Akut iskemik inmeli hastalarda miyokard fonksiyonunun doku Doppler miyokardiyal performans indeksi ile değerlendirilmesi

Yıl 2019, Cilt: 44 Sayı: 4, 1425 - 1431, 29.12.2019

Ünal Öztürk , Önder Öztürk , Yusuf Tamam

https://doi.org/10.17826/cumj.570096

Öz

Amaç: Bu çalışmanın amacı, akut iskemik inmeli hastalarda National Institutes of Health Stroke Ölçeği  (NIHSS) ile doku Doppler miyokard performans indeksi ile değerlendirilen miyokard fonksiyonları arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntem: Çalışmaya akut iskemik inme geçiren 128 hasta (erkek,55; kadın, 73; yaş, 68 ± 19) alındı. 20 hasta çalışmadan çıkarıldı. NIHSS skoruna göre hastalar iki gruba ayrıldı (Grup 1, NIHSS skor <16; Grup 2, NIHSS skoru ≥ 16).  Bütün hastalardan demografik, klinik ve laboratuvar verileri toplandı. Hastaların kardiyak fonksiyonları, nöroloji yoğun bakım ünitesine yatırıldıktan sonraki 48 saat içerisinde transtorasik ekokardiyografi değerlendirildi.

Bulgular: Hastaların demografik özellikleri açısından gruplar arasında anlamlı farklılık saptanmadı. Doku Doppler miyokard performans indeksi, Grup 2 hastalarında, Grup 1 hastalarına göre anlamlı derecede daha yüksek bulundu (0.62±0.28 ile 0.46±0.16).

Sonuç: Yapmış olduğumuz bu çalışmada, akut iskemik inme ile yatan hastalarda, inme şiddeti ile doku doper miyokard performans indeksi arasında bir ilişki olduğu sonucuna varılabilir. Doku Doppler MPİ, LV EF’dan farklı olarak, global miyokardiyal disfonksiyonunun bir göstergesidir. Doku Doppler MPİ, hem sistolik, hem de diyastolik zaman intervallerini içermekte olup, global kardiyak disfonksiyonu değerlendirir.

Anahtar Kelimeler

Ventrikül disfonksiyonu, ekokardiyografi, inme

Assessment of myocardial function by tissue Doppler imaging myocardial performance index in patients with acute ischemic stroke

Öz

Purpose: The aim of this study is to investigate the relationship between myocardial function assessed by tissue Doppler imaging myocardial performance index (TDI-MPI) and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke. 

Materials and Methods: The study comprised 128 patients (males, 55; females, 73; 68 ± 19 years) with acute ischemic stroke. 20 patients were excluded. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score < 16; Group 2, NIHSS score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac function was evaluated by transthorasic echocardiography within 48 hours of admission to the neurology care unit.

Results: There were no significant differences among demographic parameters of patients. Tissue Doppler myocardial performance index was significantly higher in Group 2 patients than in Group 1 patients (0.62±0.28 vs 0.46±0.16).

Conclusion: Our results suggest that TDI-MPI is associated with stroke severity on admission in patients with acute ischemic stroke. TDI-MPI is an indicator of global myocardial dysfunction with a different from LVEF. TDI-MPI, which includes both systolic and diastolic time intervals to assess the global cardiac dysfunction.

Anahtar Kelimeler

Ventricular dysfunction, echocardiography, stroke

Kaynakça

• Rojek A, Gąsecki D, Fijalkowski M, Kowalczyk K, Kwarciany M, Wolf J, et al. Left ventricular ejection fraction and aortic stiffness are independent predictors of neurologicaloutcome in acute ischemic stroke. J Hypertens 2016:34(12):2441-2448.
• Malik AN, Gross BA, Rosalind Lai PM, Moses ZB, Du R, et al. Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2015:83(6):880-885.
• Kerro A, Woods T, Chang JJ. Neurogenic stunned myocardium in subarachnoid hemorrhage. J Crit Care 2017:38:27-34.
• Ermis E, Demirelli S, Ceylan M, Firtina S, Ipek E, Yalcin A, et al. The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography. J Clin Ultrasound 2016:44(5):305-311.
• Kim H, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, et al. Usefulness of tissue Doppler imagingmyocardial performance index inthe evaluation of diastolicdysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011 Aug;34(8):494-9.
• Ozturk O, Ulgen MS, Tekes S, Ozturk U, Toprak N. Influence of the Angiotensin Converting Enzyme I/D Gene Polymorphisms on Right Ventricular Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction. Circ J 2005;69:211-215.
• Öztürk Ö, Toprak N. Akut Anteriyor Miyokard İnfarktüslü Hastalarda Geliş Miyokardiyal Performans İndeksi ile Lökositoz Arasındaki İlişki. Dicle Med J 2004:(2): 36-41.
• Lyden P. Using the National Institutes of Health Stroke Scale: A Cautionary Tale. Stroke 2017:48(2):513-519.
• Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015:28(1):1-39.
• Zawadka-Kunikowska M, Slominski K, Slomko J, Tafil-Klawe M, Klawe JJ, Sokołowski L et al. Comprehensive non-nvasive cardiac and autonomic assessment in acute ischaemic strokepatients: pilot study. Minerva Cardioangiol 2018:66(4):376-385.
• Vemmos K, Ntaios G, Savvari P, Vemmou AM, Koroboki E, Manios E, et al: Stroke etiology and predictors of outcome in patients with heart failure and acute stroke: a 10-year follow-up study. Eur J Heart Fail 2012: 14:211-218.
• Holmström A, Fu ML, Hjalmarsson C, Bokemark L, Andersson B. Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurol 2013:23:13:122.
• Ripoll JG, Blackshear JL, Díaz-Gómez JL. Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am 2018:29(2):281-297.
• Constantinescu V, Matei D, Cuciureanu D, Corciova C, Ignat B, Popescu CD et al. Cortical modulation of cardiac autonomic activity in ischemic stroke patients. Acta Neurol Belg 2016:116(4):473-480. Epub 2016 Apr 20.
• Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, Figueredo V, et al. A Review of Neurogenic Stunned Myocardium. Cardiovasc Psychiatry Neurol 2017:2017:5842182.
• Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiol Intensive Ther 2015:47(2):175-180.
• Kim WJ, Nah HW, Kim DH, Cha JK, et al: Association between Left Ventricular Dysfunction and Functional Outcomes at Three Months in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2016.25(9):2247-2252.
• Milionis H, Faouzi M, Cordier M, D'Ambrogio-Remillard S, Eskandari A, Michel P, et al: Characteristics and early and long-term outcome in patients with acute ischemic stroke and low ejection fraction. Int J Cardiol 2013.168:1082-1087.
• Sung PH, Chen KH, Lin HS, Chu CH, Chiang JY, Yip HK. The Correlation between Severity of Neurological Impairment and Left Ventricular Function in Patients after Acute Ischemic Stroke. J Clin Med. 2019:8(2). pii: E190. doi: 10.3390/jcm8020190.
• Bonardo P, Pantiú F, Ferraro M, Chertcoff A, Bandeo L, Cejas LL, et al. Impact of Infarct Size on Blood Pressure in Young Patients with Acute Stroke. J Vasc Interv Neurol 2018:10(1):14-16.
• Hendrix P, Sofoluke N, Adams MD, Kunaprayoon S, Zand R, Kolinovsky AN, et al. Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion. Stroke 2019:50(5):1074-1080.
• Chang A, Ricci B, Grory BM, Cutting S, Burton T, Dakay K, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2019 Mar 19. pii: S1052-3057(19)30057-6. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.013.
• Lindsberg JP, Roine RO. Hyperglycaemia in acute stroke. Stroke 2004;35:363-4.
• Ryu WS, Bae EK, Park SH, , Jeong SW, Schellingerhout D, Nahrendorf M, et al. Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. J Stroke Cerebrovasc Dis 2018:27(5):1275-1282.
• Mostofsky E, Wellenius GA, Noheria A, Levitan EB, Burger MR, Schlaug G, et al. Cerebrovasc Dis 2009.28(1):88-94.