Kalp yetersizliğinde yeni bir prognostik belirteç: Pik mitral regurgitasyon velositesinin sol ventrikül çıkış yolu velosite zaman integraline oranı

Abstract

Amaç: Sistemik vaskuler rezistans (SVR), kalp yetersizliğinde risk tahmini ve tedavi klavuzluğunda kullanışlıdır. Pik mitral regurgitasyon velositesinin (MRV) sol ventrikül çıkış yolu velosite zaman integraline (LVOT VTI) oranının SVR ile pozitif yönde korele olduğu gösterilmiştir. Bu çalışmada düşük ejeksiyon fraksiyonlu kalp yetersizliği (DEF-KY) hastalarında MRV/LVOT VTI oranının bilinen prognostik belirteçlerle ilişkisi ve 1 yıllık ve uzun dönem birleşik son noktayi öngördürmedeki prognostik rolünü değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Prospektif olarak 72 DEF-KY hastası ve 10 sağlıklı kontrolü çalışmaya dahil ettik. Hastalar medyan 40.5 ay takip edildi. Birincil birileşik son nokta (BSN) mekanik dolaşım desteği, kalp transplantasyonu ve tüm nedenlere bağlı ölüm olarak tanımlandı.
Bulgular: BSN(+) hastalarında daha yüksek MRV/LVOT VTI oranı saptandı (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI oranı fonksiyonel sınıf (β=0.539, p=0<001), troponin I (β=0.415, p<0.001), serum BNP seviyesi (β=0.479, p<0.001), ve ürik asit düzeyi (β=0.235 p=0.018) ile pozitif yönde korele ve SEATTLE skor ile elde edilen yaşam beklentisi (β=-0.248, p=0.032) ile negatif korele izlendi. Diğer parametrelerle birlikte MRV / LVOT VTI oranındaki her 0,1 artış bir yıllık BSN riskini % 27 ve uzun dönem BSN riskini % 24,6 artırdı. Kaplan Meier analiziNDE MRV / LVOTVTI oranı ≥ 0.39 olan hastalarda diğerlerine göre uzun dönemde daha fazla BSN görüldü.
Sonuç: MRV / LVOT VTI oranı diğer bilinen DEF-KY prognostik göstergeleri ile ilişkili olarak, kötü prognozun faydalı bir belirteci olarak görünmektedir

Keywords

• sistemik vaskular rezistans,kalp yetersizliği,Pik mitral regurgitasyon velositesinin sol ventrikül çıkış yolu velosite zaman integraline oranı

A new prognostic marker in failing heart: Peak mitral regurgitation velocity to left ventricular outflow tract time velocity ıntegral ratio

Abstract

Aim: Systemic vascular resistance (SVR) is useful for risk estimation and therapy guidance in HF. It has been shown that the ratio of peak mitral regurgitation velocity (MRV) to left ventricular outflow tract velocity-time integral (LVOT VTI) correlated positively with SVR. We aimed to assess the association of MRV/LVOT VTI ratio with established prognostic markers and its prognostic role for predicting one year and long term composite end-points in patients with HF and reduced ejection fraction (HFrEF).
Material and Methods: We prospectively enrolled a total of 72 patients with HFrEF and 10 control subjects. Patients were followed up patients for median 40.5 months. Primary composite endpoint (CEP) was defined as any of these outcomes including requiring mechanical circulatory support, cardiac transplantation, and all-cause mortality.
Results: CEP(+) patients had higher MRV/LVOT VTI ratio than others (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI ratio was positively correlated with functional status (β=0.539, p=0<001), serum BNP level (β=0.479, p<0.001),troponin I (β=0.415, p<0.001), and Uric acid level (β=0.235 p=0.018) and negatively correlated with SEATTLE score derived life expectancy (β=-0.248, p=0.032). Adjusted with other parameters, every 0.1 increase in MRV/LVOT VTI ratio increased the one-year CEP risk by 37% and long-term CEP risk by 35%. In Kaplan Meier analysis, patients with MRV/LVOTVTI ratio ≥ 0.39 had more long-term CEP compared to others.
Conclusion: MRV/LVOT VTI ratio seemed to be a useful predictor of poor prognosis associated with other established HF prognostic markers.

Keywords

• Systemic vascular resistance,Heart failure and reduced ejection fraction,peak mitral regurgitation velocity to left ventricular outflow tract velocity-time integral

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