.

Hastalar ve Yöntem: Orta ve ileri mitral darlığı olan 28 hasta (ortalama yaş 37.6 ± 7.4, %50’si erkek) çalışmaya dahil edilmiştir. PMBV girişimine aday olan hastaların işlem öncesi ve sonrasındaki birinci yılda atriyal ileti zamanı (ACT) açısından ayrıntılı ekokardiyografik incelemeleri doku Doppler yöntemiyle yapılmıştır. Ayrıca her hastanın işlemden bir gün önce ve birinci yılda  maksimum ve minimum P dalga süreleri (Pmax ve Pmin) ve P dalga dispersiyonu (PWD) elektrokardiyografi ile değerlendirilmiştir.

Bulgular: PMBV işleminden sonra ACT (148.1 ± 20.5 vs. 121.3 ± 20.5, p< 0.001), Pmax (151.7 ± 15.8 vs. 137.3 ± 15.6, p< 0.001), PWD (84.7 ± 18.8 vs. 71.1 ± 18.5, p< 0.001) değerleri istatistiksel anlamlı olarak düşmüştür. İşlem öncesi ve sonrası ACT, Pmax, PWD, LAVi ve PAPs parametreleri arasında güçlü pozitif korelasyon tespit edilmiştir. Ayrıca işlem sonrası ve öncesi değerlerin çıkarılmasıyla hesaplanan Δ değerleri arasında güçlü korelasyon tespit edilmiştir. Buna göre; ΔACT’nin ΔPmax ve ΔPWD (r= 0.5, p= 0.007 ve r= 0.55, p= 0.002, sırasıyla) değerleriyle korele olduğu tespit edildi ve  ΔACT, ΔPmax ve  ΔPWD, ekokardiyografik parametrelerden sadece  ΔLAVi ve ΔPAP ile anlamlı olarak korele idi.

Sonuç: Bu çalışma mitral darlıklı hastalarda EKG ve TDI yöntemleriyle değerlendirilen atriyal ileti özelliklerinin diğer ekokardiyografik parametrelerle önemli derecede korele olduğunu göstermiştir. Ayrıca işlem sonrası birinci yılda bu parametrelerde önemli düzeyde düzelme meydana gelmiştir. Yapılacak prospektif özellikte daha fazla çalışma atriyal elektromekanistik özellikler ve AF gelişimi arasındaki ilişki açısından daha fazla bilgi sağlayabilir.

Keywords

• Romatizmal mitral darlık,atriyal fibrilasyon,atriyal ileti zamanı,P dalga dispersiyonu,perkütan mitral balon valvüloplasti

Atrial Electrical and Electromechanical Characteristics in Patients with Rheumatic Mitral Stenosis

Abstract

Introduction: AF in patients with mitral stenosis (MS) causes significant morbidity and mortality. PMBV, which is a treatment of choice for patients with MS, is a highly successful procedure that provides significant improvement in symptoms and echocardiographic parameters. In this study we aimed to demonstrate the probable effects of PMBV on novel echocardiographic and electrocardiographic parameters that can predict the development of AF in 1-year period in patients with MS.

Patients and Methods: Twenty-eight patients with moderate or severe rheumatic MS (mean age 37.6 ± 7.4 years; 14 (50%) males) were enrolled this study. All patients who were eligible for this procedure underwent comprehensive echocardiographic examinations with evaluation of ACT measured using tissue Doppler imaging (TDI) before PMBW and repeated at the end of the 1 year after successful PMBV. In addition, 12-lead ECGs were recorded for each patient 1 day before PMBV for the evaluation of baseline maximum and minimum P-wave duration and P-wave dispersion (PWD); this was repeated at the end of the 1 year after successful PMBV.

Results: ACT (148.1 ± 20.5 vs 121.3 ± 20.5 p< 0.001), P-max (151.7 ± 15.8 vs 137.3 ± 15.6 p< 0.001) and PWD (84.7 ± 18.8 vs 71.1 ± 18.5 p< 0.001) were found to be significantly decreased after PMBV. A strong positive correlation was detected between ACT, P-max, PWD, LAVi ve PAPs before and after PMBV. In addition, there was a strong correlation between Δ values that were measured by subtracting the baseline measurements from the post-PMBV measurements. Accordingly, ΔACT was correlated with ΔP-max ve ΔPWD (r= 0.5 p= 0.007 and r= 0.55 p= 0.002, respectively). ΔACT, ΔP-max and ΔPWD correlated significantly with only ΔLAVi and ΔPAP in echocardiographic parameters.

Conclusion: This study demonstrated that atrial conduction properties that have also been evaluated with ECG and TDI studies significantly correlate with other echocardiographic parameters in patients with MS. In addition, significant improvement occurred in these parameters at the end of the 1 year after PMBV. Further prospective investigations may provide useful data for the detection of the relation between atrial electromechanical characteristics and development of AF in patients with MS.

Keywords

• Rheumatic mitral stenosis,atrial fibrillation,atrial conduction tine P-wave dispersion,percutaneous mitral balloon valvuloplasty

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