Organik Mitral Yetmezlikli ve Sol Ventrikül Fonksiyonu Korunmuş Asemptomatik Hastalarda BNP Serum Düzeyleri ile Sol Ventrikül Mekaniği ve Mitral Yetersizliği Ciddiyeti Arasındaki İlişki

Öz

Amaç: Orta ve ciddi mitral yetersizliğinde, sol ventrikül sistolik disfonksiyonu zamanla gelişir. Biz bu çalışmada, mitral yetersizliğinin, sol ventrikül mekanik fonksiyonlarına olan etkisini 2D strain ekokardiyografi ile araştırmayı amaçladık. Ayrıca BNP seviyesi ile LV mekaniği ve MY ciddiyeti arasındaki ilişkiyi araştırdık.Gereç ve Yöntemler: Organik orta ciddi mitral yetmezliği olan yirmi dört asemptomatik hasta çalışmaya dahil edildi. Sol ventrikül global longitudinal strain LV-GLS , global sirkumferensiyal ve global radyal strain hesaplandı ve serum BNP düzeyi ölçüldü. BNP değerlerine göre [≥140 pg /ml grup 1 ve

Anahtar Kelimeler

• Brain natriüretik peptit, Ekokardiyografi, Global longitudinal strain, Hemodinamik, Mitral yetmezliği

Relationship between Serum Levels of BNP and Left Ventricular Mechanics with Severity of Mitral Regurgitation in Asymptomatic Patients with Organic Mitral Regurgitation and Preserved Left Ventricular Function

Öz

Objective: In moderate and severe mitral regurgitation MSMR , left ventricular systolic dysfunction develops in time. We aimed to investigate the effect of mitral regurgitation on left ventricular mechanics as assessed with 2D strain echocardiography. We also sought to explore the correlation between BNP and severity of MR and also between BNP and LV mechanics.Material and Methods: Twenty four asymptomatic patients with organic MSMR were included. Left ventricular global longitudinal strain LV-GLS , global circumferential strain and global radial strain were calculated and serum BNP was measured. Patients were divided into two groups according to their BNP value [≥140 pg/ml group 1 and < 140 pg/ml group 2 ].Results: Demographic data were similar in both groups. Group 1 had higher mitral E and A valve velocities 0.915±0.297 vs. 1.2±0.337, p=0.023 and 0.634±0.191 vs. 0.862±0.255, p=0,035 respectively . There was a significant difference in GLS values between group 1 and 2 -20.159 ± 0.386 vs. -15.35±0.912, p

Anahtar Kelimeler

• Brain natriuretic peptide, Echocardiography, Global longitudinal strain, Hemodynamic, Mitral regurgitation

Kaynakça

1. Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, Frye RL. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996; 335:1417-23.
2. Delahaye JP, Gare JP, Viguier E, Delahaye F, De Gevigney G, Milon H. Natural history of severe mitral regurgitation. Eur Heart J 1991; 12 suppl B:5-9.
3. Baumgartner H, Falk V, Bax J, Bonis M, Hamm C, Holm P, Lung B, Lancellotti P, Lansac E, Rosenhek D, Sjögren J, Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano J. ESC Scientific Document Group. Guidelines for the management of valvular heart disease: The task force for the management of valvular heart disease of the european society of cardiology and the european association for cardio-thoracic surgery. Eur Heart J 2017; 38:2739-91.
4. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H,Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A. 2017 AHA/ACC focused update of the 2014 AHA/ ACC guideline for the management of patients with valvular heart disease. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Circulation 2017; 135:e1159-e95.
5. Ahmed MI, Gladden JD, Litovsky SH, Lloyd SG, Gupta H, Inusah S, Denney T Jr, Powell P, McGiffin DC, Dell’Italia LJ. Increased oxidative stress and cardiomyocytemyofibrillar degeneration in patients with chronic isolated mitral regurgitation and ejection fraction >60%. J Am Coll Cardiol 2010; 55:671-9.
6. Konstam MA, Abboud FM. Ejection fraction: Misunderstood and overrated (changing the paradigm in categorizing heart failure). Circulation 2017; 135:717-9.
7. Topilsky Y, Suri R, Schaff H V, Enriquez-Sarano M. When to intervene for asymptomatic mitral valve regurgitation. Semin Thorac Cardiovasc Surg 2010; 22:216-24.
8. Marwick TH, Leano RL, Brown J, Sun JP, Hoffmann R, Lysyansky P, Becker M, Thomas JD. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: Definition of normal range. JACC Cardiovasc Imaging 2009; 2:80-4.

9. Chan J, Hanekom L, Wong C, Leano R, Cho GY, Marwick TH. Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function. J Am Coll Cardiol 2006; 48:2026-33.
10. Lancellotti P, Cosyns B, Zacharakis D, Attena E, Van Camp G, Gach O, Radermecker M, Piérard LA. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: Assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr 2008; 21:1331-6.
11. Redfield M, Rodeheffer R, Jacobsen S, Mahoney DW, Bailey KR, Burnett JC Jr. Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol 2002; 40:976-82.
12. Agricola E, Galderisi M, Oppizzi M. Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation. Heart 2004; 90:406-10.
13. Lee R, Hanekom L, Marwick TH, Leano R, Wahi S. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with asymptomatic severe mitral regurgitation. Am J Cardiol 2004; 94:1333-7.
14. Davis K, Fish L, Elahi D, Clark BA, Minaker KL. Atrial natriuretic peptide levels in the prediction of congestive heart failure risk in frail elderly. JAMA 1992; 267:2625-9.
15. Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 1998; 135(5 pt 1):825-32.
16. Omland T, Aakvaag A, Bonarjee VV, Caidahl K, Lie RT, Nilsen DW, Sundsfjord JA, Dickstein K. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal pro atrial natriuretic peptide. Circulation 1996; 93:1963-9.
17. Tsutamoto T, Wada A, Maeda K, Hisanaga T, Maeda Y, Fukai D, Ohnishi M, Sugimoto Y, Kinoshita M. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: Prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation 1997; 96:509-16.
18. Detaint D, Messika-Zeitoun D, Avierinos JF, Scott C, Chen H, Burnett JC Jr, Enriquez-Sarano M. B-type natriuretic peptide in organic mitral regurgitation: Determinants and impact on outcome. Circulation 2005;111:2391-7.
19. Kerr AJ, Raffel OC, Whalley GA, Zeng I, Stewart RA. Elevated B-type natriuretic peptide despite normal left ventricular function on rest and exercise stress echocardiography in mitral regurgitation. Eur Heart J 2008; 29:363-70.
20. Pizarro R, Bazzino OO, Oberti PF, Falconi M, Achilli F, Arias A, Krauss JG, Cagide AM. Prospective validation of the prognostic usefulness of brain natriuretic peptide in asymptomatic patients with chronic severe mitral regurgitation. J Am Coll Cardiol 2009; 54:1099-106.
21. Klaar U, Gabriel H, Bergler-Klein J, Pernicka E, Heger M, Mascherbauer J, Rosenhek R, Binder T, Maurer G, Baumgartner H. Prognostic value of serial B-type natriuretic peptide measurement in asymptomatic organic mitral regurgitation. Eur J Heart Fail 2011; 13:163-9
22. Detaint D, Messika-Zeitoun D, Avierinos JF, Scott C, Chen H, Burnett JC, Jr, Enriquez-Sarano M. B-type natriuretic peptide in organic mitral regurgitation: Determinants and impact on outcome. Circulation 2005; 111:2391-7.
23. Magne J, Mahjoub H, Pierard LA, O’Connor K, Pirlet C, Pibarot P, Lancellotti P. Prognostic importance of brain natriuretic peptide and left ventricular longitudinal function in asymptomatic degenerative mitral regurgitation. Heart 2012; 98:584-91.
24. Lang RM, Bierig M, Devereux RB, Flachskampf FA. Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18(12):1440-63.
25. Nagueh SF, Appleton CP, Gillebert TC. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am SocEchocardiogr 2009; 22(2): 107-33.
26. Tacik J, Oh JK, Seward JB. The Echo Manual. 3th ed. New Delhi: Lippincott Williams & Wilkins - a Wolters Kluwer Business, 2006.
27. Magne J, Lancellotti P, Pierard LA. Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation. Circulation 2010; 122:33-41.
28. Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL; European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: Mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010;11:307-32.
29. Becker M, Hoffmann R, Kuhl HP, Grawe H, Katoh M, Kramann R, Bücker A, Hanrath P, Heussen N. Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction. Eur Heart J 2006; 27:2560-6.
30. Chan J, Hanekom L, Wong C, Leano R, Cho GY, Marwick TH. Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function. J Am Coll Cardiol 2006; 48:2026-33.
31. Alashi A, Mentias A, Patel K, Gillinov AM. Synergistic utility of brain natriuretic peptide and left ventricular global longitudinal strain in asymptomatic patients with significant primary mitral regurgitation and preserved systolic function undergoing mitral valve surgery. Circ Cardiovasc Imaging 2016;9:e004451.
32. Elbey MA, Arslan Ş, Aksakal E, Şenocak H, Karakelleoğlu Ş, Arıtürk Z, Öntürk Tekbaş E, Çil H. Relationship between the severity of mitral regurgitation, left ventricular dysfunction and plasma brain natriuretic peptide level: An observational strain imaging study. J of Clin Experim Invest 2012; 3(4):451-6.