Korunmuş Sol Ventrikül Sistolik Fonksiyonuna Sahip Diyabetik Hipertansif Hastalarda Uzun Dönem Takipte Tüm Nedenlere Bağlı Mortaliteyi Tahmin Etmede Strain Parametrelerinin Rolü

Abstract

Amaç: Korunmuş sol ventrikül ejeksiyon fraksiyonu (SoV-EF) olan diyabetik hipertansif vaka kohortunda uzun vadede tüm nedenlere bağlı mortalite ile benek izleme ekokardiyografi parametreleri arasındaki ilişkiyi göstermek. Gereç ve yöntemler: Çalışmaya, korunmuş SoV-EF'li 141 diyabetik hipertansif vaka dahil edildi ve retrospektif olarak analiz edildi. Dışlama kriterleri uygulandıktan sonra 121 hasta çalışmaya dahil edildi. Hastane dışı mortalite durumuna göre iki grup oluşturuldu. Laboratuvar ve ekokardiyografi verileri analiz edildi. Bulgular: 121 hastanın ortalama yaşı 58,4±8,04 yıl ve medyan takip süresi 10,08 yıldı. Mortalite grubunda yaş(57,2±7,7 vs. 64,2±6,9 yıl, p değeri:<0,001), diabetes mellitus süresi (6,4±5,1 vs. 9,2±7,2 yıl, p değeri:0,041) ve hipertansiyon süresi (6,48±5,1 vs. 10,5±9,1 yıl, p değeri: 0,003) açısından istatistiksel olarak daha yüksek değerler saptandı. Ekokardiyografik sol atriyum strain parametreleri, yani sol atriyum rezervuar faz strain(35,7±8,7 - 29,8±7,3, p değeri: 0,047), sol atriyum kondüit faz strain(LAScd%)(17,6±5,8 - 13,3±4,1, p değeri: 0,028) ve sol atriyum rezervuar faz pik strain(1,5±0,4 - 1,22±0,3, p değeri: 0,037), mortalite grubunda daha kötüydü. Sağ ventrikül strain değerlendirmesinde, dört odacıklı sağ ventrikül strain (RV4CSL%)(26,1±5,4 - 20,8±6,2, p değeri:0,005) de mortalite grubunda daha kötüydü. Çok değişkenli analiz, ortalama gündüz sistolik kan basıncının (olasılık oranı [OR]: 1,769, p değeri: 0,028), LAScd%'nin(OR: 0,820, p değeri: 0,015), RV4CSL%'nin (OR: 0,078, p değeri: 0,043) mortaliteyi bağımsız olarak öngördüğünü ortaya koydu. Kaplan-Meier analizi, LAScd%≤15,3 ve RV4CSL%≤24,8'in mortaliteyi öngördüğünü gösterdi (sırasıyla p değerleri: 0,023 ve 0,016). Sonuç: Ekokardiyografi ile değerlendirilen strain parametreleri, özellikle geleneksel hacimsel parametrelerle karşılaştırıldığında, diyabetik hipertansif hastalarda prognozu belirlemek ve erken risk faktörü yönetimine rehberlik etmek için yararlı tanı ve takip araçları olabilir.

Keywords

• Hipertansiyon
• Diabetes mellitus
• Strain parametreleri
• Korunmuş ejeksiyon fraksiyonu
• Mortalite

The Predictive Role of StrainParameters in Predicting All-Cause Mortality in Diabetic Hypertensive Patients with Normal Left Ventricular Systolic Function in Long-Term Follow-up

Abstract

Objective: To demonstrate the relationship of all-cause mortality in the long term and speckle-tracking echocardiography parameters in a cohort of diabetic hypertensive cases that had preserved left ventricle ejection fraction (LV-EF). Methods: The study included 141 diabetic hypertensive cases with preserved LV-EF were retrospectively analyzed. After applying exclusion criteria, 121 patients were included. Two groups were formed according to out-of-hospital mortality status. Laboratory and echocardiography data were analyzed. Results: The mean age of the 121 patients was 58.48.04 years, and the median follow-up duration was 10.08 years. Echocardiographic left atrial strain parameters, namely left atrium reservoir phase strain (35.7±8.7 vs 29.8±7.3, p-value: 0.047), left atrium conduit phase strain (LAScd%) (17.6±5.8 vs 13.3±4.1, p-value: 0.028), and left atrium reservoir phase peak strain (1.5±0.4 vs 1.22±0.3, p-value: 0.037), were worse in the mortality group. In right ventricular strain evaluation, four-chamber right ventricular strain (RV4CSL%) (26.1±5.4 vs. 20.8±6.2, p-value: 0.005) was also worse in the mortality group. Multivariate analysis revealed that the mean daytime systolic blood pressure (odds ratio [OR]: 1.769, p-value: 0.028), LAScd% (OR: 0.820, p-value: 0.015), RV4CSL% (OR: 0.078, p-value: 0.043) independently predicted mortality. Kaplan-Meier analysis showed that LAScd%≤15.3 and RV4CSL%≤24.8 were predictive of mortality (p-values: 0.023 and 0.016, respectively). Conclusion: Strain parameters, assessed via echocardiography, can be useful diagnostic and follow-up tools for determining prognosis and guiding early risk factor management in diabetic hypertensive patients, especially in comparison to traditional volumetric parameters.

Keywords

• Hypertension
• Diabetes mellitus
• Strain parameters
• Preserved ejection fraction
• Mortality

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