Assessment of right ventricular function in patients with rheumatic mild mitral involvement by tissue Doppler Echocardiography

Yıl 2012, Cilt: 1 Sayı: 3, 149 - 155, 01.09.2012

Mustafa Kurt Mehmet Fatih Karakaş Göktürk İpek Uğur Arslantaş Emine Bilen İsa Öner Yüksel Ayşe Saatci Yaşar Mehmet Bilge

https://doi.org/10.5505/abantmedj.2012.69875

Öz

OBJECTIVE: There is no data related to right ventricular functions in mild mitral stenosis patients with normal pulmonary pressure. Therefore, in the present study we investigated right wntricular functions in mild mitral stenosis patints who had visually normal right ventricul by tissue Doppler imaging.METHODS: The study population consisted of 42 rhuematic mild mitral stenosis patients and 31 age-sex matched controls. All patients underwent conventional echocardiography and tissue Doppler imaging. Isovolumetric myocardial accelearation, myocardial performance index and peak sistolic velocities were calculated from the tissue Doppler parameters. RESULTS: The study grops were comparable regarding age, sex, systolic pulmonary artery pressure, systolic-diastolic blood pressure and heart rate. When compared to the control group patients with mitral stenosis had significabtly lower values of isovolumetric myocardial acceleration p: 0,001 , myocardial performance index p: 0,014 and peak systolic velocity p: 0,001 . Within the tisstue Doppler parameters, isovolumetric myocardial acceleration was the most closely correlated parameter with the mitral valve area r: 0.59; p: 0,0001 CONCLUSION: Rheumatic mild mitral stenosis patients with visually normal right ventricle had impaired right ventricular function assessed by tissue Doppler imaging. This impaired function might be related to the rheumatismal myocardial involvement rather than abnormalities in the pulmonary vasculatories.

Anahtar Kelimeler

Rheumatic mitral stenosis, right ventricular function, tissue Doppler

Romatizmal Hafif Mitral KapakTutulumunda Sağ Ventrikül Fonksiyonlarının Doku Doppler Ekokardiyografi ile Değerlendirilmesi

Öz

AMAÇ: Romatiznal hafif mitral darlıklı hastalarda, pulmoner arter basıncı normalken sağ ventrikül fonksiyonları ile ilgili veri yoktur. Biz bu çalışmamızda görsel ve boyutsal olarak normal sağ ventriküle sahip hafif mitral darlığı hastalarında sağ ventrikül fonksiyonlarını doku Doppler ile değerlendirmeyi planladıkYÖNTEMLER: Çalışmaya 42 romatizmal hafif mitral darlıklı hasta ve 31 yaş ve cinsiyet eşleşmiş kontrol grubu alındı. Hastalara konvensiyonel ve doku Doppler ekokrdiyografi yapıldı. Doku Doppler parametlerinden izovolümetrik miyokardiyal akselarasyon, miyokard performans indeksi ve tepe sistolik velosite hesaplandı. BULGULAR: Her iki grupta yaş ortalaması, cinsiyet, sistolik pulmoner arter basıcı sistolik ve diyastolik kan basıncı ve kalp hızı değerleri benzerdi. Doku Doppler parametrelerinden izovolümetrik miyokardiyal akselarasyon p: 0,001 , miyokard performans indeksi p: 0,014 ve tepe sistolik velosite p: 0,001 anlamlı olarak hasta grubunda düşük saptandı. İzovolümetrik miyokardiyal akselarasyon doku Doppler parametrelerinden arasında mitral kapak alanı ile en iyi korele olan paramatre olarak bulundu r: 0.59; p: 0,0001 SONUÇ: Görsel ve boyutsal olarak normal sağ ventriküle sahip romatizmal hafif mitral darlığı hastalarında doku Doopler ile değerlendirilen sağ ventrikül fonksiyonları bozulmuştur. Sağ ventrikül fonksiyonlarındaki bu bozukluk pulmoner vaskülatürdeki değişikliklerden çok sağ ventrikülün romatizmal tutulumuna bağlı olabilir.

Anahtar Kelimeler

Romatizmal mitral darlığı, sağ ventrikül fonksiyonları, doku Doppler

Kaynakça

• Rahimtoola SH, Durairaj A, Mehra A, Nuno I. Current evaluation and management of patients with mitral stenosis. Circulation 2002;106:1183.
• Arslan S, Buyukkaya S, Gundogdu F, Sevimli S, Buyuk- kaya E, Aksakal E, Karekelloglu Ş. Assessment of right ventricular functions by tissue Doppler echocardiog- raphy in patients with rheumatic mitral valve stenosis associated with sinus rhythm or atrial fibrillation. Turk Kardiyol Dern Arş 2007;35:475-81.
• Iung B, Gohlke-Bärwolf C, Tornos P, Tribouilloy C, Hall R, Butchart E, Vahanian A; Working Group on Valvular Heart Disease. Recommendation on the management of the asymptomatic patient with valvular heart dis- ease. Eur Heart J. 2002;23:1253-66
• Otto CM: Mitral stenosis. In Otto CM (ed): Valvular Heart Disease. 2nd ed Philadelphia, WB Saunders, 2004, pp 252–255
• Hirata N, Sakakibara T, Shimazaki Y, Watanabe S, Nomura F, Akamatsu H, Sasaki J, Kodama K, Nakano S, Kawashima Y. Preoperative and postoperative right ventricular function during exercise in patients with mitral stenosis. J Thorac Cardiovasc Surg 1992;104:1029-34.
• Burger W, Brinkies C, Illert S, Teupe C, Kneissl GD, Schrader R. Right ventricular function before and af- ter percutaneous balloon mitral valvuloplasty. Int J Cardiol 1997;58:7-15.
• Nagel E, Stuber M, Hess OM. Importance of the right ventricle in valvular heart disease. Eur Heart J 1996;17:829-36
• Diwan A, McCulloch M, Lawrie GM, Reardon MJ, Nagueh SF. Doppler estimation of left ventricular fill- ing pressures in patients with mitral valve disease. Circulation 2005;111:3281-9.
• Ozdemir K, Altunkeser BB, Gok H, Icli A, Temizhan A. Analysis of the myocardial velocities in patients with mitral stenosis. J Am Soc Echocardiogr 2002;15:1472- 8.
• Tanboga IH, Kurt M, Bilen E, Aksakal E, Kaya A, Isik T, Ekinci M, Karakoyun S, Sevimli S. Assessment of Right Ventricular Mechanics in Patients with Mitral Stenosis by Two-Dimensional Deformation Imaging. Echocar- diography. 2012 Jun 7. doi: 10.1111/j.1540- 8175.2012.01738.x.
• Ozdemir AO, Kaya CT, Ozdol C, Candemir B, Turhan S, Dincer I, Erol C. Two-dimensional longitudinal strain and strain rate imaging for assessing the right ven- tricular function in patients with mitral stenosis. Echocardiography. 2010;27:525-33.
• Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Aytekin S. Assessment of Right Ventricular Endocardi- al Dysfunction in Mild-to-Moderate Mitral Stenosis Patients Using Velocity Vector Imaging. Echocardiog- raphy. 2011 Nov 2. doi: 10.1111/j.1540- 8175.2011.01529.x.
• Saricam E, Ozbakir C, Yildirim N, Tufekcioglu O, Ocal A, Bascil S, Bozboga S, Sabah Prof I. Evaluation of the relationship between functional capacity and right ventricular diastolic function in patients with isolated mitral stenosis and sinus rhythm: a tissue Doppler study. Echocardiography. 2007;24:134-9.
• Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, Sahn DJ, Schiller NB, Tajik A, Teichholz LE, Weyman AE. Report of the American Society of Echo- cardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Cir- culation. 1980;62:212-7.
• Feigenbaum H, Armstrong WF, Ryan T, editors. He- modynamics. In: Feigenbaum’s echocardiography. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 234-5.
• Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26:135-6.
• Göktürk İpek, Emine Bilen, Mustafa Kurt, Mehmet Fatih Karakaş, Uğur Arslantaş, İsa Öner Yüksel, Ayşe Saatci Yaşar, Mehmet Bilge. Metabolic syndrome and Gender Difference: Tissue Doppler Study. Abant Med J. 2012; 1: 39-44
• Tayyareci Y, Nisanci Y, Umman B, Oncul A, Yurdakul S, Altun I, Umman S, Bugra Z. Early detection of right ventricular systolic dysfunction by using myocardial acceleration during isovolumic contraction in patients with mitral stenosis. Eur J Echocardiogr. 2008;9:516- 21.
• Tayyareci Y, Tayyareci G, Tastan CP, Bayazit P, Nisanci Y. Early diagnosis of right ventricular systolic dysfunc- tion by tissue Doppler-derived isovolumic myocardial acceleration in patients with chronic obstructive pul- monary disease. Echocardiography. 2009;26:1026-35.
• Tayyareci Y, Tayyareci G, Nişanci Y, Umman B, Buğra Z. Evaluation of the severity of mitral stenosis with a new index: isovolumic myocardial acceleration. Turk Kardiyol Dern Ars. 2008;36:388-94.
• Vogel M, Schmidt MR, Kristiansen SB, Cheung M, White PA, Sorensen K, Redington AN. Validation of myocardial acceleration during isovolumic contrac- tion as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure- volume relations in an animal model. Circulation. 2002;105:1693-1699.
• Vogel M, Cheung MM, Li J, Kristiansen SB, Schmidt MR, White PA, Sorensen K, Redington AN. Noninva- sive assessment of left ventricular force-frequency re- lationships using tissue Doppler-derived isovolumic acceleration: validation in an animal model. Circula- tion. 2003;107:1647- 1652.
• Shimizu M, Nii M, Konstantinov IE, Li J, Redington AN. Isovolumic but not ejection phase Doppler tissue indi- ces detect left ventricular dysfunction caused by cor- onary stenosis. J Am Soc Echocardiogr. 2005;18:1241- 1246.
• Mohan JC, Sengupta PP, Arora R. Immediate and delayed effects of successful percutaneous trans- venous mitral commissurotomy on global right ven- tricular function in patients with isolated mitral ste- nosis. Int J Cardiol 1999;68:217-23.